Kasabach-Merritt syndrome is the association of thrombocytopenia, disorder of coagulation, spontaneous bleeding and enlargement of a hemangima or extensive hemangiomatosis, which can be often life threatening. We experienced a three years-old girl with suddenly enlarging hemangioma of right cheek, complicated by severe thrombocytopenia, consumptive coagulopathy and hemorrhagic cystitis. Generalized petechia and ecchymosis were noted on the overlying skin of hemangioma, trunk and extremities. But the study of MRI and angiography, hypevascular was located within the right masseter muscle extending to temporalis muscle and anterior to parotid gland. So selective embolization with PVA (polyvinyl alcohol) was performed through the distal branch of internal maxillary artery and facial artery. She was medicated with oral corticosterioid for 3 weeks. After embolizationn, blood flow to hemangioma and facial swelling were markedly decreased. Patient was followed up for 7 years and she showed normal contour of face and no bleeding diathesis.
Angiography ; Arteries ; Cheek ; Cystitis ; Disease Susceptibility ; Ecchymosis ; Extremities ; Female ; Hemangioma ; Hemorrhage ; Hemorrhagic Disorders* ; Humans ; Kasabach-Merritt Syndrome* ; Magnetic Resonance Imaging ; Masseter Muscle ; Maxillary Artery ; Parotid Gland ; Skin ; Thrombocytopenia

No abstract available.
Humans ; Plasma* ; Tranexamic Acid* ; Urticaria*

No abstract available.
Animals ; Lordosis*

BACKGORUND: A tourniquet is commonly used to achieve bloodless field in surgery of the extremities. However, use of tourniquet occasionally has been associated with intraoperative hypertension, but the mechanism of this tourniquet-induced hypertension is unknown. We investigated the effect of preoperative ketamine on tourniquet-induced changes of arterial blood pressure (BP), heart rate (HR), cardiac index (Ci), and systemic vascular resistance index (SVRi). METHODS: Twenty-two patients of ASA physical status class 1 and 2, scheduled for lower extremity surgery using a tourniquet, were randomly assigned into two groups. Anesthesia was maintained with 1.5-2.0 vol% enflurane and 50% N2O in O2 with endotracheal intubation. The changes of BP, HR, Ci, and SVRi were measured (1) at 10 minutes after induction, (2) at 10 minutes after injection of normal saline (control group) or ketamine 0.25 mg/kg, i.v. (ketamine group) before skin incision and tourniquet inflation, (3) at immediately and 5, 10, 15, 20, 30, and 40 minutes after inflation of tourniquet, and (4) immediately after deflation of tourniquet. RESULTS: During tourniquet inflation, BP and HR were not significantly changed in each group and there was no significant differences between the two groups. However, Ci decreased during inflation of the tourniquet in both groups, and it significantly decreased in the control group at the time of 5 and 40 minutes after inflation of tourniquet. SVRi significantly increased during inflation of the tourniquet, and decreased immediately after deflation of the tourniquet in the control group. CONCLUSiONS: We concluded that preoperative iV ketamine, 0.25 mg/kg can prevent tourniquet-induced hemodynamic changes in patients under general anesthesia.
Anesthesia ; Anesthesia, General* ; Arterial Pressure ; Enflurane ; Extremities ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension ; Inflation, Economic ; Intubation, Intratracheal ; Ketamine* ; Lower Extremity* ; Skin ; Tourniquets* ; Vascular Resistance

Among various soft tissue tumors, extraskeletal chondroma is a rare benign cartilaginous tumor most frequently found in the hands, adjacent to periarticular tissue. We recently experienced a case of extraskeletal chondroma in a 47-year-old woman. The skin lesion showed a slowly-growing, solitary nodule on the dorsal aspect of her foot, causing pain and tenderness. An excisional biopsy was undertaken, revealing a well-encapsulated subcutaneous nodule which was mainly composed of mature hyaline cartilage.
Biopsy ; Chondroma* ; Female ; Foot* ; Hand ; Humans ; Hyaline Cartilage ; Middle Aged ; Skin

