BACKGROUND: The APACHE scoring system of the Health Care Financing Administration (HCFA) has been being used for serious patients. The scoring system is composed of acute physiologic variables and chronic disease. METHODS: Among patients who underwent emergency operations from 1992 to 1997 because of gastrointestinal perforation, we analyzed 110 cases with five kinds of diseases: duodenal ulcer perforation, small bowel perforation, perforated appendicitis, gastric ulcer perforation and colon perforation. RESULTS: The results were as follows: 1) The preoperative APACHE II scores ranged from 0 to 21. The scores of 64 cases (60.9%) were from 0 to 5. 2) There were no death in case for which pre-peration APACHE II score was from 0 to 10, 25% of the mortality occurred in cases with scores from 11 to 15, 50% in those with scores from 16 to 20, and 100% in those with scores above 21. 3) The APACHE II score decreased continuously from the 3rd to the 7th postoperative day. 4) The preoperative APACHE II scores in gastric ulcer perforation patients were significantly higher than those in duodenal ulcer perforation patients. In the cases of gastric and duodenal ulcer perforations, the APACHE II scores in patients who underwent primary closure were higher than the scores in those who underwent a more definitive operation. 5) In death cases, all of their APACHE II scores were higher at the 3rd postoperative than at the 7th postoperative day, but their APACHE III scores continuously increased postoperatively. CONCLUSIONS: It is thought that the APACHE scoring system is more reliable than clinical experience in the classification of patients by operative risk and in estinating the result and giving a prognosis. Thus, the principle of treatment should be established by estinating patient's score before the operation. Careful preoperative management is necessary for patients with scores more than 10. Because patientswith scores more than 21 have very a high mortality, operative time and method must be carefully decided. The APACHE III scoring system seems to be more sensitive than the APACHE II scoring system in predicting deaths and further investigations and clinical applications should be performed.
APACHE* ; Appendicitis ; Centers for Medicare and Medicaid Services (U.S.) ; Chronic Disease ; Classification ; Colon ; Duodenal Ulcer ; Emergencies ; Humans ; Mortality ; Operative Time ; Prognosis ; Stomach Ulcer

Leiomyosarcoma is a malignant tumor showing smooth muscle differentiation, and it accounts for 2% to 8% of soft tissue sarcoma. Clinically, substantial mortality and morbidity are related to the propensity for distant metastasis and local recurrence, respectively. Microscopic findings characteristically reveal intersecting bundles of spindle-shaped cells having fibrillar cytoplasm and blunt-ended nuclei. Immunohistochemistry for intermediate filaments is helpful in establishing a definitive diagnosis. We experienced a case of large protruding leiomyosarcoma that developed on an old burn scar of the medial calf of a 45-year-old man. On preoperative evaluation, we recommended amputation due to a distant metastasis to the lung(stage IV). As the patient refused amputation of his lower leg, the tumor was radically excised and immediate reconstruction was done using free latissimus dorsi muscle flap and skin graft. Four months after excision despite adjuvant chemotherapy, amputation was performed due to local recurrence.
Amputation ; Burns ; Chemotherapy, Adjuvant ; Cicatrix ; Cytoplasm ; Diagnosis ; Humans ; Immunohistochemistry ; Intermediate Filaments ; Leg ; Leiomyosarcoma* ; Middle Aged ; Mortality ; Muscle, Smooth ; Neoplasm Metastasis ; Recurrence ; Sarcoma ; Skin ; Superficial Back Muscles ; Transplants ; Ulcer*

BACKGROUND: Hand-foot-mouth disease (HFMD) is mainly caused by the infection of coxsackievirus A16. But recently several epidemics of HFMD with meningitis or myocarditis due to enterovirus 71 have been reported in Southeast Asia. It was necessary that the possibility of enterovirus 71 epidemic in Korea should be ruled out. This study was designed for the determination of causative agents of HFMD in Cheju province in the spring of 1998. METHODS: Serum specimens were collected from 45 pediatric patients with HFMD at Cheju Hankook Hospital in March and April,1998. Virus isolation was performed with RD cell culture through up to three passages. Reverse transcription-PCR and nucleotide sequencing were performed by the method of Oberste et al.(J Clin Microbiol 1999;37:1288-93). The serotypes of viral isolates were determined by BLAST program of National Center for Biotechnology Information, U.S.A. RESULTS: Virus could be isolates from 4 patients, whose age was ranged from 11 months to 3 years. All of 4 viral isolates showed about 430-bp product of RT-PCR using primers 011 and 012. The serotype showing the highest similarity with the nucleotide sequences of all of these viral isolates was coxsackievirus A16. CONCLUSIONS: The causative enteroviral agent of HFMD in Cheju province in the spring of 1998 was coxsackievirus A16. We could not detect enterovirus 71 from the patients' sera in Cheju Province in the spring of 1998.
Asia, Southeastern ; Base Sequence ; Biotechnology ; Cell Culture Techniques ; Enterovirus ; Humans ; Jeju-do* ; Korea ; Meningitis ; Myocarditis ; Polymerase Chain Reaction

