A nineteen year-old boy with progressive enlargement of the joints and distal extremities, clubbing, coarse facial features and hyperhidrosis was investigated. In physical examination, thickening of the scalp with furrowing (cutis verticis gyrata) and greasy thickening of skin (pachyderma) was prominent. His endocrine profile was normal. Radiological studies demonstrated bilateral symmetrical periosteal new bone formation with acroosteolysis and incidental microadenoma of pituitay gland. After extensive investigation to exclude systemic and endocrine causes, the patient was diagnosed as pachydermoperiostosis (PDP). PDP is a rare syndrome manifested clinically by finger clubbing, extremity enlargement, hypertrophic skin changes, and periosteal bone formation. The pathogenesis of the disorder has not been clarified though few endocrine abnormalities were seen. To aware of these clinical phenotype would help to differentiate PDP from acromegaly.
Acro-Osteolysis ; Acromegaly ; Extremities ; Fingers ; Humans ; Hyperhidrosis ; Joints ; Male* ; Osteoarthropathy, Primary Hypertrophic* ; Osteogenesis ; Phenotype ; Physical Examination ; Scalp ; Skin ; Young Adult*

PURPOSE: The admission rates for pediatric asthma are increasing annually and are partially responsible for the increased rates of readmission. Selections of children with a high-risk of readmission and aggressive treatments of them may improve treatment outcome and cost- effectiveness. The purpose of this study is to evaluate the risk factors affecting readmission in cases of bronchial asthma in children. METHODS: We reviewed the medical records of 95 cases under 14 years of age who were admitted to the Department of Pediatrics, Kyung-Hee University, from March 1996 to February 1997 and divided them into readmission and first admission group. RESULTS: Readmission cases were 52 (55%). Age, sex, duration of admission, duration of oxygen therapy, serum IgE concentration, duration of symptoms prior to admission and severity of asthma were not statistically significant compared with those of the control group (t-test) (P>0.05). Use of prophylactic agents, family history of allergic diseases and past history of bronchiolitis were significant (P<0.05), but age under 4 years and sex were not significant (X2-test). Age under 4 years, history of bronchiolitis, and history of previous hospital admission for asthma were significant (P<0.05), but sex, severity of asthma, history of frequent upper respiratory tract infection, family history, and the use of prophylactic agents were not statistically significant (P>0.05) as independent risk factors. CONCLUSION: Age under 4 years, past history of bronchiolitis, and history of previous hospital admission for asthma were significant risk factors for hospital readmission. Further study needs to be done to decrease the readmission rates.
Asthma* ; Bronchiolitis ; Child ; Humans ; Immunoglobulin E ; Medical Records ; Oxygen ; Patient Readmission ; Pediatrics ; Respiratory Tract Infections ; Risk Factors* ; Treatment Outcome

No abstract available.

Malignant histiocytosis is a rare, usually fatal malignant neoplasm of reticuloendothelial systems. The disease is associated with fever, malaise, weight loss, hepatosplenomegaly, lymphadenopathy, pancytopenia, jaundice, and purpura. A 44-year-old female patient is described who had multiple, purple crusted nodules and plaques in the skin. In the laboratory study, pancytopenia was noted on the peripheral blood. In addition many atypical histiocytes were seen on the bone marrow aspiration. A lesional biopsy showed nodular infiltrations of atypical histiocytes in the dermis and some erythrophagocytosis was seen. Immunohistochemically, the histiocytes were weakly stained for lysozyme and α-l-antichymotrypsin, but were unstained for S-100 protein, cytokeratin, CEA(carcinoembryonic antigen), pan T/B marker CD30(ki-1), UCHL-1 LCA(leukocyte common antigen), and α-l-antitrypsin.
Adult ; Biopsy ; Bone Marrow ; Dermis ; Female ; Fever ; Histiocytes ; Histiocytic Sarcoma* ; Humans ; Jaundice ; Keratins ; Lymphatic Diseases ; Mononuclear Phagocyte System ; Muramidase ; Pancytopenia ; Purpura ; S100 Proteins ; Skin ; Weight Loss

The location of the sigmoid colon varies within the abdominal cavity, but its mesocolon is fixed to the left side. Right side fixation of the sigmoid colon is a very rare congenital positional anomaly. In addition, it has been reported that hepatocolic fistula is also a very rare disease that may present lower gastrointestinal bleeding. Here, the authors describe a case of a 71-year-old man who underwent surgery for hepato-sigmoidocolic fistula complicated by hepatocellular carcinoma and the right side fixation of the sigmoid colon.
Abdominal Cavity ; Carcinoma, Hepatocellular ; Colon, Sigmoid ; Fistula ; Hemorrhage ; Humans ; Mesocolon ; Rare Diseases

With the wide and extensive use of immunosuppressive agents and broad-spectrum antibiotics, opportunistic fungla infections have been increased. Fusarium spp. are known to be significant emerging pathogens of opporthunistic local infection. But very rarely it may cause fatalc systemic infection. A 4-year-old boy with acute lymphocytic leukemia develped asymptomatic disseminated purpura with high fever unresponsive to the antibiotics during chemotherapy. The skin lesions gradually increased in size and number, and prgreassed to forming central necrosis. Many septated hyphae and variable sized spore-like fungal elements are found in the epidrmis, dermis and subcuit on histologic sections. The pathogenic fungus was idenified as Fusarium oxysporum by culture and scanning electronic microscopic findings.
Anti-Bacterial Agents ; Child, Preschool ; Dermis ; Drug Therapy ; Fever ; Fungi ; Fusarium* ; Humans ; Hyphae ; Immunocompromised Host* ; Immunosuppressive Agents ; Male ; Necrosis ; Opportunistic Infections ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Purpura ; Skin

