The symmetrical peripheral gangrene syndrome consists of sudden onset of symmetrical gangrene of the fingers, toes and more raely, the nose, upper lip, ear lobes, or genitalia. There is no evidence of occulusion of large vessels or vasculitis. We experienced a case of symmetrical peripheral gangrene developed in fingers and toes with disseminated intravascular coagulation in 20 day-old permature infant with sepsis by Enterobacter aerogenes. Thereafter, we presented a case with a brief review of the related literatures.
Disseminated Intravascular Coagulation* ; Ear ; Enterobacter aerogenes ; Fingers ; Gangrene* ; Genitalia ; Humans ; Infant ; Lip ; Nose ; Sepsis ; Toes ; Vasculitis

PURPOSE: The purpose of this study was to evaluate the CT findings of acute pyelonephritis (APN) in children and to assess the correlation between these findings, clinical parameters and renal scar development, as seen on follow-up CT scans. MATERIALS AND METHODS: Contrast-enhanced CT scans of thirty children in whom APN had been diagnosed were assigned to one of three groups according to whether an abscess had formed, and then to subgroups on the basis of the number of lesions in the renal parenchyme. Initial CT findings were retrospectively correlated with five clinical parameters (maximal body temperature, fever duration, leukocytosis, pyuria and admission period) and renal scar development, as seen on follow-up CT (n=12). RESULTS: CT scans demonstrated linear, wedge-shaped, low-density renal parenchymal lesions in 35 kidneys of 25 patients and abscesses in seven kidneys of seven patients, but no abnormal lesions in five patients. In the three groups there was correlation between these findings and some clinical parameters (maximal body temperature, fever duration and admission period), but no subgroup showed significant correlation with any clini-cal parameter. Renal cortical scars detected by follow-up CT were more prevalent in patients in whom initial CT demonstrated the presence of an abscess. CONCLUSION: Clinical parameters correlated with the presence of renal parenchymal hypoenhancing lesions and abscess formation, as seen on CT scans, rather than the number of renal parenchymal lesions. Renal cortical scars were more prevalent in patients in whom initial CT revealed the presence of an abscess. Enhanced CT is thought to be useful both for diagnosing APN and for predicting its clinical course in children.
Abscess ; Body Temperature ; Child ; Cicatrix ; Fever ; Follow-Up Studies ; Humans ; Kidney ; Leukocytosis ; Pyelonephritis* ; Pyuria ; Retrospective Studies ; Tomography, X-Ray Computed

A case of arterial priapism was treated by superselective transcatheteric autologous clot embolization of cavernosal artery 25 days after blunt periheal trauma. No immediate improvement was noted but the priapism subsided on 48th day after the procedure. Normal physiclogic erectlie function was achieved on 53rd day after the procedure, and the period of postprocedure impotence was shortened, as compared with previously reported cases. Autologous blood clot embolization may be an effective treatment method even in delayed priapism, and superselective technique is thought to be more effective to shorten the postprocedure erectlie dysfunction
Arteries ; Erectile Dysfunction ; Male ; Priapism*

