Primary cutaneous aspergillosis is rare. In this report we describe primary skin infection by Aspergillus in 9 children with leukemia. The skin lesion was characterized clinically by erythematous macule and papule associated with pain and itching, followed by a rapid progression to ulcer and central black eschars with raised erythematous border at the site of venipuncture, insertion of intravenous cannula, or where arm boards had been taped to extremities. Diagnosis was confirmed by skin biopsy and wound culture. Positive revealed in 6 patients, including A. glaucus in 2 cases, A. flavus in 1 case. Treatment consisted of temporary withdrawl of anticancer chemotherapy, intravenous amphotericin B, oral flucytosine, itraconazole and/or rifampin. One patient recovered completely without antifungal medication with resolution of leukopenia. Six of eight treated patients recovered. One patient discharged against medical advice, while cutaneous aspergillosis was improving. One patient died with persistent skin lesion and neutropenia. We conclude that primary cutaneous aspergillosis is increasingly recognized in association with intravenous cannula, intravenous puncture or prolonged contact with arm boards in immunocompromised patients, and that this serious disease can be treated successfully with appropriate management.
Amphotericin B ; Arm ; Aspergillosis* ; Aspergillus ; Biopsy ; Catheters ; Child* ; Diagnosis ; Drug Therapy ; Extremities ; Flucytosine ; Humans ; Immunocompromised Host ; Itraconazole ; Leukemia ; Leukopenia ; Neutropenia ; Phlebotomy ; Pruritus ; Punctures ; Rifampin ; Skin ; Ulcer ; Wounds and Injuries

No abstract available.
Cystadenocarcinoma, Mucinous* ; Female* ; Humans ; Mucins*

No abstract available.
Brain Neoplasms* ; Brain* ; Drug Therapy ; Medulloblastoma ; Neoplasm Metastasis* ; Neuroectodermal Tumors, Primitive

No abstract available.
Diarrhea* ; Hypokalemia* ; Vipoma

Squamous cell carcinoma of bladder is best treated with a radical cystectomy. Squamous cell carcinoma of bladder invading the abdominal wall is not commonly reported and hard to manage surgically. Abdominal wall defect caused by a wide resection of squamous cell carcinoma invading abdominal wall can be reconstructed using various muscle flaps. We performed a salvage cystectomy for a patient with squamous cell carcinoma of bladder invading abdominal wall up to skin, and the abdominal wall defect was successfully reconstructed using a unilateral tensor fascia lata myocutaneous flap.
Abdominal Wall* ; Carcinoma, Squamous Cell* ; Cystectomy ; Fascia Lata* ; Fascia* ; Humans ; Myocutaneous Flap* ; Skin ; Urinary Bladder*

Background and objectives: Carvedilol is a cardiovascular drug, beta- and alpha1-adrenoceptor antagonist, currently approved for the treatment of hypertension, angina, congestive heart failure by FDA. Carvedilol has been shown to attenuate oxygen free radical-initiated lipid peroxidation and to inhibit neointimal formation of aorta following vascular injury by balloon angioplasty. We have investigated the effect of carvedilol on DNA synthesis of vascular smooth muscle cells (VSMC) stimulated by platelet-derived growth factor (PDGF)-BB. MATERIALS AND METHOD: Rat aortic smooth muscle cells were obtained by the combined collagenase and elastase methods. Cells between the 4th and 8th passages were used for the experiments. Incorporated radioactivity of [3H]-thymidine was measured by liquid scintillation spectrometry. RESULTS: PDGF-BB (1 nM) increased [3H]-thymidine incorporation about 70-100% over basal value in cultured VSMC. PDGF-stimulated increase in DNA synthesis was significantly suppressed by simultaneous administration of carvedilol. In contrast, propranolol did not significantly affect 3[H]-thymidine uptake in rat aortic VSMC. CONCLUSION: The present study demonstrate that carvedilol significantly inhibits the proliferation of vascular smooth muscle cell in our condition. These results indicate that carvedilol may be effective in the treatment of cardiovascular diseases principally associated with abnormal vascular smooth muscle growth.
Angioplasty, Balloon ; Animals ; Aorta ; Cardiovascular Diseases ; Cell Proliferation ; Collagenases ; DNA ; Heart Failure ; Hypertension ; Lipid Peroxidation ; Muscle, Smooth, Vascular* ; Myocytes, Smooth Muscle ; Oxygen ; Pancreatic Elastase ; Platelet-Derived Growth Factor ; Propranolol ; Radioactivity ; Rats ; Spectrum Analysis ; Vascular System Injuries

Postoperative gas-forming bacterial infection is very rare. However, it can be a life threatening problem if not properly addressed. Authors treated a patient who was infected with gas forming Escherichia coli after both knee arthroplasty with incision and drainage, as well as arthroscopic synovectomy and antibiotics. Herein, we report a case of postoperative gas-forming bacterial infection with literature review.
Anti-Bacterial Agents ; Arthroplasty, Replacement, Knee* ; Bacterial Infections* ; Drainage ; Escherichia coli ; Humans

