In 1908 Leiner described the peculiar skin condition among infants to which he applied the name erythroderma desquamativa. The four cardinal features of Leiners disease are generalized seborrheic dermatitis, intractable severe diarrhea, recurrent local and systemic infections usually of gram negative etiology, and marked wasting and cyst rophy. A 2-month-old female presented to our clinic with generalized seborrheic erythrodermic eruption and intractable diarrhea. She had sufferd from these symptoms since birth. Her body weight was 3.4kg (below 3rd percentile). Her scalp was covered with thick yellowish crsts. There was generalized erythroderma covered vith scales and crusts. Laboratory result; revealed gram negative sepsis and DIC. Chest X-ray showed the findings of minimal aspir ition pneumonia in the right upper lobe. She expired on the following day.
Body Weight ; Dacarbazine ; Dermatitis, Exfoliative ; Dermatitis, Seborrheic ; Diarrhea ; Female ; Humans ; Infant ; Parturition ; Pneumonia ; Scalp ; Sepsis ; Skin ; Thorax ; Weights and Measures

No abstract available.
Hemorrhage*

No abstract available.
Ixodes* ; Tick Bites* ; Ticks*

The appendiceal mucocele is very rare disease of 0.2% incidence. About 24% of patients are asymptomatic and symptomatic patients present with pain in the right lower quadrant of abdomen in 64%, plapable maas in the right lower quadrant of abdomen in 50%, and rarely, melena, hematochezia, anemia, diarrhea, malaise, and abdominal distension. The gastrointestinal bleeding may be presented in the patient with intussusception, but the massive bleeding is generally absent. We report a case of appendiceal mucocele accompanying with gastrointestinal bleeding and review of literature.
Abdomen ; Anemia ; Diarrhea ; Gastrointestinal Hemorrhage ; Hemorrhage* ; Humans ; Incidence ; Intussusception ; Melena ; Mucocele* ; Rare Diseases

Primary gastrointestinal lymphoma primarily confined to gastrointestinal tract is relatively rare diaease. Although the lymphoma primarily involved colorectum or small bowel was commonly reported than primary gastric lymphoma in Korea, the concurrent primary lymphoma of colon and small bowel is very rare in reported cases. We report a case of combined primary malignant lymphoma of the jejunum and cecum, who was admitted due to melena and anemia. She had right hemicolectomy and end-to-side ileotransverse colostomy at 2 months ago, due to primary colon lymphoma. The laparotomy was performed and identified hard, 2 x 3 cm sized masses on distal 25 cm, 80 cm and 150 cm from the Treitz ligament. The histology of these small ma showed histiocytic lymphoma as same as cecal specimen. In general, the small bowel lymphoma shaws poor prognosis than gastric or colorectal lymphoma due to diffieulty in diagnosis and late symptoms, but this problem could be resolved through the knowledge about primary gastrointestinal lymphoma and the development of diagnostic methods.
Anemia ; Cecum ; Colon* ; Colostomy ; Diagnosis ; Gastrointestinal Tract ; Jejunum ; Korea ; Laparotomy ; Ligaments ; Lymphoma* ; Lymphoma, Large B-Cell, Diffuse ; Melena ; Prognosis

In modem medical industries as in others, it has been emphasized by many experts such as Dr. Mayer and Dr. Donabedean that there should be quality assurance activities applying statistical knowledges in the processes of medical management and medical staff themselves for the better medical care and customer satisfaction. Three of our quality assurance programs for the purpose of shortening the treatment time In the department of emergency medicine in Keimyung University, Dong-San Medical Center had been carried out during the period of June 94 through December 95. Our methodology was mainly the process emphasized ; finding the causes of delaying factors in various processes related to the works of nurses, doctors, laboratory services, radiology services etc. in the emergency room, holding various meetings among the related groups with genuine discussions, notifying the new results in each step, encouraging the positive ones and also applying the new leadership technics. During the period of June 94 through December 95(for 1.5 years), the average E.R. patient treatment time from registrations to dispositions had been reduced by about 2 hours (from 5 hours 3 minutes to 2 hours 5 minutes) and its variations among the different specialities had been narrowed down to significant degree (p<0.05) revealing the preprogram base line standard deviation of 2.43 to 1.28 in post program through continuous quality assurance programs. It was also noted that the successful results of Q/A program have been closely related to the fact that the process should be designed and redesigned repeatly as needed and that all the participants related were actively involved in the planning and redesigning processes.
Emergency Medicine ; Emergency Service, Hospital ; Humans ; Leadership ; Medical Staff ; Modems

