The antiphospholipid syndrome is characterized by arterial thrombosis, venous thrombosis, pregnancy wastage, and thrombocytopenia associated with a persis tently positive lupus anticoagulant and/or moderate to high positive anticardiolipin antibodies(IgG or IgM). The antiphospholipid antibodies have been detected in many medical conditions, but the antiphospholipid syndrome (APS) has mainly been restricted to the primary antiphospholipid syndrome and APS associated with systemic lupus erythematosus. Rarely, the APS has been reported in other autoimmune disorders in the literature. We describe a woman with a limited form of scleroderma and the APS manifested by complete occlusion of left axillary artery with probable thrombotic occlusive nature, thrombocytope nia, prolonged aPTT, and persistently positive lupus anticoagulant.
Antibodies, Antiphospholipid ; Antiphospholipid Syndrome* ; Axillary Artery ; Female ; Humans ; Lupus Coagulation Inhibitor ; Lupus Erythematosus, Systemic ; Pregnancy ; Scleroderma, Limited* ; Thrombocytopenia ; Thrombosis ; Venous Thrombosis

Epidermal cyst in the fibroadenoma of the breast is very rare. A 29-year-old woman presented with a lump in the upper outer quadrant of the right breast. Clinically it was a fibroadenoma and the excisional specimen showed an encapsulated, firm lobulated lesion with a cystic area on cut surface. The cystic area showed squamous metaplasia of the ductal epithelium and keratinous cyst formation in the fibroadenoma. We report this unusual case with review of literatures.
Adult ; Breast ; Epidermal Cyst* ; Epithelium ; Female ; Fibroadenoma* ; Humans ; Metaplasia

A reproducible noninvasive technique for measuring right ventricular ejection fraction (RVEF) was developed using first pass quantitative radionuclide angiocardiography. Tests were carried out in the right anterior oblique position with a computerized multicrystal scintillation camera with high count rate capabilities. RVEF was calculated on beat to beat basis from the high frequency components of the background-corrected right ventricular time-activity curve. The following results were obtained; 1) In 10 normal adults, RVEF averaged 50.9+/-8.2. In 20 patients with chronic obstructive lung diseases (COPD), RVEF was 37.9+/-6.1% and significantly lower than that of normal persons(P<0.005). 2) There was meaningful correlation between RVEF and forced expiratory volume (FEVI) in patients with COPD (r=0.51). And there was significant difference of RVEF between 13 patients with FEVI less than IL/min (6 patients with right ventricular failure, 7 patients with patients without that) and 7 patients with FEVI IL/min or more (35.7+/-6.0%, 42.1+/-3.2% respectively. P<0.005). 3) All 6 patients with clinical manifestation of right heart failure had abnormal RVEF and had FEVI less than IL/min, which was significantly lower than that of 14 patients without clinical manifestation of right heart failure (33.6+/-4.8%, 39.8+/-5.6%, respectively. P<0.005). 4) In 14 patients without clinical manifestation of right heart failure, 11 patients among whom 7 patients had FEVI less than IL/min, had abnormal RVEF.
Adult ; Angiocardiography ; Forced Expiratory Volume ; Gamma Cameras ; Heart Failure ; Humans ; Lung Diseases, Obstructive* ; Pulmonary Disease, Chronic Obstructive ; Radionuclide Ventriculography* ; Stroke Volume ; Ventricular Function, Right*

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

No abstract available.
Mycobacterium* ; Skin*

Spondylometaphyseal dysplasia (SMD) is an extremely rare, which affects the spine and metaphy-ses of the tubular bones on terms of enchondrogenesis. Children who had Kozlowski dwarfism, type of SMD are not recognized until they reach school age since they have normal clinical feature, weight and size in early childhood. Authors experienced a typical case of Kozlowski type of SMD in a 10 years old male who had i) generalized platyspondyly with anterior tapering of vertebrae ii) generalized metaphyseal dysplasia iii) minimal changes in the carpal and tarsal bones. This case is to be reported with review of references.
Child ; Dwarfism ; Humans ; Male ; Spine ; Tarsal Bones

