Progressive ischemia can result in gangrenous changes of the tissues. Most commonly the digits are affected initially, but progression to the hand is not unusual. Small amounts of infection superimposed on a severe chronic ischemic state can progress very rapidly to gangrene. Clinically, dry and wet gangrene should be differentiated. Dry gangrene represents mummification of tissue, and active purulent tissue and cellulitis are absent. Wet gangrene is characterized by active infection with cellulitis and purulent tissue planes and is an indication for urgent amputation to prevent ascending infection. We experienced a case of dry gangrenous extremity due to septic shock after anethesia.
Amputation ; Cellulitis ; Extremities* ; Gangrene ; Hand ; Humans ; Ischemia ; Shock, Septic*

BACKGROUND AND OBJECTIVES: Meniere's disease (MD) is a clinical cluster of common symptoms by various causes rather than a single disease entity. Many causes such as autoimmune, allergy, vascular insufficiency have been thought to be related with Meniere's disease. We assumed that different pathologic mechanisms have contribution in each gender. With this premise, we compared clinical characteristics between male and female patients to determine if there is any difference indicating heterogeneous underlying pathology. MATERIALS AND METHODS: We reviewed medical records of 61 patients (43 female, 18 male) who were diagnosed as unilateral definite MD and underwent vestibular function test and audiologic evaluation (more than two times of pure tone audiometry during the follow-up period) from October 2005 to December 2011. RESULTS: The average duration of dizziness in females was longer than in males. In the worst ipsilateral pure tone audiometry, low frequency thresholds were lower in females than in males. Female had lesser hearing difference at all frequencies between the sides and showed more hearing fluctuation than male. There was no significant difference between male and female in the vestibular function test. CONCLUSION: These results are insufficient to suggest that the pathogenesis of MD differs between the genders. However, some differences between the genders prompt a need for future studies involving more patients.
Audiometry ; Dizziness ; Female ; Follow-Up Studies ; Hearing ; Humans ; Hypersensitivity ; Male ; Medical Records ; Meniere Disease ; Vestibular Function Tests

BACKGROUND: Elevation in plasma homocysteine has been widely studied as an independent risk factor for atherosclerosis. And epidemiologic studies have demonstrated that the persons who take the folate and vitamin B6 have lower incidence of atherosclerotic vascular disease and lower plasma homocysteine level. But, not yet the effects of vitamin B6 and folate on the level of plasma homocysteine and brachial artery dilation on healthy subjects was not evaluated. METHODS: We evaluated the effects of 50 mg of vitamin B6 and 1 mg of folate on endothelial function, plasma homocysteine levels to one healthy postmenoausal woman and nineteen men in a randomized, double-blind, placebo-controlled, crossover design. RESULTS: In our study, supplement of vitamin B6 and folate significantly lowered plasma homocysteine level (placebo : folate =6.56 +1.55 micromol/L vs. 5.37 +1.04 micromol/L, p=.001). But, there were no statistically significant increament of flow-mediated dilation (FMD) compared to placebo (placebo : folate =5.12 +3.26% vs. 6.69 +2.60%, p=.070) and there were no significant correlation between the improvement of homocysteine level and increament of flow mediated dilation on healthy subjects. CONCLUSION: Compared to persons with absolute or relative hyper-homocysteinemia, our study did not show such favorable effects in healthy persons. So further studies must to be held to discover the effect of folate and vitamine B6 in healthy persons.
Atherosclerosis ; Brachial Artery* ; Cross-Over Studies ; Female ; Folic Acid* ; Homocysteine* ; Humans ; Incidence ; Male ; Plasma* ; Risk Factors ; Vascular Diseases ; Vitamin B 6* ; Vitamins*