BACKGROUND: Langerhans cells (LC), keratinocytes and Thy-1+ dendritic epidermal cells(DEC) are epidermal cells which are known to have important roles in inflammatory or immunologic skin disorders. Allergic contact dermatitis(ACD) is a prototype of a delayed hypersensitive reaction in which LC, keratinocytes and T lymphocytes play an important role. The role of LC in ACD is well known, but the role of Thy-1+ DEC is not yet fully revealed. Futhermore, the mechanism of irritant contact dermatitis(ICD) is not known and more study is required on the interaction between these epidermal cells in ICD. OBJECTIVE: The aim of this study is to observe the changes of these cells in ACD and ICD and to discuss their possible roles in the disease precess. MEHTODS: We evoked ACD with DNFB and ICD with croton oil in BALB/c mice and observed the morphologic changes of LC, Ia+ keratinocytes, and Thy-1+ DEC by immunoperoxidase staining when the inflammation was at its peak and at the resolution state. RESULTS: 1. In the control group, LC were evenly distributed and their average number was 1147+/-132/mm*. Thy-1+ DEC were slightly bigger than LC and showed uneven distribution. The average number of Thy-1+ DEC was 57+/-69/mm* Ia+ keratinocytes did not appeared. 2. On the 1st day of DNFB challenge, the number of LC was significantly decreased and their size and dendritic processes were increased when compared to those of the control group. Most of the keratinocytes showed Ia antigen expression on their surfaces. 3. On the 12th day of DNFB challenge, no significant changes in the number and morphologyof LC were noted when compared to the cotrol group, Ia+ keratinocytes were not observed. 4. there were no significant changes in the number and morphology of Thy-1+ DEC in ACD on the 1st and 12th day after DNFB challenge. 5. On the 2nd day after croton oil application, the number of LC was significantly decreased but the morphology not significantly changed. Ia+ keratinocytes were not observed. 6. On the 20th day after croton oil application, the number of LC was significantly increased but the morphology was not significantly changed. Ia+ keratinocytes were not observed. 7. There were no significant changes in th number and morphology of Thy-1+ DEC in ICD on the 2nd and 20th day after application of croton oil. Ia+ keratinocytes were not observed. CONCLUSION: In can be deduced that the LC have important roles in the mechanisms of both ACD and ICD reactions. Ia+ keratinocytes have an important role mainlyin the inflammatory precess of ACD. In addition, since the changes of the number of Langerhans cells in ACD and ICD showed different time courses and Ia+ keratinocytes appeared only in ACD, we hypothesized that different pathways of inflammation exist in ACD and ICD, and different cytokines may be responsible. It is probable that Thy-1+ DEC does not have any significant role in the inflammatory process of both ACD and ICD.
Animals ; Croton Oil ; Cytokines ; Dermatitis, Allergic Contact* ; Dermatitis, Contact* ; Dinitrofluorobenzene ; Histocompatibility Antigens Class II ; Inflammation ; Keratinocytes ; Langerhans Cells ; Mice ; Skin ; T-Lymphocytes

We report a case of B-cell chronic lymphocytic leukemia (CLL) with trisomy 12 detected by FISH using chromosome 12 alpha-satellite Probe (Oncor , USA) in uncultured interphase cells. Chromosome studies did not produce an analyzable metaphase by standard short term culture and revealed only normal female karyotype by B cell mitogen (phorbol 12-myristate 13-acetate) stimulated 96 hr culture. The patient, a 59-year-old female, did not have hepatomegaly, splenomegaly, lymphadenopathy and any other symptoms. The peripheral blood of the patient showed marked lymphocytosis (WBC : 28,300/microL, Lymphocyte: 80%) and the diagnosis by immunophenotyping was B cell CLL:CD5, CDl9, CD2O, SmIg, HLA-DR positive.
Chromosomes, Human, Pair 12 ; Diagnosis ; Female ; Fluorescence* ; Hepatomegaly ; HLA-DR Antigens ; Humans ; Immunophenotyping ; In Situ Hybridization* ; Interphase ; Karyotype ; Leukemia, Lymphocytic, Chronic, B-Cell* ; Lymphatic Diseases ; Lymphocytes ; Lymphocytosis ; Metaphase ; Middle Aged ; Splenomegaly ; Trisomy*

