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

PURPOSE: This study was aimed to evaluate the value of electrophysiologic tests for determining prognosis in children with facial nerve palsy. METHODS: We retrospectively analyzed 37 children diagnosed as the facial nerve palsy at the pediatric neurology clinic, Kyungpook National University Hospital from January 1, 2000 to March 31, 2007. RESULTS: A total of thirty seven children were involved in the study(male to female 21:16, and the mean age 87.5 months). Among those twenty one had electrophysiologic tests. As compared with the normal values, the amplitude decreased by 54.5%(0.6+/-0.5 mV) and the latency was prolonged by 11.0%(3.6+/-0.5 msec) in electroneurography(ENoG). Early response(R1) was absent in 15 out of 21(71.4%) and ipsilateral response(R2) was absent in 19 children(90.5%). As compared with the children who had the decrease of amplitude 90% or less in ENoG, the children with the decrease of amplitude greater than 90% showed poor recovery(100% vs 60%, P<0.05) and longer duration of follow-up(43.7+/-30.0 days vs 184.00+/-196.8 days, P<0.05). All children who had R1 and R2 responses in the Blink test were completely recovered from the illness, but they were not statistically different from the other groups. CONCLUSION: Decrease of amplitude in ENoG and responsiveness in the Blink test can be important prognostic determinants in children with facial nerve palsy, but further studies are needed.
Child* ; Facial Nerve* ; Female ; Gyeongsangbuk-do ; Humans ; Neurology ; Paralysis* ; Prognosis ; Reference Values ; Retrospective Studies

BACKGROUND: We evaluated the changes in heart rate variability (HRV) in elderly patients with or without hypertension before and after combined spinal-epidural anesthesia (CSE). METHODS: Elderly hypertensive (group H, n = 28) and non-hypertensive patients (group C, n = 32) were recruited. We analyzed the spectral components of HRV, total power (< or = 0.4 Hz), low and high frequency power expressed as natural logarithm (LnTP, LnLF, and LnHF), normalized HF (HFnorm), normalized LF (LFnorm), and LF/HF ratio, from 5-minute electrocardiography recordings. We also measured blood pressures (systolic; SBP, diastolic; DBP, mean; MAP), heart rate (HR) and analgesia level before and after CSE. Each group was divided into two subgroups (< or = T7 [L] or > or = T6 [H]) according to fixed analgesia level. RESULTS: Before CSE, group H showed significantly lower LnLF than that of group C (P < 0.05). Fifteen and 10 min after CSE, decrease of SBP and increase of HR in group HH were significantly greater compared with group CL and lesser with group CH, respectively. LnTP, LnLF and LnHF in both control groups (CL and CH) were significantly decreased 15-20 min after CSE compared with pre-CSE values. LnLF and LnHF in group HH were significantly lower than those in group HL 10-15 min after CSE. But there were no significant changes of LFnorm, HFnorm and LF/HF in all four groups. CONCLUSIONS: The group H showed significantly lower LnLF than that of group C before CSE. In group HH, LnLF and LnHF were significantly lower than those in group HL 10-15 min after CSE, but the balance of the autonomic nervous system was not changed significantly.
Aged* ; Analgesia ; Anesthesia* ; Autonomic Nervous System ; Electrocardiography ; Heart Rate* ; Heart* ; Humans ; Hypertension

Recurrent or a second attack of acute poststreptococcal glomerulonephritis have been known to be extremely rare. Acute exacerbation in chronic glomerulonephritis and recurrence of acute poststeptococcal glomerulonephritis would be distinguishable clearly by histopathological, immuno-fluorescent and electron microscopic studies from renal biopsy material. Recently we dealt with two cases of a second attack of APSGN in a 9 year old girl and a 12 year old boy and reviewed the literature and the possible mechanism is discussed.
Biopsy ; Child ; Female ; Glomerulonephritis ; Humans ; Male ; Recurrence

