A case of Cleido-Cranial-Dysostosis, which characterized by deficient formation of the clavicle with delayed and imperfect ossification of the cranium, associated with other anatomical errors, was experienced at The Department of Orthopaedic Surgery of Kyung Hee University Hospital in January 73. We report this rare and interest case with reference review.
Clavicle ; Skull

Keratoacanthoma is a rapidly growing tumor that has the tendency of spontaneous involution but it may persist for some times, continue to enlarge and may become invasive and destructive. Many modalities are available for the treatment of keratoacanthoma. Although excisional surgery is the treatment of choice, this can result in functional and cosmetic defects when large or strategically located lesions are treated. An effective nonsurgical treatment would be desirable in such cases. We report two cases with unusually large or facial keratoacanthoma treated with intralesional methotrexate. One case showed complete resolution over 6 injections and the other after 2 injections. We suggest that intralesional injection of methotrexate is a simple, effective, safe and inexpensive method for the treatment of large keratoacanthoma.
Injections, Intralesional ; Keratoacanthoma* ; Methotrexate*

BACKGROUND: Vibrio(V.) vulnificus is a halophilic, gram-negative bacillus that causes a fatal sepsis in patients with underlying chronic disease such as liver cirrhosis and alcoholic abuse. Because V. vulnificus infection has a fulminant course and high mortality rate, early recognition and rapid diagnosis with prompt therapy are necessary to improve survival rate. OBJECTIVE: The purpose of this study was to develop a new selective medium for rapid identification of V. vulnificus through color change of medium according to pH from patients suspected of having V. vulnificus sepsis. METHODS: Rapid isolation and identification of V. vulnificus can be possible by modifying the component of PNC(5% peptone, 1% NaCl, and 0.08% cellobiose [pH 8.0]) broth medium. From this PNC broth, a basal broth(5% peptone+1% NaCl+cellobiose) was prepared and used to evaluate additional medium supplements(cellobiose concentration [0.08, 0.2, 0.1%], pH [6.8, 7.5, 8.0] and pH indicator dye [bromthymol blue, thymol blue, phenol red, bromcresol purple, crystal violet, cresol red, and neutral red]). To examine the rapid identification and selectivity of this basal medium according to various conditions, V. vulnificus was tested by using saline and normal human blood containing these bacteria(1, 000 bacteria/ml), respectively at 37degrees C. A positive reaction(V. vulnificus growth) appeared as color change. The selectivity and identification capacity of this new broth was tested by using other 6 Vibrio species and 14 strains of other bacteria. RESULTS: Color change appeared only in the medium including bromthymol blue and thymol blue as a pH indicator dye. It was called the basal medium containing blue dyes as PNCB(peptone, NaCl, cellobiose and blue dye) medium. It took an average time of 4.8hr for becoming aware of yellow color change in PNCB broth after cultivating with saline mixed with V. vulnificus and 6hr in PNCB broth after cultivating with blood mixed with V. vulnificus. One Vibrio species and another 3 bacteria produced color change. So we confirmed that the final composition and pH of PNCB broth medium was 5% peptone, 1% NaCl, 0.2% cellobiose, 0.0004% bromthymol blue and 0.0004% thymol blue [pH 7.5] CONCLUSIONS: PNCB broth could be used as a selective and differential medium for rapid isolation and identification of V. vulnificus in patients with V. vulnificus sepsis.
Alcoholics ; Bacillus ; Bacteria ; Bromcresol Purple ; Bromthymol Blue ; Cellobiose ; Chronic Disease ; Coloring Agents ; Diagnosis ; Gentian Violet ; Humans ; Hydrogen-Ion Concentration ; Liver Cirrhosis ; Mortality ; Peptones ; Phenolsulfonphthalein ; Sepsis* ; Survival Rate ; Thymol ; Vibrio vulnificus* ; Vibrio*

