Craniofacial clefts are rare among facial anomalies with an incidence of 1.5 to 5 per 100,000 births, and 1 per 100 cases of cleft lip and palate. The Tessier No. 7 clefts are unusual lesions that result from failure of the embryonic mandibular and maxillary processes to properly fuse and form the corners of the mouth. We experienced a case of Tessier No. 7 craniofacial cleft in a 1 day-old female patient who presented with a macrostomia and auricular malformation. The diagnosis was established by clinical and radiographic findings. A brief review of literature was made.
Cleft Lip ; Diagnosis ; Female ; Humans ; Incidence ; Macrostomia ; Mouth ; Palate ; Parturition

Epidermal growth factor receptor (EGFR) is overexpressed in various malignancies including carcinoma of the breast, lung, esophagus, cervix, and stomach. In patients with cervical carcinoma, its overexpression may be associated with advanced stage and poor prognosis. So, we evaluated the levels of serum EGFR in patients with cervical carcinoma. The level of EGFR extracellular domain was determined in serum from 57 cervical carcinoma patients(adenocarcinoma: 2, squamous cell carcinoma: 39, carcinoma in situ(CIS): 16) and 28 cases of healthy control using enzyme-linked immunosorbent assay(Calbiochem). In invasive carcinoma, serum EGFR level was measured in 11 cases of Stage Ia, 9 cases of Stage Ib, 4 cases of Stage IIa, 15 cases of Stage IIb, 2 cases of stage III patients. The mean ages of the healthy controls, of the wome with carcinoma in situ(CIS), and with invasive cervical carcinoma were not different(49.3, 44,4, 49.5, respectively, p 0.241). The mean serum level of EGFR in healthy control(n 28), carcinoma in situ(CIS)(n 16), and invasive carcinoma patients(n=41) were not significantly different(71.4+/-12.8fmol/ml, 79.2+/-26.8fmol/ml, 61.8+/- 18.4 fmol/ml, respectively, p=0.071). In conclusion, the expression of EGFR was not increased in patients with cervical cancer compared with normal women. And no significant differences were found depending on the clinical stage.
Breast ; Carcinoma, Squamous Cell ; Cervix Uteri ; Enzyme-Linked Immunosorbent Assay ; Esophagus ; Female ; Humans ; Lung ; Prognosis ; Receptor, Epidermal Growth Factor ; Stomach ; Uterine Cervical Neoplasms*

In this paper, we analyzed a fictional character from the movie series (James Bond from the 007 series) based on Kohut’s self psychology to understand the formation and evolution of narcissistic personality traits. James Bond experienced sudden parental loss due to a tragic accident. He endured childhood bullying, leading to a deficiency in mirroring selfobject experiences, idealized selfobject experiences, and twinship selfobject experiences. These deficits culminated in his developing narcissistic personality disorder. However, James Bond was able to undergo a process of transmuting internalization through new selfobjects such as M and Madeleine. This enabled him to reactivate disrupted developmental processes and ultimately reach a state of healthy self.

No abstract available.
Antibodies* ; Chlamydia trachomatis* ; Chlamydia* ; Humans ; Neisseria gonorrhoeae* ; Neisseria* ; Prevalence*

No abstract available.
Antibodies* ; Chlamydia trachomatis* ; Chlamydia* ; Humans ; Neisseria gonorrhoeae* ; Neisseria* ; Prevalence*

