Paraneoplastic pemphigus is a distinct and rare autoimmune disease characterized by extensive and painful mucosal ulcerations and polymorphic desquamated skin lesions in the setting of an underlying neoplasm, typically of lymphoreticular origin. Thus difficulties in the management of anesthesia can be expected. A 66-years-old man was scheduled for removal of intraabdominal sarcoma associated with paraneoplastic pemphigus. Physical examination showed multiple erythematous bullae, crusts, plaques and target-like lesions on the whole body and desquamated erythematous skin lesions on the back and extremities. In the operating room, his right femoral artery was cannulated with a 20 G, 12.7 cm CVP catheter and left femoral and subclavian veins with 14 G, 20 cm CVP catheters, respectively. After application of 4 % lidocaine spray, his oropharynx and supraglottic area were evaluated under direct laryngoscopy and revealed multiple ulcerations on oral mucosa, but no distinct lesion on supraglottic area. Anesthesia was induced by rapid-sequence method with fentanyl, thiopental sodium and succinylcholine followed by endotracheal intubation. The endotracheal tube was held by a roll gauze around the neck and its cuff was minimally inflated to avoid overpressure against his tracheal wall. After the end of surgery, his oral cavity was suctioned with no remarkable bleeding, and tracheal wall including cuff-contacted area was evaluated under fiberoptic bronchoscopy, revealed intact wall without any bulla or ulceration. The patient was transferred to intensive care unit for proper postoperative management after extubation of endotracheal tube.
Anesthesia ; Autoimmune Diseases ; Bronchoscopy ; Catheters ; Extremities ; Femoral Artery ; Fentanyl ; Hemorrhage ; Humans ; Intensive Care Units ; Intubation, Intratracheal ; Laryngoscopy ; Lidocaine ; Mouth ; Mouth Mucosa ; Neck ; Operating Rooms ; Oropharynx ; Pemphigus* ; Physical Examination ; Sarcoma ; Skin ; Subclavian Vein ; Succinylcholine ; Suction ; Thiopental ; Ulcer

This is to report a clinical observation on 81 cases of genito-urinary tract injuries treated at the urology service. Capital Army Hospital, during the period from January, 1960 to July, 1963. Of 81 Cases which stood for 0.82% of all genito-urinary out patients, 58 cases (or 71.6%) occurred in the urethra, the most common site of involvement, and 6 cases (or 7.2%) showed multiple injuries. Age ranged between 21 and 10 years with the highest incidence of 58.4% in the ages between 21-25 years. In lateralyzation of injury while the kidney showed nosignificant difference the ureter was more frequently involved in the left than in the right with a ratio of 4:1. Traffic accident was listed as high as 56.9% to be most frequent cause of injury and contusion, fall, gun-shot and explosion were listed less frequently. Of associated major injuries, pelvic fracture was seen in 20 cases (33.9%) and all the urethral injuries were accompanied with injuries to gastro-intestinal tract. Of all cases herein reported, 62.3% of cases were treated surgically and the remaining 37.7%. non-surgically. Surgical intervention was necessary in 33.3% of kidney injury, 100% of ureteral injury, 67.8% of urethral injuries and 40% of genital injuries. Average hospitalization required 20.2 days for renal injury and 67.2 days for urethral injury.
Accidents, Traffic ; Contusions ; Explosions ; Hospitalization ; Hospitals, Military ; Humans ; Incidence ; Kidney ; Multiple Trauma ; Outpatients ; Ureter ; Urethra ; Urology

A 5-month-old male infantshowed greasy sealy papules on the scalp, dirty scaly papules on the trunk and scaly petechial papules on both the palms and soles since birth. When admitted to the hospital, the patient exhibited lymphadenopathy, hepatomegaly, abdominal distension, mild fever and skin eruption. The biopsy specimens from the skin and lymph node showed an infiltrate composed almost entirely of histiocytic cells with irregularly shaped nuclei and abundant, well demarcated cytoplasm. The histiocytic cells of the infiltrate were proved as Langerhans cells by electron microscopic examination and S-100 protein study. He was treated with methotrexate 30mg/m twice a week and prednisolone 40mg/m daily. Initially skin lesions and general condition were improved, but the patient expired. due to septicemia after 3 months.
Biopsy ; Cytoplasm ; Fever ; Hepatomegaly ; Humans ; Infant ; Langerhans Cells ; Lymph Nodes ; Lymphatic Diseases ; Male ; Methotrexate ; Parturition ; Prednisolone ; S100 Proteins ; Scalp ; Sepsis ; Skin

Cutis verticis gyrata is a morphologic term, typically occurring on the scalp, characterized by eleuated, folded convolutions of the scalp, which may be either secondary to local disease in the scalp, or primary(idiopathic) disease. This case report was a 33-year-old woman, teacher. A birth, the patient had a small, round, soft, convoluted mass on the right parietal scalp. The mass slowly enlarged in size with the same rate of body growth. Now, the lesion is 15*13cm in size, well demarcated, oval shaped, soft, convoluted mass with overlying normal skin colored or hyperpigmented macules. Light microscopic findings of the skin kesion showed deeper extension of the nevus cells into the dermis and subcutis, which presented as an intradermal nevus, Electron microscopy showed that the nevus cell had an indented nucleus and numerous mitochondrias and melanosomes in the cytoplasm.
Adult ; Cytoplasm ; Dermis ; Female ; Humans ; Melanosomes ; Microscopy, Electron ; Mitochondria ; Nevus ; Nevus, Intradermal* ; Parturition ; Rabeprazole ; Scalp ; Skin

No abstract available.

