A 1-year-old Korean domestic short-haired cat presented with skin hyperextensibility and a severely macerated wound on the skin of the dorsal part of the neck. Diagnostic studies including histopathology and skin extensibility index revealed congenital cutaneous asthenia (Ehlers-Danlos syndrome). In this cat, the skin wounds and defects were successfully managed with standard wound management and cosmetic surgery. Although skin hyperextensibility is persistent, the cat has lived well without other complications to date. To the best of our knowledge, this is the first report of cutaneous asthenia in a cat in Korea.
Animals ; Asthenia* ; Cats* ; Ehlers-Danlos Syndrome ; Joint Instability ; Korea ; Neck ; Skin ; Surgery, Plastic ; Wounds and Injuries

OBJECTIVES: Rapidly progres s ive glomerulonephritis (RPGN) is a clinico- pathologic entity characterized by extens ive crescent formation(usually involving 50% or more of glomeruli) as the principal his tologic finding and a rapid deterioration of kidney function, which can lead to end s tage renal disease within a few weeks. T he etiology and incidence of RPGN has been well defined in Europe and North America, however, there has been no report of a large series in Korea. T he aim of the present s tudy was to analyze the etiology and clinico- pathologic features of 26 patients with RPGN, seen during 1983-1997. METHODS: T wenty-six patients with RPGN(crescents in > 50% of glomeruli) were obs erved during a period of las t 14 years. Male to female ratio was 1:1.4, and the mean age was 30(6-75) years. Mean time from the initial symptoms to the ESRD was 3.1 months . RESULTS: The incidence of RPGN in our series was 2.1% of primary glomerulonephritis. Immunecomplex mediated disease was presented in 14 cases (54%), including 6 sys temic lupus erythematos us, 3 post- streptococcal glomerulonephritis, 3 Henoch- Schonlein purpura, and 2 IgA nephropathy. Pauci- immune disease was presented in 12 cases (46%), including 3 Wegener' s granulomatos is, one necrotizing crescentic glomerulonephritis, and 8 idiopathic crescentic glomerulonephritis. However, there was none of anti-GBM- mediated disease in our s tudy. ANCA were found in 6 patients. All 3 patients with WG were C- ANCA pos itive, whereas one patient with PSGN, necrotizing cres centic GN, and idiopathic crescentic GN were P- ANCA pos itive, respectively. Initial clinical and laboratory features included edema(80%), hypertens ion(72%), oliguria(68%), a decreased renal function(serum creatinine > 5mg/dL, 35%), and gros s hematuria(36%). Renal biopsy showed large crescents more than 80% of the glomeruli in 14 cases (54%) which were predominantly fibrocellular. Fifteen patients (58%) were treated with prednis olone alone, and 12 of them received puls e doses of corticosteroids. Five patients were treated with prednisolone and cyclophos phamide IV pulse. Two cases received plasma exchange. During the mean follow-up of 31+/-37 months, 18 patients (69%) developed inexorable progression of renal failure, three(12%) showed recovery of renal function, and two(8%) showed partial improvement, which is followed by varying degrees of renal insufficiency. During follow-up, three patients died : two from res piratory failure with severe pulmonary hemorrhage and one from opportunistic pulmonary infection during immunosuppressive therapy. Poor prognos is is as sociated with hypertension, increased serum creatinine level at the time of diagnosis, large crescents more than 85% of glomeruli, and glomerular scleros is . CONCLUSION: We conclude that an earlier diagnos is including kidney biopsy and the more aggressive treatment are essential in the management of RPGN.
Adrenal Cortex Hormones ; Antibodies, Antineutrophil Cytoplasmic ; Biopsy ; Creatinine ; Diagnosis ; Europe ; Female ; Follow-Up Studies ; Glomerulonephritis* ; Glomerulonephritis, IGA ; Hemorrhage ; Humans ; Hypertension ; Immune System Diseases ; Incidence ; Kidney ; Kidney Failure, Chronic ; Korea ; Male ; North America ; Plasma Exchange ; Prednisolone ; Purpura ; Renal Insufficiency ; Systemic Vasculitis

