Necrotizing fasciitis, first described by Wilson in 1952, is one of the most dramatic infectious diseases which develops at the level of superficial fascia and involves the overlying dermis. Clinical diagnosis is often initially confused with cellulitis, and delay in the diagnosis and treatment is associated with high mortality in the range from 30% to 70%. Early diagnosis and prompt excision of all devitalized tissue are critical because any remaining necrotic tissue will continue the rapidly progressive infectious process. We, herein, report a 64-year-old man who was presented with a typical clinical course of necrotizing fasciitis.
Cellulitis ; Communicable Diseases ; Dermis ; Diagnosis ; Early Diagnosis ; Fasciitis, Necrotizing* ; Humans ; Middle Aged ; Mortality ; Subcutaneous Tissue

This experiment was aimed to investigate the contractile responses of the fermoral artery to the electrical stimulation and the inhibitory effects of verapamil and papaverine on the electrical stimulation of the fermoral artery in the control (n=46) and the diabetic rabbits(n=40). Diabetic rabbits were made by and administration of alloxan (100 mg/kg) intravenously and sacrified 8 weeks later. Femoral arterial rings 3 mm in length were taken and mounted on the force-displacement transducer for the measurements of isometric tension. All experiments were done in the aerated (95% O2 with 5% CO2)biological chamber filled with Kreb's solution and the initial tension of 1.5g was applied to the rings. After 1 hour of equilibrium of the rings, the contractile responses of the electrical stimulation on the femoral arterial rings were taken without vasoactive drugs and then, under verapamil and papaverine solution. And we compared the morphologic findings of the vessels in the two groups in relation to the functional changes by transmission electron miroscopy. The results are as follows: 1. The contractile responses in the presence of verapamil or papaverine solutions to the electrical stimulation were lowed significantly in the fermoral arterial rings of the diabetic rabbits compared with that of the control rabbits (verapamil; 10M~10M: p<0.01, papaverine; 10M & 10M: p<0.01). 2. Transmission electron microphotographs showed many morphological differences of the femoral arteries between the control and the diabetic rabbits. These were irregularities of the internal elastic lamina and the hypertrophy of the cytoplasms of the smooth muscle cells. And also, there were many vacuoles in the cytoplasm of the endothelial cells, lateral to the internal elastic laminaes, and between the smooth muscle cells in the diabetic rabbit femoral artery. By this study, we found that the contractile responses of the femoral arterial rings to the electrical stimulation were decreased in the diabetic rabbits, and the vasodiatory effects of verapamil and papaverine on the electrically stimulated femoral arterial rings were also lowered in the diabetic rabbits compared with the control rabbits. These changes of the vasular responses of the diabetic vessel may be associated with morphological changes manifested by transmission electron microscopy or any other functional derangement of the vessels.
Alloxan ; Arteries ; Cytoplasm ; Electric Stimulation* ; Endothelial Cells ; Femoral Artery ; Hypertrophy ; Microscopy, Electron, Transmission ; Myocytes, Smooth Muscle ; Papaverine ; Rabbits ; Transducers ; Vacuoles ; Vasodilator Agents* ; Verapamil

No abstract available.
Hormone Replacement Therapy ; Humans ; Incheon* ; Osteoporosis* ; Physicians, Primary Care* ; Primary Health Care*

Ictal vomiting is a rare clinical manifestation of temporal lobe epilepsy. This manifestation is considered a clinical lateralizing sign pointing toward seizure activity within the nondominant temporal lobe. However, we have experienced a case of ictal vomiting associated with temporal lobe epilepsy within the dominant hemisphere. The ictal vomiting occurred early in the course of the seizure when rhythmic discharges predominantly involved the left temporal lobe. This patient underwent a left anterior temporal lobectomy and experienced markedly reduced seizure frequency for more than 2 years.
Anterior Temporal Lobectomy ; Epilepsy ; Epilepsy, Temporal Lobe* ; Humans ; Seizures ; Temporal Lobe* ; Vomiting*

