Leukocytoclastic vasculitis is a small vessel inflammatory disease, mediated mostly by deposition of immune complexes. Medications cause 10~24% of cases of leukocytoclastic vasculitic skin lesions, but warfarin has rarely been implicated. We report a case of warfarin-induced leukocytoclastic vasculitis in a 72-year-old woman which developed 45 days after warfarin medication. Palpable purpura, hemorrhagic vesicles, and ulcers developed on both lower legs. A skin biopsy showed characteristic features of leukocytoclastic vasculitis. Warfarin was replaced by clopidogrel, and the skin lesions gradually disappeared after 3 weeks.
Aged ; Antigen-Antibody Complex ; Biopsy ; Female ; Glycosaminoglycans ; Humans ; Leg ; Purpura ; Skin ; Ticlopidine ; Ulcer ; Vasculitis ; Vasculitis, Leukocytoclastic, Cutaneous ; Warfarin

Decubitus ulcer is a pressure-induced ischemia-reperfusion injury overlying a bony prominence. Various dressing methods have been developed to treat it, but clinical management is still a challenging practice. A patient presented with stage IV decubitus ulcer on the left lateral side of the buttock, which was caused by compulsively lying down on the left side due to schizophrenia. The ulcer was resistant to occlusive dressing method for five weeks. However, the patient successfully recovered in three weeks by our applying a negative pressure dressing with the portable vacuum-assisted closure (VAC) system. Our experience shows negative pressure dressing can be effectively used to treat intractable decubitus ulcer in outpatient settings.
Bandages ; Buttocks ; Deception ; Humans ; Negative-Pressure Wound Therapy ; Occlusive Dressings ; Outpatients ; Pressure Ulcer ; Reperfusion Injury ; Schizophrenia ; Ulcer

Dermatofibrosarcoma protuberance is a relatively rare malignant soft tissue tumor which is locally invasive and looks like a protruded hardened plaque composed of multiple nodules. It seldom occurs on the scalp and the occurrence rate is less than 5%. Nowadays there is a tendency to choose Mohs surgery as a primary treatment instead of a wide excision, because Mohs surgery can reduce cases of recurrence. We report a case of multiple dermatofibrosarcoma protuberans on the scalp of a 32-year-old man. We planned a delayed operation using tissue expanders. We inserted two skin expanders and successfully expanded scalp tissue more than 150% after 7 months. Mohs surgery was performed with a 4 cm distance from borderline of lesions and then the large scalp skin defect was covered by the expanded skin which had been prepared by tissue expanders. It has been 9 months since the operation was performed and there have been no signs of recurrence.
Adult ; Dermatofibrosarcoma* ; Humans ; Mohs Surgery* ; Recurrence ; Scalp* ; Skin ; Tissue Expansion Devices ; Tissue Expansion*

Systemic sclerosis is an autoimmune rheumatic disease of unknown etiology, often manifested with excessive, fibrosis of the skin. The viscous properties of the skin are impaired, and the main histologic changes include a thicker dermis, absence of pilosebaceous units, and a decreased space between collagen bundles. We present a case of 20-year-old Korean woman with micrognathia and microchilia due to systemic sclerosis who came for improvement of her doll-like appearance. We saw an improvement in her micrognathia and microchilia by using Restylane(R) and Perlane(R).
Collagen ; Dermis ; Female ; Fibrosis ; Humans ; Rheumatic Diseases ; Scleroderma, Systemic* ; Skin ; Young Adult

A congenital ectopic nail is a rare anomaly and usually manifests itself as a small abnormal nail appearing alongside the normal nail. In most of the cases, abnormal nails have been found on the palmar surface of the fifth finger. The pathogenesis of the ectopic nail remains unclear. It has been postulated to be a kind of polydactyly or generation from stray germ cell or inoculation of the nail matrix after trauma. We observed a case of a 5-month-old boy with congenital ectopic toenail on the right second toe. The ectopic toenail was removed by surgical excision and the histopathological finding was consistent with ectopic toenail. We report a case of congenital ectopic toenail on the right second toe of a 5-month-old boy.
Fingers ; Germ Cells ; Humans ; Infant ; Nails ; Nails, Malformed ; Polydactyly ; Toes

