OBJECTIVE: We analyzed the clinical features of amniotic fluid embolism confirmed by autopsy or clinical dicision for making a plan of rapid diagnosis and intensive emergency care. STUDY DESIGN: We experienced 2 clincal cases in Ewha Mokdong Hospital and Severance Hospital at 1995, and reviewed the medical record & autopsy report of 15 cases in National Institute of Scientific Investigation from Jan, 1991 to Dec, 1995. RESULTS: The mean maternal age was 31+/-3 years. The mean gestational age was 40+/-1 weeks. The number of delivery were 1.4+/-0.8. The number of abortion history. were 2.6+/-2. The sexuality of fetus were six males (35 %), five females (29%), and unknown six cases (35 %) and the fetal mortality rate was 29 % (5 cases). The initial clinical symptoms and signs were hypotension (12 patients, 71%), vaginal bleeding(ll patients, 65%), cardiac arrest (6 patients, 35 %), dyspnea (5 patients, 29 %), and seizure (2 patients, 12%). In the case of normal spontaneous vaginal delivary (NSVD), the symptoms occurred during induction in 3 (18%), during delivery in 1 (6%), and after delivery in 9 (53%). In the case of Cesarean section, the symptoms occurred during section in 2 (12%), and after section in 1 (6%). There are one case whose symptoms occurred during 3rd gestational period. CONCLUSIONS: We should alert for the amniotic fluid embolism in the clinical findings of acute collapse and vaginal bleeding, respiratory symptoms, and seizure at any peripartum. With eary suspicion of this disease and aggressive intensive care we can reduce amniotic fluid embolism mortality rate and it's legal problem.
Abortion, Induced ; Amniotic Fluid* ; Autopsy ; Cesarean Section ; Diagnosis ; Dyspnea ; Embolism, Amniotic Fluid* ; Emergency Medical Services ; Female ; Fetal Mortality ; Fetus ; Gestational Age ; Heart Arrest ; Humans ; Hypotension ; Critical Care ; Male ; Maternal Age ; Medical Records ; Mortality ; Peripartum Period ; Pregnancy ; Seizures ; Sexuality ; Uterine Hemorrhage

STUDY DESIGN: This study assessed the final functional results after treatment of thoracolumbar burst fractures and compared the relationship between the results and the parameters of reduction and state of the fractures. OBJECTIVES: To define prognostic factors affecting the final results and to present some precautions to minimize the treatment failure. SUMMARY OF LITERATURE REVIEW: In the treatment of the thoracolumbar burst fractures in which flexion loads are predominant, the sagittal contour is crucial to achieve permanent pain-free stability, but definitive therapeutic guidelines have remained a controversal topic. MATERIALS AND METHODS: We reviewed 37 thoracolumbar burst fractures with an average follow up period of 1.8 years: group 1 consisting of 20 cases treated conservatively and group 2 consisting of 17 cases treated surgically with posterior instrumentation. Finally functional results were analysed with the Denis'pain and work scores, and were compared between groups on anterior body height and local kyphosis. RESULTS: A satisfactory pain score less than or equal to P3 was in 15(75%) in group 1 and 15(88.2%) in group 2(p>0.05), but satisfactory work score less than or equal to W3 was in 12(60%) in group 1 and in 14(82.4%) in group 2(p<0.05). But, some loss of body height and local kyphosis in group 1 was not reversely related with functional outcomes. Eight cases in group 1 showing unsatisfactory result in work scores were analyzed as 4 osteoporosis(Jikei grade I, II/III), 3 associated compression fracture of the contiguous vertebra and one combined osteoporosis and compression fracture, showing significant loss of vertebral height and increase of kyphosis(p<0.01). CONCLUSIONS: Functional results of group 1 showing loss of vertebral height less than 50% and increased kyphosis less than 200 were comparable to those of group 2. The osteoporosis and associated compression fracture of adjacent vertebra were the risk group to develop posttraumatic kyphosis and might be added to the surgical indication of the thoracolumbar burst fractures.
Body Height ; Follow-Up Studies ; Fractures, Compression ; Kyphosis ; Osteoporosis ; Spine ; Treatment Failure

