A 51-year-old man had small, tender, skin colored firm nodule on the helix of the both ears for eight months. He was found to have classic features of chondrodermatitis nodularis chronica helicis, namely, tender nodule less than 1 cm in length with central crusting, localization to helix, age, men, and histologic findings. The histologic examination of the biopsy specimen showed the presence of thinned epiderrnis on center. acanthosis on the adjacent epidermis, with hyperkeratosis and parakeratosis, and cleft between epidermis and dermis. In the dermis, highly vascularized connective tissue and chronic inflarnmatory infiltrate were visible with perichondrial fibrosis. Elastic tissue stain showed degeneration of elastic fibers. After complete excision, no recurrence was obsered until now.
Biopsy ; Connective Tissue ; Dermis ; Ear ; Elastic Tissue ; Epidermis ; Fibrosis ; Humans ; Hypertrichosis ; Male ; Middle Aged ; Parakeratosis ; Recurrence ; Skin

PURPOSE: We present a case of a patient with coexisting neuromyelitis optica and systemic lupus erythematosus (SLE). CASE SUMMARY: A 26-year-old female was hospitalized in our medical center due to decreased visual acuity in her left eye; she had a history of gastric ulcers and herpes zoster infection. Steroid treatment was started under suspicion of optic neuritis, and she was diagnosed with SLE. After treatment, her vision improved, but eleven months later she was hospitalized with paresthesia on the abdomen and left flank progressing to the lower extremities. Spinal MRI showed transverse myelitis, suggesting multiple sclerosis. Fifteen months later, the patient was hospitalized due to decreased visual acuity and ocular pain in the right eye. Her vision was improved by steroid therapy. However, optic neuritis recurred in the right eye after five weeks, thus azathioprine was added to the treatment. Anti-aquaporin-4 Ab test was conducted based on the suspicion of neuromyelitis optica, and the serum was positive for anti-aquaporin-4 Ab (NMO-IgG). The patient was hospitalized again due to paraplegia after three months. Coexistence of neuromyelitis optica was verified because spinal MRI showed longitudinally extensive transverse myelitis. The symptoms were improved by high doses of steroids, a series of plasmaphereses, and rituximab. Optic neuritis was repeated in the right eye and the symptoms were improved with high doses of steroids. Myelitis recurred later and the symptoms improved with high doses of steroids and a series of plasmaphereses. CONCLUSIONS: Coexisting neuromyelitis optica should be considered in cases with relapsing events which have transverse myelitis without cranial lesions in autoimmune diseases such as SLE.
Abdomen ; Adult ; Antibodies, Monoclonal, Murine-Derived ; Autoimmune Diseases ; Azathioprine ; Eye ; Female ; Herpes Zoster ; Humans ; Lower Extremity ; Lupus Erythematosus, Systemic ; Multiple Sclerosis ; Myelitis ; Myelitis, Transverse ; Neuromyelitis Optica ; Optic Neuritis ; Paraplegia ; Paresthesia ; Plasmapheresis ; Steroids ; Stomach Ulcer ; Vision, Ocular ; Visual Acuity ; Rituximab

This is a report of clinical study on the 63 patients of symptomatic urinary tract infection who were hospitalized at the Department of Pediatrics in Kangnam General Hospital during the period between the May of 1989 and the September of 1992. The observation results were as follows: 1) The frequency of urinary tract infection (UTI) was the highest in children under the age of one year (66.7%). 35 patients were male, while the other 28 were female. The ratio of male and female patients was 1.25:1. 2) Fever was observed in most of the cases. Systemic nonspecific manifestation was predominant in the infancy and early childhood, whereas local symptom of UTI was predominant in the late childhood. Among the 35 male patients, 32 cases were phimoses. As for the other 3 cases, Phimoses were not identified. 3) E. coli had the most frequency (65.3%), followed by Klebsiella, Enterobacter, Pseudomonas in descending order. 4) In the vitro antimicrobial susceptibility test, Gram negative organisms such as E. coli Klebsiella, Enterobacter were sensitive to cefotaxime, amikacin, and ampicillin/sulbactam. Meanwhile, Gram positive organisms such as Staphylococcus, Enterococcus were sensitive to vancomycin and cephradine. 5) The renal ultrasonography test was performed for 59 patients, 13 cases of whom showed abnormal findings. 6 cases out of the 13 abnormal patients had hydronephrosis. 6) DMSA renal scan was performed for 40 patients within 2 months of an acute pyelonephritic attack. Signs of pyelonephritic change were found in 18 patients. DMSA scan was repeated 4~12 months later in 4 of these patients. This showed renal cortical scarring in all patients. 7) Voiding cystourethrographic findings in 38 patients showed vesicoureteral reflux in 13 patients. 8) We performed urine culture again after 48 hours from the beginning of therapy and 85.5% of the cases became sterile. 9) The recurrent percentage of UTI was 23.8% with the ratio of 1:1.5 between male and female. Most of the patients were clildren under the age of one year. 10) Operations were made on two cases showing the increase of reflux during the follow-up of unilateral Grade ll and Grade 3 reflux, respectively. Operations were also performed on other two cases with bilateral Grade IV reflux. All the cases were good after the operations. In the meantime, as for another two cases having the right reflux of Grade lland the bilateral reflux of Grade lll, the refluxes were able to be reduced by prophylaxis only, in the course of following up.
Amikacin ; Cefotaxime ; Cephradine ; Child* ; Cicatrix ; Enterobacter ; Enterococcus ; Female ; Fever ; Follow-Up Studies ; Hospitals, General ; Humans ; Hydronephrosis ; Infant* ; Klebsiella ; Male ; Pediatrics ; Phimosis ; Pseudomonas ; Staphylococcus ; Succimer ; Ultrasonography ; Urinary Tract Infections* ; Urinary Tract* ; Vancomycin ; Vesico-Ureteral Reflux