No abstract available.
Pregnancy*

No abstract available.
Orbit*

Free flaps have been widely used in lower leg reconstruction. However, in cases with extensive injury to the vessels as well as to the bone and soft tissues, and having only one intact major vessel in the lower leg(single vessel leg), careful selection of recipient vessels for the free flap transfer is mandatory for preventing further vascular compromise of the distal lower leg. The sural artery and its vena comitantes are frequently protected form externally harmful forces by the bulky surrounding gastrocnemius muscle and can be used as recipient vessles for free flaps without any detrimental influence on the vascularity of the distal lower leg. In our department, three latissimus dorsi muscle free flap were transferred with sural vessels as recipient vessels in the reconstruction of the single vessel legs. Except for one case of flap failure due to serious infection at the microvascular anastomoses site, all the other cases were successfully reconstructed without any necrosis of the gastrocnemius muscle or the distal leg. In addition, the sural vessels were easily accessed in any patient position and their caliber was similar to that of the vascular pedicles of the donor muscle flaps. In conclusion, the sural vessels can be another useful option in selecting recipient vessels for free flap transfer in the reconstruction of the single vessel leg.
Arteries ; Free Tissue Flaps* ; Humans ; Leg* ; Muscle, Skeletal ; Necrosis ; Superficial Back Muscles ; Tissue Donors

A 24-year-old woman was seen for evaluation of an skin lesion on thiright nipple. Examination revealed a solitary 1.5 x 1cm-sized, erythematous, oozing, eroded andruted, verrucous nodule on the right nipple. A small amount of serous discharge was found but there was no pain or tenderness. Histopathologic findings showed cystic invaginations extending down vard from the epidermis and papillary projections extending into the lumina of the invagination. Pupiae were lined by two rows of cells. In stroma, there were marked inflammatory infiltrates containing any plasma cells. The overlying dermis showed an adenomatous growth pattern with a prolifertion of round, oval or irregular shaped ducts and fibrotic stroma.
Adenoma* ; Cytochrome P-450 CYP1A1 ; Dermis ; Epidermis ; Female ; Humans ; Nipples* ; Plasma Cells ; Skin ; Young Adult

No abstract available.
Dermoid Cyst*

Chorea may be a manifestation of systemic lupus erythematosus or other types of diseases such as collagen vascular diseases, antiphospholipid syndrome, Huntingtonanjx disease, or a metabolic disease. Although SLE is a well known cause of chorea, chorea as an initial manifestation of SLE is rare. The pathogenesis is unclear, and for this reason, sev-eral pathophysiologic mechanisms are suggested. We report a 19-year-old girl who presented with chorea in the absence of clinically evident SLE and had positive antiphospholipid antibodies, a normal brain image study, and a good response to steroids.
Antibodies, Antiphospholipid ; Antiphospholipid Syndrome ; Brain ; Chorea* ; Collagen ; Female ; Humans ; Lupus Erythematosus, Systemic* ; Metabolic Diseases ; Steroids ; Vascular Diseases ; Young Adult

This study was undertaken to evaluate the status of human paragonimiasis in Kang Hwa Gun, Kyunggi Do, Korea from March 1973 to October 1975 by the use of intradermal screening test with Veronal buffered saline antigen. A total number of 7,352 (male 3,936; female 3,4l6) consisting of 3,447 primary school children, 2,689 middle school students, l,008 high school students of 9 Myuns out of 13 Myuns of this County and 208 residents of all age group in Kilgeong-Ri, Yangdo Myun were examined by the intradermal test with Paragonimus antigen. In order to detect Paragonimus egg, the sputum and the stool examinations were undertaken on the residents in Kilgeong-Ri. The infestation rate of crayfish with Paragonimus metacercaria was also examined in Konneung and Jeongha village in Kilgeong-Ri. The following results were obtained in this survey: As a whole, 16.6 per cent of the examiners showed positive reaction with sexual difference of 16.1% in male and 14.8 per cent in female. In age groups, the highest positive rate showed in middle school age group (17.1 per cent) than primary school (14.0 per cent) and high school age group (11.4 per cent). In regional differences of positive rates, the highest rate (28.4 per cent) showed at Yangdo Myun followed by Kilsang Myun (27.0 per cent), Hwado Myun (25.0 per cent), and Naega Myun(20.8 per cent). In the result of 208 residents Kilgeong-Ri, the positive of 36.1 per cent in male and 20.2 per cent in female. The highest positive rate showed in 10 to 19 age group (41.5 per cent). Among the residents in Kilgeong-Ri, Paragonimus eggs were detected in 11 residents by the sputum and the stool examinations. The infestation rate of crayfsh with Paragonimus metacercariae was 100 per cent (41 out of 41 crayfishes) in Konneung village, and 84.6 per cent (9 out of 13 crayfishes) in Jeongha village, Kilgeong-Ri The fluctuation of the infection rate of crayfish with Paragonimus metacercariae was decreased in Konneung village in 2 years after the treatment with Bilevon against 10 paragonimiasis patients.
parasitology-helminth-trematoda ; epidemiology-paragonimiasis ; Paragonimus westermani ; crayfish-Cambaroides similis