A 35-year-old housewife was diagnosed with onychomycosis and treated by oral terbinafine, 250mg/day, for 4 months. Clinically all infected nails improved gradually. However, her left great toe-nail was not improved thereafter. At that time the proximal end of the onychomycotic lesion was marked with surgical blade, and terbinafine therapy was continued for four weeks. However, the onychomycotic nail was not improved, and the scratch mark passed by the proximal end of the infected nail. Therefore, we detected the resistance to the therapy and switched the medication to itraconazole 100 mg/day and then another scratch mark was done at the proximal end of the onychomycotic lesion. After another 2 weeks the infected nail went along with the scratch mark distally, and showed clinical improvement. After 8 weeks therapy of itraconazole, she was cured clinically and mycologically. The fungal culture was identified as Aspergillus sydowii.
Adult ; Aspergillus* ; Humans ; Itraconazole ; Onychomycosis*

A clinical study was done on 16 cases of cerebellar hemorrhage and 3 cases of cerebellar infarction which were diagnosed with brain CT scan at Keimyung university Dongsan hospital from July 1981 to June 1985 and conclusions obtained are as follows. 1. The incidence of cerebellar hemorrhage and infarction was 3.5% and 0.6% of all spontaneous intracranial parenchymal hemorrhage and infarction, respectively. 2. The most prevalent age group was 7th decade and sex ratio was higher in male in cerebellar stroke. 3. Major single percipitating factor of cerebellar stroke was hypertension. 4. Most of cerebellar stroke showed catastrophic or sudden onset type. 5. The most common initial symptoms of cerebellar stroke were nausea and vomiting, followed by headache and dizziness or vertigo, in order of frequency. 6. The most common neurologic signs on admission were impaired consciousness, constricted pupil with preserved light reflex and cerebellar signs. 7. The common site of cerebellar hemorrhage was right hemisphere, followed by vermis and left hemisphere, in order of frequency, and that of cerebellar infarction was right posterior hemisphere. 8. The better the consciousness on admission, the better the outcome of cerebellar stroke. 9. The following parameters indicated good prognosis with medical therapy, so called benign cerebellar hemorrhage: clear consciousness on admission, gradual onset type, less than 20cc of hematoma, no or mild hydrocephalus, no ventricular hematoma, no vermis involvement on CT scan.
Brain ; Consciousness ; Dizziness ; Headache ; Hematoma ; Hemorrhage ; Humans ; Hydrocephalus ; Hypertension ; Incidence ; Infarction ; Male ; Miosis ; Nausea ; Neurologic Manifestations ; Prognosis ; Reflex ; Sex Ratio ; Stroke ; Tomography, X-Ray Computed ; Vertigo ; Vomiting

No abstract available.
Peristalsis*

No abstract available.
Mandibular Reconstruction* ; Ribs* ; Transplants*

STUDY DESIGN: A case report. OBJECTIVES: Lumbar burst fracture was treated with operation, which delayed recollapse of L1 and led to conus medullaris syndrome. SUMMARY OF LITERATURE REVIEW: After operation, conus medullaris syndrome causing by delayed recollapse is not frequently reported. MATERIALS AND METHODS: A 56-year-old male was admitted with lower back pain caused by a fall. Radiologic findings showed L1 burst fracture with about 42% of height loss. There was no neurologic deficit. Posterior fusion was performed using instrumentation. Five weeks after the operation, the patient was admitted for urination and defecation difficulty. Radiologic findings showed that the L1 had recollapsed with about 38% of height loss. To resolve the problem, anterior surgery was performed. RESULTS: Two years after surgery, bladder and anal sphincter dysfunction wasn't recovered. CONCLUSIONS: Lumbar burst fracture should be follow up carefully until union of the fracture because burst fracture leads to delayed recollapse.
Anal Canal ; Defecation ; Humans ; Low Back Pain ; Male ; Middle Aged ; Neurologic Manifestations ; Spinal Cord Compression* ; Urinary Bladder ; Urination