A 51-year-old female had disseminated, symmetrically distributed, brownish black pigmentation and papillary hypertrophy on the intertriginous and flexural areas for 6 months, and gastric adenocarcinoma was confirmed during the evaluation of internal malignancy, The cutaneous finding of acanthosis nigricans was a significant cutaneous marker of internal malignancy in this case.
Acanthosis Nigricans* ; Adenocarcinoma* ; Female ; Humans ; Hypertrophy ; Middle Aged ; Pigmentation

PURPOSE: The aim of this study was to determine the frequency, epidemiology and the clinical manifestation of human metapneumovirus (hMPV) infection in Korean children. METHODS: From February 2010 to January 2012, we collected nasopharyngeal aspiration from 1,554 children who were hospitalized for acute lower respiratory tract infections at the Department of Pediatrics, Severance Children's Hospital. hMPV was detected by performing reverse transcriptase-polymerase chain reaction (RT-PCR). The medical records of the patients with positive results were retrospectively reviewed. RESULTS: We detected hMPV in 99 of the 1,554 hospitalized children. The mean age of the hMPV infected children was 25 months, and 87% of the illnesses occurred between April and June. The most common diagnoses were pneumonia (73%) and bronchiolitis (16%). The clinical manifestations included cough, fever, respiratory distress, hoarseness, tachypnea, and wheezing. Coinfection with other respiratory viruses was found in 43 children (43%). CONCLUSION: hMPV is one of the major virus causing acute respiratory tract infection in the age between 13 months and 48 months old with peaks during April to June. Reports of hMPV in Korea has been increasing but additional studies are required to define the epidemiology and the extent of disease caused by hMPV to determine future development of this illness in Korean children.
Bronchiolitis ; Child ; Child, Hospitalized ; Coinfection ; Cough ; Fever ; Hoarseness ; Humans ; Korea ; Medical Records ; Metapneumovirus ; Pediatrics ; Pneumonia ; Respiratory Sounds ; Respiratory Tract Infections ; Retrospective Studies ; Tachypnea ; Viruses

PURPOSE: To evaluate the clinical effect of intraoperative application of polyether ester urethane (Nasopore(R)) in endonasal dacryocystorhinostomy. METHODS: Endonasal dacryocystorhinostomy was performed on 77 eyes diagnosed with nasolacrimal duct obstruction between January 2010 and February 2011. Nasopore(R) was applied to the newly-formed internal lacrimal opening in the experimental group (41 eyes), and vaseline gauze was applied in the control group (36 eyes). For the evaluation of clinical effects regarding postoperative adhesion and stenosis of the internal lacrimal opening, subjective symptom improvement, lacrimal irrigation tests, and endoscopic examinations were performed at 1 week, 2 weeks, 1 month, 3 months, and 6 months, postoperatively. RESULTS: In subjective symptom improvement and lacrimal irrigation tests, differences between the 2 groups were not statistically significant. In endoscopic findings, the Nasopore(R) group showed significantly lower severity of adhesion and stenosis of the internal lacrimal opening at 1 week, 2 weeks, and 1 month after operation (p < 0.05). CONCLUSIONS: Application of the Nasopore(R) may effectively reduce initial postoperative adhesion or stenosis of the internal lacrimal opening after endonasal dacryocystorhinostomy and has usefulness as an auxiliary method.
Constriction, Pathologic ; Dacryocystorhinostomy ; Eye ; Nasolacrimal Duct ; Petrolatum ; Urethane

