No abstract available.
Impetigo*

PURPOSE: There are a few reports in the literature that deal with the results of total knee replacement arthroplasty in young rheumatoid arthritis patients. This study was undertaken to evaluate the results of total knee replacement arthroplasty in rheumatoid arthritis patients under the age of 45 years. MATERIALS AND METHOD: Between 1989 and 1993, 43 total knee replacement arthroplasties were performed in 26 adults with rheumatoid arthritis. The age at operation ranged from 23 to 45 years old (average 36.3 years). Of these, four patients (six knees) were lost to follow-up, so 37 knees in 22 patients were available for the follow-up evaluation at a mean 7.8 years (5-8.9). RESULTS: Preoperative flexion contracture was found in 33 knees (89.2%) among 37 knees and it was corrected by operation from 33.1 to 2.6 postoperatively. So the range of motion also improved by an average of 25.6 compare with preoperative state. At the time of final follow-up, six patients were free of pain and 15 patients had mild pain during weight-bearing state, but one patient, with loosening evidence complained of occasional moderate pain. The American Knee Society knee score was improved from a mean of 37.9 points preoperatively to 84.9 points postoperatively. There were 22 excellent, 14 good and one poor (loosening case) results. All patients were able to walk after the operation from 11 non-ambulators and 11 ambulators, assisted with a walking device in preoperative state. The average functional score also improved from 11.9 points to 86.8 points. Radiographic evaluation revealed a radiolucency rate of 43.2%, and revealed radiolucent line adjacent to 3 femoral and 15 tibial components. Almost all of the patients (91%) were satisfied with the result of operation, subjectively. Only one patient had a revision because of subsidency and loosening of a tibial prosthesis. CONCLUSIONS: We considered that total knee replacement arthroplasty for patients with rheumatoid arthritis and was less than 45 years old provided satisfactory and effective results.
Adult ; Arthritis, Rheumatoid* ; Arthroplasty* ; Arthroplasty, Replacement, Knee* ; Contracture ; Follow-Up Studies ; Humans ; Knee ; Lost to Follow-Up ; Middle Aged ; Prostheses and Implants ; Range of Motion, Articular ; Walking ; Weight-Bearing

It is deirable to identify the tumoric factors anticipating the therapeutic failure in breast cancer patients received postoperative adjuvant chemotherapy. So, we studued the tumoric topoisomerase II alpha enzyme, c-erbB-2 oncoprotein, and Pgp expression in breast cancer tissues to identify the roles of these factors as the predictors of chemotherapeutic result. The results were as follows. 1) There wee no significant differences in the average value of topoisomerase II alpha enzyme, c-erb B-2 oncoportein overexpression, and Pgp expression according to stages. 2) CAF chemotherapy was suggested to be more effective than CMF chemotherapy in more advance stages. 3) There was a possible suggestion that the breast cancer with high topoisomerase II alpha enzyme activity might indicate the failure with CMF chemotherapy. 4) C-erbB-2 oncoportein overexperession suggested the possibility of therapeutic failure with CMF chemotherapy and the selection of CAF chemotherapy might improve the survival of advanced breast cancer patients with c-erbB-2 overexpression. In conclusion, it was suggested that c-erb-2 oncopotein overexpression and high topoisomerase II alpha activity might have a meaningful role in the selection of proper chemotherapeutic regimen in setting of adjuvant chemotherapy and predict the therapeutic failure of some chemotherapeutic agents for breast cancer. An expanded study for these factors is required to reveal the clinical significance in chemotherapy for breast cancer patients.
Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; DNA Topoisomerases, Type II* ; Drug Therapy* ; Humans ; P-Glycoprotein*

Background: Folliculitis decalvans and dissecting cellulitis are types of primary neutrophilic cicatricial alopecia characterized by permanent hair loss. Clinicopathological differentiation is poorly described in literature. Objective: This study aimed to determine the clinicopathological distinction between folliculitis decalvans and dissecting cellulitis. Methods: A retrospective review was conducted in 45 patients diagnosed with dissecting cellulitis and folliculitis decalvans between 2011 and 2021. We reviewed the clinical features using electronic medical records, clinical photographs, and histopathologic features. Results: Clinically, middle-aged men with folliculitis decalvans showed polytrichia (80%) and papulopustules (55%), while young men with dissecting cellulitis had deeply seated nodules (84%). Histopathologically, follicular plugging was more frequently observed in dissecting cellulitis (80%) than in folliculitis decalvans (50%). There was a difference in the depth of inflammation between the two types. Conclusion A difference in clinical manifestations was observed according to the depth of inflammation. These findings may contribute to the differential diagnosis of primary neutrophilic cicatricial alopecia.

