A 3,480 g male neonate showed tachypnea symptom with a serum ionized calcium level of 0.66 mmol/L by routine clinical analysis. He was injected calcium gluconate intravenously through femoral vein catheter to treat the hypocalcemia. On second day after the injection, he started to show erythema in the flank area. The lesion became firm and changed into whitish crust consist of small crystals. Abdominal X-ray and ultrasonography showed the accumulation of calcium deposit in the subcutaneous layer of the lesion. Surgical debridement was performed to remove the crust with calcium deposit and acellular fish skin graft rich in omega-3 (Kerecis) was applied to the defect site for secondary intention of the defect wound. After 2 months, the skin and soft tissue defect were fully covered with healthy normal skin without depression or contracture. This report is a first case of iatrogenic calcinosis cutis without extravasation symptom.

Liver function tests before treatment showed abnormalities of liver function tests during treatment, while 15(68. 2%) of 22 patients who had abnormal liver function tests before treatment showed abnormalities during treatment. In 12 of the 25 patients who showed abnormalities of liver function tests during treatment with allopurinol, allopurinol was stopped and all patients showed improvement of liver function tests. In remaining 13 patients, 10 patients were improved and other 2 patients showed only mild abnormalities of liver function tests despite of continuing allopurinol and 1 patient was lost during follow-up. CONCLUSION: Abnormalities of liver function tests were common during treatment with allopurinol. Most patiensts who had mild abnormalities of liver functions tests during treatment with allopurinol were improved regardless of continuing allopurinol.
Allopurinol* ; Follow-Up Studies ; Gout* ; Humans ; Liver Function Tests* ; Liver*

OBJECTIVE: The goal of this study is to assess the safety and efficacy of the Codman Hakim programmable valve versus differential pressure valve in the treatment of patients with hydrocephalus. METHODS: The authors conducted a retrospective study of 83 patients who were implanted the Codmam Hakim programmable valve and differential pressure valve between January 1996 and April 2001. We analyzed complications, the number of shunt revision, and prognosis between the two groups. We analyzed initial pressure setting, the cause of reprogramming, and the number of reprogramming in Codman Hakim programmable valve. RESULTS: No statistically significant difference was apparent between the Codmam Hakim programmable valve group and a differential pressure valve group in complications, primary disease entities in shunt revision cases and prognosis(p>0.05). And statistically difference was not apparent in the number of shunt revision(p=0.07). The average pressure and range of initial pressure setting in the Codmam Hakim programmable valve was 97.1mmH2O and 50~150mmH2O, respectively. The number of cases of reprogragmming in the Codmam Hakim programmable valve was 12 in total, 1 time in 9 cases , 2 times in 2 cases, and 3 times in 1case. CONCLUSION: The Codmam Hakim programmable valve can decrease shunt revision caused by underdrainage and overdrainage complications. The optimal pressure settting is the key point to decreasing reprogramming and complications in the Codmam Hakim programmable valve and a differential pressure valve.
Humans ; Hydrocephalus* ; Prognosis ; Retrospective Studies

We have recently managed a case of syringomyelia associated with Chiari I Type malformation. The syrinx was found at C2 level to T10 level. And the patient complained left forearm pain and paresthesia in left shoulder, arm with segmental dissociated sensory loss. The cranio-vertebral decompression(suboccipital craniectomy, cervical laminectomy) and the shunting procedures were performed. Postoperative course was not uneven, the clinical and neurological improvement was observed. M.R.I. permitted rapid, exact diagnosis including localization of syrinx and information of associated anomaly.
Arm ; Diagnosis ; Forearm ; Humans ; Paresthesia ; Shoulder ; Syringomyelia*

In systemic lupus erythematosus (SLE), besides immunosuppressive therapy, the immunological abnormalities such as impaired phagocytosis and deficiency of cell-mediated immunity contribute to the increased risk of infection. Most of all, the incidence of tuberculous infection is higher and the pattern tends to be more extensive and extrapulmonary than in general population. Therefore the contributory role of tuberculous infection in mortality of SLE should be emphasized, especially in areas endemic for Mycobacterium tuberculosis like Korea. When tuberculous infection involves central nervous system, it can mimic lupus myelitis, showing the clinical manifestations like paraplegia, sensory impairment and bladder dysfunction. Tuberculous myelitis should be differentiated with lupus myelitis as early as possible for proper treatment and better prognosis. We report a 52 year-old woman with SLE presented with paraplegia and urinary incontinence, who were initially suspected as lupus myelitis. But the AFB smear and culture of cerebrospinal fluid were compatible with tuberculosis myelitis.
Central Nervous System ; Cerebrospinal Fluid ; Female ; Humans ; Immunity, Cellular ; Incidence ; Korea ; Lupus Erythematosus, Systemic ; Middle Aged ; Mortality ; Mycobacterium tuberculosis ; Myelitis* ; Paraplegia ; Phagocytosis ; Prognosis ; Tuberculosis ; Urinary Bladder ; Urinary Incontinence

Cerebral cysticercosis is relatively common disease in Korea. But cysts in the ventricular system are rare form. In the ventricular system, they occur most frequently in the 4th ventricle, more rarely in the lateral and 3rd ventricle. We have recently experienced a case of cerebral cysticercosis which involved the 3rd ventricle. A sixty-year old man was admitted because of generalized seizure attack followed by drowsy mentation. On admission, there were no specific localizing and lateralizing neurological abnormalities except bilateral, mild degree optic papilledema. Brain CT scan after intraventricular metrizamide administration disclose a cystic mass in the third ventricle. And the serum ELISA test was positive(patient's titer : 0.31, normal : below 0.18). Anterior transcallosal approach was performed and cystic mass was removed from the third ventricle. Pathological diagnosis of the specimen was cysticercosis. Following surgery, the patient's symptom cleared up and papilledema disappeared gradually.
Brain ; Cysticercosis* ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Korea ; Metrizamide ; Papilledema ; Seizures ; Third Ventricle ; Tomography, X-Ray Computed

