Tension pneumothorax during one-lung ventilation is an insidious, life threatening emergency. Even though early diagnosis and rapid intervention are necessary to prevent mortality, treatment may be difficult because of the clinical diagnosis-mediastinal shift, hypoxemia, hypotension and increased airway pressure may be confusing in the operative setting. We present here the case of a patient who underwent right thoracotomy with one-lung ventilation and the patient developed left tension pneumothorax with resulting cardiac arrest.
Anoxia ; Early Diagnosis ; Emergencies ; Heart Arrest* ; Humans ; Hypotension ; Mortality ; One-Lung Ventilation ; Pneumothorax* ; Thoracotomy*

BACKGROUND: The development of androgenetic alopecia is thought to be caused by increased androgen action on the hair follicles in the genetically predisposed person. Although most reports about dehydroepiandrosterone sulfate(DHEA-S) and total testosterone in female androgenetic patients are within normal limits, there are some controversies about comparing the mean values of the patients with those of the normal control group. OBJECTIVE: The purpose of this study was to compare the mean value of plasma DHEA-S and total testosterone of the patients with those of normal controls according to their ages, and evaluate relations between hormone levels and clinical type and hyperandrogenic symptoms(HAS). METHOD: We examined 60 female patients with androgenetic alopecia for clinical types, symptoms, family histories, and other systemic diseases. The mean value of the patients were compared with those of 42 normal controls according to ages, clinical types, and HAS. RESULTS: 1. Forty two cases(70.0%) were Ludwig type I, 16 cases(26.7%) were type II, 2 cases(3.3%) were type III. 26 cases(43.3%) were between 20-29 years, 19 cases(31.7%) were between 30-39 years. 2. Common age of onset was between 20-29years(23 cases, 38.3%) and below 19 years old(21 cases, 35.0%). 3. There were 32 cases(53.3%) who showed HAS and seborrhea was the most common symptom (20 cases). 4. There were 33 cases(55.0%) who showed a family history and the father was the most common relative(19 cases). Family history of first degree relative was 31 cases(51.7%). 5. Plasma DHEA-S levels of both patients and control group were all within normal limits, and there were no significant differences in the mean values between the patients ( 1633.03+/-736.31 ng/ml) and normal controls(1764.72+/-690.94 ng/ml). There were also no difference between the patients and controls according to their ages. 6. In total testosterone, 7 out of 60 patients and 3 out of 42 normal controls were beyond the normal limit and there were no significant differences in the mean values between the patients(0.548+/-0.386 ng/ml) and normal controls(0.563+/-0.501 ng/ml). There were also no differences between the patients and controls according to their ages. 7. There was no significant difference in the mean value of DHEA-S and total testosterone among type I, types II & III, and normal controls. 8. There was no significant difference in the mean value of DHEA-S and total testosterone among patients with HAS, without HAS, and normal controls. CONCLUSION: There were no significant differences in the mean values of plasma DHEA-S and total testosterone between the patients and normal controls and no significant differences in the mean values of hormone levels according to clinical type and HAS.
Age of Onset ; Alopecia* ; Dehydroepiandrosterone Sulfate* ; Dehydroepiandrosterone* ; Dermatitis, Seborrheic ; Fathers ; Female* ; Hair Follicle ; Humans ; Plasma ; Testosterone*

BACKGROUND: Sensitive skin has been described as a skin type showing higher reactivity than normal skin and developing exaggerated reactions when exposed to internal stimulants and external irritants. The lactic acid sting test is widely accepted as a marker of skin sensitivity and employed for the selection of subjects experiencing invisible sensory irritation. OBJECTIVE: To carry out an epidemiological study to assess the prevalence and possible related factors of sensitive skin in a regional population, and to examine the relationship between sensitive skin and subjective irritation using the lactic acid sting test. METHODS: A total of 514 people responded to self-assessment questionnaires composed of questions about the self-perception, related factors, symptoms and signs of sensitive skin. We assessed subjective irritation using the lactic acid sting test in 54 volunteers. RESULTS: The results are summarized as follows: 1. The incidences of self-reported sensitive skin were 55.7% for women, 38.9% for men and 51.0% for all responders. 2. The family history and seasonal variation of sensitive skin were significantly more common in sensitive skin group. 3. The face especially the cheek area was the most sensitive portion of body, cosmetics were common irritants. 4. The lactic acid stinging scores were significantly higher in the sensitive skin group. CONCLUSION: Our survey indicated that sensitive skin is a common problem for people and a complex problem with genetic, individual, environmental implications and the lactic acid sting test is a valuable method to define skin sensitivity.
Bites and Stings* ; Cheek ; Epidemiologic Studies ; Female ; Humans ; Incidence ; Irritants ; Lactic Acid* ; Male ; Patient Selection ; Prevalence ; Seasons ; Self Concept ; Self-Assessment ; Skin* ; Volunteers ; Surveys and Questionnaires

