Acromelanosis progressiva is a peculiar progressive pigmentary disorder characterized by intensely dark and sharply demarcated hyperpigmentation over the dorsa of fingers and toes, and the pigmentation rapidly spread proximally. A 19-year-old female had sharply demarcated symmetric dark aroarn macules on the dorsa of her hands and feet, forearms, lower legs, face and neck. These pigmentations at first appeared at the age of 5 on the dorsa of her fingers and toes, thereafter these pigmertatons spread progressively to the proximal portion of her body. Histologically, a proliferation of mela biocyte at the epidermal-dermal junction was seen, associated with mild hyperkeratosis. She was othervise normal on physical examination and had no family historv of consanguinity.
Consanguinity ; Female ; Fingers ; Foot ; Forearm ; Hand ; Humans ; Hyperpigmentation ; Leg ; Neck ; Physical Examination ; Pigmentation ; Toes ; Young Adult

PURPOSE: Pelvic ring fractures amount to 1.5% of all joint fractures. The most frequent causes of pelvic trauma are related to car accidents (50~60%) and car-pedestrian crashes (24~28%). The incidence and severity according to the types of acetabular fractures are not known well. We wanted to evaluate the clinical characteristics of acetabular fractures. METHODS: We reviewed the medical records and radiographic findings of 46 cases of the acetabular fractures in patients who suffered motor vehicle accidents during a 2 year period (from March 2007 to April 2009). RESULTS: The proportion of acetabular fractures was 35.7% of all the pelvic bone fractures due to motor vehicle accidents. The males made up 65.0% of the patients. The mean patient age was 44 year old. The majority of cases were driver-accidents (37.0%). As basis on Tile's grouping, the anterior fracture was the most common type (45.6%). The initial ISS score was higher for anterior fracture than that for the other types of acetabular fractures. Surgical operations were performed for 59.0% of the study patients. When the operative intervention was performed within 3 days, the ICU stay of the patients was much longer. Early surgical intervention could not reduce the development of late complications or improve the overall clinical outcomes. CONCLUSION: Acetabular fractures are not a rare type of pelvic bone injury in patients who are injured in motor vehicle accidents. Anterior fracture was the most common type and it showed a poor prognosis. Early surgical intervention cannot reduce the length of the hospital stay of patients with acetabular fractures or the development of late complications.
Acetabulum ; Fractures, Bone ; Humans ; Incidence ; Injury Severity Score ; Joints ; Length of Stay ; Male ; Medical Records ; Motor Vehicles ; Pelvic Bones ; Prognosis

Idiopathic thrombocytupenic purpura is known as an autommune t,hrombocytopenic purpura. It is characterized by either an acute or gradual onset of petechiae or ecchymoses in the skin and mucous membranes, especially in the mouth. Epistaxis, conjunct.ival hemorrhage, hemorrhagic bullae in the mouth, gingival bleeding, melena, and hematemesis may occur. We report a case of idiopathic thrombocytopenic purpura in a 10-year-old male, who showed multiple petechiie and ecchymoses on both lower extremities, and hemorchagic bullae in the mouth. Periheral blood smear showed decreased platlet count, and in the bone marrow megakeyocytes were incraesed. Bleeding time was increased, but coagulation time was normal.
Bleeding Time ; Bone Marrow ; Child ; Ecchymosis ; Epistaxis ; Hematemesis ; Hemorrhage ; Humans ; Lower Extremity ; Male ; Melena ; Mouth ; Mucous Membrane ; Purpura ; Purpura, Thrombocytopenic, Idiopathic* ; Skin

We report a rare case of multiple intracerebral hemorrhage, subarachnoid hemorrhage, and intraventricular hemorrhage that developed after successful cardiopulmonary resuscitation (CPR). A 66-year-old man underwent CPR for about 10 minutes in his community hospital. At that time, his only sequela was ST depression in leads V3, and V4 with an ECG. There was no definite parenchymal lesion in the brain computed tomography (CT) scan taken in the community hospital, and the patient was transferred to Wonju christian hospital for post-resuscitation management. Upon arrival, echocardiographic findings showed akinesia of the anterior wall and anteroseptal wall together with decreased ejection fraction (34%). A cardiac enzyme assay showed a CK-MB concentration of 19.4 ng/ml and a troponin-I level of 1.66 ng/ml. He was mentally comatose and both pupils were isocoric and reflexive to light. We concluded that the cause of cardiac arrest was acute myocardial infarction (AMI), and the patient was treated with drugs including aspirin, clopidogrel, enoxaparin-sodium (1 mg/kg subcutaneous), and isosorbide dinitrate. At 10 hours after admission, a follow-up ECG showed ST elevation in lead I, aVL and all leads from V1 to V6. Right anisocoria was seen in neurologic examination at that time. A subsequent brain CT revealed multiple intracerebral hemorrhage, subarachnoid hemorrhage into all cisternal spaces, and intraventricular hemorrhage. Clotting evaluations yielded a prothrombin time (PT) of 14.6 sec., partial thromboplastin time (PTT) of 45.3 sec. and an INR of 1.32, and a hemoglobin count of 16.2 g/dL.
Aged ; Anisocoria ; Aspirin ; Brain ; Cardiopulmonary Resuscitation ; Cerebral Hemorrhage ; Coma ; Depression ; Electrocardiography ; Enoxaparin ; Enzyme Assays ; Follow-Up Studies ; Heart Arrest ; Hemoglobins ; Hemorrhage ; Hospitals, Community ; Humans ; International Normalized Ratio ; Intracranial Hemorrhages ; Isosorbide Dinitrate ; Light ; Myocardial Infarction ; Neurologic Examination ; Partial Thromboplastin Time ; Prothrombin Time ; Pupil ; Reflex ; Resuscitation ; Subarachnoid Hemorrhage ; Ticlopidine ; Troponin I

