Three cases of necrotizing vasculitis clinically showing bullous skin lesions and histopathologically confirmed as leukocytoclastic vasculitis are reported. Compared with those of skin -limited non-bullous forms of cutaneous vasculitis, these cases showed relatively frequent abnormalities in urinalysis and required more aggresive corticosteriod therapy. Clinicians should be aware of the possible systemic involvements when the skin lesions are bullous in cutaneous necrotizing vasculitis.
Skin* ; Urinalysis ; Vasculitis*

A 79-year-old man with balanitis circumscripta plasmacellularis(BCP), presenting as an erythematous constricting band of the inner surface of the prepuce encircling the penile shaft is described. The biopsy specimen of the lesion showed, in addition to the typical histologic findings of BCP, increased fibrosis and decreased amount of elastic fibers which correlate well with our clinical observations. Electron microscopic examination revelaed no viral particles or elastic fibers. Immunohistologically, IgG was found to be the major immunoglobulin class in the plasma cellular inf iltrate.
Aged ; Balanitis* ; Biopsy ; Elastic Tissue ; Fibrosis ; Humans ; Immunoglobulin G ; Immunoglobulins ; Male ; Plasma ; Virion

BACKGROUND: It has been known that arterial carbon dioxide tension is 4~5 mmHg higher than end-tidal carbon dioxide tension in healthy adults during general anesthesia. But negative arterial to end-tidal PCO2 difference was reported in pregnant patients undergoing cesarean section. The purpose of this study was to elucidate the difference between arterial and end-tidal PCO2 in anesthetized patients with reduced functional residual capacity. METHODS: 90 patients were divided into 3 groups i.e. control group (n=30), obese group (n=20, body weight more than 20% greater than ideal weight), pregnant group (n=40). All patients had no cardiac or respiratory abnormalities and never smoked. Arterial blood gas analysis and measurement of end-tidal PCO2 were done 20 minutes after induction of anesthesia in control and obese group and just before uterine incision and 20 minutes after fetal delivery in pregnant group. RESULTS: There were significant correlations between arterial and end-tidal PCO2 in all groups. The incidences of negative arterial to end-tidal PCO2 difference were 10% in control group, 40% in obese group, 42.5% in pregnant group (p<0.05). CONCLUSION: From this study, it is concluded that patients with reduced functional residual capacity have more incidences of negativity than normal patients in the values of arterial to end-tidal PCO2 difference during general anesthesia. So when the tight control of PaCO2 is required in patients with reduced FRC, we recommend to measure PaCO2 for better anesthetic management.
Adult ; Anesthesia ; Anesthesia, General ; Blood Gas Analysis ; Body Weight ; Carbon Dioxide* ; Carbon* ; Cesarean Section ; Female ; Functional Residual Capacity* ; Humans ; Incidence ; Pregnancy ; Smoke

In this study, the authors would like to establish the guideline for effective utilization of blood and blood components in various elective surgeries. We investigated the amount of tansfused blood and blood components units, C/T ratio (crossmatching to transfusion ratio), disused rate of blood ordered in 861 elective surgery cases during the period from October I990 to September 1991. overall mean units of transfusional units per patient were 5.3 units and overall C/T ratio was 1.14. Of all the transfusional units the ratio of whole blood was 51.5%, packed red blood cell was 7%, fresh frozen plasma was 41% respectively. From this study, the guideline for the optimal blood ordering for each elective surgery was made.
Erythrocytes ; Humans ; Plasma

Compression of the airway is relatively common in pediatric patients, although it is often an unrecognized complication of congenital cardiac and aortic arch anomalies. Aortopexy has been established as a surgical treatment for tracheobronchial obstruction associated with vascular anomaly, aortic arch anomaly, esophageal atresia, and tracheoesophageal fistula. The tissue-to-tissue arch repair technique could result in severe airway complication such as compression of the left main bronchus which was not a problem before the correction. We report three cases of corrective open heart surgery monitored by intraoperative bronchoscopy performed during prebypass, and performed immediately before weaning from bypass, to evaluate tracheobronchial obstruction caused by congenital, complex cardiac anomalies in the operating room.
Airway Obstruction* ; Aorta, Thoracic ; Aortic Coarctation ; Bronchi ; Bronchoscopy* ; Esophageal Atresia ; Humans ; Operating Rooms ; Thoracic Surgery ; Tracheoesophageal Fistula ; Weaning

