A middle-aged female patient showed long-standing multiple or confluent small hyperkeratotic papules on her palms and soles with subsequent development of well differentiated squamous cell carcinoma on the left sole and poorly differentiated pulmonary carcinoma. Arsenic as a possible etiological factor is discussed.
Arsenic ; Carcinoma, Squamous Cell* ; Female ; Fibrinogen ; Humans

No abstract available.
Emergencies* ; Emergency Service, Hospital*

No abstract available.
Congenital Hypothyroidism*

Major surgery in a patient with pancytopenia might be associated with increased surgical risks, especially for bleeding and infection. A 66-yr-old man was admitted to the hospital due to shortness of breath. His dyspnea was classified by the New York Heart Association (NYHA) as functional class III. Prior to admission, he had a 5-yr history of medical management for idiopathic aplastic anemia. The severity of aplastic anemia of the patient was graded as non-severe aplastic anemia. Echocardiography revealed reduced left ventricular function and severe aortic valve regurgitation (grade IV) with left ventricular end diastolic dimension measuring 87 mm. Because of dyspnea and echocardiographically documented aortic valve insufficiency, the patient underwent elective aortic valve replacement. Although extracorporeal circulation for valve operations might be associated with aggravation of impaired blood cell function, the patient recovered from surgery uneventfully. Here, we report a successful cardiac surgery with extracorporeal cardiopulmonary bypass in a patient with severe aortic valve insufficiency and concomitant idiopathic aplastic anemia.
Aged ; Anemia, Aplastic/*surgery/*therapy ; Anticoagulants/therapeutic use ; Aortic Valve/pathology ; Aortic Valve Insufficiency/*surgery ; *Cardiac Surgical Procedures ; Echocardiography/methods ; Heart Valve Prosthesis ; Humans ; Male ; Treatment Outcome

Thirty-one distal femoral and nine proximal tibial primary bone tumor patients who had prosthetic replacements were reviewed retrospectively. Average follow-up was thirty-eight months(range: 12- 109 months). There were thirty-two(osteosarcoma: 29, chondrosarcoma: 3) stage IIB lesions and eight 1B lesions(giant cell tumor). Twenty-nine patients were surviving at final follow-up. Overall prosthetic survival was 81%, 27% at 2 and 5 year respectively. Eleven prostheses were revised. The causes of revisions were infection(7), metal failure(2), fracture of host bone(1), and loosening(1). Eight revisions were successful, one was fair, and two patients needed an amputation. Prognostic factors which were analyzed for survival of prostheses were age, sex, location of primary lesion, percent of bone resected, and stage. Only the location of primary lesion showed statistical significance and diabolic pattern of survival curve was noted between two groups in resection length(<40% versus >40%). Average functional score was 26. The tibial side had worse prosthetic survival and a major threat to this procedure was due to infection.
Amputation ; Chondrosarcoma ; Follow-Up Studies ; Humans ; Knee Joint* ; Knee* ; Prostheses and Implants ; Prosthesis Failure ; Retrospective Studies ; Sarcoma

BACKGROUND: In the patients complaining of alopecia or hair thinning, many different disease entities are included. Although there have been many clinical studies on each individual disease of them, few reports dealing with all of the alopecia patients in a dermatologic clinic are found. OBJECTIVE: We attempted to reveal the collective clinical aspects of all of different diseases resulting in loss of hairs in a dermatologic clinic. METHOD:Clinical records of 1505 patients with various alopecia seen from March 1978 to July 1998 at the department of Dermatology, Chonbuk National University Medical School were analyzed for their diagnosis, age, sex, and annual distribution in all dermatoses. Among them, 1252 cases were further studied for their subtypes, causes, result of treatments and other details. RESULTS: 1. The incidence of total alopecia patients among the total new patients during the period was 2.9%(1505/51140), 1.24% in average during the 1980s and 4.7% during the 1990s. 2. The incidence of different alopecia was as follows:alopecia areata; 55.0%(827/1505), androgenetic alopecia; 26.1%(392/1505), telogen effluvium; 7.0%(106/1505), trichotillomania; 3.6%(54/1505), accidental alopecia; 1.9%(28/1505), seborrheic alopecia; 1.2%(18/1505), and nutritional alopecia:0.9%(14/1505). 3. The sex distribution showed 761 men and 744 women. The age distribution showed a peak incidence in the third decade(37.4%, 563/1252). 4. The duration from the recognition of initial hair loss to the time of the first visit to the hospital was less than 3 months in 46.4%(581/1252), and less than 6 months in 60%. 5. The subtypes of 686 cases of alopecia areata consist of 549(80%) cases of common type, 77(11.3%) cases of alopecia totalis, and 60(8.7%) cases of alopecia universalis. 6. The relapse rate after treatment in alopecia areata was 29.4%. In 7.4% there was no response to the treatment. 7. Of the 160 male androgenetic alopecia patients Hamilton's type II and III were most common (92.5%). Of the 60 female androgenetic alopecia patients Ludwig's type I was most common(58.5%) 8. The presumed causes of telogen effluvium was as follow:delivery(23.1%), febrile illness (22.0%), traction(8.8%), drug administration(6.6%), crash diet(5.5%). 9. In trichotillomania, the male to female ratio was similar. 70% of the patients belonged to the 1-20 year age group. 10. Accidental alopecia or the alopecia caused by accidental trauma occurred most commonly in women(79%, 22/28). 11. All patients of nutritional alopecia or the alopecia due to diminished diameter of the hair(14cases) and traction alopecia (6cases) were women. CONCLUSION: We made clinical analysis of all of the patients complaining of hair loss by any causes during the past 20 years from March 1978 to July 1998.
Age Distribution ; Alopecia Areata ; Alopecia* ; Dermatology ; Diagnosis ; Female ; Hair ; Humans ; Incidence ; Jeollabuk-do ; Male ; Recurrence ; Schools, Medical ; Sex Distribution ; Skin Diseases ; Traction ; Trichotillomania