PURPOSE: Refractory status epilepticus(RSE) is a serious neurological emergency in children. The mortality is high and the neurological outcome is not good. This study aimed to evaluate the clinical significance of cerebrospinal fluid(CSF) pleocytosis in refractory status epilepticus in children. METHODS: From January 1999 to January 2006, 25 out of 37 children with refractory status epilepticus had spinal tapping. We retrospectively analyzed the data from these children's medical records. We compared the results between groups with and without CSF pleocytosis, and between a group with first seizure and a group with epilepsy . RESULT: Six out of 25 children had CSF pleocytosis. The group without CSF pleocytosis had a higher mortality rate and required higher doses of antiepileptic drugs as compared with the group with CSF pleocytosis. The group with CSF pleocytosis had much worse neurologic segualae. However, except for the children with CNS infection, the overall prognosis between the group with and without CSF pleocytosis was not significantly different. All children with CSF pleocytosis came in with first seizures. CONCLUSION: In children with RSE, a CSF study must be perfomed as soon as possible to exclude the possibility of CNS infection. A CSF study is even more important in cases of first seizure or CNS infection suspected. Mild CSF pleocytosis without evidence of infection does not seem to affect the prognosis, so physicians should therefore be more cautious in selecting antibacterial or antiviral agents for it.
Anticonvulsants ; Antiviral Agents ; Cerebrospinal Fluid* ; Child ; Emergencies ; Epilepsy ; Humans ; Leukocytosis* ; Medical Records ; Mortality ; Prognosis ; Retrospective Studies ; Seizures ; Spinal Puncture ; Status Epilepticus*

A case-control study was conducted to investigate the association between the risk of cancer and selenium concentration in blood and toenails. Seventy three patients and two hundreds eighty three controls were selected at the Yeungnam University Hospital between May and September in 1991. The selected cases were patients who had been hospitalized for stomach or colon cancer at the Department of General Surgery. The controls were people who visited to check physical examination at the Automated Mediscreening Center. The selenium concentration in whole blood and toenails were measured by atomic absorption spectrophotometer equipped with graphite furnace atomizer. The following information was ascertained for all cancer patients and controls: sex, age, body mass index, blood pressure, total serum cholesterol, and history of smoking and drinking. The mean selenium concentration in blood and toenail for all cancer patients were 143.6±10.8 µg/l and 1.04±0.62 µg/g and for the controls. 167.0±14.5 µg/l and 1.15±0.55 µg/g, respectively. The difference in blood and toenail selenium concentrations of the two cancer sites was not statistically significant. Metastasis did not influence the concentration of selenium in blood and toenails. In the multiple logistic regression analysis, the blood selenium concentration (aOR: 0.888, 95% CI: 0.860-0.918), age, BMI and total serum cholesterol were significant variables for risk of cancer, but the selenium concentration in toenail was not shown to be a significant variable in this regression analysis. The coefficient for blood selenium concentration adjusted for age, sex, diastolic blood pressure, total serum cholesterol, body mass index and smoking was -0.1184 (p<0.01). These findings suggest that low selenium concentration is associated with gastrointestinal cancers. Further epidemiologic studies including important variables such as other antioxidant micronutrients will be necessary.
Absorption ; Blood Pressure ; Body Mass Index ; Case-Control Studies ; Cholesterol ; Colonic Neoplasms ; Drinking ; Epidemiologic Studies ; Gastrointestinal Neoplasms ; Graphite ; Humans ; Logistic Models ; Micronutrients ; Nails* ; Nebulizers and Vaporizers ; Neoplasm Metastasis ; Physical Examination ; Selenium* ; Smoke ; Smoking ; Stomach

Free vascularized tissue transfer to preserve upper extremity amputation level is uncommon but very useful procedure. To cover the below-elbow amputee stump and restore the function of the elbow, we have used a free flap as a spare part concept from the contralateral hand which was so severely damaged that amputation was inevitable.
Amputation ; Amputees* ; Elbow* ; Forearm* ; Free Tissue Flaps ; Hand ; Humans ; Upper Extremity

