BACKGROUND: Pernio or chilblain is an abnormal reaction to damp cold air, resulting in pruritic erythematous swellings on acral skin. The histologic features are subepidermal edema, diffuse fluffy edema of endothelial cell, and superficial or superficial and deep perivascular lymphocytic infiltrates. Many studies with a large sample size have been conducted in western countries, but there were no collective studies of pernio that have been reported in Korea. OBJECTIVE: The purpose of this study was to clarify the clinical and histopathologic features of pernio in Korea. METHODS: We reviewed the clinical and histopathologic findings in ten patients with pernio who visited the Department of Dermatology, Kosin Medical College Gaspel Hospital during the 10 year period from 1988 to 1997. RESULTS: The results were as follows.1. The age distribution was in the range of 6-50 year old. The prevalance was heighest in the third and fourth decade. Sex ratio was 1:4 (2 males :8 females).The duration of symptoms ranged from 4 days to 30 years. All patients developed skin lesions on the acral area. Two male patients developed skin lesions on the hand associated with cold exposure and outdoor works. All patient had itching and burning papules and/or plaques, and one had a painful hard nodule. Laboratory studies were all negative and within normal ranges.2. Histopathologic features revealed subepidermal edema, diffuse fluffy edema of endothelial cell, and superficial or superficial and deep perivascular lymphocytic infiltrates in all specimens. 3. Treatment includes prophylatic measures against cold and nifedipine(calcium channel inhibiting drug). In more severe cases, pentoxifylline might be helpful. CONCLUSION: Our study suggests that pernio commonly occurs in twenty to forty year old females during fall and winter. Upon exposure to cold temperatures, the acral skin develops pruritic erythematous papules and plaques. If these lesions persisit for a long time or recur, they may progress to vesicle and ulceration and possibly develop vasculitis which does not respond to therapy well. Thus, a thorough understanding of clinical and histopathologic features of pernio is vital in making a diagnosis, a treatment plan and determining the prognosis.
Age Distribution ; Burns ; Chilblains ; Cold Temperature ; Dermatology ; Diagnosis ; Edema ; Endothelial Cells ; Female ; Hand ; Humans ; Korea ; Male ; Pentoxifylline ; Prognosis ; Pruritus ; Sample Size ; Sex Ratio ; Skin ; Ulcer ; Vasculitis

In order to appreciate the incidence of scabies, the authors conducted an observation of ll,848 cases of scabies in 152,254 outpatients at Chilgok Catholic Skin Clinic from January 1968 to December 1979 and the following results were obtained; The incidence of scabietic patients was 7.78% among total outpatients and the annual frequency increased progressively from 1972 (3.86%), showed maximal incidence in 1975(12. 35%), and thereafter decreased. In sexual distribution, males predominated over female 1.9: 1. In age distribution, 2nd and 3rd decades occupied 64 of total scabietic patients. The monthly distribution of total scabietic patients was highest in December (10.85%) and lowest in August (4.57%) but no seasonal variation was observed. Over half(54.9%) of 5,273 scabietic patients visited within 2 months after their infection. 1,031 cases(10.27%) of 10, 036 scabietic patients revealed the complications such as infection (5.04%), eczematization (3.37%) and nodule (1.86%).
Age Distribution ; Female ; Humans ; Incidence ; Male ; Outpatients ; Scabies* ; Seasons ; Skin

A case of multilocular solitary cyst of the kidney containing approximately 5000 ml. of fluid has been reported along with a literatural review.
Bone Cysts* ; Kidney*

The diagnosis of insulinoma is made primarily by the detection of an inappropriately elevated serum insulin level in the presence of a low blood glucose level. The successful resection of insulin-secreting islet cell turnors is greatly facilitated by accurate preoperative localization. But, the modalities of ultrasonography, computer tomography, magnetic resonance imaging and selective arteriography often fail to detect insulinoma smaller than 1.5 cm in diameter. In this report, we describe a patient with an insulinoma successfully localized by percutaneous transhepatic portal vein sampling but not by abdominal ultrasonography, computer tomography and selective arteriography. Percutaneous transhepatic portal vein catheterization with insulin sampling showed sudden step-up of insulin concentrations near 6 cm from distal splenic vein. During operation, a 1×1.3cm sized tumor was found at the junction of body and tail of pancreas, so distal pancreatectomy was performed, We propose that preoperative percutaneous transhepatic portal vein catheterization with measurement of radioimmunoactive insulin concentration is a safe and reliable method and plays an important role to localize insulinoma that are considered occult after conventional diagnostic studies have been negative.
Angiography ; Blood Glucose ; Catheterization ; Catheters ; Diagnosis ; Humans ; Insulin ; Insulinoma ; Islets of Langerhans ; Magnetic Resonance Imaging ; Methods ; Pancreas ; Pancreatectomy ; Portal Vein ; Splenic Vein ; Tail ; Ultrasonography

