We report a case of paraneoplastic acrokeratosis(Bazex syndrome) occurring in a 70 year old man with small cell carcinoma of the lung. The skin lesions showed violaceous erythema and psoriasiform scaling of the face, aural helices, scalp, and palmoplantar regions with severe nail dystrophy, Histcipathological findings revealed hyperkeratosis, acanthosis and spongiosis in the epiderrnis, and lyrnphocytic infiltration in the upper dermis. He was treated with cis-diamine dichloroplanum(Cisplan), 4 o-demethy-l-o-epipodo- phyllotoxin (Etoposide ) and steroid onitrnent. But eight months later, he died of lung carcinoma.
Aged ; Carcinoma, Small Cell ; Dermis ; Erythema ; Humans ; Lung ; Scalp ; Skin

We report a case of Kyrles disease occuring in a 19-year-old man with chronic renal failure. The patient had multiple hyperkeratotic papules with central plug on the upper extremities, lower extremities and buttocks. Histopathological findings showed epidermal invagination filled with parakeratotic column and basophilic debris. Many dyskeratotic and vacuolated cells were present below the keratotic plug, and penetration of the parakeratotic column into the dermis was seen.
Basophils ; Buttocks ; Dermis ; Humans ; Kidney Failure, Chronic ; Lower Extremity ; Upper Extremity ; Young Adult

We report here a case of angioimmunoblastic lyinphadenopathy with dysprote inemia(AILD) in a 65-year-old male associated with skin nodules on the face. Physical examina.tion showed generalized lymphadenopathy, hepatosplenomegaly, erythematous maculopapular eruptions on the trunk and extremities, and er the matous nodules on the face. Lahoratory findings showed hemolytic anernia, arid polyclonal gammopathy. Histopathological findings of lymph node revealed typical features of AILD. I-iistopathological findings of maculopapules revealed lymphohistiocytic infiltra tion and extravasated erythrocytes around the blocked vessels, whereas histological picture of nodules on the face mirrorred that of the lymph node. After taking systemic chemotherapy, his general condition and skin lesions were improved.
Aged ; Drug Therapy ; Erythrocytes ; Extremities ; Humans ; Immunoblastic Lymphadenopathy* ; Lymph Nodes ; Lymphatic Diseases ; Male ; Skin*

BACKGROUND: Breast lesions in children and adolescents are rare and develop mainly in females. The management of breast masses in children and adolescents can be a perplexing problem for pediatricians and surgeons. It is well documented that breast lesions in females under 20 years of age rarely represent malignant disease. However, they frequently are a source of discomfort and anxiety for the patient, particularly when they do not resolve spontaneously. METHODS: To determine the frequency of different breast masses in females under 20 years of age on whom surgery was performed, we carried out a retrospective study of females under 20 years who were admitted to the Department. of Surgery of Soonchunhyang University Hospital for surgery between 1993 and 1995. RESULTS: The mean age was 17.9 years. A total of 44 surgical procedures were performed in 40 patients. The masses ranged in size from 0.8 cm through 7.0 cm. As to the location, the mass was in the right breast of 22 patients (50%) and in the left breast of 22 (50%). The most common location of the mass was in the right upper outer quadrant (13 patients, 29.5%). Of the 44 masses, fine-needle aspiration cytology was performed in 33 masses. Of them, 28 were fibroadenomas, 4 were fibrocystic disease, and 1 was a lipoma. Excisional biopsy was performed on 44 masses. Of them, 33 were fibroadenomas, 4 were fibrocystic disease, 5 was fibroadenoma and fibrocystic disease, 1 was a lipoma, and 1 was a lymphangioma. There were no malignancies. CONCLUSIONS: In female patients under 20 years of age, we suggest that benign breast should be studied for diagnosis, treatment, and histological feature.
Adolescent ; Anxiety ; Biopsy ; Biopsy, Fine-Needle ; Breast* ; Child ; Diagnosis ; Female* ; Fibroadenoma ; Humans ; Lipoma ; Lymphangioma ; Retrospective Studies

