OBJECTIVE: The spot sign is related with the risk of hematoma expansion in spontaneous intracerebral hemorrhage (ICH). However, not all spot sign positive patients undergo hematoma expansion. Thus, the present study investigates the specific factors enhancing the spot sign positivity in predicting hematoma expansion. METHODS: We retrospectively studied 316 consecutive patients who presented between March 2009 to March 2011 with primary ICH and whose initial computed tomography brain angiography (CTA) was performed at our Emergency Department. Of these patients, 47 primary ICH patients presented spot signs in their CTA. We classified these 47 patients into two groups based on the presence of hematoma expansion then analyzed them with the following factors : gender, age, initial systolic blood pressure, history of anti-platelet therapy, volume and location of hematoma, time interval from symptom onset to initial CTA, spot sign number, axial dimension, and Hounsfield Unit (HU) of spot signs. RESULTS: Of the 47 spot sign positive patients, hematoma expansion occurred in 26 patients (55.3%) while the remaining 21 (44.7%) showed no expansion. The time intervals from symptom onset to initial CTA were 2.42+/-1.24 hours and 3.69+/-2.57 hours for expansion and no expansion, respectively (p=0.031). The HU of spot signs were 192.12+/-45.97 and 151.10+/-25.14 for expansion and no expansion, respectively (p=0.001). CONCLUSIONS: The conditions of shorter time from symptom onset to initial CTA and higher HU of spot signs are the emphasizing factors for predicting hematoma expansion in spot sign positive patients.
Angiography ; Blood Pressure ; Brain ; Cerebral Hemorrhage* ; Emergency Service, Hospital ; Hematoma* ; Humans ; Retrospective Studies

PURPOSE: A retrorectal developmental cyst (tailgut cyst, epidermoid cyst, dermoid cyst, teratoma, and duplication) is very rare disease, and the symptoms are not characteristic so that sometimes this disease is still misdiagnosed as a supralevator abscess or a complex anal fistula. We would like to present a clinical approach to this disease. METHODS: We retrospectively examined the charts of 15 patients who were treated for retrorectal cysts from January 2001 to November 2009. RESULTS: All 15 patients were female. The average age was 41 years (range, 21 to 60 years). Fourteen patients (93.3%) were symptomatic, and the most common symptom was anal pain or discomfort. Nine patients (60%) had more than one previous operation (range, 1 to 9 times) for a supralevator abscess, an anal fistula, etc. In 12 patients (80%), the diagnosis could be made by using the medical history and physical examination. Thirteen cysts (80%) were excised completely through the posterior approach. The average diameter of the cysts was 4.8 cm (range, 2 to 10 cm). Pathologic diagnoses were 8 tailgut cysts (53.3%), 5 epidermoid cysts (33.3%) and 2 dermoid cysts (13.3%). The average follow-up period was 18.3 months (range, 1 to 64 months). CONCLUSION: In our experience, high suspicion and physical examination are the most important diagnostic methods. If a female patient has a history of multiple perianal operations, a retrorectal bulging soft mass, a posterior anal dimple, and no conventional creamy foul odorous pus in drainage, the possibility of a retrorectal developmental cyst must be considered.
Abscess ; Adult ; Dermoid Cyst ; Drainage ; Epidermal Cyst ; Female ; Follow-Up Studies ; Humans ; Odors ; Physical Examination ; Rare Diseases ; Rectal Fistula ; Retrospective Studies ; Suppuration ; Teratoma

Eczema herpeticum is the dissemination of herpes simplex virus in the setting of a preexisting skin disease. Hailey- Hailey disease [familial benign chronic pemphigus] is a blistering dermatosis that is inherited as an autosomal dominant trait and it usually presents itself around the third or fourth decades. Coexistence of eczema herpeticum and Hailey-Hailey disease is an infrequent occurrence. Four such cases have been reported in the English and German medical literature. We report here on an unusual case of eczema herpeticum that coexisted with Hailey-Hailey disease in a 47 years old man and we review the relevant literatures.
Blister ; Eczema ; Kaposi Varicelliform Eruption ; Methylmethacrylates ; Pemphigus, Benign Familial ; Polystyrenes ; Simplexvirus ; Skin Diseases

Pyoderma gangrenosum is a rare destructive inflammatory skin disease. The lower extremities are most commonly affected, but the head and neck are rarely affected. We call the cases in which the head and neck are involved malignant pyoderma, which could be lethal. We report here on a case of malignant pyoderma in a 66-year-old man. His condition was markedly aggravatedin spite of the medical treatment. The lesions were improved by adjuvant surgery, including aggressive ulcer excision and grafting of autologous skin.
Aged ; Head ; Humans ; Lower Extremity ; Neck ; Pyoderma ; Pyoderma Gangrenosum ; Skin Diseases ; Transplants ; Ulcer

