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

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

PURPOSE: To compare the therapeutic effects on upper extremity paresthesia of intra-muscular steroid injections into the scalene muscle with those of stretching exercise only. MATERIALS AND METHODS: Twenty patients with upper extremity paresthesia who met the criteria were recruited to participate in this single-blind, crossover study. Fourteen of 20 patients were female. The average age was 45.0+/-10.5 years and duration of symptom was 12.2+/-8.7 months. Each participant completed one injection and daily exercise program for 2 weeks. After randomization, half of all patients received ultrasound-guided injection of scalene muscles before exercise, while the other was invested for the other patients. RESULTS: After two weeks, there was a significant decrease of the visual analog scale score of treatment effect compared with baseline in both groups (6.90 to 2.85 after injection and 5.65 to 4.05 after stretching exercise, p<0.01). However, injection resulted in greater improvements than stretching exercise (p<0.01). The number of patients with successful treatment, defined as >50% reduction in post-treatment visual analog scale, was 18 of 20 (90.0%) after injection, compared to 5 of 20 (25.0%) after stretching exercise. There were no cases of unintended brachial plexus block after injection. CONCLUSION: Ultrasound-guided steroid injection or stretching exercise of scalene muscles led to reduced upper extremity paresthesia in patients who present with localized tenderness in the scalene muscle without electrodiagnostic test abnormalities, although injection treatment resulted in more improvements. The results suggest that symptoms relief might result from injection into the muscle alone not related to blockade of the brachial plexus.
Adult ; Brachial Plexus/*drug effects ; Cross-Over Studies ; *Exercise Therapy ; Female ; Humans ; *Injections, Intramuscular ; Male ; Middle Aged ; Neck Muscles/drug effects ; Pain/drug therapy ; Pain Measurement ; Paresthesia/*drug therapy/rehabilitation ; Single-Blind Method ; Thoracic Outlet Syndrome/diagnosis/*drug therapy ; Treatment Outcome

STUDY DESIGN: Prospective controlled study. PURPOSE: The results of conventional open surgery was compared with those from minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for lumbar fusion to determine which approach resulted in less postoperative paraspinal muscle degeneration. OVERVIEW OF LITERATURE: MI TLIF is new surgical technique that appears to minimize iatrogenic injury. However, there aren't any reports yet that have quantitatively analyzed and proved whether there's difference in back muscle injury and degeneration between the minimally invasive surgery and conventional open surgery in more than 1 year follow-up after surgery. METHODS: This study examined a consecutive series of 48 patients who underwent lumbar fusion in our hospital during the period, March 2006 to March 2008, with a 1-year follow-up evaluation using MRI. There were 17 cases of conventional open surgery and 31 cases of MI-TLIF (31 cases of single segment fusion and 17 cases of multi-segment fusion). The digital images of the paravertebral back muscles were analyzed and compared using the T2-weighted axial images. The point of interest was the paraspinal muscle of the intervertebral disc level from L1 to L5. Picture archiving and communication system viewing software was used for quantitative analysis of the change in fat infiltration percentage and the change in cross-sectional area of the paraspinal muscle, before and after surgery. RESULTS: A comparison of the traditional posterior fusion method with MI-TLIF revealed single segment fusion to result in an average increase in fat infiltration in the paraspinal muscle of 4.30% and 1.37% and a decrease in cross-sectional area of 0.10 and 0.07 before and after surgery, respectively. Multi-segment fusion showed an average 7.90% and 2.79% increase in fat infiltration and a 0.16 and 0.10 decrease in cross-sectional area, respectively. Both single and multi segment fusion showed less change in the fat infiltration percentage and cross-sectional area, particularly in multi segment fusion. There was no significant difference between the two groups in terms of the radiologic results. CONCLUSIONS: A comparison of conventional open surgery with MI-TLIF upon degeneration of the paraspinal muscle with a 1 year follow-up evaluation revealed that both single and multi segment fusion showed less change in fat infiltration percentage and cross-sectional area in the MI-TLIF but there was no significant difference between the two groups. This suggests that as time passes after surgery, there is no significant difference in the level of degeneration of the paraspinal muscle between surgical techniques.
Follow-Up Studies ; Humans ; Intervertebral Disc ; Muscles ; Prospective Studies

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

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

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

Paraffinoma induces many unexpected complications such as tissue necrosis, granuloma formation, hypersensitivity, embolism and even carcinoma. The treatment modality is known to be primary repair, flap surgery, skin graft, radiotherapy and high frequency current treatment after the excision of the lesion. Although these methods can remove the paraffinoma and resurface penile shaft, various complications such as skin tension after surgery, hypertrophic scars, difficulty of erection, and deficiency of bulkiness are frequently occurred. Groin flap is the proper method for the patients who want simultaneously soft tissue reconstruction and augmentation of penis. A 32 year-old male patient who visited our clinic had firm mass, abscess, skin necrosis, and dyspareunia after the injection of paraffin into penis 3 months ago. Reconstruction was executed using right side of the groin flap after the radical resection of the whole tissues ruined by infections and infiltration of paraffin. The penile bulkiness, erectile function and duration of erection was all satisfactory. The follow-up period was 7 months after the surgery and no specific complication was developed. Groin flap is the satisfactory method to enhance penile bulkiness as well as resurface the lesion.
Abscess ; Adult ; Cicatrix, Hypertrophic ; Dermatologic Surgical Procedures ; Dyspareunia ; Embolism ; Female ; Follow-Up Studies ; Granuloma ; Groin* ; Humans ; Hypersensitivity ; Male ; Necrosis ; Paraffin ; Penis ; Radiotherapy ; Skin ; Transplants