Eccrine poroma is a benign skin appendage tumor originating from the intradermal part of the sweat duct. It is found commonly on the hairless surface of the feet, although eccrine poroma of the hands, head, trunk, and legs have been reported. Histopathologically, the tumor extends from the lower portion of the epidermis into the dermis as broad, anastomosing bands. The tumor cells are smaller than squamous cells, having a uniform cuboidal appearance and a round, deeply basophilic nucleus, connected by intercellular bridges. In eccrine poromas, narrow ducta1 lumina and occasional cystic spaces are found within the tumor bands, but a large cystic space is very unusual. We report a case of eccrine poroma with a large cystic space extending from epidermis into the reticular dermis.
Basophils ; Dermis ; Epidermis ; Foot ; Hand ; Head ; Leg ; Poroma* ; Skin ; Sweat

Diffuse neonatal hemangiomatosis is rare and a life-threatening disorder characterized by multiple cutaneous and visceral hemangiomas. The organs most commonly affected are the liver, lung. brain, GI tract. The complications are high output cardiac failure, hemorrhage, Kassabach-Meritt syndrome, etc. A 30-day-old girl was diagnosed to have diffuse neonatal hemangiomatosis by her multiple cutaneous and hepatic hemangiomas. She was treated with corticosteroid and interferon alfa-2a. During the treatment the number and size of hemangiomas were markedly reduced.
Brain ; Female ; Gastrointestinal Tract ; Heart Failure ; Hemangioma ; Hemorrhage ; Humans ; Interferons ; Liver ; Lung

The Job's syndrome is a relatively rare primary immunodeficiency disorder characterized by recurrent staphylococcal infection and abscess formation, defective neutrophil chemotaxis, and markedly elevated serum IgE level. Clinical features are atopiclike dermatitis, furunculosis, paronychia, pulmonary bacterial pneumonia etc. We reported a case of Job's syndrome in a 12-year-old girl who had recurrent pneumonia, scaly pruritic dermatitis, fissured tongue, and nail dystrophy with elevated serum IgE level.
Abscess ; Chemotaxis ; Child ; Dermatitis ; Female ; Furunculosis ; Humans ; Immunoglobulin E ; Job Syndrome* ; Neutrophils ; Paronychia ; Pneumonia ; Pneumonia, Bacterial ; Staphylococcal Infections ; Tongue, Fissured

BACKGROUND: The coronary collateral circulation has been frequently observed in significant coronary artery disease and its protective role in ischemic myocardium is still remained unclear. But the study on the anti-ischemic effect in human model of ischemic myocardium is rare. METHODS: To observe the anti-ischemic role of coronary collateral circulation in ischemic myocardium, perfusion defect areas were measured during PTCA(percutaneous transluminal coronary angioplasty) in angina patients with single vessel disease and analyzed according to the grade of collateral circulation. The 99mTc-MIBI myocardial scanning images were obtained at 24 hours before PTCA with dipyridamole stress, at ballooning during PTCA and at 24 hours after the opening of the artery and perfusion defect volume ratios(DVR) were measured in each of the images of the patient with angina and single vessel disease. RESULTS: 1) Studied subjects were 14 patients(10 male, 4 female, mean age : 56.6+/-103) and subdivided into two groups. All patients had angina with single vessel disease, 7 proximal left anterior descending artery(LAD) stenosis, 4 middle LAD stenosis, 1 middle right coronary artery(RCA) stenosis and 2 proximal left circumflex artery(LCX) stenosis. Group A was composed of 7 patients with angina and coronary collateral circulation more than grade 1. Group B was 7 patients with angina and grade 0 collateral. 2) Mean age of group A was 62.4+/-8.2 years, 5 male and 2 female patients, That of group B was 56.6+/-8.9 years and all male patients. Group A was composed of 7 patients ; 5 unstable and 2 stable angina ; 2 proximal LAD stenosis, 3 midddle LAD stenosis, 1 middle RCA stenosis and 1 proximal LCX stenosis. One patients had grade 1, two patients grade 2 and four patients grade 3 coronary collateral circulation. All of the patients were unstable angina in group B showing 5 proximal LAD stenosis, 1 middle RCA stenosis and 1 proximal LCX stenosis. No collateral circulation was demonstrated in group B. 3) In group A, DVR was 17.5+/-13.9% on stress image before PTCA and 7.1+/-1.4% on the ballooning image during PTCA. DVR was smaller in ballooning image than in stress image(p<0.01). 4) In group B, DVR was 12.4+/-16.0% on stress image before PTCA and 26.6+/-10.0% on ballooning image during PTCA. DVR was larger in ballooning image than in stress image(p<0.001). 5) DVR on stress image and open image were not different in both groups, but DVR on ballooning image were 7.1+/-4.7% in group A and 26.6+/-10.0% in group B, which was larger than in group A(p<0.01). CONCLUSION: These results suggest that myocardial perfusion defect area may be smaller in angina patients with good collateral circulation than patients with no collateral, and coronary collateral circulation have a protective role on the jeopardized myocardium during coronary artery occlusion.
Angina Pectoris* ; Angina, Stable ; Angina, Unstable ; Arteries ; Collateral Circulation* ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Vessels ; Dipyridamole ; Female ; Humans ; Male ; Myocardium ; Perfusion*