We reviewed 50 skin biopsies obtained from 40 patients with cutaneous leiomyoma during a 10 year period from January 1980 to December 1989. The result.s were summarized as follows: 1) Sex distribution showed a female preponderance with male.female ratio of 1: 1.9. 2) The age distribution was relatively even from childhood to old age. The mean age was 47,8 years, 3) The most common site of lesion was lower leg(34%) followed by hand(24%), foot(12% ), anterior chest(8% ), face(6% ), neck(4%), upper arm(4% ), labia major(2 %) and nipple(2%). 4) The lesions were relatively well circumscribed subcutaneous nodule, papule, plaque and nodule which measured between 0.3cm to 5cm in size and their colors were erythematous to light brown. 5) The most common clinical and histopathologic type was angioleiomyoma(75%) followed by solitary piloleiomyoma(12.5%), multiple piloleiomyoma(7,5%) and solitary genital leiomyoma(5% ). Angioleiomyomas were clincally associated with cavernous hemangioma, myoma of uterus and systemic lupus erythematosus. 7) The clinical diagnoses were mass(30% ), epidermal cyst(20%), dermatofibroma (12.5% ), leiomyoma(12,5%), neurilemmoma(5%), lipoma(5%), calcifying epithelioma(2.5%), metastatic carcinoma(2.5%), morphea(2.5% ), fibrocystic disease(2.5%), glomus tumor(2.5 % ) and Dupuytrens contracuture(2..5%).
Age Distribution ; Angiomyoma ; Biopsy ; Diagnosis ; Female ; Hemangioma, Cavernous ; Histiocytoma, Benign Fibrous ; Humans ; Leiomyoma ; Lupus Erythematosus, Systemic ; Myoma ; Sex Distribution ; Skin ; Uterus

Open tibial pilon fractures present extensive soft tissue disruption and common complications such as sepsis or skin slough, and deserve special cosideration in addition to the challenging reconstructive problems. The purpose of this study is to assess the effectiveness of limited internal fixation and external fixation for the treatment of the open tibial pilon fractures, and to introduce some idea in Ilizarov device use. We reviewed 27 open tibial pilon fractures treated with limited internal fixation and external fixation from Feb. 1992 to Mar. 1996(follow-up range, 1 to 5 years). Fracture classification(Ruedi and Allgower) was type I in 5, type II in 10 and type III in 12, open wound type(Gustilo-Anderson) was II in 8, IIIA in 17 and IIIB in two. Secondary procedures were 16 soft tissue procedures, 13 bone graftings and 2 limb lengthening. Mean time for removal of the external fixators was 3.5 months(range, 6 to 21 weeks), and clinical union averaged 4.3 months(range, 12 to 25 weeks). At the time of last follow-up, radiologic grading(Burwell and Charnley) showed 13 good(48%), 10 fair(37%) and 4 poor results(15%). Objective functional grading(Ovadia and Beals) showed 5 excellent(19%), 15 good(56%), 6 fair(22%) and 1 poor(4%), and subjective grading 2 excellent(7%), 16 good(59%), 7 fair(26%) and 2 poor(7%). Common complications included 10 wound sepsis(37%), 6 posttraumatic arthritis(22%) and 5 malunions(19%). In conclusion, we cosider limited internal fixation and external fixation is an effective treatment modality till bone union for open tibial pilon fractures, and Ilizarov method using tension wires crossed only through the fracture fragments can provide a sufficient early and late stability.
External Fixators ; Extremities ; Follow-Up Studies ; Ilizarov Technique ; Sepsis ; Skin ; Tibia ; Transplants ; Wounds and Injuries