PURPOSE: The purpose of this study was to assess optimal chest compression depth for infants and children compared with adults, when the simulated compression depth was delivered according to the current guidelines. METHODS: A total of 467 consecutive chest computed tomography scans (93 of infants, 110 of children, and 264 of adults) were reviewed. The anteroposterior (AP) diameter and compressible diameter (CD) for infants and children were measured at the inter-nipple level and at the middle of the lower half of the sternum for adults. Compression ratio (CR) to CD was calculated at simulated one-fourth, onethird, and one-half AP compressions in infants and children and simulated 5-cm, 6-cm compressions in adult. RESULTS: In adults, the CRs to CD at simulated 5-cm, 6-cm compression depth were 41.7±0.16%, 50.0±7.3%, respectively. In children and infants, the CRs to CD at onethird chest compression were, respectively, 55.1±2.4%, 51.8±2.4% and 82.7±3.7%, 77.7±3.6% at one-half chest compression. The CRs to CD of 4-cm compression depth in infants and 5-cm compression depth in children were 74.4±10.9%, 62.5±8.7%, respectively. The CRs to CD for children and infants were significantly higher compared with adults (p<0.001). The CR to CD of 4-cm compression depth in children was similar to that of 6-cm compression depth in adults (50.0±6.9% vs 50.0±7.3%, p=0.985). CONCLUSION: The current pediatric guideline for compression depth was too deep compared with adults. We suggest that one third of the AP chest diameter or approximately 4-cm in children and less than 4-cm in infants is more appropriate.
Adult ; Child ; Humans ; Infant ; Pediatrics ; Sternum ; Thorax*

OBJECTIVE: This study aimed to compare the optimal chest compression depth for infants and children with that of adults when the simulated compression depth was delivered according to the current guidelines. METHODS: A total of 467 consecutive chest computed tomography scans (93 infants, 110 children, and 264 adults) were reviewed. The anteroposterior diameter and compressible diameter (CD) for infants and children were measured at the inter-nipple level and at the mid-lower half of the spine for adults. Compression ratio (CR) to CD was calculated at simulated 1/4, 1/3, and 1/2 antero-posterior compressions in infants and children, and simulated 5- and 6-cm compressions in adults. RESULTS: In adults, the CRs to CD at simulated 5- and 6-cm compression depth were 41.7±0.16%, 50.0±7.3% respectively. In children and infants, the CRs to CD at 1/3 chest compression were 55.1±2.4% and 51.8±2.4%, respectively, and at 1/2 chest compression, CRs were 82.7±3.7% and 77.7±3.6%, respectively. The CRs to CD of 4-cm compression depth in infants and 5-cm compression depth in children were 74.4±10.9%, 62.5±8.7%, respectively. The CRs to CD for children and infants were significantly higher than in adults (P<0.001). The CR to CD of 4-cm compression depth in children was almost similar to that of 6-cm compression depth in adults (50.0± 6.9% vs. 50.0±7.3%, P=0.985). CONCLUSION: Current pediatric guidelines for compression depth are too deep compared to those in adults. We suggest using 1/3 of the anteroposterior chest diameter or about 4 cm in children and less than 4 cm in infants.
Adult ; Child ; Humans ; Infant ; Pediatrics ; Spine ; Thorax*

