Epidermodysplasia vertuciformis (E.V.) is a generalized viral infection due to the wart virus, which is chacterized by wartlike papules often distributed over the entire body and generally starting in infancy, of which a high percetage develops into cancer. We present a case of E.V. in a 31 year old male with typical skin lesions resembling flat warts and tinea versicolor-like lesions that eventuated in malignancy, i.e., Bowens disease and squamous cell carcinoma on the forehead. The skin lesions appeared initially on the foerhead at the age of 6 and gradualIy generalized all over the whole bcdy thereafter. The light brown scaling papules on erythernatous hase and walnut sized ulcerative lesion on the forehead had been noticed for 4 to 6 years and identified as Bowens disease and squamous cell carcinoma.
Adult ; Bowen's Disease* ; Carcinoma, Squamous Cell ; Epidermodysplasia Verruciformis* ; Forehead ; Humans ; Juglans ; Male ; Skin ; Tinea ; Ulcer ; Warts

BACKGROUND: To investigate the possibie difference, if any, between office blood pressure(BP) and home BP may be important in the diagnosis and treatment of hypersensive patients. This report deails the difference between the two BP's and the usefulness of digital electronic sphygmomanometer(DES) for self-monitoring of home BP. METHODS: The BP's of 14 patients with essential hypertension were measured with mercury sphygmomanometers at outpatient department by physician and with DES at home(twice a day) by the patients. Patients were followed up every 2 weeks for 4 weeks and previous 2 weeks' average home BP's were compared with the office BP's of each 2 weeks' end. RESULTS: There was a significant difference between office and home BP(both systolic and diastolic) ; office average BP(151/95mmHg) was higher than home average BP(136/86mmHg). CONCLUSION: Caution may be needed in the interpretation of office BP unless it is measured several times after adequate rest.
Blood Pressure* ; Diagnosis ; Humans ; Hypertension ; Outpatients ; Sphygmomanometers*

The lack of sufficient oral mucosa available for intra-oral reconstruction has been dealt with by the use of skin or oral mucosa grafts harvested from donor sites but grafts requires more than one surgical procedures and could cause donor site morbidity. Many investigators have attempted to increase available soft tissue by tissue engineered skin or oral mucosa replacements for clinical applications. But, reconstructed mucosa by several methods have low physical properties such as rolling and contraction. The aims of this study were to develope an in vitro experimental model that maintains an epithelial-mesenchymal interaction by organotypic raft culture, and to characterize biologic properties of three-dimensionally cultured oral mucosa embedded with Polydioxanone mesh by histological and immunohistochemical analysis. The results were as follows; 1. Oral mucosa reconstructed by three-dimensional organotypic culture revealed similar morphologic characteristics to equvalent normal oral mucosa in the point that they show stratification and differentiation. 2. The expression of cytokeratin 10/13 and involucrin in the cultured tissue showed the same pattern with normal oral mucosa suggesting that organotypic co-culture condition is able to induce cellular differentiation. 3. After insertion of polydioxanone mesh, increased tensile strength were observed. These results suggest that three-dimensional organotypic co-culture of the oral mucosa cell lines with the dermal equvalent consisting type I collagen and fibroblasts reproduce the morphologic and immunohistochemical characteristics similar to those in vivo condition. And increased physical properties by use of polydioxanone mesh will helpful for clinical applications.
Cell Line ; Coculture Techniques ; Collagen Type I ; Fibroblasts ; Humans ; Keratins ; Models, Theoretical ; Mouth Mucosa* ; Mucous Membrane ; Polydioxanone* ; Research Personnel ; Skin ; Tensile Strength ; Tissue Donors ; Transplants