BACKGROUND: The MicroScan MICroSTREP plus panel for susceptibility testing of various streptococci, including Streptococcus pneumoniae, has recently been introduced in Korea. The current study evaluated the usefulness of MicroScan MICroSTREP plus panel for antimicrobial susceptibility test of S. pneumoniae. METHODS: A total of 75 clinical isolates of S. pneumoniae were tested for antimicrobial susceptibility to penicillin, cefotaxime, ceftriaxone, meropenem, vancomycin, clindamycin, erythromycin, and levofloxacin with the MicroScan MICroSTREP plus panel and clinical and laboratory standard institute (CLSI) reference broth microdilution method. For 46 of 75 isolates, additional susceptibility tests to penicillin and cefotaxime were performed with Etest. RESULTS: The overall essential agreement of MICs (within one dilution of MICs) defined by the MicroScan MICroSTREP plus panel and reference method was 93.0%. Overall there were 11.7% minor, 0.7% major, and 0.7% very major interpretative category errors observed. The results of antibiotic susceptibility testing by Etest were similar to those obtained by the MicroScan MICroSTREP plus panel. CONCLUSION: The MicroScan MICroSTREP plus panel, a commercial broth microdilution method, has a comparable accuracy to CLSI broth microdilution method for the resistance testing of S. pneumonia. This panel can be used for determining susceptibilities of S. pneumoniae to a wide variety of antimicrobial agents in clinical microbiology laboratories.
Anti-Infective Agents ; Cefotaxime ; Ceftriaxone ; Clindamycin ; Erythromycin ; Korea ; Ofloxacin ; Penicillins ; Pneumonia ; Streptococcus ; Streptococcus pneumoniae ; Thienamycins ; Vancomycin

PURPOSE: The results of the bronchial provocation test were different by the method of inhalation, but there was no data in children. We performed the provocation test by 2 different methods such as two-minute tidal breathing versus five vital capacity breathing and compared the datas. METHODS: Methacholine inhalation test was performed for the In 17 patients with suspected bronchial hyperresponsiveness in Pocheon university Bundang Cha hospital, under identical conditions, except for the method of inhalation. All the patients were performed two-minute tidal breathing (2 min-TB) in one test and five vital capacity breathing (5VCB) with interval 1 to 7 days. Baseline and postsaline FEV1 were also measured to compare effects by two inhalation methods. Methacholine PC20 was calculated by linear interpolation between the last two data parts on the dose-response curve, and the cut off value of bronchial asthma was 8 mg/mL. RESULTS: The rate of positive brochial provaction test in 5VCB was 88.24% which was not significantly lower than 70.59% in 2 min-TB. In 12 patients with positive bronchial provocation test in both inhalation methods, the mean PC20 in 5VCB (5VC-PC20) was 4.40 mg/mL, being significantly higher than 1.02 mg/mL in 2 min-TB (2 min-PC20) (P< 0.05). There was a significant positive correlation between 5VC-PC20 and 2 min-PC20 (R=0.76, P< 0.001). CONCLUSION: We conclude from this study that the results of bronchial provocation test in children are different according to methods of inhalation in using the same nebulizer. Therefore, when we analyze the result of bronchial provocation test, we need attention to factors which are nebulizer output and method of inhalation to influence the response to the test.
Asthma ; Bronchial Provocation Tests* ; Child* ; Humans ; Inhalation ; Methacholine Chloride ; Nebulizers and Vaporizers ; Respiration* ; Vital Capacity*

BACKGROUND: The catheter ablation usin radiofrequency(RF) energy in patients with atrioventricular nodal reentrant tachycardia(AVNRT) and atrioventricular reentrant tachycardia(AVRT) ahs been proved as a safe and effective nonpharmacologic therapeutic modality. The purpose of our study was to evaluate the success rate and complications of the initial experience and to determine the extent of myocardial damage of RF catheter ablation. METHODS: Electrophysiologic study was performed with the standard technique. Twenty five patinents(M:F=16:9, mean age:42 years old) underwent RF catheter ablation in St. May's Hospital from April to December in 1994. The RF generator in this study was RFG-3D model and catheters were 6F or 7F steerable catheters with 4mm kistal tip. In order to evaluate the extent of myocardial damage the WBC count, LDH, CK, and CK-MB fraction were checked before and after RF catheter ablation and the Tc99m myocardial scintigraphy was performed within 72 hours of the porcedure. RESULTS: Six of twenty five patients had AVNRT, in which the success rate of selective ablation of the slow pathway was 83.8%. Nineteen patients with AVRT had one accessory pathway. The ablation success rate of 14 accessory pathways in left free wall location was 85.7%, and that of 3 in left posteroseptal location was 66.6%. Two right sided accessory pathways were not ablated successfully. The level of CK-MB fraction after ablation was within normal limit. Only one case revealed grade 2 of hot spot in Tc99m myocardial scintigraphy. CONCLUSION: The RF catheter ablation in patients with AVNRT and AVRT is a safe and effective nonpharmacologic therapeutic modality. But right sided accessory pathways are more difficult to ablate than left sided accessory pathways, requiring more experiences and better technique. The extent of myocardial damage after RF catheter ablation reveals relatively minimal by cardiac enzyme study and Tc99mmyocardial scintigraphy.
Catheter Ablation* ; Catheters ; Humans ; Myocardial Perfusion Imaging ; Radionuclide Imaging ; Tachycardia, Supraventricular*