We performed trans scleral fixation techniques for implantation of posterior chamber lens in 25 eyes, in case of incomplete zonular or capsular support. This was done by securing both haptics of the posterior chamber lens to the sclera at the ciliary sulcus with 10-Onylon suture. Postoperative follow-up time ranged from 12 to 23 months, with all patients having at least one year of follow up. At the last follow up visit, 16 eyes (72%) had a vision of 20/50 or better, and 13 eyes (52%) had a vision of 20/30 or better. The transscleral fixation related complications included retinal detatchment, glaucoma and cystoid macular edema. During the relatively longterm follow up period, we did not find any serious complications due to the intraocular lens and there was no significant postoperative changes in the visual acuities.
Follow-Up Studies ; Glaucoma ; Humans ; Lens Implantation, Intraocular ; Lenses, Intraocular* ; Macular Edema ; Retinaldehyde ; Sclera ; Sutures ; Visual Acuity

BACKGROUND: 1970, Pinkus described large cell acanthoma(LCA) as a benign epidermal neoplasm which clinically resembles a actinic keratosis or seborrheic keratosis. However, the entity of this disease is still unclear.OBJECTIVE: The purpose of this study was to find out if LCA is a distinctive entity by investigating its clinical features, histopathologic features and Ki-67 expression. METHODS: 20 LCA samples including normal tissue were analyzed after investigating their clinicopathologic features and immunohistochemical analysis of Ki-67 expression which was performed on the formalin-fixed, praffin-embedded tissue section. The assessment of immunohistochemical staining was based on the growth fraction(GF), defined as the number of Ki-67 positive cells divided by the total number of tumor cells counted, and was expressed in a percentage. RESULTS: 1. LCA was usually presented as a well demarcated, brown or light brown, 5 to 30 mm, round, flat to hyperkeratotic scaly patch and plaque. It predominantly affected female (5.6 females:1 males) aging from 37 to 76 years of age(mean 51 year-old). The duration of LCA ranged from 6 months to 30 years. In eleven cases, the lesion was located on the face and in nine cases, on the extremities. Eight cases showed a solitary lesion and twelve cases showed multiple lesions. Transformation to malignancy was not found.2. Histopathologic study showed sharply circumscribed epidermal neoplasms characterized by large (approximately twice the normal size) uniform keratinocytes with proportionally large nuclei and an increase of melanin in the basal layer. In many cases, hypergranulosis(18 cases) and hyperkeratosis(17 cases) were observed. Occasionally, acanthosis(10 cases), papillomatosis(9 cases) and epidermal atrophy(7 cases) were also observed. However, keratinocyte necrosis was not observed. Moderate solar elastosis and moderate lymphocytic infiltration was observed in the upper part of the dermis in all cases. Mild and moderate melanin incontinence was observed in 14 cases and 1 case respectively. Appendage involvement(follicular infundibulum and acrosyringium) was observed in all cases.3. The Ki-67 expression of LCA tissue(4.87 +/- 3.10%) was significantly higher than the adjacent normal skin(2.50 +/- 1.89%, p=0.01). CONCLUSION: Our study of the clinical and histopathologic features and the expression of Ki-67 strongly suggests that LCA is a distinctive entity.
Acanthoma* ; Aging ; Dermis ; Extremities ; Female ; Humans ; Keratinocytes ; Keratosis, Actinic ; Keratosis, Seborrheic ; Melanins ; Necrosis

Congenital insensitivity to pain with anhidrosis (CIPA) is a rare hereditary sensory and autonomic neuropathy. CIPA is characterized by inability to sweat, insensitivity to pain, self-mutilation, recurrent episodes of hyperpyrexia, mental retardation, and autonomic nervous system abnormality. Patients with CIPA may undergo surgery because of susceptibility to trauma, bony fracture and osteomyelitis due to insensitivity to pain. We report a child who had undergone anesthesia with total intravenous anesthesia. The anesthetic management of this condition is discussed.
Anesthesia ; Anesthesia, Intravenous ; Autonomic Nervous System ; Child* ; Hereditary Sensory and Autonomic Neuropathies* ; Humans ; Intellectual Disability ; Osteomyelitis ; Pain Insensitivity, Congenital* ; Propofol ; Sweat

