BACKGROUND: Neonatal hypocalcemia is not an infrequent condition, especially in the premature neonate. It is effectively treated by intravenous administration of calcium gluconate. Complications of extravasation during intraveous infusion included calcification and, occasionally necrosis. But the exact mechanism of calcinosis cutis following extravasation of calcium gluconate remains unknown and there is no specific mode of treatment except cold packs and skin graft. OBJECTIVE: Our purpose was to evaluate the clinical and histological features in rabbits after subcutaneous injection of 10% calcium gluconate and a mixed solution of gluconate and triamcinolone acetonide. METHODS: Two rabbits were divided into 3 groups and were subcutaneously injected with the following materials on the back; 10% calcium gluconate, a mixed solution of calcium gluconate and triamcinolone acetonide, and 25% normal saline as controls respectively. The injection site including the skin and subcutaneous fat was excised and fixed with natural buffered formalin. The biopsied specimens were stained with Hematolxylin and Eosin. RESULTS: 1) In the 10% calcium gluconate injected group, there was some erthema and induration after three days. By the fifth to the seventh days there was more erythema and firm induration. At 15 days, nodules and large ulcreated lesions developed. Multiple, linear shaped, ulcreative surfaced and indurated masses were noted at 37days.l from 45days to 2months there was progressive healing with decrease in ulceration, and gradual disapppearance of the mass. Histologically, at the 8th day calcium was seen in the walls of the arteries and veins, after 15days, the reaction was at its peak and epidermal necrosis was seen on the injected site. From 30 to 3days, calcium deposition and granuloma formation were seen in the dermis. In addition discharge of calcium deposits began to place by means of transepidermal elimination. After 45days, although the response was subsiding, the calcium and mucin deposition was observed focally in the dermis. 2. In the 10% calcium gluconate and triamcinolone acetonide adjuvant injected group, there was development of some erythema at 8days. After 15days, some erythema and induration were seen of the injected site ad this gradually disappeared. By 37days, the injection site was normal in appearance. Histologically, at 15days calcium deposition was seen on the upper dermis and the injection site was histologically normal after one month. 3. In 25% normal saline injected group, the injection site was clinically normal. Histologically there was no reaction except for focal perivascular eosinophilia after 24horus. CONCLUSION: We conclude that the important mechanism of calcinosis cutis appears to be elevated concentration as well as the tissue damage at the site of the extravasation of calcium gluconate. The final common pathway of calcification is the formation of crystalline and insoluble calcium phosphate mineral, in the form of hydroxyapatite. The intralesional injection of triamcinolone for the treatment of calcinosis cutis in our study was effective due to its antiinflammatory effect and the reabsorption of calcium in the tissues.
Administration, Intravenous ; Arteries ; Bowen's Disease ; Calcinosis* ; Calcium Gluconate* ; Calcium* ; Carcinoma, Squamous Cell ; Crystallins ; Dermis ; Durapatite ; Eosine Yellowish-(YS) ; Eosinophilia ; Erythema ; Formaldehyde ; Granuloma ; Humans ; Hypocalcemia ; Infant, Newborn ; Injections, Intralesional ; Injections, Subcutaneous ; Keratoacanthoma ; Keratosis, Actinic ; Mucins ; Necrosis ; Proliferating Cell Nuclear Antigen ; Rabbits ; Skin ; Subcutaneous Fat ; Transplants ; Triamcinolone ; Triamcinolone Acetonide ; Ulcer ; Veins