BACKGROUND: Idiopathic left ventricular tachycardia (ILVT), one of common idiopathic ventricular tachycardias which develop without structural abnormality of the heart. It has been reported that ILVT has a typical QRS morphology of right bundle branch block and left axis and unique clinical and electrophysiological characteristics. Intravenous verapamil is shown to be very effective in acute termination. However, radio-frequency catheter ablation is now recommended as the treatment of choice for long-term managemnt. This study was performed to determine the clinical and electrophysiological characteristics of ILVT and to evaluate the effects of radiofrequency catheter ablation (RFCA) of ILVT. METHODS: Seventeen patients (12 men, 5 women:mean age : 39+/-15 years) with ILVT were included in this study. ILVT was diagnosed based on the results of electrocardiogram, echocardiogram, cardiac catheterization, and electrophysiology study (EPS). EPS was performed with the standard technique in fasting state for more than 6 hours. In patients with their clinical VTs reproducibly induced during EPS, RFCA was attempted using endocardial activation mapping and pace-mapping. The mode of induction and termination, response to verapamil, and site of origin of the ILVT were evaluated. The local electrogram chacteristics at the sites of successful catheter ablation were also evaluated in patients undergoing RFCA. RESULTS: All 17 patients presented with recurrent palpitation but none with syncope or sudden cardiac death. None had a significant heart disease. The spontaneous ventricular tachycardias were of right bundle branch block morphology with left superior axis in 11 cases, right inferior axis in 1, and northwest axis in 5. The VTs were terminated with intravenous verapamil in all of 14 patients receiving IV verapamil. VT of same morphology as the clinical VT was induced with programmed electrical stimulation in 13 cases (76.4%), of whom 2 cases required isoproterenol infusion. The most frequent mode of induction was single ventricular extrastimulation (7 cases). Mean cycle length of the induced VTs was 320+/-59 ms. RFCA was attempted in 11 cases and successful in 9 (82%). The successful ablation sites were and central mid septum (3 cases), posterior mid septum (3 cases), posterior apical septum (3 patients) of the left ventricle (3 patients). At the successful ablation sites, the local ventricular activation preceded the onset of QRS complex by 34+/-15 ms (range : 10-58) and the paced QRS complexes during pace-mapping were identical to those of the induced or spontaneous VTs in 11.7+/-0.4 leads (range : 11-12). However, Purkinje potential was recorded only in 2 cases. There were no complications associated with EPS and RFCA. CONCLUSIONS: The present study suggests that ILVT is mild in symptoms, highly sensitive to verapamil, mostly caused by reentry, and can be cured by radiofrequency catheter ablation guided by pace-mapping and activation mapping.
Axis, Cervical Vertebra ; Bundle-Branch Block ; Cardiac Catheterization ; Cardiac Catheters ; Catheter Ablation* ; Catheters* ; Death, Sudden, Cardiac ; Electric Stimulation ; Electrocardiography ; Electrophysiology ; Fasting ; Heart ; Heart Diseases ; Heart Ventricles ; Humans ; Isoproterenol ; Male ; Syncope ; Tachycardia, Ventricular* ; Verapamil

