We describe cytologic findings of two cases of pilomatrixoma which had been cytologically misdiagnosed as suspicious malignant and malignant lesions in 35 year-old and 22 year-old females who presented a palpable neck mass. The cytologic smears showed many basaloid cells with a high nuclear-cytoplasmic ratio, nuclear hyperchromatism and prominent nucleoli, keratinized squamous cells with pyknotic nuclei, foreign body giant cells, and chronic inflammatory cells in necrotic background. Retrospective view of this aspiration smear revealed that these findings were characteristic features of pilomatrixoma, and the evenly distributed chromatin pattern as well as the lack of nuclear pleomorphism were considered to be the differential points from malignant neoplasm. Pilomatrixoma is a benign neoplasm which should be included in differential diagnosis if the fine needle aspiration cytologic smear of a neck mass or subcutaneous mass of any site showed these features.
Female ; Humans ; Diagnosis, Differential

No abstract available.
Hypoglossal Nerve ; Hypoglossal Nerve Diseases

A prospective study had been performed in infants with hydronephrosis due to ureteropelvic junction stenosis to determine adequate management plan. Forty infants (47 renal units) were selected for the study during the period from January 1995 to July 1997 in the Department of Pediatrics, Asan Medical Center. They were diagnosed prenatally or early postnatally (<3 months of age) on the basis of renal ultrasonography and techotium-99m-mercap- toacetyltriglycerine (MAG3) scan. The antero-poste- rior pelvic diameter (APPD) was measured from serial renal ultrasonography and relative renal function and clearance half time (T1/2) were calculated from serial MAG3 scan. Those who had accompanying other urogenital anomalies or vesicoureteral reflux were excluded in this study. Follow-up tests (ultrasonography and MAG3 scan) and surgical corrections, if necessary, were performed according to the predetermined algorithrn. The male to female ratio was 3: 1. Hydronephrosis was involved the left side in 24 renal units, the right side in 9 renal units, and the bilateral sides in 14 renal units. All the hydronephrotic renal units were divided into 2 groups; Group A (19 renal units) those had taken surgical correction, and group B (28 renal units) those revealed spontaneous improvement without surgical correction. The mean follow-up duration was 7.2+/-6.3 months in group A and 14.1+/-12.6 months in group B. The mean APPD in the first postnatal renal ultrasonography was 19.4+6.8 mm in group A and 10.0+/-3.0mm in group B and this was statistically significant (P<0.01). The rela- tive renal function of group A in the first MAG3 scan was under 35% in 7 renal units and over 35M in 12 renal units. In group B, the relative renal function was over 35% in the all 28 renal units. Tl/2 in the first MAG3 scan was longer than 20 minutes in the all 19 renal units in group A. In group B, Tl/2 was shorter than 10 minutes in 15 renal units, between 10 minutes and 20 minutes in 6 renal units, and longer than 20 rninutes in 7 renal units. The mean APPD of the 7 renal units in group B of which Tl/2 was longer than 20 minutes was 12.62.6mm and that of group A was 19.4+/-6.8mrn and this was statistically significant (P<0.01). In conclusion, the renal ultrasonography and MAG3 scan can be used effectively to determine the degree of the stenosis of the ureteropelvic junction in hydronephosis during infancy. When the babies are diagnosed with hydronephrosis due to ureteropelvic junction stenosis in the early infantile period, serial renal ultrasonography and MAG3 scan play an important role in the decision of the management.
Chungcheongnam-do ; Constriction, Pathologic ; Female ; Follow-Up Studies ; Humans ; Hydronephrosis* ; Infant ; Male ; Pediatrics ; Ultrasonography* ; Vesico-Ureteral Reflux

