The symmetrical peripheral gangrene syndrome consists of sudden onset of symmetrical gangrene of the fingers, toes and more raely, the nose, upper lip, ear lobes, or genitalia. There is no evidence of occulusion of large vessels or vasculitis. We experienced a case of symmetrical peripheral gangrene developed in fingers and toes with disseminated intravascular coagulation in 20 day-old permature infant with sepsis by Enterobacter aerogenes. Thereafter, we presented a case with a brief review of the related literatures.
Disseminated Intravascular Coagulation* ; Ear ; Enterobacter aerogenes ; Fingers ; Gangrene* ; Genitalia ; Humans ; Infant ; Lip ; Nose ; Sepsis ; Toes ; Vasculitis

PURPOSE: Our purpose was to deterrnine the efficacy of maternal corticosteroid therapy on the morbidity of premature infants between 26 and 31 weeks' gestation. METHOD: A total of 62 premature infants between 26 and 31 weeks gestation admitted to pediatric department of National Medical Center from Nov, 1990 to June 1996 were analyzed to evaluate the efficacy of prenatal corticosteroid therapy on the morbidity such as hyaline membrane disease, intreventricular hernorrhage, necrotizing enterocolitis, sepsis, neonatal death, days on ventilation and hospital days. RESULT: Among 62 women who delivered premature infants between 26 and 31 weeks, 22 received betamethasone before delivery and 40 did not. 1) The rate of hyaline membrane disease was less in the betamethasone group (41% vs. 70%, P<0.05). 2) The rate of intracranial hemorrhage was less in the betamethasone group (0 vs. 20%, P<0.05). 3) The days of ventilator care was less in the betamethasone group among survival cases (27+/-3.2 vs. 5.2+/-4.6, P<05). 4) Arnong 14 women who delivered at 26 to 28 weeks, 4 received betamethasone before delivery and 10 did not. The rate of neonatal death was less in the betamethasone group (o% vs. 80%, P<0.05). 5) Among 48 women who delivered at 29 to 31 weeks, 18 received betamethasone before delivery and 30 did not. The rate of hyaline membrane disease was less in the betamethasone group (39% vs. 73%, P<0.05). CONCLUSION: Betamethasone appears to reduce hyaline membrane disease, intraven- tricular hemorrhage, neonatal death and the morbidity significantly in premature infants between 26 and 31 weeks' gestation.
Betamethasone ; Enterocolitis, Necrotizing ; Female ; Hemorrhage ; Humans ; Hyaline Membrane Disease ; Infant, Newborn ; Infant, Premature* ; Intracranial Hemorrhages ; Pregnancy ; Sepsis ; Ventilation ; Ventilators, Mechanical

Various cancer types have been associated with cancer-related cerebral infarction. In this study, we describe the first case of cancer-related cerebral infarction in which the underlying disease was primary bone marrow lymphoma (PBML). A 79-year-old man presented with abruptly developed bilateral lower extremity weakness and confusion. Diffusion-weighted imaging on admission showed multiple cortical and subcortical embolic infarction lesions in multiple vascular territories. Diagnostic evaluations to determine the embolic source revealed no abnormalities. Laboratory testing demonstrated elevated D-dimer (2.59 μg/mL) but no other prothrombotic abnormalities. In suspicion of cancer-related stroke, we performed chest CT, abdomen CT, and FDG-PET to detect the hidden malignancy. Findings revealed no evidence of cancer; however, they did reveal signs of anemia (hemoglobin 9.0 g/dL). Bone marrow aspiration biopsy showed large atypical B cell involvement suggestive of high-grade B cell lymphoma. The patient was diagnosed with primary bone marrow diffuse large B-cell lymphoma initially presenting with ischemic stroke. Our case suggests that primary bone marrow cancer may be a candidate for the differential diagnosis of hidden malignancy in patients with suspected cancer-related stroke. Bone marrow biopsy may be essential for establishing an appropriate differential diagnosis in patients with abnormal hematologic findings.

