We report cases of two patients with acute generalized exanthematous pustulosis(AGEP). One patient had localized cutaneous infection and the other rhinoplasty. Both were being treated with ampicillin and developed intense erythemas followed by generalized subcorneal pustulation associated with fever and a neutrophilic leukocytosis. Histopathological findings were subcorneal spongiform pustules showing preponderance of polymorphonuclear leukocytes. Generalized pustular psoriasis, subcorneal pustular dermatosis, impetigo and pemphigus foliaceus should be differentiated from AGEP. The causative drug in both of our cases was ampicillin and fast resolution of pustules was observed with a low dosage of systemic steroid within 5 days.
Acute Generalized Exanthematous Pustulosis* ; Ampicillin* ; Erythema ; Fever ; Humans ; Impetigo ; Leukocytosis ; Neutrophils ; Pemphigus ; Psoriasis ; Rhinoplasty ; Skin Diseases, Vesiculobullous

Failure of a glaucoma filtering operation mainly results from scarring at the filtering wound, and postoperative proliferation and migration of fibroblasts play an important role histologically in the formation of scar tissue. As an inhibitory agent for fibroblast proliferation, gamma-interferon has been introduced, and the application of gamma-interferon following filtering surgery is now being made on a trial basis. We studied the effect of gamma-interferon histologically on the fibroblast proliferation and collagen synthesis occurring at the filtering site by comparing the effect of gamma-interferon on the experimental group with that of 5-fluorouracil on the control group, using 10 rabbits (20 eyes) after posterior lip sclerectomy. Both groups showed similar flat and diffused bleb grossly and also showed a similar inhibitory effect on fibroblast proliferation and collagen fiber synthesis histologically. Our findings seem to justify the clinical use of gamma-interferon. Further studies on adequate dosage, method of administration, and local and systemic complications would be desired.
Animals ; Anterior Chamber/drug effects ; Cell Division/drug effects ; Collagen/*biosynthesis ; Fibroblasts/drug effects ; Fluorouracil/pharmacology ; Glaucoma/pathology/*surgery ; Interferon-gamma/*pharmacology ; Rabbits ; Sclera/pathology ; *Sclerostomy

BACKGROUND: Epidural anesthesia became most popular for a cesarean section, but it is more time consuming and involves a higher incidence of insufficient or superficial blockade, especially of the motor root, despite large doses of local anesthesia. Combined spinal epidural anesthesia has gained an increasing interest as it combines the reliability of the spinal block and the flexibility of an epidural block. A dural puncture using the combined spinal epidural technique making an early sacral blockade might be a solution to disadvantages in epidural anesthesia. We investigated the efficacy of combined spinal epidural anesthesia and epidural anesthesia with prior dural puncture for a cesarean section. METHODS: Sixty pregnant women at full term were divided into three groups. Group I (EPI, n = 20) received epidural anesthesia with 100 mg of 0.5% bupivacaine. Group II (CSE, n = 20) received combined spinal epidural anesthesia with 1.2 1.4 ml of 0.5% hyperbaric bupivacaine intrathecally, followed by sensory block at T10 after by 7 8 ml of 0.5% bupivacaine through the epidural catheter. Group III (DP, n = 20) received epidural anesthesia with prior dural puncture. A dural puncture with a 27 G whitacre needle was done before an infusion of 20 ml of 0.5% bupivacaine through the epidural catheter. The quality and side effects of surgical anesthesia were compared between the three groups. RESULTS: Time to T10 (P< 0.001) and surgical onset time (P< 0.001) were significantly shorter in the CSE group. Maximal sensory block level (P< 0.001) was significantly higher in the CSE group. Muscle relaxation (P< 0.05) and motor block (P< 0.001) were much better in the CSE group. Hypotension occurred in 25% (EPI group), 40% (CSE group) and 20% (DP group) of the patients. While 65% of the EPI group and 50% of the DP group complained of intraoperative pain, only 25% of CSE group did (P< 0.05). CONCLUSIONS: We can conclude that combined spinal epidural anesthesia has great efficacy and less side effects for a cesarean section than epidural anesthesia and epidural anesthesia with prior dural pucture.
Anesthesia ; Anesthesia, Epidural ; Anesthesia, Local ; Anesthetics ; Bupivacaine ; Catheters ; Cesarean Section* ; Female ; Humans ; Hypotension ; Incidence ; Muscle Relaxation ; Needles ; Pliability ; Pregnancy ; Pregnant Women ; Punctures*

