Calciphylaxis has been described as a rare condition in patients with end-stage renal disease and secondary hyperparathyroidism. Selye et al. first coined the term calciphylaxis to describe soft-tissue calcification and cutaneous necrosis. The common manifestation include painful digital necrosis and medial calcification of small and medium sized vessels. Calciphylaxis is a clinical diagnosis and is characterized by painful, violaceous, mottled skin lesions. Radiographic studies reveal calcification of median and small vessels under the knee but vascular calcification is not specific for calciphylaxis. Histolopathologic findings show a markedly reduced lumen, secondary to the fibrin deposition and inflammation in and around the outer media with an outer ring of calcification which leads to progressive ischemic tissue necrosis. Kidney transplantation and parathyroidectomy is recommened but it is controversial. We present the case of a 64-years-old man with chronic renal failure as well as painful ischemic necrosis on the lower extremity. The pertinets literature is reviewed.
Calciphylaxis ; Diagnosis ; Fibrin ; Humans ; Hyperparathyroidism, Secondary ; Inflammation ; Kidney Failure, Chronic* ; Kidney Transplantation ; Knee ; Lower Extremity ; Necrosis ; Numismatics ; Parathyroidectomy ; Skin ; Vascular Calcification

Autoerotic death is an accident occurring during individual, usually solitary sexual activity in which a device or apparatus used to enhance the sexual stimulation. Although it is a well-known phenomenon described in many forensic medicine reports, cases are rare in Korea because of conservative tradition of the society and embarrassment of the victim 's family members. It may be far more common than realized. We present a case of the autoerotic accident involving a plastic bag asphyxia in a 67-year-old man. The death scene investigation and findings at autopsy will provide police officers and physicians with adequate knowledge about this phenomenon to make an accurate diagnosis.
Aged ; Asphyxia ; Autopsy ; Diagnosis ; Forensic Medicine ; Humans ; Korea ; Plastics ; Police ; Sexual Behavior

Congenital pneumonia is defined as pneumonia acquired transplacentally or perinatally. It is frequently associated with prolonged rupture of the membranes, chorioamnionitis, prolonged labor, premature labor, fetal distress, prematurity and meconium staining. It is one of the important causes of neonatal death. We report a case of congenital pneumonia of a full-term, female neonate who was born by cesarian section and died at 10th hours of her life. There were no maternal signs and symptoms of infection and amniotic fluid was not stained with meconium at birth. We insist that full physical examination and routine laboratory examinations including simple chest X ray are required even in grossly normal neonate without specific risk factors and that possibility of neonatal pneumonia should always be considered when the cause of death cannot be explained immediately by gross autopsy findings.
Amniotic Fluid ; Autopsy ; Cause of Death ; Chorioamnionitis ; Death, Sudden* ; Female ; Fetal Distress ; Humans ; Infant, Newborn ; Meconium ; Membranes ; Obstetric Labor, Premature ; Parturition* ; Physical Examination ; Pneumonia* ; Pregnancy ; Risk Factors ; Rupture ; Sudden Infant Death ; Thorax

BACKGROUND: Based on a recent study showing that the reactivation of HSV-1 may be one of the possible pathogenesis of idiopathic facial mononeuropathy, antiviral therapy has been suggested as a good treatment modality. However, the efficacy of antiviral therapy is still controversial. This argument may be caused by the absence of a reliable system of grading facial nerve paralysis. We performed this study to investigate the therapeutic effects of an antiviral agent and possible prognostic factors using the Sunnybrook scale. METHODS: Patients with idiopathic facial mononeuropathy were divided as two groups according to the treatment regimens (Acyclovir & Steroid vs. Steroid only). Clinical efficacy was evaluated using the House-Brackmann grading system and Sunnybrook scale. Electrodiagnostic studies including the blink reflex, facial nerve conduction study, and facial nerve excitability test were performed. The clinical improvement rate between the two groups and the usefulness of the electrodiagnostic studies as prognostic factors were analyzed. RESULTS: No significant differences of the clinical improvement rate was revealed with a 70% improvement rate for the Acyclovir treatment group and 84% for the steroid only group. Among electrodiagnostic studies, the compound muscle gamma action potential (CMAP) amplitude (=0.637, p=0.000) and nerve excitability =0.688, gamma test (p=0.000) on 2 weeks showed significant correlations to the final Sunnybrook score. There is good correlation between the two facial nerve grading systems. CONCLUSIONS: Acyclovir may not be effective in the recovery of idiopathic facial mononeuropathy. CMAP amplitude and nerve excitability tests on 2 weeks may provide valuable prognostic factors. The Sunnybrook scale may be useful as a facial grading system.
Action Potentials ; Acyclovir* ; Blinking ; Facial Nerve ; Herpesvirus 1, Human ; Humans ; Mononeuropathies* ; Paralysis