OBJECTIVE: To evaluate the effects of strengthening exercise for isolated lumbar extensor muscles on chronic low back pain patients. METHOD: 28 patients with chronic low back pain in back school program participated in this study. Initially, isometric lumbar extensor strength, 10 point of Visual analog scale (VAS) and questionnaires related to self-experienced symptoms and daily activity (ADL) were checked. Isometric lumbar extensor strength test and strengthening exercise were performed with MedXTM lumbar extensor machine, which was designed to stabilize the pelvis. After 8 weeks of training program, isometric lumbar extensor strength & other pain related variables were checked again in the same way. RESULTS: The results were as follows: 1) After 8 weeks of lumbar extensor strengthening program, isometric lumbar extensor strength was increased at all the measured points significantly (p<0.01). 2) VAS and ADL were improved from 6.7 to 3.7, and from 6.9 to 9.1 respectively (p<0.05). CONCLUSION: 8 weeks of lumbar extensor strengthening program with pelvic stabilization was effective therapeutic tools for patients with chronic low back pain.
Activities of Daily Living ; Education ; Humans ; Low Back Pain* ; Muscles ; Pelvis ; Surveys and Questionnaires ; Visual Analog Scale

OBJECTIVE: To evaluate the role of anterior lumbar interbody fusion in treatment of failed back surgery syndrome, the authors present a retrospectively analysis of the clinical & radiological results of anterior lumbar interbody fusion. METHODS: Between September 2000 and September 2001, twenty two patients underwent anterior lumbar interbody fusion for treatment of failed back surgery syndrome. We analyzed clinical & radiological changes. The mean follow-up period was 19 months. RESULTS: Overall satisfactory outcome was 90%. The mean VAS was changed from 8.3 to 3.7. The mean Oswestry Disability Index(%) was changed from 70 to 33. The fusion rate was 86%. There were 2 complications; wound infection, sympathetic dysfunction. CONCLUSION: We conclude that the anterior lumbar interbody fusion seems to be a safe and favorable method in treating selective patients with failed back surgery syndrome.
Failed Back Surgery Syndrome* ; Follow-Up Studies ; Humans ; Retrospective Studies ; Wound Infection

In this paper, we propose a brain detection algorithm of cross-sectional images through a 3D volume. The proposed brain detection algorithm uses several steps. They are as follows; In the first step, the standard value and downward from input image data are removed. in the second step, the pixels with maximum intensity are removed but undesirable many small areas were appeared as by-products. In order to detect brain, these small areas need to be removed. In the third step, many small areas are removed by masking but some small areas still remained. In the fourth step, they are removed using three-dimensional connectivity. The proposed algorithm was applied to real human MRI data and the brain area was successfully detected.
Brain* ; Humans ; Magnetic Resonance Imaging ; Masks

An increase in the dose of chemotherapy enhances the response of many experimental and clinical cancers, but the extent of chemotherapy dose escalation and repeated use is often limited by myelosuppression. The side effects of chemotherapy including bleeding and infection due to myelosuppression have resulted in delayed therapy and a reduction in the therapeutic dose, therefore it is necessary to overcome myelosuppression especially leukopenia in patients with gynecologic malignancies who recieved chemotherapy. This study is undertaken to investigate the clinical effects of rhG-CSF(recombinant human Granulocyte-colony stimulating factor) in 29 patients with gynecologic malignancy who recieved chemotherapy. It was given at a dose of 100 microgram bid/day subcutaneously until significantly increase of leukocyte count in leukopenic patient. The results showed, the rhG-CSF has significantly increased the number and function of leukocyte. The use of rhG-CSF was effective and useful to treat chemotherapy induced leukopenia and to accelerate the recovery from this complications.
Drug Therapy* ; Hemorrhage ; Humans* ; Leukocyte Count ; Leukocytes ; Leukopenia*

A study was to evaluate the efficacy and clinical utility of second look operation in the managements of malignant ovarian tumor at the Department of Obstetrics and Gynecology, Kosin medical colleage from January 1986 to September 1993. Of 220 patients diagnosed as ovarian cancer, 48 patients who had underwent primariy laparotomy were performed second look operation. Thirty-seven patients were found to have no evidence of disease. The result revealed that negative second look operation rate was noted 96.3% at stage I, 66.6% at stage II, 50.0% at stage III, and 42.9% at stage IV and total negative second look operation rate was 77.1%. The 2 year survival rate for stage I, II, III, IV were 85.2%, 66.6%, 50.0% and 42.9% respectively. The survival rate of negative second look operation was 86.5%, that of positive second look operation was 18.1%. In conclusion, second look operation in early stage ovarian cancer need to be justified.
Follow-Up Studies* ; Gynecology ; Humans ; Laparotomy* ; Obstetrics ; Ovarian Neoplasms* ; Survival Rate