A tender, non-healing ulcer of 3 months' duration developed on the tongue tip of a 51-year-old male with active pulmonary tuberculosis. Acid-fast bacilli were grown in the tissue and sputum cultures. The patient was anergic to PPD skin test before the treatment and IL-2 productivity was significantly decreased. Sections from the tongue tip showed ulceration, infiltration of neutrophils and tuberculoid granulornas accompanying caseation necroses in the dermis. The ulcer healed after administration of anti-tuberculosis medication for 2 months.
Dermis ; Efficiency ; Humans ; Interleukin-2 ; Male ; Middle Aged ; Necrosis ; Neutrophils ; Skin Tests ; Sputum ; Tongue* ; Tuberculosis* ; Tuberculosis, Pulmonary ; Ulcer

Sarcoidosis is a rare d:sease in Korea and its association with erythema nodosurn is even rarer. Recently we saw a patient of bihilar adenopathy, who had arthralgia and erythematous nodules of both lower legs. A skin biopsy obtained from the erythematous nodule of the lower leg showed septal panniculitis, consitent with erythema nodosum, and a biopsy from the mediastinal lymph node revealed a pathology consistent with sarcoidosis. This is the first case of Lofgrens syndrome confirmed by histology ir, Korea.
Arthralgia ; Biopsy ; Erythema ; Erythema Nodosum ; Humans ; Korea ; Leg ; Lymph Nodes ; Panniculitis ; Pathology ; Sarcoidosis ; Skin

Augmentation rhinoplasty is one of the most popular aesthetic procedures in Asians. Numerous alloplastic implants have been used, however alloplastic implants may cause many problems in nasal and perinasal areas because of thin soft tissue cover. For these reasons, an ideal implant should be nonpalpable, readily exchangeable and biocompatible. Among these alloplastic implants, Gore-Tex(R) is a polymer of carbon bound to fluorine composed of solid nodes connected by very fine fibers. It has been reported that this material become permeated and surrounded by mature connective tissue, forming a strong supporting envelop for the material, yet the implant is easily removed because of limited tissue ingrowth. Since it's development, Gore-Tex(R) has found many applications in the field of facial plastic and reconstructive surgery. From November, 2001 to December, 2002, Gore-Tex(R) implants were removed from 17 patients due to several problems such as; decreased dorsal height, tip deformity, chronic inflammation. The implants were very hard to remove and coinciding injury of the surrounding tissue were inevitable. An analysis of the length and thickness changes in these removed implants was made. The results showed, decrease in length and thickness with a volume loss averaging, 46.3% in 45x4.0mm implants, 49.3% in 50x5.0mm implants. In view of the experiences of 17 cases of Gore-Tex(R) implants in rhinoplasty, we have concluded that Gore-Tex(R) implants were structurally unstable, fibrovascular tissue ingrowth into pores were minimal, the implants were very hard to remove and the implants caused a postoperative volume reduction. Therefore, Gore-Tex(R) use in augmentation rhinoplasty should be approached with caution.
Asian Continental Ancestry Group ; Carbon ; Congenital Abnormalities ; Connective Tissue ; Fluorine ; Humans ; Inflammation ; Plastics ; Polymers ; Polytetrafluoroethylene* ; Rhinoplasty*

BACKGROUND: Epidural and intravenous (IV) administration of opioids are commonly used for postoperative pain management. However, studies that compare the epidural and IV routes of opiate administration show conflicting results. The purpose of this study was to determine the superior route of analgesics by comparing the effect of epidural fentanyl-bupivacaine with IV morphine using patient-controlled analgesia (PCA) system in the management of posterior thoracic surgery pain. METHODS: Sixty patients undergoing elective thoracic surgery were randomly assigned to receive either Epiural-PCA (Epi-PCA, n=30) or IV-PCA (n=30) when postoperative pain first increased to 40/100 mm (by visual analogue scale; VAS). Epi-PCA group received epidural bolus of 0.1% bupivacaine 10 ml containing fentanyl 100 microgram and then followed by Epi-PCA with 0.1% bupivacaine 100 ml containing fentanyl 800 microgram (basal infusion 2 ml/hr, PCA dose 1 ml, lock-out interval 30 min), IV-PCA group received repeated IV boluses of 3 mg of morphine until postoperative pain decreased to 40/100 mm and then followed by a IV-PCA with morphine (basal infusion 0.005 mg/kg/hr, PCA dose 0.02 mg/kg, lock-out interval 8 min). Analgesic efficacy, degree of patient satisfaction and pain, analgesics consumptions, forced vital capacity (FVC), forced expired volume in one second (FEV1) and side effects were evaluated. RESULTS: There were no significant differences in analgesic efficacy and degree of patient satisfaction and pain in both group. But the PHS were significantly lower (p<.05), and FEV1 higher (p<.05) in Epi-PCA group, signifying better analgesia during movement (cough and deep breaths). CONCLUSIONS: We concluded that an epidural PCA with mixture of fentanyl and bupivacaine administration is superior to that of intravenous PCA with morphine in the management of pain after thoracic surgery.
Analgesia ; Analgesia, Patient-Controlled* ; Analgesics ; Analgesics, Opioid ; Bupivacaine ; Fentanyl ; Humans ; Hydrogen-Ion Concentration ; Morphine* ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Patient Satisfaction ; Thoracic Surgery* ; Vital Capacity

No abstract available.
Granuloma Annulare* ; Granuloma* ; Herpes Zoster*

No abstract available.
Hemangioma, Cavernous*

The incidence of conjoined twins is so rare that few anesthesiologists have an opportunity of managing them. Especially in Korea, there are only a few reports describing the anesthetic management for surgical separation of newborn conjoined twins. We experienced the successful anesthetic management for surgical separation of thoraco-xiphopagus conjoined twins without any particular problems. After applying the noninvasive monitors (ECG, pulse oximeter), one of the twins (twinA) with congenital heart disease was administered with intravenous ketamine for induction of anesthesia and intubated without neuromuscular blocker. Anesthesia was maintained with N2O-O2 and hand ventilation using Mapleson D breathing circuit. After maintaining airway of the twinA, the twinB was intubated and maintained with the same manner. Eighteen days after the separation procedure, the twinA with congenital heart disease died and the other one, twinB has been alive with normal growth and development.
Anesthesia ; Growth and Development ; Hand ; Heart Defects, Congenital ; Humans ; Incidence ; Infant, Newborn ; Ketamine ; Korea ; Neuromuscular Blockade ; Respiration ; Twins, Conjoined* ; Ventilation

No abstract available.

No abstract available.
Femur* ; Tibia*

Pseudoaneurysm of the femoral artery complicating internal fixation of the trochanteric fracture of the femur results mainly from a penetrating injury by the drill bit or screw and involves particularly the profunda femoris artery. Recently, we experienced a case of pseudoaneurysm of the superficial femoral artery following insertion of the Gamma nail for trochanteric fracture of the femur and scrutinized the causes of this injury. The superficial femoral artery lies in close proximity to the femur by adduction of the involved limb against the perineal post on the fracture table during Gamma nailing.
Aneurysm, False* ; Arteries ; Extremities ; Femoral Artery* ; Femur*