Since the first report by Berberich and Hirsch in 1923, conventional angiography had been playing essential roles in diagnosis and treatment in the field of Orthopedic Surgery. Angiography is still the most definitive method for evaluating arterial disease, and is also an invaluable aid in the diagnosis of certain abnormalities which characteristically alter the normal vascular pattern. But the clinical use of conventional angiography as a routine diagnostic study has been limited by the risk associated with arterial catheterization cost, and poor patient acceptance. With improvement of radionuclide angiography and development of the methods for the identification and amplification of signals from small quantities of intravascular administered iodinated contrast agent and their combination with image subtraction (so called digital subtraction angiography, DSA), we have partially substituted the DSA and Radionuclide angiography for conventional angiography in diagnosis and post-operative evaluation of orthopedic patients. We have analyzed and compared the 197 cases who had taken conventional angiography from August, 1981 to July, 1985, and 16 cases who had taken radionuclide angiography from January, 1983 to July, 1985, and 21 cases who had taken DSA from October, 1983 to July, 1985 in Department of Orthopedic Surgery, Seoul National University Hospital. The results were as follow: 1. Conventional angiography is the most reliable and most widely used method in diagnosis of peri pheral arterial disease and evaluating the distribution of peripheral circulation of patient who need arterial reconstruction. But the clinical use of the angiography has been limited by the risk of complications. 2. DSA is simple, relatively non-invasive and can be done in out-patient basis. DSA is particulary useful and can replace the conventional angiography in post-operative assessment of peripheral vascular reconstruction, in the assessment of blunt and penetrating peripheral arterial trauma, and in the evaluation of peripheral aneurysm and vascular malformation. 3. Radionuclide angiography is also simple, and has no morbidity and useful in the patients who may be allergic to the contrast medium. Radionuclide angiography is useful in the evaluation of obstruction of major artery, deep vein thrombosis, and in repeated post-operative evaluation of arterial reconstruction.
Aneurysm ; Angiography ; Angiography, Digital Subtraction ; Arteries ; Catheterization ; Catheters ; Diagnosis ; Extremities ; Humans ; Methods ; Orthopedics ; Outpatients ; Radionuclide Angiography ; Seoul ; Vascular Malformations ; Venous Thrombosis

Twenty nine cases of wrist tuberculosis were reviewed(19 joint involvement cases and 4 tendon involvement cases) and twenty three cases were followed up more than one and half years. The mean follow up period was 26.7 months. Synovectomies were not satisfactory in cases of joint involvement and they were useful only in cases of tendon involvement. Arthrodesises were used for 16 cases of joint involvement and were satisfactory in 87,5 percent by Robin's criteria. Finger stiffness was most serious complication(initially, 8.7 percent and finally, 34.8 percent) and it is suggested that early motion of fingers after arthrodesis can prevent this complication.
Arthrodesis ; Fingers ; Follow-Up Studies ; Joints ; Tendons ; Tuberculosis ; Wrist

The use of steroids has long been reported many side effects. Steroid-induced mental disorder is one of many complications associated with corticosteroid therapy. Steroid psychosis is not common disease but it may be more popular due to high steroid therapy such as pulse therapy or high dose steroid therapy. Euphoria, irritability, insomnia, and hallucination are predominating symptoms. The dosage, duration of the treatment may not be correlated with the time of the onset, duration, severity, or type of mental disturbances, but the risk of developing psychosis is increased to the high dose of steroid. It is usually reversible on dose reduction or discontinuation of the drug.
Euphoria ; Hallucinations ; Mental Disorders ; Psychotic Disorders* ; Sleep Initiation and Maintenance Disorders ; Steroids

The taxonomy of Acanthamoeba spp., an amphizoic amoeba which causes granulomatous amoebic encephalitis and chronic amoebic keratitis, has been revised many times. The taxonomic validity of some species has yet to be assessed. In this paper, we analyzed the morphological characteristics, nuclear 18s rDNA and mitochondrial 16s rDNA sequences and the Mt DNA RFLP of the type strains of four Acanthamoeba species, which had been previously designated as A. divionensis, A. parasidionensis, A. mauritaniensis, and A. rhysodes. The four isolates revealed characteristic group II morphology. They exhibited 18S rDNA sequence differences of 0.2-1.1% with each other, but more than 2% difference from the other compared reference strains. Four isolates formed a different clade from that of A. castellanii Castellani and the other strains in morphological group II on the phylogenetic tree. In light of these results, A. paradivionensis, A. divionensis, and A. mauritaniensis should be regarded as synonyms for A. rhysodes.
Acanthamoeba/*classification/*genetics ; Animals ; DNA, Mitochondrial/genetics ; DNA, Ribosomal/genetics ; Phylogeny ; Polymorphism, Restriction Fragment Length ; RNA, Ribosomal, 18S/genetics