Traditionally, preeclamptic women who meet established criteria for severe disease aredelivered expeditiously. Although delivery is always appropriate thrapy for the mother, itmay not be for the fetus remote from term. The purpose of this investigation was to evaluatethe differences of pregnancy and neonatal outcome of severe preeclampsia and normalpregnancy, especially before 34 weeks gestational age, and to determine whether aggressiveor expectant management of severe preeclampsia before 34 weeks is more beneficial tomaternal and fetal outcome. A hundred and twenty consecutive pregnancies complicated bysevere preeclampsia and a hundred and twenty normal pregnancies were stuided.The results were as follows:1. The incidence of severe preeclampsia was 3.9%(130 of 3328). The 26~30 year oldage group was most common, 43%(52 patients).2. In case of study between severe preeclamptic patients and normal pregnant patient,there was no differences regarding gestational age at delivery, birth weight, cesarean sectionrate, incidence of RDS, perinatal death. The 1min/5 min Apgar scores of severe preeclampsiais significantly lower than control group(6/7 vs 7/8, p < 0.05). Neonates with SGA(small for gestational age) were found in 29% neonates of patients with severe preeclampsia,which is significantly higher than normal pregnancy group(6%, p < 0.05).3. There was no significant difference between expectant(n=10) and aggressive(n=21)management group less than 34 weeks gestation regarding the gestational age of admissionand delivery, blood pressure, proteinuria, serum creatinine, hemoglobin, hematocrit, pletelets,liver enzymes, and LDH. Only the prolongation of gestational age in the expectant managementgroup is significantly higher than in the aggressive management group(7 vs 2 days,p < 0.05).4. The neonatal and pregnancy outcome of expectant(n=10) and aggressive managementgroup(n=15) were as follow: The birth weight in the expectant management groupis lower than in the aggressive management group(1316.7+/-668.8g vs 1576.2+/-428.7 g, p < 0. 05). The incidence of SGA in the expectant management group is higher than in theaggressive management gorup(50% vs 27%, p=not significant). There was no significant differencebetween expectant and aggressive management group regarding the 1 min/ 5 minApgar score, the cesarean section rate, and the frequency of respiratory distress syndrome,cerebral hemorrhage, renal failure, sepsis, DIC of neonates.
Birth Weight ; Blood Pressure ; Cesarean Section ; Creatinine ; Dacarbazine ; Female ; Fetus ; Gestational Age ; Hematocrit ; Hemorrhage ; Humans ; Incidence ; Infant, Newborn ; Mothers ; Pre-Eclampsia ; Pregnancy ; Pregnancy Outcome ; Proteinuria ; Renal Insufficiency ; Sepsis

Facial scar is one of the most common problems in plastic surgery department. Many various methods are attempted to improve facial scars, but there is no definite satisfactory method on scar revision. Authors have been interested in a tendency to show good results when traumatic lacerations were accompanied by abrasions. The improved appearance of the scars with this situation is the result that there were fewer elevations and depressions, and no break in continuity of the epidermal covering on both sides of the scar. But mechanical or other dermabrasive methods have a risk of hyperpigmentation. Authors suggest the scar revision with frostbite using dry ice. This method has little hyperpigmentation due to the sensitivity of melanocytes to cold injury. And the tissue destruction is progressed selectively because of the resistance of collagen against the cold injury and the preserved dermal fibrous network as the structural framework. These characteristics of cryotherapy improve the result of scar revision with fewer side effects rather than other dermabrasive methods. We performed this method to 349 patients from 1993 to 2003 and obtained high patients' satisfaction (85.9% more than fair). Moreover, this method is simple, cheap and handy. In conclusion, the scar revision with frostbite using dry ice is very useful method to improve facial scars.
Cicatrix* ; Collagen ; Cryotherapy ; Depression ; Dry Ice* ; Frostbite* ; Humans ; Hyperpigmentation ; Lacerations ; Melanocytes ; Surgery, Plastic

