Purpura fulminans (gangrenosa) is a rare clinical syndrome characterized by sudden appearance of rapidly progressive symmetrical subcutaneous ecchymosis durimg the convalescent stage of various infectious disease. A 4 year-old. boy has developed multiple skin defects with necrosis on extrernities and gangrenous changes on the left foot following a meningococcemia. B-K amputation on left leg and. free skin graft for multiple skin defect on extremities were, carried out.
Amputation ; Child, Preschool ; Communicable Diseases ; Ecchymosis ; Extremities ; Foot ; Humans ; Leg ; Male ; Necrosis ; Purpura Fulminans* ; Purpura* ; Skin ; Transplants

Three cases of orbital rhabomyosarcoma are reported here. Histological studies comfirmed the lesion 1:0 be the alveolar type in all cases. This tumor is a rare disease entity in Orient than Europe and America and accordingly, rarely encountered in our ophthalmologic practice, although it is the commonest primary malignant orbital tumor in children. Of the three cases reported here one occurred in adu1t and the other two in children. Case I. This 15 month old male showed a swelling of the left upper lid toward the medial side for 2 months and visited to our hospital on March 10, '69 with complaints of progressive swelling on the region with ptosis. The eye ball was slightly displaced toward the lower temporal side and ocular movement is limitted to upward. On palpation, the childthumb sized tumor was palpable in the upper nasal portion of the orbit. On excision of the tumor, the mass was found to be originated from the superior oblique muscle. The mass round measuring 2.5 X 2.5 X 1.5 cm in size. Histological diagnosis was alveolar rhabdomyosarcoma without cross-striation. No follow-up could be done. Case II. This patient of 15 month old male showed a swelling on the right lower lid existed 6 months and visited to our hospital on September 8, '69. The physical examination revealed that the left eye and the other routine examinations were within normal limits. The right eye showed the swelling of the lower lid, congestion of the palpebral conjunctiva, limitted movement of the eye ball toward the lower side and a palpable bean-sized mass on the region. The excision of tumor was performed under the general anesthesia. This mass was attached with the inferior oblique muscle with no other recognizable adhesion seemingly originating from that muscle. The mass was round and oval in shape, measuring 2 X 2 X 1 cm in size, diagnosis was alveolar rhabdomyosarcoma. The post-operative follow-up studies were unavailable. Case III. This case in one of adult alveolar rhabdomyosarcoma. At the age of 25 years, this man showed a proptosis of the right eye associated with migrain like headache, ocular pain and visual disturbance. This symptoms existed 6 months and gradually increased in intensity. On the physical examination, the left eye was found to be normal. The skull and orbit x-ray and c.b.c. were with in normal limits. The right eye revealed about 5mm proptosis compared with left eye and the adult thumb sized tumor was palpated on the inner side of the lower orbital rim. The visual acuity was in zero. The right optic disc was edematous and elevated about 4.0 D. The pupil showed marked dilatation and the light reflex was abscent and ocular movement was markedly limitted and eye ball is deviated toward the upper side. Under the general anesthesia, the exenteration of the orbit associated with the removal of tumor was carried out with no untoward complications. Origin of the mass was the inferior oblique muscle penetrating to the deeper part of the optic foraman and optic nerve was surrounded by the tumor completely Histology confirmed alveolar rhabdomyosarcoma. Follow-up study was impossible.
Adult ; Americas ; Anesthesia, General ; Child ; Conjunctiva ; Diagnosis ; Dilatation ; Estrogens, Conjugated (USP) ; Europe ; Exophthalmos ; Headache ; Humans ; Infant ; Male ; Optic Nerve ; Orbit* ; Palpation ; Physical Examination ; Pupil ; Rare Diseases ; Reflex ; Rhabdomyosarcoma* ; Rhabdomyosarcoma, Alveolar ; Skull ; Thumb ; Visual Acuity

