Parry-Romberg syndrome(Progressive hemifacial atrophy), described in the last century by Parry(1825) and Romberg(1846), is a very rare disorder characterized by a slowly progressive and self-limited unilateral(rarely bilateral) atrophy of the faces affecting variably the skin, subcutaneous fat tissues, musculature, connective tissue, cartilage and bones. And this disorder is usually accompanied by contralateral Jacksonian epilepsy, trigerminal neuralgia, and changes in the eyes and hair. The onset is slow and progressive, starting at 5-15 years of age and lasting from 2-10 years, ending with the face being "burned out". There are a few cases of this disease which presented during the neonatal period. This disorder seems to affect females more than males, and its etiology and incidence has yet to be determined. Trauma, infection with a slow virus, sympathetic dysfunction, immunological abnormality and cranial vascular malformation are proposed causes. No typical or consistent neuropathologic findings occur. No specific treatment for the syndrome exists; however, various reconstructive surgical procedures can have in reasonably good cosmetic effects, as well as antiinflammatory or immunosuppressive treatment. We report a case of Parry-Romberg syndrome, which was presented at 1 month of age, and has progressd to contralateral hemiparesis.
Atrophy ; Cartilage ; Connective Tissue ; Epilepsy ; Facial Hemiatrophy* ; Female ; Hair ; Humans ; Incidence ; Infant, Newborn* ; Male ; Neuralgia ; Paresis ; Reconstructive Surgical Procedures ; Skin ; Subcutaneous Fat ; Vascular Malformations

Multiple symmetric lipomatosis (MSL) is an extremely uncommon disorder. In the medical literatures about 200 cases have been reported. MSL is not associated with other generalized lipomatous disorders, nor are these patient to be necessarily obese. The cause of MSL is unknown. The disorder usually occurs in middle-aged males and there is frequently a history of alcoholism. Some instances of familial occurrence have been reported, but the majority of cases are sporadic. Two cases of MSL are presented.
Humans ; Lipomatosis ; Lipomatosis, Multiple Symmetrical/*diagnosis/pathology ; Male ; Middle Aged

PURPOSE: Enterobacter is one of the important organisms in neonatal intensive care unit. We reviewed the clinical characteristics, underlying diseases, invasive procedures during admission, mortality and antibiotic sensitivity of Enterobacter infection in NICU. METHODS: We retrospectively reviewed 21 neonatal patients whose blood cultures yielded Enterobacter between June 1994 and June 1997 at Dongguk University Hospital. RESULTS: Blood cultures were positive in 62 from 2,025 neonates and 21 was Enterobacter. The clinical spectrums were diverse such as sepsis (85%), pneumonia, disseminated intravascular coagulopathy and necrotizing enterocolitis. The underlying conditions upon admission were composed of prematurity (38%), hyaline membrane disease (38%), jaundice, sepsis and pneumonia. The procedures used during admission were endotracheal intubation (57%), mechanical ventilation (57%), umbilical vessel catheterization, gastric tube inserition, total parenteral nutrition and exchange transfusion. The antibiotic sensitivity was as follows : ampicillin (0%), ceftriaxone (0%), amikacin (55%), gentamicin (85%), ciprofloxacin (100%), imipenem (100%). Overall mortality was 26.5%. Mortality was significantly high in cases of leukopenia (P< or = 0.01), thrombocytopenia (P< or = 0.01) and use of inappropriate antibiotics (P< or = 0.01). CONCLUSION: Enterobacter is an important organism in the cause of nosocomial infection in NICU and has a high rate of mortality. Enterobacter infection was associated with prolonged hospitalization, invasive procedures and preceding antibiotics. Commonly used antibiotics such as penicillin and cephalosporin would be inappropriate for the treatment of Enterobacter infection. We consider the use of gentamicin or imipenem to be far more effective in the initial therapy of Enterobacter infection.
Amikacin ; Ampicillin ; Anti-Bacterial Agents ; Bacteremia* ; Catheterization ; Catheters ; Ceftriaxone ; Ciprofloxacin ; Cross Infection ; Enterobacter* ; Enterocolitis, Necrotizing ; Gentamicins ; Hospitalization ; Humans ; Hyaline Membrane Disease ; Imipenem ; Infant, Newborn ; Intensive Care, Neonatal* ; Intubation, Intratracheal ; Jaundice ; Leukopenia ; Mortality ; Parenteral Nutrition, Total ; Penicillins ; Pneumonia ; Respiration, Artificial ; Retrospective Studies* ; Sepsis ; Thrombocytopenia

