We experienced a boy manifesting sexual precocity with unilateral testicular tumor, who was finally diagnosed as CAH with 21-hydroxylase deficiency. Initial laboratory findings were compatible with peripheral precocious puberty. Ultrasonogram for testes showed heterogenous high echoic mass in the right testicle. Radical orchiectomy was performed and its pathology revealed benign Leydig cell tumor without Reinke crystal. But, testosterone was not decreased after 1 month of surgery. Second laboratory exam revealed increased DHEA-S and 17-hydroxyprogesterone. Finally, this case was recognized as CAH(simple virilizing type) with unilateral testicular adrenal rest tumor. In conclusion, CAH should always be considered during etiologic study for the male sexulal precocity even with unilateral testicular tumor.
17-alpha-Hydroxyprogesterone ; Adrenal Hyperplasia, Congenital ; Adrenal Rest Tumor ; Humans ; Leydig Cell Tumor* ; Male ; Orchiectomy ; Pathology ; Puberty, Precocious ; Steroid 21-Hydroxylase ; Testis ; Testosterone ; Ultrasonography

Pseudomyxoma peritonei often have synchronous appendiceal and ovarian mucinous tumors. There has been considerable debate as to whether the ovarian tumors are secondary to the appendiceal tumor or they are independent primary ovarian tumors. It is important to reveal the primary site for treatment and prognosis of a patient. Five cases of synchronous mucinous tumors of the ovary and appendix were studied. Four cases had pseudomyxoma peritonei and pseudomyxoma ovarii. The ovarian tumors were bilateral in two cases, right in two, and left in one. The ovarian tumors were four mucinous cystadenoma of borderine malignancy and one mucinous cystadenocarcinoma, and the appendiceal tumors consisted of four mucinous tumors of borderline malignancy and one mucinous adenocarcinoma. The histology of the ovarian and appendiceal tumors was similar. Rupture of the tumor was seen in all appendiceal tumors and two ovarian tumors. It has been reported that cytokeratin 7 is a useful marker for distinguishing primary ovarian neoplasms from metastases of intestinal origin. All ovarian and appendiceal tumors showed positive reaction for broad-spectrum cytokeratin, but negative for cytokeratin 7. Based on the clinicopathologic and immunohistochemical features, it should be considered that the appendiceal tumors are primary and ovarian tumors are secondary in the synchronous presentation of the ovarian and appendiceal mucinous tumors.
Adenocarcinoma, Mucinous ; Appendix* ; Cystadenocarcinoma, Mucinous ; Cystadenoma, Mucinous ; Female ; Humans ; Keratin-7 ; Keratins ; Mucins* ; Neoplasm Metastasis ; Ovarian Neoplasms ; Ovary* ; Prognosis ; Pseudomyxoma Peritonei* ; Rupture

We have experienced a case of plexiform neurofibrorna of the right upper eyelid and orbit in a 12-year-old girl who had typical skin features of neurofibromatosis and no family history. The non-pulsating proptosis of the right eye and diffuse thickening with hypertrophy of the upper lid, had increased insiduciusly since the birth on. Biopsy taken from eyelirl lesion showed the features of plexiform neurofibroma. Skull X-ray and brain computerized tomogram showed that the right orbit was wider, with the enlarged mass and defects in orbital roof and lesser and greater wings of the sphenoid bone. The surgical excision of the right eyelid lesion was performed.
Biopsy ; Brain ; Child ; Exophthalmos ; Eyelids* ; Female ; Humans ; Hypertrophy ; Neurofibroma, Plexiform* ; Neurofibromatoses* ; Orbit* ; Parturition ; Skin ; Skull ; Sphenoid Bone

There are some effective methods for removing layers of skin to improve aging face and dermatologic defects : chemabrasion (chemical peeling), dermabrasion(surgical removal), laserabrasion. Chemabrasion, generally performed with a chemical solution, is most useful for removal of fine facial wrinkles and abnormal pigmentation. The application of chemical caustics, especially TCA (trichloroacetic acid), is known to be an effective and is now commonly practiced to improve the surface of the facial skin that has been blemished by pigmentation, wrinkles, solar damage and certain scars. Trichloroacetic acid is a colorless melting crystal and derivatives of acetic acid which das protein precipitating properties. It has specific odor but there is not systemic toxic effect like a phenol. It has heavy caustic effect on skin and mucosa and cause the coagulation necrosis of the skin and therefore, it must be handled carefully and stored in the proper condition. Especially, moderate to high concentrated TCA solution must be treated by well-trained persons. A 46-year-old woman visited a private clinic for removal of fine wrinkles around the lip. She was refered to our department because of acute upper lip coagulation necrosis which was caused by injection of 35% TCA solution mistaken for lidocaine, which was supposed to be used for anesthesia. At her arrival, cental half of upper lip showed severe coagulation necrosis. The lesion was well discriminated in a few days, then debridement and immediate reconstruction was done using an Abbe flap. Chemical peeling is a relatively effective procedure for improvement of aging skin lesion in a lower cost with a short time operation, if the practitioner has much experience and optimal indication is properly selected. But not so as, side effect and complication may be often ocurred in a mistake and as a result irreversible scars are remained. We experienced a rare case of upper lip necrosis which was caused by TCA injection mistaked for lidocaine in a private clinic and so, We report this case with the results of experiment of rabbit model which was observation of macroscopic and microscopic changes of the abdominal skin of the rabbit injected with serially diluted TCA solution.
Acetic Acid ; Aging ; Anesthesia ; Caustics ; Cicatrix ; Debridement ; Female ; Freezing ; Humans ; Lidocaine ; Lip* ; Middle Aged ; Mucous Membrane ; Necrosis* ; Odors ; Phenol ; Pigmentation ; Skin ; Trichloroacetic Acid

