No abstract available.
Adenocarcinoma* ; Epidermal Growth Factor* ; Recurrence*

No abstract available.
Acidosis*

Dermatofibrosarcoma protuberans is an uncommon, locally aggressive fibroblastic tumor, characterized by infrequent metastasis and a marked tendency of local recurrence after excision. Histologically, it shows large uniformed spindle shaped cells arranged in a cartwheel or storiform pattern. We report a case of dermatoribrosarcoma protuberans on the lower abdomen of a man aged of thirty, treated with Mohs micrographic surgery and purse-string suture repair.
Abdomen ; Dermatofibrosarcoma* ; Fibroblasts ; Mohs Surgery* ; Neoplasm Metastasis ; Recurrence ; Sutures*

A 33 year old woman with tuberous sclerosis and pulmonary lymphangiomyomatosis was undertaken bilateral sequential lung transplantation. Due to the progressive dyspnea and recurrent pneumothorax, she could not handle her normal daily life without oxygen supplements. The natural history of a patient with tuberous sclerosis and symptomatic lung involvement says the mean expected survival is 4 years. Such guidelines as severe obstructive lung disease, unavailable medical therapy, substantial limitation in activities of daily living, and limited life expectancy made her be a recipient of lung transplantation expecting both prolongation of life and the better quality of life. In this transplantation case, we have experienced such delicate problems as gross ventilation-perfusion mismatch, reperfusion pulmonary edema, much decreased renal function, etc.
Activities of Daily Living ; Adult ; Dyspnea ; Female ; Humans ; Life Expectancy ; Life Support Care ; Lung Diseases, Obstructive ; Lung Transplantation* ; Lung* ; Lymphangioleiomyomatosis ; Natural History ; Oxygen ; Pneumothorax ; Pulmonary Edema ; Quality of Life ; Reperfusion ; Tuberous Sclerosis

BACKGROUND: In 1987, the British Thoracic Society (BTS) subjected an extensive list of patient variables to statistical analysis in a prospective study of prognosis in 453 adults with communityacquired pneumonia and, subsequently published guidelines for management of severe community acquired pneumonia. It was hoped that those at risk of dying from community acquired pneumonia could be easily identified and treated appropriately, thereby reducing mortality. To date, severe community acquired pneumonia has not been well studied in Korea. Therefore, we studied retrospectively 10 patients dying of severe community acquired pneumonia in Dongsan Hospital to see clinical manifestations of .dying of severe community-acquired pneumonia. METHODS: Between July 1987 and july 1993, 498 patients were admitted to Keimyung University Dongsan Hospital with community acquired pneumonia, and 77 of them received intensive care. Of the 77 patients, 10 patients died. We reviewed medical records of these patients. RESULTS: 1) The mean age of the patients was 56.2 years(range, 25 to 75 years). There were 7 men and 3 women. Seven patients(70%) were older than 60years of age. 2) The clinical features on admission were as follows: tachypnea, hypoxemia, mental change, cyanosis, leukopenia, leukocytosis, azotemia, hypotension, hypoalbuminemia in order of frequency. Three patients had one abnormal physical finding, 3 patients had 2, 2 patients had 3, and 2 patients had none of these abnormal physical findings. All patients had at least one of the abnormal laboratory findings. 3) A potential bacterial pathogen was isolated in sputum culture from 2 patients. One was E.coli, the other Enterobacter species. Sputum stain were positive in eight cases (G(+)cocci in six, G(+)cocci and G(-)bacilli in two). 4) Features of respiratory failure were the main reasons for ICU transfer, but two patients were transferred only following a cardiac or respiratory arrest in the general ward. 5) The mean of 2.7 different antibiotics were given to the patients. The aminoglycoside and first generation cephalosporin were the most frequently prescribed antibiotics, followed by the third generation cephalosporin and vancomycin. The most frequently prescribed antibiotics combination was a 1st generation cephalosporin plus an aminoglycoside. 6) Save patients death(70%) occured after admission within the first five days, and a mean duration of hospitalization was 11.2 days. CONCLUSION: As the results show most death occured within the first days after admission and aged patients; consequently, an aggressive intensive treatment should be provided early to the patients with severe community acquired pneumonia, and we should pay more attention to the aged patients.
Adult ; Anoxia ; Anti-Bacterial Agents ; Azotemia ; Cyanosis ; Enterobacter ; Female ; Hope ; Hospitalization ; Humans ; Hypoalbuminemia ; Hypotension ; Critical Care ; Korea ; Leukocytosis ; Leukopenia ; Male ; Medical Records ; Mortality ; Patients' Rooms ; Pneumonia* ; Prognosis ; Prospective Studies ; Respiratory Insufficiency ; Retrospective Studies ; Sputum ; Tachypnea ; Vancomycin

