Elephantiasis nostras, the result of recurrent skin infection or chronic lymphedema is characterized by marked skin fibrosis and massive enlargement of a body part. We present a case of elephantiasis nostras due to chronic recurrent erysipelas which affected the lower extremities in a 62-year-old man. The patient had had persisting non-pitting edema, and tender multiple verrucous brownish plaques and nodules on both lower legs for 1 year. On histological examination, there was hyperkeratosis and papilomatosis in the epidermis, fibroplasia, dilated thick walled venules and collagen fibers oriented vertical to the skin surface, and hyperplasia of eccrine ducts in the dermis.
Collagen ; Dermis ; Edema ; Elephantiasis* ; Epidermis ; Erysipelas ; Fibrosis ; Humans ; Hyperplasia ; Leg ; Lower Extremity ; Lymphedema ; Middle Aged ; Skin ; Venules

BACKGROUND: To identify the prevalence and related factors for vitamin D deficiency in the patients who admitted to the medical intensive care unit (ICU) of a Korean tertiary care hospital. METHODS: We retrospectively analyzed the data from ICU patients requiring mechanical ventilation (MV) for a period of > 48 h to identify the prevalence and associated factors for vitamin D deficiency. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D [25(OH)D] level < 20 ng/mL. RESULTS: Among 570 patients admitted to the ICU, 221 were enrolled in the study, 194 in the vitamin D deficient group and 27 in the non-deficient group. Prevalence of vitamin D deficiency in critically ill patients was 87.8%. The patient age was lower in the vitamin D deficient group compared with the non-deficient group (64.4 ± 15.4 vs. 71.0 ± 9.6 years, p = 0.049). A higher acute physiology and chronic health evaluation II (APACHE II) score (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.10-1.37) and chronic illness (OR 3.12, 95% CI 1.08-9.01) were associated with vitamin D deficiency after adjusting for age and body mass index. Clinical outcomes of duration of MV, ICU stay, and 28- and 90-day mortality rates were not significantly different between the vitamin D deficient and nondeficient groups. CONCLUSIONS: Vitamin D deficiency was common in critically ill patients, particularly among younger patients. Higher APACHE II score and chronic illness were associated with vitamin D deficiency.
APACHE ; Body Mass Index ; Calcitriol ; Chronic Disease ; Critical Care ; Critical Illness* ; Humans ; Intensive Care Units ; Mortality ; Prevalence* ; Respiration, Artificial ; Retrospective Studies ; Tertiary Healthcare ; Vitamin D Deficiency* ; Vitamin D* ; Vitamins*

No abstract available.
Hepatitis B* ; Hepatitis*

No abstract available.
Spina Bifida Occulta*

Missing data such as appropriateness ratings in clinical research are a common problem and this often yields a biased result. This paper aims to introduce the multiple imputation method to handle missing data in clinical research and to suggest that the multiple imputation technique can give more accurate estimates than those of a complete-case analysis. The idea of multiple imputation is that each missing value is replaced with more than one plausible value. The appropriateness method was developed as a pragmatic solution to problem of trying to assess "appropriate" surgical and medical procedures for patients. Cataract surgery was selected as one of four procedures that were evaluated as a part of the Clinical Appropriateness Initiative. We created mild to high missing rates of 10%, 30% and 50% and compared the performance of logistic regression in cataract surgery. We treated the coefficients in the original data as true parameters and compared them with the other results. In the mild missing rate (10%), the deviation from the true coefficients was quite small and ignorable. After removing the missing data, the complete-case analysis did not reveal any serious bias. However, as the missing rate increased, the bias was not ignorable and it distorted the result. This simulation study suggests that a multiple imputation technique can give more accurate estimates than those of a complete-case analysis, especially for moderate to high missing rates (30 - 50%). In addition, the multiple imputation technique yields better accuracy than a single imputation technique. Therefore, multiple imputation is useful and efficient for a situation in clinical research where there is large amounts of missing data.
Cataract Extraction/*methods ; Humans ; Logistic Models ; Research Support, Non-U.S. Gov't

No abstract available.
DNA* ; Plasmids* ; Restriction Mapping* ; Yersinia enterocolitica* ; Yersinia*

We reviewed the result of one-stage hypospadias repair of 32 cases, from Jan. 1989 to Dec. 1994, according to the site of urethral opening after release of chordee. The following results were obtained. 1. The posterior hypospadias (posterior penile, penoscrotal) was 18 cases and the anterior & middle hypospadias was 16 cases. 2. Success rate of posterior hypospadias repair was 9/18(50%) and that of anterior & middle hypospadias was 9/16(56.3%), it was not different statistically (P<0.05). 3. Complication rate of posterior hypospadias repair was 9/18 (50%) and of anterior & middle hypospadias was 7/16(43,5%), it was not different statistically (P<0.05) and complications were managed by simple procedure and require no further treatment. In condition, one stage repair of hypospadias could be applicable in most cases of hypospadias. The complication and morbidity were minimal.
Female ; Hypospadias* ; Male

We reviewed the result of one-stage hypospadias repair of 32 cases, from Jan. 1989 to Dec. 1994, according to the site of urethral opening after release of chordee. The following results were obtained. 1. The posterior hypospadias (posterior penile, penoscrotal) was 18 cases and the anterior & middle hypospadias was 16 cases. 2. Success rate of posterior hypospadias repair was 9/18(50%) and that of anterior & middle hypospadias was 9/16(56.3%), it was not different statistically (P<0.05). 3. Complication rate of posterior hypospadias repair was 9/18 (50%) and of anterior & middle hypospadias was 7/16(43,5%), it was not different statistically (P<0.05) and complications were managed by simple procedure and require no further treatment. In condition, one stage repair of hypospadias could be applicable in most cases of hypospadias. The complication and morbidity were minimal.
Female ; Hypospadias* ; Male

Transfer of large quantities of fetal blood across the placental barrier to the maternal circulation is a rare occurrence which results in severe anemia in the newborn infants. This phenomenon is believed to occur most often during labor and delivery and apparently, is more frequent when abnormal obstetric conditions are present. However, fetal erythrocytes have been identified in the naternal circulation throughout most of pregnancy indicating some degree of constant or intermittent transplacental transfusion. We experienced a case of stillbirth due to large amount of fetomaternal transfusion. Acid elutionl test of maternal blood was positive and direct and indirect Coombs test was negative. Ultrasonographic finding on abdomen and cranium to rule out the internal hemorrhage was normal. We report a case of stillbirth due to fetomaternal transfusion with a brief review of related literatures.
Abdomen ; Anemia ; Coombs Test ; Erythrocytes ; Female ; Fetal Blood ; Fetomaternal Transfusion* ; Hemorrhage ; Humans ; Infant, Newborn ; Pregnancy ; Skull ; Stillbirth*

Dubin-Johnson Syndrome is a form of benign, familial idiopathic jaundice presenting with chronic intermittentconjugated hyperbilirubinnmia and a melamin-like pigment has been found in the parenchymal liver cells. This disorder is rarely diagnosed in the neonatal period. We report a case of Dubin-Johnson syndrome presenting with neonatal cholestasis.
Cholestasis ; Jaundice ; Jaundice, Chronic Idiopathic* ; Liver