Herpes zoster involving noncontiguous dual dermatomes is very rare in both immunocompetent and immunocompromised persons. This unique presentation has been referred to as zoster duplex unilateralis or bilateralis, depending whether one or both halves of the body are involved. A 22-year-old woman, who had been treated for acute leukemia, congestive heart failure and chronic disseminated candidiasis, was referred to our department for painful papulovesicular eruptions on the right side of the anterior chest and upper back for 2 days, and the left buttock for 1 day. Tzanck smear revealed multinucleated giant cells with intranuclear inclusion bodies. We report a rare case of zoster duplex bilateralis.
Buttocks ; Candidiasis ; Female ; Giant Cells ; Heart Failure ; Herpes Zoster* ; Humans ; Intranuclear Inclusion Bodies ; Leukemia ; Thorax ; Young Adult

Eosinophilia-myalgia syndrome(EMS) is a systemic illness that occurred as an epidemic by ingestion of over-the counter L-tryptophan preparation in the United States in October 1989. We report a Korean case of EMS not associated with the ingestion of either L-tryptophan or other nutritional supplements such as lysine and niacin.
Eating* ; Eosinophilia-Myalgia Syndrome* ; Lysine ; Niacin ; Tryptophan ; United States

Idiopathic atrophoderma of Pasini and Pierini(IAPP) is an uncommon condition of unknown etiology and typically affects persons in the second and third decades of life. IAPP consists of asymptomatic grey to brown depressed lesions with "cliff drop" borders, which are usually bilateral and located on the trunk. A 40-year-old woman visited our department because of unilateral atrophic lesions on the abdomen, right arm, and posterior aspect of right thigh for 20 years. Laboratory evaluations were normal and histologic examination revealed significantly decreased thickness in dermis. We report an unusual case of idiopathic atrophoderma of Pasini and Pierini presenting unilateral distribution.
Abdomen ; Adult ; Arm ; Dermis ; Female ; Humans ; Thigh

BACKGROUND: Tourniquet pain is probably mediated by C-fiber. The ability of fentanyl to interrupt this nociceptive conduction was studied by administering either fentanyl or saline intrathecally along with hyperbaric bupivacaine for spinal anesthesia. METHOD: The incidence of tourniquet pain was evaluated in 60 patients having orthopedic surgery of the lower extremities during spinal anesthesia by administering either 30 mcg fentanyl (group 2) or saline (group 1) along with 0.5% hyperbaric bupivacaine 10 mg. We measured the maximal sensory spread of analgesia to pinprick, the incidence of tourniquet pain, and the sensory anesthesia to pinprick at the onset of tourniquet pain. RESULTS: The average maximal sensory spread of analgesia was the same in both groups (T9). The incidence of tourniquet pain was significantly greater in group 1 (33%) than in group 2 (10%). The sensory levels of anesthesia at the onset of tourniquet pain were not different in two groups. CONCLUSIONS: Intrathecal fentanyl was effective against tourniquet pain for 2 hours of the orthopedic surgery of the lower extremities.
Analgesia ; Anesthesia ; Anesthesia, Spinal* ; Bupivacaine* ; Fentanyl* ; Humans ; Incidence ; Lower Extremity ; Orthopedics ; Tourniquets*

No abstract available.
Animals ; Brain* ; Corpus Striatum* ; Neurons* ; Neuropeptides* ; Rats*

No abstract available.

PURPOSE: To report the clinical experience and surgical results of modified transposition surgery, in which half-width tendons are isolated and sutured into the paralyzed extraocular muscle. METHODS: We retrospectively reviewed the medical records of 6 patients (7 eyes), who had undergone modified transposition surgery to correct severe limitation of eye movement from January 1996 to December 2001. First, we divided the half-width tendons of two rectus muscles adjacent to the paralyzed rectus muscle and disinserted the halves from the sclera. The two half-width tendons were positioned underneath of the scleral insertion of the paralyzed muscle, sutured together and then sutured to the paralyzed muscle. In the case of contracture of the antagonizing extraocular muscle, recession of the antagonist was performed. RESULTS: Five of the six patients showed deviation under 15 prism diopters at primary gaze at distance, while synergistic divergence recurred in the sixth patient. CONCLUSIONS: Modified transposition surgery as described in this paper is thought to be an effective and safe method for correction of paralytic strabismus.
Contracture ; Eye Movements ; Humans ; Medical Records ; Muscles ; Retrospective Studies ; Sclera ; Strabismus ; Tendons

