Aplasia cutis congenita is a rare disorder characterized by localized or generalized absence of skin at birth. The various hypothesis and classification are proposed. Type V in Frieden's classification, which is associated with fetus papyraceus or placental infarcts, occurs as a large cutaneous defect on the trunk and extremities. We experienced the patient had skin defect affecting the lower abdomen symmetrically, with no family history of the any disorders or chromosomal anomalies and associated anomalies. A twin fetus was died in utero. We report a case of aplasia cutis congenita associated with fetus papyraceus with the review of the associated literatures.
Abdomen ; Classification ; Ectodermal Dysplasia* ; Extremities ; Fetus ; Humans ; Parturition ; Skin ; Twins

Succinylcholine is a depolarizing neuromuscular blocking agent(NMB) and is used in induction of anesthesia. Succinylcholine-assisted endotracheal intubation has been routinely used in the operating room and rapid sequence incubation with NMB agent has been the method for airway management in emergency department(ED). Adverse effects of succinylcholine are hyperkalemia, malignant hyperthermia, transient hypotension, arrhythmia, and increased intracranial, intraocular and gastric pressure, etc. This study carried out the change of serum potassium as an adverse effects of succinylcholine during endotracheal intubation in ED. A prospective, noncontrolled design was used to study serial serum potassium levels in pre- and postendotracheal intubation(5min) from February 1996 to August 1996. Succinycholine was selectively used in patient with a problem of difficult endotracheal intubation (alert to drowsy mental status with intact gag reflex). The dose of succinylcholine was 1.5 mg/kg and injected into intravenous line during preoxygenation with bag-valve-mask device. Student's two-tailed t-test was used and p-value was < 0.05. Among the total of 48 patients(male 27, female 21), the postintubation level of the serum potassium of 25 patients were increased and those of 21 persons were decreased compared with preintubation level. Two patients showed no change in amount. The average serum potassium indicated 3.7+/-.8 mEq/L before the injection of the succinylcholine and 3.8+/-.9 mEq/L 5 minutes after its injection. P-value showed more than 0.05 and as the result statistically there was no noteworthy difference. All patients were intubated within 30 sec and no patients were failed. We concluded that succinylcholine-assisted endotracheal incubation is a rapid and safe method as an endotracheal incubation practiced in ED and succinylcholin-induced hyperkalemia is minimal and no adverse effect.
Airway Management ; Anesthesia ; Arrhythmias, Cardiac ; Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Hyperkalemia ; Hypotension ; Intubation, Intratracheal* ; Malignant Hyperthermia ; Neuromuscular Blockade ; Operating Rooms ; Potassium* ; Prospective Studies ; Succinylcholine*

Placement of a pulmonary artery catheter is associated with various complications, including catheter knotting. Fluoroscopy can be used to visualize and confirm catheter knotting. Transesophageal echocardiography is readily available to detect knot formation in the operating room or intensive care unit. We present a case in which pulmonary artery catheter knotting was detected by transesophageal echocardiography. This method may be useful in the operating room or in the intensive care unit to identify the presence and location of catheter knotting.
Catheters ; Echocardiography, Transesophageal ; Fluoroscopy ; Intensive Care Units ; Operating Rooms ; Pulmonary Artery

