A 12-year-old girl presented with a 1-week duration of hair loss associated with splitting of the hair ends and whitish dots on the occipital hairs. On microscopic examination, a longitudinal splitting of the hair shaft with reconstitution of the normal hair distal to the fracture, nodular swellings, with the appearance of broomsticks pushed into one another, at the site of whitish swellings, and the flattening and twisting of the hair shaft around the long axis were demonstrated. Minor trauma to injury-prone hair is a common cause of hair shaft defects, however the reports with the combined conditions are insufficient in the literature. We describe a patient with central trichoptilosis associated with localized trichorrhexis nodosa and pili torti.
Axis, Cervical Vertebra ; Child ; Female ; Hair ; Humans

Two typical cases of epithelioid sarcoma were examined by immunohistochemical stain using antibodies to epithelial membrane antigen, carcinoembryonic antigen, vimentin and cytokeratin. Both cases showed positive reactivity for the four kinds of antibodies. These results point to the fact that epithelioid sarcoma simultaneously expresses epithelial markers and characteristic mesenchymal phenotypes. Epithelioid sarcoma appears to be a tumor derived from a multipotential mesenchymal cell with multidirectional differentiation.
Antibodies ; Carcinoembryonic Antigen ; Keratins ; Mucin-1 ; Phenotype ; Sarcoma* ; Vimentin

BACKGROUND: The safety of ergonovine provocation for coronary vasospasm (CVS) performed outside the catheterization laboratory has been questioned. We sought to address the issues of safety, feasibility and clinical impact of noninvasive diagnosis of CVS. METHOD AND RESULTS: We retrospectively analyzed the results of bedside ergonovine provocation testing with monitoring of left ventricular regional wall motion abnormalities (RWMAs) by 2-dimensional echocardiography (ergonovine echocardiography, Erg Echo). After confirmation of no significant fixed epicardial coronary artery disease, 1,504 Erg Echo were performed in 1,372 patients from July 1991 to December 1997. Erg Echo was prematurely terminated in 13 patients (0.9%) due to limiting side effects unrelated with myocardial ischemia. Among 1,491 completed tests, 32% (477) showed positive results with development of RWMAs in 467 tests (98%) or ST displacement in ECG in 10 tests (2%). During the test, transient arrhythmias developed in 1.7% (26/1491) including transient ventricular tachycardia (2) and atrioventricular block (4), which were promptly reversed with nitroglycerin. There were no procedure-related death or development of myocardial infarction. On the basis of angiographic criteria in 218 patients, who also underwent invasive spasm provocation test during coronary angiography, the sensitivity and specificity of Erg Echo for the diagnosis of CVS were 93% and 91% respectively. From 1990 to 1997, total 2,073 spasm provocation tests were performed either during invasive coronary angiography in the catheterization or in the echocardiography laboratory. Since 1994, noninvasive Erg Echo became a more popular diagnostic method and comprised more than 95% of all spasm provocation tests in recent 3 years. Erg Echo was also performed safely in outpatient clinic setting without hospital admission in 34% (500/1491). CONCLUSIONS: Erg Echo is highly feasible, accurate and safe for diagnosis of CVS and can replace the invasive spasm provocation test during coronary angiography in the catheterization laboratory.
Ambulatory Care Facilities ; Arrhythmias, Cardiac ; Atrioventricular Block ; Catheterization ; Catheters ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vasospasm* ; Diagnosis* ; Echocardiography ; Echocardiography, Stress* ; Electrocardiography ; Ergonovine* ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Nitroglycerin ; Retrospective Studies ; Sensitivity and Specificity ; Spasm ; Tachycardia, Ventricular

BACKGROUND: The safety of ergonovine provocation for coronary vasospasm (CVS) performed outside the catheterization laboratory has been questioned. We sought to address the issues of safety, feasibility and clinical impact of noninvasive diagnosis of CVS. METHOD AND RESULTS: We retrospectively analyzed the results of bedside ergonovine provocation testing with monitoring of left ventricular regional wall motion abnormalities (RWMAs) by 2-dimensional echocardiography (ergonovine echocardiography, Erg Echo). After confirmation of no significant fixed epicardial coronary artery disease, 1,504 Erg Echo were performed in 1,372 patients from July 1991 to December 1997. Erg Echo was prematurely terminated in 13 patients (0.9%) due to limiting side effects unrelated with myocardial ischemia. Among 1,491 completed tests, 32% (477) showed positive results with development of RWMAs in 467 tests (98%) or ST displacement in ECG in 10 tests (2%). During the test, transient arrhythmias developed in 1.7% (26/1491) including transient ventricular tachycardia (2) and atrioventricular block (4), which were promptly reversed with nitroglycerin. There were no procedure-related death or development of myocardial infarction. On the basis of angiographic criteria in 218 patients, who also underwent invasive spasm provocation test during coronary angiography, the sensitivity and specificity of Erg Echo for the diagnosis of CVS were 93% and 91% respectively. From 1990 to 1997, total 2,073 spasm provocation tests were performed either during invasive coronary angiography in the catheterization or in the echocardiography laboratory. Since 1994, noninvasive Erg Echo became a more popular diagnostic method and comprised more than 95% of all spasm provocation tests in recent 3 years. Erg Echo was also performed safely in outpatient clinic setting without hospital admission in 34% (500/1491). CONCLUSIONS: Erg Echo is highly feasible, accurate and safe for diagnosis of CVS and can replace the invasive spasm provocation test during coronary angiography in the catheterization laboratory.
Ambulatory Care Facilities ; Arrhythmias, Cardiac ; Atrioventricular Block ; Catheterization ; Catheters ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vasospasm* ; Diagnosis* ; Echocardiography ; Echocardiography, Stress* ; Electrocardiography ; Ergonovine* ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Nitroglycerin ; Retrospective Studies ; Sensitivity and Specificity ; Spasm ; Tachycardia, Ventricular