Primary inoculation tuberculosis, also called tuberculosis chancre or tuberculosis primary complex, is the result of direct inoculation of M. tuberculosis in the skin of a host who has not been infected. A 33-year-old laboratory male presents with painless erythematous nodule and central ulcer on the left middle finger for 3 weeks. The skin lesion was developed after he punctured his finger with a needle containing M. tuberculosis. He had no history of tuberculosis. Histopathologic finding showed a wedged shaped abscess mixed with nuclear dust and eosinophils in the epidermis, and inflammatory cell infiltrations and caseation necrosis within the granuloma in the dermis. No bacillus was found in the lesion on AFB stain. We performed polymerase chain reaction with lesional tissue and obtained a positive result. So we diagnosed this case as a primary inoculation tuberculosis, and started antituberculosis medication. After 2 months of treatment, the erythema and ulcer improved. The patient completed a 9 months course of antituberculosis therapy without complication.
Abscess ; Adult ; Bacillus ; Chancre ; Dermis ; Dust ; Eosinophils ; Epidermis ; Erythema ; Fingers ; Granuloma ; Humans ; Male ; Necrosis ; Needles ; Polymerase Chain Reaction ; Skin ; Tuberculosis* ; Ulcer

Acrodermatitis enteropathica is a rare autosomal recessive disorder affecting early infancy. This syndrome is characterized by acral and periorificial dermatitis, alopecia and intractable diarrhea. Whereas hereditary acrodermatitis enteropathica is caused by mutation affecting intestinal zinc absorption, transient acrodermatitis enteropathica is caused by inadequate supply or malabsorption of zinc in the premature infant. We report a case of transient acrodermatitis enteropathica in a 5-month-old, breast-fed premature infant.
Absorption ; Acrodermatitis* ; Alopecia ; Dermatitis ; Diarrhea ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Zinc

Fibroma of the tendon sheath is a benign soft tissue tumor and this mostly occurs in the distal portion of an extremity. The tumor usually appears as a slow-growing, firm, painless, small nodule in association with tendons and tendon sheaths. Histopathologically, it shows a well-demarcated nodule that consists of haphazardly-arranged, fibroblast-like spindle cells that are embedded in a dense collagenous matrix. A 52-year-old woman presented with a tender, solitary, 2.5x2.0 cm-sized, subcutaneous nodule on the right elbow. The skin biopsy specimen showed that the well-circumscribed tumor contained densely-arranged collagen areas with spindle cells and slit-like vascular channels. We herein report on a rare case of fibroma of a tendon sheath on the right elbow.
Biopsy ; Collagen ; Elbow ; Extremities ; Female ; Fibroma ; Humans ; Middle Aged ; Skin ; Tendons

Ketoprofen is an nonsteroidal anti-inflammatory drug derived from propionic acid. It has been widely used as topical preparations, as gel or patch. It has been reported that topical ketoprofen can cause contact dermatitis and photocontact dermatitis. We experienced five cases of contact dermatitis, developed after applying ketoprofen patch(Ketotop(R), Pacific pharmaceutical Co., Korea) for the control of oste omuscular or joint pain. While one patient had generalized urticarial eruption, the rest of patents showed localized erythematous pruritic eczematous skin eruptions. It was verified through intradermal skin test and pin prick test that ketoprofen itself was not the causative drug for the skin eruption. Patch test excluded the possibility of allergic skin reaction to rubber compounds. It should be elucidated which compounds are allergic or toxic to the skin, contained in woven fabrics.
Arthralgia ; Dermatitis, Contact* ; Dermatitis, Photoallergic ; Diethylpropion ; Humans ; Ketoprofen* ; Patch Tests ; Rubber ; Skin ; Skin Tests

PURPOSE: The aim of this study is to examine whether conventional primary closure of the bile duct without routinely inserting a T-tube could be performed after all the surgeries used to treat choldocholithiasis. METHODS: From April 2002 to July 2005, we retrospectively analyzed 125 bile duct stone disease patients who underwent primary closure of the bile duct. RESULTS: Wound infection was the most frequent surgical complications, and it showed a higher trend in the patients who had a history of previous biliary operation, and it showed a trend to be slightly higher in the recurrent biliary stone cases than that in the de novo cases. However, these findings were not statistically significant. In addition, surgical complications developed in 16 of 100 patients who were older that 60 years, whereas there was only 1 of 25 patients who developed complications for the patients younger than 60 years. The development of complications has a tendency to be higher for the older patients, yet the level was not statistically significant. In regard to postsurgical hyperamylasemia, although a statistically significant difference could not be detected, this malady developed in 3 of 12 cases in whom endoscopic nasobiliary drainage (ENBD) tubes were inserted. This showed a trend to be higher than that for 13 cases of 113 patients for whom endoscopic nasobiliary drainage tubes were not inserted. Concerning the postsurgical hospitalization period, it was significantly longer in the cases who developed complications (p=0.018), and there was a tendency for a prolonged hospitalization period for the patients who were older than 60 years, for women, recurrent cases and the cases with a history of the bile duct surgery. Yet these had no statistical significance CONCLUSION: It appears that the primary closure of bile duct is a technique that could be performed safely for all choledocolithotomy patients , and this is regardless of the size of bile duct diameter, history of surgery on the bile duct system, gender, emergency operation, age, recurrent biliary stones, the presence of presurgical nasobiliary drainage tube and the presence of concomitant diseases.
Bile Ducts* ; Bile* ; Choledocholithiasis ; Drainage ; Emergencies ; Female ; Hospitalization ; Humans ; Hyperamylasemia ; Length of Stay ; Retrospective Studies ; Wound Infection