Familial combined hyperlipidemia is one af the manogenic disorders frequently found in humans and is seen in 0.5~2% of the general populatian, accounting for at least 10% of persons with pemature atlmmcletusis. The distinguishing feature of familial combined hyperlipidemia, in camparison with other single-gene abnarmalities of lipoprotein metabolism, is that not all affected members have the same plasma lipid phenotype; some individuals have an elevation of cholesterol concentration alane(type IIa lipoprotein pattern), while some athers have an elevation of triglyceride concentration alone(type IV pattem), and still others have elevations of both values(type IIb pattem). In any one persan, the lipid phenotype can change as a result of dietary or drug treatment. Familial combined hyperlipidemia should be suspected in those subjects with moderate hypertriglyceridemia and/or moderate hypercholestaolemia (lipoprotein types IIa, Ilb, IV), especially when premature coronary heart disease is evident in the family histary. Low plasma HDL-cholesterol, obesity, insulin resistance and hyperuricemia are often . Family members affected by familial combined hyperlipidemia should be identified and be treated, since tbe condition is associated with premature caronary heart diasease. We have found one family of familial combined hyperlipidemia with one member(case 1) associated with insulin resistance, hyperuricemia and gout, and another member(case 2) associated with diabetes mellitus and infertiTity.
Cholesterol ; Coronary Disease ; Diabetes Mellitus ; Gout ; Heart ; Humans ; Hyperlipidemia, Familial Combined* ; Hypertriglyceridemia ; Hyperuricemia ; Insulin Resistance ; Lipoproteins ; Metabolism ; Obesity ; Phenotype ; Plasma ; Triglycerides

A five month female was referred complaining of intermittent vomiting with protrusion of a sausage-like mass through the oral cavity. Esophageal endoscopy and esophagogram revealed a mass in the upper esophagus, which was diagnosed as a fibrovascular polyp. Under general anesthesia, the mass was grasped through the oral cavity with a forcep and ligated and excised at the base, where a stump arose from the posterior wall of the cervical esophagus. The pathology was confirmed as a fibrovascular polyp, which is a rare benign esophageal lesion occurring mostly in adult males, and has not been reported in infancy.
Blood Vessels/pathology ; Case Report ; Esophageal Neoplasms/surgery ; Esophageal Neoplasms/pathology* ; Esophageal Neoplasms/blood supply ; Esophagoscopy ; Female ; Fibrosis ; Human ; Infant ; Polyps/surgery ; Polyps/pathology* ; Polyps/blood supply

BACKGROUND: Left ventricular hypertrophy is common in chronic renal failure patients and may contribute increased risk of cardiovascular morbidity and mortality. We evaluated the left ventricular morphology and function in renal transplant recipients to find the relationship between hemodynamic changes and morphologic and functional improvement after transplantation. METHODS: Serial echocardiographic evaluations were performed in 27 adults(20 men and 7 women) at the time of transplantaion and posttransplantation 1 month and 4 months. The average duration of hemodialysis was 16+/-24 months(mean+/-S.D.). RESULTS: At the time of transplantation, the hematocrit level was 21+/-6% and posttransplantation 1 month and 4 months, that was increased to 39+/-5% and 42+/-7%, respectively(p<0.001). Left ventricular mass index by echocardiography was decreased significantly from 246+/-87g/m2(pre-KT) to 169+/-38g/m2(post-KT 1 month) and 153+/-40g/m2(post-KT 4 months), respectively (p<0.001). Interventricular septal thickness and left ventricular posterior wall thickness were decreased significantly after 4 months of transplantation. Left ventricular systolic and diastolic dimensions were also decreased significantly after 1 month and 4 months of transplantation. Left ventricular volumes and cardiac output were also decreased significantly. But A/E ratio, ejection fraction and fractional shortening did not change significantly. CONCLUSION: These findings showed that pretransplant high output state was resolved radipidly(within 1 month) but the diastolic function did not improved after transplantation 1 month and 4 months.
Cardiac Output ; Echocardiography* ; Hematocrit ; Hemodynamics ; Humans ; Hypertrophy, Left Ventricular ; Kidney Failure, Chronic ; Kidney Transplantation ; Male ; Mortality ; Renal Dialysis ; Transplantation*