BACKGROUND: Neonatal hypocalcemia is not an infrequent condition, especially in the premature neonate. It is effectively treated by intravenous administration of calcium gluconate. Complications of extravasation during intraveous infusion included calcification and, occasionally necrosis. But the exact mechanism of calcinosis cutis following extravasation of calcium gluconate remains unknown and there is no specific mode of treatment except cold packs and skin graft. OBJECTIVE: Our purpose was to evaluate the clinical and histological features in rabbits after subcutaneous injection of 10% calcium gluconate and a mixed solution of gluconate and triamcinolone acetonide. METHODS: Two rabbits were divided into 3 groups and were subcutaneously injected with the following materials on the back; 10% calcium gluconate, a mixed solution of calcium gluconate and triamcinolone acetonide, and 25% normal saline as controls respectively. The injection site including the skin and subcutaneous fat was excised and fixed with natural buffered formalin. The biopsied specimens were stained with Hematolxylin and Eosin. RESULTS: 1) In the 10% calcium gluconate injected group, there was some erthema and induration after three days. By the fifth to the seventh days there was more erythema and firm induration. At 15 days, nodules and large ulcreated lesions developed. Multiple, linear shaped, ulcreative surfaced and indurated masses were noted at 37days.l from 45days to 2months there was progressive healing with decrease in ulceration, and gradual disapppearance of the mass. Histologically, at the 8th day calcium was seen in the walls of the arteries and veins, after 15days, the reaction was at its peak and epidermal necrosis was seen on the injected site. From 30 to 3days, calcium deposition and granuloma formation were seen in the dermis. In addition discharge of calcium deposits began to place by means of transepidermal elimination. After 45days, although the response was subsiding, the calcium and mucin deposition was observed focally in the dermis. 2. In the 10% calcium gluconate and triamcinolone acetonide adjuvant injected group, there was development of some erythema at 8days. After 15days, some erythema and induration were seen of the injected site ad this gradually disappeared. By 37days, the injection site was normal in appearance. Histologically, at 15days calcium deposition was seen on the upper dermis and the injection site was histologically normal after one month. 3. In 25% normal saline injected group, the injection site was clinically normal. Histologically there was no reaction except for focal perivascular eosinophilia after 24horus. CONCLUSION: We conclude that the important mechanism of calcinosis cutis appears to be elevated concentration as well as the tissue damage at the site of the extravasation of calcium gluconate. The final common pathway of calcification is the formation of crystalline and insoluble calcium phosphate mineral, in the form of hydroxyapatite. The intralesional injection of triamcinolone for the treatment of calcinosis cutis in our study was effective due to its antiinflammatory effect and the reabsorption of calcium in the tissues.
Administration, Intravenous ; Arteries ; Bowen's Disease ; Calcinosis* ; Calcium Gluconate* ; Calcium* ; Carcinoma, Squamous Cell ; Crystallins ; Dermis ; Durapatite ; Eosine Yellowish-(YS) ; Eosinophilia ; Erythema ; Formaldehyde ; Granuloma ; Humans ; Hypocalcemia ; Infant, Newborn ; Injections, Intralesional ; Injections, Subcutaneous ; Keratoacanthoma ; Keratosis, Actinic ; Mucins ; Necrosis ; Proliferating Cell Nuclear Antigen ; Rabbits ; Skin ; Subcutaneous Fat ; Transplants ; Triamcinolone ; Triamcinolone Acetonide ; Ulcer ; Veins

BACKGROUND: Pustular eruptions due to drugs are uncommonly reported. We studied the characteristics of clinical and histopathologic findings of pustular drug eruption. OBJECTIVE: We observed th.e causative agents, clinical featurs and histopathologic findings of pustular drug eruption and identified differential points of generlized pustular eruption. METHODS: We evaluated t,he clinical and histopathologic findings of 8 patients with pustular drug eruption and reviewed the literatures reported cases of pustular drug eruption. RESULTS: All patients diagnosed pustular drug eruption suffered from generalized pustular eruption associated with systemic symptoms such as fever, headachened myagia one to three days after treatment with causative agents. The causative agents of putular drug eruption are antibiotics such as ceftriaxone, analgesics and antipyretics. The pustule resolved after a few days of treatment with systemic corticosteroids and antihistamines. Laboratory findings revealed leukocytosis, neutrophilia, and analevated erythrocyte sedimentation rate, On histopatologic findings, we observed subcorneal pustuls containing neutrophils, eosinophils and some lymphocytes and spongiosis, exocytosis of acute iiflammatory cells. Perivascular infiltration of lymphocyte ancl edema of papillary dermis was also bserved in the dermis. CONCLUSION: Pustular drug eruption is characterized by generalized pustular eruption associated with systemic symptoms and histopathologic findings of that are sterile subcorneal pustules. Therefore differential diagnosis of other generalized pustular erupticns are relatively easy by careful history of medication, clinical and histopathologic findings.
Adrenal Cortex Hormones ; Analgesics ; Anti-Bacterial Agents ; Antipyretics ; Blood Sedimentation ; Ceftriaxone ; Dermis ; Diagnosis, Differential ; Drug Eruptions* ; Edema ; Eosinophils ; Exocytosis ; Fever ; Histamine Antagonists ; Humans ; Leprosy ; Leukocytosis ; Lymphocytes ; Neutrophils