OBJECTIVE: Stenotrophomonas maltophilia has been emerging as an important nosocomial pathogen in recent years in patients with impaired host- defense mechanism or who has been exposed to large amount of inocula. This organism is usually resistant to multiple (commonly used) antimicrobial agents, particularly to those of the beta-lactam class. To evaluate the clinical feature of Stenotrophomonas maltophilia infection and in vitro anti- microbial susceptibility, we performed a retrospective study. METHODS: We analyzed the result of in vitro antimicrobial susceptibility test for 200 isolates of S. maltophilia and the annual isolation rate during the period between January 1990 and December 1994 in our institution, and performed a retrospective study for the available records of 165 cases among them. The data were obtained with only the first isolation of the organism for each patients. RESULTS: Total of 165 initial isolates, the isolates were from wounds in 50(30.3%), urine in 47(28.5%), the respiratory tract in 37(22.4%), blood in 9(5.5%), bile in 6(3.6%), and miscellaneous sources in 16(9.7%). The 84.2% of isolates were hospital-acquired isolate and 58.3% of these patients had received antecedent antibiotic therapy: polymicrobial growth was demonstrated in 61.9% of the cases. In vitro antimicrobial susceptibiiity test, ofloxacin was active against the isolates in 89.2%, moxalactam in 85.9%, ciprofloxacin in 83.9%, TMP-SMX(trimethoprim-sulfamethoxazole) in 64.2%, As expected, S. maltophilia isolates were, in general, not susceptible to cephalosporins, penicillins. The annual isolation rate at Kyung Hee University hospital was not increased significantly from 1990 to 1994, 19.53 per 10,000 patients dismissals in 1990, 13.56 in 1994. The major underlying diseases of patients were malignancy(17.6%), cerebrovascular disorder(17%), diabetic mellitus(13.3%). Mortality rate is 10.3%. CONCLUSION: S. maltophilia has been emerging as an important nosocomial pathogen in immunocompromised patients, especially those receiving broad-spectrum antimicrobial therapy. And this organism is resistant to multiple antimicrobial agents, particularly to those of the beta-lactam class. When antimicrobial treatment is necessary, the clinician should be guided by results of in vitro susceptibility testing because of the notable in vitro resistance of S. maltophilia to commonly used antibiotics. And when S. maltophilia has been recovered from a patient, wound and contact isolation is warranted.
Anti-Bacterial Agents ; Anti-Infective Agents ; Bile ; Cephalosporins ; Ciprofloxacin ; Humans ; Immunocompromised Host ; Mortality ; Moxalactam ; Ofloxacin ; Penicillins ; Respiratory System ; Retrospective Studies ; Stenotrophomonas maltophilia ; Stenotrophomonas* ; Wounds and Injuries

Intracranial aspergillosis is a rare pathologic condition, difficult to treat and often fatal, which generally affects immuosuppressed patients. A case of brain abscess secondary to pulmonary localization in a child with acute lymphoblastic leukemia with a favorable outcome is described. A 4-year-old boy diagnosed with acute lymphoblastic leukemia was induced with vincristine, cyclophosphamide, daunorubicin, L-asparaginase and dexamethasone. On the second week of induction chemotherapy, he suffered febrile neutropenia (absolute neutrophil count below 100). Blood and sputum culture disclosed the presence of Aspergillus fumigatus, and chest X-ray examination showed thin-walled cavitation of infiltrates compatible with aspergilloma. The patient was treated with amphotericin B (1 mg/kg/day) and with G-CSF for neutropenia. Fever subsided a few days later and complete hematologic remission was attained on the sixth hospital week, during which antifungal treatment with amphotericin B was continued. Repeated blood and sputum cultures were sterile. On the fifty-sixth hospital day, the patient suffered from afebrile tonic seizure with right side weakness. CT scan of the brain showed multiple well-circumscribed, rim-enhancing round lesions in right frontal lobe and bilateral parieto-occipital area causing gross edema and displacement of the central structures. Itraconazole was added from eightieth hospital day and supportive care was provided for brain edema. After 2 weeks, there was marked clinical improvement, and the pulmonary aspergilloma had completely regressed on follow-up chest X-ray at the sixty-fifth hospital day. Follow-up brain CT scan at the sixty-eighth hospital day showed marked decrease in size, thickness of abscess wall, and brain edema. Patient also attained neurologic improvement. Amphotericin B therapy was continued for 9 weeks (cumulative dose 908 mg, 58 mg/kg) without discer-nable side effects and the patient was discharged on the ninety-sixth hospital day with improved condition. 6 months after detection of brain abscess, magnetic resonance image of the brain showed resolution of all brain lesions. To the best of our knowledge, this is the first reported case survived CNS aspergillosis in an immunocompromised setting in Korea which was successfully treated with medical therapy only. We present a case report with a brief review.
Abscess ; Amphotericin B ; Aspergillosis* ; Aspergillus fumigatus ; Brain ; Brain Abscess ; Brain Edema ; Child* ; Child, Preschool ; Cyclophosphamide ; Daunorubicin ; Dexamethasone ; Edema ; Febrile Neutropenia ; Fever ; Follow-Up Studies ; Frontal Lobe ; Granulocyte Colony-Stimulating Factor ; Humans ; Induction Chemotherapy ; Itraconazole ; Korea ; Male ; Neutropenia ; Neutrophils ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Seizures ; Sputum ; Thorax ; Tomography, X-Ray Computed ; Vincristine