INTRODUCTION: To report the result of the thigh perforator free flap for the reconstruction of the soft tissue defect of the lower extremities and usefulness of this flap. MATERIALS AND METHODS: We have performed 23 cases of thigh perforator free flap to reconstruct the soft tissue defect of the lower extremities between February 2004 and July 2005. The anterior aspect of the legs were 9 cases, the ankle joints were 4 cases, the dorsal aspect of the feet were 6 cases, the sole of the feet were 4 cases as recipient sites. The anterolateral thighs were 13 cases, the anteromedial thighs were 10 cases as donor sites. The size of the flap ranged from 4 x 5 cm to 12 x 18 cm. The mean flap area was 73.2 cm2. The length of the pedicle ranged from 5 cm to 15 cm. Every patient except children was operated under the spinal anesthesia. RESULTS: 21 flaps (91.3%) survived, 2 flaps (8.7%) failed. In the 21 flaps that had survived, there were partial necrosis in 4 cases, which healed without any additional operation. In the 13 anterolateral thigh perforator flaps, 9 cases survived totally, 3 cases had the partial necrosis, 1 case failed. In the 10 anteromedial thigh perforator flaps, 8 cases survived totally, 1 case had the partial necrosis, 1 case failed. CONCLUSION: The authors had a good result with the thigh perforator free flap and believe that this flap is a good option for the reconstruction of the soft tissue defect of the lower extremities, because this flap has a thin thickness and it is easy to dissect the vessels. Moreover the patients can be operated with supine position.
Anesthesia, Spinal ; Ankle Joint ; Child ; Foot ; Free Tissue Flaps* ; Humans ; Leg ; Lower Extremity* ; Necrosis ; Perforator Flap ; Supine Position ; Thigh* ; Tissue Donors

Clincal studies were made on 166 cases of spontaneous subarachnoid hemorrhage (SAH), were admitted to the keimyung university Dongsan hospital from January 1981 to March 1984. The age and sex distribution, causes of SAH, clinical symptoms and signs, computed tomographic (CT) findings, aneurysmal site, number and size, comparison between the highest density on CT findings and site of aneurysm confirmed by angiography,relationship between CT class and clinical grade, complication, and relationship between hospital course and clinical grade on admission were analysed. The results summarized as follow. 1. The most prevalent age group was between 41-60 years of age, and above 61 years, 31-40 years and below 30 years of age in the order of frequency. Male to female ratio was 43.4 : 56.6. 2. The most common causes of 100 cases of SAH confirmed by cerebral angiography was cerebral aneurysm (75 cases), and the other causes were unknown cause (16 cases), arteriovenous malformation (6 cases), moyamoya disease (3 cases) in the order of frequency. 3. The clinical symptoms on admission in the order of frequency were headache, nausea and vomiting, brief loss of consciousness, dizziness, seizure, and urinary incontinence. The neurological findings showed stiffneck, hemiparesis, cranial nerve palsies, papilledema and/or hemorrhage on the fundus, and Babinski sign in that order. 4. CT findings (158 cases) revealed typical high densities consistent with SAH in 125 cases (79.1%), associated with the low density (13 cases), and visible cerebral aneurysm (5 cases), while negative findings were 33 cases (20.9%). 5. The most common site of aneurysm among the 75 cases of SAH confirmed by the cerebral angiography was the region of the anterior communicating artery (AcomeA) which accounted for 30 cases (35.3%), and posterior communicating artery (PcomeA) and middle cerebral artery (MCA) 23 cases (27%), respectively, the internal carotid artery 5 cases (5.9%), the anterior ecrebral artery (ACA) 2 cases (2.4%), the posterior inferior cerebellar artery and basilar artery 1 cases (1.2%), respectively in the order of frequency. Among the 75 cases of cerebral aneurysms, single aneurysms were 67 cases (89.3%) and multiple aneurysms were 8 cases (10.7%). The most common size of the aneurysms was 6-10 mm (47 cases), and below 5 mm (30 cases), and above 10 mm (8 cases) in the order of frequency. 6. Sixteen out of 27 cases of AcomA aneurysms present the highest density on CT scan in the anterior hemispheric fissure, 9 out of 22 cases of PcomA aneurysms in syulvian fissure and 6 cases in suprasellar cistern, and all cases of MCA aneurysm (21 cases) in the ipsilateral aneurysmal site. 7. Comparison between CT grade by Davis (1980) and clinical grade by Hunt-Hesse (1968) revealed that the 93 of 94 patients (pts) with CT class 1 or 2 belong to under clinical grade 3, the 17 of 64 pts with CT class 3 or 4 belong to clinical grade IV or V, and the 17 of 18 pts with clinical grade IV or V belong to CT class 3 or 4. 8. The most common complication was the hydrocephalus (30.1%), and cerebral arterial spasm (24.1%), SIADH (8.4%), and rebleeding confirmed by lumbar puncture and/or CT (4.2%), in the order of frequency. 9. One hundred and four pts (62.7%) out of total 166 patient with SAH were improved, whereas 39 pts (23.5%) were not improved or signed out without clinical improvement, and 23 pts (13.8%) were died. The 81 (77.9%) of 104 pts who were improved belong to clinical grade I or II on admission, the 18 (78.3%) of 23 pts who were expired belong to clinical grade III or IV, and the 19 (48.7%) of 39 pts who were signed out without improvement belong to clinical grade III to V.
Aneurysm ; Arteries ; Arteriovenous Malformations ; Basilar Artery ; Carotid Artery, Internal ; Cerebral Angiography ; Cranial Nerve Diseases ; Dizziness ; Female ; Headache ; Hemorrhage ; Humans ; Hydrocephalus ; Inappropriate ADH Syndrome ; Intracranial Aneurysm ; Male ; Middle Cerebral Artery ; Moyamoya Disease ; Nausea ; Papilledema ; Paresis ; Reflex, Babinski ; Seizures ; Sex Distribution ; Spasm ; Spinal Puncture ; Subarachnoid Hemorrhage* ; Tomography, X-Ray Computed ; Unconsciousness ; Urinary Incontinence ; Vomiting

