OBJECTIVES: The purpose of this study was to assess the clinical features, microbiologic results, and the efficacy of perineal hygienic care of pediatric vulvovaginitis. METHODS: Forty-two unselected premenarcheal patients with symptoms or signs of vulvovaginitis who were attended the outpatient pediatric and adolescent gynecology clinic at Pundang CHA General Hospital from August 1997, to September 1999 were systematically interviewed and examined using a standardized format, studied microbiologically, and followed the efficacy of perineal hygienic measures prospectively. RESULTS: The median age of the patients was 4.8 years (range 2.9 years to 10.9 years). Vaginal complaints of 42 patients were discharge(79%), genital pain or irritation(31%), odor(17%), pruritus(14%), and vaginal bleeding(7%). On physical examination, vaginal discharge and vulvar erythema were noted in 17(40%) and 22(52%) patients, respectively. Aerobic bacteria or yeast excluding vaginal normal flora were found in 24 of 42 patients(57%). Convincing evidence of specific pathogens was found in 9 of 42 patients(21%) including one case of pinworm infestation. Isolated pathogens were H. influenza(3), S. pyogenes(2), K. pneumonia(2) and N. gonorrhea(1). No patients were found to have chlamydial infection or trichomoniasis. In 14 patients, risk factors were identified such as swimming(14%), bubble bath(5%), sexual abuse(5%), genital trauma(5%) and foreign body(2%). After two weeks instructions of perineal hygienic care, 26(62%) of 42 patients revealed complete resolution of symptoms and signs of vaginitis without antibiotics. Efficacies of perineal hygienic care were 94%(17/18) in the patients with normal flora alone, 60%(9/15) in the patients with organisms suspected for nonspecific infection and 0%(0/9) in the patients with specific pathogens(p<0.05). CONCLUSION: Majority(62%) of the pediatric patients with symptoms or signs of vulvovaginitis were cured with perineal hygienic care alone. And the efficacy of hygienic measure were higher in the patients without specific pathogens(79%, 26/33). Therefore, proper physical examination, microbiologic study and appropriate instructions of perineal hygienic care were more important than empirical antibiotic treatment in initial management of pediatric vulvovaginitis.
Adolescent ; Anti-Bacterial Agents ; Bacteria, Aerobic ; Enterobius ; Erythema ; Gynecology ; Hospitals, General ; Humans ; Outpatients ; Physical Examination ; Prospective Studies ; Risk Factors ; Vaginal Discharge ; Vaginitis ; Vulvovaginitis* ; Yeasts

We report a case of acantholytic dyskeratotic epidermal nevus in a 28-year-old female. The patient showed unilateral, asymptomatic, grouped, 2 mm sized, brownish, follicular ant non-follicular, keratotic papules disposed along Blaschko´s lines on the right side of th back, flank and abdomen. She had had this condition for 4 years. The biopsy specimen obtaine, from the abdomen showed hyperkeratosis, parakeratosis, acanthosis, acantholytic suprabasal clefts, corps ronds, and grains. Although cryotherapy with liquid nitrogen was per formed on half of the lesions, the whole skin lesions healed with focal hypertrophic scars 4 weeks later. There was no recurrence after a 12 months follow-up period. To our knowledge this is the first reported case of acantholytic dyskeratotic epidermal nevus in Korean dermatologi, literature.
Abdomen ; Adult ; Ants ; Biopsy ; Cicatrix, Hypertrophic ; Cryotherapy ; Darier Disease* ; Female ; Follow-Up Studies ; Humans ; Nitrogen ; Parakeratosis ; Recurrence ; Skin

The first myelography with air was carried out by Walter Dandy in 1919, and the myelography with positive contrast medium was done by Sicard and Forestier in 1922. Since Pantopaque was adopted as a contrast material by University of Rochester group in 1944, it has been rapidly popularized. Although higher diagnostic accuracy has been made with a development of the diagnostic aids such as electromyography, discography, epidural venography and computerized tomography, myelography has been popularized in our country with electromyography. The authars have seen and studied 107 cases of herniated lumbar disc with respect to the diagnostic accuracy of myelographic examination from January, 1976 to December, 1981 at the department of Orthopedic Surgery, Yonsei University College of Medicine. The results were as follows: l. Of the 107 cases, 59 were found in the age of 20 to 40 years and the ratio of male and female was 2:l. 2. Fifty eight cases (54.2%) had no history of back injury, but 40 cases (37.4%) had sprain of the back and 9 cases had direct trauma history. 3. In all cases, plain X-ray and myelogram were taken. Among them 55 cases showed narrowing of intervertebral space in plain film, and 100 cases showed positive myelographic findings such as lateral indentation of dural sac (41 cases), hour-glass defect (30 cases), root sleeve defect (12 cases), block defect (10 cases) and combined defects (7 cases). 4. Sixty one cases which confirmed by operation, the most frequent level of disc herniation was in L4-5 space. Clinical diagnosis was correct in 57.4%, and myelographic accuracy was coincided with operative finding in 80.3%. 5. Twelve (19.7%) of the 61 cases showed discrepancy between myelographic and operative findings, and these 12 cases consisted of 5 cases of level discrepancy, 3 cases of false positive and 4 cases of false negative.
Back Injuries ; Clinical Study ; Diagnosis ; Electromyography ; Female ; Humans ; Iophendylate ; Male ; Myelography ; Orthopedics ; Phlebography ; Sprains and Strains

