We have experienced a case of congenital pyloric atresia associated with epidermolysis bullosa in a premature newborn who was born at the gestation period of 33+3 week. She showed a few blisters on left ankle at birth and the easy formation of blisters involving the area of trauma or friction with depigmentation after healing. The histologic finding of the lesion showed junctional epidermolysis bullosa. Abdominal roentgenographic finding on day 2 showed single bubble sign. That suggested pyloric atresia. It was confirmed by upper gasrtointestinal series radiography and corrected by surgery, gastrojejunostomy on day 16. She discharged on day 50. The severity of the formation of blisters decreased but the poor weight agin became the main problem. The brief review of literatures was made.
Ankle ; Blister ; Epidermolysis Bullosa* ; Epidermolysis Bullosa, Junctional ; Friction ; Gastric Bypass ; Humans ; Infant, Newborn ; Parturition ; Pregnancy ; Radiography

Radiant heart(RD) and Meperidine(MEP) have been used to suppress postanesthesia shivering. However their efficacies to date have only been assessed by observation of visible shivering. We measured the effects of RH and MEP on oxygen consumption (VO2), minute volume(VE) in sixteen otherwise healthy patients(two groups of eight each) shivering after general anesthesia. RH successfully supressed visible shivering in all patients and was associated with significant decrease in VO2(16% of baseline) and VE(13% of baseline, p<0.05). In the reshivering patients, the effect of RH on VO2 was less than initial RH therapy owing to sustained invisible shivering. MEP suppressed visible shivering in seven patients and was associated with 13% decrease in VO2. In conclusion, RH and MEP are effective methods of reducing the elevated oxygen consumption by shivering.
Analgesics ; Anesthesia, General ; Heart ; Hot Temperature* ; Humans ; Meperidine* ; Metabolism ; Oxygen Consumption* ; Oxygen* ; Shivering*

Mercury poisoning affects various organs including peripheral and central nervous systems, especially cerebellum. We report a case of mercury intoxication presenting cerebellar ataxia. From several days after exposure to mercury vapor, scanning speech, head titubation, bilateral limb and truncal ataxia developed and progressed slowly. On admission, brain MRI did not show remarkable change. However, nine months later, atrophic changes in both cerebellar hemispheres on follow-up brain MRI and perfusion defects in same areas on brain SPECT were found.
Ataxia ; Brain ; Central Nervous System ; Cerebellar Ataxia* ; Cerebellum ; Extremities ; Follow-Up Studies ; Head ; Magnetic Resonance Imaging ; Mercury Poisoning ; Perfusion ; Poisoning ; Tomography, Emission-Computed, Single-Photon

A patient who underwent a transfusion due to an aplastic anemia subsequently experienced secondary hemochromatosis, which is very rare in Korea. The 56 year old female was admitted to our hospital with complaints of general weakness, fatigue, a brown-colored facial complexion, dyspnea upon exertion, and abdominal distension. Laboratory examination disclosed functional impairment of the liver and echocardiography revealed a congestive heart failure pattern. Gastrofiberscopy revealed brown colored gastric mucosa, and a fundal mucosa biopsy revealed a hemosidt pigment in iron stain.
Anemia, Aplastic ; Biopsy ; Dyspnea ; Echocardiography ; Fatigue ; Female ; Gastric Mucosa ; Heart Failure ; Hemochromatosis* ; Humans ; Iron ; Korea ; Liver ; Middle Aged ; Mucous Membrane