BACKGROUND: Pustular eruptions due to drugs are uncommonly reported. We studied the characteristics of clinical and histopathologic findings of pustular drug eruption. OBJECTIVE: We observed th.e causative agents, clinical featurs and histopathologic findings of pustular drug eruption and identified differential points of generlized pustular eruption. METHODS: We evaluated t,he clinical and histopathologic findings of 8 patients with pustular drug eruption and reviewed the literatures reported cases of pustular drug eruption. RESULTS: All patients diagnosed pustular drug eruption suffered from generalized pustular eruption associated with systemic symptoms such as fever, headachened myagia one to three days after treatment with causative agents. The causative agents of putular drug eruption are antibiotics such as ceftriaxone, analgesics and antipyretics. The pustule resolved after a few days of treatment with systemic corticosteroids and antihistamines. Laboratory findings revealed leukocytosis, neutrophilia, and analevated erythrocyte sedimentation rate, On histopatologic findings, we observed subcorneal pustuls containing neutrophils, eosinophils and some lymphocytes and spongiosis, exocytosis of acute iiflammatory cells. Perivascular infiltration of lymphocyte ancl edema of papillary dermis was also bserved in the dermis. CONCLUSION: Pustular drug eruption is characterized by generalized pustular eruption associated with systemic symptoms and histopathologic findings of that are sterile subcorneal pustules. Therefore differential diagnosis of other generalized pustular erupticns are relatively easy by careful history of medication, clinical and histopathologic findings.
Adrenal Cortex Hormones ; Analgesics ; Anti-Bacterial Agents ; Antipyretics ; Blood Sedimentation ; Ceftriaxone ; Dermis ; Diagnosis, Differential ; Drug Eruptions* ; Edema ; Eosinophils ; Exocytosis ; Fever ; Histamine Antagonists ; Humans ; Leprosy ; Leukocytosis ; Lymphocytes ; Neutrophils

Common adverse effects due to topical therapy with DPCP(Diphenyprone) are severe contact dermatitis, dermographism, urticaria, generalized pruritus, lymphadenoiathy, and dermatitis on the remote areas. Rarely, DPCP can induce vitiligo or dyschromia in confetias side effects on the pigmentary system. It is not clear yet whither DPCP induced the vitiligcbatoxic effect of phenol ring in DPCP or by koebner phenomenon clue to repeated contact dermatitis in cases where vitiligo was in latent subclinical condition. We describe a patient with alopecia areatairho developed vitiligo due to topical therapy with DPCP. A 20-year-old woman developed alopecia areata with a loss of eye shows and eyelashes. After sensitization, DPCP was topically applieid to the scalp every week. Vitiligo, confirmed by electron microscopic study, appeared 4 month. after the beginning of treatment and was localized only to the areas of topical application. Both alogecia aieata and vitiligo are improving now under systemic and topical corticosteroid therapy.
Alopecia Areata* ; Alopecia* ; Dermatitis ; Dermatitis, Contact ; Eyelashes ; Female ; Humans ; Phenol ; Pruritus ; Scalp ; Urticaria ; Vitiligo ; Young Adult