PURPOSE: Recent studies have reported the association of obesity and advanced stage prostate cancer. We researched the association between body mass index(BMI), which is widely used to diagnose obesity, and the prostate-specific antigen(PSA) screening test for prostate cancer. METERIALS AND METHODS: The authors examined the association between BMI and PSA for 26,193 men who visited the health promotion center at our medical center from July 1998 to June 2004. The BMI(weight in kg/height in m2) was calculated from the measured height and weight and this was categorized as follows: BMI<18.5(underweight), BMI 18.5-23.0(normal weight), BMI 23.0-27.5(overweight), BMI>27.5(obesity). We measured the mean PSA value of each BMI category. After adjust for age, we evaluated the PSA according to BMI by using error bars and 95% confidence intervals. RESULTS: The patients' age distribution was from 20 to 90 years old and their mean age was 46.1. The mean PSA value increased in a linear fashion with an increase in the age category(p<0.001), while it decreased in a linear fashion with an increase in the BMI category(p<0.001). After adjusting for age, the mean PSA value also decreased in a linear fashion with an increase in the BMI category(p<0.001). CONCLUSIONS: Men with an elevated BMI tend to have a lower value of PSA and to be misdiagnosed with prostate cancer. The PSA value should considered in relation to age and the BMI for the early detection of prostate cancer.
Age Distribution ; Aged, 80 and over ; Body Mass Index* ; Health Promotion ; Humans ; Male ; Mass Screening ; Obesity ; Prostate-Specific Antigen* ; Prostatic Neoplasms

BACKGROUND: Many laboratories use 4 delta check methods: delta difference, delta percent change, rate difference, and rate percent change. However, guidelines regarding decision criteria for selecting delta check methods have not yet been provided. We present new decision criteria for selecting delta check methods for each clinical chemistry test item. METHODS: We collected 811,920 and 669,750 paired (present and previous) test results for 27 clinical chemistry test items from inpatients and outpatients, respectively. We devised new decision criteria for the selection of delta check methods based on the ratio of the delta difference to the width of the reference range (DD/RR). Delta check methods based on these criteria were compared with those based on the CV% of the absolute delta difference (ADD) as well as those reported in 2 previous studies. RESULTS: The delta check methods suggested by new decision criteria based on the DD/RR ratio corresponded well with those based on the CV% of the ADD except for only 2 items each in inpatients and outpatients. Delta check methods based on the DD/RR ratio also corresponded with those suggested in the 2 previous studies, except for 1 and 7 items in inpatients and outpatients, respectively. CONCLUSIONS: The DD/RR method appears to yield more feasible and intuitive selection criteria and can easily explain changes in the results by reflecting both the biological variation of the test item and the clinical characteristics of patients in each laboratory. We suggest this as a measure to determine delta check methods.
Alanine Transaminase/blood ; Alkaline Phosphatase/blood ; Aspartate Aminotransferases/blood ; Bilirubin/blood ; Blood Urea Nitrogen ; Chemoembolization, Therapeutic ; Clinical Chemistry Tests/methods/*standards ; Creatine/blood ; *Decision Trees ; Humans ; Reference Values ; Renal Dialysis ; Uric Acid/blood

BACKGROUND: Many laboratories use 4 delta check methods: delta difference, delta percent change, rate difference, and rate percent change. However, guidelines regarding decision criteria for selecting delta check methods have not yet been provided. We present new decision criteria for selecting delta check methods for each clinical chemistry test item. METHODS: We collected 811,920 and 669,750 paired (present and previous) test results for 27 clinical chemistry test items from inpatients and outpatients, respectively. We devised new decision criteria for the selection of delta check methods based on the ratio of the delta difference to the width of the reference range (DD/RR). Delta check methods based on these criteria were compared with those based on the CV% of the absolute delta difference (ADD) as well as those reported in 2 previous studies. RESULTS: The delta check methods suggested by new decision criteria based on the DD/RR ratio corresponded well with those based on the CV% of the ADD except for only 2 items each in inpatients and outpatients. Delta check methods based on the DD/RR ratio also corresponded with those suggested in the 2 previous studies, except for 1 and 7 items in inpatients and outpatients, respectively. CONCLUSIONS: The DD/RR method appears to yield more feasible and intuitive selection criteria and can easily explain changes in the results by reflecting both the biological variation of the test item and the clinical characteristics of patients in each laboratory. We suggest this as a measure to determine delta check methods.
Alanine Transaminase/blood ; Alkaline Phosphatase/blood ; Aspartate Aminotransferases/blood ; Bilirubin/blood ; Blood Urea Nitrogen ; Chemoembolization, Therapeutic ; Clinical Chemistry Tests/methods/*standards ; Creatine/blood ; *Decision Trees ; Humans ; Reference Values ; Renal Dialysis ; Uric Acid/blood

PURPOSE: Intravenous gamma globulin(IVGG) treatment has reduced symptoms and complications in Kawasaki disease(KD). However, fever persisted in 20-30% of the patients, and there are no reliable data on the indication and dosage of IVGG re-treatment. Therefore, we tried to reveal the effectiveness of IVGG re-treatment and to find risk factors in predicting the re-treatment. METHODS: Among 57 patients with typical KD, 47(82.5%) patients were put into group A, which improved after the treatment with standard 2g/kg of IVIG. 10(17.5%) patients were put into group B, which retreated with 1-2g/kg of IVIG due to persistent fever for at least 3 days after standard IVIG therapy. We compared clinical symptoms, laboratory findings and echocardiograms between group A and B, retrospectively. RESULTS: All patients in group B responded IVGG re-treatment and no considerable side effects. The total duration of the fever was significantly longer(P<0.001) and the initial and peak levels of CRP and the peak levels of ESR were significantly higher(P<0.01) in group B compared to group A. Even though leukocytosis, cervical lymphadenitis and coronary artery aneurysm were more frequent, and the levels of serum lipids at admission were lower in group B, without significance. CONCLUSION: IVGG re-treatment appeared to be effective in the treatment of refractory KD, but could not reduce the incidence of coronary artery aneurysm. We concluded it was difficult to predict risk factors for IVGG re-treatment from these data. Further studies are needed to determine the indication and appropriate dosage of IVGG re-treatment.
Aneurysm ; Coronary Vessels ; Fever ; gamma-Globulins* ; Humans ; Immunoglobulins, Intravenous ; Incidence ; Leukocytosis ; Lymphadenitis ; Mucocutaneous Lymph Node Syndrome* ; Retrospective Studies ; Risk Factors

