No abstract available.
Lichen Nitidus* ; Tacrolimus*

No abstract available.
Giant Cells* ; Granuloma, Giant Cell*

No abstract available.
Hyperpigmentation ; Paget Disease, Extramammary* ; Scrotum*

BACKGROUND: The testes are one of the most common extramedullary sites of relapse in boys with acute lymphoblastic leukemia(ALL). The reported incidence of isolated testicular relapse varies from 3 to 40%. If these patients are treated exclusively with testicular irradialion, a systemic relapse occurs within a few months. Recently, the use of intensive chemotherapy and testicular irradiation improved the survival rate for boys with testicular leukemia. So, we performed this study to identify clinical manifestations, disease free survival and prognostic factors of testicular leukemia in children. METHODS: We reviewed 33 patients of testicular leukemia among total 410 boys with ALL diagnosed at the Department of Pediatrics, Seoul National University Children's Hospital from Jan. 1970 to Aug. 1996. Testicular leukemia was confirmed by testicular biopsy in all 33 patients. These patients were treated with combined local testicular irradiation(2,400~2,500 cGy/8~12fractions) and systemic chemotherapy. Two patients, in whom testicular relapse was diagnosed before 1979, unilateral orchiectomy of the involved site and testicular irradiation of the opposite site were performed. Probability estimates of disease free survival (DFS) were calculated by the method of Kaplan and Meier, and the relationship of prognostic factors to DFS was compared using the chi-square test in survival analysis. RESULTS: In 410 boys with ALL, testicular leukemia occurred in 33 patients(8%). Of 33 patients, 6 patients presented with testicular involvement at initial diagnosis, 16 patients had testicular relapse while still receiving chemotherapy and 11 patients had testicular relapse 3 to 57 months(median : 15 months) after cessation of chemotherapy. The median age of 33 patients was 7.4 yrs(9 months~18 yrs) and median WBC count 7,600/ L(2,700~270,000/L). All patients presented with painless testicular enlargement and testicular leukemia was confirmed by testicular biopsy. Among 33 patients, 2 had prior CNS relapse and 11 had concomitant bone marrow and/or CNS relapse. Twenty nine patients were treated with combined local testicular irradiation and systemic chemotherapy. Eleven had second relapse(6 bone marrow, 3 CNS, 2 opposite testis). Seventeen have been followed until now: 6 patients on chemotherapy and 11 patients(37.9%) in complete remission for 48.5+/-22.3 months(19~86 months). The 3 year DFS for 29 patients was 55.3%+/-10.1%. The following prognostic factors showed no significant association with DFS in testicular relapse : age and WBC count at initial diagnosis, age at testicular relapse, and concomitant relapse. Whether testicular relapse occurred on initial therapy or off initial therapy has prognostic value in predicting DFS. The 3 year DFS for boys with testicular relapse on and off initial therapy were 40.0%+/-12.9% and 78.8%+/-13.4%, respectively(P: 0.046). CONCLUSION: With the use of chemotherapy and testicular irradiation, prolonged second re mission can be achieved in many patients with testicular leukemia. The patients with testicular relapse off initial therapy fared significantly better than patients on therapy. So, to improve the DFS for boys with testicular leukemia, a better understanding of its biology and prognostic factors is needed.
Biology ; Biopsy ; Bone Marrow ; Child ; Diagnosis ; Disease-Free Survival ; Drug Therapy ; Humans ; Incidence ; Leukemia ; Missions and Missionaries ; Orchiectomy ; Pediatrics ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Recurrence ; Seoul ; Survival Rate ; Testis

In a small island community with a population of less than 100 residents, nine persons died and five experienced severe illness during the period from November 1986 to May 1988. Their initial symptoms were sore throat and fever. Renal failure and hepatitis developed which one week after the onset. Oral mucosal ulcer developed in some cases. After one week, progressive respiratory failure and dyspnea developed evidently and severe respiratory distress and hypoxia preceded those fatal cases. Chest X-ray findings revealed bilateral diffuse multiple cystic lesion with occasional multiple large emphysematous bullae. Based on these features paraquat poisoning was diagnosed and route of poisoning was investigated. In three sources of drinking water, trace amount of paraquat was detected in November 1988, six months after the incidence of recent fatal case. In November 1988, soybean sauces and soybean pastes from 12 households were found contaminated with high concentration of paraquat, the cause of this mass poisoning has been suggested.
Anoxia ; Drinking Water ; Dyspnea ; Eating ; Family Characteristics ; Fever ; Hepatitis ; Humans ; Incidence ; Ointments ; Paraquat* ; Pharyngitis ; Poisoning* ; Renal Insufficiency ; Respiratory Insufficiency ; Soybeans ; Thorax ; Ulcer

A rare case of intramedullary Cysticercosis, at the thoracic cord is introduced which was misdiagnosed as intramedullary tumor and was confirmed after operation. After myelogram developed progressive paraplegia, which was not improved after operation. The myelographic finding of intramedullary Cysticercosis can't differenciate from intramedullary tumor and we have to consider this condition making diagnosis of intramedullary tumor.
Cysticercosis* ; Diagnosis ; Paraplegia