We reviewed 37 skin biopsies obtained from 35 patients with secondary syphilis during the period of 9 years from January 1980 to June 1988, which had been diagnosed by dark field examination, serologic tests for syphilis, and identification of spirochetes by immunoperoxidase method (avidin-biotin complex) in the skin biopsies. We investigated the histologic features of the skin lesions in secondary syphilis according to the types and patterns of inflammatory cell infiltration in the dermis, vascular reactions and epidermal changes. We matched these histologic findings with the clinical features of the skin lesions. The results were as follows; 1) The histologic patterns of dermal infiltrate in order of frequency were as follows; junctional pattern in 14 biopsies (38%), lichenoid pattern in 10 biopsies (27%), diffuse pattern in 5 biopsies (14%), patchy pattern in 3 biopsies (8%), normal pattern in 3 biopsies (8%) and undertermined in 2 biopsies (5%). 2) The dermal infiltration of plasma cells was found in 24 biopsies (65%). All the biopsies of diffues and lichenoid patterns, 7 biopsies of junctional and one biopsy of patchy pattern showed plasma cells but none in normal pattern. 3) Eosinophils were observed in the dermis in 11 biopsies (30%). There was no difference in incidence of eosinophils in the dermis among morphologic patterns. However, they were frequently seen in the dermis and epidermis of condyloma lata (4 of 7 biopsies). 4) The vascular changes in the dermis included endothelial cell swelling in 23 biopsies (62%), endothelial cell proliferation in 22 biopsies (60%) and vascular dilatation in 10 biopsies (27%). They were most commonly observed in the lichenoid pattern followed by diffuse and junctional patterns. Three cases showed lymphocytic vasculitis. 5) Epidermal changes were seen in all of the biopsies exocytosis, parakeratosis, hydropic change of basal cells, acanthosis, spongiosis, keratinocyte necrosis and hyperkeratosis in the order of frequency. 6) In relation to the clinical manifestations, junctional pattern (14 biopsies) consisted of 6 papulosquamous lesions, 5 macules and 3 papules. Lichenoid pattern (10 biopsies) consisted of 7 papulosquamous lesions and 3 papules. All the biopsies showing diffuse pattern (5 biopsies) appeared in condyloma lata. Patchy pattern (3 biopsies) consisted of 2 macules and 1 papule. All of the normal pattern (3 biopsies) appeared in macules. In conclusion, with dermal and epidermal changes, the acknowlegement of the 5 basic histologic patterns in secondary syphilis seems to be very helpful for the diagnosis of syphilis.
Incidence ; Biopsy

BACKGROUND: Xerosis is a relatively common disorder, especially in the elderly. The condition is characterized by fine scaling and is associated with generalized pruritus. OBJECTIVE: The purpose of this study was to evaluate the clinical efficacy, safety and tolerability of Zalsming cream in patients with xerosis and pruritus. METHODS: Thirty patients were treated with Zalsming cream. Clinical efficacy, as measured by the score of subjective symptom and objective signs, transepidermal water loss(TEWL) and electron microscopic finding, were asessed at 2, 4, and 6 weeks after topical application of the cream. RESULTS: The scores of clinical signs and TEWL showed statistically significant improvements. No one developed any local or systemic side effects. CONCLUSION: Topical application of Zalsming cream was found to be effective and safe for patients suffering from xerosis and pruritus.
Aged ; Humans ; Pruritus*

The authors report the clinical results of ten cases of complex supracondylar fractures treated by external fixation with a mean follow up of 21 months. Six cases were closed comminuted fracture, and four cases were open fractures. By AO classification six cases were type C2, two type C3, one type Al, and one type A3. Four cases had associated vascular injury. Reduction was performed by closed method in eight cases, and two cases were reduced through open wound. All cases healed at average of 142 days. Final healing of all cases occurred with an average range of motion of 3°-119° except one case which required reapplication due to infected nonunion with a gap. In nine cases of the ten functional results were rated as "good", and one case was "fair" by Iowa Knee Rating Scale. In conclusion, definitive external fixation can be a good alternative treatment modality despite previous recommendations to limit external fixation to temporary application in cases of limb salvage, such as severe comminution or pre-existing infection.
Classification ; External Fixators ; Femur ; Follow-Up Studies ; Fractures, Comminuted ; Fractures, Open ; Iowa ; Knee ; Limb Salvage ; Methods ; Range of Motion, Articular ; Vascular System Injuries ; Wounds and Injuries