The increased incidence of the trochanteric fracture of the femur was accompanied by the development of the vehicle and the prolongation of the average life-span. Recently it has been also increased in an active person from thirties to forties. 87 cases of the trochanteric fracture of the femur in 86 patients who have been admitted and treated at the Department of Orthopedic Surgery of Hanyang University Hospital during 8 years and 10 months, from May, 1972 to February, 1981, were reviewed. The results of this study were as follows: 1. The trochanteric fracture of the femur was more common in male and was frequent in a person who was from thirties to forties and who had vigorous social activity. 2. An injury from traffic accident was the most common cause of the fracture from thirties to forties and an injury from slip down was most common in seventies. 3. The unstable fracture which was classified by Evans' classification, Boyd and Griffin Type II Fx. and Tronzo Type III Fx. were most common in the intertrochanteric fracture and the Fielding Type II Fx. was most common in the subtrochanteric fracture of the femur. 4. Other injuries were accompanied by the trochanteric fracture of the femur in 38 patients (44.2%) and the pelvic bone fracture was the most common associated injury in these patients. 5. The weight bearing was allowed earlier in the patient who had been given the surgical Tx. than in the patient who had been given the conservative Tx. 6. In adults, there was no significant differences in the duration to achieve the bony union between the conservative treatment and surgical treatment performed. 7. We considered that the diminution of the probable complications by early weight bearing after accurate open reduction in accordance with the Type of the Fx. followed by secure internal fixation with devices is an ideal method of the Tx.
Accidents, Traffic ; Adult ; Classification ; Clinical Study ; Femur ; Hip Fractures ; Humans ; Incidence ; Male ; Methods ; Orthopedics ; Pelvic Bones ; Weight-Bearing

Pilomattiaoma, aften called calcifying epithelioma of Malherbe, is a benign tumor originating from the outer root sheath cell of the hair follicle and extending into the hair matrix, Pilomatricoma usually occurs as a single, asymptomatic dermal or subcutaneous nodule. Multiple lesions are quite unueuel, comprising only 2-3.5% of cases. We report two patients with multiple pilomatricoma.
Hair ; Hair Follicle ; Humans ; Pilomatrixoma*

Melanosis coli is the brownish pigmentation of the colon associted with the ingestion of anthraquinone compounds as iaxatives. The brownish discoloration of the colon mucosa is due to accumulation of macrophage containing lipofuscin pigment in the lamina propria. This is the one of the complications of laxative abuse, but the pigments disappear by withdrawing the anthraquinone. We report a case of malanosis coli histologically confirmed by fibersigmoidoscopic biopsy in a 70-year-old female patient consuming anthraquinone compound for twelve months with a review of the literature.
Aged ; Biopsy ; Colon ; Eating ; Female ; Humans ; Lipofuscin ; Macrophages ; Melanosis* ; Mucous Membrane ; Pigmentation

PURPOSE: Narcolepsy is a specific neurologic syndrome consisting of excessive daytime drowsiness, cataplexy, and the additional phenomena of sleep paralysis and intense dreamlike hallucinations at sleep-wake transitions. We are reporting a patient with narcolepsy whose repeated self-injury caused traumatic eyeball perforation. METHODS: A 26-year-old male with narcolepsy injured himself, which resulted in eyeball perforation in his both eyes. We diagnosed him as traumatic corneal laceration, traumatic cataract, and vitreous opacity due to lens material in vitreous in both eyes. RESULTS: After improvement of narcoleptic symptom and healing of corneal perforation, we performed cataract extraction and pars plana vitrectomy under local anesthesia. During operation, we found preretinal gliosis at superior portion of optic disc and subretinal hemorrhage in the right eye. We observed successful improvement in visual acuity through intraocular lens implantation.
Adult ; Anesthesia, Local ; Cataplexy ; Cataract ; Cataract Extraction ; Corneal Perforation ; Gliosis ; Hallucinations ; Hemorrhage ; Humans ; Lacerations ; Lens Implantation, Intraocular ; Male ; Narcolepsy ; Sleep Paralysis ; Sleep Stages ; Visual Acuity ; Vitrectomy

Bullous pemphigoid(BP) and herpes gestationis(HG) are subepidermal bullous diseases which show clinical and immunological similarities. Both diseases show immune deposits along the basement membrane zone and their autoantibodies bind a common antigenic site within the non-collagenous stretch of the 180 kDa BPAG2 ectodomain. Besides its association with pregnancy, HG has some characteristic features that distinguish it from BP. The serum of patients with HG often contains an IgG that avidly fixes complement, and showes IgG1 subclass predominance. We report here two cases of non-pregnant young women presenting clinical and histological features of bullous pemphigoid or herpes gestationis. The immunopathology, IgG subtyping and immunoblotting studies showed that the autoantibodies in the patients were the characteristic ones of herpes gestationis. The patients might be a subtype of BP that have characteristics of autoantibodies of HG patients.
Autoantibodies* ; Basement Membrane ; Complement System Proteins ; Female ; Humans ; Immunoblotting ; Immunoglobulin G ; Pemphigoid Gestationis* ; Pemphigoid, Bullous* ; Pregnancy

