PURPOSE: The purpose of the study is to investigate the correlation between the symptoms and the incidence of anatomical variant without mucosal abnormality. MATERIALS AND METHODS: Out of 892 patients with CT performed for the evaluation of sinus disease symptoms between March 1991 and March 1993, we observed the anatomic variations in 82 symptomatic patients without mucosal abnormality(male:female=43:39, mean age 36. 4 years). The control group included 88 patients with facial bone CT performed for the evaluation of trauma during the same period while patients with recent paranasal sinusitis were excluded. (male:female=76:12, mean age 22. 4 years). The scouis were performed with 5-ram section thickness from posterior margin of sphenoid sinus to anterior margin of posterior ethmoid and then with 3 mm thickness from anterior margin of posterior ethmoid to anterior margin of frontal sinus. The artatomic variations included nasoseptal deviation, concha bullosa, Hailer cells, Agger nasi cells, etc. RESULTS: The anatomic variations were demonstrated in 71 our of 82 symptomatic patients(86. 5%), whereas they were seen 26 of 88 patients(29. 5%) in control group. CONCLUSION: Our data suggest that there is a possible causal relationship between anatomic variations and symptomas. Even though without accompaning mucosal abnormalities, anatomic variations could contribute simply to its symptomas. ^natomic variants may obstruct or narrow the airway, leading to turbulating air flow or interrupting ucociliary movement, and finally may produce a series os symptoms.
Facial Bones ; Frontal Sinus ; Humans ; Incidence ; Sinusitis ; Sphenoid Sinus

We report a case of disseminated cutaneous metastatic carcinoma from stomach carcinoma in a 66-year-old male who complained chiefly of widespread cutaneous nodules. He had been admitted to the Department of Internal Medicine for stomach carcinoma. A radiological examination revealed a diffuse stomach wall thickening from the fundus to the antrum, and enlargement of paraaortic and pericaval lymph nodes during an abodominal CT scan. The clinical findings manifested above may suggest cutaneous metastasis from stomach carcinoma. A histological examination of the skin and stomach biopsies showed atypical cells with pleomorphic, hyperchromatic nuclei and bubble-like cytoplasm, which are consistent with poorly differentiated adenocarcinoma. Immunohistochemical stainings showed that these cells were positive for epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA) and low molecular weight cytokeratin.
Adenocarcinoma ; Aged ; Biopsy ; Carcinoembryonic Antigen ; Cytoplasm ; Humans ; Internal Medicine ; Keratins ; Lymph Nodes ; Male ; Molecular Weight ; Mucin-1 ; Neoplasm Metastasis ; Skin ; Stomach* ; Tomography, X-Ray Computed

BACKGROUND/AIMS: The caudal anesthsia is most commonly used for benign anorectal surgery, The combination of long-acting anesthetics and opiates has been used for longer duration and successful control of postoperative pain. But the side effects of peridural anesthesics and morphine have commonly occured in caudal anesthesia. This study was performed to assess the difference in clinical effects between peridural mepivacaine and bupivacaine with morphine. METHODS: We evaluated the clinical effects in 60 patients who had anal operation with Jack-Knife position under caudal anesthesia. We divided randomly these 60 patients into two groups, M and B groups (in each group, 30 patients included). Group M (n=30) was given 2% mepivacaine 20 ml with morphine 2 mg caudally, and Group B (n=30) was given 0.5% bupivacaine 20 ml with morphine 2 mg in the same manner. We measured the onset time, duration, postoperative analgesia, and side effects including urinary retention. RESULTS: The onset time for analgesia was significantly shorter in group M than in group B. The duration of postoperative pain complaints was significantly longer in group M than in group B. The postoperative analgesic effects and side effects were not significantly different between two groups. CONCLUSIONS: Caudal mepivacaine and morphine mixture is effective for control of postoperative pain without significant side effects.
Analgesia ; Anesthesia, Caudal* ; Anesthetics ; Bupivacaine* ; Humans ; Mepivacaine* ; Morphine* ; Pain, Postoperative ; Urinary Retention

Granulocytic sarcoma is an uncommon extramedullary localized tumor composed of granulocytic precursor cells. The majority of cases have been reported in association with acute myeloid leukemia(AML) especially in children, but infrequently may occur in patients with myeloproliferative disorders or myelodysplastic syndromes. Most common sites of involvement were bone, soft tissue, lymph nodes and skin, but gastrointestinal tract, testis, central nervous system are also involved rarely. We present an unusual case of granulocytic sarcoma of the intracranium and the retro-orbital soft tissue occurring in a patient with concurrent myelodysplastic syndrome, diagnosed by brain magnetic resonance images and ultrasound guided needle biopsy.
Biopsy, Needle ; Brain ; Central Nervous System ; Child ; Gastrointestinal Tract ; Granulocyte Precursor Cells ; Humans ; Lymph Nodes ; Myelodysplastic Syndromes* ; Myeloproliferative Disorders ; Sarcoma, Myeloid* ; Skin ; Testis ; Ultrasonography

