The eruptive collagenoma is a connective tissue nevus without family history. We report a case of eruptive collagenoma in a 5 year old boy, who had multiple, variable sized orange colored nodules on his back since birth. The histopathologic finding showed increased number and size of collagen fiber and increased dermal thickness.
Child, Preschool ; Citrus sinensis ; Collagen ; Connective Tissue ; Humans ; Male ; Nevus ; Parturition

Mucin-hypersecreting biliary neoplasm excretes excessive mucin that fills the biliary tree and results in marked dilatation of the bile ducts and obstructive jaundice. In these neoplasm, the mucin produced by the tumor rather than the tumor itself plays an important role in clinical course and radiologic patterns. The purpose of this paper is to report characteristic radiologic patterns of mucin-hypersecreting biliary neoplasms in two cases. These neoplasms were characterized by not only multilocular cystic hepatic mass or extra-hepatic bile duct mass resulting in marked biliary dilatation distal to the mass on US or CT, but also change of shape and extent of amorphous filling defects in the markedly dilated bile duct on serial cholangiograms.
Bile Ducts ; Biliary Tract ; Dilatation ; Jaundice, Obstructive ; Mucins

BACKGROUND: A number of recent reports have described the usefulness of the epidural injection of narcotics for the relief of postoperative pain. Morphine, a u-receptor agonist, produce strong analgesic effect with some side effects. Nalbuphine, is a u-antagonist and k-agonist, has an analgesic effect comparable to morphine with little side effects. METHOD: We divided 60 patients into 3 groups utilizing the five-day Baxter Infusor in 0.125% bupivacaine at 0.5 ml/hr: 1) Group M (n=20) received initial 2 mg of bolus + 2 mg/day of maintenance morphine 2) Group N(n=20); initial 4 mg of bolus + maintenance 8 mg/day nalbuphine 3) Group M+N(n=20); initial 2 mg morphine of bolus + maintenance 8 mg/day nalbuphine. Analgesic effect was evaluated by visual analogue scale(0-10) at 6, 12, 18, 24 and 48 hour postoperatively. Changes in blood pressure, heart rate, and incidence of side effects were observed. RESULTS: No significant hemodynamic changes were seen in any of the groups. The patients of group M and M+N get less pain than group N but side-effects of group M were significantly more than group N, M+N. CONCLUSIONS: Nalbuphine hydrochloride could be better agent than morphine in terms of complication and the dose of group M+N (initial morphine 2mg of bolus + maintenance 8 mg/day nalbuphine) may be recommended for postoperative analgesia.
Analgesia ; Blood Pressure ; Bupivacaine ; Heart Rate ; Hemodynamics ; Humans ; Incidence ; Infusion Pumps ; Injections, Epidural ; Morphine* ; Nalbuphine* ; Narcotics ; Pain, Postoperative*

A 36-year-old male patient with no remarkable medical history was admitted to our hospital for a health check up. On chest radiography, bilateral aortic notches at the level of aortic arch were shown suggesting aortic arch anomaly without any clinical symptoms. Two aortic arches were almost same-in-size on suprasternal view of transthoracic echocardiography. In addition, multidetector computed tomography showed balanced type double aortic arch forming a complete vascular ring which encircled the trachea and esophagus. The trachea was slightly compressed by the vascular ring whereas the esophagus was intact. Nevertheless, the pulmonary function test was normal. The patient was discharged from hospital with instructions for periodic follow-up.
Adult ; Aorta, Thoracic ; Echocardiography ; Esophagus ; Follow-Up Studies ; Humans ; Male ; Multidetector Computed Tomography ; Respiratory Function Tests ; Thorax ; Trachea

Neurogenic pulmonary edema (NPE) occurs in association with CNS lesions and in the absence of underlying cardiopulmonary disease. The dramatic increase in intracranial pressure (ICP) that follows aneurysmal rupture appears to trigger a massive autonomic discharge which causes virtually instantaneous circulatory adjustments i.e. NPE. When we anesthetize a cerebral aneurysmal patient combined with NPE, not only is there the risk of hypoxemia due to NPE, but also we have difficulty in managing to control hemodynamics and hypervolemia. As we experienced a cerebral aneurysmal patient combined with NPE, we report this case with a review of the literature.
Aneurysm ; Anoxia ; Hemodynamics ; Humans ; Intracranial Aneurysm* ; Intracranial Pressure ; Pulmonary Edema* ; Rupture*

Achromobacter xylosoxidans can cause various types of infections, but its infection in humans is rare. A. xylosoxidans has been reported as a rare etiological agent of infections including primary bacteremia, catheter-related bloodstream infection, endocarditis, otitis, and pneumonia, particularly in immunocompromised hosts. We encountered a case of septic shock caused by A. xylosoxidans in a 52-year-old, immunocompetent woman with no underlying disease, who received extracorporeal shock wave lithotripsy to remove a left upper ureteral stone. She was treated with antibiotics to which the organism was susceptible but died as a result of septic shock.
Achromobacter denitrificans* ; Achromobacter* ; Anti-Bacterial Agents ; Bacteremia ; Endocarditis ; Female* ; Humans ; Immunocompromised Host ; Lithotripsy* ; Middle Aged ; Otitis ; Pneumonia ; Shock* ; Shock, Septic* ; Ureter*

