The development of tophi in th absence of prior episodes of gauty arthritis is unusual. We report a case of extensive tophi in a 31 year-old man, whose initial skin lesion had started without arthritis.
Adult ; Arthritis ; Gout* ; Humans ; Skin

BACKGROUND: Primary stenting as a direct reperfusion procedure after acute myocardial infarction might reduce recurrent myocardial infarction and target vessel revascularization. However, result of long or multiple stenting in the long or tandem lesions were not known. METHOD: From Jan. 1996 to Dec. 1998, patients with acute myocardial infarction including cardiogenic shock were undergone primary stenting using long or multiple stent. The clinical end points were death, recurrent infarction, subsequent bypass surgery, or repeat angioplasty of the infarct-related vessel. The results were compared with age, sex, lesion, and risk matched standard stenting group. RESULT: Baseline characteristics were similar for the 20 patients who underwent standard length stenting and the 13 patients who underwent long or multiple stenting. Stent diameter was similar in two group (3.4+/-0.3 mm vs. 3.5+/-0.4 mm, p=0.65), but total stent length was longer in long or multiple stenting group (15.5+/-1.8 mm vs. 40.18.4 mm, p=0.01). Average numbers of stent using in multiple stenting were 1.5+/-0.7. Stenting in the infarct-related artery was successful in all patients randomized to stent treatment. At 6 months, the incidence of the primary end point was 25% (5/20) in the standard stent group and 31%(4/13) in the long or multiple stent group (p=0.5). CONCLUSION: Outcomes of long or multiple stenting including mortality, recurrent myocardial infarction and target vessel revascularization was similar to standard stenting. Long or multiple stenting after acute myocardial infarction may possible procedure in some selective cases having long or tandem lesion.
Angioplasty* ; Arteries ; Humans ; Incidence ; Infarction ; Mortality ; Myocardial Infarction ; Reperfusion ; Shock, Cardiogenic ; Stents*

Nowadays shoulder ultrasound is commonly used in the assessment of shoulder diseases and is as accurate as magnetic resonance imaging in the detection of several pathologies. Operator dependence is the main disadvantage of shoulder ultrasound. After adhering to a strict examination protocol, good knowledge of normal anatomy and pathologic processes and an awareness of common pitfalls, it can be used as a focused examination providing rapid, real-time diagnosis, and treatment by ultrasound-guided interventions in desired clinical situations. Also shoulder ultrasound can help the surgeon decide whether treatment will be surgical or nonsurgical. If arthroscopy is planned, sonographic findings help to counsel patients regarding surgical and functional outcomes. If a nonsurgical approach is indicated, ultrasound can be used to follow patients. This review article presents the examination techniques, the normal sonographic appearances and the main pathologic conditions found in shoulder ultrasound. And also addresses a simplified approach to scanning and ultrasound-guided intervention. Knowledge of optimal techniques, normal anatomy, dynamic maneuvers, and pathologic conditions is essential for optimal performance and interpretation of images.
Arthroscopy ; Diagnosis ; Humans ; Magnetic Resonance Imaging ; Pathologic Processes ; Pathology ; Shoulder* ; Ultrasonography*