Kaposi's sarcoma(KS) is a multicentric proliferative vascular tumor involving cutaneous and visceral tissues. KS was one of the first recognized manifestations of AIDS. A 71-year-old woman was seen with multiple violaceous nodules and painful erythematous cellulitis-like swelling on both lower legs. Easy bruising and senile purpura was also noted on her forearms. She had been suffered from lower back pain for 7 years, and had been treated with corticosteroids. Clinical picture and hormonal study revealed that she had iatrogenic Cushing's syndrome. The histopathologic study from skin lesion showed abnormally proliferated and dilated vessels, vascular slits, spindle shaped cells in the entire dermis. Human herpesvirus 8(HHV-8) was detected by nested polymerase chain reaction(PCR) using the paraffin-embedded skin tissue. She received localized radiotherapy(50 Gray) to both lower legs with favorable response. But five months later, her skin lesions had recurred and progressed into more aggressive pattern mainly on her left lower leg. We report a rare case of human herpesvirus 8 related KS in iatrogenic Cushing's syndrome.
Adrenal Cortex Hormones ; Aged ; Cushing Syndrome* ; Dermis ; Female ; Forearm ; Herpesvirus 8, Human* ; Humans* ; Leg ; Low Back Pain ; Purpura ; Sarcoma, Kaposi* ; Skin

BACKGROUND: Nettles, of the plant family Urticae, cause nonimmunologic contact urticaria by stinging hairs. Light application of the leaf or stem to the skin results in the rapid development of a short-lived stinging sensation accompanied by wheal formation and itching. The types of chemical mediators causing the stinging sensation and wheal have not yet been clarified. OBJECTIVE: To investigate stinging and urticating substances causing contact urticaria when the skin is in contact with nettle(Urtica thunbergiana). METHODS: Twenty two volunteers were used for the clinical portion of this investigation. The time to wheal development and the evanescent time of pain and wheal were measured after pricking the forearm skin with nettle trichomes, following the administration of antihistamine, antiserotonin or corticosteroid, respectively or a combination of two, either with or without the application of substance P antagonist(capsaicin cream, 0.025%). Nettle extracts were prepared from dry stems and leaves of Urtica thunbergiana. Histamine, serotonin and substance P(SP) contents of nettle extracts were measured by gas chromatographic mass spectroscopy. RESULTS: After puncture of the skin by trichome of nettle, a stinging sensation developed within a few seconds but disappeared faster at the site where capsaicin cream had been applied than at the nonapplied skin site(p<0.05). The development and evanescent time of wheal were not significantly correlated with the application of capsaicin cream. The evanescent time of pain after pricking the skin with trichome following the administration of antiserotonin was significantly shortened at the nonapplied skin site. Pain disappeared more rapidly at the capsaicin applied site following the administration of antihistamine or antiserotonin than at the nonapplied sites(p<0.05), but not following prednisolone administration. Wheal development was delayed significantly at both the capsaicin applied and nonapplied sites after antihistamine administration(p<0.05). Histamine was detected only in the nettle extract. SP and serotonin were not detected because of their insolubility in solvents. CONCLUSION: These results suggest that wheal-and-flare reaction to nettle stings is due primarily to the histamine and partly to the serotonin and SP introduced by the nettle. SP may be mainly involved and partially involved by serotonin in stinging pain.
Bites and Stings ; Capsaicin ; Forearm ; Hair ; Histamine ; Humans ; Mass Spectrometry ; Plants ; Prednisolone ; Pruritus ; Punctures ; Sensation ; Serotonin ; Skin ; Solvents ; Substance P ; Trichomes ; Urticaria* ; Volunteers