No abstract available.
Fibrosis* ; Hepatitis C, Chronic* ; Humans ; Interferons* ; Ribavirin*

BACKGROUND: Idiopathic calcinosis cutis (CC) is currently sub-classified as tumoral CC, sub-epidermal calcified nodules, idiopathic CC of the scrotum, and milia-like CC. This sub-classification system is obscure and can be confusing at times. OBJECTIVE: This study was designed to characterize the clinical and histologic features of idiopathic CC, to evaluate the adequacy of the current sub-classification system, and to propose a new sub-classification system. METHODS: Thirty patients with idiopathic CC were sub-classified according to the Lever classification and the Walsh and Fairley classification and were also categorized based on the type of the primary lesion. RESULTS: Idiopathic CC lesions were most common on the buttock (n=7), followed by the scrotum (n=5), arms and legs (n=5), hands and feet (n=4), inguinal area (n=3), ears (n=2), neck (n=2), trunk (n=1), and face (n=1). With the Lever classification, twenty-three of 30 cases were categorized as "unclassified". With the Walsh and Fairley classification, twenty-three cases were categorized as "unclassified", whereas with our new classification system, we managed to classify all cases as either nodular or papular calcification according to the type of the primary lesion. CONCLUSION: In this study, we identified a common location and the primary morphological features of idiopathic CC. Our findings suggest that our new sub-classification system based on the type of the primary lesion would be useful.
Arm ; Buttocks ; Calcinosis ; Ear ; Foot ; Hand ; Humans ; Leg ; Neck ; Scrotum

We report a rare case of pseudoaneurysm of the inferior epigastric artery and inguinal hematoma extending to the scrotum following the removal of a femoral venous catheter in a 24-year-old male patient undergoing two consecutive neurosurgical procedures.
Aneurysm, False ; Catheters ; Epigastric Arteries ; Femoral Vein ; Hematoma ; Humans ; Male ; Neurosurgical Procedures ; Scrotum ; Young Adult

PURPOSE: The purpose of this study is to define the geographic patterns of partial avascular necrosis (AVN) of the talar body and to determine whether there were any predictors of both the location and occurrence of partial AVN. MATERIALS AND METHODS: Nineteen patients with fracture of the talar neck treated by open reduction and internal fixation and followed up for more than 1 year were analyzed. The radiographs were examined 6 to 8 weeks after the operation for Hawkins sign and if it was not observed, magnetic resonance scans were performed. The three-dimensional analysis was performed using Mimics 17.0 (Materialise). The incidence of collapse and time to operative intervention was recorded. RESULTS: Partial AVN of the talar body was observed in six out of 19 patients. The avascular segment of the talar body was located predominantly in the anterolateral portion. The average volume of the avascular segment was 289 mm3, and it occupied 1% of total volume of the talus, and 10% of the talar dome. Collapse occurred in one patient in the area of the avascular process. There were no observable trends with regard to Hawkins classification, incidence of collapse, or time to operative intervention to the location of the avascular segment. CONCLUSION: Partial AVN can occur after fracture of the talar neck. The predominant location of the avascular segment was the anterolateral portion of the talar body. This information may be helpful to understanding the process of avascular necrosis of the talar body.
Classification ; Humans ; Incidence ; Neck* ; Necrosis* ; Talus

The purpose of this paper is to review the colonoscopic fingings of twenty two patients with colonic tuberculosis which were diagnosed by colonoscopic finding, histopathology, and follow-up observation after antituberculosis chemotherapy at Pusan National University Hospital from January 1992 to December 1994. The results were as follows: 1) The male to female ratio was 1: 1.2, and the average age of the patients was 39.4 years with a slight predominance in women. The age of peak incidence was the 4th decade 40.9%). 2) Abdominal pain(95%), diarrhea(63%), and weight loss(50%) were the most common clinical findings. Others were constipation, melena, and palpable abdominal mass. The location of the pain was right lower abdomen, epigastrium, central abdomen, and left lower abdomen in decreasing order. 3) Hematologic findings showed decrease in hemoglobin level, increase in ESR, and positive CRP(61.5%). The white blood cell counts were mostly normal. 4) The stool examination showed positive occult blood in 7 cases among 18 cases (38.9%). Acid-fast bacteria was observed in stool of one case. 5) On colonoscopy, the lesion sites were ileoeecal valve(75%), ascending colon(72.7 %), terminal ileum(52.6%), cecum(42.9%), transverse colon(31.8%), descending colon (27.3%), sigmoid colon(9%), and rectum(9%) in decreasing order of frequency. Most of them involved ileocecal area. 6) On colonoscopy, the shape of ulcer revealed circular(41%), fusion(36%), and irregular pattern(18%). It found skipped area in 9 cases, pseudopolyp in 8 cases, patency of ileocecal valve in 5 cases, and severe deformity of ileocecal valve in 6 cases. 7) Microscopic finding of biopsy specimens revealed noncaseating granulomatous inflammation in 12 cases, and nonspecific ulcerative inflammation in 10 cases. In conclusion the diagnostic yield may be greatly enhanced by obtaining multiple target biopsies frorn tbe deep portion of the ulcer bed and margins. Judged from the colonoscopic finding and clinical improvement after antituberculosis chemotherapy, more accurate diagnosis can be acquired.
Abdomen ; Bacteria ; Biopsy ; Busan ; Colon* ; Colon, Descending ; Colon, Sigmoid ; Colonoscopy ; Congenital Abnormalities ; Constipation ; Diagnosis ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Ileocecal Valve ; Incidence ; Inflammation ; Leukocyte Count ; Male ; Melena ; Occult Blood ; Tuberculosis* ; Ulcer

