We observed a case of tuberculosis cutis orificialis, which occurred in 50 year-old man. He had been suffered from single markedly inflamed, erythematous painful ulcer, covered by dirty brown pseudomembranous material, around anus for 3 months. The laboratory findings (CBC, routine urinalysis, stool ova and parasite with occult blood) are within normal limits except elevated ESR (52mm/hr.). Staphyloeoccus aureus and proteus are observed on wound culture, and many AFB are seen on scrapings of wound but not on sputum for 3 times. Unfortunately culture was not done. Tuberculin skin test revealed strong reaction (36mm/hr.). Chest PA and small bowel series showed far advanced pulmonary tuberculosis and intestinal tuberculosis on ileocecal area. But the findings of upper gastro-intestinal series and barium enema are within normal limits. Histopathologic findings of skin lesion showed tuberculous and tuberculoid granuloma in the deep dermis and subcutaneous tissue. We observed a case of tuberculosis cutis orificialis, which occurred in 50 year-old man. He had been suffered from single markedly inflamed, erythematoas painful ulcer, covered by dirty brown pseudomembranous material, around anus for 3 months. The laboratory findings (CBC, routine urinalysis, stool ova and parasite with occult blood) are within normal limits except elevated ESR (52mm/hr.). Staphyloeoccus aureus and proteus are'observed on wound culture, and many AFB are seen on scrapings of wound but not on sputum for 3 times. Unfortunately culture was not done. Tuberculin skin test revealed strong reaction (36mm/hr.). Chest PA and small bowel series showed far advanced pulmonary tuberculosis and intestinal tuberculosis on ileocecal area. But the findings of upper gastro-intestinal series and barium enema are within normal limits. Histopathologic findings of skin lesion showed tuberculous and tuberculoid granuloma in the deep dermis and subcutaneous tissue. Treatment with INH, myambutol and rifampin resulted in some improvment on the chest and considerable improvement on the skin and intestine within 6 months.
Anal Canal ; Barium ; Dermis ; Enema ; Ethambutol ; Granuloma ; Humans ; Intestines ; Middle Aged ; Ovum ; Parasites ; Proteus ; Rifampin ; Skin ; Skin Tests ; Sputum ; Subcutaneous Tissue ; Thorax ; Tuberculin ; Tuberculosis* ; Tuberculosis, Pulmonary ; Ulcer ; Urinalysis ; Wounds and Injuries

Pityriasis lichenoides chronica is characterized by unknown etiology, chronicity and by being essentially asymptomatic and refractory to therapy. Nine patients with pityriasis lichenoides chronica were treated with orally administrated 8-Methoxypsoralen and UVA irradiation(PUVA Therapy). After S-45 PUVA treatments, lesions were completely cleared.
Humans ; Methoxsalen ; Pityriasis Lichenoides* ; Pityriasis* ; PUVA Therapy*

Since the myofascial trigger point(MFTrP) has been described fifty years ago, its underlying pathophysiology has been remained unclear. The diagnosis also depends on the characteristic pain, tenderness and physical findin gs, which is yery subjective. In recent years, some physicians investigated the objective findings of MFTrP, using the pressure algometer and thermography. We investigated the electromyographic findings of MFTrP to evaluate the clinical usefulness of local twitch response(LTR) and sympathetic skin response (SSR), and to evaluate the electrophysiologic characteristics of MFTrP. 21 patients, diagnosed as myofascial trigger point syndrome on upper trapezius and so on, were evaluated for the triggering pain with visual analog scale(VAS), pressure threshold(THpr) using pressure algometer(Dolorimeter), LTP with concentric needle electrode and SSR on the palm. There was a significant negative correlation between VAS and THpr, but no significant correlation with electromyographic findings of LTR. Thus LTR could support the existence of MFTrP electrodiagnostically, but, could not explain the clinically correlated severity of MFTrP. There were only 3 patients showing abnormal SSR, who were all complaining the sympathetic sympathetic symptoms on the affected arm with reffered pain. Even though referred pain to arm and hand existed. SSR was normal because suggested autonomic dysfunction of MFTrP is localized mechanism. Among the 13 patients underwent the trigger point block, 8 patients who showed no residual LTR immediate after MFTrP block, had a great symptomatic improvement of MFTrP in a week, but 5 patients who showed the residual LTR did not, Regardless of complaint of pain and soreness immediate after block, loss of LTR would be predicted as a good treatment result. In some cases, spontaneous EMG activity exist within the 3-4mm sized focus of MFTrP. although the taut band of MFTrP is 3-4cm length and depth. But this focus of MFTrP is a electrophysiologic changes within a muscle, not a structural changes seen by ultrasonography.
Arm ; Diagnosis ; Electrodes ; Electromyography ; Hand ; Humans ; Needles ; Pain, Referred ; Skin ; Superficial Back Muscles ; Thermography ; Trigger Points* ; Ultrasonography