Although myocardial bridge is not thought to have any hemodynamic significance in most cases, some have suggested that when it produces severe systolic narrowing, ischemia or infarction may result. Myocardial bridge in adults with hypertrophic cardiomyopathy may be associated with a higher incidence of sudden death, myocardial wall-motion abnormalities, and perfusion defects on thallium-201 scintigraphy. When myocardial bridge is associated with left ventricular hypertrophy, it is known to affect longer segment and cause more severe compression during systole. We report a case of hypertrophic cardiomyopathy with myocardial bridge at the middle part of the left anterior descending coronary artery, who also showed reversible perfusion defect on the thallium scan at the same coronary territory.
Adult ; Cardiomyopathy, Hypertrophic* ; Coronary Vessels ; Death, Sudden ; Hemodynamics ; Humans ; Hypertrophy, Left Ventricular ; Incidence ; Infarction ; Ischemia ; Perfusion ; Radionuclide Imaging ; Systole ; Thallium

No abstract available.
Humans

During colonoscopy, air insufflation to distend the lumen and facilitate careful inspection and scope insertion can induce pain and cause discomfort. Carbon dioxide (CO₂) insufflation can decrease abdominal pain and discomfort during and after colonoscopy. The advantage of CO₂ insufflation is the rapid absorption of the gas across the intestine. Another painless option is water-assisted colonoscopy. Two methods for water-assisted colonoscopy are available: water immersion and water exchange. In a recent direct comparison, the water exchange method was superior to water immersion, CO₂ insufflation, and air insufflation with respect to pain during colonoscopy, although it still had the disadvantage of being a time-consuming procedure. Cap-assisted colonoscopy is a simple technique involving the use of a small transparent cap attached to the tip of the scope. Three studies showed an advantage of this technique in terms of reduced patient discomfort compared with the conventional method. Three robotic colonoscopy systems (Endotics System [Era Endoscopy], NeoGuide [NeoGuide Systems Inc.], and Invendoscope [Invendo Medical]) have been introduced to evaluate pain reduction during colonoscopy, but none has been widely adopted and used in practice. In this review, clinical trials of several techniques and new devices for painless colonoscopy are described and summarized.
Abdominal Pain ; Absorption ; Carbon Dioxide ; Colonoscopy* ; Humans ; Immersion ; Insufflation ; Intestines ; Methods ; Water

No abstract available.
Aged* ; Colonoscopy* ; Humans

No abstract available.
Epidermal Cyst ; Pilomatrixoma

Multiple myeloma is characterized by the development of multiple tumors of bone that are multicentric in origin and composed of mature or immature plasma cells. It rarely can involve the eyeball, ocular adnexa and orbit in a variety of ways. When it dose occur, giving rise to proptosis and other signs of an orbital tumor. The authors experienced a case of multiple myeloma which involved the orbit and extraocular muscles associated with retinal hemorrhage and exudate.
Exophthalmos ; Exudates and Transudates ; Multiple Myeloma* ; Muscles ; Orbit* ; Plasma Cells ; Retinal Hemorrhage

BACKGROUND: Elevated plasma homocysteine concentrations are an independent risk factor for vascular disease. The metabolism of homocysteine is closely related to vitamin B12 and folic acid. The purpose of this study is to evaluate the correlation between homocysteine and vitamin B12 as well as folic acid in patients with coronary artery disease. METHODS: Sixteen patients, in whom coronary angiography revealed more than 50% of stenosis at least in one coronary vessel, were enrolled as the patient group, and sixteen hypertensive subjects were selected as the control group. Blood was collected in the peripheral vein to measure the concentrations of homocysteine, vitamin B12, and folate. We evaluated the correlation between homocysteine, vitamin B12 and/or folate in both groups. RESULTS: Total plasma homocysteine concentrations were higher in the coronary artery disease group than in the control group. There were no significant differences in the folate and vitamin B12 levels between the coronary artery disease group and the control group. In the control group, the concentrations of homocysteine showed negative correlation with both vitamin B12 and folate concentrations, but similar trends were not observed in the coronary artery disease group.
Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels ; Folic Acid* ; Homocysteine* ; Humans ; Metabolism ; Plasma* ; Risk Factors ; Vascular Diseases ; Veins ; Vitamin B 12*