A retrospective review was performed of 297 patients admitted to Chung Ang Gil Hospital between June 1995 and December 1996 with a diagnosis of blunt chest trauma. Of these patients, 34% suffered either immediate or delayed complications. Immediate complications included hemothorax in 58.8%, pneumothorax in 26.5%, and pulmonary contusion in 20.5%. Delayed complications occurred in 9.1% of patients overall; these included pulmonary contusion in 12.7%, pneumonia in 9.8%, pulmonary embolism in 2%, poeumothorax in 2%, and hemothorax in 2%. The mean age of the patients were 43 years. 210 patients(70.7%) were under age 50 and 87(29.3%) were 50 years of age or older. Male to female ratio was 1.9:1. Mean Initial Revised Trauma Score (RTS) and the Injury Severity Score (ISS) were 7.10+/-0.94 and 14+/-8.69, respectively. There were associated injuries in 225(75.8%) patients. Overall mortality rate was 7.1% and the mortality rate was significantly greater in patients with a RTS<6, ISS>or=16, associated injuries, advanced age(50 years of age or older), and pulmonary complications. Pulmonary complications were significantly greater in patients with a RTS<6, ISS>or=16, and an associated injuries.
Contusions ; Diagnosis ; Female ; Hemothorax ; Humans ; Injury Severity Score ; Male ; Mortality* ; Pneumonia ; Pneumothorax ; Pulmonary Embolism ; Retrospective Studies ; Thorax*

BACKGROUND: We conducted this study to verify whether a mechanical ventilator is adequate for cardiopulmonary resuscitation (CPR). METHODS: A self-inflating bag resuscitator and a mechanical ventilator were used to test two experimental models: Model 1 (CPR manikin without chest compression) and Model 2 (CPR manikin with chest compression). Model 2 was divided into three subgroups according to ventilator pressure limits (P(limit)). The self-inflating bag resuscitator was set with a ventilation rate of 10 breaths/min with the volume-marked bag-valve procedure. The mode of the mechanical ventilator was set as follows: volume-controlled mandatory ventilation of tidal volume (Vt) 600 mL, an inspiration time of 1.2 seconds, a constant flow pattern, a ventilation rate of 10 breaths/minute, a positive end expiratory pressure of 3 cmH2O and a maximum trigger limit. Peak airway pressure (P(peak)) and Vt were measured by a flow analyzer. Ventilation adequacy was determined at a Vt range of 400-600 mL with a P(peak) of < or = 50 cmH2O. RESULTS: In Model 1, Vt and P(peak) were in the appropriate range in the ventilation equipments. In Model 2, for the self-inflating bag resuscitator, the adequate Vt and P(peak) levels were 17%, and the P(peak) adequacy was 20% and the Vt was 65%. For the mechanical ventilator, the adequate Vt and P(peak) levels were 85%; the P(peak) adequacy was 85%; and the Vt adequacy was 100% at 60 cmH2O of P(limit). CONCLUSIONS: In a manikin model, a mechanical ventilator was superior to self-inflating bag resuscitator for maintaining adequate ventilation during chest compression.
Cardiopulmonary Resuscitation* ; Manikins* ; Models, Theoretical ; Positive-Pressure Respiration ; Thorax ; Tidal Volume ; Ventilation* ; Ventilators, Mechanical*

We report a patient with pachydermoperiostosis accompanied by hypertrophic gastritis. A 26-year-old man showed deep folds and furrows of the face and scalp, and terminal spade-like expansion of fingers and toes. Physical examination revealed no abnormalities except a grotesque appearance. Results of routine laboratory tests were unremarkable. Mild periosteal reactoins of both femurs and humeri were noted on long bone series, and hypertrophic gastritis on fibroscopic examination drew our attention. The relationship between pachydermoperiostosis and hypertrophic gastritis is uncertain. However it is probable that hypertrophic gastritis may be the endodermal counterpart of the ectodermal manifestations of pachydermoperiostosis.
Adult ; Ectoderm ; Endoderm ; Femur ; Fingers ; Gastritis, Hypertrophic* ; Humans ; Osteoarthropathy, Primary Hypertrophic* ; Physical Examination ; Scalp ; Toes

The purpose of this study was to compare estimates of human body composition determined from single-frequency bioelectrical impedance methods (S-BIM) and multi-frequency bioelectrical impedance methods (M-BIM) . The human body composition was assessed by dual energy X-ray absorptiometry (DEXA), 5 brands of S-BIM, and 2 brands of M-BIM. Forty-five women, aged 26-58 years, served as subjects. The S-BIM and M-BIM fat-free mass (FFM) estimates were highly correlated with the FFM measured by DEXA (r=0.82-0.93) . The standard errors of estimate (SEE) for FFM were approximately 2 kg. With the exception of the MLT-100 (which slightly underestimated FFM), all brands of BIM slightly overestimated FFM. The absolute mean differences between FFMDEXA and each of the 7 BIM estimates ranged from -3.02 kg to 3.46 kg. Although the 7 brands of BIM provided slightly different estimates, the results of this study suggest that 5-BIM and M-BIM are relatively valid in human body composition.