BACKGROUND: The patients of trichotillomania seem to have received much attention based on patients behavioral psychological aspects, but most of the patients are met in dermatological clinics. Dermatological observation of the lesion dose not seem to not sufficient. OBJECTIVE: The purpose of this study is to exarnine clinical and histopathological characteristics of the lesion of trichotillomania. METHODS: We have observed 28 cases of the trichotillornania and exarnined their cutaneous lesions and histopathological featwres. Histopathological examination with vertical serial sections was done in 21 cases. Because hai folllicles are independent of each other and a usual 5 thickness vertical sect,ion shows only very limited numbers of the hair follicles, authors accomplished sectioning of the biopsied scalp tisue to have 300 serial sections cut and 60 representative sections observed to allow the fullest qiiantitative and qualitative examinations of the follicular pathology of the lesion. RESULTS: The important featuies are as follows. 25 cases(89.2%) were under 18 years old with a slight male predorninance(M:F=1.3:1). Only in 2 cases, psychiatric consultation was made. The degree of involvement was vari ble from less than 5%(6 cases) of the scalp up to 100% involvement of the scalp(3 cases). Thr rnean duration of illness was 12.5 months. The involved hair follicles showed one of the following five roots of hairs they are new hairs with tapered ends, broken short hairs, vellus or intermediate hairs, comedone-like hair bodies or empty follicle orifices. Microscopical observation of thr epilat,ed hairs was done in 16 cases, of which in 13 cases there were no telogen roots of terminal hairs, The histopathological results were as follows : 1. Catagen follicles were increased in 20 cases(95.2%). The actual number of catagen follicles was 1386(37.5%) out of a tota 3695 follicles observed in the total examined slides. 2. Trichornalacia were seen ir 11 cases(52.4%). The actual number of hairs with trichomalacia was 195(10.5%) out of a total 1005 hair canals observed. 3. Pigment clumps of the follicular infundibula were seen in 9 cases(42.9%). The actual number of the pigment-laden infundibula was 148(17.9%) out of a total 826 infundibula observed. 4. Destruction of the hair canal wall were seen in 4 cases(19.0% ). The actual number of destructed hair canal wall was 190(10.2%) out of a total 1863 hair canals observed. Hernorrhage around the follicles was not seen. CONCLUSION: The involved areas of trichotillomania were varied in size up to the whole scalp and showed four different type of hairs. Histopathologically catagen follicles increased in almost all cases with 37.5% of all follicles examined. Trichomalacia, pigmented clumps, and the destruction of hair canals were seen by less frequently.
Adolescent ; Hair ; Hair Follicle ; Humans ; Male ; Pathology ; Scalp ; Trichotillomania*

Primary tumors of the heart are rare, three quarter of the tumors are benign, and nearly half of the benign heart tumors are myxomas. Cardiac myxoma usually originate in the left atrium about 75 percent, however, only 3 to 4 percent of myxoma are detected in the left ventricle. We report on a 32 years old woman with left ventricular myxoma who presented with shortness of breath, chest tightness, and general weakness. Acute pulmonary embolism and left ventricular myxoma were found on a perfusion lung scan and echocadiogram. A mass located on septal wall of left ventricle was excised en bloc. The patient recovered uneventfully and careful follow up has be performed periodically.
Adult ; Dyspnea ; Female ; Follow-Up Studies ; Heart ; Heart Atria ; Heart Neoplasms ; Heart Ventricles ; Humans ; Lung ; Myxoma* ; Perfusion ; Pulmonary Embolism* ; Thorax

Papular mucinosis, also known as lichen myxedematosus or scleromyxedema, is a chronic cutaneous disorder characterizecl by infiltration of mucin in the dermis without abnormalities of thyroid function. It often combines serum monoclonal paraproteins. Various drugs have been used for the treatment without consistent results. We report a case of papular mucinosis in a 51-year-old man, who started the disease on his scalp 10 years before the first examination. Subsequent development of the characteristic glistening papular lesions on his entire scalp, eye brows, ears and upper back continued for 5 years thereafter until complete resolution. Treatment with corticosteroids and melphalan showed only limited effects during the period.
Adrenal Cortex Hormones ; Dermis ; Ear ; Humans ; Melphalan ; Middle Aged ; Mucins ; Paraproteins ; Scalp ; Scleromyxedema* ; Thyroid Gland

