Mycetoma is a clinical syndrome of localized, indolent, deforming, swollen lesions and sinuses, involving cutaneous and subcutaneous tissues, fascia, and bone. Its lesions. are composed of suppurat.ing abscesses, granulomata, and dra ning sinuses and the etiologic agents are wide variety of bacteria (actinomycotic mycetoma) and fungi(eumcotic mycetoma) from plant and soil. The patient was a 65-year-old female and a farnier. She was referred by the skin lesion loalized on the dorsum of her lefther left hand and wrist for three months. It showed multiple subcutaneclis nodules, abscesses, and discharging fitula based on the erythematous plaque. The skin biopsy frorn the lesion revealed the PAS positive hyphae in the granulocytic infiltration. Fungus cult,ure with a piece of tissue on sabouraud media shows hin, floccose, white colonies. Slide culture and biochemical idcrtification of pathogen led to the final diagnosis as Mycetoma caused by Pseudallescheria boydii(Monosporium apiospermum). The lesions disappeared gradualy following systemic oral administratior of Itraconazole 200mg daily for six weeks.
Abscess ; Aged ; Bacteria ; Biopsy ; Diagnosis ; Fascia ; Female ; Fungi ; Hand ; Humans ; Hyphae ; Itraconazole ; Mycetoma* ; Plants ; Pseudallescheria* ; Skin ; Soil ; Subcutaneous Tissue ; Wrist

An etiologic agent in seborrheic dermatitis is now considered to be due to Pityrosporum ovale. The connection between the yeast and the disease has been clearly dernonstrated in a number of patients treatd with antifungal agents. However, the fact, that Pityrosporum ovale (Pityrosporum orbiculare) belongs to the normal human cutaneou. flora makes it difficult, to explain the role of the organism in seborrheic dermatitis. In this clinical study, twenty eight subjects were divided into two group by treatment regimen of topical 2% ketoconazole shampoo(TKS)and 0.3% prednisolone valerate solution (PVS). Before and during the four weeks treatment periods, the number of Pityrosporum ovale on the scalp were evaluated by scrub Giemsa staining method, which estimat,ed by score scale, under direct. microscopic examination. Also clinical symptoms including erythema, scales and itching were recorded by scores every week and compared between two treatment group. Topical application of 2% ketoconazole shampoo(TKS) is a very effective treatment regimen to reduce the yeasr cell score(from 5.8+1.3 to 1.8+1.4) than PVS(from 6.4+1.3 to 3.5+1.5), significantly(p<0.05). So the results of this study acconsistent with the view that density of Pityrosgourum ovale plays a role in the cause and course of seborcheic derrnatitis on the scalp. And antifungal agent(TKS) shows favorable effects ori tnis disease clinically and mycologically.
Antifungal Agents ; Azure Stains ; Dermatitis, Seborrheic* ; Erythema ; Humans ; Ketoconazole* ; Malassezia ; Prednisolone ; Pruritus ; Scalp* ; Weights and Measures ; Yeasts

In general, satisfactory results can be obtained by nonoperative means in the management of proximal femoral shaft fracture in children. Howerver, it is sometimes difficult to maintain the fracture alignment by the nonoperative means because of different muscle pulls in the thigh. The proximal fragment tend to be displaced and roentgenograms are difficult to be taken during traction. These problems have led some authors to advocate open reduction and internal fixation which facilitate overall care. We report our experiences on nonoperative and.operative treatment for proximal femoral fracture at the Chon-ju Presbyterian Medical Center from February 1987 to January 1991. The results are as follows ; 1. There were 20 cases in male, 7 cases in female. Average age at injury was 6.9 years (range, 6 months to 12 years and 8 months). Traffic accident was the most common cause (70.3%). 2. Average immobillization time was 9.2 weeks (range, 6.0 weeks to 12.1 weeks) in the nonoperative treatment group(17 cases), while 8.1 weeks(range, 6.1 weeks to 11.4 weeks) in the operative treatment group (10 cases). 3. Average bony union time was 9.6 weeks (range, 6.3 weeks to 12.5 weeks) in the nonoperative treatment group(17. cases) and 11.2 weeks (range, 9.0 weeks to 13.4 weeks) in the operative treatment group (P < 0.05). 4. Average overgrowth of femur was 3.3mm(range,
Accidents, Traffic ; Child ; Clinical Study ; Female ; Femoral Fractures ; Femur ; Humans ; Jeollabuk-do ; Male ; Protestantism ; Thigh ; Traction