BACKGROUND: Idiopathic left ventricular tachycardia (ILVT), one of common idiopathic ventricular tachycardias which develop without structural abnormality of the heart. It has been reported that ILVT has a typical QRS morphology of right bundle branch block and left axis and unique clinical and electrophysiological characteristics. Intravenous verapamil is shown to be very effective in acute termination. However, radio-frequency catheter ablation is now recommended as the treatment of choice for long-term managemnt. This study was performed to determine the clinical and electrophysiological characteristics of ILVT and to evaluate the effects of radiofrequency catheter ablation (RFCA) of ILVT. METHODS: Seventeen patients (12 men, 5 women:mean age : 39+/-15 years) with ILVT were included in this study. ILVT was diagnosed based on the results of electrocardiogram, echocardiogram, cardiac catheterization, and electrophysiology study (EPS). EPS was performed with the standard technique in fasting state for more than 6 hours. In patients with their clinical VTs reproducibly induced during EPS, RFCA was attempted using endocardial activation mapping and pace-mapping. The mode of induction and termination, response to verapamil, and site of origin of the ILVT were evaluated. The local electrogram chacteristics at the sites of successful catheter ablation were also evaluated in patients undergoing RFCA. RESULTS: All 17 patients presented with recurrent palpitation but none with syncope or sudden cardiac death. None had a significant heart disease. The spontaneous ventricular tachycardias were of right bundle branch block morphology with left superior axis in 11 cases, right inferior axis in 1, and northwest axis in 5. The VTs were terminated with intravenous verapamil in all of 14 patients receiving IV verapamil. VT of same morphology as the clinical VT was induced with programmed electrical stimulation in 13 cases (76.4%), of whom 2 cases required isoproterenol infusion. The most frequent mode of induction was single ventricular extrastimulation (7 cases). Mean cycle length of the induced VTs was 320+/-59 ms. RFCA was attempted in 11 cases and successful in 9 (82%). The successful ablation sites were and central mid septum (3 cases), posterior mid septum (3 cases), posterior apical septum (3 patients) of the left ventricle (3 patients). At the successful ablation sites, the local ventricular activation preceded the onset of QRS complex by 34+/-15 ms (range : 10-58) and the paced QRS complexes during pace-mapping were identical to those of the induced or spontaneous VTs in 11.7+/-0.4 leads (range : 11-12). However, Purkinje potential was recorded only in 2 cases. There were no complications associated with EPS and RFCA. CONCLUSIONS: The present study suggests that ILVT is mild in symptoms, highly sensitive to verapamil, mostly caused by reentry, and can be cured by radiofrequency catheter ablation guided by pace-mapping and activation mapping.
Axis, Cervical Vertebra ; Bundle-Branch Block ; Cardiac Catheterization ; Cardiac Catheters ; Catheter Ablation* ; Catheters* ; Death, Sudden, Cardiac ; Electric Stimulation ; Electrocardiography ; Electrophysiology ; Fasting ; Heart ; Heart Diseases ; Heart Ventricles ; Humans ; Isoproterenol ; Male ; Syncope ; Tachycardia, Ventricular* ; Verapamil

PURPOSE: To report the clinical results after the implantation of intrastromal corneal ring segments (Intacs(R)) by manual tunnel creation for the correction of keratoconus. METHODS: This retrospective case series was comprised of 10 eyes of 8 consecutive keratoconic patients. Visual acuity, refractive outcome, keratometric values, anterior chamber depth, central corneal thickness, and endothelial cell density were evaluated before and at 1 month, 3 months, and 6 months postoperatively. In addition, the implanted ring segment depth was measured by anterior segment optical coherence tomography at postoperative 6 months. Any postoperative complications were also recorded. RESULTS: Visual acuity was improved in 9 out of 10 eyes. Spherical equivalent and keratometric values were decreased in all eyes. There was no significant difference in central corneal thickness, but endothelial cell density and anterior chamber depth were slightly decreased. The depth of ring segments was almost constant at superior, middle, and inferior. There was a single case of descented implanted ring segments and 6 cases of stromal infiltration around ring segments, but visual acuity was unaffected. In addition, 1 case showed implanted ring exposure, thus the superior ring segment was removed at postoperative 4 months. CONCLUSIONS: Intrastromal corneal ring segment implantation (Intacs(R)) by manual tunnel creation appears to be effective in improving the visual acuity and stabilizing corneal refractive power in keratoconic patients.
Anterior Chamber ; Endothelial Cells ; Eye ; Humans ; Keratoconus ; Postoperative Complications ; Retrospective Studies ; Tomography, Optical Coherence ; Visual Acuity