OBJECTIVES: Recent studies have suggested that the personality and communication style of the mother can affect the progress of disease in children with chronic illnesses. The current study assessed the characteristics, attachment type and communication skill of mothers who have children with alopecia areata that may concern their children. METHODS: The subjects of this study were 46 mothers of children with alopecia areata (alopecia children: mean age 7.52+/-3.41yrs ; 27 males, 19 females), who visited the alopecia clinic at the Dermatology Department of Chung-Ang University Hospital, and 42 mothers of normal children (control children : mean age 6.85+/-0.46 yrs; 20 males, 22 females). The Minnesota Multiphasic Personality Inventory (MMPI) subscale, the Revised Adult Attachment Scale (RAAS), the Parent Adolescent Communication Inventory (PACI), and the Campbell Index of Well-Being were administered to all the subjects for the purpose of comparing the mothers of the alopecia group with those of the normal controls. RESULTS: There were no differences in socio-demographic characteristics between the alopecia and control group mothers. The MMPI scores of both groups were within the normal profile ranges, but the scores of the mothers in the alopecia areata group were significantly lower than those in the control group mothers on the Pd(4), Mf(5), and Ma(9) subscales (p=0.028, p=0.001, p=0.005 respectively). There were significant differences in communication style between the two groups. Alopecia group mothers showed less open family communication (p=0.034) and more problems in family communication (p=0.000) than the control group mothers. The scores on problems in family communication were positively correlated with Pd(4) scores (r=0.48, p=0.03). An insecure attachment style was more common in the alopecia group mothers than in control group mothers (p=0.023). There was no difference between the two groups of mothers on the Index of Well-Being. CONCLUSION: Compared with the mothers of control group children, the mothers of children with alopecia areata had more depressed and suppressed personality characteristics not expressing their psychological conflicts directly (low Pd, Mf, and Ma scores), more problems in family communication with their children and more insecure attachment type. We suggest that these results should be considered in the treatment of children with alopecia, and that psychological intervention for their mothers is needed.
Adolescent ; Adult ; Alopecia ; Alopecia Areata ; Child ; Chronic Disease ; Dermatology ; Humans ; Male ; MMPI ; Mothers ; Object Attachment ; Parents

PURPOSE: There are so many causes of an altered mental status, including acute stroke and nonorganic causes. Making the differential diagnosis and the diagnostic approach for cases with an altered mental status represent a challenge to all emergency physicians. The serum S-100B protein concentration and the neuron-specific enolase (NSE) concentration have been used to evaluate brain damaged patients. We evaluated the usefulness of the serum S-100B protein concentration and the NSE concentration as screening tests for the patients with an altered mentality METHODS: Seventy-eight patients with an altered mentality were included in this prospective study. The patients were divided in two groups. One was the acute stroke group and the other was the non-organic cause group. We analyzed the serum S-100B protein and NSE concentrations of the two groups. We also assessed the correlation of the serum S-100B protein and NSE concentrations with the clinical and laboratory data of the two groups RESULTS: The serum concentration of S-100B was higher in the acute stroke group (median: 0.376, interquartile range: 0.18-1.05) than that in the nonorganic group (0.123, 0.087-0.307, p=0.000). The NSE level was also higher in the acute stroke group (median: 19.12, interquartile range: 14.42-27.19) than that in the non-organic group (13.71, 10.48-19.29, p=0.002). To differentiate the acute stroke group from the non-organic group, the sensitivity and specificity was 81.1% and 61.0%, respectively, at a cutoff value for the serum S-100B protein concentration of 0.14 microgram/L, and these were 81.1% and 51.2%, respectively, at a cutoff value for the serum NSE concentration of 13.71 microgram/L CONCLUSION: Our study suggests that the serum S-100B protein and NSE concentrations may be useful as screening markers for differentiating acute stroke from non-organic causes. However, further studies are needed to evaluate the relationship between the two proteins and the various diseases that have possibility to alter patients' mental status before these two proteins can be used clinically as screening tests.
Brain ; Diagnosis, Differential ; Emergencies ; Humans ; Mass Screening ; Mentally Ill Persons ; Nerve Growth Factors ; Phosphopyruvate Hydratase ; Prospective Studies ; Proteins ; S100 Proteins ; Sensitivity and Specificity ; Stroke