Streptococcus anginosus is a member of Streptococcus milleri group, and is found in the oral mucosa, respiratory tract, and gastrointestinal tract as normal flora. It can develop into a disease in patients with deteriorating clinical condition or with clinical risk factors. A previously healthy 15-year-old boy was admitted due to fever, abdominal discomfort and vomiting which lasted for 7 days. He had a history of dental procedure 1 day before the development of fever. He was diagnosed with acute acalculous cholecystitis based on the clinical, laboratory, and imaging finding, and S. anginosus was isolated from the blood culture. The patient was successfully treated with antibiotic therapy.
Acalculous Cholecystitis ; Adolescent ; Bacteremia ; Cholecystitis ; Fever ; Gastrointestinal Tract ; Humans ; Mouth Mucosa ; Respiratory System ; Risk Factors ; Streptococcus ; Streptococcus anginosus ; Streptococcus milleri Group ; Vomiting

We developed an animal model to recreate the condition of an open fracture in communication with the maxillary sinus. We then studied wound healing of the sinus wall structures following fracture in the presence of autogenous bone and alloplastic implant. This model is designed to simulate the repair of an orbital floor fracture in humans. The New Zealand White rabbit was used as the animal model. Standardized 8mm defects were made bilaterally in the maxillary sinuses to include bone and mucosa in 36 rabbits. Two different implants and autogenous calvarial bone graft were placed in the soft-tissue pockets to obturate the defects, exposing one surface of the implant to the open sinus. Medpor porous polyethylene, silicone and calvarial bone implant were compared. Animals were killed at 1, 2 and 8 weeks after implantation. Gross examination of the specimens for the amount of mucosal closure and implant tissue fixation was performed. Histological sections were evaluated for bone and soft-tissue morphology juxtaposed to the implant. Complete closure of the mucosal defect was demonstrated with each type of implant. Medpor implants showed both vascular and soft-tissue ingrowth into pores by week 1. Bone ingrowth was seen by week 2. Closure of the Medpor obturated defects occurred more rapidly than in the silicone group. The Medpor implants and calvarial bone demonstrated bone and soft-tissue fixation, callus formation and maturation, while mature overlying mucosa was reconstituted over the defects. Silicone implants demonstrated a fibrous tissue reaction within 1 week of implantation and they never became fixed to bone or soft tissue. Maxillary sinus wall regeneration occurred in all defects. This study supports clinical observations of maxillary sinus wall regeneration in humans.
Animals ; Bony Callus ; Fractures, Open ; Humans ; Maxillary Sinus ; Models, Animal ; Mucous Membrane ; New Zealand ; Orbit ; Polyethylene ; Rabbits ; Regeneration ; Silicones ; Tissue Fixation ; Transplants ; Wound Healing

This study includes 19 cases of complicated low extremity injury to whom underwent microvascular free-tissue transfer in cases of open comminuted fracture, osteomyelitis, and vascular compromise or extensive soft tissue defect from Nov. 1994 to July 1997. The average time after injury to coverage was 25 days. The nineteen patients underwent a total of nineteen free tissue transfers primarily, and eighteen (94.7 per cent) of the transfers survived. Major complications were encountered recurrent failure of the free tissue transfer in one patient and partial necrosis in the other flap, which were successfully treated by flow-through radial forearm free flap and distally based superficial sural artery flap respectively. Two patients were sustained below knee amputation, one above knee amputation, despite of survival of flaps. This reveals limb salvage in 84 percent. The microvascular reconstruction is a versatile and reliable methods in complicated cases after severe trauma. Free tissue transplantation should be considered as a primary treatment in such complicated cases.
Amputation ; Arteries ; Extremities ; Forearm ; Fractures, Comminuted ; Free Tissue Flaps ; Humans ; Knee ; Limb Salvage ; Lower Extremity* ; Necrosis ; Osteomyelitis ; Tissue Transplantation ; Transplants

No abstract available.

No abstract available.
Diarrhea* ; Follow-Up Studies* ; Milk Hypersensitivity* ; Milk*

No abstract available.
Humans ; Infant* ; Zinc*

A case of transient neonatal diabetes mellitus combined with congenital adrenal hyperplasia(CAH) is described. A female infant was born by cesarean delivery due to fetal distress, she had sunken eyeball and anterior fontanelle, large protruded tongue and thin subcutaneous tissues. She had large clitoris and progressive pigmentation on whole body was observed since 10th day of birth. Hyperglycemia and glycosuria was noted at 3rd day of birth. Level of insulin and C-peptide was 3.0 mU/L and 0.35 ng/mL respectively. Serum ACTH was 870.4 pg/mL and 17-hydroxyprogesterone was increased to 20,000 ng/dL. Serum Na was 124 mEq/L, K 5.6 mEq/L. Abdominal MRI showed no abnormality. Chromosomal study showed 46,XX. Genetic analysis with polymorphic DNA markers for chromosome 6 showed paternal uniparental isodisomy at D6S276, D6S1704 and DNA analysis of CYP 21 gene showed mutation at P435S. She required insulin therapy for 8 months after birth. Hydrocortisone and florinef was needed for the control of CAH.
17-alpha-Hydroxyprogesterone ; Adrenal Hyperplasia, Congenital* ; Adrenocorticotropic Hormone ; C-Peptide ; Chromosomes, Human, Pair 6 ; Clitoris ; Cranial Fontanelles ; Diabetes Mellitus* ; DNA ; Female ; Fetal Distress ; Genetic Markers ; Glycosuria ; Humans ; Hydrocortisone ; Hyperglycemia ; Infant ; Insulin ; Magnetic Resonance Imaging ; Parturition ; Pigmentation ; Subcutaneous Tissue ; Tongue ; Uniparental Disomy