PURPOSE: To report the results of 134 cases in which add-on stereotactic core biopsy (ASCB) was performed in patients with mammographically detected breast lesions, and to evaluate the usefulness of this procedure. MATERIALS AND METHODS: We analyzed the results of ASCB of 134 breast lesions in 125 patients, performed during a 41-month period. The mammographic findings were suspicious malignant lesion in 38 cases, benign lesion in 18, and indeterminate lesion in 78. Surgical excision was performed in 23 cases, and follow-up mammography in 39. We analyzed the pathologic results according to each mammographic finding and correlated the results of core biopsy with those of surgical excision. We also evaluated the mammographic changes seen during follow-up, and associated complications and procedural difficulties. RESULTS: Samples were adequate for pathologic diagnosis in 95% of cases (127/134). ASCB revealed malignancy in 47% of cases (18/38) in which this was suspected on the basis of mammographic findings, and in 5% of cases (4/78) in which these findings were indeterminate. The pathologic results of core biopsy and of surgical excision agreed in 78% of cases (18/23). In two of five false-negative cases, ASCB revealed the presence of atypical ductal hyperplasia. The mammographic findings in these five cases were suspicious malignancy in three, and indeterminate in two. Specimen radiography showed calcifications in four cases. The size or extent of mammographic lesions did not change during the mean follow-up period of 17.3 months. In 13/125 patients (10%), the complications and procedural difficulties noted included arterial bleeding, dizziness, syncope, patient movement, and instrument failure. CONCLUSION: ASCB is accurate, safe and useful, but surgical excision should be considered when the ASCB result is either atypical ductal hyperplasia or benign but with mammographic diagnosis of suspicious malignant or indeterminate lesions.
Biopsy* ; Breast* ; Diagnosis ; Dizziness ; Follow-Up Studies ; Hemorrhage ; Humans ; Hyperplasia ; Mammography ; Radiography ; Syncope

OBJECTIVE: To evaluate the clinical usefulness of ICF (International Classification of Functioning, Disability and Health) through correlation among existing functional evaluation tools and examined environmental factors affecting its function. METHOD: One hundred eight persons with disabilities living in Seoul were randomly selected according to disability severity categories. Functional Independence Measure (FIM), modified Barthel index (MBI) and ICF were examined and subjects were interviewed by trained rehabilitation doctors and occupational therapists. We compared correlation between these three functional measurements. We coded environmental factors affecting function. That was used in second level of 74 ICF items. RESULTS: The average of FIM, modified Barthel index, capacity and performance scores of ICF was 112.76, 92.97, 5.74 and 3.19. There was a statistical correlation among FIM, Barthel index, and ICF. The facilitator chapters among ICF's environmental factors were support and relationships (51.9%), attitudes (45.8%) in order. Most facilitated second level domains among the 68 items were immediate family (66.77%) and health professionals (52.8%). The most barrier chapters in ICF were product and a technology (19.5%), environment changes (15.5%) in order. Most barrier second level domains were design, construction and technology of buildings for public use (37%) and assets (37.0%). CONCLUSION: ICF correlates with the existing functional evaluation tool and can facilitate management of activity and participation by linking the result with the environmental factors, which may exacerbate or minimize them
Disabled Persons ; Health Occupations ; Humans