No abstract available.
Carbon Dioxide* ; Carbon* ; Lasers, Gas* ; Vulva*

In a previous communication, we described a relatively simpli. method for assaying quantities of sweat using the skin surface hydrometer. In order to evaluate the pharmacologic response of weat glands in psoriasis, vitiligo and loalized scleroderma, we measured the basal skin conductance and the quantity of sweat induced by intradermal injections of pilocarpine nitrate in the lesional and per ilesional skin. The results were as follows : 1. In psoriatic plaques, based skin surface hydration and the sweat response to pilocarpine was markedly reduced (p<0.05), but there were no significant differences in normal perilesional skin. 2. In generalized vitiligo, basal skin surface hydration and the sweat gland response was normal. In the case of the segmental type, there was a slightly decreased sweat response in the lesion but, not significant statistically. 3. In the morphea plaque, basal skin surface hydration and the sw.at response to pilocarpine was markedly reduced but was normal in perilesional skin. This study presents evidence of the functional changes in the development of sweat secretion and surface hydration in the lesions of psoriasis, morphec and segmental type of vitiligo. The demonstration of ahnormalities in the pharmacolopic response to pilocarpine induction led us to suggest the possibility that some degree of sweat gland involvement is induced by the pathogenetic mechanisms of these diseases.
Injections, Intradermal ; Pilocarpine ; Psoriasis* ; Scleroderma, Localized ; Skin ; Sweat Glands* ; Sweat* ; Vitiligo*

We present a case of venous hemangioma which is seen beneath a clavus (corn) developed in the interdigital area of the foot. Clinically, a violaceous papule was located on the third and fourth interdigital spaces under an overlying corn. Histopathologic examination showed a non-encapsulated dermal mass composed of thick-walled and thin walled vessels lined by a single layer of endothelial cells. Some thick-walled vessels had protruding endothelial cells into the lumen and through Verhoeff-van Gieson and Masson-trichrome stain of the tissue section, we found that the vascular mass was composed of vein.
Endothelial Cells ; Foot ; Hemangioma* ; Veins ; Zea mays

PURPOSE: To reduce complications and provide proper management for better clinical outcomes in the treatment of macular edema through a large-scale analysis of the incidence and risk factors for complications of intravitreal triamcinolone injection. METHODS: The medical records of 490 eyes that received intravitreal triamcinolone (4.0 mg) injection for treatment of macular edema caused by various diseases were retrospectively reviewed, and relevant parameters were included in a multivariate regression model. RESULTS: Vitrectomized (p < 0.001) and pseudophakic (p = 0.054) eyes were less likely to exhibit an intraocular pressure increase, but glaucoma (p < 0.001) and young age (p = 0.073) were found to be significant risk factors for this complication. Vitrectomized eyes (p = 0.011), diabetic macular edema (p < 0.001), secondary ocular hypertension (p = 0.029) and old age (p = 0.059) were associated with cataract progression. Three consecutive case of sterile endophthalmitis, which differs from bacterial endophthalmitis in clinical course and prognosis, occurred during the same period. CONCLUSIONS: Risk factors and the incidence of complications after intravitreal triamcinolone injection should be evaluated through regular follow-up evaluation to ensure proper management and a better prognosis.
Cataract ; Dietary Sucrose ; Endophthalmitis ; Eye ; Follow-Up Studies ; Glaucoma ; Incidence ; Intraocular Pressure ; Macular Edema ; Medical Records ; Ocular Hypertension ; Prognosis ; Retrospective Studies ; Risk Factors ; Triamcinolone ; Triamcinolone Acetonide