OBJECTIVE: To compare transverse abdominis (TrA) contractility in stroke patients with hemiparesis and healthy adults using musculoskeletal ultrasonography. METHODS: Forty-seven stroke patients with hemiparesis and 25 age-matched healthy control subjects participated in this study. Stroke patients were divided into three groups on the basis of their degree of ambulation. Group A consisted of 9 patients with wheelchair ambulation, group B of 23 patients with assisted ambulation, and group C of 15 patients with independent ambulation. Inter-rater reliability regarding ultrasonographic measurement of abdominal muscle thickness in the control group was assessed by two examiners. The TrA contraction ratio (TrA contracted thickness/TrA resting thickness) was measured during abdominal drawing-in maneuver and was compared between the patients and the control group and between the ambulation groups. RESULTS: The inter-rater reliability ranged from 0.900 to 0.947. The TrA contraction ratio was higher in the non-paretic side than in the paretic side (1.40+/-0.62 vs. 1.14+/-0.35, p<0.01). The TrA contraction ratio of the patient group was lower in the non-paretic side as well as in the paretic side than that of the control group (right 1.85+/-0.29, left 1.92+/-0.42; p<0.001). No difference was found between the ambulation regarding the TrA contraction ratio. CONCLUSION: The TrA contractility in hemiparetic stroke patients is significantly decreased in the non-paretic side as well as in the paretic side compared with that of healthy adults. Ultrasonographic measurement can be clinically used in the evaluation of deep abdominal muscles in stroke patients.
Abdominal Muscles ; Adult ; Humans ; Muscle Contraction ; Paresis ; Stroke* ; Ultrasonography ; Walking ; Wheelchairs

OBJECTIVE: The purpose of this study was to investigate the relationship between the facial skeletal patterns and the shape of the mandibular symphysis in adults with malocclusion by using a structural equation model (SEM). METHODS: Ninety adults who had malocclusion and had records of facial skeletal measurements performed using cone-beam computed tomography were selected for this study. The skeletal measurements were classified into three groups (vertical, anteroposterior, and transverse). Cross-sectional images of the mandibular symphysis were analyzed using generalized Procrustes and principal component (PC) analyses. A SEM was constructed after the factors were extracted via factor analysis. RESULTS: Two factors were extracted from the transverse, vertical, and anteroposterior skeletal measurements. Latent variables were extracted for each factor. PC1, PC2, and PC3 were selected to analyze the variations of the mandibular symphyseal shape. The SEM was constructed using the skeletal variables, PCs, and latent variables. The SEM showed that the vertical latent variable exerted the most influence on the mandibular symphyseal shape. CONCLUSIONS The relationship between the skeletal pattern and the mandibular symphysis was analyzed using a SEM, which showed that the vertical facial skeletal pattern had the highest effect on the shape of the mandibular symphysis.

OBJECTIVETo explore the operative technique and clinical results of using peroneal perforator-based sural neurofasciocutaneous flaps to repair skin and soft tissue defects in lower extremities.

METHODSFrom January 2009 to March 2012, 26 patients with skin and soft tissue defects at distal region of leg and foot were hospitalized. Among them, 9 patients suffered from tendon or bone exposure at the distal region of leg after injury due to traffic accident; 4 patients suffered from skin defects in the ankle as a result of electric injury; 8 patients suffered from chronic ulcer at the distal part of leg and foot; 5 patients suffered from plantar pressure ulcer. After debridement, soft tissue defect sizes ranged from 11 cm×5 cm to 18 cm×13 cm. According to the position and size of the defects, peroneal perforator-based sural neurofasciocutaneous flaps were designed and procured to repair the skin and soft tissue defects. The size of flaps ranged from 12 cm×6 cm to 20 cm×15 cm. Flap donor sites were closed by direct suture or skin grafting.

RESULTSTwenty-five flaps survived completely. Only one flap suffered partial margin necrosis in the size of 2 cm×1 cm, which was healed after dressing change. Patients were followed up for 6 to 12 months. The appearance and sensation of flaps were satisfactory; no ulcer occurred; the movement of lower extremities was normal.

CONCLUSIONSIt is suitable to repair the skin and soft tissue defects at distal region of leg and foot with the peroneal perforator-based sural neurofasciocutaneous flap, as it possesses reliable blood supply, long and non-bulky pedicle, and sufficient available size. The operation is also easy to perform.

Adult ; Aged ; Female ; Humans ; Lower Extremity ; surgery ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Soft Tissue Injuries ; surgery ; Sural Nerve ; transplantation ; Surgical Flaps ; blood supply ; innervation ; Young Adult