BACKGROUND: Recent studies have shown that Mohs micrographic surgery (MMS) decreased the recurrent rate of tumors and conserved the normal, unaffected tissue. Therefore, MMS is accepted as the first choice treatment modality for cutaneous malignant tumors. OBJECTIVE: The purpose of this study was to review the use of MMS and reconstruction of cutaneous malignant tumors over the past 10 years. METHOD: We retrospectively evaluated 104 patients who had been diagnosed with cutaneous malignant tumors between January 1994 and December 2003, and had been treated with MMS and tumor reconstruction. RESULTS: There were 54 males and 50 females. The mean age was 62. Basal cell carcinoma was the most common skin tumor, and the most common anatomical site was the face. Mean number of stages of MMS were 1.91, and the mean size of the final defect after MMS was 19.46x25.4 mm. A local flap was most commonly used to repair the surgical defects (59%). Recurrent cases totalled 2 out of 104 over the 4-60 months of follow up. CONCLUSION: MMS and proper reconstruction are a reliable and effective method for the treatment of cutaneous malignant tumors and offers the lowest functional and cosmetic morbidity in skin cancer treatment.
Carcinoma, Basal Cell ; Female ; Follow-Up Studies ; Humans ; Male ; Mohs Surgery* ; Retrospective Studies ; Skin ; Skin Neoplasms

Basal cell carcinoma (BCC) is noted for its many histologic variants because of its pluripotential origin from epithelial germ cells. Clear cell BCC has been recognized as a distinct variant and has a clear cell component made up of cells which are either vacuolated or display a finely granular eosinophilic cytoplasm. We report a case of clear cell BCC in a 62-year-old man who had a well-demarcated, skin-colored nodule on the left nasal ala. It was treated by surgical excision with a Burow's graft and no recurrence has been observed.
Carcinoma, Basal Cell* ; Cellular Structures ; Cytoplasm ; Eosinophils ; Germ Cells ; Humans ; Middle Aged ; Recurrence ; Transplants

No abstract available.
Down Syndrome* ; Primary Myelofibrosis*

An eruptive vellus hair cyst is an uncommon, benign, epithelial tumor with hair differentiation. Clinically, it presents as asymptomatic, flesh-colored to yellowish, follicular papules, 1 to 4 mm in diameter, most commonly on the chest. It is usually seen in children and young adults but may be congenital. Histologically, it shows a middermal cyst lined by squamous epithelium containing keratinous material and vellus hairs. It has a tendency to clear spontaneously but may be persistent. We report a case of congenital eruptive vellus hair cyst in an 11-year-old girl who presented multiple pinhead-sized brown to black papules on her anterior chest since birth.
Child ; Epithelium ; Female ; Follicular Cyst ; Hair* ; Humans ; Parturition ; Thorax ; Young Adult

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is highly prevalent in hospitals in Korea. The overall rate of MRSA in hospitals in Korea was estimated over 60%. Recently hospital infections caused by MRSA are getting increased and problematic in Korea, Our hospital Seoul Paik Hospital, has been trying to solve this problem. We had not applied exact methods for hospital infection control. Therefore, we adapted strict methods under the control of hospital infection control committee (HICC) and assessed the effectiveness of these methods. METHODS: Every month, the number of MRSA isolates was collected and analyzed; the results of the analysis were reported to every ward. All wards were supplied with Microshild(R) (Johnson & Johnson, Australia), Clean N' Fresh(R) (Carroll, USA), and standard paper towels. Health care workers were regularly educated for hospital infection control. The use of antibiotics was controlled by the HICC. We compared MRSA isolation rate between before and after applying the strict infection control methods under the regulation of HICC. Mann-Whitney U test, one-way ANOVA, and Chi-square test were used for statistical analysis of the results. RESULTS: After restricting the uses of antibiotics, glycopeptides and carbapenems were prescribed 15% less (20.3 vs 17.3 DDD /1000 patient-days) and 35% less (9.3 vs 6.0 DDD /1000 patient-days) respectively, compared to before restricting antibiotics. Methicillin resistance rate was decreased from 78% to 69% compared to before the methods(p=0.02). The isolation rate of MRSA was reduced by 31-42% from 2.33 to 1.35-1.60/1000 patient-days compared to before adapting strict infection control methods (p=0.04-0.07). CONCLUSION: This study showed that applying the strict infection control methods in the hospital can be effective to reduce the isolation rate of MRSA.
Anti-Bacterial Agents ; Carbapenems ; Cross Infection* ; Delivery of Health Care ; Dichlorodiphenyldichloroethane ; Glycopeptides ; Infection Control ; Korea ; Methicillin Resistance ; Methicillin* ; Methicillin-Resistant Staphylococcus aureus ; Seoul ; Staphylococcus aureus* ; Staphylococcus*