BACKGROUND: Bone mineral density (BMD) is influenced by genetic, hormonal, and environmental factors. Long-term antiepileptic drug (AED) use also causes osteopenia or osteoporosis that have been most extensively described in institutionalized patients. But, the mechanism of these abnormalities is unclear. The objective of this study is to determine the effect of AED on bone density and to explain the pathophysiologic mechanisms by analyzing bone related factors. METHODS: We prospectively examined BMD by dual-energy X-ray absorptiometry in 45 patients with epilepsy. We measured the serum calcium, phosphorus, protein, alkaline phosphatase (ALP), bone specific ALP, vitamin D and osteocalcin to analyze the factors that influence bone metabolism. RESULTS: BMD was significantly lower in the patient group than in the control group (p<0.05). 13% of patients had osteopenia and 3% of patients had osteoporosis. The level of bone specific ALP was higher in the patient group, but the level of vitamin D was not different, implying that BMD is decreased by the direct effect of antiepileptic drugs. There was a weak negative correlation and marginal significance between BMD and the duration of therapy in the patient group (r=-0.407, p<0.05). CONCLUSIONS: Long-term antiepileptic drug therapy in patients who have seizures causes significant bone loss in the lumbar spine even in the absence of vitamin D deficiency. In addition, the degree of bone mineral density was weakly related with the therapeutic duration of antiepileptic drugs. The regular evaluation of BMD in patients with long-term antiepileptic drugs might be helpful to prevent decreases in BMD.
Absorptiometry, Photon ; Alkaline Phosphatase ; Anticonvulsants* ; Bone Density* ; Bone Diseases, Metabolic ; Calcium ; Drug Therapy ; Epilepsy ; Humans ; Metabolism* ; Osteocalcin ; Osteoporosis ; Phosphorus ; Prospective Studies ; Seizures ; Spine ; Vitamin D ; Vitamin D Deficiency

BACKGROUND: Hemichorea-Hemiballism (HCHB) can be caused by various diseases such as cerebrovascular disease, hyperglycemia, tumor, and inflammatory diseases. However, there are a few case studies using functional imaging such as single photon emission computed tomography (SPECT). METHODS: In this study, we included patients with HCHB. The patients with hyperglycemia over 250 mg/dl or high signal intensity on T1 weighted imaging were excluded. Clinical and neuroimaging characteristics of the patients were obtained and analyzed. RESULTS: We included 20 patients (M:F=12:8, mean age=67.1+/-15.3). Sixteen patients were presented with hemiballism and four with hemichorea. Six patients had no structural lesions causing HCHB. Subthalamic nucleus was the causative lesion in 6 patients. Other lesions associated with HCHB were basal ganglia, thalamus, and cortices. In a patient without structural lesion, anti-double stranded DNA antibody was detected. Brain SPECT showed not only perfusion abnormalities in the cases without structural lesions but also additional abnormalities in those with definite lesions. CONCLUSIONS: Various mechanisms were related to the development of HCHB. Functional imaging such as SPECT and immunological work-up is needed to investigate the underlying pathomechanism of HCHB.
Basal Ganglia ; Brain ; DNA ; Dyskinesias ; Humans ; Hyperglycemia ; Neuroimaging* ; Perfusion ; Subthalamic Nucleus ; Thalamus ; Tomography, Emission-Computed, Single-Photon

PURPOSE: The purpose of this study was to identify the risk factors for recatheterization after holmium laser enucleation of the prostate (HoLEP). MATERIALS AND METHODS: A total of 166 consecutive patients treated with HoLEP by a single surgeon from January 2010 to June 2011 were enrolled in this study. We collected data on preoperative and intraoperative parameters, including intraoperative bladder distention volume. The patients were divided into two groups. Group 1 included patients who voided successfully after removal of the catheter, and group 2 included patients who required recatheterization. Analysis and comparison of the perioperative parameters of both groups was performed for identification of risk factors for recatheterization. RESULTS: Recatheterization was required in 9 of 166 (5.4%) patients. No significant differences in age or preoperative parameters, including prostate-specific antigen, prostate volume, International Prostate Symptom Score, peak flow rate, postvoid residual urine, maximal bladder capacity, and Abrahams Griffiths number, were observed between the two groups. Of the intraoperative parameters, intraoperative bladder distention volume was significantly smaller in group 1 than in group 2 (700.65 mL vs. 897.78 mL, p<0.001). In the multivariate logistic regression analysis, after adjustment for other variables, intraoperative bladder distention volume was found to be a statistically significant risk factor for postoperative recatheterization (hazard ratio, 1.006; confidence interval, 1.002 to 1.010; p=0.002). CONCLUSIONS: Nine of 166 (5.4%) patients failed to void after HoLEP and required catheterization. Intraoperative bladder distention volume was found to be a statistically significant risk factor for recatheterization in this patient group.
Catheterization ; Catheters ; Holmium ; Humans ; Lasers, Solid-State ; Logistic Models ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia ; Risk Factors ; Urinary Bladder ; Urinary Retention

