We report a case of epidermolysis bullosa acquisita in a 53 year-old woman who had. extreme skin fragility, trauma induced blisters and erosions usually localized to extensor site of the skin surface, and healing with scars and milia for several years. Histologic findings of perilesional skin showed normal epidermis, subepid malblister and spirsely infiltration of inflammatory cells. Direct immuncofluorescence showed depositiori of IgCi and C3 in a linear pattern along the epidermal basement, membrane in the per ilesional skin. In indirect immuriofluorescence, using 1.0M sodium chloride separated nor mal human skin as the sntbstrate, antitodies(IgG at a titer of 1:40) were bound to dermal site of the separation, indicating that the patient serum yields the reaction in or below the lamiria densa. Electronmicroscopic findings showed the roof of the blister was located. below the basal lamiria.
Blister ; Cicatrix ; Epidermis ; Epidermolysis Bullosa Acquisita* ; Epidermolysis Bullosa* ; Female ; Humans ; Membranes ; Middle Aged ; Skin ; Sodium Chloride

No abstract available.
Colorectal Neoplasms* ; Fluorouracil* ; Humans ; Interferon-gamma*

In order to investigate the efficacy and safety of oral cilazapril, a new angiotensin converting enzyme inhibitor, on essential hypertension, a single daily dose of 2.5 to 5.0mg cilazapril was administered in 30 hypertensive patients with diastolic blood pressure in the range of 95??15mmHg while off all other anti-hypertensive agents for 10 weeks. Blood pressure and heart rate were measured every 2 weeks. The complete blood count with platelet count, blood chemistry by SMA-12 including lactic dehydrogenase and serum electrolytes, and urinalysis were performed at 4th and 10th week of therapy. The electrocardiography was performed at the beginning and the end of treatment period. Any kinds of side effects were actively questioned by the examining physicians. The following results were obtained : 1) The mean age was 49.2 years, and the ratio of male-to-female was 1 : 1.3. 2) Blood pressure started to fall significantly within 2 weeks of treatment with cliazpril 2.5mg(M+/-S.E., 15.4+/-17.4mmHg vs 138.5+/-23.3, 100.3+/-6.2 vs 89.4+/-6.6, p<0.05), and after 6 weeks of treatment with a mean dosage of 2.84mg. diastolic blood pressure of all subjects was maintained below 90mmHg throughout the rest of trial. 3) Pulse rate or body weight were not significantly changed during the entire treatment period(69.3+/-6.0/min vs 10th week : 69.0+/-7.7, 64.7+/-7.4kg vs 63.6+/-6.7, p>0.05). 4) There were no significant changes in blood chemistry including blood sugar, cholesterol and electrolytes, except mild changes of serum creativine and alkaline phosphatase values. 5) Hematologic findings, urinalysis and electrocardiographic findings remained unchanged. 6)Side effects were mostly mild in nature without potentially serious episodes(dry cough : 20%, indigestion, headache, dizziness, in order), but there was 1 cases in whom the dosage was redyced due to postural hypotension. From the above results, cilazapril with the dosage of 2.5 to 5.0mg was effectvie and well tolerated in essential hypertensive patients with diastolic blood pressure of 95 to 115mmHg, and cilazapril seems to be appropriate for monotherapy of mild to moderate hypertensive patients.
Alkaline Phosphatase ; Antihypertensive Agents ; Blood Cell Count ; Blood Glucose ; Blood Pressure ; Body Weight ; Chemistry ; Cholesterol ; Cilazapril* ; Cough ; Dizziness ; Dyspepsia ; Electrocardiography ; Electrolytes ; Headache ; Heart Rate ; Humans ; Hypertension ; Hypotension, Orthostatic ; Oxidoreductases ; Peptidyl-Dipeptidase A ; Platelet Count ; Urinalysis

From February 1996 to May 1997, 18 patients underwent mitral valve repair for mitral regurgitation. There were 9 male and 9 female patients aged from 19 to 68 years (mean, 53). Thirteen patients were in New York Heart Association (NYHA) class III and IV. The cause of mitral regurgitation was degenerative in 12 patients, rheumatic in 5 patients and infective in 1 patient. Fifteen patients were in Carpentier's functional classification II, 2 patients in Carpentier's class III and 1 patient in Carpentier's class I. Surgical procedures included prosthetic ring annuloplasty (16 cases), rectangular resection of posterior leaflet (15 cases), chordal shortening (5 cases), triangular resection of anterior leaflet (2 cases), commissurotomy (2 cases), partial transposition of posterior leaflet (1 case). These procedures were combined in most patients. There was no operative death. These patients have been followed from 1 to 15 months, mean of 6.7 months. There was one late death resulted from low cardiac output following mitral valve replacement. The function of the repaired valve in other 17 patients has remained satisfactory during the observed interval. We consider that mitral valve repair is highly satisfactory in patients with mitral regurgitation.
Cardiac Output, Low ; Classification ; Female ; Heart ; Humans ; Male ; Mitral Valve Insufficiency* ; Mitral Valve*

