Decubitus ulcer is often seen in the skin and underlying tissue of debilitated or immobilized patients as the result of prolonged pressure and impaired circulation. It manifests chiefly as an ulcer over bony prominences, but tumefaction is an extremely unusual presentation. A 53-year old male, a paralytic of the lower extremity for 18 years, developed a recurrent decubital ulcer despite repeated surgical repair, from which a rapidly growing, large fungating mass grew within a month. The last resected mass was bosselated and measured 15x9x3 cm with a major area of cicatrix-like induration, interdigitated with skeletal muscle bundles at the central area. Microscopically, the mass was composed of an upper half of active granulation tissue layer and a deeper half of dense, poorly cellular, fibrocollagenous bundles admixed with florid proliferation of atypical fibroblasts, but the absence of mitosis and the multifocal admixture of active inflammatory process-granulation tissue formation seemed to help exclude genuine fibromatosis, nodular fasciitis or proliferative myositis. We assume that this rapidly growing pseudofibromatosis is an additional manifestation of a prolonged decubitus ulcer, possibly related to the modified reparative process of decubitus ulcer following repeated excisions, for which we propose a term of decubitoma.

We performed a histopathologic and immunohistochemical study of 23 cases of surgically resected large cell undifferentiated carcinoma(LCUC) of the lung. The relative incidence of LCUC was 7.6% among the total resected cases of primary lung cancer over 7 years(1987-1993). The mean age of the patients was 56 years and 21 cases were male. The mean size of the mass was 5 cm and 11 cases were located peripherally. According to the histologic features, LCUC could be divided into three groups: squamous cell carcinoma-like(6 cases), adenocarcinoma-like(13 cases), and small cell carcinoma-like(4 cases) groups. The histologic differences were related to the variations of the immunohistochemical properties, but there were no differences in prognosis among these groups. Immunoreactivity to cytokeratin(CAM 5.2) was demonstrated in 22/23(96%). Carcinoembryonic antigen was positive in 13/23(57%). Neuron specific enolase and chromogranin were positive in 11/23(48%) and 5/23(22%), respectively. Vimentin was seen in 11/23(48%). From these observations, we could subclassify them by their immunologic phenotypes; exocrine features in 6/23(26%), neuroendocrine(NE) features in 4/23(17%), both exocrine and NE phenotypes in 7/23(30%), and 6 cases(26%) showed neither phenotype. The group with NE features showed a worse prognosis(P<0.05) and immunoreactivity for vimentin was also related to a worse prognosis(P<0.05). These findings imply that the immunohistochemical properties of LCUC are closely related to the histopathologic features. The groups, subdivided by histology and immunoreactivity, showed no prognostic difference except for the NE differentiation and reaction for vimentin.
Incidence ; Lung Neoplasms

Twenty-three cases of the scaphoid fracture which were treated at the Department of the Orthopaedic Surgery, Catholic University Medical College during the period of december 1978 to december 1987 were analysed. The main purpose of this study was to clarify the significant factors affecting the union rate of the scaphoid fracture. The results obtained were as follows ; 1. The great majority of 23 cases was male with mean age 31. 2. Ulnar deviated stress oblique view with msking a fist was the most reliable means for diagnosing the fracture, location of fracture and stability of wrist after scaphoid fracture. 3. Union rate was obtained from 88.8% in undisplaced fresh fracture, 85.7% in displaced fresh fracture and 71.4% in old neglected fracture. 4. The union rate and associated factors affecting the prognosis after scaphoid frscture seems to be depended on the location of fracture, the severity of initial displacement of fracture fragments, time elapsed of treatment after fracture and accompanied injuries around the ipsilateral wrist.
Humans ; Male ; Prognosis ; Wrist

Infantile esotropia is an esodeviation with onset before six months of age, characterized by a large stable angle and initial alternation with cross fixation. The natural history of infantile esotropia has not yet been verified. A 39-month-old girl presented with a history of esotropia. She was firstnoted to constantly cross her eyes at three months of age. At the age of five months, she was diagnosed by one of the authors[SHH]to have 25 prism-diopters of esotropia with a low hyperopic refractive error of 0.50D sphere. At that time, she fixed and followed with either eye. Ductions and versions were full. On three more examinations in her first year, she consistently showed 25~30 prism-diopters of esotropia. Against medical recommendation, she did not undergo any surgery. At the age of 39 months, she was found to be orthophoric at distance and at near by another author[JMH]. She could not identify flies or animals in random dot stereograms or Titmus stereograms. At the age of four years, she was still orthophoric at distance and at near. All the ophthalmologic findings remained the same. At the age of five years, she developed exophoria and DVD OS. She still could not identify flies. In conclusion, in rare cases infantile esotropia with a relatively small angle may spontaneously resolve without any treatment.
Animals ; Child, Preschool ; Diptera ; Esotropia* ; Exotropia ; Female ; Humans ; Natural History ; Refractive Errors

