No abstract available.
Pancreaticoduodenectomy*

It is generally recognized that several chemical mediators are involved in tbe pathogenesis of sunbum; however, the exact mechanism is still to he resolved. Recently, prostaglandin has been found to be one of the inflammatory mediators in sunbum, particularly in the delayed erythema response and several investigators have shown that the nonsteroidal antiinflammatory drugs inhibit the in vivo synthesis of prostaglandin. On the assumption that the nonsteroidal antiinflammatory drugs might exert a beneficial effect on the sunbum through the antiprostaglandin effect, several authors have reported the effect of indomethacin on sunbum. This study was undertaken to evaluate the effect of topical indomethacin on the delayed erythema response induced by artificial sunlamp and sunlight by clinical and histopathological examination. Indomethacin(2. 5% ointment, 2. 5% solution, 5% solution) was applied immediately after 3 MED irradiation of artificial sunlamp to the shaved back skin of 6 healthy albino guinea pigs weighing 550-850gm and 9 human volunteers and the delayed erythema response was observed at 2, 4, 6, 12, 24 and 48 hours after irradiation respectively. Punch biopsies of the skin were performed on 6 guinea pigs at 6, 12, 24 a.nd 48 hours after irradiation and the histologic changes were observed. Four human volunters were exposed t,o 3 MED of sunlight and indomethacin preparations were applied immediately after irradiation. The delayed erythema response was observed at 2, 4, 6, 12, 24 and 48 hours postirradiation and in one volunteer, the skin was biopsied at 24 hour for histologi.c evaluation. The results were as follows: 1. Topical indomethacin in ointment or solution forms delayed and decreased the appearance and degree of erythema induced by sunlight and artificial sunlamp in both human and animal subjects. 2. Histologically, the number of sunbum cells at 24 hour in the epidermis of one human volunteer was decreased on indomethacin applied sites. The dermis showe6 no difference in histologic changes between control and indomethacin sitea. In animal study, however, no detectable difference in epidermal or dermal changes was observed between control and indomethacin applied sites. The autors confirmed that topical indometha,cin was effective in delaying and blanching of the delayed erythema of sunbum in guinea pigs as well as in human volunteers, though there was no difference in histologic changes between indomethacin and control sites in guinea pigs. The mechanism involvel on this aspect is remained to be resolved.
Animals ; Biopsy ; Dermis ; Epidermis ; Erythema ; Guinea Pigs ; Healthy Volunteers ; Humans ; Indomethacin* ; Research Personnel ; Skin ; Sunburn* ; Sunlight ; Volunteers

BACKGROUND AND OBJECTIVES: Studies in patients with mitral valve prolapse syndrome (MVPS) have shown the coexistence of various forms of autonomic dysfunction, and so this is an area that requires further investigation. METHODS AND MATERIALS: The study group consisted of 65 patients (36 men and 29 women), aged 16 to 43 years (mean+/-SD, 28+/-8) with symptomatic, echocardiographically proven mitral valve prolapse (MVPS) who were free of other organic heart diseases and arrhythmias. In a prospective study, heart rate variability (HRV) indexes were calculated from 24-hour Holter recordings obtained during normal daily activity and plasma norepinephine was measured, and then these data were compared among the study group according to clinic heart rate (HR). RESULTS: The study group was divided into below 60 bpm (group 1: n=13), 60 - 80 bpm (group 2: n=36) and over 80 bpm (group 3: n=16) on the basis of clinic HR. These patient groups were matched with respect to age and gender. There were significant difference in SDNNIDX, rMSSD and pNN50 between these groups (p=0.005, 0.009 and 0.002 respectively), and these HRV measures correlated inversely with clinic HR (p<0.01). As clinic HR increased, there was a tendency for plasma norepinephrine concentration to also rise (p<0.05), but there was no statistical significant difference between these groups. CONCLUSION: Our data suggests that MVPS may have subgroups of HRV, reflecting cardiac autonomic modulation, according to clinic HR.
Arrhythmias, Cardiac ; Heart Diseases ; Heart Rate* ; Heart* ; Humans ; Male ; Mitral Valve Prolapse* ; Mitral Valve* ; Norepinephrine ; Plasma ; Prospective Studies

Ovarian tumor in pregnancy is not rare and benign cystic teratoma is most common ovarian tumor in pregnancy. Most ovarian tumor in pregnancy is found at first and second trimester but sometimes found at third trimester and it is difficult to make a decision for management. Moreover physician should consider fetal age and mother's condition, and weigh outcome of operation for complicated ovarian tumor in pregnancy. Torsion of ovarian tumor is not an uncommon complication during first trimester of pregnancy and puerperium but rare occurs during the third trimester of pregnancy. We have experienced a case of torsion of benign cystic teratoma of ovary which occurred at 37 weeks gestation in a 25 year-old woman. So we report this case with a brief review of literature.
Adult ; Female ; Gestational Age ; Humans ; Impetigo* ; Ovary ; Postpartum Period ; Pregnancy Trimester, First ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third ; Pregnancy* ; Teratoma