BACKGROUND: Vitiligo is an acquired disorder characterized by a progressive loss of melanocytes, which is difficult to manage and has an unknown prognosis. The subtype of segmental vitiligo (SV) has been established but it has not been adequately characterized. OBJECTIVE: To collect long-term follow-up data for evaluating the clinical course of SV. METHODS: This study included 87 patients who were diagnosed with SV and were monitored at a clinic. Patients were classified into the following three groups according to disease activity. RESULTS: Among the patients with SV, 63.2% had stable disease, 14.9% had disease recurrence between two and four years after disease onset, and 21.8% had disease recurrence at four or more than four years after disease onset. Among the 44 patients (50.2%) who were monitored continuously over a four-year period, 19 (43.2%) experienced a recurrence at four or more than four years after disease onset. CONCLUSION: Our results suggest that, contrary to previous reports, some patients with SV may not experience disease stability over an extended period of time. Disease recurrence can occur after years of stability, and we propose that long-term follow-up data can be used to characterize SV. This information about the clinical course of SV has implications for treatment and prognosis.
Follow-Up Studies ; Humans ; Melanocytes ; Prognosis ; Recurrence ; Retrospective Studies* ; Vitiligo*

Pachyonychia congenita is an uncommon genodermatosis of abnormal keratinization characterized by dystrophic nails and hyperkeratosis of the palms, soles, oral mucosa, and hair follicles. Mutations in keratin 6, 16, and 17 have been identified in a number of families. The 4 major features of the syndrome are onychogryphosis, palmoplantar keratoderma, follicular hyperkeratosis, and oral leukokeratosis. Treatment is only palliative, however, with attempts directed at improving symptoms that cause significant disability. We report a case of pachyonychia congenita in a 5-day-newborn with characteristic changes of nail, palms, soles, and oral mucosa.
Hair Follicle ; Humans ; Keratin-6 ; Keratoderma, Palmoplantar ; Leukoplakia, Oral ; Mouth Mucosa ; Nails, Malformed* ; Pachyonychia Congenita*

BACKGROUND: Reactive perforating collagenosis is one of the perforating disorders that are characterized by transepidermal elimination of dermal materials. It can be associated with systemic disease such as chronic renal disease and/or diabetes mellitus. OBJECTIVE: We wanted to investigate the clinical and histopathological features of reactive perforating collagenosis. METHODS: We reviewed the medical records, clinical photographs and histopathologic slides of 14 cases of reactive perforating collagenosis that were seen in our department. RESULTS: The most common clinical features were flesh-colored, dome-shaped papules with a keratinous plug. Residual scarring was seen from the previously healed lesions. Half of the patients had skin lesions on the whole body except the face, palm and sole. Most of the patients (79%) had at least one systemic disease. Chronic renal failure (21%) and diabetes mellitus (29%) were the most commonly associated conditions. The other associated conditions were hypertension, acute pyelonephritis, non-small cell lung cancer, herpes zoster, transplantation and non-Hodgkin lymphoma. Three of the cases (21%) were otherwise healthy. Most patients benefited from topical steroid and oral antihistamine when their disease was regressing. CONCLUSION: This study demonstrated the clinicopathologic features of reactive perforating collagenosis. It is frequently associated with diabetes mellitus and chronic renal failure, but this may also develop in patients with other systemic disorders, and also in those patients who are without any medical problems.
Carcinoma, Non-Small-Cell Lung ; Cicatrix ; Diabetes Mellitus ; Herpes Zoster ; Humans ; Hypertension ; Keratins ; Kidney Failure, Chronic ; Lymphoma, Non-Hodgkin ; Medical Records ; Pyelonephritis ; Renal Insufficiency, Chronic ; Skin ; Transplants