PURPOSE: To determine the significance of anomalous position of the gallbladder. MATERIALS AND METHODS: Sixteen patients with anomalous position of the gallbladder were evaluated for analysis. The diagnosis was confirmed by ultrasonography(15 patients) and oral cholecystography(1patient). Among those, six patients underwent CT scan and a patient had 99mTc-DISIDA scan. The images were analysed with respect to the location of the GB and configuration and associated abnormality of the liver and hepatobiliary systems. Medical records of each patient were also reviewed. RESULTS: Among 16 patients having an anomalous position of the gallbladder, nine had retrodisplaced gallbladder, four had left-sided gallbaldder, two had suprahepatic gallbladder, and one had floating gallbladder. Except for one patient, fifteen had abnormality in the liver such as focal atrophic or hypoplastic change and liver cirrhosis. Intrahepatic stones were demonstrated in 6 patients. CONCLUSION: Our results showed that anomalous position of the gallbladder was commonly associated with atrophy or hypoplasia of the liver rather than congenital in origin. The possiblity of an anomalous location of gallbladder should be kept in mind when GB is not in its normal location.
Atrophy ; Diagnosis ; Gallbladder* ; Humans ; Liver ; Liver Cirrhosis ; Medical Records ; Technetium Tc 99m Disofenin ; Tomography, X-Ray Computed

In anesthetized rabbits, the superior oblique muscle was excited by stimulation of a vestibular canal nerve. Induced reflex ocular movements were observed by the naked eyes, and were recorded by means of nystagmographic and oculographic techniques. Superior oblique muscle contraction induced by stimulation of a vestibular canal nerve produced ocular incycloduction associated with elevation. The elevatory action of superior oblique muscle was also demonstrated by means of the nystagmographic recording. Contraction of the superior oblique muscle caused augmented incycloduction in adduction of the eyeball, whereas excitation of the muscle produced augmented elevation in abduction of the eyeball. When these eye movements produced by the superior oblique muscle are compared to those of Tokumasu et al. observed in monkey and cat, the direction of the rotatory action appears to be contradictory. Such phenomenon may be ascribed to the anatomical differences of the oblique muscles in these animals endowed with the binocular or monocular vision.
Animals ; Cats ; Eye Movements ; Haplorhini ; Muscle Contraction ; Muscles ; Rabbits* ; Reflex ; Telescopes ; Vision, Monocular

Abrupt increase in the size of cervico-mediastinal tumor due to infection or spontaneous hemorrhage into cyst can induce severe tracheal compression and therefore sudden death. A 5 year old boy, who had a history of URI, had an enlarging cystic hygroma on the right side of the neck and anterior mediastinum. Under diagnosis of the cervico-mediastinal cystic hygroma, surgical removal was scheduled. After induction of anesthesia, intubation was done without any difficulty. A few minutes later, signs of partial airway obstruction were appeared. And within a very short period, total airway occlusion occurred. The tracheal tube was removed and manual ventilation was performed with positive airway pressure, but ineffective. We attempted to puncture cricothyroid membrane with 14 Gauge needle in order to ventilate manually. As soon as we puncture cricothyroid membrane, straw-colored fluid, not air, gushed out through a needle. After aspiration of about 200ml of cystic fluid, the obstructive signs disappeared and the patency of the airway was maintained. Intraoperatively, no more airway problems occured and vital signs were stable. And postoperatively, patient had no specific complications and discharged on the 7th day after operation.
Airway Obstruction* ; Anesthesia ; Child, Preschool ; Death, Sudden ; Diagnosis ; Hemorrhage ; Humans ; Intubation ; Intubation, Intratracheal* ; Lymphangioma, Cystic* ; Male ; Mediastinum ; Membranes ; Neck ; Needles ; Punctures ; Ventilation ; Vital Signs