Osteoblastoma is a rare tumor which forms osteoid and bone with highly vascular stroma, account for less than 1 percent of all bone tumors. The lesion had been thought to be controlled with curettage and locat excision. In recent years, cases of locally aggressive but not metastasizing osteoblastomas have been described as aggressive osteoblastoma or malignant osteoblastoma, separated from the innocuous behavior of usual osteoblastoma. It represents the histologic characteristics of the presence of epithelioid osteoblasts, trabecular rather than lace-like osteoid, low mitotic rate with no atypical form with prominent giant cells of osteoclastic type The differential diagnosis between aggressive osteoblastoma and osteogenic sarcoma is extremely difficult, but its peculiar histologic pattern and ist different clinical and radiologic features and better prognosis are helpful. We report here a case of aggressive osteoblastoma of 17 years old female patient with 2 years and 5 months follow-up period and review the literature.
Female ; Humans ; Diagnosis, Differential

OBJECTIVES: The myelodysplastic syndromes (MDS) are a group of acquired clonal hematopoietic disorders characterized by peripheral cytopenias and a hypercellular or normocellular dysplastic bone marrow. The mechanisms responsible for development of MDS are not known. We performed this study to evaluate the hematopoietic abnormalities and apoptosis in MDS. METHODS: Long-term bone marrow culture (LTBMC) was performed for colony assays, cobblestone area assay, stromal morphologic changes from 7 patients with MDS and 7 normal controls. In situ nick end labeling (ISNEL) method was performed for detection of apoptosis from LTBMC in 7 patients with MDS and 7 normal controls. ISNEL method also performed in bone marrow cell bloc samples in 36 patients with MI3S. RESULTS: Viability of nonadherent cells from LTBMC of patients with MDS was not decreased compared with normal controls at 1 week, but significantly decreased at 2 and 3 weeks compared with normal controls (P<0.0001). Formation of the cobblestone areas from patients with MDS was slightly decreased compared with normal controls at 1st week, but significantly decreased at 2nd and 3rd weeks compared with normal controls (P<0.0001). Slightly decreased compared with normal controls at 1 week, but significantly decreased at 2 and 3 weeks compared with normal controls (P<0.0001). Stromal layers produced in LTBMC of normal controls and 1 patient with MDS were detected at 1 week and were formed confluent stroma from 3 weeks, but another patients with MDS who did not form a confluent stroma. Patients with MDS had significantly lower colony forming unit granulocyte-macrophage (CFU-GM) compared with normal controls at 1 (P<0.01) and 2 weeks (P<0.001) of LTBMC. Two weeks of LTBMC resulted more profound inhibition of CFU-GM formation than 1 week (P<0.0001). Apoptotic cell death was absent in adherent and non adherent cells from normal controls at 1 and 2 weeks, but massive apoptotic cell death was found in adherent and non adherent cells from patients with MDS at 1 and 2 weeks and the degree of apoptosis was profound at 2 weeks compared with 1 week. Among the 36 patients, fifteen patients demonstrated varying degrees of apoptosis positive cells, 4 having low, 8 intermediates, and 3 high scores. Remaining 21 patients showed absent apoptosis or only occasional positive cells. CONCLUSION: Hematopoietic abnormalities such as a failure of differentiation are caused by the stromal defects and the biologic basis of the apparent paradox of peripheral cytopenias in the face of hypercellular (or normocellular) marrow is related by intramedullary apoptotic cell death of the stromal and hematopoietic cells.
Apoptosis* ; Bone Marrow Cells ; Bone Marrow* ; Cell Death ; Granulocyte-Macrophage Progenitor Cells ; Humans ; In Situ Nick-End Labeling* ; Myelodysplastic Syndromes* ; Stem Cells

Pressure sores are common complications in patients with spinal injuries or cerebrovascular accidents. The management of pressure sores requires prolonged hospitalization and repeated surgical interventions with a high recurrence rate. Particularly osteomyelitis following initial pressure sores persistently complicates wound healing and recovery. Furthermore, it may also ultimately result in serious sepsis; thus an early diagnosis of osteomyelitis in pressure sore patients is crucial along with appropriate surgical and antibiotic therapy. Although many diagnostic methods were reported, there is no single 'gold' standard for early diagnosis of pressure sore-associated osteomyelitis. Authors reviewed pre-operative CBC, plain X-ray, Tc-99m bone scan, and post-operative biopsy results in 37 patients who had received surgical treatment for pressure sores in a 5-year period from September 1991 to August 1996. Based on these reviews, authors compared and analyzed the sensitivity and specificity in diagnosing osteomyelitis.The results were as follows: 1. Of 37 patients studied, 25 cases were confirmed histologically as osteomyelitis. Ischial region revealed the highest incidence of pressure sore-related osteomyelitis(78%, 14 out of 18 cases) while the regional incidence was as following in descending order : ischial, sacral, and greater trochanteric area. 2. Tc-99m bone scan had superior sensitivity(100%) and specificity(83%) to other pre-operative studies in diagnosing osteomyelitis.In conclusion, authors suggest that Tc-99m bone scan is the best diagnostic method because of its high sensitivity and specificity if osteomyelitis is clinically suspected in pressure sore patients. And in case the test result is positive, agressive surgical bone resection and appropriate antibiotic therapy based on bacterial culture from deep bone specimen should be combined to prevent complications or recurrences.
Biopsy ; Early Diagnosis ; Femur ; Hospitalization ; Humans ; Incidence ; Osteomyelitis ; Pressure Ulcer* ; Recurrence ; Sensitivity and Specificity ; Sepsis ; Spinal Injuries ; Stroke ; Wound Healing