BACKGROUND: The pericytes in the blood vessel wall have recently been identified to be important in regulating vascular formation, stabilization, remodeling, and function. We isolated and identified pericyte-like platelet-derived growth factor receptor beta-positive (PDGFRβ+) cells from the stromal vascular fraction (SVF) of adipose tissue from critical limb ischemia (CLI) patients and investigated their potential as a reliable source of stem cells for cell-based therapy. METHODS: De-identified subcutaneous fat tissues were harvested after amputation in CLI patients. Freshly isolated SVF cells and culture-expanded adipose-derived stem cells (ADSCs) were quantified using flow cytometry. A matrigel tube formation assay and multi-lineage differentiation were performed to assess pericytic and mesenchymal stem cell (MSC)-like characteristics of PDGFRβ+ ADSCs. RESULTS: PDGFRβ+ cells were located in the pericytic area of various sizes of blood vessels and coexpressed mesenchymal stem cell markers. PDGFRβ+ cells in freshly isolated SVF cells expressed a higher level of stem cell markers (CD34 and CXCR4) and mesenchymal markers (CD13, CD44, CD54, and CD90) than PDGFRβ– cells. In vitro expansion of PDGFRβ+ cells resulted in enrichment of the perivascular mesenchymal stem-like (PDGFRβ+/CD90+/CD45–/CD31–) cell fractions. The Matrigel tube formation assay revealed that PDGFRβ+ cells were located in the peritubular area. CONCLUSIONS: PDGFRβ+ ADSCs cells demonstrated a good multilineage differentiation potential. Pericyte-like PDGFRβ+ cells from the SVF of adipose tissue from CLI patients had MSC-like characteristics and could be amplified by in vitro culture with preservation of their cell characteristics. We believe PDGFRβ+ cells in the SVF of adipose tissue can be used as a reliable source of stem cells even in CLI patients.
Adipose Tissue ; Adipose Tissue, White* ; Adult Stem Cells ; Amputation ; Blood Vessels ; Extremities* ; Flow Cytometry ; Humans ; In Vitro Techniques ; Ischemia* ; Mesenchymal Stromal Cells ; Pericytes ; Platelet-Derived Growth Factor* ; Receptors, Platelet-Derived Growth Factor ; Stem Cells ; Subcutaneous Fat

The main feature of acute renal failure is a decline in the glomerular filtration rate. However, urine leakage into the peritoneal cavity due to bladder rupture may cause pseudo-renal failure. This is a situation in which renal function is normal, along with the presence of elevated serum creatinine. A 47-year-old woman presented with abdominal distension and pretibial pitting edema on both lower extremities. She had no traumatic history. She did not complain of abdominal pain, and exhibit neither oliguria nor anuria. Her blood urea nitrogen (BUN) and serum creatinine was 105 and 11.2 mg/dL. Ascites showed that urea nitrogen and creatinine were 160 and 29 mg/dL, respectively. We confirmed bladder rupture by an abdominal CT scan and retrograde cystography. She underwent an emergency laparotomy to repair the ruptured bladder. Azotemia was normalized 2 days after the operation. Here we present a rare case of uremia due to bladder rupture.
Abdominal Pain ; Acute Kidney Injury ; Anuria ; Ascites ; Azotemia ; Blood Urea Nitrogen ; Creatinine ; Edema ; Emergencies ; Female ; Glomerular Filtration Rate ; Humans ; Laparotomy ; Lower Extremity ; Middle Aged ; Nitrogen ; Oliguria ; Peritoneal Cavity ; Rupture ; Urea ; Uremia ; Urinary Bladder

BACKGROUND: AML with myelodysplasia related changes (AML MRC) is known to show a poor prognosis compared with de novo AML, but controversies exist about the prognostic impact of multilineage dysplasia (MLD) among MRC. We investigated the prognostic impact of MLD in AML MRC. METHODS: A total of 357 patients newly diagnosed as AML at Asan Medical Center from January 2001 to December 2005 were analyzed. They were diagnosed and classified as AML with recurrent genetic abnormalities, AML MRC, and AML not otherwise specified (AML NOS). Prognostic markers including overall survival (OS) and event free survival (EFS) were obtained through retrospective analysis of electronic medical records. RESULTS: AML MRC patients showed a lower complete remission (CR) rate (44.7% vs. 64.9%, P=0.002) and shorter OS (297 vs. 561 days, P=0.004) and EFS (229 vs. 374 days, P=0.004) than AML NOS patients. Patients with MLD among AML MRC also showed a lower CR rate (37.7%, P=0.001) and shorter OS (351 days, P=0.036) and EFS (242 days, P=0.076) than AML NOS patients. However, among AML MRC patients, there were no differences in OS, EFS and CR between patients with and without MLD. CONCLUSIONS: AML MRC patients showed a lower CR rate and shorter OS and EFS than AML NOS patients. AML MRC patients with MLD showed similar results and their prognosis was not different from those without MLD. MLD findings among AML MRC could be an independent poor prognostic factor in de novo AML.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cell Lineage ; Child ; Child, Preschool ; Data Interpretation, Statistical ; Disease-Free Survival ; Female ; Humans ; Infant ; Leukemia, Myeloid, Acute/complications/diagnosis/*mortality ; Male ; Middle Aged ; Myelodysplastic Syndromes/complications/*diagnosis ; Prognosis ; Retrospective Studies ; Survival Analysis

