We report a case of subcutaneous fat necrosis associated with pancreatitis that may be the first case in Korean hterature as for we know. The patient was a 41-year-old man wbo presented erythema nodesum-like erythematous subcufaneous nodules on both lower extremities. Histopathologic findings showed subcutaneoms focal fat necrosis and ghoat-like cells. Granular basophilic material was deposited in and around the necrotic fat cells and stained positively with von Kossa stain. The lesioas subsided gradwdly without any specific treatment, as the underlying pancreatitis was ameliorated.
Adipocytes ; Adult ; Basophils ; Erythema ; Fat Necrosis ; Humans ; Lower Extremity ; Necrosis* ; Pancreatitis* ; Subcutaneous Fat*

Lymphangiomas or cystic hygromas are quite commonly seen in children. During a 22-year period, from January 1980 to December 2001, 117 patients with lymphangioma were treated and followed in the Department of Pediatric Surgery at Hanyang University Hospital. The male-to-female ratio was 1.9:1 (77:40) with a male preponderance. As for the age incidence at time of diagnosis, 10 (8.5 %) patients were noted under 1 month of age, 37 (31.6 %) were between 1 month and 1 year of age, 12 (10.3 %) between 1 and 2 years of age, so 59 (50.4 %) were under 2 years of age. Sixty one (52.1 %) lymphangioma-cases were located in the neck, including one case at the nape. Axilla was the second in frequency and the rest were scattered at various sites. The intrascrotal lymphangioma is very rare but we have experienced one case of primary intrascrotal lymphangioma. Eighteen (15.4 %) cases were located in the intraabdominal area, 10 in the mesentery, 2 in the greater omentum and 6 in the retroperitoneum. The chief complaints of intraabdominal lymphangioma were abdominal pain, intestinal obstruction, inguinal hernia, palpable mass, and/or abdominal distension. Among 77 histologically proven cases, 14 cases were cavernous lymphangiomas and the rest were cystic lymphangiomas. Bleeding in the lymphangioma was noted in 20 (17.1 %) cases of all. As for the treatment, a complete excision was performed in 77 (65.8 %) patients and AgNO3 sclerotherapy after incomplete excision was performed in 23 (19.7 %). Picibanil (OK-432) sclerotherapy was performed in 17 (14.5 %) patients. Recurrence rate was 7.7 % and mortality occurred in one case who had a large neck lymphangioma extending into the mediastinum.
Abdominal Pain ; Axilla ; Child* ; Diagnosis ; Hemorrhage ; Hernia, Inguinal ; Humans ; Incidence ; Intestinal Obstruction ; Lymphangioma* ; Lymphangioma, Cystic ; Male ; Mediastinum ; Mesenteric Cyst ; Mesentery ; Mortality ; Neck ; Omentum ; Picibanil ; Recurrence ; Sclerotherapy