In 10 cases with intracranial arterivenous malformation (AVMs) diagnosed by MR spin echo images, MR angiography was evaluated and compared with conventional angiography in regard to depiction of nidus, arterial feeders, and draining veins. Spin echo images demonstrated the nidus of the AVM in all cases, but displayed the feeding vassels inadequately. These vessels were directly visualized with 3 dimensional STAGE(small tip angle gradient echo) MR angiography using rephasing/dephasing pulse sequences. In 5 cases MR angiography and conventional angiography showed the same results. However, in the others, MR angiography showed lower resolution than conventional angiography. MR angiography is useful in preangiographic evaluation of intracranial AVM but improvement in image resolution, which is dependent on MR hard ware and pulse sequence, is still to be desired.
Angiography* ; Intracranial Arteriovenous Malformations* ; Veins

BACKGROUND: Reducing skin contamination rate and improving the positive rate in blood culture is essential for the correct diagnosis and management of sepsis. Chlorhexidine-alcohol was compared with povidone-iodine for the efficiency of disinfection. Positive rates were compared between the collection of 10 mL and 20 mL of blood per sample. METHODS: The study population included adult patients > or = 18 years old requested for blood culture in the Emergency Department. Povidone-iodine (10%) was used for antiseptic skin preparation from March to June 2011, and 0.5% chlorhexidine-alcohol from July to October 2011. The standard for blood collection was 10 mL in the first period and 20 mL in the second period. The dedicated phlebotomists had been educated on the optimal skin preparation and sample collection. RESULTS: After 10% povidone-iodine application, 31 of 2,755 samples (1.1%) were considered to be contaminated; whereas, a total of 60 of 3,064 samples (2.0%) were contaminated (P=0.011) after application of 0.5% chlorhexidine-alcohol. The positive rate of blood culture was 12.5% (345/2,755) in the first period versus 17.1% (524/3,064) in the second period (P<0.001). CONCLUSION: Both disinfectants appeared acceptable for skin preparation for blood culture collection, although chlorhexidine-alcohol had a higher contamination rate than povidone-iodine. The positive rate of blood culture was in accordance with the amount of sample collected. Continuous education and monitoring are needed for the proper collection and management of blood culture.
Adult ; Antisepsis ; Blood Volume ; Disinfectants ; Disinfection ; Emergencies ; Humans ; Povidone-Iodine ; Sepsis ; Skin

No abstract available.
Child* ; Down Syndrome* ; Humans ; Hypothyroidism* ; Incidence*

BACKGROUND: Porokeratosis is a rare disorder characterized by an abnormal keratinization. Five different clinical types have been described, however most reports are on a small scale and rest,ricted to a particular type. OBJECTIVE: We tried to distinguish clinical and histopathologi'cal feat.ures of each type of porokeratosis. Methods: All patients with porokeratosis visiting the Dermatological Department of Chonnam University Hospital were retrospectively reviewed and finally 79 patients were evaluated. RESULTS: Disseminated superficial actinic porokeratosis(DSAP) was most common it was present in 44 patients(56%). This was f'ollowed by the plaque type(28%), linear type(14%) and punctate type(2%). The:;oungest average age of onset was in the linear type at 13 years old (range 2-34 years old), and the oldest in DSAP which appeared in all patients after the age of 20. The plaque type was predominant in males 2.6 times rnore than in females. The predilection sites were the trunk in the plaque type, the unilateral lower limbs in the linear type and the face lower limbs in DSAP. 1tching was a complaint in 71% of DSAP and pain was in 14% of t.he plaque type. DSAP revealed a family history in 23% and a solar exacervation in 41%. Three cases of the plaque type t ad a malignant change. The average number of cornoid lamella per section was 1.8(ranging from one to seven). The height and invagination depth of cornoid lamellae were most prominent in the plaque type, and the le~ast in DSAP. Dysk(ratotic cells and vacuolar cell degenerat,ion in t.he underlying epidermis were most frequent in the plaque type. However dermal melanophage were present in DSAP. The Epidermis inside ring of:o~rnoid lamella was acanthotic chiefly in the plague type and atrophic chiefly in DSAP. CONCLUSION: These resuts demonstrate that each type of porokeratosis is somewhat, different in clinical and histopathological features.
Actins ; Adolescent ; Age of Onset ; Epidermis ; Female ; Humans ; Jeollanam-do ; Lower Extremity ; Male ; Plague ; Porokeratosis* ; Retrospective Studies