PURPOSE: Forecasting the demand for Emergency Physicians (EP) is a long, complex problem involving many variables. Although Korean Emergency Medicine Law has guidelines for the minimal numbers of EPs, it doesn't take into account the number of patients or the severity of their symptoms. Previous research involved rough estimates of the number of physicians for Emergency Departments (ED), without any consideration for workload. Our study objective was to determine whether there are an adequate number of EPs by estimating the number of EPs while considering their workload and working hours, according to the 2010 Korean Emergency Physician Survey (KEPS). METHODS: Data on the workload and working hours of Korean EPs were analyzed. The annual increase in the number of emergency patients and the annual application for residency posts were used to calculate the EP demand. Ideally, all patients must be treated by EPs; one full time equivalent (FTE) was calculated as serving 36 hours per week with two patients per hour (PPH) as the minimum. RESULTS: There were 841 EPs working in EDs and 463 EDs across Korea in 2010. A total of 635(75.5%) EPs were clinically active. EPs spent 65.6% of their working hours on clinical duty. Ideally, there should have been 2,871 FTEs and 5,797 EPs needed in 2010. CONCLUSION: There is an absolute shortage of EPs and it will get worse. The excessive hours and workloads of EPs threaten the safety of patients. Therefore, EP demand and forecasting should be focused on increasing patient coverage by EPs.
Emergencies ; Emergency Medicine ; Forecasting ; Humans ; Internship and Residency ; Jurisprudence ; Korea

PURPOSE: To evaluate the results of the treatment of intercondylar fractures of the humerus using Y-plate. MATERIALS AND METHODS: The subjects were 17 patients with intercondylar fracture of humerus who were treated using the Y-plate. Nine cases were C1 type, 4 were C2 type, and the remaining 4 were C3 type. 11 subjects had accompanying fractures of another part of the body. The average age was 48.8. The average follow up period was 33 months. We used Mayo Elbow Performance Score and Risborough-Radin's rating score for each patient as the methods of rating. RESULTS: The average range of motion of the elbow was 105 degrees (50~150 degrees). According to Cassebaum's classification for elbow range of motion, 7 cases were rated very good, 1 cases were good, 4 cases were fair, and 1 cases were poor. According to Mayo Elbow Performance Score, 7 were excellent, 7 were good, 2 fair, and 1 poor. Of the 3 patients who were fair or poor in Mayo Elbow Performance Score, 2 were type C3 fractures, and all 3 had major accompanying fractures. No significant postoperative complications developed in all cases. CONCLUSION: The fixation with Y-plate can still be a relatively good modality of treatment for interconylar fractures of the humerus in selected cases, in spite of the known mechanical weakness of the Y-plate. The patients with severe intra-articular comminution showed relatively poor results. And we think that the age of the patient and the energy of the injury have more or less influence on the results of treatment.
Classification ; Elbow ; Follow-Up Studies ; Humans ; Humerus* ; Postoperative Complications ; Range of Motion, Articular

Nonpalpable breast abnormalities which require excision and biopsy usually require marker localization. Many of these abnormalities are visible on ultrasound and this imaging technique can be used to guide fine needle aspiration and the placement of a wire marker prior to surgical excision. A non-invasive technique which does not require placement of a wire marker would offer significant advantages, being more pleasant for the patient and less demanding on resources. We attempted to localize 36 nonpalpable breast masses with non-invasive ultrasound marker technique at the department of general surgery, Soon Chun Hyang University Hospital, between January 1994 and February 1995. Cases clearly visible on ultrasound, whether on mammography(15 patients) or not(17 patients), underwent non-invasive ultrasound localization. In all cases the abnormality was easily identified and removed during surgery. The surgical biopsies contained fibroadenoma(19 cases), fibrocystic disease(12 cases), epithelial hyperplasia(1 case), intraductal papilloma(1 case), parasitic disease(1 case) and infiltrating ductal carcinoma(2 cases). The average age was 43 years old.. This non-invasive technique is a simple and accurate method for localizing small ultrasonically visible nonpalpable breast abnormalities, especially in younger female patient with dense breast, though further trials and studies will be attempted.
Adult ; Biopsy* ; Biopsy, Fine-Needle ; Breast* ; Female ; Humans ; Ultrasonography*