Background: Korean dental hygienists perform various tasks under the supervision of dentists in addition to the tasks listed in the law. Many meaningful studies have been conducted to determine the actual tasks of dental hygienists, but these studies did not show common results due to the differences in research methods or designs. Hence, this study aimed to review the reported data on the tasks of dental hygienists in Korea and to clarify them based on a systematic literature review. Methods: For the literature search, the COre, Standard, and Ideal model presented by the National Library of Medicine was referenced. Seven databases were searched for literatures published in Korea, including PubMed, and Google Scholar. Of the 352 studies found using key words, titles, and abstracts, 46 were finally extracted based on the first and second exclusion criteria. After confirming the tasks of Korean dental hygienists in 46 literatures, 136 tasks were listed and calculated as appearance rate in the literature. Results: The most common tasks in 46 studies were fluoride application (67.2%), radiography (65.4%), scaling (65.4%), sealant (60.7%), patient management and counseling (56.7%), tooth-brushing education (52.2%), impression taking with alginate (50.1%), and making temporary crowns (47.9%). The most mentioned tasks of dental hygienists in public health centers were fluoride application (100%), sealant (100%), oral health education (71.4%), public oral health program evaluation (71.4%), school fluoride mouth-rinsing program (71.4%), water fluoridation (57.1%), tooth-brushing education (57.1%), school oral health programs (57.1%), and public elderly oral health programs (57.1%). Conclusion This study showed that Korean dental hygienists had 136 tasks by reviewing 46 related studies and that the main job of Korean dental hygienists was oral disease prevention including scaling, sealant, and fluoride application.

The clinico-pathological observation was done on 28 children with recurrent hematuria, who had been admitted to the Pediatric ward of NMC from January 1981 to July 1991. The results were as follows; 1) Most of the children with recurrent hematuria were over 6 years of age(24 cases, 85.7%)and the sex ratio was about 2.5:1. 2) IgA nephropathy (17 cases, 60.7%) was the leading pathologic lesion and mild focal nonspecific glomerulonephritis (5 cases), membranous nephropathy (2 cases), minimal chage (2 cases), Alport syndrome (1case), abnormal glomerular basement membrane (1 case) followed. 3) Types of recurrent hematuria ware gross in 22 cases and microscopic in 6 cases. Flank pain was noted only 1 case. The prodromal events of hematuria were upper respiratory infection in 15 cases and severe exercise in 2 cases. 4) There were no significant differences in clinical features and laboratory findings between IgA nephropathy and other pathologic lesions, except for higher frequency of proteinuria in former group. 5) During the follow-up periods, three cases were resulted in chronic renal failure and they were two cases of IgA nephropathy Class IV and one case of Alport syndrome. And one case of IgA nephropathy was resulted in nephrotic syndrom.
Child ; Flank Pain ; Follow-Up Studies ; Glomerular Basement Membrane ; Glomerulonephritis ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranous ; Hematuria* ; Humans ; Kidney Failure, Chronic ; Nephritis, Hereditary ; Proteinuria ; Sex Ratio

PURPOSE: To perform and compare differential diagnosis of patients with thyroid-associated myopathy, idiopathic orbital myositis and normal controls based on orbital computed tomography. Orbital fat and extraocular muscle densities were quantified using Hounsfield Unit (HU) and their characteristics were compared and analyzed. METHODS: From February 2005 to January 2013, orbital computed tomography was performed on 90 eyes of 47 thyroid-associated myopathy patients, 18 eyes of 14 idiopathic orbital myositis patients and 280 eyes of 140 normal subjects. The average values of orbital fat and extraocular muscle densities were measured and compared using HU. The density differences between the patients with thyroid-associated myopathy and the normal group were analyzed by age, clinical activity score, ocular protrusion and disease duration. RESULTS: In the thyroid-associated myopathy group, orbital fat and extraocular muscle densities were -87.8 +/- 12.5 HU and 48.7 +/- 7.1 HU, respectively. In the idiopathic orbital myositis group, the orbital fat and extraocular muscle densities were 79.9 +/- 9.9 HU and 49.2 +/- 9.1 HU, respectively. There was a statistically significant lower result of orbital fat in the thyroid-associated myopathy group (p = 0.002), however, the extraocular muscle density did not show a statistically significant difference (p = 0.775). The orbital fat and extraocular muscle densities of the normal group were -79.0 +/- 11.2 HU and 54.3 +/- 6.3 HU, respectively. There were significantly lower results in both orbital fat and extraocular muscle densities in the thyroid-associated myopathy group than normal group (p = 0.000). In active cases and those accompanied by ocular protrusion, there was no significant difference in orbital fat density (p = 0.345 and p = 0.952, respectively), while extraocular muscle density significantly decreased (p = 0.007 and p = 0.003, respectively). CONCLUSIONS: A difference between the orbital fat and extraocular muscle densities in thyroid-associated myopathy and idiopathic orbital myositis could be quantitatively found using HU and orbital computed tomography.
Diagnosis, Differential ; Humans ; Muscles* ; Muscular Diseases* ; Orbit* ; Orbital Myositis*