PURPOSE: This study was performed to determined by follow-up observation, the result of the arthroscopic treatment for advanced degenerative arthritis of the knee joint. MATERIALS AND METHODS: During the period from January 1991 to December 1995, 270 cases had been followed for more than one year after arthroscopic treatment for degenerative arthritis of the knee joint. There were 66 males and 204 females of average age 61 years. On the Kellgren and Lawrence radiological grading system, follow-up radiography was conducted after the treatment in those cases Grade III before the treatment. A clinical assessment was performed pain, range of motion and the Hospital for Special Surgery (HSS) knee score before and after operation, and the Baumgaertner scale was used for the 2 and 48 month follow-up after operation. Recurrence was considered to have occurred when conditions were the same as before treatment. RESULTS: According to the Baumgaertner scale, clinical assessment showed overall rates of excellent and good in 191 cases (70.8%) at 2 month post-operatively, and 157 cases (58.1%) at 48 month post-operatively. Comparing the radiologic results before and after treatment using Baumgaertner's scale. the radiologically lower grade was the better result And a degenerative symptom was aggravated an average of 3.8 years. CONCLUSION: This study shows that the arthroscopic treatment is an effective option if used during the early stage of degenerative arthritis of the knee joint.
Female ; Follow-Up Studies ; Humans ; Joints* ; Knee Joint ; Knee* ; Male ; Osteoarthritis ; Radiography ; Range of Motion, Articular ; Recurrence

BACKGROUND: Etomidate is a rapid acting sedative agent used for the induction of general anesthesia. One of the side effects of etomidate limiting its usage is myoclonus. This study was designed to determine whether a small dose of midazolam decreases the incidence of myoclonus after infusion of etomidate. METHODS: Eighty ASA physical status 1 or 2, 16-60 year old patients undergoing elective surgery were randomly allocated into two groups. Group 1 (n = 40) received normal saline 0.04 ml/kg and group 2 (n = 40) received midazolam 0.04 mg/kg 3 minutes before the administration of etomidate 0.3 mg/kg. We measured and compared the incidence, severity, onset time and duration of myoclonus, and blood pressure and heart rate. RESULTS: There were significant differences in the onset time and severity of myoclonus, but no significant differences in the incidence and duration of myoclonus. Systolic blood pressure was significantly higher in group 1 than group 2 at 3 minutes after pretreatment drug administration, immediatly after etomidate administration and 3 minutes after etomidate administration. CONCLUSIONS: An infusion of 0.04 mg/kg midazolam 3 minutes before etomidate decreases the severity of myoclonus and the onset of myoclonus.
Anesthesia, General ; Blood Pressure ; Etomidate* ; Heart Rate ; Humans ; Incidence ; Midazolam* ; Myoclonus*

For many years, interest in cardiac function has primarily centered around the systolic pump performance of the left ventricle. it is now recognized, however, that diastolic abnormalities may be just as important in the pathophysiology of certain cardiac disease states. To examine the left ventricular abnormalities (especially diastolic events) in hypertension, diastolic and systolic time intervals were measured from simultaneous high-speed recordings of a phonocardiogram, ECGs, apexcardiogram, echocardiogram and external carotid pulse in 35 hypertensive patients and were compared with those in 15 normal subjects. The hypertensive patients showed significantly prolonged preejection period (PEP) and shortened ejection time (ET), compared to those in normal control subjects (p<0.005, p<0.05 respectively). The PEP/ET ratio too was different from the control subjects in hypertensive patients (0.335+/-0.050 vs 0.422+/-0.666; p<0.005). The isovolumic relaxation time (IVRT) was increased to 81.3+/-15.0 msec, which was significantly longer (p<0.005) than in normal subjects (56.7+/-10.7 msec), in patients with hypertension. The active filling period (AFP) was also prolonged. In patients with hypertension there was no significant difference in rapid filling period and slow filling period compared with those in normal subjects. It is likely that in hypertensive patients the alterations of diastolic time intervals, reflecting disorders in elasticity and compliance, may occur in conjunction with abnormal systolic events.
Compliance ; Elasticity ; Electrocardiography ; Heart Diseases ; Heart Ventricles ; Humans ; Hypertension ; Relaxation ; Systole*