BACKGROUND: Recently, the legal and ethical issues relative to euthanasia are becoming controversial in Korea. This study was designed to verify the differences of the attitudes on euthanasia between judicial apprentices and residents. METHODS: The questionnaire was conducted on the 35th-group of the judicial apprentices on March 24, 2004, and on the residents from April 2 to May 22, 2004. The respondents were 636 in total consisting of 460 judicial apprentices and 176 residents. RESULTS: Of the total 636 subjects, 373 (81.1%) of the judicial apprentices and 149 (84.7%) of residents agreed that allowing euthanasia is moral, without any significant difference (P>0.05). The number of residents was greater (59 people, 33.5%) than that of judicial apprentices (112 people, 24.4%) who agreed with active euthanasia (P<0.05). Among the total, 397 (86.3%) of the judicial apprentices and 160 (91.4%) of the residents answered that the law for euthanasia was necessary, without any significant difference (P>0.05). But, among these supporters, the respondents who agreed on active euthanasia were significantly different in number between judicial apprentices (n=93, 23.4%) and residents (n=54, 33.8%) (P<0.05). CONCLUSION: This study did not find any significant differences between the two groups in the necessity of the law for euthanasia, but the rate of agreement on active euthanasia was higher in residents group than in judicial apprentices group.
Surveys and Questionnaires ; Ethics ; Euthanasia* ; Euthanasia, Active ; Euthanasia, Passive ; Jurisprudence ; Korea

OBJECTIVES: Diffuse tensor imaging (DTI) was applied to explore the difference in regional distribution and extent of white matter (WM) abnormalities in boys with Attention-deficit/hyperactivity disorder (ADHD) versus boys with comorbid ADHD and tic disorders. METHODS: Fifteen boys with ADHD (mean age 9.3+/-1.8), 24 ADHD boys with chronic tic disorder or Tourette's disorder (9.9+/-1.2) and 9 age-, gender-matched controls (9.2+/-1.8) received DTI assessments. Fractional Anisotropy (FA) maps of WM were compared between groups with a voxel-wise analysis after intersubject registration to MNI space. RESULTS: Both groups, ADHD group and ADHD with tic disorder group, commonly showed decreased FA than healthy control group in left cerebellar middle peduncle and right frontal lobe, increased FA in right middle occipital WM. In the common areas of left cerebellar middle peduncle and right middle occipital WM, comorbid group showed broader areas of significant FA. The comorbid group also showed increased FA in right cerebellar peduncle, additionally. CONCLUSION: The findings in ADHD group support previous ADHD hypothesis of the functional abnormalities in corticocerebellar circuit, and suggest that ADHD might have more complicated pathology of neuronal circuit including occipital visual system. The comorbid group showed common areas of overlapping but more extensive abnormalities and also had additional WM abnormalities. ADHD with chronic tic disorders may represent a severe form of ADHD with additional regions of abnormal connectivity.
Anisotropy ; Attention Deficit Disorder with Hyperactivity ; Diffusion ; Diffusion Tensor Imaging ; Frontal Lobe ; Humans ; Neurons ; Tic Disorders ; Tics ; Tourette Syndrome

We report a case of a 5-year-old girl who developed left hemiparesis and left facial palsy, 6 days after the initiation of fever and respiratory symptoms due to pneumonia. Chest radiography, conducted upon admission, showed pneumonic infiltration and pleural effusion in the left lung field. Brain magnetic resonance imaging showed acute ischemic infarction in the right middle cerebral artery territory. Brain magnetic resonance angiography and transfemoral cerebral angiography revealed complete occlusion of the right middle cerebral artery. Mycoplasma pneumoniae infection was identified by a 4-fold increase in IgG antibodies to M. pneumoniae between acute and convalescent sera by enzyme-linked immunosorbent assay. Fibrinogen and D-dimer levels were elevated, while laboratory exams in order to identify other predisposing factors of pediatric stroke were all negative. This is the first reported pediatric case in English literature of a M. pneumoniae-associated cerebral infarction involving complete occlusion of the right middle cerebral artery.
Antibodies ; Brain ; Causality ; Cerebral Angiography ; Cerebral Infarction ; Child, Preschool ; Enzyme-Linked Immunosorbent Assay ; Facial Paralysis ; Female ; Fever ; Fibrinogen ; Humans ; Immunoglobulin G ; Infarction ; Infarction, Middle Cerebral Artery ; Lung ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Middle Cerebral Artery* ; Mycoplasma pneumoniae* ; Mycoplasma* ; Paresis ; Pleural Effusion ; Pneumonia* ; Pneumonia, Mycoplasma* ; Radiography ; Stroke ; Thorax