The author carried out a study on the effectiveness of the boric acid as a stomach poison for German cockroach control from July to September 1971. The test was performed by the feeding method under conditions of 20 C and 80 per cent relative humidity. The baits were composed of one control group and five different combination groups with boric acid and sugar as follows. 10 g sugar only(control group), 1 g powedered boric acid to 9 g sugar(1:9 poison baits), 2 g powdered boric acid to 8 g sugar(2:8 poison baits), 4 g powdered boric acid to 6 g sugar(4:6 poison baits), 5 g powdered boric acid to 5g sugar(5:5 poison baits), 10 g powdered boric acid only (10:0 poison baits). The insects were composed of 360 female adult German cockroaches collected by traps at the kitchens of restaurants and house holds in Seoul City. The results were as follows: The total mortality by poison baits in 72 hours after treatment were: 44.3 per cent by 1:9 poison baits , 79.4 per cent by 2: poison baits , 96.7 per cent by 4:6 poison baits(the most effective poison baits), 88.3 per cent by 5:5 poison baits, 91.1 per cent by 10:0 poison baits. The peak mortality by the treatment hours were: Up to 21 hours: 23.3 per cent by 5:5 poison baits, 20.0 per cent by 10:10 poison baits, From 24 to 48 hours: 71.1 per cent by 4:6 poison baits, 55.6 per cent by 10:0 poison baits, From 48 to 72 hours: 21.9 per cent by 2:8 poison baits, 19.6 per cent by 1:9 poison baits. The most effective treatment hours was from 24 to 48 hours.
parasitology-arthropoda-cockcroach ; Blattella germanica ; chemotherapy ; boric acid

No abstract available.
Urinary Incontinence*

Intraaortic balloon counterpulsation (IAB) has been shown to prolong survival in the critically ill cardiac patients. Originally developed for use in the patients with cardiogenic shock, the indications have been expanded. But despite technical advances, the complication rate associated with IAB remains high. The most commonly reported complications include damage to the femoral artery and distal embolization. Other reported major complications are balloon rupture, limb loss, bleeding, systemic infection and bowel infarction. We report a patient complicated by ischemic colitis causing stenosis and intestinal obstruction after IAB insertion.
Colitis, Ischemic* ; Constriction, Pathologic* ; Counterpulsation* ; Critical Illness ; Extremities ; Femoral Artery ; Hemorrhage ; Humans ; Infarction ; Intestinal Obstruction ; Rupture ; Shock, Cardiogenic

BACKGROUND: Although the superior reperfusion and improved clinical outcome following angioplasty for acute myocardial infarction (AMI) have been well known, 10 to 15% of reinfarction and recurrent ischemia in hospital are main limitation of primary percutaneous transluminal coronary angioplasty (PTCA). This study was undertaken to examine the safety and feasibility of stent-supported primary angioplasty in acute myocardial infarction. METHODS: Between July 1995 and Jun. 1997, 32 patients underwent direct or rescue PTCA, including patients with cardiogenic shock. After PTCA, stenting was attempted in patient with dissection or having more than 30% of residual stenosis. Result: In patient with direct PTCA, angiographic success rate was obtained in 91% (30/32). Stenting was attempted in 15 of 30 patients. These patients had suboptimal results (8 patients), non-occlusive dissection (3 patients) and acute occlusion (2 patient). Thrombolysis in myocardial infarction (TIMI) grade 3 flow was restored in 28 patients (93%). In one patient no-reflow phenomena was observed following stent insertion. Despite intra-aortic balloon pumping, there was one death during the hopitalization due to cardiogenic shock following PTCA. Subacute stent thrombosis developed in two patients. 27 patients (90%) were event-free and clinically improved through out the follow up period (11.5+/-5.2 month). Quantitative angiography showed excellent angiographic result after stenting compared with balloon PTCA (2.4+/-0.6 mm vs. 3.4+/-0.3 mm p<0.01). CONCLUSION: After failure of initial angioplasty, coronary stenting can be a supportive therapeutic strategy. Coronary stenting results in a high degree of angiographic success, a low incidence of subacute thrombosis.
Angiography ; Angioplasty* ; Angioplasty, Balloon* ; Angioplasty, Balloon, Coronary ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Incidence ; Intra-Aortic Balloon Pumping ; Ischemia ; Myocardial Infarction* ; Reperfusion ; Shock, Cardiogenic ; Stents ; Thrombosis