Hepatic sinusoidal obstruction syndrome (SOS) is a life-threatening syndrome that generally occurs as a complication after hematopoietic stem cell transplantation or, less commonly, after conventional chemotherapy. Regarding SOS in rhabdomyosarcoma patients who received conventional chemotherapy, the doses of chemotherapeutic agents are associated with the development of SOS. Several cases of SOS in rhabdomyosarcoma patients after receiving chemotherapy with escalated doses of cyclophosphamide have been reported. Here, we report on a 9-year-old female with rhabdomyosarcoma who developed severe SOS after receiving chemotherapy consisting of vincristine, actinomycin-D, and a moderate dose of cyclophosphamide. She was treated successfully with defibrotide without sequelae to the liver.
Child* ; Cyclophosphamide* ; Drug Therapy ; Female ; Hematopoietic Stem Cell Transplantation ; Hepatic Veno-Occlusive Disease* ; Humans ; Liver ; Rhabdomyosarcoma* ; Vincristine*

BACKGROUND: Unilateral spinal anesthesia prolongs sensory blockade and provides hemodynamic stability. Intrathecal opioids enhance spinal anesthesia without prolonging motor recovery or hemodynamic side effects. The author evaluated the effect of intrathecal fentanyl on unilateral spinal blockade with hyperbaric bupivacaine for knee arthroscopy. METHODS: Thirty-six healthy patients undergoing unilateral knee arthroscopy randomly received unilateral spinal anesthesia with 0.5% hyperbaric bupivacaine 4 mg (Group I) or 0.5% hyperbaric bupivacaine 4 mg combined with fentanyl 10 microgram (Group II). A lateral decubitus position was maintained for 15 minutes after intrathecal injection. The level and duration of sensory and motor blockade were recorded. RESULTS: The regression time of sensory block by two segments on dependent site was prolonged on Group II more than Group I (P < 0.05). There was no significant difference between two groups in recovery time of sensory and motor block. Unilateral sensory block was observed in 18 patients in Group I (100%) and in 2 patients in Group II (11%). Hemodynamic side effects were minimal in both groups, but pruritus was observed in 6 patients in Group II (33%). CONCLUSIONS: Small dose of intrathecal fentanyl with bupivacaine unilateral spinal anesthesia prolonged the duration of sensory block on operated site, but did not increase side effects and the duration of motor block and recovery. But intrathecal fentanyl with bupivacaine made disturbance of successful unilateral spinal block by the sensory block of nonoperated site.
Analgesics, Opioid ; Anesthesia, Spinal* ; Arthroscopy* ; Bupivacaine* ; Fentanyl* ; Hemodynamics ; Humans ; Injections, Spinal ; Knee* ; Pruritus

Ketoprofen, a propionic acid derivative is a non-steroidal anti-inflammatory drug with analgesic activity and it is used in the symptomatic treatment of rheumatoid arthritis and osteoarthritis. When exposed to sunlight, ketoprofen is broken down into various benzophenones. 3-ethyl-benzophenone as the major photoproduct is responsible for the photoallergic reaction to ketoprofen. A 30-year-old male presented with well-demarcated erythematous patches with itching sensation on both his ankle areas. He had applied Ketotop(R) plasters on both his ankle areas for arthralgia, and then the Ketotop(R) plaster-detached areas were exposed to sunlight. Patch test and photopatch test with?as is?showed positive reaction in photopatch test and the ingredients of Ketotop(R) plaster revealed positive reaction to the ketoprofen contained in Ketotop(R) plaster in photopatch test.
Adult ; Ankle ; Arthralgia ; Arthritis, Rheumatoid ; Benzophenones ; Dermatitis, Photoallergic* ; Diethylpropion ; Humans ; Ketoprofen* ; Male ; Osteoarthritis ; Patch Tests ; Pruritus ; Sensation ; Sunlight

STATEMENT OF PROBLEM: One of the common problems of dental implant prosthesis is the loosening of the screw that connects each component, and this problem is more common in single implant-supported prostheses with external connection, and in molars. PURPOSE: The purposes of this study were: (1) to compare the initial abutment screw detorque values of the six different implant-abutment interface designs, (2) to compare the detorque values of the six different implant-abutment interface designs after cyclic loading, (3) to compare the detorque values of regular and wide diameter implants and (4) to compare the initial detorque values with the detorque values after cyclic loading. MATERIAL AND METHODS: Six different implant-abutment connection systems were used. The cement retained abutment and titanium screw of each system were assembled and tightened to 32Ncmwith digital torque gauge. After 10 minutes, initial detorque values were measured. The custom titanium crown were cemented temporarily and a cyclic sine curve load(20 to 320N, 14Hz) was applied. The detorque values were measured after cyclic loading of one million times by loading machine. One-way ANOVA test, scheffe's test and Mann-Whitney U test were used. RESULTS: The results were as follows : 1. The initial detorque values of six different implant-abutment connections were not significantly different(p> 0.05). 2. The detorque values after one million dynamic cyclic loading were significantly different (p <0.05). 3. The SS-II regular and wide implant both recorded the higher detorque values than other groups after cyclic loading(p <0.05). 4. Of the wide implants, the initial detorque values of Avana Self Tapping Implant, MIS and Tapered Screw Vent, and the detorque values of MIS implant after cyclic loading were higher than their regular counterparts(p <0.05). 5. After cyclic loading, SS-II regular and wide implants showed higher detorque values than before(p <0.05).
Crowns ; Dental Implants ; Molar ; Prostheses and Implants ; Titanium ; Torque