BACKGROUND: The purpose of this study is to investigate the effects of volume and concentration in a constant dose of subarachnoid bupivacaine on the extent and duration of sensory and motor blocks. METHODS: Forty parturients scheduled for cesarean section were randomly assigned to two groups for spinal anesthesia. In group 1, 3.5 ml of hyperbaric 0.25% bupivacaine (8.75 mg) with 0.25 mg morphine and 10 microgram fentanyl were injected into the subarachnoid space; in group 2, 1.75 ml of hyperbaric 0.5% bupivacaine (8.75 mg) with 0.25 mg morphine and 10 microgram fentanyl were injected. Dural punctures were performed at the L3-L4 or L2-L3 interspaces with a 25 gauge needle in the sitting position after which the patients were turned to the supine horizontal position. The level and extent of the sensory and motor block were measured at 3, 5, 10, and 15 minutes. The onset, duration and regression of sensory and motor blocks were studied. RESULTS: There were no significant differences between two groups in the level and extent of sensory and motor blocks. From onset time to maximal sensory block took 12.1 +/- 3.0 min in group 1, and 13.3 +/- 3.7 min in group 2, and from onset time to complete motor block took 10.2 +/- 2.7 min in group 1 and 11.4 +/-2.6 min in group 2. There was no significant difference in the time taken to complete the regression of seosory block, and the complete resolution of the motor block. CONCLUSIONS: A constant 8.75 mg dose of subarachnoid hyperbaric bupivacaine produced, in all groups, a similar, statistically insisnificant, level and extent of sensory and motor block, in spite of different volumes and concentrations.
Anesthesia, Spinal* ; Bupivacaine* ; Cesarean Section ; Female ; Fentanyl ; Humans ; Morphine ; Needles ; Pregnancy ; Punctures ; Subarachnoid Space

BACKGROUND: The purpose of this study is to investigate the effects of volume and concentration in a constant dose of subarachnoid bupivacaine on the extent and duration of sensory and motor blocks. METHODS: Forty parturients scheduled for cesarean section were randomly assigned to two groups for spinal anesthesia. In group 1, 3.5 ml of hyperbaric 0.25% bupivacaine (8.75 mg) with 0.25 mg morphine and 10 microgram fentanyl were injected into the subarachnoid space; in group 2, 1.75 ml of hyperbaric 0.5% bupivacaine (8.75 mg) with 0.25 mg morphine and 10 microgram fentanyl were injected. Dural punctures were performed at the L3-L4 or L2-L3 interspaces with a 25 gauge needle in the sitting position after which the patients were turned to the supine horizontal position. The level and extent of the sensory and motor block were measured at 3, 5, 10, and 15 minutes. The onset, duration and regression of sensory and motor blocks were studied. RESULTS: There were no significant differences between two groups in the level and extent of sensory and motor blocks. From onset time to maximal sensory block took 12.1 +/- 3.0 min in group 1, and 13.3 +/- 3.7 min in group 2, and from onset time to complete motor block took 10.2 +/- 2.7 min in group 1 and 11.4 +/-2.6 min in group 2. There was no significant difference in the time taken to complete the regression of seosory block, and the complete resolution of the motor block. CONCLUSIONS: A constant 8.75 mg dose of subarachnoid hyperbaric bupivacaine produced, in all groups, a similar, statistically insisnificant, level and extent of sensory and motor block, in spite of different volumes and concentrations.
Anesthesia, Spinal* ; Bupivacaine* ; Cesarean Section ; Female ; Fentanyl ; Humans ; Morphine ; Needles ; Pregnancy ; Punctures ; Subarachnoid Space