In 1908 Leiner described the peculiar skin condition among infants to which he applied the name erythroderma desquamativa. The four cardinal features of Leiners disease are generalized seborrheic dermatitis, intractable severe diarrhea, recurrent local and systemic infections usually of gram negative etiology, and marked wasting and cyst rophy. A 2-month-old female presented to our clinic with generalized seborrheic erythrodermic eruption and intractable diarrhea. She had sufferd from these symptoms since birth. Her body weight was 3.4kg (below 3rd percentile). Her scalp was covered with thick yellowish crsts. There was generalized erythroderma covered vith scales and crusts. Laboratory result; revealed gram negative sepsis and DIC. Chest X-ray showed the findings of minimal aspir ition pneumonia in the right upper lobe. She expired on the following day.
Body Weight ; Dacarbazine ; Dermatitis, Exfoliative ; Dermatitis, Seborrheic ; Diarrhea ; Female ; Humans ; Infant ; Parturition ; Pneumonia ; Scalp ; Sepsis ; Skin ; Thorax ; Weights and Measures

Periosteal chondroma is a slowly growing cartilage tumor of limited size, which develops within and beneath the periosteal connective tissue and characteristically erodes and induces sclerosis of the contiguous cortical bone. The typical morphology of this tumor consists of an area of outer cortex scalloping involving the metaphyseal lesion of a long bone with slightly overhanging edges and a small amount of cartilage calcified matrix adjacent to the scalloping. Histologically this benign tumor can mimic chondrosarcoma. Awareness of this fact is important in order to avoid overdiagnosis and resultant overtreatment of the benign lesion. We report three cases of periosteal chondromas arising in the phalangeal bones of the hand. All were treated by curettage. No local recurrence was seen following this treatment.
Cartilage ; Chondroma ; Chondrosarcoma ; Connective Tissue ; Curettage ; Cytochrome P-450 CYP1A1 ; Hand ; Medical Overuse ; Pectinidae ; Recurrence ; Sclerosis

BACKGROUND: Opioids can produce potent antinociceptive effects by interacting with local opioid receptors in inflamed peripheral tissue. However, reports on pain relief with intra-articular morphine after arthroscopic knee operations are conflicting. In this study we examined the analgesic effects of the intraarticular administration of morphine after knee surgery. METHODS: In a double-blind, randomized trial, we studied 26 patients who had received one of two injections at the end of surgery. The patients in group M(n=11) received 3 mg of morphine intraarticularly; those in group P(n=15), saline 20 ml intraarticularly as a placebo. RESULTS: Patients in the morphine group had significantly lower pain scores throughout the 24-h postoperative period compared with those in the placebo group(P<0.05). There was less requirement for supplementary analgesics in the morphine group. CONCLUSIONS: Low doses of intraarticular morphine can significantly reduce pain after knee surgery without any systemic side effect.
Analgesics ; Analgesics, Opioid ; Humans ; Knee* ; Morphine* ; Postoperative Period ; Receptors, Opioid

PURPOSE: To compare the usefulness of double-dose contrast-enhanced CT (DDCE-CT) and conventional contrast-enhanced CT (CCE-CT) in the detection of metastatic brain lesions. MATERIALS AND METHODS: Sixteen patients with brain metastases were evaluated with both CCE-CT and thinslice DDCE-CT. For CCE-CT, an initial injection of 100 ml contrast medium was given, and DDCE-CT with both 10-mm and 5-mm thickness was performed after the addition of an extra 100 ml of contrast medium. The numbers of metastatic lesions detected by CCE-CT and by DDCE-CT were compared, as were the findings of contrast-enhanced MRI (CE-MRI) and thin-slice DDCE-CT in seven patients who underwent both these procedures. RESULTS: Fourteen metastatic brain lesions were detected by CCE-CT, 22 by 10-mm-thickness DDCE-CT, and 36 by 5-mm thickness DDCE-CT. Thus, almost 2.6 times more lesions were detected by thin-slice DDCE-CT than by CCE-CT. Metastatic lesions were detected by 10-mm-thickness DDCE-CT in 16 patients and by CCECT in seven; in five, edema only was detected, while in four there were no detectable metastases. CCE-CT detected four lesions of less than 5 mm in diameter, while 10-mm-thickness DDCE-CT and 5-mm-thickness DDCE-CT detected seven and 18 lesions, respectively. Eleven lesions were detected by thin-slice DDCE-CT and 17 by CE-MRI in the seven patients who underwent both CE-MRI and DDCE-CT. The lesions detected only by CE-MRI were less than 5 mm in diameter and were discovered in the cerebellum or inferior temporal lobe. CONCLUSION: Thin-slice DDCE-CT was superior to CCE-CT in detecting metastatic brain lesions.
Brain* ; Cerebellum ; Edema ; Humans ; Magnetic Resonance Imaging ; Neoplasm Metastasis* ; Temporal Lobe ; Tomography, X-Ray Computed*