Staphylococcus species are one of prevalent pathogens found in hospitals. Microbes that are a primary cause of nosocomial infection were isolated from a dental and medical environment it may assist the reader to explain what this is and how it differs from the 'dental health care providers and ward health care providers'. To investigate the distribution of staphylococcus species in this environment, we used vitek II to measure drug sensitivity, and further performed biochemical testing. The isolation rate of staphylococcus species from the dental and medical environment was 100% but from dental health care providers and ward health care providers were 44.4% and 33.3%, respectively. In the analyses, staphylococcus species showed resistance to diffusion of cefoxitin and oxacillin discs. These staphylococci may be sufficiently positive for the mecA gene. Our results suggest that staphylococci might be an important cause of nosocomial infection in the dental clinic.
Adenosine ; Anti-Infective Agents ; Cefoxitin ; Cross Infection ; Delivery of Health Care ; Dental Clinics ; Diffusion ; Health Personnel ; Humans ; Oxacillin ; Staphylococcus

INTRODUCTION AND OBJECTIVES: A kidney in the growing state and the possibility of spontaneous improvement are characteristics of the pediatric ureteropelvic junction obstruction (UPJO) that make the treatment of this disease difficult. We have tried to determine the histopathologic changes of the kidneys with UPJO relating to age, differential renal function and urinary tract infection (UTI). METHODS: The total number of patients was 38 (40 kidneys). The age at the operation time was under 3 months in 9 cases (9 kidneys), 3 to 12 months in 10 cases (10 kidneys), and 1 to 18 years in 20 cases (21 kidneys). Needle biopsies from 3 different sites at the lower pole of the kidney were taken. The tissue was blindly observed for the presence of irreversible change (arteriolar thickening, glomerulosclerosis, interstitial fibrosis and periglomerular fibrosis) and reversible change (inflammatory cell infiltration) by light microscopy. Each pathological finding was graded as I, II or III, and each grade was given a numerical value. Statistical analysis was done with ANOVA. RESULTS: Although the kidneys from patients under 3 months tended to show better histopathologic findings, there was no statistically significant difference in all 5 pathologic findings regardless of patient age. 5 cases (5 kidneys) with previous percutaneous nephrostomy (PCN) were not included in any group for analysis due to possible histologic changes of the renal parenchyma. Inflammatory cell infiltration, arteriolar thickening, glomerulosclerosis and periglomerular fibrosis were statistically significant in patients with previous or present UTI (14 kidneys) compared to the patients without UTI (26 kidneys). The patients with a mean differential renal function less than 30% (7 kidneys) as measured by DTPA or DMSA renal scan showed statistically significant changes in all of the 5 histopathologic findings compared to the patients with differential renal function greater than 30% (27 kidneys). 4 cases with bilateral UPJO (6 kidneys) were excluded from comparing the differential renal function. 5 kidneys with previous PCN had statistically significant degree of glomerulosclerosis compared to others. CONCLUSIONS: Although we did not determine whether pediatric UPJO affects renal growth, it is probable that statistically significant irreversible histopathologic changes do not occur according to age. Considering histopathologic findings only, differential renal function and UTI Should be key factors in deciding the management of pediatric UPJO. In addition, PCN seems to induce more severe histopathologic changes of the kidney.
Biopsy, Needle ; Fibrosis ; Humans ; Kidney* ; Microscopy ; Nephrostomy, Percutaneous ; Pentetic Acid ; Pregnenolone Carbonitrile ; Succimer ; Urinary Tract Infections

A case of right-sided infective endocarditis in a 22-year-old male with ventricular septal defect of perimembranous type, right ventricular(RV) infundibular and pulmonic valve stenosis was reported. The vegetations were found on the mural endocardium of RV infundibulum and pulmonic valve. Streptococcus viridans was identified in 5 consecutive blood cultures, Pulmonary embolism and septic infarction in the lung was associated with systemic embolization, which was manifested by left renal infarction. The RV infundibular stenosis was due to anomalous muscle bundle at the proximal portion. Therefore, we thought that the mechanism of RV infundibular vegetation was probably due to 'Venturi effect and turbulence'. Several clinical features which were found in this case were also reviewed.
Constriction, Pathologic ; Endocarditis* ; Endocardium ; Heart Septal Defects, Ventricular ; Humans ; Infarction ; Lung ; Male ; Pulmonary Embolism ; Viridans Streptococci ; Young Adult