BACKGROUND: Cerebral white matter change (WMC) is usually seen in stroke patients. This study was aimed at determining whether there might be a relationship between the extent of WMC and whether to control hypertension or not and the frequency of previous stroke lesion. Stroke subtypes were also analyzed to elucidate WMC distribution. METHODS: We investigated demographic features, vascular risk factors, subtypes, and WMC in 339 ischemic stroke patients over forty years of age who had brain MRI from the Hallym Stroke Registry between January 1998 and December 2001. In hypertension, it was divided into with therapy and with no therapy. In frequency of previous stroke lesion, we subdivided the patients into three groups by number of frequency: 0, 1, and >or=2. Stroke subtypes were classified into large artery atherosclerosis (LAA), small artery occlusion (SAO), cardioembolism (CE), and stroke of undetermined etiology (SUE). WMC was quantitatively estimated by subdividing into 5 grades (0~IV). RESULTS: Age, female, hypertension, previous stroke lesion, and SAO correlated significantly with prevalence of WMC (p<0.001, =0.002, <0.001, <0.001 and <0.001, respectively). In hypertension, there was significant difference between normotensive and hypertensive (p=0.001). But there was no statistical difference between with therapy and with no therapy (p>0.05). In previous stroke lesion, it showed significant difference between 0 and (1 and >or=2) (p<0.001) and between 1 and >or=2 (p<0.001). In subtype, CE also correlated significantly with prevalence of WMC as well as SAO than LAA (p<0.001). CONCLUSIONS: WMC seen in patients with stroke is related with small-vessel disease and is mainly affected by age, female, hypertension, and previous stroke lesion.
Arteries ; Atherosclerosis ; Brain ; Female ; Humans ; Hypertension ; Magnetic Resonance Imaging ; Prevalence ; Risk Factors* ; Stroke*

Implant success is achieved by the synergistic combination of numerous biomechanical factors. This report examines the mechanical aspect of implants. In particular, it is focused on macrodesign such as thread shape, pitch, width and depth, and crestal module of implants. This study reviews the literature regarding the effect of implant thread geometry on primary stability and osseointegration under immediate loading. The search strategy included both in vitro and in vivo studies published in the MEDLINE database from January 2000 to June 2014. Various geometrical parameters are analyzed to evaluate their significance for optimal stress distribution, implant surface area, and bone remodeling responses during the process of osseointegration.
Bone Remodeling ; Dental Implants ; Osseointegration*

Kaposi's varricelliform eruption is a characteristic syndrome of disseminated vesiculopustules superimposed on variable pre-existing dermatoses. Among these, atopic dermatitis is most common disease. We report two cases of Kaposi's varicelliform eruption associated with atopic dermatitis in a pair of identical twins. Diagnosis was made by the history, clinical feature, histologic examination and serologic test. These patients' condition was much improved by the treatment with antiviral agent and antibiotics.
Anti-Bacterial Agents ; Dermatitis, Atopic ; Diagnosis ; Humans ; Kaposi Varicelliform Eruption* ; Serologic Tests ; Skin Diseases ; Twins, Monozygotic*

Febrile ulceronecrotic pityriasis lichenoides et varioliformis acuta (PLEVA) is a very rare cutaneous disorder clinically characterized by the acute onset of erythematous papules, vesicles and large coalescent ulceronecrotic lesions on the whole body accompanied by high fever and severe constitutional symptoms. In general, ulceronecrotic lesion is preceded by a typical rash of PLEVA. Histopathologically, it shows widespread epidermal necrosis and fibrinoid necrosis of blood vessel walls in addition to the superficial and deep perivascular lymphocytic infiltrations. Several regimens including systemic corticosteroid, antibiotics, methotrexate or ultraviolet therapy have been challenged in this disorder . We report a typical case of febrile ulceronecrotic PLEVA in a 10-year-old child who showed a dramatic response to methotrexate.
Anti-Bacterial Agents ; Blood Vessels ; Child* ; Exanthema ; Fever ; Humans ; Methotrexate ; Necrosis ; Pityriasis Lichenoides* ; Pityriasis* ; Ultraviolet Therapy