Serovars of 22 leptospiral field isolates from rats trapped in Korea were identified by cross-agglutinin absorption test (CAAT). Genomic characteristics of 7 selected isolates and 6 antigenically closely related reference serovars of lai, yeonchon, birkini, gem, mwogolo, and canicola were differentiated by arbitrarily primed PCR (AP-PCR) and southern blot hybridization using 16S rRNA gene probe from Borrelia burgdorferi. Among the 22 isolates, 21 strains were identified as serovar lai by CAAT, while the serological reactivity of NR13 did not accord with that of serovar lai. Results of AP-PCR using primers RSP, KF and PB-1 were in general agreement with those obtained by serological identification, and all 7 isolates including NR13 showed the same profile with serovar lai or yeonchon. In the southern blot hybridization with 16S rRNA gene probe, the isolates were divided into two ribotype groups when HindIII and BamHI digests were employed: isolates NR4, NR13, and serovar lai showed the same profile, and isolates JR34, JR57, KR48, JR77, and JR82 were classified as the another ribotype group. Isolate NR13 and serovar yeonchon, which were isolated in Korea and showed serological differences with serovar lai, were indistinguishable from serovar lai in this DNA study using AP-PCR and ribotyping. These results demonstrate that Korean leptospiral isolates were closely related in DNA level, and ribotyping would be useful for subgrouping of field isolates.
Absorption ; Animals ; Blotting, Southern ; Borrelia burgdorferi ; DNA ; Genes, rRNA ; Korea ; Leptospira* ; Polymerase Chain Reaction* ; Rats ; Ribotyping*

The study of pain has recently received much attention, especially in understanding its neurophysiology by using new brain imaging techniques, such as positron emission tomography (PET) and functional magnetic resonance imaging (fMRI), both of which allow us to visualize brain function in vivo. Also the new brain imaging devices allow us to evaluate the patients pain status and plan to treat patients objectively. Functional activation of brain regions are thought to be reflected by increases in the regional cerebral blood flow in the brain imaging studies. Regional cerebral blood flow increases to noxious stimuli are observed in second somatic (SII) and insular regions and in the anterior cingulate cortex and with slightly less consistency in the first somatic area (S1), motor area, supplementary motor area, prefrontal area, amygdala and contralateral thalamus. These data suggest that pain has multidimensions such as sensory-discrimitive, motivational-affective and cognitive-evaluative.
Amygdala ; Brain ; Gyrus Cinguli ; Humans ; Magnetic Resonance Imaging ; Neuroimaging ; Neurophysiology ; Positron-Emission Tomography ; Thalamus

The study of pain has recently received much attention, especially in understanding its neurophysiology by using new brain imaging techniques, such as positron emission tomography (PET) and functional magnetic resonance imaging (fMRI), both of which allow us to visualize brain function in vivo. Also the new brain imaging devices allow us to evaluate the patients pain status and plan to treat patients objectively. Functional activation of brain regions are thought to be reflected by increases in the regional cerebral blood flow in the brain imaging studies. Regional cerebral blood flow increases to noxious stimuli are observed in second somatic (SII) and insular regions and in the anterior cingulate cortex and with slightly less consistency in the first somatic area (S1), motor area, supplementary motor area, prefrontal area, amygdala and contralateral thalamus. These data suggest that pain has multidimensions such as sensory-discrimitive, motivational-affective and cognitive-evaluative.
Amygdala ; Brain ; Gyrus Cinguli ; Humans ; Magnetic Resonance Imaging ; Neuroimaging ; Neurophysiology ; Positron-Emission Tomography ; Thalamus