BACKGROUND: All though the cause of alopecia areata is not known, many studies have recenty focused on the autoimmunity of alopecia areata. OBJECTIVES: The objectives of this study were to detect autoantibodies against hair follicular antigens and compare the autoantibody level before and after treatment of alopecia areata. METHODS: We collected serum from: (a) 7 alopecia areata patients with good therapeutic responses, (b) 5 alopecia areata patients with poor therapeutic responses (c) 5 normal control people. First, we detected the antigens of hair follicles with SDS-PAGE. Secondly we reacted the antigens with the patients' and normal control serums by Western blotting. RESULTS: The follicular antigens were seen in the range of 44kD-57kD. Autoantibodies obviously apparent in patients of alopecia areata but not in the normal control. High concentrations of were Autoantibodies against follicular antigens seemed to be present in the patients with good therapeutic responses and as they had been treated well, the level of autoantiboies has decreased. Autoantibodies, however, were present in small amounts and were almost an changed between before and after treatment in the patients with poor therapeutic responses except for one case. CONCLUSION: There are kinds of autoantibodies against hair follicles in the serums of alopecia areata patients, and the titers of antibodies may be correlated with therapeutic responses.
Alopecia Areata* ; Alopecia* ; Antibodies ; Autoantibodies* ; Autoimmunity ; Blotting, Western ; Electrophoresis, Polyacrylamide Gel ; Hair Follicle* ; Hair* ; Humans

Twenty-nail dystrophy is an idiopathic nail dystrophy in which all twenty nails are uniformly and simultaneously affected with excess longitudinal ridging and loss of lustre. The pathogenesis is controversial, and the treatment is unsuccessful. It is thought to have a self-limiting and reversible nature when it develops in childhood, but in adults, it is unusual and exists persistently. We re-port here two cases of adult patients with dystrophy of all twenty nails, whose ages were 58 and 55. The disease had been present for one year and may be associated with alopecia areata in the 58 year old and an idiopathic condition in the 55 year old. Negative results were obtained on mycological studies. Biopsies taken from the nail bed revealed marked hyperkeratosis consistent with nail dystrophy.
Adult ; Alopecia ; Alopecia Areata ; Biopsy ; Humans

Two-thirds of ependymomas arise in the infratentorial or intraventricles, whereas one-third are located supratentorially. But supratentorial "cortical" ependymomas are very rare. We report a case of a cortical ependymoma in a 21-month-old boy. The patient presented with simple partial seizures. This tumor was located in the postcentral gyrus and he had gross total excision. Microscopy and immunohistochemistry showed grade II differentiation ependymoma.
Ependymoma* ; Epilepsies, Partial ; Humans ; Immunohistochemistry ; Infant* ; Male ; Microscopy ; Pediatrics ; Supratentorial Neoplasms

BACKGROUND: Pneumonia is the most common cause of death among patients with infectious disease in Korea. However, studies of pneumonia with septic shock in patients presenting to the emergency department are limited. The aim of this study was to investigate the prognostic factors associated with pneumonia with septic shock in patients presenting to the emergency department. METHODS: From January 2008 to September 2014, patients with pneumonia with septic shock admitted through the emergency department were retrospectively examined. RESULTS: Of the 561,845 patients who visited the emergency department, 398 were admitted for pneumonia with septic shock. The 28-day mortality rate in these patients was 36.4%. The independent prognostic factors were old age (>70 yrs) (odds ratio [OR], 2.42; 95%, confidence interval [CI], 1.35-4.32), Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR, 1.04; 95% CI, 1.01-1.08), leukopenia (OR, 3.63; 95% CI, 1.48-8.94), prolonged PT-INR (OR, 2.53; 95% CI, 1.41-4.54), and hypoxemia (OR, 2.88; 95% CI, 1.30-6.38). CONCLUSIONS: A poor prognosis of patients with pneumonia is associated with old age (>70 yrs), increased APACHE II score, leukopenia, prolonged PT-INR, and hypoxemia.
Anoxia ; APACHE ; Cause of Death ; Communicable Diseases ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Korea ; Leukopenia ; Mortality ; Pneumonia* ; Prognosis ; Retrospective Studies ; Shock, Septic*

No abstract available.
Pregnancy*

BACKGROUND: Subparalyzing dose of nondepolarizing muscle relaxants is often given prior to succinylcholine to reduce its adverse effects. At the same time, priming dose may worsen the intubating condition due to its antagonizing effect at neuromuscular junction. Although optimal priming dose of rocuronium is known to 0.03-0.04 mg/kg but higher priming dose may reduce interval from priming drug to succinylcholine. This study was designed to determine the maximal priming dose of rocuronium. METHODS: Sixty ASA I or II adult patients were randomized into three groups: group R1 received 0.06 mg/kg of rocuronium, group R2, 0.09 mg/kg and group Scc, normal saline. About 3 minutes after priming dose, thiopental 4 mg/kg, fentanyl 1microg/kg and succinylcholine 2 mg/kg were administered for anesthesia induction. The presence and severity of fasciculations and intubating conditions were evaluated with the incidence of side effects. RESULTS: In preventing fasciculations, group R1 and R2 were significantly better than group Scc, without significant difference between group R1 and R2. Intubation conditions were significantly worse in group R2 than in group Scc. CONCLUSIONS: The maximal priming dose of rocuronium to prevent fasciculations and optimizing intubating condition was 0.06 mg/kg.
Adult ; Anesthesia ; Fasciculation* ; Fentanyl ; Humans ; Incidence ; Intubation ; Neuromuscular Junction ; Succinylcholine* ; Thiopental