BACKGROUND: The eosinophil chemotactic and activating effects of eotaxin and the known association of eosinophils with asthma suggest that eotaxin expression is increased during an asthma attack. This study was aimed to determine whether the plasma eotaxin levels are higher in patients during as asthma attack and to correlate the eotaxin levels with the disease activity, severity and response to therapy. METHOD: A case-control study of the plasma eotaxin levels was performed in 100 patients with exacerbated asthma and 48 age-and sex-matched subjects with stable asthma. RESULTS: The plasma eotaxin levels were significantly higher in the 100 patients with exacerbated asthma (233±175 pg/ml) than in the 48 subjects with stable asthma(169±74 pg/ml). A tread toward higher eotaxin levels was observed in asthmatic subjects who were taking oral steroids (332±225 pg/ml) than in those who were not (214±159 pg/ml) and higher levels were found in those admitted to the hospital (275±212 pg/ml) than in those discharged after receiving only emergency treatment (190±115 pg/ml). The eotaxin levels inversely correlated with the FEV1 (r=-0.25, p<0.01). The eotaxin levels were higher in moderate persistent (323±256 pg/ml) and severe persistent asthmatics (276±170 pg/ml) than in mild intermittent asthmatics (160±60 pg/ml). CONCLUSION: Eotaxin expression is directly associated with asthma exacerbation, impaired pulmonary function and the disease severity.
Asthma* ; Case-Control Studies ; Emergency Treatment ; Eosinophils ; Humans ; Plasma* ; Steroids

PURPOSE: To report a case of ocular myasthenia gravis in conjunction with thyroid-associated ophthalmopathy in a patient who showed incomitant strabismus and blepharoptosis as well as to discuss the clinical features and tests that may help distinguish these 2 diseases. CASE SUMMARY: A 46-year-old man without any previous history of systemic and ophthalmic disease presented with binocular diplopia that occured a month earlier. The patient had no other systemic symptoms except a 7 kg weight loss within the last month. The patient was referred to the department of internal medicine and brain magnetic resonance imaging was performed to ascertain the cause of suspected left superior oblique muscle palsy. The patient was diagnosed with Graves' disease and underwent medical treatment. One month later, the patient presented with consistent diplopia and exophthalmos and showed a swelling of eyelid and ptosis in the right eye. Intravenous high-dose steroid therapy was administered to the patient. After the treatment, symptoms of diplopia and lid swelling were improved, however ptosis persisted. Ocular myasthenia gravis was suspected and various tests were conducted. Anti-acetylcholine receptor antibodies were detected in large amounts and ptosis was improved dramatically by an administration of an anticholinesterase agent. The patient was diagnosed with ocular myasthenia gravis in conjunction with thyroid-associated ophthalmopathy. CONCLUSIONS: Ocular myasthenia gravis should be suspected in patients with thyroid-associated ophthalmopathy who have signs or symptoms of ptosis.
Antibodies ; Blepharoptosis ; Brain ; Diplopia ; Exophthalmos ; Eye ; Eyelids ; Graves Disease ; Graves Ophthalmopathy ; Humans ; Internal Medicine ; Magnetic Resonance Imaging ; Middle Aged ; Muscles ; Myasthenia Gravis ; Paralysis ; Polyenes ; Strabismus ; Telescopes ; Weight Loss

Moyamoya disease is a rare, progressive, occlusive cerebrovascular disorder characterized by bilateral stenosis of the intracranial portion of the internal carotid artery. Symptoms including transient ischemic attacks, seizures, intracranial hemorrhage and cerebral infarction, are variable. There are few case reports of moyamoya disease in pregnancy. Since hyperventilation-induced cerebral ischemia and hypertension are provoked by active labor, cesarean section has been recommended to avoid neurologic complications for pregnant women with moyamoya disease. The optimal anesthetic management for cesarean section in these patients has not been discussed. We report a case of moyamoya disease in a patient presenting for cesarean section at 40 weeks' gestation. Epidural anesthesia was administered using 0.5% bupivacaine and fentanyl. Intraoperative hemodynamic state was stable. The patient has no significant postoperative complications.
Anesthesia* ; Anesthesia, Epidural ; Brain Ischemia ; Bupivacaine ; Carotid Artery, Internal ; Cerebral Infarction ; Cerebrovascular Disorders ; Cesarean Section* ; Constriction, Pathologic ; Emergencies* ; Female ; Fentanyl ; Hemodynamics ; Humans ; Hypertension ; Intracranial Hemorrhages ; Ischemic Attack, Transient ; Moyamoya Disease* ; Postoperative Complications ; Pregnancy ; Pregnant Women ; Seizures

