We report herein a case of tethered cord syndrome with recurrent ulcerations of the skin in a 17-year-old girl. The patient presented an asymptomatic punched-out deep ulcer on the right buttock and right heel. The lesions were noticed as bullae on the sites, which developed into ulceration. At birth, a reddish nodule was noted on the lower back, which was excised when she was 3 years old at a private clinic. Neurological examination revealed hypoesthesia below the LS dermatome. We suspected a simple neurotrophic ulcer which was treated with zinc oxide dressing and oral antibiotics. 1 month later, the ulcers had healed, but tense bullae had developed on the same right buttock. Spina bifida with intraspinal lipoma was revealed by plain X-ray film and magnetic resonance imgaing. Tethered cord syndrome was diagnosed, and treated with a surgical excision of the lipoma, and repair of the dura. This is a vary rare etiology of a neurotrophic ulcer due to a central nervous system disease, and is the first reported case in the Korean dermatologic literature.
Adolescent ; Anti-Bacterial Agents ; Bandages ; Buttocks ; Central Nervous System ; Female ; Heel ; Humans ; Hypesthesia ; Lipoma ; Neural Tube Defects* ; Neurologic Examination ; Parturition ; Skin ; Spinal Dysraphism ; Transcutaneous Electric Nerve Stimulation ; Ulcer* ; X-Ray Film ; Zinc Oxide

BACKGROUND: The purpose of carotid endarterectomy is to prevent stroke regardless of past neurologic events. Major concern in the carotid endarterectomy is the inadequate blood flow of ipsilateral hemisphere during clamping of the carotid artery. It is well known that internal carotid artery back pressure means collateral cerebral blood flow. Our study is intended to determine the guideline of shunt placement according to the carotid back pressure and electroencephalographic finding. MATERIAL AND METHOD: The study population comprised of 16 consecutive patients who underwent carotid endarterectomy for carotid stenosis in our institution between from February 1996 to March 1999. There were 14 men and 2 women between the ages of 56 and 78 years(mean age 66.25+/-6.53 years). The carotid stenosis in the operative site was ranged from 61% to 95%(mean 73.8+/-12.33%) and the mean carotid stenosis of the contralateral side was 60.99+/-25.03%. During the operation, electroencephalographic monitoring was taken in all cases. The internal carotid artery back pressure was measured to estimate the collateral cerebral blood flow, and in all patients with back pressure below 40 mmHg(11 patients) and patients with complete occulusion of contralateral carotid artery(2 patients), an internal shunt was installed. RESULT: One postoperative death occurred in a patient with large evolving cerebral infarction and severe ipsilateral carotid stenosis, who underwent emergent carotid endarterectomy. The cause of death was hemorrhagic infarction in the corresponding cerebral territory. We observed that immediate operation after a major stroke negatively influenced the postoperative outcome. No intraoperative ischemic neurologic complication developed. During the follow-up upto now(mean follow-up 21.5+/-11.85 months), there has been no early or late recurrence of stroke except one patient ,in whom cerebral infarction developed in the contralateral side on the first postoperative day. CONCLUSION: At least 4-6 weeks stabilization after a stroke is recommended for surgical management. The carotid endarterectomy is an effective surgical intervention for prevention of anticipated stroke and can be performed safely if an internal shunt is used in patients whose internal carotid arterial back pressure is below 40 mmHg.
Carotid Arteries ; Carotid Artery, Internal ; Carotid Stenosis* ; Cause of Death ; Cerebral Infarction ; Constriction ; Endarterectomy ; Endarterectomy, Carotid* ; Female ; Follow-Up Studies ; Humans ; Infarction ; Male ; Recurrence ; Stroke

Nevoid basal cell carcinoma syndrome is a genetically determined disorder characterized by multiple basal cell carcinoma, palmoplantar pits and defects in other organs or tissues. Basal cell carcinoma may arise any sit of body. But infrequently typical basal cell carcinomas arise from the depressed epidermis which forms the base of the pits on the hands and feet. The patient was a 12 years old girl who developed multiple black-colored papules on the face and a dark reddish to black-colored pit over the palm and skin-colored depressed circumscribed pits on the plantar surface of feet. she also had an odontogenic cyst in the right maxilla, epidermal cyst on the trunk and mutiple intradermal nevi on the face. But the family history was not present. The histopathologic findings of the depressed pit of the palm showed a crater on the stratum corneum, and a well marginated tumor nest of basal cell carcinoma showing keratotic feature on the center of the lesion and reticulated feature on the periphery.
Basal Cell Nevus Syndrome* ; Carcinoma, Basal Cell* ; Child ; Epidermal Cyst ; Epidermis ; Female ; Foot ; Hand ; Humans ; Maxilla ; Nevus, Intradermal ; Odontogenic Cysts