OBJECTIVE: The aim of this study was to develop professionalism competency for residents and medical students in the field of emergency medicine. METHODS: Twenty emergency medicine specialists working at a university hospital were recruited for the modified Delphi method. Seventy-three items were generated and classified into five domains: 13 items in patient care, 19 in communication and cooperation, nine in social accountability, 24 in professionalism, and eight in education and research. Two-step surveys were conducted. RESULTS: Items with a low content validity ratio (< 0.42) were deleted, or combined when the meanings of the items were similar or duplicated through two-step surveys. Finally, 59 items for residents were used: 12 items in patient care, 11 in communication and cooperation, six in social accountability, 23 in professionalism, and seven in education and research. In addition, 23 items for medical students were settled: six items in patient care, five in communication and cooperation, none in social accountability, 11 in professionalism, and one in education and research. CONCLUSION: The items related to social accountability and communication and cooperation with society were considered less important by the panels. In addition, there was a tendency to clearly distinguish between resident and student levels in professionalism competency. Based on the results of this study, it is important to form a basis for developing educational programs of professionalism of emergency medicine for senior medical students and residents.
Clinical Competence ; Delphi Technique* ; Education ; Emergencies* ; Emergency Medicine* ; Humans ; Methods ; Patient Care ; Professionalism* ; Social Responsibility ; Specialization ; Students, Medical*

BACKGROUND: Vascular lesions are the major cause of morbidity and mortality in hypertensive patients. However, the pathologic characteristics of gradually evolving, chronic hypertension have not been adequately studied and the mechanism by which hypertension accelerates atherosclerosis is still uncertain. This study was undertaken to invertigate the ultrastructural changes of the aorta and the effect of high cholesterol diet in spontaneously hypertensive rats(SHR). METHODS: Spontaneously hypertensive rats (n=80, male, 5 weeks old) and Wistar rats (n=40, male, 5 week old) were used. Forty SHR were fed with 2% cholestrol diete, while the remainder with control diet. Systolic blood pressure was measured weekly until 16 weeks after birth, and then biweekly until 40 weeks after birth. Transmission and scanning electron microscopy were used to evaluate ultrastrucural changes of the aorta. RESULTS: 1) The blood pressure of SHR rose stedily and progressively from the 5 weeks after birth and reached nearly 190mmHG at the 16 weeks after birth. 2) In SHR, the subendothelial component contained finely granular substances, abundant fibrillar collagen and elastin. Infiltration of the mononuclear blood leukocytes into the intima was frequently seen. 3) Endothelium from cholestrol-fed SHR did exhibit numerous pinocytotic vesicles and contained many cytoplasmic filaments. There were a number of large mononuclear lipid-filled cells in the intimal lesions. Blistering of the endothelial plasma membrane was also observed in high cholesterol diet-fed SHR. Later on, adhesion of platelets, febrin, and white blood cells as well as damage of intima shown as multiple small holes were more marked. 4) There was no significant difference in systoloic blood pressure between high cholesterol diet-fed and control diet-fed SHR. CONCLUSION: In the aorta of SHR, the most prominent change was an expansion of the subendothelial space and infiltration of the mononuclear leukocytes into the intima. The present study showed that the SHR was indeed a reliable model for the essential hypertension. In some SHR, high cholesterol diet could induce more pronounced vascular lesions, which were enhanced by hypertension.
Aorta* ; Atherosclerosis ; Blister ; Blood Pressure ; Cell Membrane ; Cholesterol* ; Cytoskeleton ; Diet* ; Elastin ; Endothelium ; Fibrillar Collagens ; Humans ; Hypertension ; Leukocytes ; Leukocytes, Mononuclear ; Male ; Microscopy, Electron ; Microscopy, Electron, Scanning ; Mortality ; Parturition ; Rats, Inbred SHR* ; Rats, Wistar

Chloroma (granulocytic sarcoma) indicates an extramedullary leukemic cell collection. It often develops in the course of, or as a presenting sign of leukemia. Cardiac chloroma is uncommon and rarely detected as a mass. We report the first case of cardiac chloroma in a patient with acute lymphocytic leukemia in Korea. A 73-year-old man was admitted because of exertional dyspnea, orthopnea and generalized weakness. Thrombocytopenia and immature leukocytes were detected in the peripheral blood. An X-ray film of the chest showed mild cardiome-galy and bilateral pleural effusion. Transthoracic and transesophageal echocardiography showed a low echogenic mass at the lateral wall of the right ventricle. The size of the mass was about 6x4 cm. MRI of the chest showed right ventricular mass with slightly increased inhomogeneous signal intensity. Bone marrow aspiration and biopsy confirmed that he had a L3 FAB subtype of acute lymphocytic leukemia. Induction chemotherapy with vincristine, prednisolone, daunorubicin resulted in hematologic complete remission. At 6 weeks after the induction chemotherapy, transesophageal echocardiography demonstrated disappearance of the right ventricular mass which suggested that it was a cardiac chloroma complicating acute lymphocytic leukemia.
Aged ; Biopsy ; Bone Marrow ; Daunorubicin ; Dyspnea ; Echocardiography, Transesophageal ; Heart Ventricles ; Humans ; Induction Chemotherapy ; Korea ; Leukemia ; Leukocytes ; Magnetic Resonance Imaging ; Pleural Effusion ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Prednisolone ; Sarcoma, Myeloid* ; Thorax ; Thrombocytopenia ; Vincristine ; X-Ray Film