BACKGROUND: Color Doppler echocardiography is sensitive in detecting mitral regurgitation and useful in quantitating its severity. The presence of an eccentric regurgitant jet suggests that regurgitation is caused by prolapsing or flail leaflet of mitral valve. Until recently the direction of regurgitant jet in mitral valve prolapse has been examined in a single(parasternal short axis view) or orthogonal plane using color Doppler echocardiography, and few in the apical rotation method of a transducer. The purpose of this study was to clarify the usefullness of the apical rotation method of a transducer in detection of the direction of mitral regurgitant jet and diagnosis of the sites of mitral valve prolapse. METHODS: Twenty four patients(8 men and 16 women, mean age:47.3+/-18.8 years) with mitral valve prolapse with eccentric regurgitant jet were examined by two-dimensional and color Doppler echocardiograply using conventional parasternal long and short axis views, and four apical longitudinal planes(four chamber, vertical, two chamber and transverse views) obtained by the apical retation method of a transducer. RESULTS: Thirty one regurgitant jets were detected in twenty four patients, eighteen patients had anterior, nine patints posterior, and three patients bi-leaflet(anterior and posterior) prolapse. In eighteen patients with anterior leaflet prolapse, ten had medial, eight had middle, three had lateral, and three had two portions(two, medial and middle; one, middle and lateral) prolapse. In nine patients with posterior leaflet prolapse, five had medial, three had middle, two had lateral, and one had two(medial and middle) scallop prolapse. CONCLUSION: Color Doppler echocardiography by the apical rotation method of transducer is useful in assessment of the site of prolapse in patients with mitral valve prolapse with eccentric regurgitation.
Axis, Cervical Vertebra ; Diagnosis ; Echocardiography* ; Echocardiography, Doppler, Color ; Female ; Humans ; Male ; Mitral Valve Insufficiency ; Mitral Valve Prolapse* ; Mitral Valve* ; Pectinidae ; Prolapse* ; Transducers*

Porokeratosis is a group of disorders characterized by epidermal keratinization associated with cornoid lamella. Porokeratosis has been described as having five distinct clinical subtypes: Mibelli or plaque type, disseminated superficial actinic porokeratosis, linear porokeratosis, punctate porokeratosis, porokeratosis palmaris et plantaris disseminata. We describe a 61-year-old Korean woman presented with porokeratosis palmaris et plantaris disseminata.
Female ; Humans ; Middle Aged ; Porokeratosis*

We analyzed 5,504 ICU patients who were admitted between Mar. 1985 and Feb. 1989 to obtain better guidance and management in the ICU. The results of analysis are as follows ; 1) The total number of patients was 5,504; 792 patients in 1981, 771 patients in 1986, 1,036 patients in 1987, 1.393 patients in 1988, and 1.512 patients in 1989. There were continual increment annually since 1986, and 95% increment in 1989 compared to 1985. 2) The male patients were 3,681 and female patients were 1,823, and the ratio of male to female patients was about 2:1. The most frequent age group was 40-49 and the rate of which was 23.%. 3) The mean admission day was 5.9 days. There were continual increment annually and 13.3 % increment in 1989 compared to 1985, The number of patients stayed in the ICU for 1-2 days was highest and the rate of which was 36.1%. 4) The number of patients of neurosurgical department was 49.5% being the highest among all the patients. 5) The mortality rate was 10.4% and shows decreasing tendency annually. The mortality rate of 1-2 admission day was highest (13.3%). In age distribution, the mortaUty rate under the 10 years old was highest (17.4%) and in distribution by department, highest in the pediatric patients (24.5%). From the above results, we can conclude that in spite of increase in number of patients and admission days, the mortality rate has decreased annually due to improved equipments, support of nursing care, and specially qualified staffs.
Age Distribution ; Child ; Female ; Gangwon-do* ; Humans ; Intensive Care Units* ; Critical Care* ; Male ; Mortality ; Nursing Care