A 63-year-old male presented with a painful skin lesion on the left side of the neck and upper chest approximately two months prior to presentation. Diffuse erythematous to purplish-colored sclerotic patches were observed. He had been treated with intravenous antibiotics for two weeks for cellulitis, but the lesion did not improve. Punch biopsy, and neck computed tomography (CT) with contrast enhancement were performed to differentiate between cellulitis and scleroderma. Histopathological examination revealed infiltration of pleomorphic and poorly differentiated tumor cells extending into thickened collagen bundles, and mitotic activity. Based on histologic and radiologic findings, the patient was suspected to have poorly differentiated carcinoma, and further evaluation of the origin of the carcinoma was performed. A subareolar mass on the left breast was observed on chest CT, and a needle biopsy was performed; results were consistent with findings from the skin biopsy. Finally, the patient was diagnosed with carcinoma en cuirasse, a subtype of cutaneous metastasis of breast cancer, was transferred to oncology, and underwent palliative chemotherapy.

PURPOSE: To understand the structure and character of the right retroperitoneal space by analysis of the extension of retroperitoneal hematoma in patients with traumatic right renal injuries. MATERIALS AND METHODS: We retrospectively reviewed CT scans of 13 patients with right retroperitoneal hematomas caused by right renal injury. At the renal level, we analyzed the relation of a hematoma contacting psoas muscle with other retroperitoneal compartmental hematomas. At the suprarenal level, a perirenal hematoma and a hematoma contacting the diaphragm were analyzed according to their relation with intrahepatic IVC and pericaval hematoma. RESULTS: Below renal hilar level, all hematomas contacting psoas muscle, observed in eight cases, were connected with retrorenal extension of anterior pararenal hematoma. At the suprarenal level, intrahepatic pericaval hematomas were not, in all 13 cases, connected with a hematoma contacting the diaphragm, but with a perirenal hematoma. At the upper suprarenal level, the only pericaval hematomas containing a medial component of perirenal hematoma extended superiorly to the upper one third of the tenth thoracic vertebral body. CONCLUSION: The anterior renal fascia envelops perirenal space except in its medial aspect. In the upper suprarenal region, the anterior and posterior planes of the anterior renal fascia unite to fuse with diaphragmatic fascia, but along the medial aspect they fuse with intrahepatic pericaval connective tissue and posteromedial diaphragm, respectively.
Connective Tissue ; Diaphragm ; Fascia ; Hematoma* ; Humans ; Psoas Muscles ; Retroperitoneal Space* ; Retrospective Studies ; Tomography, X-Ray Computed

BACKGROUND: The possibility that anesthesia may alter the course of an infection has been under consideration for more a century. Alterations have been found in every component of the immune response during anesthesia and surgery. In this work, we have investigated the effect of lidocaine and propofol on interleukin-2 (IL-2), interleukin-4 (IL-4), and nitric oxide (NO) production in mice. METHODS: The culture supernatants of splenocytes exposed with anesthetics and lipopolysaccharide (LPS), or sera from mice injected with these agents were harvested to assay IL-2, IL-4, and NO. RESULTS: We detected that IL-2 productions of splenocytes culture supernatants and mice sera after exposure with lidocaine or propofol were decreased while IL-4 productions were increased. In addition, NO of mice sera was increased after lidocaine or propofol exposures. CONCLUSIONS: These findings suggest that lidocaine and propofol interfere with IL-2, IL-4, and NO production. This may explain the clinically well-recognized disturbance of human immunity after surgery and anesthesia.
Anesthesia ; Anesthetics ; Animals ; Humans ; Interleukin-2 ; Interleukin-4* ; Interleukins* ; Lidocaine* ; Mice* ; Nitric Oxide* ; Propofol*