BACKGROUND: Pressure support ventilation(PSV) is a new form of mechanical ventilatory support that assists spontaneous inspiratory effort of an intubated patient with a clinician-selected amount of positive airway pressure. Low level pressure support during inspiration can overcome the resistive component of inspiratory work imposed by ah endotracheal tube. However the clinical efficacy of PSV as a weaning method has not been established yet. Object : The aim of study was to evaluate the efficacy of PSV when it is added to intermittent mandatory ventilation (IMV) in facilitating weaning process compared to IMV mode alone. METHOD: When the subject patients became clinically stable with their arterial blood gas analysis in acceptable range, they underwent weaning process either by IMV alone or by IMV plus PSV. The level of pressure support was held constant through the weaning period. For the patients who required mechanical ventilation for less than 72hr, 2h weaning trial was performed with IMV rate starting from 6/min. For the patients who required mechanical ventilation more than 72 hr, 7 hr weaning retrial was performed with IMV rate starting from 8/min. For the patients who failed three consecutive trials of weaning, retrial of weaning was attempted over 3 days with IMV rate starting from 8/min. Clinical characteristics, APACHE II score and nutritional status were compared. For all patients, heart rate, mean blood pressure and respiratory rate were mornitored for 48 hrs after weaning trial started. RESULTS: The total number of weaning trial was 37 in 23 patients(18 by IMV, 19 by IMV+PSV). Total ventilation time, APACHE II score and nutritional status were not statistically different between the two groups. The weaning success rate were not statistically different(38.3% by IMV, 42.1% by IMV+PSV) and the changes of mean blood pressure, heart rate, respiratory rate during first 48 hours were not different between the two groups. CONCLUSION: Low level PSV when added to IMV for weaning trial does not seem to improve the success rate of weaning from mechanical ventilation. PSV at 10cm H2O did not induce significant physiologic changes during weaning process.
APACHE ; Blood Gas Analysis ; Blood Pressure ; Heart Rate ; Humans ; Nutritional Status ; Respiration, Artificial ; Respiratory Rate ; Ventilation* ; Weaning*

No abstract available.
Angiotensin II* ; Angiotensins* ; Capillary Permeability ; Female ; Ovarian Hyperstimulation Syndrome

The purpose of this study is to evaluate the effects of occlusive wet dressing by using hydrophilic polyurethane foam (Medifoam ) in the management of donor sites of split thickness skin graft. The outer layer of Medifoam is made of a polyurethane film, which is impermeable to water and microorganisms. It provides moist wound environment and effective bacterial barrier. The middle layer is polyurethane foam, the absorption layer. Its swelling ratio is 1020% and the layer contains wound promoters (Glycosamnioglycan, etc.). The inner layer is polyurethane film, which has micro pores whose size is below 20mum. It prevents epithelial ingrowth into the pore. We performed half side test to compare Medifoam to AHD (the hydrocellular dressing materials). We divided STSG donor site into AHD dressing site and Medifoam dressing site in random fashion. This study was performed in Seoul National University Hospital from April 2001 till August 2001 with 32 patients, who needed to skin graft. We investigated about pain, comfort, easiness of handling, and time for complete healing. The Medifoam dressed site had less pain, more comfortable, easier handling and more rapid wound healing. The average healing time of Medifoam is 9.4 +/- 1.9 days and AHD is 12.6 +/- 1.9 days(p< 0.001). So we concluded that the occlusive dressing with Medifoam is an effective dressing method in split thickness skin graft donor site. And we expect that it is also effective dressing material in many other wounds.
Absorption ; Bandages* ; Humans ; Occlusive Dressings ; Polyurethanes* ; Seoul ; Skin* ; Tissue Donors* ; Transplants* ; Wound Healing ; Wounds and Injuries