No abstract available.
Blood Platelets* ; Cardiopulmonary Bypass*

Drug-induced thrombocytopenia and purpura have boon developed by many various agents. Rifampin and Pyrazinamide have been known as bactericidal antituberculous drugs, but, the above side effects have been a problem. Especially, hematologic side effects art fatal to patients occasionally. Rifampin-induced thrombocytopenia and purpura have been well known, also, pyrazinamide-induced thrombocytopenia have been reported. A new quilonone agent Ciprofloxacin, has been commonly used in clinics now, but it's side effects are not known well. So, we report a case of a 23-year-old female with thrombocytopenia and purpura after taking Rifampin, Pyrazinamide, and Ciprofloxacin as antituberculous agents.
Ciprofloxacin* ; Female ; Humans ; Purpura* ; Pyrazinamide* ; Rifampin ; Thrombocytopenia* ; Young Adult

No abstract available.
Fistula*

No abstract available.
Colorectal Neoplasms* ; Fluorouracil* ; Leucovorin*

An encepholocele is defined as a herniation of cranial contents through a defect in the skull. Encephaloceles are classified accroding to their contents and location. Encephalocele is a useful general term to refer to common features of the various forms of anomaly, but considerable differences exist in the pathology, treatment and prognosis of encephaloceles at each anatomical location. Improved neuroimaging facilities, especially MRI, make it easy not only to detect the encephalocele including its contents and location, but also to get preoperative informations. We have reviewed a total of 22 patients with encephalocele whom we have experienced from 1986, July to 1990, June. Twelve were at occipital location, six at cranial vault, three at cranial base, one at frontoethmoidal location. The size of cranium bifidum and herniating sac of the cranial vault and occipital location is larger than that of frontobasal location. The incidence of associated hydrocephalus is in order of occipital, cranial vault, frontobasal form, and its prognosis is also better in frontobasal form than in occipital of cranial vault form.
Encephalocele* ; Humans ; Hydrocephalus ; Incidence ; Magnetic Resonance Imaging ; Neuroimaging ; Pathology ; Prognosis ; Skull ; Skull Base

Total body water is increased after cardiopulmonary bypass resulting in tissue edema and organ dysfunction. Ultrafiltration has been used to reduce this accumulation of water. We have carried out a prospective randomized study in 17 children undergoing open heart surgery, comparing modified ultrafiltration (MUF) with nonfiltered controls. MUF was carried out for about 10 minutes after completion of cardiopulmonary bypass to a hematocrit 36~42%. Blood loss, blood transfused, hemodynamics, and laboratory data were recorded for 24 hours postoperatively. The results were analyzed using Mann-Whitney U test, comparing controls (n=7) to ultrafiltered (n=10). There was no death in each group. The mean filtrate volume (ml/kg) was 42 (30~68). Blood loss (ml/kg/24hr) was 14.5 mean (4.0~26.6) in controls versus 12.1 mean (6.0~21.5) in MUF (p>0.05) ; blood transfused (ml/kg/24hr) was 9.4 mean (6.0~36.3) in controls versus 3.4 mean (0~11.4) in MUF (p<0.05). There was rise in arterial blood pressure during MUF. Percent rise of systolic blood pressure was 4.2 (0~11.7) in controls versus 19.8 (7.0~36.9) in MUF (P=0.001). Percent rise of diastolic blood pressure was 10.0 (1.6~20.8) in controls versus 30.6 (5.8~73.3) in MUF (p<0.05). Platelet count, fibrinogen, and oncotic pressure rose after MUF. No complications directly attributable to the ultrafiltration were observed. Conclusively, MUF is safe, effective means of removing body water and beneficial to hemodynamics.
Arterial Pressure ; Blood Pressure ; Body Water ; Cardiopulmonary Bypass ; Child ; Edema ; Fibrinogen ; Heart* ; Hematocrit ; Hemodynamics ; Humans ; Platelet Count ; Prospective Studies ; Thoracic Surgery* ; Ultrafiltration*