BACKGROUND: Although the clinical and histopathological findings of pityriasis lichenoides(PL) are well known, there are few vailable data in Korea. OBJECTIVE: The purpose of this study was to evaluate the clinical and histopathologic features of pityriasis lichenoides(PL). METHOD: The clinical charts, photographies and skin biopsy slides of 86 patients who had been clinically diagnosed as PL at the initial visit were reviewed. Finally 49 patients were diagnosed as PL. They were classified into 5 groups(PLA, PLA>C, PLA=C, PLC>A, and PLC) according to the distribution ratio of acute and chronic lesions, and into 3 groups(diffuse, central, and pheripheral) by Gelmetti's method. And then the evaluation of age at onset, sex distribution, form and distribution of skin lesions, associated symptoms, clinical course, response to the treatment, and histopathologic features was conducted. RESULTS: 1. PL was more common in young adults(mean age 26.6 years) and males(male : female 2.5: 1). The trunk and proximal extremities were the predilection sites but also the acral(1) and facial(2) areas were involved. There were no specific symptoms in most cases, but, mild itching sensations in 7 cases and fever in i case. 2. The clinical course in 22 followed-up patients was 25.05+/-37.51months. The acute forms (PLA, PLA>C, and PLA=C) tended to run a fairly longer course than the chronic forms(PLC >A and PLC) but the statistical significance of these difference was low. 3. Most patients were improved by oral tetracycline, topical steroid application, and UVB therapy within the range of a few weeks to several months. But in 2 cases the lesions lasted over a year. 4. The histopathologic study of both PLA and PLC revealed the perivascular lymphocytic infiltration, obscuring of the dermo-epidermal junction by lymphocytic infiltration and exocytosis. In addition to the deeper and severe lymphocytic infiltration, the findings of dyskeratosis, epidermal necrosis, intraepidermal RBC trapping, RBC extravasation in dermis and papillary dermal edema were more prominent in PLA than PLC. 5. The diseases which were chnically confused with PL included the subacute or chronic dermatitis, insect bite, drug eruption, folliculitis, pityriasis rosea, etc. CONCLUSION: PL is an epidermal and dermal inflammatory condition that has a benign and self limited course in most cases. The classification according to the distribution ratio of acute and chronic lesions seems more useful in the evaluation of clinical type and course.
Biopsy ; Classification ; Dermatitis ; Dermis ; Drug Eruptions ; Edema ; Exocytosis ; Extremities ; Female ; Fever ; Folliculitis ; Humans ; Insect Bites and Stings ; Korea ; Necrosis ; Photography ; Pityriasis Lichenoides* ; Pityriasis Rosea ; Pityriasis* ; Pruritus ; Sensation ; Sex Distribution ; Skin ; Tetracycline

OBJECTIVES: The most common chromosomal abnormality contributing to recurrent abortion is the balanced chromosomal translocation. However the exact incidence of fetal losses are still unknown. The objectives of this study were to evaluate the incidence of fetal chromosomal abnormalities and outcome of pregnancy in recurrent miscarriage couples with balanced translocation. DESIGN: A retrospective analysis of recurrent spontaneous abortion patients with balanced chromosomal translocation. MATERIALS AND METHODS: Cytogenetic analysis was performed in 56 couples with history of recurrent abortions from 1995 to 1999. The use of high resolution banding technique and fluorescent in situ hybridization (FISH) in the chromosomal analysis has made the precise evaluation of chromosome aberrations. RESULTS: Among 56 couples, 42 patients had reciprocal translocation and 14 had Robertsonian translocation. Chromosomal aberrations were more frequent in women (36 cases) than in men (20 cases). Prenatal cytogenetic analyses were carried out in 14 subsequent pregnancies for carrier couples with balanced translocation. The fetal karyotypes showed that 5 cases (35.7%) was normal, 8 (57.1%) were balanced translocation, and 1 (7.1%) was unbalanced translocations. And cytogenetic analyses were done on 15 subsequent chorionic villi samples of abortuses for carrier couples with balanced translocations. Fourteen of fifteen abortuses (93.3%) were abnormal karyotype. CONCLUSIONS: Although the incidence of chromosomal imbalance in the fetuses was relatively low in prenatal cytogenetic analysis, individuals with balanced translocations are predisposed to giving birth to malformed offsprings with chromosomal imbalance (partial trisomy or monosomy). Therefore we recommend preimplantation genetic diagnosis (PGD) for recurrent abortions with balanced translocation and preventing the birth of offspring with chromosomal abnormalities.
Abnormal Karyotype ; Abortion, Habitual* ; Abortion, Spontaneous ; Chorionic Villi ; Chromosome Aberrations* ; Cytogenetic Analysis ; Family Characteristics* ; Female ; Fetus ; Humans ; In Situ Hybridization, Fluorescence ; Incidence* ; Karyotype ; Male ; Parturition ; Pregnancy ; Preimplantation Diagnosis ; Retrospective Studies ; Translocation, Genetic ; Trisomy