Because of the shortage of living-related donor and social acceptance of brain death, cadaveric renal transplantation is performed in recent days more frequently than in the past. However, clinical situation of cadaveric transplantation in Korea is somewhat different from that in western countries and the outcome is different also. PURPOSE: We performed this study to know the predicting factors and the survival rate of cadaveric renal transplantation. We also tried to compare our results to that of the western countries to try to establish the correct therapeutic strategy of cadaveric renal transplantation. MATERIALS AND METHODS: We analyzed 41 cadaveric renal transplants performed at Seoul National University Hospital from August, 1993 to July, 1997. All patients had follow-up period of more than 6 months. RESULTS: The mean age of recipients was 34.8 years(2~62). All patients except two were primary renal transplants. Male to female ratio was 28:13. Mean HLA mismatching number was 3.66. The immunosuppressive regimen was triple therapy based on cyclosporine. If delayed graft function(DGF) occurred, cyclosporine was held till renal function became normalized. The incidence of DGF was 17.1%. The overall incidence of biopsy-proven acute rejection was 26.8%(11 cases). Seven cases were diagnosed as acute rejection at protocol biopsies performed at 7 days after renal transplantotion, but had normal renal function. The other 4 cases who had both histologic evidence and clinical features of acute rejection were treated with anti-rejection therapy. The factors affecting graft survival in cadaveric renal transplantation were the acute rejection(p=0.0003) and preservation solution (p=0.0033). The graft survival rate at 1, 2, 3, 4 year was 86.9%, 86.9%, 80.7%, 80.7%, respectively. Total 6 renal transplants were lost due to 1 chronic rejection, 1 CMV pneumonia, 1 Kaposi's sarcoma at lung, and 3 sepsis. CONCLUSION: Our results was comparable to that of the western countries. Careful manipulation of the donors and recipients and prevention of acute rejection are necessary to increase the survival of the cadaveric renal transplants.
Biopsy ; Brain Death ; Cadaver* ; Cyclosporine ; Female ; Follow-Up Studies ; Graft Survival ; Humans ; Immunosuppression ; Incidence ; Kidney Transplantation* ; Korea ; Lung ; Male ; Pneumonia ; Risk Factors ; Sarcoma, Kaposi ; Seoul* ; Sepsis ; Social Distance ; Survival Rate ; Tissue Donors ; Transplants

Because of the shortage of living-related donor and social acceptance of brain death, cadaveric renal transplantation is performed in recent days more frequently than in the past. However, clinical situation of cadaveric transplantation in Korea is somewhat different from that in western countries and the outcome is different also. PURPOSE: We performed this study to know the predicting factors and the survival rate of cadaveric renal transplantation. We also tried to compare our results to that of the western countries to try to establish the correct therapeutic strategy of cadaveric renal transplantation. MATERIALS AND METHODS: We analyzed 41 cadaveric renal transplants performed at Seoul National University Hospital from August, 1993 to July, 1997. All patients had follow-up period of more than 6 months. RESULTS: The mean age of recipients was 34.8 years(2~62). All patients except two were primary renal transplants. Male to female ratio was 28:13. Mean HLA mismatching number was 3.66. The immunosuppressive regimen was triple therapy based on cyclosporine. If delayed graft function(DGF) occurred, cyclosporine was held till renal function became normalized. The incidence of DGF was 17.1%. The overall incidence of biopsy-proven acute rejection was 26.8%(11 cases). Seven cases were diagnosed as acute rejection at protocol biopsies performed at 7 days after renal transplantotion, but had normal renal function. The other 4 cases who had both histologic evidence and clinical features of acute rejection were treated with anti-rejection therapy. The factors affecting graft survival in cadaveric renal transplantation were the acute rejection(p=0.0003) and preservation solution (p=0.0033). The graft survival rate at 1, 2, 3, 4 year was 86.9%, 86.9%, 80.7%, 80.7%, respectively. Total 6 renal transplants were lost due to 1 chronic rejection, 1 CMV pneumonia, 1 Kaposi's sarcoma at lung, and 3 sepsis. CONCLUSION: Our results was comparable to that of the western countries. Careful manipulation of the donors and recipients and prevention of acute rejection are necessary to increase the survival of the cadaveric renal transplants.
Biopsy ; Brain Death ; Cadaver* ; Cyclosporine ; Female ; Follow-Up Studies ; Graft Survival ; Humans ; Immunosuppression ; Incidence ; Kidney Transplantation* ; Korea ; Lung ; Male ; Pneumonia ; Risk Factors ; Sarcoma, Kaposi ; Seoul* ; Sepsis ; Social Distance ; Survival Rate ; Tissue Donors ; Transplants

Endovascular aneurysm repair (EVAR) for the treatment of abdominal aortic aneurysm (AAA) is a widely used method, and its decreased invasiveness compared to traditional surgical repair has brought about reduced rates of morbidity and mortality. Several vascular complications related to the procedure have been reported, but non-vascular complications have rarely occurred. We report herein the case of a 78-year-old man who underwent EVAR for AAA and presented with active duodenal ulcer bleeding and acute acalculous cholecystitis as complications after the procedure. We must consider that a wide spectrum of complications may occur following EVAR, and therefore it is important to evaluate the risks of complication and to take the necessary measures to minimize them.
Acalculous Cholecystitis ; Aged ; Aneurysm ; Aortic Aneurysm, Abdominal ; Duodenal Ulcer ; Hemorrhage ; Humans