OBJECTIVE: To describe the radiographic findings of primary pulmonary tuberculosis (TB) in previously healthy adolescent patients. MATERIALS AND METHODS: The Institutional Review Board approved this retrospective study, with a waiver of informed consent from the patients. TB outbreaks occurred in 15 senior high schools and chest radiographs from 58 students with identical strains of TB were analyzed by restriction fragment length polymorphism analysis by two independent observers. Lesions of nodule(s), consolidation, or cavitation in the upper lung zones were classified as typical TB. Mediastinal lymph node enlargement; lesions of nodule(s), consolidation, or cavitation in lower lung zones; or pleural effusion were classified as atypical TB. Inter-observer agreement for the presence of each radiographic finding was examined by kappa statistics. RESULTS: Of 58 patients, three (5%) had normal chest radiographs. Cavitary lesions were present in 25 (45%) of 55 students. Lesions with upper lung zone predominance were observed in 27 (49%) patients, whereas lower lung zone predominance was noted in 18 (33%) patients. The remaining 10 (18%) patients had lesions in both upper and lower lung zones. Pleural effusion was not observed in any patient, nor was the mediastinal lymph node enlargement. Hilar lymph node enlargement was seen in only one (2%) patient. Overall, 37 (67%) students had the typical form of TB, whereas 18 (33%) had TB lesions of the atypical form. CONCLUSION: The most common radiographic findings in primary pulmonary TB by recent infection in previously healthy adolescents are upper lung lesions, which were thought to be radiographic findings of reactivation pulmonary TB by remote infection.
Adolescent ; *Disease Outbreaks ; Female ; Humans ; Male ; Mass Screening ; Polymorphism, Restriction Fragment Length ; Radiographic Image Interpretation, Computer-Assisted ; *Radiography, Thoracic ; Republic of Korea/epidemiology ; Retrospective Studies ; Schools ; Tuberculosis, Pulmonary/epidemiology/*radiography

An adenosquamous carcinoma of the penis is an exceedingly rare, highly malignant tumor, with histological features of a squamous cell carcinoma and an adenocarcinoma, which originates in the penile surface epithelium, and possibly in embryologically misplaced mucus glands of the perimeatal region of the glans mucosa. We report a case of an adenosquamous carcinoma of the penis in a 73-year-old man who had been suffering from a painful ulcerative mass on his penis for 2 years.
Adenocarcinoma ; Aged ; Carcinoma, Adenosquamous* ; Carcinoma, Squamous Cell ; Epithelium ; Humans ; Male ; Mucous Membrane ; Mucus ; Penis* ; Ulcer

Tick paralysis is caused by a neurotoxin secreted by female tick. Characteristic initial manifestation is bilateral flaccid ascending paralysis similar to Guillain-Barr? syndrome. The predominant electrophysiological abnormality is a reduction in complex muscle action potentials. Here, we present a 62-year-old man who initially experienced a sudden biting pain on his scalp. Subsequently he developed bilateral lower extremity paralysis that ascended symmetrically involving the upper extremities. Within 2 weeks, the patient showed a full recovery without treatment.
Action Potentials ; Bites and Stings ; Female ; Humans ; Lower Extremity ; Middle Aged ; Muscles ; Paralysis ; Scalp ; Tick Paralysis ; Ticks ; Upper Extremity

We sought to determine whether early amniocentesis is a safe and acceptable method of genetic evaluation in early pregnancy. During the 20-month period from February 1994 to September 1995, 80 consecutive early amniocentesis were performed transabdominally at 12(+3)-14(+6) weeks of gestation and 305 consecutive mid-second-trimester transabdominal amniocenteses were performed at 16(+0)-18(+0) weeks of gestation. All amniotic fluid samples were cultured using flask method. There were no significant differences between the early and mid-second-trimester amniocenteses in failed sampling, ambiguous results, pregnancy loss within 4 weeks after the procedure, pregnancy loss from 4 weeks after procedure to 28 weeks of gestation, preterm birth, and perinatal death. We may conclude that early amniocentesis is a safe and acceptable method for prenatal diagnosis.
Amniocentesis* ; Amniotic Fluid ; Female ; Pregnancy ; Premature Birth ; Prenatal Diagnosis