We report a case of a 5-year-old girl who developed left hemiparesis and left facial palsy, 6 days after the initiation of fever and respiratory symptoms due to pneumonia. Chest radiography, conducted upon admission, showed pneumonic infiltration and pleural effusion in the left lung field. Brain magnetic resonance imaging showed acute ischemic infarction in the right middle cerebral artery territory. Brain magnetic resonance angiography and transfemoral cerebral angiography revealed complete occlusion of the right middle cerebral artery. Mycoplasma pneumoniae infection was identified by a 4-fold increase in IgG antibodies to M. pneumoniae between acute and convalescent sera by enzyme-linked immunosorbent assay. Fibrinogen and D-dimer levels were elevated, while laboratory exams in order to identify other predisposing factors of pediatric stroke were all negative. This is the first reported pediatric case in English literature of a M. pneumoniae-associated cerebral infarction involving complete occlusion of the right middle cerebral artery.
Antibodies ; Brain ; Causality ; Cerebral Angiography ; Cerebral Infarction ; Child, Preschool ; Enzyme-Linked Immunosorbent Assay ; Facial Paralysis ; Female ; Fever ; Fibrinogen ; Humans ; Immunoglobulin G ; Infarction ; Infarction, Middle Cerebral Artery ; Lung ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Middle Cerebral Artery* ; Mycoplasma pneumoniae* ; Mycoplasma* ; Paresis ; Pleural Effusion ; Pneumonia* ; Pneumonia, Mycoplasma* ; Radiography ; Stroke ; Thorax

Human tails or caudal cutaneous appendages are rare congenital anomalies with lesions usually arising from the midline of the lumbosacrococcygeal area. There have been only around 70 cases reported in literature. A 4-month-old male infant born as the 1st child of a dizygotic twin was presented with a penis-shaped mass of 4-cm in the coccygeal area. The mass was entirely covered by skin without any skin defect and was connected to the midline skin of the posterior coccygeal area by a stalk. Magnetic resonance images showed fat density of the mass without any demonstrable communication with the spinal canal nor any underlying central nervous system anomalies. The patient underwent a simple surgical excision of the mass without residual effects and complications. Histopathologic examination of the mass revealed lobules of mature adipose tissue, fibromuscular soft tissue, small vessels and nerves with normal hair follicles on the skin.
Adipose Tissue ; Central Nervous System ; Child ; Hair Follicle ; Humans ; Infant ; Magnetic Resonance Spectroscopy ; Male ; Skin ; Spinal Canal ; Twins, Dizygotic

Intracranial dermoid cyst is a rare congenital disease originating in the embryo. Intracranial dermoid cysts are usually detected before five years of age; however, asymptomatic cysts have been discovered after the third decade of life through various complications. Sometimes, there are neurologic symptoms caused by a cystic mass effect and if there is a dermoid sinus, purulent infections can occur. Early diagnosis is important and as such, CT or MR imaging for recognition of the location, size, and characteristics of the cysts are recommended before surgical resection. Extradural dermoid cysts with an intact occipital dermoid sinus are a rare event. We report a case of intracranial dermoid cyst associated with scalp abscess. In this case, a three-year-old boy was presented with scalp abscess and we performed MR imaging, which revealed a cystic region. The prognosis after resection operation was good without any complication.
Abscess ; Dermoid Cyst ; Early Diagnosis ; Embryonic Structures ; Neurologic Manifestations ; Prognosis ; Scalp ; Spina Bifida Occulta

Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare but life-threatening complication. VITT strongly mimics heparin-induced thrombocytopenia (HIT) and shares clinical features. Heparin is commonly used to prevent coagulation during hemodialysis.Therefore, nephrologists might encounter patients needing dialysis with a history of heparin exposure who developed thrombotic thrombocytopenia after vaccination. A 70-year-old male presented with acute kidney injury and altered mental status due to lithium intoxication. He needed consecutive hemodialysis using heparin. Deep vein thrombosis of left lower extremity and accompanying severe thrombocytopenia of 15,000/µL on 24 days after vaccination and at the same time, nine days after heparin use. Anti-platelet factor 4 antibody test was positive.Anticoagulation with apixaban and intravenous immunoglobulin (IVIG) infusion resolved swelling of his left calf and thrombocytopenia. There were no definitive diagnostic tools capable of differentiating between VITT and HIT in this patient. Although VITT and HIT share treatment with IVIG and non-heparin anticoagulation, distinguishing between VITT and HIT will make it possible to establish a follow-up vaccination plan in a person who has had a thrombocytopenic thrombotic event. Further research is needed to develop the tools to make a clear distinction between the clinical syndromes.