BACKGROUND: It is known that severe infection and inflammation lead to hemostatic abnormalities. Recently, much attention is focused on the mechanisms of infection or inflammation and on how it plays a central role in effecting the coagulation system. Disseminated intravascular coagulation in particular, is a common phenomenon in patients with sepsis, but the clinical implications of this condition are not clear. Therefore we attempted to evaluate the changes of the coagulation system in patients with sepsis and studied the factors that lead to such changes. METHODS: One hundred one patients diagnosed with sepsis were enrolled in this study. The patients were clinically evaluated for underlying disease and data for inflammatory status and coagulative changes were evaluated retrospectively. RESULTS: The WBC count increased in 76% and decreased in 6% of sepsis patients in comparison to the reference interval. The platelet count decreased in 65.3%. Changes in coagulative tests such as prothrombin time, activated partial thromboplastin time, antithrombin III, and D-dimer were observed in 70.4%, 52.7%, 87.2% and 100% of the patients, respectively. Correlation between ESR and fibrinogen was the highest in relation to the other coagulation factors. CRP also showed the highest correlation with fibrinogen in contrast to the other coagulation factors. CONCLUSIONS: This study confirmed the clear activation of coagulation in patients with sepsis. Of the evaluated factors involved in coagulation and fibrinolysis, fibrinogen showed the highest correlation to indices representing the inflammatory state. However further studies on the anticoagulant pathway are necessary in elucidating this matter.
Adult ; Aged ; Aged, 80 and over ; Bacterial Infections/diagnosis ; Biological Markers/analysis ; *Blood Coagulation ; Blood Coagulation Tests ; C-Reactive Protein/analysis ; Disseminated Intravascular Coagulation/*diagnosis/etiology ; Female ; Humans ; Inflammation/diagnosis ; Male ; Middle Aged ; Platelet Count ; Retrospective Studies ; Sepsis/*blood/complications/diagnosis ; Statistics as Topic

We describe a 27-year-old man who developed gait disturbance and dysarthria 2 years after the onset of cardinal symptoms of Behcet's disease. Positron emission tomography with 18F-fluorodeoxyglucose revealed severe hypometabolism in the cerebellum, in accordance wih cerebellar symptoms and sign of the patient. However, single-photon emission tomography with Tc-99m-HMPAO and Tc-99m-ECD did not disclose significant perfusion abnormalities in the brain. Routine brain magnetic resonance imaging did not show signal abnormalities. The findings of imaging studies compared with neurological manifestations of the patient are discussed.
Adult ; Brain ; Cerebellum ; Dysarthria ; Gait ; Humans ; Magnetic Resonance Imaging* ; Neurologic Manifestations ; Perfusion ; Positron-Emission Tomography ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: 1) to construct cohorts according to risk scores calculated with the Gail Breast Cancer Risk Assessment Tool (Gail et al., 1989) (Gail) and the Breast Cancer Risk Appraisal (Lee et al,. 2003) (Lee) 2) to identify the distribution of risk factors and preventive behavior stages between the cohorts 3) to identify abnormal breast conditions in risk cohort. METHOD: Using convenience sampling, 775 rural women were selected. Risk appraisal was scored using Gail and Lee. Preventive behavior stages for BSE (Breast self examination) and mammography were measured using 4 stages of the Transtheoretical Model (Prochaska & DiClemente, 1983). RESULTS: 1) The risk cohort according to Gail was 12.3% (n=95), and Lee, 3.1% (n=24). 2) There were significant differences in the distribution of risk factors (age, family history, age at 1st live birth, age at menarche, number of breast biopsy, history of breast disease, and breast-feeding) between cohorts. 3) There was a significant difference in the distribution of the stage of BSE according to Lee. 4) Six women in the risk group detected masses or nodules and physician consultation and ultrasonography were recommended. CONCLUSION: On the basis of the constructed cohorts, further longitudinal studies of cohorts are recommended with interventions according to characteristics of cohorts.
Biopsy ; Breast Diseases ; Breast Neoplasms* ; Breast* ; Cohort Studies* ; Female ; Humans ; Live Birth ; Mammography ; Menarche ; Risk Assessment ; Risk Factors ; Ultrasonography

Aldosterone synthase gene (CYP11B2) -344C/T polymorphism has been reported to be associated with serum aldosterone level, urinary aldosterone excretion, blood pressure, and left ventricular size and mass. The aim of this study was to evaluate the relation between CYP11B2 polymorphism and end-stage renal disease (ESRD) in the Korean population and the association with CYP11B2 polymorphism and cardiovascular morbidity in ESRD patients on hemodialysis. Genotyping was performed in 134 control subjects and 271 ESRD patients for CYP11B2 polymorphism using polymerase chain reaction through subsequent cleavage with restriction enzyme. Also current blood pressure, demographic, anthropometric and biochemical variables were investigated. The genotype distribution did not differ between ESRD patients and controls and there were no significant differences in blood pressure, use of antihypertensive medication, left ventricular hypertrophy and cardiovascular disease among the three genotypes in ESRD patients on hemodialysis. Our findings do not support the hypothesis that CYP11B2 polymorphism may be associated with prevalence of ESRD and suggest that CYP11B2 polymorphism may not be a genetic marker for cardiovascular morbidity in Korean ESRD patients.
Aldosterone ; Aldosterone Synthase ; Blood Pressure ; Cardiovascular Diseases ; Genetic Markers ; Genotype ; Humans ; Hypertrophy, Left Ventricular ; Kidney Failure, Chronic ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Prevalence ; Renal Dialysis