BACKGROUND: Various molecular methods such as polymerase chain reaction (PCR) and DNA hybridization have been introduced to diagnose the hepatitis B more accurately. Recently, Hybrid Capture Assay (HCA) was developed, which uses the signal amplification solution hybridization capture assay with chemiluminescent detector. So we evaluated the sensitivity and clinical utility of the HCA and PCRs for the detection of hepatitis B virus DNA (HBV DNA) and compared these results with serologic markers. METHODS: We analysed the 50 samples from the hepatitis B patients using enzyme immunoassay, HCA and nested PCRs with two different primer sets. The primers of PCR I and PCR II were targeted to pol and core region respectively. RESULTS: In 18 cases, HBV DNA were detected by HCA in which the positive rates by PCR I and PCR II were 55.6%, and 88.9%, respectively. And in 32 cases in which HBV DNA by HCA was negative, the positive rates by PCR I and PCR II were 6.2% and 31.3%, respectively. In 44 cases which were positive for HBsAg, the positive rates for HBV DNA were 38.6% by HCA, 27.3% by PCR I, and 56.8% by PCR II. In cases positive for HBeAg, the positive rates were 93.3% by HCA, 60.0% by PCR I and 80.0% by PCR II. In cases positive for anti-HBe and negative for HBeAg, the positive rates were 10.3% by HCA, 10.3% by PCR I, and 44.8% by PCR II. CONCLUSIONS: Both HCA and PCR compensated each other yet as to the accurate investigation of the viral replication in patients with hepatitis B and the sensitivity was better in HBV PCR with primers to core region than to pol region.
DNA ; Hepatitis B e Antigens ; Hepatitis B Surface Antigens ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Humans ; Immunoenzyme Techniques ; Polymerase Chain Reaction*

BACKGROUND: With increase of antibiotics use and invasive procedures, infections caused by multi-resistant Acinetobacter baumannii (MRAB) are increasing. Recently, we experienced the outbreak of- nosocomial infections caused by MRAB resistant to imipenem and cefoperazone/sulbactam in intensive care units (ICU) and general ward. We analyzed the clinical characteristics of the infected patients and antibiotic susceptibility of the organisms. And surveillance cultures and IRS-PCR were performed to find out the transmission route. METHODS: We collected data from physical examination and clinical records. We performed surveillance cultures of environment, patients not infected with MRAB in ICU, and hands of health care workers. RESULTS: Between November 1996 and June 1997, 49 strains of MRAB were isolated from the 26 patients hospitalized in Kangnam St. Mary' s Hospital. The lower respiratory infection (13 cases) was the most common infection and sputum was the most common sources (47.1%). All strains of MRAB showed the same genotype. In disk diffusion test, all strains were resistant to piperacillin, gentamicin, amikacin, ceftazidime, cefoperazone/sulbactam, aztreonam, imipencm, ciprofloxacin. From the surveillance cultures, the genotypically identical strains were isolated from ventilator Y-piece, the floor of ICU, and hands of health care workers. It suggested that this strain was transmitted through ventilatory device or hands of health care workers. We instructed all the health care workers to wash hands, to disinfect hospital environment completely. Since July 1997, no further case has occurred. CONCLUSIONS: Since A. baumannii could be transmitted through ventilatory devices and the hands of health care workers, it is important to wash hands and to disinfect hospital environment completely.
Acinetobacter baumannii* ; Acinetobacter* ; Amikacin ; Anti-Bacterial Agents ; Aztreonam ; Ceftazidime ; Ciprofloxacin ; Cross Infection* ; Delivery of Health Care ; Diffusion ; Genotype ; Gentamicins ; Hand ; Humans ; Imipenem* ; Critical Care Units ; Patients' Rooms ; Physical Examination ; Piperacillin ; Sputum ; Ventilators, Mechanical