BACKGROUND: Porokeratosis is a rare disorder characterized by an abnormal keratinization. Five different clinical types have been described, however most reports are on a small scale and rest,ricted to a particular type. OBJECTIVE: We tried to distinguish clinical and histopathologi'cal feat.ures of each type of porokeratosis. Methods: All patients with porokeratosis visiting the Dermatological Department of Chonnam University Hospital were retrospectively reviewed and finally 79 patients were evaluated. RESULTS: Disseminated superficial actinic porokeratosis(DSAP) was most common it was present in 44 patients(56%). This was f'ollowed by the plaque type(28%), linear type(14%) and punctate type(2%). The:;oungest average age of onset was in the linear type at 13 years old (range 2-34 years old), and the oldest in DSAP which appeared in all patients after the age of 20. The plaque type was predominant in males 2.6 times rnore than in females. The predilection sites were the trunk in the plaque type, the unilateral lower limbs in the linear type and the face lower limbs in DSAP. 1tching was a complaint in 71% of DSAP and pain was in 14% of t.he plaque type. DSAP revealed a family history in 23% and a solar exacervation in 41%. Three cases of the plaque type t ad a malignant change. The average number of cornoid lamella per section was 1.8(ranging from one to seven). The height and invagination depth of cornoid lamellae were most prominent in the plaque type, and the le~ast in DSAP. Dysk(ratotic cells and vacuolar cell degenerat,ion in t.he underlying epidermis were most frequent in the plaque type. However dermal melanophage were present in DSAP. The Epidermis inside ring of:o~rnoid lamella was acanthotic chiefly in the plague type and atrophic chiefly in DSAP. CONCLUSION: These resuts demonstrate that each type of porokeratosis is somewhat, different in clinical and histopathological features.
Actins ; Adolescent ; Age of Onset ; Epidermis ; Female ; Humans ; Jeollanam-do ; Lower Extremity ; Male ; Plague ; Porokeratosis* ; Retrospective Studies

No abstract available.
Orbit* ; Orbital Fractures*

Background: Blood volume is the most important parameter for an optimal blood culture; however, the effect of blood volume on blood culture is not clearly understood from patients with sepsis. Methods: Blood cultures were obtained from 1,049 patients (≥ 15 years old) who visited the emergency department (ED). Two sets of 20 mL each was collected from each patient, 12 mL of which was transferred to 2 and 10 mL FA Plus (aerobic) bottles (bioMérieux, USA) and the remaining into an FN Plus (anaerobic) bottle. Medical records were reviewed to confirm the diagnosis and clinical significance of the blood culture isolates. The positive rate and time-todetection (TTD) were compared between the 2 and 10 mL groups. Results: Among the 2,098 sets collected, 612 sets (29.2%) were excluded due to inadequate (either too much or too little) blood volume. The positive rate of clinically significant pathogens was lower in the 2 mL group (6.1%) than in the 10 mL group (7.5%) (P = 0.003) among the 1,486 sets. However, there was no significant difference in the positive rate (11.0% vs. 12.5%, P= 0.152) and TTD (15.7 hours vs. 14.2 hours, P = 0.299) among the 585 (39.4%) patients with sepsis. Conclusion The positive rate and TTD were similar between the 2 and 10 mL groups from patients with sepsis who visited the ED, suggesting a high concentration of bacteremia in this group. Therefore, a smaller blood volume should be carefully considered in patients with sepsis in the ED.