PURPOSE: To investigate the clinical and radiological results after primary or revision total knee arthroplasty using fresh frozen femoral head strut allograft for severe bone defect. SUBJECTS AND METHODS: Seventeen patients (18 cases) with severe bone defect were taken primary or revision TKA from 1997 to 2001 using fresh frozen femoral head allograft. 12 cases of revision TKA and 6 of primary TKA were conducted. The average age was 66 years old(55~74) and the follow up period was 29 months(12~63 months). Bone defects were found at proximal tibia in 10 cases, distal femur in 2 and both sites in 6 cases. PCL substituting TKA with extension rod were 15, and PCL retaining TKA were 3. The clinical result was assessed with the knee score of Hospital for Special Surgery(HSS) and for assessment of allograft, simple X-ray film was employed. RESULTS: Average range of motion was increased from 71 degrees to 103 degrees and HSS score was increased from 46(18 ~68) to 83(68 ~91). With 17 of 18 femoral head strut allograft, union was seen and no clinical collapse was present. In one, partial allograft absorption was occured. The preoperative alignment was an average of 7 degrees varus(range 5 degrees~15 degrees) and postoperative alignment was averaged 6.1 degrees valgus(range 3 degrees ~7 degrees). No radiolucent lines were 2 mm or more in width, and there was no case of infection or fracture of allograft. CONCLUSIONS: Femoral head strut allograft was a satisfactory method of managing severe bone defect in primary or revision TKA.
Absorption ; Allografts* ; Arthroplasty* ; Femur ; Follow-Up Studies ; Head* ; Humans ; Knee* ; Range of Motion, Articular ; Tibia ; X-Ray Film

A 47-year-old woman visited the hospital in 1989 for the evaluation of severely pruritic reddish to brownish patches of 3 year's duration on the face, trunk, back, upper and lower extremities. With the diagnosis of mycosis fungoides(premycotic stage), she had been treated with topical steroids, nitrogen musterd and PUVA with a recurrence. Then five years later, a tumorous skin lesion with ulceration developed on the left wrist joint, which did not respond to the previous topical therapies and cherriotherapy(BAM-M). So we tried electron beam therapy with a high-dose radiation(4,000cGy, 6 MeV). The electron beam therapy for 1 month resulted in a complete remission, which did not reveal any evidence of relapse during the one year follow-up period. As the electron beam therapy in mycosis fungoides has not yet been reported in Korean literature, we report a case of mycosis fungoides of advanced stage(TNM II b) showing a favorable response to the electrori beam therapy.
Diagnosis ; Female ; Follow-Up Studies ; Humans ; Lower Extremity ; Middle Aged ; Mycosis Fungoides* ; Nitrogen ; Recurrence ; Skin ; Steroids ; Ulcer ; Wrist Joint

No abstract available.
Toluene*

BACKGROUND: Diabetes mellitus is a common condition, and the majority of patients have one or more cutaneous complications. Among them, xerosis is well known to be closely related to diabetics. The xerosis is inversely reflected upon skin surface hydration, the state of which can be exactly assessed with various investigating instruments, such as a hydrometer and corneometer. OBJECTIVE: Our purpose was to compare the hydration state of diabetics with normal persons by the use of a corneometer and hydrometer. METHODS: A total of 267 diabetics were asked whether they felt xerosis or pruritus. In a subgroup of 31 patients, the water content was evaluated and compared by the parameters of diabetic severity. Forty-one non-diabetics were selected for the normal control.
Diabetes Mellitus ; Humans ; Pruritus ; Skin* ; Water