The Korean law on medicine was amended in 2003 to introduce new provisions for telemedicine, electronic medical record, and electronic prescription. However, this has not satisfied the realities of the increased demand on medical services and related technology development, resulting in calls for a legislative amendment. In this regard, recent active promotion projects and the advance notice proposing a new amendment by the Ministry of Health, Welfare, and Family Affairs have raised the need for active discussions on telemedicine because the current law on medicine and its amendment do not adequately address the individual privacy protection aspect in the telemedicine environment. In this regard, this study examines current domestic and foreign legal systems on telemedicine and privacy protection, drawing and reviewing subjects to be discussed for individual privacy protection in telemedicine, and proposes plans that may improve Korea's legal system. The domestic and foreign literature on telemedicine and privacy protection was reviewed, recent legislations on telemedicine and views of interest groups were considered, and expert opinions were collected. In addition, the main discussions on privacy protection in telemedicine were identified and reviewed, including information ownership, the scope of privacy protection, the right to review and request correction, and privacy protection matters related to foreign patients. The recent amendment to tele medicine contains a provision only on penalties for privacy protection violations. The main discussions in this study on privacy protection are expected to be reflected in future amendments to enforcement rules and sub-ordinances such as the enforcement ordinance.
Electronic Health Records ; Electronic Prescribing ; Expert Testimony ; Humans ; Jurisprudence ; Ownership ; Privacy ; Public Opinion ; Telemedicine

BACKGROUND: This study aimed at identifying the effects of improved methods of endotracheal suction and hand washing on incidence of nosocomial pneumonia (NP) in the neurosurgical ICU. METHOD: Repeated training of nurses about hand washing and adherence of the single use of suction catheter and sterile normal saline of endotracheal suction was provided. Then hand washing compliance of nurses before and after training was investigated. and the incidence of NP in all patients hospitalized for more than 72 hours in the neurosurgical ICU was investigated from Sep 1, 2000 to Jan 31, 2001 (2nd surveillance). The NP rate of that period was compared with the incidence of the 1st surveillance period, from Sep 1, 1999 to Jan 31, 2000. The data were analyzed with chi-square-test. Fisher's exact test and logistic regression analysis by SAS 8.0. RESULT: The proportion of hand washing performance increased from 15.6% to 46.8%. The rates of NP per patient during 1st surveillance and 2nd surveillance were 10.3%, 3.9%(p=0.01) patient-days rates of NP were 10.0 cases/1,000 patient days, 4.1 cases/1,000 patient days(p=0.04), and ventilator-days rates of NP were 67.6 cases/1.000 ventilator days, 16.2 cases/1,000 ventilator days(p=0.00) respectively. Out of 29 isolates, 18 were methicillin-resistant Staphylococcus aureus, which was the most frequently isolated microorganism. The risk factors associated with incidence of NP were age, length of stay, Glasgow coma scale, diabetes mellitus, duration of intubation, insertion of endotracheal tube, duration of tracheostomy, presence of tracheostomy, duration of ventilator, use of ventilator, and insertion of nasogastric tube. CONCLUSION: These results showed that single use of suction catheters and sterile normal saline and increased compliance of hand washing were important factors to decrease the incidence of NP.
Catheters ; Compliance ; Diabetes Mellitus ; Glasgow Coma Scale ; Hand Disinfection* ; Hand* ; Humans ; Incidence* ; Intensive Care Units* ; Critical Care* ; Intubation ; Length of Stay ; Logistic Models ; Methicillin-Resistant Staphylococcus aureus ; Pneumonia* ; Risk Factors ; Suction* ; Tracheostomy ; Ventilators, Mechanical