Ventricular tachycardia is an important tachyarrhythmia which is encountered commonly in clinical field. The accompanying manifestations could be variable just from palpitation to sudden cardiac death. The classification of this arrhythmia has not completly settled yet, but in a broad way this arrhythmia is classified according to the prescence or abscence or underlying heart disease, especially coronary artery disease. Recently, therapeutic modalities for this arrhythmia have been changed a lot from classical antiarrhythmic drugs to radiofrequency ablation or ICD implantation although there are still some problems to overcome. We experienced a case of 34-year-old female having an incessant ventricular tacycardia which was abolished after endomyocardial biopsy performed to differentiate underlying myocardial pathology.
Adult ; Anti-Arrhythmia Agents ; Arrhythmias, Cardiac ; Biopsy* ; Catheter Ablation ; Classification ; Coronary Artery Disease ; Death, Sudden, Cardiac ; Female ; Heart Diseases ; Humans ; Pathology ; Tachycardia ; Tachycardia, Ventricular*

Duodenal diverticulitis is a rare complication of the duodenal diverticulum. Its rarity is due to the relatively large diameter of the duodenum, which makes the intraluminal flow of sterile liquid duodenal contents fluent. Additionally, nonspecific signs and symptoms of duodenal diverticulitis make it very difficult to diagnose properly. We describe a patient presenting with abdominal pain, nausea, and leukocytosis, with diverticulitis of the third portion of the duodenum caused by the impaction of a foreign body, who was diagnosed and treated with enteroscopy.
Abdominal Pain ; Diverticulitis ; Diverticulum ; Double-Balloon Enteroscopy ; Duodenum ; Foreign Bodies ; Humans ; Leukocytosis ; Nausea

PURPOSE: To investigate the accuracy and reproducibility of Optical Low Coherence Reflectometry (OLCR) corneal thickness measurements compared with the Orbscan system and ultrasound pachymeter (IOPac, Mentor). METHODS: Two examiners measured corneal thicknesses of 78 normal eyes and in 36 eyes that had undergone LASIK, and five sequential measurements of corneal thickness with OLCR, Orbscan system, Mentor, and IOPac were performed. Remeasurements of corneal thickness in 24 normal eyes were performed after two days to investigate intra-examiner reproducibility. RESULTS: The average corneal thickness measured in normal subjects was 536.3+/-23.8 micrometer in OLCR, 542.4+/-25.3 micrometer in the Orbscan system, 535.4+/-23.7 micrometer in Mentor, and 534.2+/-24.1 micrometer in IOPac. The average corneal thickness measured in patients who had undergone LASIK was 487.3+/-30.8 micrometer in OLCR, 492.5+/-36.5 micrometer in the Orbscan system, 487.5+/-30.8 micrometer in Mentor, and 485.3+/-30.8 micrometer in IOPac. There was no statistically significant difference between the four pachymeters. The inter-examiner and intra-examiner reproducibilities were shown to be highly reliable. CONCLUSIONS: The OLCR showed similar measurments of corneal thickness with the Orbscan system and ultrasound pachymeter, and showed no difference in reproducibility with different examiners.
Corneal Pachymetry* ; Humans ; Keratomileusis, Laser In Situ ; Mentors ; Ultrasonography*