Intracytoplasmic sperm injection (ICSI) recently has been utilized widely as the most successful technique to overcome the unfertilization problem in cases of severe male infertility in couples who could not be treated by conventional IVF. Recently, indications of ICSI have been extended further and more fertilized oocytes become available. Thus, it is necessary to examine the efficiency of freezing the surplus embryos obtained from ICSI. We compared the survival rate and the future outcome of cryopreserved embryos obtained either after conventional IVF or ICSI during the same period. After ICSI or IVF, five best-quality embryos from each patient were transferred in the stimulation cycle and the surplus pronuclear (PN) stage oocytes or multicellular embryos were cryopreserved by slow freezing protocol with 1,2-propanediol (PROH) as a cryoprotectant.4 total of 792 embryos from ICSI trial were thawed and 65.2% (516/792) survived. The survival rates of PN stage oocyte, multicellular embryo and PN + multicellular embryo were 63.5%, 68.2%, 64.0%, respectively. After 111 transfers, 34 pregnancies were achieved, corresponding to a clinical pregnancy rate of 30.6% per transfers. We thawed 1033 embryos from IVF trials and 57.5% (594/1033) survived. In IVF cycle, the survival rates of PN stage oocyte, multicellular embryo and PN + multicellular embryo were 58.2%, 65.2%, 40.2%, respectively. Thirty eight clinical pregnancies were established after 134 transfers, corresponding to a pregnancy rate of 28.4% per transfer The cleavage rate of thawed PN stage oocytes from ICSI trial (61.3%) was significantly higher than those from conventional IVF (53.4%). The developmental rates of good embryo (> or = grade II) in thawed PN stage oocytes obtained from conventional IVF and ICSI were 63% and 65%, respectively. We concluded that PN stage oocytes, multicellular embryos resulting from ICSI procedure can be successfully frozen/thawed with reasonable clinical pregnancy rates comparable to those of IVF.
Embryonic Structures* ; Family Characteristics ; Fertilization in Vitro* ; Freezing ; Humans ; Infertility, Male ; Male ; Oocytes ; Pregnancy ; Pregnancy Rate ; Propylene Glycol ; Sperm Injections, Intracytoplasmic* ; Survival Rate

Endometriosis is defined as the abnormal growth of endometrial tissue outside the uterine cavity, but in rare cases may also occur on the skin. Cutaneous endometriosis frequently develops at the site of a prior abdominal or pelvic procedure, although apparent spontaneous occurrence has been reported. We present a case of non-symptomatic, cutaneous endometriosis in the episiotomy scar. The patient had no evidence of concurrent pelvic endometriosis.
Cicatrix* ; Endometriosis* ; Episiotomy* ; Female ; Humans ; Skin

Hidradenoma papilliferum is a rare benign neoplasm that occurs almost exclusively on the skin of the female anogenital region. It is usually a slow-growing cystic dermal mass that can be either asymptomatic or ulcerate and bleed, and represents an adenoma with apocrine differentiation. We present a case of hidradenoma papilliferum in a 46-year old woman with a erythematous to brownish papule on the left labium majora and the typical histopathologic findings.
Acrospiroma* ; Adenoma ; Female ; Humans ; Middle Aged ; Skin ; Ulcer

BACKGROUND: Bronchioloalveolar carcinoma (BAC) has been reported to diveres spectrum of chinical presentations and radiologic patterns. The three representative radiologic patterns are followings; 1) a solitary nodule or mass, 2) a localized consolidation, and 3) multicentric or diffuse disease. While, the localized consolidation and solitary nodular patterns has favorable prognosis, the multicentric of diffuse pattern has worse prognosis regardless of treatment BAC presenting as a solitary pulmonary nodule is often misdiagnosed as other benign disease such as tuberculoma. Therefore it is very important to make proper diagnosis of BAC with solitary nodular pattern, since this pattern of BAC is usually curable with a surgical resection. METHODS: We reviewed the clinical and radiologic features of patients with pathologically-proven BAC with solitary nodular pattern from January 1995 to September 1996 at Samsung Medical Center. RESULTS: Total 11 patients were identified. 6 were men and 5 were women. Age ranged from 37 to 69. Median age was 60. Most patients with BAC with solitary nodular pattern were asymptomatic and were detected by incidental radiologic abnormality. The chest radiograph showed poorly defined opacity or nodule and computed tomography showed consolidation, ground glass appearance, internal bubble-like lucencies, air bronchogram, open bronchus sign, spiculated margin or pleural tag in most patients. The initial diagnosis on chest X-ray were pulmonary tuberculosis in 4 patients, benign nodule in 2 patients and malignant nodule in 5 patients. The FDG-positron emission tomogram was performed in eight patients. The FDG-PET revealed suggestive findings of malignancy in only 3 patients. The pathologic diagnosis was obtained by transbronchial lung biopsy in 1 patient, by CT guided percutaneous needle aspiration in 2 patients, and by lung biopsy via video-assited thoracocopy in 8 patients. Lobectomy was performed in all patients and postoperative pathologic staging were T1N0M0 in 8 patients and T2N0M0 in 3 patients. CONCLUSION: Patients of BAC presenting with solitary nodular pattern were most often asymptomatic and incidentally detected by radiologic abnormality. The chest X-ray showed poorly defined nodule or opacity and these findings were often regarded as benign lesion. If poorly nodule or opacity does not disappear on follow up chest X-ray, computed tomography should be performed. If consolidation, ground glass appearance, open bronchus sign, air bronchogram, internal bubble like lucency, pleural tag or spiculated margin are found on computed tomography, further diagnostic procedures, including open thoracotomy, should be performed to exclude the possiblity of BAC with solitary nodular pattern.
Adenocarcinoma, Bronchiolo-Alveolar* ; Biopsy ; Bronchi ; Diagnosis ; Female ; Follow-Up Studies ; Glass ; Humans ; Lung ; Male ; Needles ; Prognosis ; Radiography, Thoracic ; Solitary Pulmonary Nodule* ; Thoracotomy ; Thorax ; Tuberculoma ; Tuberculosis, Pulmonary