Drowning is the second most common cause of accidental death of children in Korea. But the study of near-drowning is very rare in Korea. The purpose of our study is to determine the factors that may influence survival on the basis of submersion time, consciousness state upon admission to hospital, the kinds of water, laboratory findings and neurological outcomes. The survey was performed by a retrospective cohort study on 28 near drowning victims of less than 15 years of age who were admitted to the emergency room in the Chosun University Hospital between May 1988 & May 1997. The results were as follows 1) Sex distribution was 22 males and 6 females. 2) Submersion time was (5 minutes in 9 cases, 5-9 minutes in 6 cases,10-14 minutes in 5 cases,15-19 minutes in 3 cases, > or =20 minutes in 5 cases. 3) Comatose patients upon arrival were 6/7 cases in the death group(86%) and 2/21 cases in the improved group(10%). they had unfavorable outcomes(P<0.05). 4) The first pH value was mean 7.02)0.12 in the death group and mean 7.31 +/-0.13 in the improved group. there was a statistically significant difference between the death and the improved group(P<0.05). 5) The patients who had increased blood glucose concentration were all 7 cases in the death group and 12/22 cases in the improved group(54%). The mean blood glucose concentration was mean 424.7235.6mg/dl in the death group and mean 140.182.7mg/dl in the improved group. There was a statistically significant difference between the death and the improved group(P<0.05). 6) The patients who had pulmonary edema upon arrival were all 7 cases in the death group and 1/21 cases in the improved group(18%). They had unfavorable outcomes(P<0.05). 7) The patients who had been submerged more than 15 minutes were all 7 cases in the death group and 6/21 cases in the improved group(5%). They had unfavorable outcomes(P<0.05). We conclude that pediatric victims of near-drowning can be assigned to high or low likelihoods of unfavorable outcomes with the use of five variables, comatose mentation upon arrival, decreased initial blood pH, increased initial blood glucose concentration, pulmonary edema, and maximum submersion time estimated longer than fifteen minutes. This prediction rule may be useful if it can be validated in another cohort.
Blood Glucose ; Child* ; Cohort Studies ; Coma ; Consciousness ; Drowning ; Emergency Service, Hospital ; Female ; Humans ; Hydrogen-Ion Concentration ; Immersion ; Korea ; Male ; Near Drowning ; Pulmonary Edema ; Retrospective Studies ; Sex Distribution

We report a recently encountered case of angioleiomyoma in oropharynx. The patient was a 26-year-old woman. The main symptoms were feeling of narrowing down of the pharynx and difficulty in breathing in the left supine position. Laryngoscopy revealed a 3.5cm-sized, spherical mass with a smooth surface, originating in the right oropharyngeal wall. The tumor was successfully removed using suspension microlaryngoscopy under general anesthesia. Histopathologically, it was well circumscribed and composed of proliferating smooth muscle fibers and dilated blood vessels. The tumor is a benign nature and recurrence is rare. Complete removal is the treatment of choice with care taken to avoid profuse bleeding.
Adult ; Anesthesia, General ; Angiomyoma* ; Blood Vessels ; Female ; Hemorrhage ; Humans ; Laryngoscopy ; Muscle, Smooth ; Oropharynx ; Pharynx ; Recurrence ; Respiration ; Supine Position

Self-induced pneumoparotitis is a rare cause of swelling of the parotid gland. It has been reported to be a result of psychosomatic disorder, unintentional habit, and it is sometimes self-induced by patients to achieve secondary gain. We report a case of a 18-year-old man who had a self-induced pneumoparotitis complicated by recurrent parotitis, subcutaneous emphysema and pneumomediastinum. With repeated behavior of insufflation, parotid acini may rupture and air may extend into the retropharyngeal space, causing pneumomediastinum or pneumothorax. In self-induced cases, treatment should necessitate psychologic therapy for behavior modification.
Adolescent ; Behavior Therapy ; Humans ; Insufflation ; Mediastinal Emphysema ; Parotid Gland ; Parotitis ; Pneumothorax ; Psychophysiologic Disorders ; Rupture ; Subcutaneous Emphysema

BACKGROUND AND OBJECTIVES: It has generally been accepted that closed reduction is the management of nasal fracture in children. But proper management is still confusing and clinical and radiological evaluation about long term results have yet to be determined. The purpose of this study is to determine which closed reduction method for nasal bone fractures in children is effective when considering clinical and radiological aspects. MATERIALS AND METHOD: We analysed the medical records of 35 children with nasal bone fractures up to the age of 15, who were operated by closed reduction between 2000 and 2002. We evaluated postoperative satisfaction of doctors and patients and postoperative CT scan score (Motomura et al 2001) of 14 children over more than at least 2 postoperative years. RESULTS: A peak incidence ages ranged from 13 to 15 years. The most frequent cause was sports injuries. The degree of postoperative satisfaction and postoperative CT scan score was favorable. CONCLUSION: In management of nasal fracture in children, closed reduction is effective and satisfactory when clinical and radiological aspects are considered.
Athletic Injuries ; Child* ; Humans ; Incidence ; Medical Records ; Nasal Bone* ; Tomography, X-Ray Computed