Diabetic muscle infarction (DMI) is an unusual neuromuscular complication of diabetes mellitus. It tends to occur in young, poorly controlled, insulin dependent diabetic patient with end-organ complication. We report a 24-year-old woman with diabetic muscle infarction in both lower extremities. DMI began with an abrupt onset of pain, tenderness, swelling and formation of a firm mass. MRI revealed an increase in the signal intensity on T2 weighted image and SPECT showed an increased uptake of Tc-99m-pyrophosphate (PYP) in affected muscles. We report this case with review of the literature.
Diabetes Mellitus ; Female ; Humans ; Infarction* ; Insulin ; Lower Extremity ; Magnetic Resonance Imaging ; Muscles ; Tomography, Emission-Computed, Single-Photon ; Young Adult

PURPOSE: This study was performed to identify the etiologic agents and antimicrobial susceptibility patterns of organisms responsible for bloodstream infections in pediatric cancer patients for guidance in empiric antimicrobial therapy. METHODS: A 5-year retrospective study of pediatric hemato-oncologic patients with bacteremia in Seoul National University Children's Hospital, from 2006 to 2010 was conducted. RESULTS: A total of 246 pathogens were isolated, of which 63.4% (n=156) were gram-negative, bacteria 34.6% (n=85) were gram-positive bacteria, and 2.0% (n=5) were fungi. The most common pathogens were Klebsiella spp. (n=61, 24.8%) followed by Escherichia coli (n=31, 12.6%), coagulase-negative staphylococci (n=23, 9.3%), and Staphylococcus aureus (n=22, 8.9%). Resistance rates of gram-positive bacteria to penicillin, oxacillin, and vancomycin were 85.7%, 65.9%, and 9.5%, respectively. Resistance rates of gram-negative bacteria to cefotaxime, piperacillin/tazobactam, imipenem, gentamicin, and amikacin were 37.2%, 17.1%, 6.2%, 32.2%, and 13.7%, respectively. Overall fatality rate was 12.7%. Gram-negative bacteremia was more often associated with shock (48.4% vs. 11.9%, P<0.01) and had higher fatality rate than gram-positive bacteremia (12.1% vs. 3.0%, P=0.03). Neutropenic patients were more often associated with shock than non-neutropenic patients (39.6% vs. 22.0%, P=0.04). CONCLUSION: This study revealed that gram-negative bacteria were still dominant organisms of bloodstream infections in children with hemato-oncologic diseases, and patients with gram-negative bacteremia showed fatal course more frequently than those with gram-positive bacteremia.
Amikacin ; Bacteremia ; Bacteria ; Cefotaxime ; Child ; Escherichia coli ; Fever ; Fungi ; Gentamicins ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Humans ; Imipenem ; Klebsiella ; Neutropenia ; Oxacillin ; Penicillins ; Retrospective Studies ; Shock ; Staphylococcus aureus ; Vancomycin

Coronary artery milking is defined as a systolic compression of the coronary artery, usually resulting from myocardial bridging. Rarely, congenital heart disease, pulmonary hypertension and ventricular aneurysm can lead to coronary artery milking, and there has been a reported case of left anterior descending coronary artery milking after coronary stenting. Percutaneous coronary intervention (PCI) is an emerging strategy for treatment of stenosis in the left main stem. We report a case of symtomatic systolic milking at the left main stem treated by direct stenting during PCI in a patient with unstable angina pectoris.
Aneurysm ; Angina, Unstable ; Constriction, Pathologic ; Coronary Vessels ; Humans ; Hypertension ; Milk ; Myocardial Bridging ; Percutaneous Coronary Intervention ; Pulmonary Heart Disease ; Stents

PURPOSE: We have undertaken this study to evaluate the effects of induction chemotherapy involving BH-AC, idarubicin, and 6-thioguanine (6-TG). METHODS: BH-AC 300mg/m2/day was administered intravenously over three hours for seven consecutive days. Idarubicin 12mg/m2/day was administered intravenously for three days. 6-TG 100 mg/m2/day was administered orally for seven days. Intrathecal ara-C was administered on the first day of treatment. RESULTS: Complete remission (CR) was achieved in 18 cases (66.7%), partial remission (PR) was achieved in 2 cases (7.4%). In previously untreated patients, complete reimission rate was 92.9% (13/ 14), in relapsed patients, 40% (2/5) and in the refractory patients, 37.5% (3/8). The remission duration until December 1996 was 45 to 630 days (median 133). Duration of the neutropenia (ANC<500/microliter) was 0 to 38 days (median 24). Side effects were nausea, vomiting (7/27, 25.9%), liver dysfunction (1/27, 3.7%), skin eruption (1/27, 3.7%), and mucositis (1/27, 3.7%). In all cases, fever developed in the neutropenic state (culture proven sepsis in 5 cases). Death occurred in 5 cases who achieved CR due to sepsis after chemotherapy (4 cases), intracerebral hemorrhage after bone marrow relapse (1 case). CONCLUSION: BH-AC, idarubicin, and 6-TG induction chemotherapy could be a useful induction chemotherapy treatment that combines supportive care for infection and bleeding.
Bone Marrow ; Cerebral Hemorrhage ; Cytarabine ; Drug Therapy ; Fever ; Hemorrhage ; Humans ; Idarubicin* ; Induction Chemotherapy* ; Leukemia, Myeloid, Acute* ; Liver Diseases ; Mucositis ; Nausea ; Neutropenia ; Recurrence ; Sepsis ; Skin ; Thioguanine* ; Vomiting