BACKGROUND: Hydration, the water content of the stratum corneum, is an important factor in both the appearance and the barrier function of the skin. Many non-invasive methods have been developed in order to assesa the hydration state of the skin and the effect of various moisturizers. The hydrometer and carneometer are commercially available instruments which are widely used in dermatologic research. OBJECTIVE: Our purpose was to compare the measuring usefulnes of both instruments on normal subjects with a wide range of hydration states of the hornylayer. METHODS: We measured the conductance with the hydrometer and the capacitance with the corneometer in various hydrating eonditions and compared both insruments. RESULTS: Conductance had a non linear correlation with capacita ice. Capacitance measured with the corneometer had a high sensitivity to moisture in a wide range of hydration levels. On the other hand, conductance guaged with the hydrometer showed a few sensitivity to moisture at a low level. When the hydretion level was measured after a moiturizer was added, 10 % urea cream showed a sharp increase by 256% in terms of conductanae, and H-base by 97.8%. Mineral oil decreased by 41.5% and petrolatum by 62% respectively. On the other hand, when measured in terms of capacitance under the same conditions as above, 38.9 increase in 10% urea cream, 19.3% increase in H-base, 20% decrease in mineral oil, and 43.5 % decrease in petrolatum were reported. Conductance showed a higher hygroscopicity and a lower water holding capacity than capacitance did. When the measurement of the moisture level iri virious parts of the human body is performed, the corneometer provided us with more stable alies than the hydrometer. While the hydrometer can not the available and appropriate under the condition of insulation, the corneometer can measure moisture levels even down at the depth of 250mm. When measured after the oily surface of the forehead was cleansed with soft tissue, conductance and capacitance revealed higher values of moisture levels than before the eleanin. However, there is no statistical significance in these values. CONCLUSION: The hydrometer is a more appropriate tool for the measurement of moisture at a high level, and the corneometer at a low moisture level. The hydrcmeter is a more sensitive method of measuring the increase and the decrease in the moisture level.
Forehead ; Hand ; Human Body ; Ice ; Lasers, Gas ; Mineral Oil ; Petrolatum ; Skin* ; Urea ; Water ; Wettability

BACKGROUND: Hydration, the water content of the stratum corneum, is an important factor in both the appearance and the barrier function of the skin. Many non-invasive methods have been developed in order to assesa the hydration state of the skin and the effect of various moisturizers. The hydrometer and carneometer are commercially available instruments which are widely used in dermatologic research. OBJECTIVE: Our purpose was to compare the measuring usefulnes of both instruments on normal subjects with a wide range of hydration states of the hornylayer. METHODS: We measured the conductance with the hydrometer and the capacitance with the corneometer in various hydrating eonditions and compared both insruments. RESULTS: Conductance had a non linear correlation with capacita ice. Capacitance measured with the corneometer had a high sensitivity to moisture in a wide range of hydration levels. On the other hand, conductance guaged with the hydrometer showed a few sensitivity to moisture at a low level. When the hydretion level was measured after a moiturizer was added, 10 % urea cream showed a sharp increase by 256% in terms of conductanae, and H-base by 97.8%. Mineral oil decreased by 41.5% and petrolatum by 62% respectively. On the other hand, when measured in terms of capacitance under the same conditions as above, 38.9 increase in 10% urea cream, 19.3% increase in H-base, 20% decrease in mineral oil, and 43.5 % decrease in petrolatum were reported. Conductance showed a higher hygroscopicity and a lower water holding capacity than capacitance did. When the measurement of the moisture level iri virious parts of the human body is performed, the corneometer provided us with more stable alies than the hydrometer. While the hydrometer can not the available and appropriate under the condition of insulation, the corneometer can measure moisture levels even down at the depth of 250mm. When measured after the oily surface of the forehead was cleansed with soft tissue, conductance and capacitance revealed higher values of moisture levels than before the eleanin. However, there is no statistical significance in these values. CONCLUSION: The hydrometer is a more appropriate tool for the measurement of moisture at a high level, and the corneometer at a low moisture level. The hydrcmeter is a more sensitive method of measuring the increase and the decrease in the moisture level.
Forehead ; Hand ; Human Body ; Ice ; Lasers, Gas ; Mineral Oil ; Petrolatum ; Skin* ; Urea ; Water ; Wettability