BACKGROUND: Malignant fibrous/fibrohistiocytic tumors are uncommon soft tissue tumors which gives dermatologists special attention on differential diagnosis. However, there has not yet been a multicenter study on these tumors in Korea. OBJECTIVE: The aim of this study was to investigate the epidemiology and clinical features of malignant fibrous/ fiborhistiocytic tumors. METHODS: A total of 62 patients from 11 training hospitals who had been confirmed with malignant fibrous/ fibrohistiocytic tumor were studied. A retrospective analysis of hospital records served as the data source for this study. RESULTS: Among patients with malignant fibrous/fibrohistiocytic tumors, the most common tumor type was dermatofibrosarcoma protuberance followed by malignant fibrohistiocytic. The male to female ratio among subjects was 1.38 to 1 and the mean age was 44 years old. Of the common complaints recorded, asymptomatic mass was the most frequent. The mean size of the subjects' tumors was 2.9 cm in the long axis and 2.3 cm in the short axis with a mean tumor thickness of 2.1 mm. The most common site for tumors was the back followed by the thigh. The recurrence rate after primary treatment was 14.5% and metastasis developed in 5 of 62 patients. CONCLUSION: This study is expected to be helpful for understanding the clinical and pathological characteristics of malignant fibrous/fibrohistiocytic tumors.
Axis, Cervical Vertebra ; Information Storage and Retrieval ; Dermatofibrosarcoma ; Diagnosis, Differential ; Female ; Hospital Records ; Humans ; Korea ; Male ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Thigh

BACKGROUND: As the proportion of old-aged people is currently increasing, the incidence of herpes zoster is also increasing. Yet there has not been any report on the epidemiology of herpes zoster in the Province of Chungcheongnam-do. OBJECTIVE: The purpose of this study was to determine the epidemiological and clinical characteristics of herpes zoster in the Province of Chungcheongnam-do. METHODS: The authors retrospectively evaluated 915 cases of herpes zoster with regard to the annual, monthly and seasonal incidences, the age and gender ratios, the associated conditions, the anatomical distribution and the complications at the Department of Dermatology in Soonchunhyang University hospital in Cheonan during 3 years from 2004 to 2006. RESULTS: The results were as follows: The annual rate of new outpatients at our dermatology clinic ranged from 1.6% to 1.9% (mean: 1.7%), and the ratio of males to females was 0.74:1. The peak incidence on monthly analysis was in August and the lowest incidence on the monthly and seasonal analysis were in February and winter for the herpes zoster inpatients. Herpes zoster was seen most frequently in the over 70 year-old group (38.0%). The most frequent involved dermatome of the herpes zoster inpatients was the thoracic dermatome (35.4%) and others included the trigeminal (26.9%), lumbar (13.8%), cervical (11.5%) and sacral (2.7%) areas. 26 (8.8%) patients had disease involving 2 different dermatomes. Of the 297 herpes zoster inpatients, associated conditions were observed for 167 patients (56.2%); hypertension (32.1%), diabetes (17.5%), malignancy (10.4%), asthma (7.5%) and so on. Complications were observed for 121 (40.7%) inpatients and the most common complication was postherpetic neuralgia (30.0%), followed by secondary bacterial infection (9.8%), ophthalmologic complications (7.7%), neurogenic bladder (1.4%) and so on. CONCLUSION: The results of our study showed higher proportions of females and old-age people with herpes zoster and a higher proportion of old-age people with postherpetic neuralgia.
Asthma ; Bacterial Infections ; Dermatology ; Female ; Herpes Zoster ; Humans ; Hypertension ; Incidence ; Inpatients ; Male ; Neuralgia, Postherpetic ; Outpatients ; Retrospective Studies ; Seasons ; Urinary Bladder, Neurogenic

Neurofibromatosis is an autosomal dominant hereditary disorder with an overall incidence of one in 3,000~4,000, and type 1 (Von Recklinghausen's neurofibromatosis) characterized by the presence of multiple cutaneous neurofibromas, axillary and groin freckling, and cafe- au-lait spot. The neurofibromatosis type 1 gene is a tumor suppressor gene. Patients with the neurofibromatosis type 1 are at increased risk of developing nervous system neoplasm, including plexiform neurofibromas, optic gliomas, ependymomas, meningiomas, astrocytomas, and pheochromocytomas. Neurofibromas may undergo secondary malignant degeneration and sarcomatous changes. Patients with neurofibromatosis type 1 show a high incidence of Wilm's tumor, rhabdomyosarcoma, nonlymphocytic leukemia, and pheochromocytoma but the gastrointestinal involvement appears to be relatively rare and usually consists of neurofibroma, ganglioneuroma, and leiomyoma. We have identified a case of early gastric adenocarcinoma and intraabdominal schwannoma in a 65-year-old man afflicted with neurofibromatosis type 1.
Adenocarcinoma* ; Aged ; Astrocytoma ; Ependymoma ; Ganglioneuroma ; Genes, Tumor Suppressor ; Groin ; Humans ; Incidence ; Leiomyoma ; Leukemia ; Meningioma ; Nervous System Neoplasms ; Neurilemmoma* ; Neurofibroma ; Neurofibroma, Plexiform ; Neurofibromatoses* ; Neurofibromatosis 1* ; Optic Nerve Glioma ; Pheochromocytoma ; Rhabdomyosarcoma ; Wilms Tumor