Traumatic subarachnoid hemorrhage (tSAH) can be almost immediately fatal. However, sudden death due to tSAH caused by delayed aneurysmal rupture is very rare sequela of mild head trauma. We experienced a death case of a 47-year-old woman who had subarachnoid hemorrhage and intraventricular hemorrhage 3 days after head trauma. Delayed death after any kinds of trauma is important to forensic and legal aspects. Herein we report a case of fatal subarachnoid hemorrhage caused by delayed rupture of traumatic aneurysm.
Aneurysm ; Craniocerebral Trauma ; Death, Sudden ; Female ; Head ; Hemorrhage ; Humans ; Jurisprudence ; Middle Aged ; Rupture ; Subarachnoid Hemorrhage ; Subarachnoid Hemorrhage, Traumatic

The overall data associated with the causes and the manners of death of individuals are necessary to make policies for the public health or judicial system in the society. To obtain basic data of the causes and the manners of death, the 206 autopsy cases performed at the Department of Forensic Medicine of Chonnam National University Medical School in 2007 and 2008 were statistically analyzed according to the cause of death and the manner of death. The results are as follows ; 1. The total number of forensic-legal autopsy was 206 (139 males and 67 females). The number of the 5th decade (58 cases) and the 6th decade (54 cases) occupied over 50 percent (54.4%) of total cases. 2. Unnatural deaths were 127 cases (61.7%), and natural deaths were 79 cases (38.3%). Of 127 cases of unnatural deaths, suicides were 33 cases (26.0%), homicides were 46 cases (36.2%), accidental deaths were 37 cases (29.1%), and undetermined deaths were 11 cases (8.7%). 3. Among 79 natural deaths, deaths of cardiac origin were 46 cases (58.2%) and it was a leading cause of death in natural deaths. Deaths due to disease of vascular system were 10 cases (12.7%), deaths due to respiratory system were 8 cases (10.1%), deaths due to digestive system were 6 cases (7.6%), and other causes were 10 cases (12.4%). 4. Child deaths under the age of 10 were 8 cases (3.9%). Three cases were homicide, 3 cases were accident, and 2 cases were natural deaths.
Autopsy ; Cause of Death ; Child ; Digestive System ; Forensic Medicine ; Homicide ; Humans ; Korea ; Male ; Public Health ; Respiratory System ; Schools, Medical ; Suicide

BACKGROUND: The Postmortem examination certificate and death certificate prove deaths of human and supply important data used to establish health statistics. However, not only the format of the form itself, but the accuracy of postmortem examination certificate and death certificate has errors which needs further study such as comparing with the postmortem study such as autopsy. METHODS: We reviewed 206 autopsies which were performed in the Department of Forensic Medicine of Chonnam National University Medical School from January 1, 2007 to December 31, 2008 and compared with their postmortem examination certificates and death certificates for analysis. RESULTS: Of the 174 cases submitted with death certifications, total 67 cases accorded with cause of death on the autopsy report. Eighty six cases had clear descriptions of cause of death. Of those 86 cases, 46 were from postmortem examination, 40 were from death certificates and 23 were natural deaths, 63 were unnatural deaths. Each of them, the accordant rates were 63.0% (29 cases/46cases), 77.5% (31 cases/40 cases), 43.5% (10 cases/23 cases), and 79.4% (50 cases/63 cases). From these results, we found various erroneous types in postmortem examination certificates and death certificates. CONCLUSIONS: This study brings into realization there is a high rate of discrepancy between causes of death on the death certificates and postmortem examination certificates. And also, there are a few useful death certificate and postmortem examination certificate. Therefore, we want to propose several remedies to increase the accuracy of death certificate and postmortem death certificate.
Autopsy ; Cause of Death ; Certification ; Death Certificates ; Forensic Medicine ; Humans ; Schools, Medical