PURPOSE: To describe the imaging findings of traumatic intracranial aneurysms (TICA) in children. MATERIALS AND METHODS: Five boys aged 3-15 (mean, 7) years with surgically confirmed TICA were included in this study. All had a history of nonpenetrating head trauma, and they underwent precontrast CT imaging immediately after the injury and follow-up CT or MRI. In all cases, angiography revealed the presence of aneurysms, which at surgery were shown to be pseudoaneurysms with severe adhesions. RESULTS: Angiography demonstrated that all aneurysms were located in the anterior cerebral artery (ACA) or its branches. The precise locations were the A2 segment of the ACA, the site of origin of the callosomarginal artery or its first branch, or of the anterior internal frontal artery, or between the first and second branch of the pericallosal artery. In all patients, precontrast CT performed immediately after trauma depicted subarachnoid hemorrhage (SAH) in the anterior interhemispheric fissure (AIHF). Follow-up precontrast CT showed nodular high density around the anterior falx in three, recurrent SAH in the AIHF in two, and intracerebral hemorrhage (ICH) with intraventricular hemorrhage in two. In two patients with a nodular high-density lesion, nodular enhancement was demonstrated at postcontrast CT, and in one, follow-up MRI revealed a nodular signal void around the anterior falx; nodular enhancement was seen at postcontrast imaging, and MR angiogram depicted a saccular aneurysm. In one patient, MRI demonstrated infarction in the caudate nucleus and ACA territory. CONCLUSION: If, after head injury, an area of nodular high density is revealed by CT, or a signal void by MRI, or if SAH or ICH is present around the anterior falx, the possibility of TICA should be considered.
Aneurysm ; Aneurysm, False ; Angiography ; Anterior Cerebral Artery ; Arteries ; Caudate Nucleus ; Cerebral Hemorrhage ; Child* ; Craniocerebral Trauma ; Follow-Up Studies ; Hemorrhage ; Humans ; Infarction ; Intracranial Aneurysm* ; Magnetic Resonance Imaging ; Subarachnoid Hemorrhage

BACKGROUND: We studied the hemodynamic changes induced by pneumoperitoneum and a reversed Trendelenburg in elderly patients with increased cardiac risk (ASA class III; n = 30; age 70.8 +/- 4.9 years, mean +/- SD) and compared the results with elderly patients at normal risk (ASA class II; n = 30; age 69.2 +/- 4.1 years) during laparoscopic cholecystectomy. METHODS: The transesophageal Doppler monitor was performed after induction of general anesthesia (pre-incision), after onset of pneumoperitoneum (insufflation), after head-up (20degrees) and a left lateral tilt (15degrees) (reversed Trendelenburg) and after deflation and horizontal position (desufflation). Mean arterial pressure (MAP), heart rate, cardiac index (CI) and systemic vascular resistance (SVR) were measured, respectively. RESULTS: Induction of pneumoperitoneum and head-up tilt in patients with cardiac risk resulted significantly in a decrease in CI and an increase in SVR compared with patients with normal risk (P < 0.05), and that remained until deflation, but no interval changes in MAP and heart rate. The CI, MAP and heart rate decreased and SVR increased significantly in patients with cardiac risk compared with patients with normal risk before incision (P < 0.05). No complications occurred. The results indicate that pneumoperitoneum and a reversed Trendelenburg are associated with significant but relatively benign hemodynamic changes. CONCLUSIONS: Anesthesia for laparoscopic cholecystectomy in elderly patients with increased cardiac risk should be performed with an adequate hemodynamic monitoring.
Aged ; Anesthesia ; Anesthesia, General ; Arterial Pressure ; Cholecystectomy, Laparoscopic ; Heart Diseases ; Heart Rate ; Hemodynamics ; Humans ; Organothiophosphorus Compounds ; Pneumoperitoneum ; Vascular Resistance

Venous lakes are small, bluish-purple, slightly-raised, soft papules or nodules occurring on the exposed skin of elderly people. The lips and ears are the most common sites. Histopathologically, large, dilated and irregular thin-walled venules are located on the upper and mid-dermis. Venous lake is not a rare disease, however, there has been no report of this condition in Korean literature. We report two cases of venous lake together with a review of the pertinent papers.
Aged ; Ear ; Humans ; Lakes* ; Lip ; Rare Diseases ; Skin ; Venules