The selection of the chemotherapeutic agents for the treatment of the urologic malignancy was one of the difficult problem in urologic practice. After the development of the in vivo sensitivity test using subrenal capsular implantation of the cancer tissue, a lot of the application of this assay were performed in various field of the advanced malignancies. We examined the histopathological changes of the implanted urologic cancer tissues under the renal capsule of the mice. The specimens, implanted under the renal capsule, were 14 cases of the bladder cancer, 2 cases of the renal cell carcinoma and one case of the prostatic carcinoma. In experiment, we used 472 immunocompetent normal mice and divide them into two groups, non-immunosuppressed normal mice and immunosuppressed group with intravenous infusion of the cyclophosphamide 200mg/kg 24 hours prior to assay. As the control group, we used athymic nude mice for human urologic cancer and C3H/He strain for MBT-2 bladder cancer. The results we found were as follow ; 1. The growth of the implanted cancer tissues was noticed in 270 mice among 291 which were sacrificed until the 6th postoperative day and the take rate was 92.8%. 2. The growth of the implanted cancer tissues was continuous until the 6th postoperative day progressively but reduced thereafter in immunocompetent group. But in immunosuppressed group, it showed progressive growth of the implanted tissue until the 8th postoperative day. The growth of the control group was similar to the immunosuppressed group, until the 6th postoperative day. 3. Calculation of the proportion of the host cellular infiltration in total dimension of the grafted tissue was done and in immunocompetent group, the 4th postoperative day group was 27.3%, the 6th postoperative group was 89.4% and the 8th postoperative group was 100%. But in contrast in immunosuppressed group, at the 4th postoperative day group was less than 10%, the 6th postoperative day was 29.4% and at the 8th postoperative day group was 91.7%. With above histopathological study, we conclude that the most easy and reasonable subrenal capsular assay(SRCA) in the in vivo chemosensitivity test for the selection of the anticancer chemotherapeutic agent for the treatment of the malignancy is the test performed under the immunosuppressed state with cyclophosphamide, 24 hours prior to SRCA, and the results is the most proper at the examination at postoperative 6th day after implantation.
Animals ; Biological Assay ; Carcinoma, Renal Cell ; Cyclophosphamide ; Humans* ; Infusions, Intravenous ; Mice ; Mice, Nude ; Transplants ; Urinary Bladder Neoplasms ; Urologic Neoplasms*

Cortical spreading Depression(CSD) is a transient depression of neuronal activity that spreads across the cortical surface and is associated with profound changes in blood flow, extracellular ion concentration. Direct Current(DC) potentials and cell membrane potentials. One of the electrophysiological disturbance in the periinfarct surrounding is spontaneous occurrence of repeated CSD like DC shifts associated with increased energy demand. Due to restricted blood flow to the periinfarct border zone, elevated metabolic demand is potentially hazardous. So the authors designed this experiment to verify the correlation between periinfarct cortical spreading depression and ischemic volume following permanent middle cerebral artery(MCA) occlusion in rats. Sprague-Dawley rats(n=27) were anesthetized with 0.5~1% halothane, and artificially ventilated through a tracheal cannula. Arterial pressure, blood gases and body temperature were controlled. The middle cerebral artery(MCA) was occluded distally to the lenticulostriate branches. Measurements of CSD activity were made for 4 hours in each animal infarct volume was determined 6 hours later in 2,3,5-triphenyl tetrazolium chloride(TTC)- stained section. For 4 hours after MCA occlusion, the CSDs were found in all experimental animals with a range of 2~9 times. Those CSDs were of varying duration: "small"(1min) SDs and mean of total duration of SD was 10.5+/-10.3 min during 4 hours of MCA occlusion. Neuropathological evaluation of brain infarct in the rats, which had been allowed to survive for 6 hours after MCA occlusion showed a mean volume of 89.7+/-45.3 mm3. Serial observation of duration of CSD prologation of duration of CSD nor the frequency of CSD in the penumbral zone correlated with the volume of infarct.However total duration of CSD was slightly related with the infarct volume after 6 hours of the permanent MCA occlusion(r=0.414, p=0.0318) .
Animals ; Arterial Pressure ; Body Temperature ; Brain ; Catheters ; Cell Membrane ; Cortical Spreading Depression* ; Depression ; Gases ; Halothane ; Neurons ; Rats* ; Rats, Sprague-Dawley