BACKGROUND: Amorolfine is a new topical antifungal drug of the morpholine class has broad spectrum fungicidal activity. Amorolfine nail lacquer 5% is a transungual delivery system which can penetrate well through the nail plate to the infected keratin and remain there for a prolonged period. OBJECTIVE: The aim of this study is to assess the efficacy and tolerability of 5% amorolfine nail lacquer given once weekly to the patients with onychomycosis. METHODS: 29 patients with onychomycosis affecting not more than 80% of the surface of nail were treated once weekly for up to 9 months with amorolfine nail lacquer 5%. Clinical and mycological examination were performed before treatment and 3, 6, 9 months after start of treatment. Final evaluation was done 3 months after the end of treatment. RESULTS: Average affected area(%) and average score of clinical signs-thickening, splitting, discoloration-were significantly decreased 3 months after start of treatment. Mycological cure rate was continuously increased according to the treatment duration reaching 75.9% at 3 months after treatment. Overall efficacy assessed by the investgators were cure in 31.0% and improvement in 41.4%. Tolerability, mode and frequency of treatment, and formulation were evaluated as good or excellent by most of the patients.No systemic or local side effect was observed. CONCLUSION: Amorolfine nail lacquer 5% used once weekly up to 9 months was relatively effective and safe for the treatment of onychomycosis.
Fingers* ; Humans ; Lacquer* ; Onychomycosis* ; Toes*

BACKGROUND AND OBJECTIVES: Although an anterior linear ablation is an effective lesion set in radiofrequency catheter ablation (RFCA) for longstanding persistent atrial fibrillation (L-PeAF), its durability for bidirectional block (BDB) is only about 60% at repeat procedure. We hypothesized that changes in electrocardiogram (ECG) may predict an anterior line block state and the clinical outcome of L-PeAF ablation. SUBJECTS AND METHODS: We studied 304 L-PeAF patients (77% male, 60±10yrs), who consistently underwent RFCA Dallas lesion set (circumferential pulmonary vein isolation, posterior box lesion, and anterior line) protocol with subsequent comparison of pre-procedural and post-procedural P wave axes, and one year follow-up (n=205) sinus rhythm (SR) ECGs. RESULTS: 1. P wave axis shifted inferiorly at immediate post-procedure (p<0.001), and was independently correlated with BDB of anterior line (β=10.4, 95% confidence interval [CI] 2.79-17.94, p=0.008). 2. The degree of post-procedural inferior shift of P wave axis did not reflect clinical recurrence within one-year (n=205, p=0.923), potentially due to conduction recovery of an anterior line. However, among 160 patients without clinical recurrence within one-year, P wave axis at one-year ECG was independently associated with very late recurrence of AF after one-year (n=160, hazard ratio [HR] 0.98; 95% CI 0.97-0.99, p=0.001), during 45.6±16.7 months of follow-up. 3. Among 22 patients who underwent repeat procedures, P wave axis shift was more significant in patients with maintained BDB of an anterior line than in those without (p=0.015). CONCLUSION: An inferior shift of P wave axis reflects the achievement and the maintenance of an anterior line BDB, and is associated with better long-term clinical outcome after catheter ablation for L-PeAF based on Dallas lesion set.
Atrial Fibrillation* ; Catheter Ablation* ; Catheters* ; Electrocardiography ; Follow-Up Studies ; Humans ; Male ; Pulmonary Veins ; Recurrence

BACKGROUND AND OBJECTIVES: Contusions and lacerations of the auricle are common, but reconstructive procedures are difficult because the auricle has an intricate cartilage framework covered with delicate skin. The purpose of this study was to present therapeutic principles of traumatized auricular laceration. SUBJECTS AND METHOD: The study was performed retrospectively and included 35 traumatized auricular laceration patients. Their wound state, degree of laceration, whether or not had exposure of cartilage, methods of reconstruction used and postoperative complications were analyzed. RESULTS: Multiple laceration was found in 11 patients. Eight of 19 patients who had cartilage exposed had been performed cartilage suture method for alignment. Primary reconstruction was performed for two avulsed subtotal injury patients. Pocket principle technique was used for one patient whose auricle was contaminated and amputated. Postoperative complications were noted as paresthesia, color change, delayed healing, deformity and partial loss of auricle. CONCLUSION: Rapid and active management of traumatized auricular lacerations is important to prevent infection and postoperative complications.
Cartilage ; Congenital Abnormalities ; Contusions ; Ear, External ; Humans ; Lacerations* ; Paresthesia ; Postoperative Complications ; Retrospective Studies ; Skin ; Sutures ; Wounds and Injuries