PURPOSE: To evaluate the usefulness of automated biopsy guns in image-guided biopsy of lung, liver. pancreas and other organs. MATERIALS AND METHODS: Using automated biopsy devices, 160 biopsies of variable anatomic sites were performed:Biopsies were performed under ultrasonographic(US) guidance in 95 and computed tomographic (CT) guidance in 65. We retrospectively analyzed histologic results and complications. RESULTS: Specimens were adequate for histopathologic diagnosis in 143 of the 160 patients(89.4%)-Diagnostic tissue was obtained in 130 (81.3%), suggestive tissue obtained in 13(8.1%), and non-diagnostic tissue was obtained in 14(8.7%). Inadequate tissue was obtained in only 3(1.9%). There was no statistically significant difference between US-guided and CT-guided percutaneous biopsy. There was no occurrence of significant complication. We have experienced mild complications in only 5 patients-2 hematuria & 2 hematochezia in transrectal prostatic biopsy, and 1 minimal pneumothorax in CT-guided percutaneous lung biopsy. All of them were resolved spontaneously. CONCLUSION: The image-guided biopsy using the automated biopsy gun was a simple, safe and accurate method of obtaining adequate specimen for the histopathologic diagnosis.
Biopsy* ; Diagnosis ; Firearms* ; Gastrointestinal Hemorrhage ; Hematuria ; Image-Guided Biopsy* ; Liver ; Lung ; Pancreas ; Pneumothorax ; Retrospective Studies

With the recent increase of coronary artery disease in Korea, coronary arteriography israpidly gaining importance as a diagnostic procedure in the management of ischemic heart disease in this country. In order to delineate normal angiographic anatomy of the coronary arteries in Korean adults, the author reviewed 63 normal or near normal coronary angiograms out of 113 consecutive cases done at the cardiac laboratory of Yonsei University Severance Hospital from February, 1976 through September, 1982 and obtained the following results. 1) The diameter of the main stems of the left and the right coronary arteries measured 2.7-6.3mm(mean, 4.0mm) and 2.1-6.0mm(mean, 3.6mm) respectively, and the length of the left main stem measured 0-23mm(mean, 9.3mm). 2) The conus branch was visualized to originate from the proximal right coronary artery in 50 cases(79.4%), and in the other 13(20.6%) in whom the conus branch was not visualized, it was assumed to have a separate ostium directly from the aortic root. 3) The sinus node artery originated from the right coronary artery in 35 cases(55.5%) and from the left circumflex 20(31.7%). The remaining 8 cases(12.7%) appeared to have dual blood supply. 4) The artery to the A-V node arose from the proximal part of the posterior descending artery as a branch of the right coronary artery in 59 cases(93.7%) and of the left circumflex in only 4(6.3%), and the pattern of the A-V node blood supply coincided with the dominancy(crossing the crux of the heart and giving rise to the posterior descending artery) of the right or the left circumflex arteries. 5) In 33 cases(52.4%), both of the arteries to the SA and the AV nodes arose from the right coronary, and in 19(30.2%), the SA node artery came from the right, whereas the AV node artery originated from the left circumflex. 6) The number of ramifications(furcation) of the main left coronary artery was two in 53 cases(83.1%), three in 9(14.3%), and four in 1(1.6%). 7) The number of diagnoal branches of the left anterior descending artery was one in 34 cases(54%), two in 28(44.4%) and 3 in 1(1.6%).
Adult* ; Angiography ; Arteries ; Atrioventricular Node ; Conus Snail ; Coronary Angiography* ; Coronary Artery Disease ; Coronary Vessels* ; Heart ; Humans ; Korea ; Myocardial Ischemia