OBJECTIVE: Stenotrophomonas maltophilia has been emerging as an important nosocomial pathogen in recent years in patients with impaired host- defense mechanism or who has been exposed to large amount of inocula. This organism is usually resistant to multiple (commonly used) antimicrobial agents, particularly to those of the beta-lactam class. To evaluate the clinical feature of Stenotrophomonas maltophilia infection and in vitro anti- microbial susceptibility, we performed a retrospective study. METHODS: We analyzed the result of in vitro antimicrobial susceptibility test for 200 isolates of S. maltophilia and the annual isolation rate during the period between January 1990 and December 1994 in our institution, and performed a retrospective study for the available records of 165 cases among them. The data were obtained with only the first isolation of the organism for each patients. RESULTS: Total of 165 initial isolates, the isolates were from wounds in 50(30.3%), urine in 47(28.5%), the respiratory tract in 37(22.4%), blood in 9(5.5%), bile in 6(3.6%), and miscellaneous sources in 16(9.7%). The 84.2% of isolates were hospital-acquired isolate and 58.3% of these patients had received antecedent antibiotic therapy: polymicrobial growth was demonstrated in 61.9% of the cases. In vitro antimicrobial susceptibiiity test, ofloxacin was active against the isolates in 89.2%, moxalactam in 85.9%, ciprofloxacin in 83.9%, TMP-SMX(trimethoprim-sulfamethoxazole) in 64.2%, As expected, S. maltophilia isolates were, in general, not susceptible to cephalosporins, penicillins. The annual isolation rate at Kyung Hee University hospital was not increased significantly from 1990 to 1994, 19.53 per 10,000 patients dismissals in 1990, 13.56 in 1994. The major underlying diseases of patients were malignancy(17.6%), cerebrovascular disorder(17%), diabetic mellitus(13.3%). Mortality rate is 10.3%. CONCLUSION: S. maltophilia has been emerging as an important nosocomial pathogen in immunocompromised patients, especially those receiving broad-spectrum antimicrobial therapy. And this organism is resistant to multiple antimicrobial agents, particularly to those of the beta-lactam class. When antimicrobial treatment is necessary, the clinician should be guided by results of in vitro susceptibility testing because of the notable in vitro resistance of S. maltophilia to commonly used antibiotics. And when S. maltophilia has been recovered from a patient, wound and contact isolation is warranted.
Anti-Bacterial Agents ; Anti-Infective Agents ; Bile ; Cephalosporins ; Ciprofloxacin ; Humans ; Immunocompromised Host ; Mortality ; Moxalactam ; Ofloxacin ; Penicillins ; Respiratory System ; Retrospective Studies ; Stenotrophomonas maltophilia ; Stenotrophomonas* ; Wounds and Injuries

BACKGROUND/AIMS: Hepatocytes on the hepatic lobule mipate from portal zone to centrilobular mea as the DNA synthesis within it. And also, the xenobiotic reactions reveal characteristic differences associated with zone specific metabolism in the liver acinus. In this study, the zonal distribution of ethylnitrosourea (ENU)-induced hepatic precancerous lesion was stereologically investigated. METHODS: Nine B6C3F1 mices were given I.p. injection of ENU (60 ug/pn body weight) when the pups were 15 days old prior to sacrifices at 8 weeks of life. All the 150 consecutive sections, 3 p m in thickness, were stained with hematoxylin and eosin and identified the basophilic precancerous lesions with 80-165 p m diameter in equatorial plane by the Zeiss microprojector. And then the distances from the center of selected foci to terminal hepatic vein or portal vein branches were estimated under the microscopic fields. As a control group, the same estimations were performed from the random points by the appointments of random digit table. RESULTS: Mean distance between ENU-induced 52 hepatocellular foci and the nearest terminal hepytic vein was 181.15+112.39 p m (Mean+ SD), but that of randomly selected 104 points was 291.73+157.98pm (Mean+5D) (Students t-test, p<0.0005). Substantially, 52.7% of ENU-induced 52 hepatocellular foci were within 300 p m from the terminal hepatic vein, but randomly selected 104 points were only 50.9% (Shapiro Wilk W test, w=0.819857, p=0.048038). Mean distance from ENU-induced 52 foci to portal vein was 398.85+149.98pm (Mean+SD), but that from the randomly selected 104 points was 315.87+145.79 pm (Mean+SD)(Students t-test, p<0.0005). CONCLUSION: Stereologically, ENU-induced mice liver cell foci distribute non-randomly to Zone III, centrilobular zone of mouse hepatic acini where promote invasion toward terminal hepatic veins.
Animals ; Appointments and Schedules ; Basophils ; Cholestasis ; DNA ; Eosine Yellowish-(YS) ; Ethylnitrosourea ; Fluconazole ; Hematoxylin ; Hepatic Veins ; Hepatocytes ; Liver ; Metabolism ; Mice* ; Portal Vein ; Veins

No abstract available.
Echocardiography, Transesophageal* ; Mitral Valve Insufficiency*