BACKGROUND: Histological analysis of tuberculosis shows a spectrum of findings, from well formed granulmatous inflammation with few bacilli in patient with normal immune response to M. tuberculosis to poorly formed granulomatous inflammation with many bacilli in patient with defective immune response. To evaluate the degree of immune response to M. tuberculosis, we studied the histologic features, including the presence of acid fast bacilli(AFB) in lymph node of patients with cervical tuberculous lymphadenitis, and compared them with clinical characteristics. METHODS: We reviewed the histologic features of 33 cases of cervical tuberculous lymphadenitis and processed the excised nodes for auramine-rhodamine staining to detect AFB. The AFB positivity in tissue was compared with the histologic features(degree of granuloma formation, presence of caseation necrosis, presence of neutrophilic infiltration) and clinical characteristics (lymph node size, duration of symptom, presence of local symptom or radiologic evidence of pulmonary tuberculosis). RESULTS: 1) The mean age at diagnosis was 42.4 years, and male to female ratio was 1 : 45. 2) Histologically, all cases showed well formed granuloma and variable degrees of caseation necrosis, and 39% of the cases showed neutrophilic infiltration in the granulomatous inflammation. 3) AFB were confirmed in 52% of the cases, and they were found extracellularly and at the periphery of caseation necrosis. 4) There was no association between AFB Positivity and histological features or clinical characteristics. CONCLUSION: Cervical tuberculous lymphadenitis showed well formed granulomatous inflammation with caseation necrosis, and there was no association between AFB positivity in the tissue and histological or clinical characteristics.
Diagnosis ; Female ; Granuloma ; Humans ; Inflammation ; Lymph Nodes ; Lymphadenitis ; Male ; Necrosis ; Neutrophils ; Tuberculosis ; Tuberculosis, Lymph Node*

Glycogen storage disease type V (GSD-V) is the most common disorder of muscle glycogenosis with characteristic clinical and laboratory findings. A 32-yr-old woman complained of exercise intolerance and myoglobulinuria since early adolescence. She reported several episodes of second-wind phenomenon. Physical examination did not show any neurological abnormality, including fixed muscle weakness or atrophy. Serum creatine kinase level was 1,161 IU/L at rest. The result of the non-ischemic forearm exercise test was compatible with GSD-V. Mutation analysis identified the compound heterozygous mutations of the PYGM, p.D510fs and p.F710del, which has not yet been reported in Korea. The present case recognizes that detail clinical and laboratory analysis is the first step in the diagnosis of GSD-V.
Adult ; Base Sequence ; Creatine Kinase/blood ; Exons ; Female ; Frameshift Mutation ; Gene Deletion ; Genotype ; Glycogen Phosphorylase, Muscle Form/genetics ; Glycogen Storage Disease Type V/*diagnosis/genetics/pathology ; Humans ; Pedigree ; Sequence Analysis, DNA