PURPOSE: There diagnostic modalities have been commonly used to detect prostate cancer to date: digital rectal examination (DRE), serum prostate specific antigen (PSA) and transrectal ultrasonography(TRUS). We evaluated the diagnostic values of these three modalities in the early detection of prostate cancer. MATERIALS AND METHODS: We analysed 215 patients with low urinary tract symptoms who had pathologic diagnosis for prostatic cancer was possible by biopsy or transurethral resection. Transectal ultrasonography guided sextant biopsies were performed if the PSA level was greater than 4.0 ng/ml or DRE was suspicious, even if TRUS revealed no ateas suspicious for cancer. TURP were performed without TRUS or biopsies if the PSA level was lesser than 4.0 ng/ml and DRE was negative. RESULTS: Of the 215 patients, 36 (16.7%) revealed prostate cancer. Positive predictive value, sensitivity and specificity was 37.0%. 83.3%. 71.5% for DRE, 30.0%, 91.7%, 58.3% for PSA and 27.6% 58.3%. 43.3% for TRUS respectively. Positive findings on serum PSA or DRE or both tests detected significantly more tumors(97.2%, 35of 36 cancers) than only PSA (91.7%, 33 for 36 cancers), DRE (83.3%, 30 of 36 cancers) and TRUS (60.0%, 21 of 35 cancers) alone. CONCLUSIONS: These result shows that DRE is more valuable and cost effective method for detection of prostate cancer than serum PSA and the use of DRE in conjunction with serum PSA enhances prostate cancer detection.
Biopsy ; Diagnosis ; Digital Rectal Examination* ; Humans ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms* ; Sensitivity and Specificity ; Transurethral Resection of Prostate ; Ultrasonography* ; Urinary Tract

Diabetic foot is one of the most frequent complications with diabetic nephropathy and diabetic retinopathy in diabetic patient. Ischemia and peripheral neuropathy are the primary pathologic mechanism leading to diabetic foot. Approximately 20% of all diabetic patients admitted for foot problems, and about 80% of these patients need leg amputations. The objective of this article is to analyze the result of strategic treatment for limb salvage and to suggest appropriate surgical management in patients with diabetic foot. This study included 97 cases of treatment of diabetic foot for 6 years since August, 1995. The patients' age ranged from 34 to 83 years. There were 59 males and 38 females. According to the wound grade, extent, and involved site, we classified into 4 groups of diabetic foot. Conservative treatment was accomplished in 53 cases, local flap and/or skin graft in 13 cases, free flaps were in 12 cases, and amputations in 19 cases. The relatively superficial defects were treated with reversed adipofascial flap and split thickness skin graft. The used free flaps were 10 radial forearm free flap, 1 radial forearm osteocutaneous free flap, 1 latissimus dorsi muscle free flap. One flap loss occurred in latissimus dorsi free flap and the patient was treated with below knee amputation. The amputations included 9 toe amputations, 3 Syme amputations, 5 below knee amputations, and 2 above knee amputations. Except one patient, all patients had primary wound healing in operated site without specific complications. We conclude that selection of treatment method is very important for diabetic foot patient. Appropriate surgical treatment for limb salvage consists of infection control, coverage of exposed tendon, joint, and bone, and prevention of recurrence. In case of rapid progression of necrosis, amputations can be considered in order to prevent sepsis and provide early rehabilitation with prosthesis.
Amputation ; Diabetic Foot* ; Diabetic Nephropathies ; Diabetic Retinopathy ; Female ; Foot ; Forearm ; Free Tissue Flaps ; Humans ; Infection Control ; Ischemia ; Joints ; Knee ; Leg ; Limb Salvage ; Lower Extremity* ; Male ; Necrosis ; Peripheral Nervous System Diseases ; Prostheses and Implants ; Recurrence ; Rehabilitation ; Sepsis ; Skin ; Superficial Back Muscles ; Tendons ; Toes ; Transplants ; Wound Healing ; Wounds and Injuries

Marjolin's ulcer is the malignant lesion which develops in a burn scar or chronic fistula. Due to the low prevalence of this lesion, there has been disagreement regarding its clinical features, methods of treatment, and prognosis. We evaluated 19 cases of patients who had been admitted to Severance Hospital from Jan. 1970 to Dec. 1985. The results were as follows: The previous lesion was a burn scar in 52% of the cases and a fistula of chronic osteomyelitis in 32%. The mean latent period was 31.5 years. The initial symptoms were increased pain (74%), discharge with foul odor (68%) and bleeding (58%). Upon histological examination, all of the cases were squamous cell carcinoma. The rate of metastasis at the time of diagnosis was 32%. Of the 16 patients treated by surgery, local recurrence was noted in 4 cases. Three of these cases were patients who had been treated by excision and split thickness skin graft. The time interval for local recurrence ranged from 6 months to 11 months (average 8.8 months). In conclusion, the squamous cell carcinoma of marjolin's ulcer seems to have a worse prognosis than other squamous cell carcinomas and it requires aggressive treatment. The burn scar or chronic fistula that occurs in elderly patients especially requires more adequate treatment and close observation.
Adult ; Aged ; Burns/complications ; Carcinoma, Squamous Cell/*epidemiology/etiology/pathology/therapy ; Case Report ; Cicatrix/complications ; Combined Modality Therapy ; Female ; Fistula/complications ; Human ; Korea/epidemiology ; Male ; Middle Age ; Neoplasm Metastasis ; Neoplasm Recurrence, Local/epidemiology ; Osteomyelitis/complications ; Prognosis ; Skin Neoplasms/*epidemiology/etiology/pathology/therapy