Although a paradoxical response of tuberculosis to antituberculous therapy is not a rare phenomenon, it can be a clinical challenge to differentiate a paradoxical response from treatment failure. A 25-year-old woman was admitted for miliary lung nodules and multiple intracranial nodules. Antituberculous treatment was started with a preliminary diagnosis of tuberculosis based on the history and clinical findings. After one month, the miliary lung nodules improved while the intracranial nodules increased in size and number. Based on a stereotactic biopsy, it was confirmed that the intracranial lesions were tuberculomas. Although the therapeutic regimen was not changed, the symptoms eventually were ameliorated and the intracranial nodules improved two months later.
Adult ; Biopsy ; Female ; Humans ; Lung ; Treatment Failure ; Tuberculoma ; Tuberculoma, Intracranial ; Tuberculosis

BACKGROUND: One of the groups with highest risk for avascular necrosis is patient with systemic lupus erythematosus (SLE). Corticosteroid therapy is also the most important risk factor. No predictive test, however, was known to detect avascular necrosis. The purpose of this study is to evaluate hemodynamic flow to the proximal femur in patients with SLE with long term corticosteroid therapy. METHODS: Twenty-two patients with SLE without avascular necrosis and with long-term corticosteroid treatment (mean months; 41 (1-156)) versus 15 healthy controls were evaluated. Medial and lateral circumflex arteries of 44 hips in 22 SLE patients and 30 hips in healthy controls were examined using ultrasoud equipment with color Doppler and power Doppler capability. Arterial pulstality index (PI) and peak systolic velocity (PSV) were determined with neutral and internal rotation position (stimulated ischemia). RESULTS: PSV was significantly increased in patients with SLE than healthy controls (70.6+/-40.4 vs 46.9+/-19.3; p<0.001) with neutral position as well as (74.8+/-42.3 vs 49.9+/-19.9; p<0.001) with internal rotation. PI was also higher in SLE patients than healthy controls (8.9+/-6.3 vs 5.5+/-3.4; p<0.001) with neutral position as well as (8.1+/-7.1 vs 3.9+/-2.5; p<0.001) with internal rotation. PI strongly correlated with PSV (r=0.99, p<0.001). But PSV or PI did not correlate with duration of corticosteroid use. CONCLUSION: Peak systolic velocity and pulstality index of arteries to the femur head in patients with SLE with long-term corticosteroid treatment were significantly higher than healthy controls. These hemodynamic changes may contribute to develop avascular necrosis of the hip in patients with SLE.
Arteries ; Femur Head* ; Femur* ; Hemodynamics* ; Hip ; Humans ; Lupus Erythematosus, Systemic* ; Necrosis ; Osteonecrosis ; Risk Factors ; Ultrasonography

The hemodynamic effects of thyroid hormones which is well established, affect myocardial contractility, heart rate, and myocardial oxygen consumption. The alterations in thyroid function test are frequently seen in patients with nonthyroidal illness and often correlate with the severity of the illness and the prognosis. In this study, thyroid hormone changes were investigated in 20 patients who received cardiopulmonary bypass(CPB). All patients showed a state of biochemical euthyroidism preoperatively. The results were as follows : 1. Serum triiodothyronine(T3) reached to its nadir(30.05+/-17.5ng/dl, p<0.001) at 10 minutes after the start of CPB and remained low(p<0.05) throughout the study period. 2. Serum thyroxine(T4) concentration slightly decreased after CPB, but maintained within normal range. 3. Serum free thyroxine(fT4) concentration slightly increased after CPB, but maintained within normal range. 4. Serum thyroid stimulating hormone(TSH) concentration increased 10 minute after CPB, reached to its nadir(3.37+/-0.81uIU/ml, p<0.001) at 2 hours after CPB. After then, serum TSH concentration decreased and reached its normal levels at 24 hours after CPB. 5. The patients whose postoperative recovery was uneventful(Group 1) had higher serum T3 levels than those who had postoperative complications(Group 2)(p<0.05). Group 1 showed elevating patterns of serum T3 in the fourth day after operation, whereas group 2 did not show such an elevating pattern. These findings are similar to the euthyroid sick syndrome seen in severely ill patients and indicate that patients undergoing open heart surgery have suppression of the pituitary-thyroid axis.
Axis, Cervical Vertebra ; Euthyroid Sick Syndromes ; Heart* ; Hemodynamics ; Humans ; Myocardial Contraction ; Oxygen Consumption ; Prognosis ; Reference Values ; Thoracic Surgery* ; Thyroid Function Tests ; Thyroid Gland* ; Thyroid Hormones

Epiploic appendagitis is a relatively rare cause of acute abdominal pain. Usually, epiploic appendagitis is a benign and self-limited condition, but it can be clinically misdiagnosed as acute appendicitis or diverticulitis, so an inaccurate diagnosis may lead to unnecessary treatment. We recently managed 7 cases of epiploic appendagitis during 1 year and review these cases with an emphasis on the clinical diagnostic features. The main pathophysiologic mechanism underlying epiploic appendagitis is thought to be triggered by appendageal torsion and caused by a subsequent blood flow disturbance. This medical condition must be kept in mind when a patient with acute abdominal pain has well-localized pain which is characteristically sharp in nature and a mild systemic inflammatory response compared to the severity of the pain.
Abdomen, Acute ; Abdominal Pain ; Appendicitis ; Diagnosis, Differential ; Diverticulitis ; Humans