PURPOSE: Reconstruction of soft tissue defects with osteomyelitis in the lower third of the leg represents a challenge to plastic surgeons. Moreover, it is more arduous in multimorbid patients. One excellent option for reconstruction of these defects is to use a delayed distally based sural flap. METHODS: We successfully used delayed distally based sural flap with a two-step procedure. During the first operation, radical debridement and elevation of flap were performed. The raised flap was fixed again at the donor site. The delay period ranged from seven to ten days. Between August 2008 and July 2009, we underwent operations for five patients using this technique. The size of flap varied from 10 x 6 cm to 12 x 14 cm. RESULTS: All flaps successfully survived. Partial skin loss of the grafted site was seen in two patients but no further surgical procedure was required for wound healing. Complaints of hypoesthesia on the lateral part of the foot was observed. In a three month follow-up period, hypoesthesia was resolved spontaneously. CONCLUSION: Delayed procedure improves the viability of distally based sural flap in high risk, critically multimorbid patients. We recommend that, if a two-stage operative approach is required, the delayed procedure should be considered.
Debridement ; Follow-Up Studies ; Foot ; Humans ; Hypesthesia ; Leg ; Organic Chemicals ; Osteomyelitis ; Skin ; Tissue Donors ; Transplants ; Wound Healing

PURPOSE: We investigated the clinical presentation of febrile pediatric patients with acute pyelonephritis (APN) with a mixed urine culture from an aseptic urine sample, and compared with that of those with a single culture. METHODS: We retrospectively reviewed the medical charts of 95 patients diagnosed as APN with fever between January 2008 and October 2010 at Korea University Medical Center. We classified the patients with APN into two groups with a positive single culture (S group) and a positive mixed culture (M group) from an aseptic urine sample of suprapubic bladder aspiration or urethral catheterization and compared the fever duration, laboratory markers such as serum white blood cell (WBC) counts and C-reactive protein (CRP) values in peripheral blood, and the presence of hydronephrosis, renal scar and vesicoureteral reflux (VUR) between the two groups (If presence of hydronephrosis, scar and VUR=1 and no=0). RESULTS: Total pediatric patients with febrile APN were 95 patients, a positive S group was 89 patients and a positive M group was 6 patients. Fever duration (S vs. M, 4.7+/-3.1 vs. 6+/-5.7 days), serum WBC (S vs. M, 18,630+/-6,483 vs. 20,153+/-7,660/microL) and CRP (S vs. M, 100.6+/-2.46 vs. 81.1+/-0.09 mg/L) values, and the presence of hydronephrosis, renal scar and VUR were not different between the two groups. CONCLUSION: Our data shows that there were no specific differences of clinical manifestation between a positive single urine culture and a positive mixed urine culture in pediatric APN. A mixed urine culture from an aseptic urine sample should be interpreted cautiously.
Academic Medical Centers ; Bacteriuria ; Biomarkers ; C-Reactive Protein ; Cicatrix ; Coinfection ; Fever ; Humans ; Hydronephrosis ; Korea ; Leukocytes ; Pyelonephritis ; Retrospective Studies ; Urinary Bladder ; Urinary Catheterization ; Urinary Catheters ; Vesico-Ureteral Reflux

PURPOSE: Glomus tumor is rare benign neoplasm arising from the normal glomus, which is a neuromyoarterial apparatus, usually seen in the nail bed of fingers. Concerning about the origin, there were few written reports about extra-digit glomus tumor of elderly patient. MATERIALS AND METHODS: A 69-year-old man presented with severe pain and tenderness localized to the distal dorsal portion of forearm for 5 years. The pain was sudden in onset resting several seconds, cold frequently exacerbated these symptoms. So much pain was caused by touching the sensitive area that the patient was quite reluctant to have the maneuver repeated. The clinical suspicion of glomus tumor was made and the lesion was completely excised. Glomus tumor was confirmed by the pathologist. RESULTS: After the operation, patient didn't complain of his symptoms anymore and there was no evidence of recurrence during 6 months follow-up period. CONCLUSIONS: We report a rare case of glomus tumor arising in subcutaneous layer of forearm with elderly patient.
Aged ; Cold Temperature ; Fingers ; Follow-Up Studies ; Forearm ; Glomus Tumor ; Humans ; Nails ; Recurrence

We report the first case of bacteremia by a novel Paenibacillus species, Paenibacillus pasadenensis, from a 55-year-old male patient with acute respiratory distress syndrome, following a microsurgical clipping procedure of a ruptured intracranial aneurysm. The bacterium was identified using 16S rRNA gene sequencing analysis, which was applied because current conventional methods employed in the clinical microbiology laboratory proved unsuccessful. Since this bacterium was first identified in 2006 and has never been reported elsewhere, we believe this report can provide practitioners with useful insight on the pathogenicity of this species.
Bacteremia* ; Genes, rRNA ; Humans ; Intracranial Aneurysm ; Male ; Middle Aged ; Paenibacillus* ; Respiratory Distress Syndrome, Adult* ; RNA, Ribosomal ; Virulence

A 60-year-old man diagnosed with unresectable hepatocellular carcinoma (HCC) presented to the hospital with pain in the perineal region. He had been taking lenvatinib every day for 2 months after he was diagnosed with HCC with metastases to the lymph node, small bowel mesentery, and retroperitoneal space. Enhanced abdominal computed tomography revealed mild elevation in intensity in the perineal subcutaneous tissue with subcutaneous emphysema. The patient was diagnosed with Common Terminology Criteria for Adverse Events grade 3, skin ulceration of stage IV with full-thickness skin loss and tissue necrosis in the muscular layer. The patient was taken off the medication with prescription of antibiotics, and after 3 weeks, the skin has fully recovered. This is the first report of an HCC patient who presented with a skin ulceration of stage IV after lenvatinib treatment. We recommend stopping the medication immediately and changing to alternative treatments with appropriate supportive care.