Liver has a dual blood supply from portal vein and hepatic artery. Hepatocellular carcinoma receive their blood supply almost exclusively from hepatic artery. Thus, the concept of treating hepatocellular carcinoma by chemoembolization through these arteries is very effective. However, there may be several collateral or parasitic vessels feeding them in case of huge tumor or previous chemoembolization. We experierced a case of huge tumor involving right upper posterior portion of liver fed by 9th, 10th, 11th right posterior intercostal arteries and an anomalous hepatic artery. We tried chemoembolization with Adriamycin-Lipiodol suspension and Gelfoam material through the right posterior intercostal arteries to treat the lesion. After the procedure, the patient(55 years old female) became paraplegic with voiding and defecation difficulty which could be due to spinal cord infarction .by anterior spinal arteri. al occlusion caused by embolic material through the artery of Adamkiewicz from a posterior intercostal artery. She recovered completely after 20 days of treatment.
Arteries* ; Carcinoma, Hepatocellular ; Defecation ; Gelatin Sponge, Absorbable ; Hepatic Artery ; Infarction ; Liver ; Portal Vein ; Spinal Cord Injuries* ; Spinal Cord*

BACKGROUND: Gastric cancer that occurs 5 or more years after a partial gastric resection for benign disease is defined as gastric remnant cancer. The purpose of this study was to examine the clinicopathologic features and the treatment results of sixteen cases of gastric remnant cancer following partial gastrectomies for benign gastroduodenal diseases. METHODS: Sixteen patients who underwent operations for gastric cancer in the remnant stomach from January 1980 to December 1996 were evaluated retrospectively. RESULTS: The mean age was 51.5 years, and 15 patients were male. All of them had undergone surgical treatment for benign disorders, including gastric ulcers (14 cases) and duodenal ulcers (2 cases), and the mean time interval between the primary operation and the diagnosis of gastric cancer was 24.5 years. Most patients presented vague, nonspecific symptoms, except two cases of early diagnosis without symptom. Surgical resection of the remnant stomach was performed in 13 patients of which 11 patients underwent a curative resection with curative intent. Of these 13 patients, a combined resection of adjacent organs was performed in 10 cases. Fifteen patients had advanced gastric cancer, most of which involved depth of invasions to seromuscular layers, and lymph-node metastases were found in 8 patients. Most of patients who underwent bypass surgery or palliative resection died within 1 year of the operation. Among the 11 patients who underwent a curative resection, 3 patients died within 1 month of the operation due to postoperative complications, 2 patients died of recurrent cancer, and another 6 patients are alive without evidence of recurrence. CONCLUSIONS: Eearly detection of gastric cancer in the remnant stomach by periodic follow up is important, especially in high-risk groups, and the application of aggressive surgical treatment will provide for better patient survival.
Diagnosis ; Duodenal Ulcer ; Early Diagnosis ; Gastrectomy* ; Gastric Stump* ; Humans ; Male ; Neoplasm Metastasis ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Stomach Neoplasms ; Stomach Ulcer

PURPOSE: To evaluate the efficacy of percutaneous transhepatic choledochoplasty of the main biliary stricture, using a 16F silastic foley catheter, in patients suffering from recurrent pyogenic cholangitis MATERIALS AND METHODS: In nine patients who had undergone stenting procedure at the site of the main stricture after the total removal of biliary stones, a 16F silastic catheter was held in position for 1-4 (mean, 2.7) months. Using ultrasonogrophy, we assessed the diameter of the bile duct 5 cm above the main stricture. RESULTS: During the follow-up period of 1-30 (mean, 18.1) months, the diameter of the bile duct above the main stricture was, in all cases, under 3 mm. CONCLUSION: In patients with recurrent pyogenic cholangitis, choledochoplasty of the biliary stricture, using a 16F silastic catheter, was therapeutically effective.
Bile Ducts ; Catheters* ; Cholangitis* ; Constriction, Pathologic* ; Follow-Up Studies ; Humans ; Stents