PURPOSE: The aim of this study was to evaluate the efficacy and safety of hexaminolevulinate fluorescence cystoscopy in the diagnosis of bladder cancer. MATERIALS AND METHODS: In a prospective design, we included patients who had a bladder lesion suggesting bladder cancer. Patients with massive hematuria, urethral Foley catheter insertion, chronic retention state, or urinary tract infection were excluded. After the bladder was emptied, hexaminolevulinate was gently administered into the bladder. One hour later, cystoscopy under white light and blue light was performed. After marking the lesions confirmed with white light or blue light, transurethral resection of the bladder lesion and pathologic confirmation were done. Transurethral resection of the lesions that were negative in both white and blue light was also performed. RESULTS: From April 2010 to September 2010, 30 patients were enrolled. From the total of 30 patients (25 men and 5 women; mean age, 60.4+/-9.22 years), 134 specimens were extracted. Among these, 101 specimens showed positive results by blue light cystoscopy (BLC). The sensitivity of BLC and white light cystoscopy (WLC) was 92.3% and 80.8%, respectively (p=0.021). The specificity of BLC and WLC was 48% and 49.1%, respectively (p>0.05). The positive and negative predictive values of BLC were 71.2% and 81.8%, respectively, whereas those of WLC were 72.0% and 68.6%, respectively. With WLC, 48 specimens showed negative findings, but of that group, 15 specimens (31.2%) were revealed to be malignant with BLC. There were no significant side effects in the 24 hours after the instillation of hexaminolevulinate. CONCLUSIONS: Photodynamic diagnosis with hexaminolevulinate helps to find tumors that could be missed by use of WLC only. Photodynamic diagnosis might be valuable in complete resection as well as for more accurate diagnosis of bladder tumor.
Aminolevulinic Acid ; Catheters ; Cystoscopy ; Diagnostic Imaging ; Fluorescence ; Hematuria ; Humans ; Light ; Male ; Prospective Studies ; Retention (Psychology) ; Sensitivity and Specificity ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urinary Tract Infections