We experienced a female neonate with congenital nephrotic syndrome (CNS) associated with congenital diaphragmatic hernia (CDH). Because of the rare combination of two conditions, we report this case with literature review. CDH was found immediately after birth and emergency operation was done for hernia repair. But on the next day, generalized edema and oliguria(0.59 mL/kg/hour) was found and her blood chemistry showed hypoalbuminemia (1.6 g/dL), increased BUN (27.7 mg/dL) and serum creatinine( 1.8 mg/dL) along with heavy proteinuria (4+). We started albumin infusion with a bolus of intravenous furosemide. We suspected the neonate had congenital nephrotic syndrome and her 24hr urine protein was 1,816 mg/day. In spite of immunosuppressive therapy, the nephrotic syndrome and renal failure progressed. We started peritoneal dialysis on the day of life 22 but it was not satisfactory. She was complicated by intracranial hemorrhage and multi-organ failure and expired at 34 days of age. Kidney necropsy was performed which showed diffuse mesangial sclerosis (DMS). Her chromosome study revealed 46, XX and her gene study revealed a heterozygous missense mutation, Arg366His, in Wilms tumor suppressor gene (WT1). This case deserves attention on account of the 4th case of CNS with CDH revealing the Arg366His mutation in the WT1 gene andG the 1st case of early onset renal failure without male pseudohermaphroditism and Wilms tumor with CNS, CDH and the Arg366His mutation in the WT1 gene. So, this report gives support to the hypothesis that Arg366His mutation in the WT1 gene can result in CNS and CDH.
46, XY Disorders of Sex Development ; Edema ; Emergencies ; Female ; Furosemide ; Genes, Suppressor ; Hernia, Diaphragmatic ; Herniorrhaphy ; Humans ; Hypoalbuminemia ; Infant, Newborn ; Intracranial Hemorrhages ; Kidney ; Mutation, Missense ; Nephrotic Syndrome ; Parturition ; Peritoneal Dialysis ; Proteinuria ; Renal Insufficiency ; Sclerosis ; Wilms Tumor

OBJECTIVES: Whether daytime sleepiness is proportional to the severity of sleep apnea in obstructive sleep apnea syndrome (OSAS) is controversial. In this study we investigated how insomnia severity affects the association between daytime sleepiness and sleep apnea severity in OSAS. METHODS: The present study included 235 male subjects who were diagnosed with OSAS based on clinical history and nocturnal polysomnography. Pearson's correlation analysis was conducted among sleep and mood-related self-reported data, polysomnographic data and demographic data of all subjects. Based on Pittsburgh Sleep Quality Index (PSQI), the subjects were divided into 2 groups; group A (n = 75; PSQI < or =5) and group B (n = 160; PSQI > 5). Partial correlation analysis was performed between the Epworth Sleepiness Scale (ESS) and other data in both groups. Multiple linear regression analysis was conducted to investigate the factors which affected the ESS in group A. RESULTS: Pearson's correlation analysis showed weak or non-existent correlations between ESS and apnea severity data such as apnea-hypopnea index (AHI) (r = 0.148, p = 0.023), apnea index (AI) (r = 0.137, p = 0.036), hypopnea index (HI) (r = 0.058, p = 0.377), oxygen desaturation index (ODI) (r = 0.149, p = 0.022) and arousal total index (ATI) (r = 0.129, p = 0.048). Positive correlations between ESS and apnea severity data such as AHI (r(p) = 0.313, p = 0.008), AI (r(p) = 0.339, p = 0.004), ODI (r(p) = 0.289, p = 0.015) and ATI (r(p) = 0.256, p = 0.031) were observed only in group A. Multiple regression analysis showed that AI (t = 2.996, p = 0.004) and BAI (t = 2.721, p = 0.008) were associated with ESS in group A. CONCLUSION: The correlation between daytime sleepiness and sleep apnea severity was shown only in group A. This result suggests that associations between daytime sleepiness in OSAS and sleep apnea severity will become prominent when controlling for insomnia-related variables.
Apnea ; Arousal ; Humans ; Linear Models ; Male ; Oxygen ; Polysomnography ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive* ; Sleep Initiation and Maintenance Disorders*