BACKGROUND: An appropriate level of sedation and pharmacological assist are essential during percutaneous transluminal balloon angioplasty (PTA). Ketamine provides good analgesia while preserving airway patency, ventilation, and cardiovascular stability with an opioid sparing effect suggesting that it would be ideal in combination with remifentanil and midazolam in spontaneously breathing patients. We evaluated the effect of a small dose of ketamine added to midazolam and remifentanil on analgesia/sedation for PTA procedures. METHODS: Sixty-four patients receiving PTA were enrolled. The Control group received midazolam 1.0 mg i.v. and continuous infusion of remifentanil 0.05 microg/kg/min. The Ketamine group received, in addition, an intravenous bolus of 0.5 mg/kg ketamine. Patients' haemodynamic data were monitored before remifentanil infusion, 5 min after remifentanil infusion, at 1, 3, 5, 30 min after incision, and at admission to the recovery room. Verbal numerical rating scales (VNRS) and sedation [OAA/S (Observer's Assessment of Alertness/Sedation)] scores were also recorded. RESULTS: The VNRS values at 1, 3, and 5 min after incision and OAA/S scores at 5 min after remifentanil infusion, and 1, 3, and 5 min after incision were lower in the Ketamine group than in the Control group. In the Control group, the VNRS value at 1 min after incision significantly increased and OAA/S values at 3, 5, and 30 min after incision significantly decreased compared to baseline values, while there were no significant changes in the ketamine group. CONCLUSIONS: A small dose of ketamine as an adjunct sedative to the combination of midazolam and remifentanil produced a better quality of sedation and analgesia than without ketamine and provided stable respiration without cardiopulmonary deterioration.
Analgesia ; Angioplasty, Balloon ; Humans ; Ketamine ; Midazolam ; Piperidines ; Recovery Room ; Respiration ; Ventilation ; Weights and Measures

BACKGROUND: Multiple system atrophy (MSA) and idiopathic Parkinson's disease (IPD) are two common neurodegenerative disorders presenting with parkinsonism. Since a brain MRI study is an available method for differentiating MSA from IPD, we tried to find further values of brain MRI studies in differentiating MSA from IPD. METHODS: We measured anteroposterior and transverse diameters (AD and TD, respectively) of the brain stem of T2-weighted axial images. We graded the severity of atrophy (grade 0: none; grade 1: mild; grade 2: moderate; and grade 3: severe) of cerebellar vermis and hemispheres on the midsagittal and parasagittal planes. RESULTS: There were 36 patients with probable MSA and 40 patients with IPD. We calculated a parameter multiplying AD of the midbrain by TD of the midbrain. The mean of the AD x TD of the midbrain was 1007.5 +/- 161.8 mm2 in patients with MSA, and it was significantly smaller than that of those with IPD (1113.3 +/- 118.7 mm2). When the cut off value was decided as 1050 mm2, the sensitivity of the parameter for the diagnosis of MSA was 83.3% and specificity was 80%. The frequency of cerebellar atrophy was 72.2% in patients with MSA, and it was significantly higher than that of those with IPD (37.5%). CONCLUSIONS: Measurements of the brain stem, particularly the midbrain, and cerebellum areas on brain MRI are helpful methods for the differential diagnosis of patients with MSA from those with IPD.
Atrophy ; Brain Stem* ; Brain* ; Cerebellum* ; Diagnosis ; Diagnosis, Differential* ; Humans ; Magnetic Resonance Imaging* ; Mesencephalon ; Multiple System Atrophy* ; Neurodegenerative Diseases ; Parkinson Disease* ; Parkinsonian Disorders ; Sensitivity and Specificity

OBJECTIVE: The aim of this study was to evaluate and compare neonatal outcome of premature twins conceived by in vitro fertilization (IVF) to those of naturally conceived. METHODS: We retrospectively analyzed neonatal outcome of sixty pairs of premature twins conceived by IVF (IVF twin group) and 34 pairs that naturally conceived (natural twin group). Maternal and obstetric characteristics were also compared. All were born before 35 weeks of gestation between January 2000 and December 2004 at Pochon-Cha Hospital and admitted to neonatal intensive care unit. Student t-test and chi-square test were used for statistical analysis. RESULTS: For obstetrical characteristics, maternal age and rates of nulliparous were sibnificanty twin group. But, other parameters (preterm labor, premature rupture of membranes, pregnancy-induced hypertension, gestational diabetes mellitus) were similar between two groups. For neonatal outcome, gestational age, duration of hospital stay, Apgar score, neonatal mortality and morbidity were reviewed. All parameters were no significant differences in IVF twin group compare to natural twin group CONCLUSIONS: In our study, IVF twin group had no significant differences in obstetric characteristics (except for maternal age and parity) and neonatal outcome compare to natural twin group.
Apgar Score ; Diabetes, Gestational ; Female ; Fertilization in Vitro* ; Gestational Age ; Humans ; Hypertension, Pregnancy-Induced ; Infant ; Infant Mortality ; Infant, Newborn ; Intensive Care, Neonatal ; Length of Stay ; Maternal Age ; Membranes ; Obstetric Labor, Premature ; Pregnancy ; Retrospective Studies ; Rupture ; Twins*