BACKGROUND: Xanthelasma palpebrarum is the most common type of xanthoma. Due to its delicate location near the eye, treatment of xanthelasma palpebrarum is rather difficult. The treatment includes surgical excision, local treatment with chemicals, and various laser therapies. OBJECTIVE: This study was designed to review the various therapeutic modalities and to evaluate the efficacy and safety of bichloroacetic acid (BCA) for the treatment of xanthelasma palpebrarum. METHODS: Nine patients, with a total of 19 xanthelasma lesions, were treated with BCA. The efficacy and safety were assessed over a follow-up period of 6 to 24 months (average, 16 months). RESULTS: All lesions were grossly removed completely with a single treatment and the treatment was well-tolerated by patients. Erythema and oozing were observed in six patients but improved after two weeks' dressing. Xanthelasma palpebrarum recurred in three patients, but the mean size of the recurred lesions was smaller in comparison to the primary lesion. CONCLUSION: BCA is an effective and safe therapeutic modality for xanthelasma palpebrarum. Advantages include simplicity, cost-effectiveness, speed, safety and efficacy.
Bandages ; Dichloroacetic Acid* ; Erythema ; Follow-Up Studies ; Humans ; Laser Therapy ; Xanthomatosis

Heterotopia refers to the finding of normal tissue in foreign sites, entirely separate from the main organ. Heterotopic gastric mucosa has been observed throughout the alimentary tract, everywhere from the oral cavity to the rectum. However, occurrences in the umbilicus are an extremely rare and peculiar phenomena. We report the case of heterotopic gastric mucosa in the umbilicus.
Gastric Mucosa ; Mouth ; Rectum ; Umbilicus

Objective: If empirical antibiotics must be administered, the pharmacy needs to deliver the drug to emergency patients as soon as possible. The purpose of this study was to investigate the impact of the installation of an automated dispensing cabinet system in an emergency center. Methods: A retrospective study was conducted through the analysis of medical records in an emergency medical center for 12 months before and after the installation of the system. The order-to-antibiotic time and door-to-antibiotic time were collected retrospectively through a system log analysis. For the satisfaction survey, nursing providers who use the dispensing system were administered a survey questionnaire related to the system. Results: This study covered 1,292 prescriptions before and 1,377 after the introduction of the system in the emergency center. It was observed that the average time from the order-to-drug administration decreased (48.7±57.9 vs. 41.1±52.3, P=0.001) after the introduction of the system. The door-to-drug administration time also showed a decrease (293.6±260.2 vs. 267.4±221.1, P=0.006). A satisfaction survey was conducted on 38 users of the system who agreed to participate and respond. The score of the satisfaction survey was 3.63±0.44. The user response showed that they were most satisfied with the prevention of medication errors (4.00±0.62) and system control (4.00±0.57). Conclusion The automated dispensing cabinet system in an emergency center can shorten the order-to-drug time and door-to-drug time. In addition, it helps to improve the satisfaction and work efficiency of emergency medical workers related to medication dispensation.

In case requiring microsurgical epididymal sperm aspiration(MESA) for congenital absence of the vas deferens or unreconstructable obstructive azoospermia, spermatozoa sometimes could not be retrieved from the epididymis or were necro and teratozoospermia. We studied whether testicular biopsy sperm extraction (TESE) in such cases could yield spermatozoa that would result in successful fertilization and pregnancy using intracytoplasmic sperm injection(ICSI) from November, 1994 to April, 1995. Thirty cycles were treated with TESE-ICSI. The mean age of husbands was 34 years(range 25 to 42 years). A total of 426 oocytes were collected and 333 were subsequently microinjected. Normal fertilization occurred in 234 oocytes(70.3%). Thirty cases underwent embryo transfer, with a total of 176 embryos(75.2%) transferred. Twelve cases conceived with a clinical pregnancy rate of 40. O% per transfer and all of whom are ongoing normal pregnancy. Conclusively, when epididymal spermatozoa can not be retrieved TESE Would be final resort that is also very effective with most patients obtaining high fertilization and pregnancy rates. It appears that all cases of obstructive azoospermia can now be successfully treated.
Azoospermia ; Biopsy* ; Embryo Transfer ; Epididymis ; Fertilization* ; Health Resorts ; Humans ; Male ; Oocytes ; Pregnancy Rate* ; Pregnancy* ; Sperm Injections, Intracytoplasmic* ; Spermatozoa* ; Spouses ; Testis* ; Vas Deferens