Complications after a median sternotomy incision, which is used currently in most open heart surgery, are serious, although it is infrequent. Reconstruction of the sternal defect resulting from dehiscence of median sternotomy is still big challenge to the most plastic surgeons. Since vascularized greater omentum was transposed to eliminate mediastinal wound problems, many vascularized regional muscle flaps became mainstay in reconstruction of median sternotomy wound. We treated 13 patients with median sternotomy dehiscence between October of 1993 and March of 1998. In two patients, the wound problems were so confined to superficial tissue that debrided and closed primarily. Eleven patients with deep wound infection were managed with vigorous debridement of all necrotic tissues and resultant defects were covered with regional muscle flaps: rectus myocutaneous flap(3) and bilateral pectoralis advancement flap(8). We used the pectoralis major advancement flaps without counter incision at humeral insertion site and the dissections were limited only medial to the anterior axillary line to preserve the axillary fold. In five patients with larger defects, we elevated muscle and cutaneous flaps separately to make these flaps more mobile. Large portion of two rectus abdominis flaps could not survive, whereas pectoralis advancement flaps had mo special wound problems. Only one patient developed fistula due to remained wire, regardless to flap surgery.
Debridement ; Fistula ; Humans ; Omentum ; Rectus Abdominis ; Sternotomy* ; Thoracic Surgery ; Wound Infection ; Wounds and Injuries

A 69-year-old-male patient was admitted because of left upper quadrant (LUQ) abdominal pain He had hard palpable mass (abaut 15x l0cm) in LUQ abdomen and mild elevated serum alkaline phosphatase (349 IU/L) and amylase (216 U/L) levels at the admission time. Abdominal CT scan revealed huge, well-marginated cystic mass in enlarged spleen with increased densities in dependent portion of cystic mass, about 8x13cm in size. Another small well-capsulated. cystic mass in anterior aspect of spleen was also seen. After ERCP, urgent surgical intervention was done. Final diagnosis was chronic pancreatitis with large intrasplenic (l2x9.5 cm) and retroperitoneal pseudocysts. So we are reporting above case with pertinent review of literatures.
Abdomen ; Abdominal Pain ; Alkaline Phosphatase ; Amylases ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis ; Humans ; Pancreatitis, Chronic* ; Spleen ; Splenomegaly ; Tomography, X-Ray Computed

Benzoyl peroxide has been known to have bacteriostatic activity against Corynebacterium acnes and to have comedolytic action in patients with acne vulgaris. The present study was undertaken to evaluate the therapeutic effect of Renoxal, a 5% benzoyl peroxide lotion, in patients with acne vulgaris. A total of 35 patients entered this study at the Department of Dermatology, Seoul National University Hospital during the five months period from March to July, 1978. All patients were instructed to apply Benoxal on their affected sites once or twice daily; and the number of lesions on three fixed areas were counted before and every week for four weeks after the treatrnent. Two female patients stopped the application due to developrnent of contact dermatitis to Benoxal The results observed in the 33 patients were as follows: 1. The percentage decrease in total number of lesions in four weeks after treatment was 51.1% 2. Closed and open comedones were gradually eliminated; and their numbers were decreased in four weeks after treatment by 45. 8% and 55. 3% respectively. The papules were decreased. by 59. 1 @2 after the first week of treatment, but showed. a transient lag around tbe second week and then marked 61. 5% in four weeks after treatment. 3. Observed side effects included burning sensation,(3 cases), tightness (3 cases), itching sensation (2 cases) and scaling (1 case). All were tolerable without any specific measure or discontinuance of the application. The authors concluded througb this experiment that Benoxal (5% benzoyl peroxide lotion) is a very effective local therapeutic agent in the treatment of acne vulgaris patients.
Acne Vulgaris* ; Benzoyl Peroxide ; Burns ; Dermatitis, Contact ; Dermatology ; Female ; Humans ; Propionibacterium acnes ; Pruritus ; Sensation ; Seoul ; Thiram