The area overlying the ischium is a frequent site for the development and recurrence of pressure sores because they directly overlie the points of maximum pressure on the sitting surface. Furthermore, they are frequently complicated by abnormal lesional bursae, or by extension, fistula toward the perineum or peritoneal cavity. In all cases of the ischial pressure sores, total en bloc excision of the ulceration, underlying bony prominence with immediate closure, and healthy, well-vascularized soft tissue is required to obtain the satisfactory result. It is well known that the choice of the treatment of the ischial pressure sore is the gluteal or posterior thigh flap. There have been many reports on the reconstruction of the ischial pressure sores such as cases involving the fasciocutaneous flap, muscle and musculocutaneous flaps, V-Y advancement flaps, rotation flaps, and long random flaps. In spite of these varieties, the recurrence of the ischial pressure sore after treatment still remains about seventy-five percent according to Conway and Griffith.9 Consequently, any surgical plane for ischial pressure sores must provide a stable, durable soft tissue cover that can be reused in the event of recurrence. From February to December 2002, we have performed the reconstruction of the ischial pressure sores on the posterior thigh's transposition flap in order to get following advantages: simplicity of the operation, sufficiency of padding with skin flap, preservation of the adjacent normal tissues and the capability of recycling this same flap in case of recurrences. Its design is somewhat different from and more extended widely than that of the gluteal or posterior thigh flap. This flap was elevated above the deep fascia to be cutaneous with appropriate backcut incision; some perforators from the inferior gluteal artery were also preserved. We present some cases of ischial pressure sores treated with a laterally based posterior thigh transposition flap herein. Therefore, the need to perform repetitive surgery in the future must be considered so that the maximum number of reconstructive options can be preserved. Although the follow-up period has not always been satisfactory, we have not had any serious complications in these patients until recently.
Arteries ; Fascia ; Fistula ; Follow-Up Studies ; Humans ; Ischium ; Myocutaneous Flap ; Perineum ; Peritoneal Cavity ; Pressure Ulcer* ; Recurrence ; Recycling ; Skin ; Thigh* ; Ulcer

To analyze the infectious causes and clinical symptoms of febrile infants aged less than 3 months presenting to a Pediatric Emergency Medical Center (PEMC) and to propose more efficient, evidence-based management and treatment. We conducted a retrospective study of 462 febrile infants aged less than 3 months who visited PEMC at Keimyung University Dongsan Medical Center from January 2015 to June 2016. Infants' sex, age, fever duration, and laboratory findings, including bacterial or viral pathogens, were recorded. To evaluate clinical signs, one point per sign was given for grunting, decreased activity, and the presence of cyanosis; total scores were compared between the bacterial infection (BI) and non-bacterial infection (NBI) groups. BI was diagnosed in 118 (25.5%) infants, and no BI was diagnosed in 344 (74.5%) infants. Escherichia coli was the most frequently isolated pathogen, accounting for 80.5% (n = 95) of all infections (n = 118). Statistically significant differences in sex, the duration of fever, sign scores, white blood cell count, neutrophil count, lymphocyte count, and C-reactive protein (CRP) level were found between the BI and NBI groups. The cut-off value for CRP was 1.445 mg/dL, with sensitivity and specificity values of 76.3% and 75.9%, respectively, in BI patients, as determined by the receiver operating characteristic curve. As more PEMCs are being built in Korea, hospital accessibility is better; thus, it may be possible to perform outpatient management of young, febrile infants aged younger than 3 months without antibiotics and lumbar puncture using individual sign scores and laboratory findings.
Anti-Bacterial Agents ; Bacterial Infections ; C-Reactive Protein ; Cyanosis ; Emergencies ; Escherichia coli ; Fever ; Humans ; Infant* ; Korea ; Leukocyte Count ; Lymphocyte Count ; Neutrophils ; Outpatients ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Spinal Puncture

Renal angiomyolipomas are uncommon benign neoplasms composed of mature adipose tissue, thick walled blood vessels and smooth muscle in varying proportions. Accurate preoperative diagnosis of renal angiomyolipoma is essential if conservative resection or angiographic embolization is to be used. In recent years, abdominal computerized tomography (CT) and renal ultrasonography have resolved the diagnostic dilemma, making detection of angiomyolipomas possible in almost all cases. Recently, we performed selective renal angioembolizations in 3 patients (2 females, 1 male). After followup period of 6 months to 1 year, all patient got better in clinical symptoms. In two of them the lesions decreased in size on followup CT but one patient showed suspicious malignant change and we performed the exploration to rule out renal malignancy. In our opinion, it is appropriate to perform the selective renal angioembolization for initial treatment of renal angiomyolipomas.
Adipose Tissue ; Angiomyolipoma* ; Blood Vessels ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Muscle, Smooth ; Ultrasonography