PURPOSE: To evaluate the portal venous anatomy in the right lobe of the liver, focusing particularly on the location and size of the anterior and posterior segmental branches of the portal vein and the relationship of the right subdiaphragmatic peripheral portal vein to the right hepatic vein. MATERIALS AND METHODS: From June 1995 to December 1995, 100 spiral CT scan which showed no abnormal findings in the hepatic area were retrospectively analysed. Portal dominant phase images were obtained after the administration of contrast media, with a delay of 60-65 seconds (100 - 120ml, 2-3ml/sec injection rate), slice thickness 10 mm and table speed 10mm/sec. On spiral CT scans, we assessed the location and size of the right portal vein and its branches and also observed the relationship of this vein to the right hepatic vein. RESULTS: In all patients, the right portal trunk divided into anterior and posterior branches. The anterior segmental portal vein was located cephalad to the posterior segment in 81 cases (81%), at the same level in 17 (17%), and caudad in two (2%). Its diameter was greater (>2mm)than that of its posterior segment in 33 cases (33%), smaller in three (3%), and similar in 64 (64%). In 95 cases, the right anterior segmetal portal vein which was directed posteriorly, supplied the subdiaphragmatic portion of segment 7. CONCLUSION: In 81% of cases, the position of the anterior segmental portal vein cephalad, and in 64%of cases it was similar in size to the posterior portal vein. In almost all cases, the subdiaphragmatic portion of segment 7 was supplied by the portal vein from segment 8. Therefore, the right hepatic vein is not in all cases an adequate landmark for dividing Couinaud segments 7 and 8 in the subdiaphragmatic portion.
Contrast Media ; Hepatic Veins ; Humans ; Liver* ; Portal Vein ; Retrospective Studies ; Tomography, Spiral Computed ; Veins

PURPOSE: To evaluate the portal venous anatomy in the right lobe of the liver, focusing particularly on the location and size of the anterior and posterior segmental branches of the portal vein and the relationship of the right subdiaphragmatic peripheral portal vein to the right hepatic vein. MATERIALS AND METHODS: From June 1995 to December 1995, 100 spiral CT scan which showed no abnormal findings in the hepatic area were retrospectively analysed. Portal dominant phase images were obtained after the administration of contrast media, with a delay of 60-65 seconds (100 - 120ml, 2-3ml/sec injection rate), slice thickness 10 mm and table speed 10mm/sec. On spiral CT scans, we assessed the location and size of the right portal vein and its branches and also observed the relationship of this vein to the right hepatic vein. RESULTS: In all patients, the right portal trunk divided into anterior and posterior branches. The anterior segmental portal vein was located cephalad to the posterior segment in 81 cases (81%), at the same level in 17 (17%), and caudad in two (2%). Its diameter was greater (>2mm)than that of its posterior segment in 33 cases (33%), smaller in three (3%), and similar in 64 (64%). In 95 cases, the right anterior segmetal portal vein which was directed posteriorly, supplied the subdiaphragmatic portion of segment 7. CONCLUSION: In 81% of cases, the position of the anterior segmental portal vein cephalad, and in 64%of cases it was similar in size to the posterior portal vein. In almost all cases, the subdiaphragmatic portion of segment 7 was supplied by the portal vein from segment 8. Therefore, the right hepatic vein is not in all cases an adequate landmark for dividing Couinaud segments 7 and 8 in the subdiaphragmatic portion.
Contrast Media ; Hepatic Veins ; Humans ; Liver* ; Portal Vein ; Retrospective Studies ; Tomography, Spiral Computed ; Veins

Methicillin-resistant Staphylococcus (S.) aureus (MRSA) is one of the most important nosocomial pathogens worldwide and the emergence of this strain has become a major clinical problem. In this study, we investigated the prevalence of MRSA and their genetic characteristics in 69 S. aureus isolated from humans and animals. In human isolates, higher antimicrobial resistance rates were observed against penicillin (80.6%), followed by erythromycin (11.9%) and tetracycline (9.0%). All of them were susceptible to clindamycin, enrofloxacin, novobiocin, pirlimycin, trimethoprim/sulfamethoxazole and vancomycin. The resistance patterns in animal isolates were similar to those of human isolates. Two (2.9%) MRSA strains were isolated from human (n = 1) and animal (n = 1), and these isolates were confirmed as carrying the mecA gene. One isolate originating from human was resistant to 7 drugs and the other isolate derived from animal was resistant to 11 drugs. Staphylococcal cassette chromosome mec (SCCmec) variant IIIB was identified in animal isolate but SCCmec type of an isolate from human was not exactly determined. Two MRSA isolates showed unrelated PFGE pattern between them. Our results indicated although the frequency of MRSA isolates from humans and animals was low, a continuous surveillance and monitoring should be called for to prevent the contamination and spread of MRSA in the community. To our knowledge, this is the first time that SCCmec type variant IIIB was detected from animals in Korea.
Adenosine ; Animals ; Clindamycin ; Erythromycin ; Fluoroquinolones ; Humans ; Korea ; Lifting ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Novobiocin ; Penicillins ; Prevalence ; Sprains and Strains ; Staphylococcus ; Tetracycline ; Vancomycin