Prader-Willi syndrome is characterized by infantile hypotonia, mental retardation, hyperhagia, hypogonadism and obesity. Approximately 60% of all PLW syndrome show an interstitial deletion of chromosome 15, 37% have apparently normal chromosome, and 3.6% have a variety of other abnormalities involving chromosome 15. Diabetes mellitus has been considered a component of PLW syndrome and the incidence is about 7%. We experienced a 17-year-old female who revealed mental retardation, hypogonadism, obesity, and non-insulin dependent type DM, compatible with Prader-Willi syndrome.
Adolescent ; Chromosomes, Human, Pair 15 ; Diabetes Mellitus* ; Female ; Humans ; Hypogonadism ; Incidence ; Intellectual Disability ; Muscle Hypotonia ; Obesity ; Prader-Willi Syndrome*

One patient is a 6-year old female, who has had intensely pruritic linear papuloplaque.", on the left side of the perineal and perianal areas for three years. The other patient, is a. 23-year old male, who has had iritensely pruritic linear papuloplagues on the left upper extremity. This condition started at 1 month of life. In both cases, microscopie examination of the lesions showed psoriasiform and eczematoid appearance. In the latter case, spongioform pustule and Munro's microabscess were also found. We believe that these cases probably represent instances of the entity that. Altman and Mehregan have called inflammatory linear verrueous epidermal nevus, and unusual clinical feature in our patients was the involvement of the left groin in case 1 and of the left upper extremity in case II, which are somewhat rare sites of involvement.
Child ; Female ; Groin ; Humans ; Male ; Nevus ; Nevus, Sebaceous of Jadassohn* ; Upper Extremity ; Young Adult

Zinc sulfate, which was used as zinc sulfate ophthalmic solution in herpetic keratitis, has been found to have the therapeutic effects in cutaneous and mucosal herpes simplex. We studied ta evaluate the therapeutic effect of zinc sulfate in patients with herpes simplex. Nine patients with primary herpes simplex and twenty five patient with recurrent herpes simplex were included in this study. Twenty five patients(six with primary type and nineteen with recurrent type were treated with topical applicatiion of 0.3% zinc sulfate solutiion seven to eight times a day and nine patients(three with primary type and six with recurrent type)were applied with placebo vehicle in the same way. Maintenance treatment was then given tc all these patients, first once a week for one month, and then twice a month indefinitely. The effect was assessed by the comparison of the duration of disappearance of symptoms, drying of vesicles and crust formation, and desiccation and sloughing-off of cursts, and recurrence rate between zine sulfat,e group and placebo group. The resuilts were summarized as follows : 1. In the average time of the disappearance of symptoms, drying of vesicles and crust formation, a,nd desiccation and sloughing-off of crusts, the resu1t observecl in zinc, sulfate group was shorter than that of placebo group, respectively ( p < 0.01). 2. In recurrence rate, 11.1% observed in zinc sulfate group was much lower than 80.0%i in placebo group(p . 0.01). These findings suggest that topical zinc sulfate is an effective agent for treatment and prevention of recurrence af herpes simplex infection.
Desiccation ; Herpes Simplex* ; Humans ; Keratitis, Herpetic ; Recurrence ; Zinc Sulfate* ; Zinc*

PURPOSE: To evaluate the effect of epinephrine on pupil size in reconstruction of an orbital wall fracture. METHODS: The authors of the present study describe 27 patients (27 eyes) who had reconstruction of an orbital wall fracture from January to July of 2009. Patients were divided into two groups according to the use of epinephrine during surgery. Preoperative and postoperative pupil sizes, operation times, and epinephrine dosages were collected. RESULTS: Preoperative pupil sizes were 1.80 +/- 0.37 mm, 1.74 +/- 0.36 mm and postoperative pupil sizes were 1.97 +/- 0.43 mm (p = 0.042), 2.18 +/- 0.52 mm (p = 0.003) in the group with of epinephrine and the group without epinephrine, respectively. Postoperative pupil size significantly increased in all groups. However, no significant difference was found regarding change in pupil size after surgery (p = 0.258). In the group with epinephrine, change in pupil size did not show a significant association with operation time (p = 0.228), nor did change in pupil size and epinephrine dosage (p = 0.922). CONCLUSIONS: The use of epinephrine is an effective modality for bleeding control and securing a clear view in orbital wall fracture reconstruction.
Epinephrine ; Hemorrhage ; Humans ; Orbit ; Pupil