Median raphe cysts are rare mid-line developmental cysts, which can arise at any point between the external urethral meatus and the anus. They most commonly affect the ventral aspect of the penis, usually near the glans. They tend to be solitary, unilocular cysts, and the inner lining is usually composed of pseudostratified columnar epithelium. We present a case of a 3-year-old boy with a median raphe cyst affecting the glans penis. The cyst, located near the urethral meatus, was slightly pruritic and 0.3cmx0.3cmx0.1cm in size. A shave biopsy, followed by CO2 laser ablation was performed, and histopathological examination revealed a unilocular cyst lined with pseudostratified columnar epithelium, which showed decapitation secretion in part. For 2 years fallawing the shave biopsy, no clinical evidence of recurrence has been observed.
Anal Canal ; Biopsy ; Child, Preschool ; Decapitation ; Epithelium ; Humans ; Lasers, Gas ; Male ; Penis* ; Recurrence

BACKGROUND AND OBJECTIVES: Protein tyrosine kinases appear to be involved in the signal transduction mechanisms, which result in vascular smooth muscle contraction, as well those required in cell growth. The present study was conducted to examine the role of tyrosine kinases in the norepinephrine-induced vascular smooth muscle contraction of isolated aortae from two-kidney, one clip (2K1C) hypertensive rats. MATERIALS AND METHODS: 2K1C hypertension was made by clipping the left renal artery of the rats, with age-matched rats receiving a sham treatment serving as controls. Thoracic aortae denuded of endothelium were mounted in tissue baths to measure the isometric tension. RESULTS: The putative tyrosine kinase inhibitors, genistein and tyrphostin 25, significantly inhibited the contractile responses of the aorta to norepinephrine in the control rats, but not in the 2K1C rats. The protein tyrosine phosphatase inhibitor, sodium orthovanadate, selectively potentiated the contractile response to norepinephrine, but only in the controls. Genistein, tyrphostin 25 and sodium orthovanadate did not affect KCl-induced vascular contractions in either the 2K1C or the controls. The vascular contraction elicited by phorbol 12, 13 dibutyrate, in the presence and absence of genistein, did not alter in either the 2K1C or the controls. CONCLUSION: These findings indicate that protein tyrosine kinases participate in the norepinephrine-induced contraction of rat aortic smooth muscle, where the role is attenuated in 2K1C renal hypertension.
Animals ; Aorta ; Aorta, Thoracic ; Baths ; Endothelium ; Genistein ; Hypertension ; Hypertension, Renal ; Muscle, Smooth ; Muscle, Smooth, Vascular ; Norepinephrine ; Phosphotransferases* ; Placebos ; Protein Tyrosine Phosphatases ; Protein-Tyrosine Kinases ; Rats* ; Renal Artery ; Signal Transduction ; Sodium ; Tyrosine* ; Vanadates

The lesions of neutrophilic dermatosis (pustular vasculitis) of the dorsal hands clinically resembled those of Sweet's syndrome and showed similar histologic evidence of a dense dermal neutrophilic infiltrate. We, herein, present a case of neutrophilic dermatosis of the dorsal hands in a 70-year-old woman with bacterial endocarditis. The patient presented with hemorrhagic pustular blisters on the dorsal hands. Histopathologic findings were pseudoepitheliomatous hyperplasia, intraepidermal pustules, histiocytic infiltration and a few perivascular neutrophilic infiltrations. The skin lesion improved spontaneously.
Aged ; Blister ; Endocarditis, Bacterial ; Female ; Hand* ; Humans ; Hyperplasia ; Neutrophils* ; Skin ; Skin Diseases* ; Sweet Syndrome