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

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

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

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*

OBJECTIVES: The prevalence of malaria is increasing in recent years and also multidrug resistant malaria is increasing around the world and there is an increasing concern about imported malaria in nonendemic areas. Now many drugs are tried to find out effect on multidrug resistant malaria. We performed this study to investigate the thrapeutic effect of halofantrine in the treatment of chloroquine resistant imported malaria. METHODS: From Feb. 1992 to May 1995, we experienced 35 patients infected with malaria and treated 14 patients among 35 patients with halofantrine. RESULTS: 1) All 14 patients were sailor with a mean age of 39.4 years and infected with malaria. 2) The majority of patients were infected with malaria at Africa. 3) 10 patients were infected with Plasmodium falciparum and the remainder were undetermined. 4) In the 11 cases of chloroquine resistant malaria treated with quinine plus tetracycline combination therapy or Fansidar, 4 cases could not be tolerable due to side effects and resistance to the therapy, we substituted halofantrine for above regimens. 5) In the 10 cases, treated after May 1994, halofantrine was the first choice of treatment because they were the cases of malaria infected in the mid-Africa where the prevalence of chloroquine resistant malaria is high. 6) With halofantrine, all 14 cases were treated with minimal side effects suc4 as nausea, vomiting, anorexia, abdominal pain and fatigue. CONCLUSION: We think halofantrine is a simple and effective regimen against chloroquine resistant malaria and consider this agent as an alternative therapeutic regimen on chloroquine resistant malaria.
Abdominal Pain ; Africa ; Anorexia ; Chloroquine* ; Fatigue ; Humans ; Malaria* ; Military Personnel ; Nausea ; Plasmodium falciparum ; Prevalence ; Quinine ; Tetracycline ; Vomiting

PURPOSE: To investigate the present situation of emergency medical services (EMS) education and to develop an EMS education curriculum for medical students, emergency medicine residents and fellows in Korea. METHODS:The objectives and curricula of the American and Canadian EMS training programs were used in the development of a questionnaire to investigate the actual situation of EMS education in Korea. The Delphi method was used to obtain the consensus of experts regarding which specific objectives should be included and how many hours would be needed in each training level. RESULTS: For medical students, the didactic component of EMS education was 57.6% (median; 60 min, IQR: 50~60 min) and the experiential component was 12.1%. For residents, the didactic component was 57.6% (median; 120 min, IQR; 75~180 min) and the experiential component was 18.2% (median; 450 minutes, IQR; 135~1720 min). Only two hospitals had EMS fellowship programs. The consensus of experts for core objectives and the proper number of hours of EMS education for different levels of training were: 9 core topics and 8 hours for medical students, 16 core topics and 40 hours for medical residents, and 21 core topics and 30 hours for Fellows. The response rate was 42.9% for the first round and 71.4% for the second round. CONCLUSION: The authors propose the core content of EMS education for each training level from a consensus of experts.
Consensus ; Curriculum ; Emergencies ; Emergency Medical Services ; Emergency Medicine ; Fellowships and Scholarships ; Humans ; Korea ; Surveys and Questionnaires ; Students, Medical