Microsporum ferrugineum was the most common cause of tinea captis in Korea until the middle of the 1970s, but this organism has been only rarely isolated from the scalp ringworm during recent years. We report, three cases of tinea capitis occurring in a 2-year-old male, a 10 year-old female and a 5-year-old male. From all three patients, Microsporum ferrugineum was isolated.
Child ; Child, Preschool ; Epidemiology ; Female ; Humans ; Korea ; Male ; Microsporum* ; Scalp ; Tinea Capitis* ; Tinea*

In order to evaluate the value of vertebral angiography in assessment of hemifacial spasm, we reviewed retrospectively the vertebral angiography of 28 patients(30 cases) with surgically proved hemifacial spasm but normal CT scans of posterior fossa. There were 9 males and 19 females. Angiography revealed vascular focus of hemifacial spasm located at anterior inferior cerebellar artery, posterior inferior cerebellar artery, and vertebral artery in 19, 9, and 2 cases respectively. Right side was involved in 20 cases. All involved vessels were elongated, tortuous, and dilated. In conclusion, vertebral angiography was valuable in evaluating hemifacial spasm of vascular origin in the posterior fossa.
Angiography* ; Arteries ; Female ; Hemifacial Spasm* ; Humans ; Male ; Retrospective Studies ; Tomography, X-Ray Computed ; Vertebral Artery

PURPOSE:The natural course of Hashimoto' thyroiditis (HT) is so dynamic that the disease progresses to overt hypothyroid or spontaneous recovery. The authors reviewed the clinical course of this disease and analysed the possible predicting factors regarding remission. METHODS:Thirty nine patients with HT (38 girls and 1 boy) were studied retrospectively. Of these patients, 30 were followed for more than 2 years. The possible remission factors were analyzed at initial diagnosis and during follow-up period. RESULTS:The mean age at the diagnosis was 11.8+/-.1 years. Initial thyroid function was euthyroid in 38.5%, compensated hypothyroid in 35.9%, overt hypothyroid in 23.1%, and hyperthyroid in 2.6% of patients. Antithyroglobulin antibody (ATA) was positive in 94.7%, and antimicrosomal antibody (AMA) was positive in 74.4%. The overall remission rate was 53.3% during the follow-up period (51+/-7 months). Initial goiter size, thyroid function status, and autoantibody titer had no relation to the remission rate statistically. Follow-up autoantibody titers in remission group were marginally lower than those in nonremission group (P<0.1), and follow-up AMA titer was significantly higher than initial titers in nonremission group (P<0.05). CONCLUSION: We could not find any predictable remission factors from the initial clinical and autoantibody status. But, during follow-up period, patients with lower autoantibody titers showed slight higher remission, and those with increasing AMA titer showed less remission. Above results suggest that we should monitor antithyroid antibody titer as well as thyroid function regularly.
Adolescent* ; Child* ; Diagnosis ; Female ; Follow-Up Studies ; Goiter ; Humans ; Retrospective Studies ; Thyroid Gland* ; Thyroiditis*

We performed 75 cases of daryocystorhinostomy from Jan. 1988 to Dec. 1990. A routine dacryocystography was performed prior to operation in all cases. A modified T oti's method was applied as a surgical technique "H" shaped incision was done. Both anterior and posterior flaps were sutured adequately and vaseline guaze was used as a plugging agent for 7 to 10 days Success was achieved in 72(96.0%) of 75 cases. The causes of 3-failures were organized granulation tissue and trauma.

OBJECTIVE: Lithium inhibits the action of inositol monophosphatase(IMPase) in phosphoinositide(PI) signal transduction system at therapeutically relevant concentration. The depletion of inositol by lithium itself cannt explain the lithium's therapeutic effect. However, attention has focused on the abnormality of PI signal transduction system as the pathophysiology of bipolar affective disorder(BPD). We investigated whether IMPase mRNA levels of lymphocytes would be different between BPD patients(n=16) and age, sex-matched normal controls(n=16). We also investigated the change of IMPase mRNA level by lithium during 4 weeks to probe the possibility that IMPase mRNA levels could predict the therapeutic response to lithium and clinical course. METHOD: Relative IMPase mRNA levels in lymphocyte were quantified by reverse transcriptase(RT)-PCR in sixteen drug-free BPD patients and sex, age-matched normal controls. The psychopathology of patients were measured using YMRS(Young Mania Rating Scale) and CGI(Clinical Global Impression). RESULTS: There was no significant difference in IMPase mRNA levels between BPD patients and normal controls. And the IMPase mRNA levels were not significantly changed by 4 week treatment with lithium. However, the basal IMPase mRNA levels were negatively correlated with the changes of CGI after 4 weeks. Furthermore, the patients with relatively high basal IMPase mRNA levels showed much more improvement during 4 weeks. CONCLUSIONS: BPD patients and normal controls were not distinguished by lymphocyte IMPase mRNA level. Although we do not support the hypothesis that lymphocyte IMPase activity would be related with the pathogenesis of BPD and the action of lithium, these data raise the possibility that lymphocyte IMPase mRNA levels could function as a predictor of therapeutic response and clinical course of BPD.
5'-Nucleotidase ; Bipolar Disorder ; Humans ; Inositol* ; Lithium* ; Lymphocytes* ; Mood Disorders* ; Psychopathology ; RNA, Messenger* ; Signal Transduction

No abstract available.