No abstract available.
Clonorchiasis* ; Clonorchis sinensis

Septic arthritis of hip is a serious problem. Delay in diagnosis and treatment can results in crippling. From September 1983 to May 1993, we have experienced 17 cases of pyogenic arthritis of the hip in neonates and infants. Ten cases were under the age of 1 month old, four were from 1 month to 2 months, and the rest of 3 cases were 11 months old with depicting high incidence in neonates within 1 month. Laboratory findings according to lag periods were as follows; The patients group (n=9) who visited within 3 days after symptom onset manifested high fever (over 38oC) in 2 cases only and 7 cases revealed normal or mild fever. The patients group (n=8) being seen later than 3 days showed high fever in most of cases. Leukocytosis was mostly unspecific in both groups. The average WBC counts tested on admission were 16,052/mm3, ESR 38.3mm/hr,and WBC count dropped to 11,264/mm3, ESR to 27.3 mm/hr after operation. Microbial culture was positive in 10 cases (58.8%), of which 4 were staphylococcus, 5 were streptococcus and 1 was ancinetobacter. Surgical drainage was done through the posterior approach. Long term follow up showed no recurrence and severe complications such as dislocation of head, avascular necrosis and osteomyelitis of proximal femoral metaphysis In conclusion, pyogenic arthritis of hip occurred more common in neonates less than month old and laboratory findings were not always accompanied by fever and hematologic changes especially when the symptom onset was less than 3 days.
Arthritis* ; Arthritis, Infectious ; Diagnosis ; Dislocations ; Drainage ; Fever ; Follow-Up Studies ; Head ; Hip* ; Humans ; Incidence ; Infant* ; Infant, Newborn* ; Leukocytosis ; Necrosis ; Osteomyelitis ; Recurrence ; Staphylococcus ; Streptococcus

BACKGROUND: Video-assisted thoracic surgery (VATS) is being used as a therapeutic modality in many diseases in which thoracotomy has been used. We studied that the VATS can substitute the thoracotomy in benign esophageal disease. MATERIAL AND METHOD: Group I (n=18) underwent video-assisted thoracic surgery, and group II (n=19) thoracotomy. Group I includes 14 leiomyomas and 4 achalasias. Group II includes 16 leiomyomas and 3 achalasias. Operative technique is enucleation in the leiomyoma and modified Heller's myotomy in the achalasia. Analyzing factors of operation-efficacy are anesthetic time, operation time, hospital stay, chest tube drainage amount and chest tube removal day. The degree of the postoperative pain is assessed by the frequency of opioid analgesics injection. RESULT: There was no death in both groups. There were 5 complications in the group I and 2 in the group II. Prolonged pleural effusion and restenosis of achalasia occurred to 1 patient in each group. In the group I, there were 1 temporaty vocal cord palsy and 2 mucosal tear leading to thoracotomy. There were no differences in anesthesia time, operation time, hospital stay, total chest tube drainage amount, chest tube removal day and frequency of opioid analgesics injection. The amount of the chest tube drainage at POD 1 day was significantly lower in group I (155.6+/-77.8cc) than in group II (572.8+/-280.1cc) (p<0.05). CONCLUSION: The results of our data showed that video-assisted thoracic surgery for benign esophageal disease is as effective as thoracotomy and in addition, cosmetic effect is much better. We concluded VATS may be a substitute for thoracotomy in benign esophageal disease.
Analgesics, Opioid ; Anesthesia ; Chest Tubes ; Drainage ; Esophageal Achalasia ; Esophageal Diseases* ; Humans ; Leiomyoma ; Length of Stay ; Pain, Postoperative ; Pleural Effusion ; Thoracic Surgery, Video-Assisted* ; Thoracotomy* ; Vocal Cord Paralysis

Purpose: We evaluated a new color vision test, thus the ColorDx Cone contrast test HD ([CCT-HD]; Konan Medical, Inc., Irvine, CA, USA) in normal and color vision-deficient (CVD) eyes of Koreans. Methods: The CCT-HD was performed on 66 healthy Koreans (125 normal eyes) and 25 patients (50 eyes) with congenital CVD. The results from normal eyes were compared and analyzed in terms of binocular agreement, patient ages, and spherical equivalents. The CCT-HD results on CVD eyes were compared and analyzed. Results: We found no significant difference in any of the long (L), medium (M), or short wavelength (S) cone cell sensitivity (L-CCT, M-CCT, S-CCT) scores for normal eyes; also, there was no significant effect of age and no significant correlation between the spherical equivalent and the CCT score. In normal eyes, all scores were >75 (normal ≥75). The average protan L-CCT score was significantly reduced (13.0 ± 13.2; p < 0.001) as was the average deutan M-CCT score (31.7 ± 16.6; p < 0.001). The CCT-HD L-CCT and M-CCT exhibited 100% sensitivity and specificity in terms of diagnosing protans and deutans respectively. Conclusions CCT-HD allows classification and quantitative evaluation of protans and deutans, and is thus useful when examining color vision status.