No abstract available.
Hemangioma, Cavernous*

This study was done to examine the correlations between weight, BMI and risk factors of coronary heart disease in men and women in their forties and fifties. The subjects were 412 adults, who had regular health examinations between January and December of 1996 at S-Hospital in Seoul. The data were analyzed using ANOVA, Scheffe test, and Pearson correlation coefficient. The results are as follows : 1. The men between 50 and 59 years of age had higher levels for BMI, weight, systolic blood pressure, diastolic blood pressure, total cholesterol, LDL-cholesterol, triglyceride, fasting blood sugar, plasminogen activator-1, and hemoglobin A1C than the group of women in their forties. Yet, HDL-cholesterol was lower than in the former group. 2. In the group of men in their forties, weight was significantly correlated to diastolic blood pressure(r=.22), LDL-cholesterol(r=.20), plasminogen activator inhibitor-1(r=.35) HDL-cholesterol(r=-.19). Their BMI was significantly corrected to systolic blood pressure(r=.27), diastolic blood pressure(r=.33), total cholesterol(r=.23), LDL-cholesterol(r=.26), plasminogen activator-1(r=.36) and HDL-cholesterol(r=-.25). 3. As for the group of women in their forties weight was significantly correlated to systolic blood pressure(r=.20), diastolic blood pressure(r=.22), triglyceride(r=.32), plasminogen activator inhibitor-1(r=.30) and HDL-cholesterol(r=-.37). Their BMI was significantly correlated to diastolic blood pressure(r=.25) triglyceride(r=.47), plasminogen activator-1(r=.35), fibrinogen(r=.27) and HDL-cholesterol(r=-.47). 4. In the group of men in their fifties, weight was significantly correlated to total cholesterol(r=.32), LDL-cholesterol(r=.29), plasminogen activator inhibitor-1(r=.26). Their BMI was significantly correlated to systolic blood pressure(r=.24), diastolic blood pressure(r=.22), total cholesterol(r=.34), LDL-cholesterol(r=.32), and plasminogen activator-1(r=.25). 5. In the group of women in their fifties, weight was significantly correlated to diastolic blood pressure(r=.33), total cholesterol(r=.21), LDL-cholesterol(r=.20), plasminogen activator inhibitor-1(r=.43) and HDL-cholesterol(r=-.21). Their BMI was significantly corrected to systolic blood pressure(r=.25), diastolic blood pressure(r=.40), total cholesterol(r=.24), LDL-cholesterol(r=.24), triglyceride(r=.22), and HDL-cholesterol(r=-.30). The above findings indicate that the BMI was more predictive than weight as a risk factor for coronary artery disease for men and women in their forties and fifties.
Adult ; Analysis of Variance ; Blood Glucose ; Blood Pressure ; Body Weight* ; Cholesterol ; Coronary Artery Disease* ; Coronary Disease ; Coronary Vessels* ; Fasting ; Female ; Humans ; Male ; Plasminogen ; Plasminogen Activators ; Risk Factors* ; Seoul ; Triglycerides

BACKGROUND: The diagnosis of dementia is dependent on the decline of cognitive and functional ability. To measure the functional ability, a Korean version of Instrumental Activities of Daily Living (K-IADL) was developed and validated. However, the characteristics of the instrument were not fully evaluated. The study was conducted for the purpose of investigating which of the variables were associated with the K-IADL scores. METHODS: The study group from Namwon, Korea, consisting of 235 participants aged 65 years and over, was given the K-IADL to evaluate the functional ability of the participants. The independent variables included sociodemographic data (age, sex, education), vascular factors (blood pressure [BP], history of hypertension and type 2 diabetes mellitus, smoking, alcohol intake, and heart rate), and anthropometric measurements (height and arm length). RESULTS: Age, female gender, low educational attainment, high systolic BP, shorter height and arm length were significantly associated with higher K-IADL scores in univariate analyses. Among the results, age, education, systolic BP, and arm length showed independent associations with the K-IADL in multivariate analysis. CONCLUSIONS: The K-IADL was not influenced by gender in adjusted regression analyses, however education and arm length affected the functional scores, which could suggest a possibility of functional reserve. Also, it was suggested that vascular risk factors could be associated with functional ability.
Activities of Daily Living* ; Aged* ; Arm ; Blood Pressure ; Dementia ; Diabetes Mellitus, Type 2 ; Diagnosis ; Education ; Female ; Heart ; Humans ; Hypertension ; Jeollabuk-do ; Korea ; Multivariate Analysis ; Regression Analysis ; Risk Factors ; Smoke ; Smoking