Sea urchin granuloma is a rare skin disorder, considered to be allergic or foreign body reaction caused by stick of spines of sea urchin. However, detection of the spine in the granuloma is quite difficult. A 27 year-old marine was seen with several asymptomatic hard nodules on the dorsum of hands, fingers, forearrns and knees at the injured site of the spines after a latent period of 6 rnonths. Histolagical examination revealed dermal granulomatous inflamation with hyperkeratotic and acanthotic epidermis. On examination with polarized microscopy, sea urchin spines in the granuloma were seen as bright white fragments in the dark field. Those nodules were regressed with intralesional injection of triamcinoIone.
Adult ; Epidermis ; Fingers ; Foreign-Body Reaction ; Granuloma* ; Hand ; Humans ; Injections, Intralesional ; Knee ; Microscopy ; Sea Urchins* ; Skin ; Spine

The incidence of conjoined twins is so rare that few anesthesiologists have an opportunity of managing them. Especially in Korea, there are only a few reports describing the anesthetic management for surgical separation of newborn conjoined twins. We experienced the successful anesthetic management for surgical separation of thoraco-xiphopagus conjoined twins without any particular problems. After applying the noninvasive monitors (ECG, pulse oximeter), one of the twins (twinA) with congenital heart disease was administered with intravenous ketamine for induction of anesthesia and intubated without neuromuscular blocker. Anesthesia was maintained with N2O-O2 and hand ventilation using Mapleson D breathing circuit. After maintaining airway of the twinA, the twinB was intubated and maintained with the same manner. Eighteen days after the separation procedure, the twinA with congenital heart disease died and the other one, twinB has been alive with normal growth and development.
Anesthesia ; Growth and Development ; Hand ; Heart Defects, Congenital ; Humans ; Incidence ; Infant, Newborn ; Ketamine ; Korea ; Neuromuscular Blockade ; Respiration ; Twins, Conjoined* ; Ventilation

We present a case of acquired tracheoesophageal fistula (TEF) which was found during induction of general anesthesia for clipping of aneurysm. The patient had been intubated with endotracheal tube for 10 days and then done tracheotomy for 45 days. Thereafter, TEF was confirmed by MRI and treated with fistula repair and tracheal fenestration. Acquired TEF can occur under the condition of prolonged tracheal intubation with high cuff pressure (>30 mmHg) and can also result from intratracheal neoplasm, mediastinitis, and other tracheal or esophageal damages. If unrecognized during anesthetic induction, TEF can cause gastric dilatation and rupture, pulmonary aspiration and respiratory failure. So early diagnosis and proper management is very important whenever TEF is suspected during anesthetic induction.
Anesthesia, General ; Aneurysm ; Early Diagnosis ; Fistula ; Gastric Dilatation ; Humans ; Intubation ; Magnetic Resonance Imaging ; Mediastinitis ; Respiratory Insufficiency ; Rupture ; Tracheoesophageal Fistula* ; Tracheotomy

Large numbers of reports have shown that thermal injury (TI) causes a wide spectrum of defects in immune response that lead to a high susceptibility to various opportunistic infections. However, it is still a matter of debate whether TI induces Th2 polarization or global impairment in Th1/Th2 response. In this study, TI in a mouse model was induced by exposing shaved dorsal skin to boiling water and cytokine production was analyzed. At day 2 of injury, whole spleen cells and T cells were collected and then stimulated with an anti-CD3 antibody. The levels of cytokine secretion were determined by cytokine ELISA. Production of IFNgamma and IL 4 by whole spleen cells from injured mice were concurrently decreased when compared to those from sham-injured controls. Proportional changes in T, B, and T-subset cells were not accompanied. Using purified T cells devoid of accessory cells (AC), it was shown that those defects resulted primarily from lowered T cell potentials. By using mixed cultures of sham T and TI-AC and vice versa, it was revealed that AC also acted as inhibitor cells in IFNgamma and IL 4 production in less extent. Blockade of glucocorticoid signals rendered the T cells partially resistant to TI-induced inhibition in IFNgamma and but not IL 4 production. These results clearly demonstrate that TI induces overall suppression in Th1 and Th2 response through T cell dysfunction together with the inhibition of AC activity, and that reduction in only IFNgamma but not IL 4, production may be caused, in part, by corticosteroid hormone that is secreted prominently during trauma.
Animals ; Enzyme-Linked Immunosorbent Assay ; Mice ; Opportunistic Infections ; Skin ; Spleen ; T-Lymphocytes ; Water

In case of acute obstruction secondary to colorectal carcinoma, emergent surgical intervention is needed and many types of operation including staged operation, subtotal colectomy and intraoperative colonic lavage have been tried. But those operations are not elective and have high morbidity and mortality. By the use of the Flexible covered stent, we resolved obstruction in 4 cases of colorectal carcinoma and prepared the bowel mechanically by polyethylene glycol. After improvement of the general state of the patients and assessment of the extent of the disease, we performed elective and single stage operation in all cases and had no complications associated with the stent. The treatment with the Flexible covered stent is a safe and effective procedure for malignant colorectal obstruction that makes it possible to perform a single stage operation.
Colectomy ; Colon ; Colorectal Neoplasms ; Humans ; Mortality ; Polyethylene Glycols ; Stents* ; Therapeutic Irrigation