PURPOSE: We present our operative experiences with uncommon carpometacarpal (CMC) injuries, excluding the thumb. MATERIALS AND METHODS: Twenty four fractures and dislocations of the CMC joint excluding thumb, which were followed up for an average of 18 months were reviewed retrospectively. Emphases were placed on associated injuries, radiographic findings, treatment and complications. RESULTS: The average age of patients was 35 years with 14 cases of indirect trauma as an injury mechanism. Eighteen of 24 cases involved the 4-5th CMC joint, one case involved the 2-3rd joint and one case involved the 3-4th joint. In addition, there were 4 cases that involved all of the CMC joints. Seven cases were operated upon by closed reduction and percutaneous pinning, 16 cases were treated by open reduction and internal fixation, and 1 case received fusion for neglected injury. Eighteen cases had satisfactory results, 2 cases had residual pain, 2 cases showed a limitation of motion and 2 cases had grip weakness. CONCLUSION: Proper diagnosis and treatment of CMC joint injuries can reduce complications and avoid additional procedures.
Carpometacarpal Joints* ; Diagnosis ; Dislocations* ; Hand Strength ; Humans ; Joints ; Retrospective Studies ; Thumb*

PURPOSE: To establish modality of diagnosis and treatment in pisiform injuries by analysis of its clinical experiences. Materials & Methods : Twelve fractures and one dislocation of the pisiform that were followed up for more than twelve months were reviewed retrospectively. RESULTS: Eight cases had associated injuries on the wrist or hand of ipsilateral side. Eight cases were diagnosed by routine radiography and three cases required additional special radiography such as the supinated oblique view or carpal tunnel view. One case was diagnosed by computed tomography. Cast immobilization was performed in nine cases and three cases underwent internal fixation. Pisiform was excised in one chronic dislocation case. The results were usually satisfactory but two cases showed pisotriquetral arthritis and one of them underwent excision of pisiform. CONCLUSION: The diagnosis of pisiform injury may accompany some difficulties due to associated carpal injuries. Routine radiography is sufficient for the screening of it if attention is paid and specific radiography such as supinated oblique view or carpal tunnel view may be very useful for confirmation. As conservative treatment alone shows good result, operative fixation is recommended for limited cases. The excision of pisiform is required in case of pisotriquetral arthritis or neglected chronic dislocation.
Arthritis ; Diagnosis* ; Dislocations ; Hand ; Immobilization ; Mass Screening ; Radiography ; Retrospective Studies ; Wrist

An aneurysm in the upper extremity is rarer than in the lower extremity, and a traumatic false aneurysm is very rare. We encountered two patients with a traumatic false aneurysm in the upper extremity. The first case developed from a posterior interosseous artery injury after an internal fixation using a plate and circumferential wiring for a comminuted fracture of the proximal shaft of radius associated with a dislocation of the left elbow joint. This patient was managed by excision of the false aneurysm, and ligation of the artery. The second case developed from a radial artery catheterization on the left wrist. This was managed by excision of the false aneurysm and an end-to-end anastomosis and resulted in the disappearance of the false aneurysm and a good vascular patency. We report two rare cases of traumatic false aneurysm in the upper extremity and a review of the literature.
Aneurysm ; Aneurysm, False* ; Arteries ; Catheterization ; Catheters ; Dislocations ; Elbow Joint ; Fractures, Comminuted ; Humans ; Ligation ; Lower Extremity ; Radial Artery ; Radius ; Upper Extremity* ; Vascular Patency ; Wrist

This study was designed to determine the effects of ketamine on contractions induced by norepinephrine (NE), K+ or histamine (Hist) and on agonist-induced calcium mobilization, in rabbit thoracic aorta with or without endothelium. Contractile responses to NE, K+ or Hist were markedly attenuated by prior exposure to ketamine. Subsequent addition of ketamine to the rabbit aorta undergoing an isometric contraction induced by NE, K+ or Hist also decreased the contractile responses in a calcium ion concentration-dependent manner. Preincubation with ketamine produced a concentration-dependent inhibition of contractile responses elicited by the addition of calcium ion (1.6 mM) to a Ca(++)-free depolarizing solution. However, the phasic contraction produced by NE with 2mM lanthanum pretreatment, which is release of intracellular calcium, was also inhibited by ketamine. Moreover, the tonic contraction produced by NE after depletion of the agonist-releasable pool of intracellular calcium, which is thought to be due to calcium influx, was depressed by ketamine. These data suggest that ketamine relaxes NE-contracted rings of rabbit thoracic aorta by decreasing calcium entry and by producing an extracellular calcium-independent relaxant effect.
Animal ; Aorta, Thoracic ; Calcium/pharmacology ; Dose-Response Relationship, Drug ; Female ; Histamine/pharmacology ; Isometric Contraction/drug effects ; Ketamine/*pharmacology ; Male ; Muscle Contraction/*drug effects ; Muscle, Smooth, Vascular/*drug effects ; Norepinephrine/pharmacology ; Rabbits ; Support, Non-U.S. Gov't