Approximately 5% of patients infected with Herpes zoster experience motor complications, such as muscle atrophy or paresis, caused by motor neuron involvement. The majority of paretic cases are associated with involvement of cranial nerves or of spinal nerves that innervate the muscles of extremities. We report the case of an 82-year-old female patient with cutaneous Herpes zoster involving the T10-11 sensory dermatomes, complicated by ipsilateral abdominal protrusion. Electromyography on the left external oblique muscle revealed marked denervation potentials, implying motor neuron involvement. One month after the onset of abdominal protrusion, the patient's motor symptoms markedly improved. Clinicians should consider the possibility of motor neuron involvement with Herpes zoster, even in cases of zoster involving thoracic branches of spinal nerves.
Aged, 80 and over ; Cranial Nerves ; Denervation ; Electromyography ; Extremities ; Female ; Herpes Zoster ; Humans ; Motor Neurons ; Muscles ; Muscular Atrophy ; Paresis ; Spinal Nerves

Approximately 5% of patients infected with Herpes zoster experience motor complications, such as muscle atrophy or paresis, caused by motor neuron involvement. The majority of paretic cases are associated with involvement of cranial nerves or of spinal nerves that innervate the muscles of extremities. We report the case of an 82-year-old female patient with cutaneous Herpes zoster involving the T10-11 sensory dermatomes, complicated by ipsilateral abdominal protrusion. Electromyography on the left external oblique muscle revealed marked denervation potentials, implying motor neuron involvement. One month after the onset of abdominal protrusion, the patient's motor symptoms markedly improved. Clinicians should consider the possibility of motor neuron involvement with Herpes zoster, even in cases of zoster involving thoracic branches of spinal nerves.
Aged, 80 and over ; Cranial Nerves ; Denervation ; Electromyography ; Extremities ; Female ; Herpes Zoster ; Humans ; Motor Neurons ; Muscles ; Muscular Atrophy ; Paresis ; Spinal Nerves

BACKGROUND/AIMS: During the past several decades pancreaticoduodenectomy has carried a tremendous operative risk. Recently, however, mortality has decreased markedly to around 5%. The aim of this study was to determine the indication, clinical course and complications for the procedure. We also assessed the risk factors of operative morbidity and mortality. METHODS: During the period from June 1979 to July 1998, 155 patients underwent pancreaticoduodenectomy at our institution. The clinical records and pathologic reports were reviewed retrospectively. RESULTS: There were 102 men and 53 women. Mean age was 55.5 years. Indications for the procedure were periampullary carcinoma in 121 patients(78.1%), other malignant tumors in 13 patients(8.2%), and benign diseases including trauma in 21 patients(13.5%). A standard pancreaticoduodenectomy was performed in 113 patients. The remaining 42 patients underwent pylorus preserving pancreaticoduodenectomy. Operative morbidity occurred in 46 patients (29.7%). Pancreatic fistula was the most common complication (11.0%). There were nine operative deaths(5.8%). For the patients with pancreatic fistula, the mortality rate was 41.1%. Patient's age, serum albumin, serum bilirubin, hemoglobin, and leucocyte count had no significant influences on the result of operation. Type of procedure, operation time, amount of transfusion, or use of octreotide were not determining factors for operative mortality. CONCLUSIONS: Pancreaticoduodenectomy was performed in 155 patients with a mortality of 5.8% and a morbidity of 29.7%. The main cause of operative death was pancreatic fistula. There were no specific contributing factors leading to operative morbidity and mortality. It is suggested that technical precision and gentleness are of great importance for patients undergoing pancreaticoduodenectomy
Bilirubin ; Female ; Humans ; Male ; Mortality ; Octreotide ; Pancreatic Fistula ; Pancreaticoduodenectomy* ; Pylorus ; Retrospective Studies ; Risk Factors ; Serum Albumin