No abstract available.
Pelvic Bones*

OBJECTIVE: To evaluate the therapeutic effect of a Tibia Counter Rotator (TCR) with toe-out gait plate (GP) upon tibial internal torsion by a comparative analysis of transmalleolar angle (TMA) and gait analysis with GP alone. METHODS: Twenty participants with tibial internal torsion were recruited for this study. Each 10 participants were included in group A with TCR and GP application and in group B with GP application only. The TMA and the kinematic results were used for the evaluation of the therapeutic effects of orthoses. RESULTS: Within each group, TMA showed a significant increase after treatment. Group A showed a continuous improvement up to six months, however, group B showed an improvement up to five months only. Group A showed a significantly higher correction effect than group B after treatment. Regarding kinematic data, both groups showed a significantly decreased mean ankle adduction angle after treatment. However, group A showed a significantly lower mean ankle adduction angle than group B after six months. CONCLUSION: The group with TCR and GP showed a significantly better outcome and continued correction force compared to the group with GP only. Our results suggest that TCR with GP may be useful therapeutic orthoses for children with tibial internal torsion.
Ankle ; Child* ; Foot Orthoses ; Gait* ; Humans ; Orthotic Devices ; Tibia*

OBJECTIVE: To evaluate the therapeutic effect of a Tibia Counter Rotator (TCR) with toe-out gait plate (GP) upon tibial internal torsion by a comparative analysis of transmalleolar angle (TMA) and gait analysis with GP alone. METHODS: Twenty participants with tibial internal torsion were recruited for this study. Each 10 participants were included in group A with TCR and GP application and in group B with GP application only. The TMA and the kinematic results were used for the evaluation of the therapeutic effects of orthoses. RESULTS: Within each group, TMA showed a significant increase after treatment. Group A showed a continuous improvement up to six months, however, group B showed an improvement up to five months only. Group A showed a significantly higher correction effect than group B after treatment. Regarding kinematic data, both groups showed a significantly decreased mean ankle adduction angle after treatment. However, group A showed a significantly lower mean ankle adduction angle than group B after six months. CONCLUSION: The group with TCR and GP showed a significantly better outcome and continued correction force compared to the group with GP only. Our results suggest that TCR with GP may be useful therapeutic orthoses for children with tibial internal torsion.
Ankle ; Child* ; Foot Orthoses ; Gait* ; Humans ; Orthotic Devices ; Tibia*

BACKGROUND: This study was performed to investigate the clinical usefulness of combined autotransfusion using preoperative autologous donation(PAD) and acute normovolemic hemodilution(ANH) compared with autotransfusion using only PAD in 30 patients undergoing spinal surgery(posterior decompression and fusion). METHODS: Control group(n=15) were transfused with PAD(3 units), and received intra- and postoperative autotransfusion. Combined group(n=15) received ANH(2 units) in addition to above 3 methods applied to control group. Patients were not allowed to predonate or receive ANH if their Hct were below 34%. We applied induced hypotension only to the control group. RESULTS: There were no significant differences between groups in perioperative Hb and Hct levels. Mean volume of autologous blood salvaged by cell saver was significantly greater in combined group(710 ml) than in control group(288 ml). Besides autologous blood, 2.33 units(mean) of homologous blood were used postoperatively in 3 patients of control group and 2 units(mean) of predonated blood were unused and discarded in 3 patients of combined group. CONCLUSION: It appears that combined autotransfusion using PAD and ANH is useful and it increases success rate of autotransfusion.
Blood Transfusion, Autologous* ; Decompression ; Hemodilution* ; Humans ; Hypotension

Amelanotic melanoma is a subtype of malignant melanoma that lacks clinically visible pigmentation. The absence of recognizable pigmentation obscures the clinical hallmark of the more typical form of malignant melanoma. Because it mimics various non-pigmented benign and malignant skin diseases, clinicians have difficulty diagnosing this lesion. An incorrect or delayed diagnosis can result in a worse outcome because the prognosis of melanoma depends on the tumor thickness and tissue invasion at the time of diagnosis. Therefore, early diagnosis is crucial for treating amelanotic melanoma. Dermoscopy is a useful non-invasive technique for diagnosing not only pigmented skin lesions, but also non-pigmented skin lesions because this modality can visualize vascular structures that are not discernible to the naked eye. Analyzing the dermoscopic vascular structures of amelanotic melanoma helps make an early diagnosis. We report here on a case of amelanotic melanoma for which the diagnosis was aided by performing dermoscopy as an adjuvant tool.
Delayed Diagnosis ; Dermoscopy ; Early Diagnosis ; Eye ; Melanoma ; Melanoma, Amelanotic ; Pigmentation ; Prognosis ; Skin ; Skin Diseases