Intracranial vasculitis is a rare and disastrous complication of tuberculous meningitis if not treated properly. Focal neurologic deficits according to the vessels involved are common manifestation. Here, we report a 29-year-old man who suffered abrupt, bizarre behavioral changes caused by vasculitis complicating tuberculous meningoencephalitis. The diagnosis of tuberculous meningitis is based upon both the CSF findings and a chest X-ray. His systemic symptoms disappeared by after being administered antituberculous medication but various psychotic features such as hypersomnia, hyperphagia and aggressivebehavior continued. A brain MRI showed multiple small parenchymal tuberculous nodules, and the brain MR angiography revealed a narrowing of the proimal middle cerebral arteries and a reduced visualization of the cerebral vessels, suggesting widespread vasculitis. Intravenous dexamethasone successfully ameliorated his behavioral changes. In addition both the follow up brain MRI and angiography showed a normalization of the previous findings.
Adult ; Angiography ; Brain ; Dexamethasone ; Diagnosis ; Disorders of Excessive Somnolence ; Follow-Up Studies ; Humans ; Hyperphagia ; Magnetic Resonance Imaging ; Meningoencephalitis* ; Middle Cerebral Artery ; Neurologic Manifestations ; Thorax ; Tuberculosis ; Tuberculosis, Meningeal ; Vasculitis

No abstract available.
Ebstein Anomaly*

Skin atrophy is one of the most common side effects of topical steroid use and results from decreased skin proalphaI collagen mRNA production due to specific alterations in collagen gene transcription or from reduced collagen mRNA stability. This report describes a case of a 8 year-old-girl who visited our hospital with a complaint of ambiguous genitalia. She was observed to have atrophic labia majora and atrophic striae resembling scrotal rugae. However, her serum levels of FSH, LH, 17-KS, 17-OHCS, 5-DHT, DHT and DHEA-S were all in normal range and her karyotype was 46,XX. Abdominal and pelvic ultrasonogram showed a normal uterus and ovaries. Careful history taking revealed frequent use of steroid ointment due to vulvar pruritus for 2 years and she was finally diagnosed to have atrophy of external genitalia induced by long-term use of topical steroid.
Atrophy* ; Collagen ; Disorders of Sex Development ; Female ; Genitalia* ; Karyotype ; Ovary ; Pruritus ; Reference Values ; RNA Stability ; RNA, Messenger ; Skin ; Ultrasonography ; Uterus

Condyloma acuminatum is a common viral disease which is transmitted by sexual intercourse. We experienced a case of condyloma acuminatum occurring in a patient of systemic lupus erythematosus who has been treated with various immunosuppressive agents for 10 years. This condylorna acuminatum was unusual in that it was very rapidly growing, recurrent and reluctant to various treatrnents. We investigated the type of human papillomavirus by Southern blot hybridization and schieved partial improvement by bleomycin intralesional injection together with 5-FU topical application.
Bleomycin ; Blotting, Southern ; Coitus ; Fluorouracil ; Humans ; Immunosuppressive Agents ; Injections, Intralesional ; Lupus Erythematosus, Systemic ; Virus Diseases

We found an error in this article. The Fig. 2B should be corrected.

BACKGROUND: The optimal management of malignant obstruction of the left colon and rectum is controversial. METHODS: A retrospective study was performed of 33 patients who underwent one-stage operation(n=11), staged operation(n=20), and palliative colostomy(n=2) at Kwangju Christian Hospital between January 1992 and December 1996. RESULTS: Eleven patients underwent one-stage operations(7 cases with anterior resection, 3 cases with left hemicolectomy, 1 case with Miles' operation). In this group, postoperative morbidity was 36.3% including 1 wound infection(9.0%), 1 anastomotic leakage (9.0%), 1 postoperative intestinal obstruction and 1 pulmonary complication, but there was no postoperative death. The average of hospital stay in this group was 18.1 days and the first day of normal diet was 6.0 days. Twenty patients underwent staged operations including 12 cases of Hartmann's procedure. In this group, postoperative morbidity was 35.0% including 3 wound infections(15.0%), 2 pulmonary complications(10.0%), 1 parastomal hernia and 1 fistula. There were two postoperative deaths as a result of sepsis. The average of hospital stay in this group was 34.9 days and the first day of normal diet was 6.8 days. CONCLUSION: We believe that one-stage operation was of value in management of malignant obstruction of the left colon and rectum in selected patients.
Anastomotic Leak ; Colon* ; Diet ; Fistula ; Gwangju ; Hernia ; Humans ; Intestinal Obstruction ; Length of Stay ; Rectum* ; Retrospective Studies ; Sepsis ; Wounds and Injuries