PURPOSE: For prevention of renal scar, early diagnosis and treatement of acute pyelonephritis are important in children with febrile urinary tract infection. But it has been difficult to differentiate acute pyelonephritis from lower urinary tract infection. We have performed this study to evaluate the diagnostic value of 99mTc-DMSA renal scan and to clarify the relationship among acute pyelonephritis, vesico-ureteral reflux and renal scar. METHODS: We have studied 100 patients with febrile urinary tract infection, from September, 1993 to June, 1995 at the Pediatric department of Ewha Womans University, Mok-dong hospital. Acute phase reactants, causative organism, renal ultrasound, 99mTc- DMSA renal scan on the acute stage, voiding cystouretherogram after 1-2 weeks of treatement, and follow-up 99mTc-DMSA renal scan were evaluated. RESULTS: Ther results are as follows; 1) 57 patients (57%) had defect on 99mTc-DMSA renal scan and diagnosed as acute pyelonephritis. 2) Acute phase reactants, renal ultrasound had low accuracy. 3) VUR was found in 31 (56.1%) of 57 patients with defect which was significantly higher than the 4 (9.3%) of 43 patients without defect on 99mTc-DMSA renal scan. 4) On the follow up 99mTc-DMSA renal scan, 34.8% of defects recorvered, and 65.2% of defects developed renal scar. CONCLUSIONS: 99mTc-DMSA renal scan is a valuable method for early diagnosis of acute pyelonephritis in children with febrile urinary tract infection. It would contribute to evaluate the relationship between acute pyelonephritis, vesico-ureteral reflux and renal scar.
Acute-Phase Proteins ; Child* ; Cicatrix ; Early Diagnosis* ; Female ; Follow-Up Studies ; Humans ; Pyelonephritis* ; Succimer ; Technetium Tc 99m Dimercaptosuccinic Acid* ; Ultrasonography ; Urinary Tract Infections* ; Urinary Tract* ; Vesico-Ureteral Reflux

PURPOSE: To determine the frequency with which ultrasonography (US) provides a correct diagnosis and suggests appropriate guidance for the treatment of patients with right lower quadrant abdominal pain. MATERIALS AND METHODS: During an 11-month period, US was consecutively performed in 84 patients who were presented with right lower quadrant abdominal pain. In the 76 [M ; F=16 ; 60, age range 14 -87 (mean, 41) years] who formed the study population, final diagnoses were made surgically or clinically. For US, a 5 -7-MHz convex-array, 4-MHz vector-array, and/or 7-MHz linear-array transducer was used, according to the patient 's body habitus. To determine how often our US reports had provided a correct diagnosis and suggested appropriate guidance for surgical or medical treatment, and to calculate their diagnostic value, the reports were retrospectively compared with final diagnoses. RESULTS: US diagnoses were acute appendicitis in 40 patients (53%), diseases other than this in 25 patients (33%), and no abnormality in 11 (14%). In 38 of the 40 patients (95%), the diagnosis of acute appendicitis was surgically confirmed as correct, and for other diseases, diagnoses based on the findings of US proved to be correct in 21 of 25 patients (84%). Overall, diagnosis was correct in 67 (88%). As regards appropriate guidance for treatment, 46 (61%) and 30 (39%) patients were diagnosed by US to have surgical and medical diseases, respectively. In 44 of the 46 (96%), it was confirmed guidance was appropriate, and for the 30 with medical disease, this was so in all but one case (97%). Overall, the treatment plan was appropriate in 72 patients (95%). CONCLUSION: Our study revealed that US was able to provide a correct diagnosis in 88% of patients with right lower quadrant abdominal pain, and in 95% of these, the treatment plan suggested was appropriate. US is, therefore, a valuable screening tool in the diagnosis and therapeutic guidance of such patients.
Abdominal Pain* ; Appendicitis ; Diagnosis ; Humans ; Mass Screening ; Retrospective Studies ; Transducers ; Ultrasonography