We report a case of B-cell chronic lymphocytic leukemia (CLL) with trisomy 12 detected by FISH using chromosome 12 alpha-satellite Probe (Oncor , USA) in uncultured interphase cells. Chromosome studies did not produce an analyzable metaphase by standard short term culture and revealed only normal female karyotype by B cell mitogen (phorbol 12-myristate 13-acetate) stimulated 96 hr culture. The patient, a 59-year-old female, did not have hepatomegaly, splenomegaly, lymphadenopathy and any other symptoms. The peripheral blood of the patient showed marked lymphocytosis (WBC : 28,300/microL, Lymphocyte: 80%) and the diagnosis by immunophenotyping was B cell CLL:CD5, CDl9, CD2O, SmIg, HLA-DR positive.
Chromosomes, Human, Pair 12 ; Diagnosis ; Female ; Fluorescence* ; Hepatomegaly ; HLA-DR Antigens ; Humans ; Immunophenotyping ; In Situ Hybridization* ; Interphase ; Karyotype ; Leukemia, Lymphocytic, Chronic, B-Cell* ; Lymphatic Diseases ; Lymphocytes ; Lymphocytosis ; Metaphase ; Middle Aged ; Splenomegaly ; Trisomy*

Hepatolithiasis is said to exist when stones are present in the right or the left hepatic ducts or their tributaries. Although it is a pathophysiologically benign disease, it causes frequently serious problems-recurrent cholangitis, liver abscess, obstructive jaundice, liver cirrhosis, and sepsis - and has challenged surgeons. Until recently, its fundamental pathogenetic mechanisms have not been elucidated, but bile duct stenosis, bile stasis, and secondary infection are considered as important pathogenetic factors. Therefore, the ultimate goal of the treatment is directed to the correction of these factors. We were retrospectively reviewed 119 cases of patients with hepatolithiasis treated by various surgical methods from Jul. 1989 to Dec. 1996 at the Department of Surgery of Maryknoll Hospital, Pusan. There were 72 women and 47 men, and the mean age was 45.5 years. Thirty-nine patients (32.8%) had previous histories of operations related to biliary stone diseases - cholecystectomy (n=13), T-tube choledocholithotomy (n=21), choledochoduodenostomy (n=9), Roux-en-Y choledochojejunostomy (n=6), and transduodenal sphincteroplasty (n=1). Operative procedures were 24 (20.2%) lithotomy, 60 (50.4%) drainages, and 35 (29.4%) hepatectomies and determined by the location of the stones, the general condition of the patient, and the anatomical change (stenosis or cystic dilatation) in intrahepatic duct. Postoperative complications occurred in 33 (27.7%) patients : wound infection (n=23), atelectasis (n=5), intra-abdominal bile collection (n=3), choledochocutaneous fistula (n=2), hemobilia (n=1), and adhesive ileus (n=1). Residual stones were detected in 39 (32.7%) patients by T-tube cholangiography, ultrasonography, computed tomography. The instances of residual stones was the lowest (17.1%) for hepatectomy compared to 45.8% for a lithotomy and 39.3% for a drainage. The follow-up study showed symptom improvement in 91.5% of the patients with a hepatectomy compared to 58.3% for a lithotomy and 71.7% for a drainage which was statistically significant(P<0.05). Since incomplete stone removal in hepatolithiasis and presence of stenosis in intrahepatic duct frequently require a repeat operation or other invasive management, the authors conclude that a hepatectomy, as an initial treatment for hepatolithiasis, is a safe, satisfactory treatment where possible.
Adhesives ; Bile ; Bile Ducts ; Busan ; Cholangiography ; Cholangitis ; Cholecystectomy ; Choledochostomy ; Coinfection ; Constriction, Pathologic ; Drainage ; Female ; Fistula ; Follow-Up Studies ; Hemobilia ; Hepatectomy ; Hepatic Duct, Common ; Humans ; Ileus ; Jaundice, Obstructive ; Liver Abscess ; Liver Cirrhosis ; Male ; Postoperative Complications ; Pulmonary Atelectasis ; Retrospective Studies ; Sepsis ; Sphincterotomy, Transhepatic ; Surgical Procedures, Operative ; Ultrasonography ; Wound Infection