A 60-year-old man diagnosed with unresectable hepatocellular carcinoma (HCC) presented to the hospital with pain in the perineal region. He had been taking lenvatinib every day for 2 months after he was diagnosed with HCC with metastases to the lymph node, small bowel mesentery, and retroperitoneal space. Enhanced abdominal computed tomography revealed mild elevation in intensity in the perineal subcutaneous tissue with subcutaneous emphysema. The patient was diagnosed with Common Terminology Criteria for Adverse Events grade 3, skin ulceration of stage IV with full-thickness skin loss and tissue necrosis in the muscular layer. The patient was taken off the medication with prescription of antibiotics, and after 3 weeks, the skin has fully recovered. This is the first report of an HCC patient who presented with a skin ulceration of stage IV after lenvatinib treatment. We recommend stopping the medication immediately and changing to alternative treatments with appropriate supportive care.

Herpetic meningoencephalitis is a devastating disease with significant morbidity and mortality. One of the most serious clinical sequelae is aphasia, usually of sensory type, whereas, Broca's or motor aphasia is not a common manifestation. We report a case of herpetic meningoencephalitis diagnosed by polymerase chain reaction (PCR) and viral culture with Broca's aphasia as a neurologic sequela. A 35-year old male patient was admitted due to fever and altered mentality for 3 days. He was accompanied by nausea, vomiting, disorientation, and memory defect. Several vesicular eruptions were noted around the lips. Neck stiffness was present, but Kernig's and Brudzinski signs were not observed. Herpetic meningoencephalitis was confirmed with PCR and other diagnostic tests such as EEG, brain MRI, brain CT scan, and viral culture. His overall clinical condition was improved after acyclovir therapy, but Broca's aphasia remained as a sequela.
Acyclovir ; Adult ; Aphasia* ; Aphasia, Broca ; Brain ; Diagnostic Tests, Routine ; Electroencephalography ; Encephalitis, Herpes Simplex* ; Fever ; Herpes Simplex* ; Humans ; Lip ; Magnetic Resonance Imaging ; Male ; Memory ; Mortality ; Nausea ; Neck ; Polymerase Chain Reaction ; Tomography, X-Ray Computed ; Vomiting

A 17-year old female presented with a chief complaint of melena and epigastric pain. She had a family history of colon cancer, her mother having been diagnosed with hereditary nonpolyposis colorectal carcinoma (HNPCC). After close examination including double-balloon enteroscopy, the patient was diagnosed with small bowel carcinoma, in spite of her young age. Here we report this rare case of small bowel carcinoma in a young patient with a family history of HNPCC.
Adenocarcinoma/*diagnosis/pathology/surgery ; Adolescent ; Double-Balloon Enteroscopy ; Female ; Humans ; Jejunal Neoplasms/*diagnosis/pathology/surgery ; Positron-Emission Tomography ; Tomography, X-Ray Computed

Duodenal diverticula are detected in up to 27% of patients undergoing upper gastrointestinal tract evaluation with periampullary diverticula (PAD) being the most common type. Although PAD usually do not cause symptoms, it can serve as a source of obstructive jaundice even when choledocholithiasis or tumor is not present. This duodenal diverticulum obstructive jaundice syndrome is called Lemmel's syndrome. An 81-yr-old woman came to the emergency room with obstructive jaundice and cholangitis. Abdominal CT scan revealed stony opacity on distal CBD with CBD dilatation. ERCP was performed to remove the stone. However, the stone was not located in the CBD but rather inside the PAD. After removal of the enterolith within the PAD, all her symptoms resolved. Recognition of this condition is important since misdiagnosis could lead to mismanagement and therapeutic delay. Lemmel's syndrome should always be included as one of the differential diagnosis of obstructive jaundice when PAD are present.
Abdominal Pain ; Aged, 80 and over ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangiopancreatography, Magnetic Resonance ; Cholangitis/complications ; Diverticulum ; Duodenal Diseases/complications/*diagnosis ; Female ; Fluoroscopy ; Gallstones/diagnosis/therapy ; Humans ; Jaundice, Obstructive/*complications ; Tomography, X-Ray Computed

Pseudoepitheliomatous hyperplasia is a benign condition that may be caused by prolonged inflammation, chronic infection, and/or neoplastic conditions of the mucous membranes or skin. Due to its histological resemblance to well-differentiated squamous cell carcinoma, pseudoepitheliomatous hyperplasia may occasionally be misdiagnosed as squamous cell carcinoma. The importance of pseudoepitheliomatous hyperplasia is that it is a self-limited condition that must be distinguished from squamous cell carcinoma before invasive treatment. We report here on a rare case of esophageal pseudoepitheliomatous hyperplasia in a 67-year-old Korean woman with a lye-induced esophageal stricture. Although esophageal pseudoepitheliomatous hyperplasia is infrequently encountered, pseudoepitheliomatous hyperplasia should be considered in the differential diagnosis of esophageal lesions.
Aged ; Carcinoma, Squamous Cell/diagnosis ; Diagnosis, Differential ; Esophageal Neoplasms/diagnosis ; Esophageal Stenosis/chemically induced/*diagnosis ; Esophagoscopy ; Female ; Humans ; Hyperplasia/*diagnosis/pathology ; Iodides/chemistry ; Lye/*toxicity