BACKGROUND AND OBJECTIVES: The proportion of mitral regurgitation caused by chordae rupture has recently been seen to be increasing, as has the role of mitral valve repair in the treatment of chordae rupture. This study evaluated the clinical characteristics and trends of surgical treatment of chordae rupture. Additionally, we attempted to discern the usefulness of transthoracic echocardiography (TTE) in the preoperative diagnosis of chordae rupture. SUBJECTS AND METHODS: Forty patients (20 men, mean age:49+/-14) presenting with chordae rupture confirmed during surgery between January 1994 and April 2001 were included in this study. Clinical, TTE and surgical data were analyzed retrospectively. RESULTS: The cause of chordae rupture was idiopathic degeneration in 28 cases, rheumatic heart disease in 5, infective endocarditis in 6, and trauma in 1 case. The sites of rupture were the anterior leaflet (14), posterior leaflet (23), and anterior and posterior leaflets (3). Mitral valve repair was performed in 20 cases and mitral valve replacement was performed in 20 cases. Most mitral valve repairs were performed beginning in 1998 (17/20). Chordae rupture diagnosed by TTE numbered 14 cases (35%). CONCLUSION: Regurgitation caused by chordae rupture was primarily associated with idiopathic degenerative change. Posterior leaflet rupture was more frequent than anterior leaflet rupture. The use of mitral valve repair has been increasing since 1998.
Chordae Tendineae ; Diagnosis ; Echocardiography ; Endocarditis ; Humans ; Male ; Mitral Valve ; Mitral Valve Insufficiency ; Retrospective Studies ; Rheumatic Heart Disease ; Rupture*

A 15-year old boy visited Samsung Medical Center complaining that when he ate curry and rice two months ago, he developed immediate palatal itching, generalized urticaria, headache and dyspnea. His chest radiographs were normal. He had no history of allergy, but a methacholine provocation challenge test revealed positive findings (PC20 3.62 mg/mL). Skin prick tests revealed positive findings to asparagus, house dust mites (Dp, Df), flower pollens (aster, chrysanthemum, golden rod), weed pollens (mugwort, ragweed, dandelion, short ragweed) and crude extract of curry powder. Specific IgE to Dp, Df and soy bean were positive (6.52, 31.2 and 1.91 kU/L) and total IgE was 1, 207 kU/L by the Pharmacia UniCAP- FEIA. After receiving parental consent, we performed an oral provocation test to confirm the relationship between his symptoms and curry powder. He ingested a small amount of curry powder with pure water, which was increased every 1 hour. We then measured his PEFR every 10 minutes after each subsequent curry powder ingestion. After he ate 20 gm of curry powder in one time, he exhibited profuse sweating, skin rash and dyspnea. When we treated him with epinephrine and bronchodilator, his symptoms improved. He developed the same symptoms 2 hours later, but these symptoms were brought under control by the same medication.
Adolescent ; Ambrosia ; Anaphylaxis* ; Chrysanthemum ; Dyspnea ; Eating ; Epinephrine ; Exanthema ; Flowers ; Headache ; Humans ; Hypersensitivity ; Immunoglobulin E ; Male ; Methacholine Chloride ; Parental Consent ; Peak Expiratory Flow Rate ; Pollen ; Pruritus ; Pyroglyphidae ; Radiography, Thoracic ; Skin ; Soybeans ; Sweat ; Sweating ; Taraxacum ; Urticaria ; Water

Hypertrophic obstructive cardiomyopathy (HOCM) is characterized by inappropriate myocardial hypertrophy that occurred in the absence of an obvious cause for the hypertrophy and dynamic left ventricular outflow tract obstruction, caused by asymmetrical septal hypertrophy and systolic anterior motion of the anterior mitral leaflet. The pathophysiological abnormality in HOCM is diastolic dysfunction, abnormal stiffness of the left ventricle with resultant impaired ventricular filling and impaired vasodilator reserve (perhaps related to the thickened and narrowed small intramural coronary arteries found in HOCM). During the early course of this progressive disease, treatment consists of negative inotropic drugs. Surgery has been the only therapeutic option in patients with hypertrophic cardiomyopathy who are resistant to drug treatment and sequential pacemaker therapy. We describe a novel catheter-based technique that may replace surgical myocardial reduction. The technique is interventional infarction of a portion of the interventricular septum by the infusion of alcohol into a selectively catheterized septal artery.
Arteries ; Cardiomyopathy, Hypertrophic* ; Catheters ; Coronary Vessels ; Heart Ventricles ; Humans ; Hypertrophy ; Infarction