Childhood intestinal tuberculosis is difficult to diagnose for its protean clinical manifestations, especially in cases without pulmonary involvement. Differential diagnosis with Crohn's disease, inflammatory bowel disease and other malignancy is also important. Surgery has often been required for pathologic confirmation or therapy. Colonoscopy may be performed safely under consciousness sedation in children for bacteriologic and histopathologic confirmation of the biopsy specimen in addition to gross appearance of the lesion. We have experienced a case of intestinal tuberculosis presenting with chronic abdominal pain, diarrhea, weight loss and anemia in a 9 year old girl who was diagnosed by a colonoscopic examination and culture of the biopsy specimen from the ascending colon. The patient was managed with antituberculous drugs and recovered uneventfully.
Abdominal Pain ; Anemia ; Biopsy ; Child ; Colon, Ascending ; Colonoscopy* ; Consciousness ; Crohn Disease ; Diagnosis, Differential ; Diarrhea ; Female ; Humans ; Inflammatory Bowel Diseases ; Tuberculosis* ; Weight Loss

Hemichorea-hemiballsim has been reported as a rare Implication of nonketotic hyperglycemia. Recently, Some reports revealed that brain magnetic resonance images of nonketotic hyperglycemic patients with hemichorea-hemiballism showed characteristic contralateral striatal signal abnormality, We present six patients with hemichorea-heniiballism. All of them had diabetes mellitus and performed brain MR images. The MR images of them showed high signal intensity on Tl-weighted images and low signal intensity on T2 weighted images in the striatum contralateal to the involuntary movement. In general, the striatal high signal intensity on TI weighted images are presumed to have developed following hemorrhagic transformation, osmotic myelinolysis, or mild ischemia with reversible deposition of calcium or other material occurred in association with nonketotic hyperglycemia. However the precise mechanism of this signal change is not clear yet and needs pathological confirmation.
Brain ; Calcium ; Diabetes Mellitus ; Dyskinesias ; Humans ; Hyperglycemia ; Ischemia

In clinical practice a serious sciatic nerve injury may result from an errornous injection of commonly used antibiotics and other therapeutic or prophylactic agents into the gluteal region which can occur at any age, especially common in infants, children and small debilitated patients. Although many isolated cases and several large series of injuries have been reported, the pathogenesis, pathology and its physiology of injection injury of the peripheral nerves in man have been poorly studied. This experimental study was conducted in order to observe the changes and degree of the functional disability of the sciatic nerve following injection of various drugs such as Rheumapyrine, Chloromycetin, Penicillin and physiological normal saline solution. Fourty-three normal adult rabbits were divided into four groups depending on injected materials and also divided into two groups of acute and chronic stages. The drugs were injected into the right sciatic nerve intraneurally and around the left sciatic nerve perineurally. For the functional study in the nerve, contractability of the calf muscle was recorded on a physiograph at intervals of 1, 3, 5, 15 and 30 minutes after the injection of the drugs. Rheobase, chronaxie and strength-duration curve of both extensor and flexor muscles of fet were recorded and measured on a chronaxie meter at intervals of 1, 2, 3 and 4 weeks after the injection. The physiogram showed the greatest reduction in contractability of the muscles in Rheumapyrine, moderate reduction in Penicillin and the least reduction in Chloromycetin group. In the measurements of rheobase and chronaxie there were marked increase of values in group of Rheumapyrine injection. There was no significant differences in values among the group of Penicillin, Chloromycetin and saline injections in comparison with those in the control group. In the analysis of strength-duration curve, it showed a pattern of complete denervation in 3 cases and a pattern of partial denervation in 3 out of 8 cases with Rheumapyrine injection, and a pattern of partial denervation in 3 out of 6 cases with Penicillin and 2 out of 8 cases with Chloromycetin injection. There was no significant differences in values of rheobase, chronaxie and strength-duration curve as time elapsed following the injury. It was postulated the functional and physiological disabilities were developed after the injection when there was a severe degree of nerve damages on the basis of histopathological study.
Adult ; Anti-Bacterial Agents ; Buttocks ; Child ; Chloramphenicol ; Chronaxy ; Denervation ; Humans ; Infant ; Muscles ; Pathology ; Penicillins ; Peripheral Nerves ; Physiology ; Rabbits ; Sciatic Nerve* ; Sodium Chloride