PURPOSE: We evaluated the change in the findings of DMSA scan after acute pyelonephritis (APN), and the relationship between renal scar formation and risk factors such as vesicoureteral reflux (VUR), organism and inflammatory reaction. METHODS: We examined 200 patients under the age of 5 years with first APN. DMSA scan, voiding cystourethrography (VCUG), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were performed initially. If the initial DMSA scan was abnormal, it was repeated after 6 months. RESULTS: Median age was 1.1 years. Initial renal defects existed in 136 (68%) of 200 cases. At 6 months after initial infection, follow up DMSA scan was checked in 61 children with initial renal defects for evaluation of scar. Initial renal defects disappeared in 19 (31%)children. Initial renal defects were present in 60 (64%) of 94 kidneys with the VUR, however, they were present in 94 (31.0%) of 306 kidneys without VUR(P<0.05). Among 72 kidneys with initial renal defects, scar developed in 27 (75%) of 36 kidneys with VUR and 22 (61%) of 36 kidneys without VUR (P>0.05). CRP was 11.0+/-7.0mg/dL in 127 patients with initial renal defects and 4.4 5.5mg/dL in 53 patients without initial renal defects (P<0.05) and CRP was 13.0+/-4.7mg/dL in 39 patients with scar and 8.7+/-4.6 mg/dL in 19 patients without scar in follow up DMSA scan (P<0.05). CONCLUSION: The presence of VUR and higher CRP level are risk factors for initial renal defects but renal scarring occured higher in the higher level of CRP, irrespective of VUR.
Blood Sedimentation ; C-Reactive Protein ; Child ; Cicatrix* ; Follow-Up Studies ; Humans ; Kidney ; Pyelonephritis* ; Risk Factors ; Succimer ; Vesico-Ureteral Reflux

Ten cases of post-inflammatory aneurysm of the thoracic aorta were studied morphologically using aortic wall and aortic valve tissue resected during the surgical repair of the lesions. Four cases of aortic aneurysm in Behcet's disease showed massive perivascular infiltration of the lymphocytes and plasma cells in adventitia and vasa vasorum. Fibrous obliteration of the vasa vasorum was seen, and neutrophilic infiltration was also associated in two cases with recurrent prosthetic valve failure. Three cases of aortic aneurysm associated with Takayasu's arteritis showed similar histologic features, but giant cells and histiocytic reactions were additional findings. Plasma cell infiltration was more pronounced compared to the Behcet's aortitis. One case of luetic aortitis showed a non-specific chronic inflammatory reaction with florid endothelial cell proliferation. One case of ankylosing spondylitis showed fibrous thickening at the periannular portion of the aortic valve cusps, but this finding was also seen in an aortic valve of a patient with Behcet's disease. One case without any disease association showed similar features of chronic inflammation with granuloma formation. The findings suggest that they have similar histologic features indistinguishable in terms of the clinical disease association, but a granulomatous reaction could be expected in Takayasu's arteritis.
Adult ; Aorta, Thoracic ; Aortic Aneurysm/*etiology/pathology ; Aortitis/*complications/pathology ; Behcet Syndrome/complications/pathology ; Female ; Humans ; Male ; Middle Aged ; Spondylitis, Ankylosing/complications/pathology ; Syphilis/complications/pathology ; Takayasu Arteritis/complications/pathology

Trauma is one of the leading causes of death in children. Abdominal trauma is about 10% of all pediatric trauma. This study describes the sex and age distribution, injury mechanism, site of intraabdominal injury, management and mortality of children aged 16 years or less who suffered abdominal trauma. The hospital records of 63 patients treated for abdominal injury between March 1997 and February 2007 at the department of surgery, Inje University Pusan Paik Hospital, were analyzed retrospectively. The peak age of incidence was between 2 and 10 years (78%) and this report showed male predominance(2.7:1). The most common mechanism of blunt abdominal trauma was pedestrian traffic accident (49%). The most common injured organ was liver. More than Grade IV injury of liver and spleen comprised of 4(12%) and 5(24%), respectively. Fourteen cases (22%) had multiple organ injuries. Forty nine cases (78%) were managed nonoperatively. Three patients (4.8%) died, who had Grade IV liver injury, Grade IV spleen injury, and liver and spleen injury with combined inferior vena cava injury, respectively. All of the three mortality cases had operative management. In conclusion, the liver or spleen injury which was more than Grade 4 might lead to mortality in spite of operation, although many cases could be improved by nonoperative management.
Abdomen ; Abdominal Injuries ; Accidents, Traffic ; Age Distribution ; Busan ; Cause of Death ; Child* ; Hospital Records ; Humans ; Incidence ; Liver ; Male ; Mortality ; Retrospective Studies ; Spleen ; Vena Cava, Inferior