Hobnail hemangioma is a benign vascular tumor that typically presents as a small, single lesion on the skin of the trunk or limb. It occurs mainly in young or middle-aged adults (mean age: 30 years) but rarely in childhood. Histologically, hobnail hemangioma is characterized by a biphasic growth pattern, with dilated vascular spaces lined by hobnail endothelial cells in the superficial dermis, and collagen dissection narrow vascular channels in the deeper dermal parts, as well as inflammatory aggregates, fibrosis, and hemosiderin deposits. We report a case of hobnail hemangioma in a 10-year-old girl who had a violaceous papule surrounded by an ecchymotic halo on the left thigh. She underwent treatment with surgical excision with primary closure. To the best of our knowledge, our case is the first reported case of childhood hobnail hemangioma in Korean dermatological literatures.
Adult ; Child ; Collagen ; Dermis ; Endothelial Cells ; Extremities ; Female ; Fibrosis ; Hemangioma* ; Hemosiderin ; Humans ; Skin ; Thigh

OBJECTIVE: The aim of our study was to compare the accuracy of CT and 18F-FDG PET for detecting peritoneal metastasis in patients with gastric carcinoma. MATERIALS AND METHODS: One-hundred-twelve patients who underwent a histologic confirmative exam or treatment (laparotomy, n = 107; diagnostic laparoscopy, n = 4; peritoneal washing cytology, n = 1) were retrospectively enrolled. All the patients underwent CT and 18F-FDG PET scanning for their preoperative evaluation. The sensitivities, specificities and accuracies of CT and 18F-FDG PET imaging for the detection of peritoneal metastasis were calculated and then compared using Fisher's exact probability test (p < 0.05), on the basis of the original preoperative reports. In addition, two board-certified radiologists and two board-certified nuclear medicine physicians independently reviewed the CT and PET scans, respectively. A receiver-operating characteristic curve analysis was performed to compare the diagnostic performance of CT and 18F-FDG PET imaging for detecting peritoneal metastasis. RESULTS: Based on the original preoperative reports, CT and 18F-FDG PET showed sensitivities of 76.5% and 35.3% (p = 0.037), specificities of 91.6% and 98.9% (p = 0.035), respectively, and equal accuracies of 89.3% (p = 1.0). The receptor operating characteristics curve analysis showed a significantly higher diagnostic performance for CT (Az = 0.878) than for PET (Az = 0.686) (p = 0.004). The interobserver agreement for detecting peritoneal metastasis was good (κ value = 0.684) for CT and moderate (κ value = 0.460) for PET. CONCLUSION: For the detection of peritoneal metastasis, CT was more sensitive and showed a higher diagnostic performance than PET, although CT had a relatively lower specificity than did PET.
*Tomography, Emission-Computed ; Stomach Neoplasms/*pathology ; Sensitivity and Specificity ; Retrospective Studies ; Radiopharmaceuticals/diagnostic use ; ROC Curve ; *Positron-Emission Tomography ; Peritoneal Neoplasms/*radiography/*radionuclide imaging/*secondary ; Middle Aged ; Male ; Iohexol/analogs & derivatives/diagnostic use ; Humans ; Fluorodeoxyglucose F18/diagnostic use ; Female ; Contrast Media ; Aged, 80 and over ; Aged ; Adult ; Adolescent

The anal canal is the most distal part of the gastrointestinal tract, and it is developed and formed during the embryonic period. Infection is the most common disease process that occurs around the anorectum, yet tumors or cysts are occasionally encountered. The abnormal development of these parts of the gastrointestinal track during the embryonic period can result in congenital lesions that are discovered in young children or adults. A 72-year-old woman presented to us with postprandial lower abdominal discomfort and fecal incontinence. An anorectal mass was felt on the rectal examination. The colonoscopy demonstrated a submucosal tumor that was closely located to the anorectal junction. The tumor was excised with a snare and it was diagnosed as an analgland cyst due to the histologic features. It is necessary to differentiate anal gland cyst from the other diseases that have submucosal characters, such as carcinoid tumor.
Child ; Adult ; Male ; Female ; Humans ; Cysts