PURPOSE: An accurate, objective scoring system to assess the severity of community-acquired pneumonia (CAP) could be helpful to physicians in predicting patient mortality and improving decisions regarding hospitalization. However reports on the severity scoring system for prediction of mortality in patients with CAP in Korea are rare. The aim of this study was to propose a new modified severity scoring system based on a previously validated A-DROP for CAP and to compare it with pneumonia severity index (PSI), CURB- 65 and A-DROP. METHODS: The medical records of 364 patients admitted with CAP via ED from January 2013 through August 2014 were reviewed retrospectively. The demographic data, comorbidities, laboratories, PSI class, CURB-65 score, and A-DROP score were reviewed. The authors investigated a modification factor by comparing the survivors with the nonsurvivors. RESULTS: The study subjects were composed of 264 men and 100 women, with a mean age of 66.2+/-15.2 years. The overall 30-day mortality was 9.6%. The areas under the receiver operating characteristic (ROC) curves for prediction of 30-day mortality in patients with CAP were 0.803 (95% confidence interval (CI): 0.739-0.868), 0.734 (95% CI: 0.652-0.816) and 0.747 (95% CI: 0.662-0.833) for PSI, CURB-65 and A-DROP respectively. The new DROP-70 scoring system which includes age> or =70 years is a simple modified version of the A-DROP. The area under the ROC curves of DROP-70 was 0.774 (95% CI: 0.698-0.850). CONCLUSION: A new severity scoring system, DROP-70, could be a useful index for predicting 30-day mortality in patients with community-acquired pneumonia.
Comorbidity ; Female ; Hospitalization ; Humans ; Korea ; Male ; Medical Records ; Mortality ; Pneumonia* ; Prognosis* ; Retrospective Studies ; ROC Curve ; Survivors

This study is undertaken to investigate the clinical effecte of Neutrogin(recornbinant human granulocyte-colony stimulatiing factor) in 25 patients with ovarian caneer who received two courses of CAP chemotherapy. In the first courae of chemotherapy as a contml course, all patients were treated with CAP chemotherapy alone and during the second course, Neutrogin was given at a dose of 2ug/kg/day subcutaneouely for 14 days 24 hours after completion of chemotherapy. Neutrogin significantly increaaed the nadir count of leukocyte and abaolute neutrophil and decreased tbe number of days per patient on which the absolute neutrophil count was 1,000/mm3 or less. The mean recovery time required for neutrophil to greater than l,500/mm3 after nadir were significantliy decreased in the seeond comse as compared with the first course. Each one patient exriened mild side effects of Neatrogin, such as fever, tene pain and malaise and rernovered without tretment. These results showed that Neutrogin is extremely effective and useful to treat chemotherapy indueed leukopenia and to accelerate the recovery from these complications.
Drug Therapy* ; Fever ; Granulocyte Colony-Stimulating Factor* ; Humans* ; Leukocytes ; Leukopenia ; Neutropenia* ; Neutrophils ; Ovarian Neoplasms

This study is undertaken to investigate the clinical effecte of Neutrogin(recornbinant human granulocyte-colony stimulatiing factor) in 25 patients with ovarian caneer who received two courses of CAP chemotherapy. In the first courae of chemotherapy as a contml course, all patients were treated with CAP chemotherapy alone and during the second course, Neutrogin was given at a dose of 2ug/kg/day subcutaneouely for 14 days 24 hours after completion of chemotherapy. Neutrogin significantly increaaed the nadir count of leukocyte and abaolute neutrophil and decreased tbe number of days per patient on which the absolute neutrophil count was 1,000/mm3 or less. The mean recovery time required for neutrophil to greater than l,500/mm3 after nadir were significantliy decreased in the seeond comse as compared with the first course. Each one patient exriened mild side effects of Neatrogin, such as fever, tene pain and malaise and rernovered without tretment. These results showed that Neutrogin is extremely effective and useful to treat chemotherapy indueed leukopenia and to accelerate the recovery from these complications.
Drug Therapy* ; Fever ; Granulocyte Colony-Stimulating Factor* ; Humans* ; Leukocytes ; Leukopenia ; Neutropenia* ; Neutrophils ; Ovarian Neoplasms

PURPOSE: The aim of this study is to propose a new, simplified formula using an upper incisor-sternal notch (UI-SN) to predict the airway length of optimal positioning of the endotracheal tube via a midsagittal magnetic resonance imaging (MRI) in pediatric patients. METHODS: Between August 2000 and September 2014, a total of 56 pediatric patients (under 8 years old) who underwent MRI for C-spine or whole spine were included for analysis. Variables, such as curved airway length from upper incisor to carina (UI-C), straight length from upper incisor to sternal notch (UI-SN), and from the clivus to sternal notch (C-SN), were measured. Linear regression was used to analyze the relationship among these variables. RESULTS: The average age was 3.5±2.6, and there were 30 (53.6%) males. The mean airway length for UI-C and UI-SN was 16.0±2.8 and 8.8±2.1 cm, respectively. There was a close linear correlation between UI-C and UI-SN (p<0.001). By linear regression, a formula was obtained as UI-C (cm)=1.26×UI-SN (cm)+5.0 (R²=0.873). CONCLUSION: The airway length from the upper incisor to the carina with the head placed in neutral position can be well predicted by a straight length from the upper incisor to the sternal notch. The proposed simplified formula (UI-C=1.26×UI-SN+5, cm) can provide good guidance in determining the optimal positioning of endotracheal tube in pediatric patients.
Cranial Fossa, Posterior ; Head ; Humans ; Incisor ; Intubation ; Linear Models ; Magnetic Resonance Imaging* ; Male ; Pediatrics ; Spine