BACKGROUND: To determine the prevalence of chronic fatigue syndrome and idiopathic chronic fatigue in Korea and to describe demographic, clinical, and psychological differences among those with chronic fatigue syndrome (CFS), those with idiopathic chronic fatigue, and healthy controls. METHODS: 1,526 persons aged 18-76 years who visited Korea university hospital health management center for general check-up between December 1998 and August 1999 were participated in the study. The questionnaire made according to the Centers for Disease Control and Prevention criteria was administered to the recruited persons and patients with chronic fatigue syndrome were diagnosed by questionnaire, physical examination and laboratory tests. The Korean version of the Center for Epidemiological Studies-Depression Scale (CES-D) was used to assess depression. RESULTS: Of the 1,526 persons studied, 433 (29.4 %) reported severe fatigue lasting at least 6 months. Of the 202 persons with unexplained chronic fatigue, 31 persons (2.0% of the study population) were classified as CFS cases. The prevalence of CFS was 2.81% in women, 1.49% in men respectively (p<0.05). When CES-D cut-off score of 25 was used, 30.43% of persons with CFS and 5.93% of persons without chronic fatigue had scores suggestive of depression. CFS patients had higher mean scores on CES-D than persons without chronic fatigue (p<0.05). CONCLUSION: Persons who met the criteria for chronic fatigue syndrome were found in 2.0%. The prevalence of chronic fatigue syndrome in our study were high, compared with previous studies in other countries. CFS patients had higher mean scores on CES-D than persons without chronic fatigue.
Centers for Disease Control and Prevention (U.S.) ; Depression ; Fatigue ; Fatigue Syndrome, Chronic* ; Female ; Humans ; Korea ; Male ; Physical Examination ; Prevalence* ; Surveys and Questionnaires

Pyoderma gangrenosum is a rare neutrophilic dermatosis manifesting as painful pustules or bullae, which rapidly become necrotic to produce an ulceration. It is often associated with systemic disease, such as inflammatory bowel disease, rheumatoid arthritis, leukemia, but myelofibrosis is reported rarely for its underlying disease. The most common location is the lower extremities, and the pyoderma gangrenosum also occur infrequently on the hand and face. As in our case, bilateral involvement of the hands are rarely reported. We present a case of pyoderma gangrenosum that had developed on both hands in a 66 year old man who had macrocytic,anemia. A bone marrow biopsy revealed proliferation of fibroblasts and a dense reticulin network consistent with myelofibrosis, the association of which is very rare world wide.
Aged ; Arthritis, Rheumatoid ; Biopsy ; Bone Marrow ; Fibroblasts ; Hand* ; Humans ; Inflammatory Bowel Diseases ; Leukemia ; Lower Extremity ; Neutrophils ; Primary Myelofibrosis* ; Pyoderma Gangrenosum* ; Pyoderma* ; Reticulin ; Skin Diseases ; Ulcer

PURPOSE: Recent data suggest that monotherapy with a broad-spectrum antibiotic may be as efficacious as, and potentially less costly than, standard multi-drug therapy. We compared mono-therapy with intravenous piperacillin-tazobactam (PT) with multi-drug therapy with cefotaxime and metronidazole (CM) in aspect of postoperative complications and hospital stay. METHODS: We reviewed the hospital records and medical costs of the pediatric patients who were managed for perforated appendicitis between April 2013 and May 2014 retrospectively. RESULTS: Forty-six patients with laparoscopic appendectomy for perforated appendicitis were included in our study. PT group was 20 and CM group was 26 patients. On admission, there were no significance in sex distribution, duration of symptoms, leukocyte count, and CRP levels. At postoperative third, fifth, and seventh day of each regimen, PT group have no statistical difference with CM group in leukocyte count, percentage of neutrophil, and CRP. There was no difference in abscess formation rate, wound infections, and hospital stay between two groups. There was only one patient who was readmitted with elevation of CRP and leukocyte count in CM group. CONCLUSION: Daily dosing with the mono-therapy of PT offers as efficient as multi-drug therapy of CM. To evaluate the efficacy of broad-spectrum antibiotics monotherapy in perforated appendicitis children, the cohort included more patients should be needed.
Abscess ; Anti-Bacterial Agents ; Appendectomy ; Appendicitis* ; Case-Control Studies* ; Cefotaxime* ; Child* ; Cohort Studies ; Hospital Records ; Humans ; Length of Stay ; Leukocyte Count ; Metronidazole* ; Neutrophils ; Postoperative Complications ; Retrospective Studies ; Sex Distribution ; Wound Infection