BACKGROUND: There have been few clinical studies of halo nevi. OBJECTIVE: The purpose of this study was aimed at evaluating the clinical and histopathologic features of halo nevi and correlation between halo nevi and vitiligo. METHODS: The medical records of 40 patients with halo nevi and biopsy specimens of 30 patients with halo nevi were reviewed. RESULTS AND CONCLUSION: 1.The ratio of male to female patients was 1:1.5. 2.The mean age of the onset was 20.1 years (male : 11.5, female : 25.9). 3.Multiple halo nevi were present in 32.5%(male : 25%, female : 37.5%). 4.The areas in which the lesions developed were head and neck(39.1%), back(32.8%), anterior chest(12.5%), abdomen(10.9%), groin(3.1%), and lower extremity(1.6%) in descending order. 5.The mean duration of each color in central nevus was as follows: black(2.7 years), pink(3.5 years), gray(4.9 years) 6.The most common pathology of the central nevus was intradermal(80%). 7.The halo nevi associated with vitiligo were 21 cases(52.5%) out of 40 patients. Among them, the cases with non-segmental vitiligo were 13(61.9%), the cases with segmental vitiligo were 8(38.1%). 8.Out of the 21 cases with halo nevi associated with vitiligo, the cases with halo nevi prior to vitiligo were 4(19.1%), concurrent onset 12(57.1%) and the cases with halo nevi after vitiligo were 5(23.8%).
Biopsy ; Female ; Head ; Humans ; Male ; Medical Records ; Nevus ; Nevus, Halo* ; Pathology ; Vitiligo

OBJECTIVE: The effect of basal day 3 luteinizing hormone (LH) and pituitary desensitized day 3 LH level on ovarian response to controlled ovarian hyperstimulation were investigated. METHODS: From January 1999 to December 2001, 445 cycles for in vitro fertilization and embryo transfer (IVF-ET) were allocated to this study. Controlled ovarian hyperstimulation (COH) was performed using long protocol of gonadotropin-releasing hormone agonist (GnRHa). All patients included in this study had blood samples drawn on cycle day 3 prior to COH and cycle day 3 after pituitary desensitization with GnRHa for measurement of FSH and LH. Infertile women were younger than 43 years old, and had normal menstrual cycle, normal day 3 FSH and LH level (<10 mIU/ml), infertility factor caused by tubal factor, mild endometriosis, unexplained infertility or mild male subfertility. The result of COH and IVF-ET were compared between low LH group and high LH group according to the level of basal LH (3 mIU/ml) and down-regulated LH (1 mIU/ml). RESULTS: The low LH groups were significantly higher FSH:LH ratio, higher dose of exogenous gonadotropin for pituitary desensitization, longer duration of gonadotropin administration. The peak estradiol, number of oocytes retrieved, number of MII oocyte, mean cumulative embryo score (MCES) were significantly lower in the low LH group than the high LH group. There were not significantly differentiation in the duration of pituitary desensitization, fertilization rate and the number of transferred embryos. The clinical pregnancy rate per cycle was not correlated with the value of basal LH concentration, but correlated with the value of down-regulated LH concentration. CONCLUSION: The lower LH activity (basal LH <3 mIU/ml, down-regulated LH <1 mIU/ml) is significantly associated with reduced ovarian response in controlled ovarian hyperstimulation after desensitization with GnRHa. These results suggest that down-regulated LH level 1 mIU/ml may be a useful predictor of the clinical pregnancy rate per cycle after controlled ovarian hyperstimulation.
Adult ; Embryo Transfer ; Embryonic Structures ; Endometriosis ; Estradiol ; Female ; Fertilization ; Fertilization in Vitro ; Gonadotropin-Releasing Hormone ; Gonadotropins ; Humans ; Infertility ; Infertility, Male ; Luteinizing Hormone ; Male ; Menstrual Cycle ; Oocytes ; Pregnancy Rate