Blue nevus may rarely appear in a plaque form. Because of its rarity and unusual appearance, this nevus may present a diagnostic problem and gives no definite prognosis. We report a case of plaque -type blue nevus in a 25-year-old man. He presented an irregularly demarcated plaque, measuring 1.5 x 3 cm, composed of multiple grouped slate gray to blue papules of varying size with intervening faint gray-blue discoloration on the back, which had existed for 10 years. Histopathological examination showed clumps of numerous heavily melanin-laden dendritic melanocytes in the reticular dermis with intervening stromal fibrosis. Numerous melanophages were intermingled with the melanocytes. There were no islands of pale cells seen in the cellular blue nevus and no malignant changes such as nuclear and cytoplasmic pleomorphism, mitotic figures and so on. The diagnosis of plaque-type blue nevus was made and its histopathological features were consistent with a common blue nevus.
Adult ; Cytoplasm ; Dermis ; Diagnosis ; Fibrosis ; Humans ; Islands ; Melanocytes ; Nevus ; Nevus, Blue* ; Prognosis

OBJECTIVES: Compliance with continuous positive airway pressure (CPAP) treatment remains a primary concern for improving treatment outcomes of obstructive sleep apnea. There are few studies that have considered the role of upper airway anatomy on the compliance with CPAP. We hypothesized that upper airway anatomy would influence the compliance with CPAP. METHODS: One hundred out of 161 consecutive patients were enrolled in this study. The following possible determinants were tested against CPAP use: demographic and anthropometric data, minimal cross-sectional area on acoustic rhinometry, cephalometric and polysomnographic data, questionnaires of Epworth sleepiness scale and Beck depression index, and histories of previous upper airway surgery, degree of nasal obstruction, daily cigarette consumption, and weekly frequency of alcohol intake. RESULTS: Univariate analysis showed that histories of previous upper airway surgery and less frequent alcohol consumption, and longer mandibular plane-hyoid length (MP-H) on cephalometry were associated with longer average daily CPAP use. After adjustment for the confounding factors with multiple linear regression analysis, alcohol consumption and MP-H were still associated with the compliance with CPAP significantly. CONCLUSION: To improve compliance with CPAP, careful evaluations of upper airway problems and life style are important before initiating CPAP.
Alcohol Drinking* ; Cephalometry ; Compliance* ; Continuous Positive Airway Pressure* ; Depression ; Humans ; Life Style ; Linear Models ; Nasal Obstruction ; Rhinometry, Acoustic ; Sleep Apnea, Obstructive ; Tobacco Products

PURPOSE: This study was performed to investigate clinical findings of acute neurologic complications and risk factors for chronic neurologic complications of bacterial meningitis in children. METHODS: Pediatric patients with community acquired bacterial meningitis diagnosed at Seoul National University Children's Hospital and Bundang Seoul National University Hospital were included. We investigated the relative frequency of neurologic complications and distribution of causative organisms. Chronic neurologic complication was defined as persistent neurologic deficit including recurrent seizures 6 months from the diagnosis. Multiple logistic regression analysis was used to identify risk factors for epilepsy and motor deficits, which were the most frequently reported chronic neurologic complications. RESULTS: A total of 90 cases were included in the study. Thirteen cases with less than 6 months follow-up duration were excluded from the analysis of risk factors for chronic neurologic complications. The mean age at diagnosis was 15.6 months. Streptococcus agalactiae was the most common pathogen accounting for 27 cases, followed by Streptococcus pneumoniae (19 cases), Hemophilus influenzae type b (13 cases), and Neisseria meningitidis (12 cases). Acute neurologic complications were found in 28 cases (31%): cerebral infarction in 16 cases, subdural effusion in 15 cases, and hydrocephalus in 9 cases. Chronic neurologic complications were found in 41 (53%) cases: epilepsy in 28 cases, motor deficit in 16 cases, hearing loss in 6 cases, and cognitive impairment in 4 cases. Cerebral infarction and S. pneumoniae infection were identified as risk factors for epilepsy. Cerebral infarction was a unique risk factor for motor deficit. CONCLUSION: Cerebral infarction is the important risk factor for the development of chronic neurologic complications including epilepsy and motor deficit in pediatric patients with bacterial meningitis.
Accounting ; Cerebral Infarction ; Child ; Epilepsy ; Follow-Up Studies ; Haemophilus influenzae type b ; Hearing Loss ; Humans ; Hydrocephalus ; Logistic Models ; Meningitis, Bacterial ; Neisseria meningitidis ; Neurologic Manifestations ; Pneumonia ; Risk Factors ; Seizures ; Streptococcus agalactiae ; Streptococcus pneumoniae ; Subdural Effusion