The leiomyosarcoma is uncommom tumor that consists of 10% of all sarcoma incidence and commonly arise from retroperitomeum or mesentery. But leiomyosarcoma arose from mediastinum is very rare and only incidental case report is present. Mediastial leiomyosarcoma may originate from superior vene cava, pulmonary artery, small vessels of alveoli, esophagus and cardiac muscle. Common symptoms that are related with leimoyosarcoma of mediastinum are cough and dydpnea but dysphagia, chest pain and hemoptysis can be produced. Although long term survival after complete resection of tumor was reported in localized disease, there wes no effective therapy that prolong the survival in patients who had disseminated disease of huge tumor mass. We report the case of posterior mediastinal leiomyosarcoma confirmed by aspiration cytology and immunohistochemical staining, along with a review of literature.
Chest Pain ; Cough ; Deglutition Disorders ; Esophagus ; Hemoptysis ; Humans ; Incidence ; Leiomyosarcoma* ; Mediastinum ; Mesentery ; Myocardium ; Pulmonary Artery ; Sarcoma

OBJECTIVE: The aim of study was to evaluate the efficacy of medical and/or laparoscopic surgical treatment for improvement of reproductive outcome of in vitro fertilization and embryo transfer (IVF-ET) in the patients with endometriosis. METHODS: 296 IVF-ET cycles except 18 cycles of cancelled embryo-transfer (unfertilization; 16 cycles, high risk of ovarian hyperstimulation syndrome; 2 cycles) in 191 infertile women with endometriosis from January 1, 1995 to December 31, 1998 were included in this study. All women's ages were < or = 35 and the factor for infetility was endometriosis only and day 3 follicle stumulating hormone (FSH) level of all the cycles was < or = 10 mIU/ml in this study. All the baseline study about infertility was done before initiating treatment of infertility. The stage of endometriosis was recorded during diagnostic laparoscopy by WHO critera. Medical treatment (GnRH agonist or danazole) or laparoscopic surgery was done independently or combinedly by the physician's decision according to the disease entity and symptoms. Short or long protocols were used for controlled ovarian hyperstimulation and 3 day embryos were transferred (maximally 4 embryos) by standard procedures in our institute. We classified the cases as 4 groups : group 1 (without pre-treatment, 80 cycles), goup 2 (laparoscopic surgery only, 37 cycles), group 3 (medication only, 140 cycles), group IV (combined pre-treatment, 39 cycles). RESULTS: The mean age (years old, mean +/- SEM) was 31.5 +/- 0.3 (group 1), 31.6 +/- 0.5 (group 2), 31.5 +/- 0.2 (group 3), 31.7 +/- 0.4 (group 4) respectively. The duration of infertility (months) was 57.7 +/- 3.3, 64.5 +/- 4.8, 59.1 +/- 1.9, 52.0 +/- 3.7 respectively among groups. The viable pregnancy rate (over 28 gestational weeks, VPR) was 12.5 % (10/80) in goup 1, 13.5 % (5/37) in goup 2, 14.3 % (20/140) in group 3, 30.8 % (12/39) in group 4 and there was statistically significant difference between group 1 and group 4 (P=0.03, Chi square test). The total used gonadotropins (ampules) for controlled ovarian hyperstimulation were 28.2 +/- 0.6.
Embryo Transfer ; Embryonic Structures ; Endometriosis* ; Female ; Fertilization in Vitro ; Gonadotropins ; Humans ; Infertility ; Laparoscopy* ; Ovarian Hyperstimulation Syndrome ; Pregnancy Rate* ; Pregnancy*