Multiple symmetric lipomatosis is a rare disease and affects almost exclusively middle aged man, usually with a background of excessive a alcohol intake. The disease is characterized by progressive growth of subcutaneous fat masses which are located symmetrically at neck, shoulders, chest, abdomen and groin, and which subsequently penetrate deeply into the surrounding spaces and structures with symptomatic compression of deep organs, such as trachea. A recent survey revealed a high incidence of sometic and autonomic neuropathy. The exact cause of the disease is not known, but a hyperplastic mechanism has been postulated, with in vitro studies demonstrating a defect in adrenergic-stimulated lipolysis of lipomatous tissue. We have experienced two cases of multiple symmetric lipomatosis. Case 1 was a 59-year-old male, complaining of slowly enlarging doughunt ring-shaped mass at his neck. He had a habit of excessive alcohol intake for many years. The subcutaneous mass at the neck was excised. The pathology report described the specimen as "normal adipose tissue". Case 2 was a 49-year-old male, complanining of slowly enlarging multiple symmetric masses at the neck, shoulders, chest, abdomen, flank and groin over a period of 6 years. He also complained of mild muscular weakness. He had a habit of excessive alcohol intake for many years. The subcutaneous mass in the neck was excised. The specimen had a tendency to form globular masses and microscopically indistinguishable from mature adipose tissue.
Incidence

No abstract available.

PURPOSE:We performed this study to compare correlation between the indices of insulin resistance using fasting insulin and glucose level and body mass index (BMI), and to determine the clinical usefulness of glucose/insulin ratio (G/I ratio), which is easily available in clinical base. METHODS:Total 119 children with simple obesity, whose BMI is over 95th percentile, were evaluated. We calculated G/I ratio, logInsulin, HOMA-IR, logHOMA-IR, and QUICKI and evaluated their relationship to BMI. RESULTS:Children with high-degree obesity had higher insulin resistance than children with mild to moderate-degree obesity (logInsulin, 1.13+/-.23 vs 1.27+/-.29; logHOMA-IR, 0.46+/-.24 vs 0.61+/-.30; QUICKI, 0.33+/-.03, 0.31+/-.03)(P<0.01), and pubertal children had higher insulin resistance than prepubertal children (G/I ratio, 7.39+/-.07 vs 4.85+/-.29; logInsulin, 1.14+/-.27 vs 1.31+/-.22; logHOMA-IR, 0.47+/-.28 vs 0.65+/-.22; QUICKI, 0.33+/-.03 vs 0.31+/-.02) (P<0.001). BMI had correlation coefficient as -0.436 for QUICKI, -0.432 for G/I ratio, 0.430 for logInsulin, and 0.425 for logHOMA-IR (P=0.000). G/I ratio was well correlated with QUICKI (r=0.901, P=0.000), logHOMA-IR (r=-0.865, P=0.000), and logInsulin (r=0.899, P=0.000). The changes of BMI were correlated with changes of G/I ratio (r=-0.547, P<0.01), QUICKI (r=-0.464, P=0.01), and logHOMA-IR (r=0.429, P<0.05). CONCLUSION: This study revealed that the degree of BMI had statistically significant correlation with insulin resistance, which can be reflected by G/I ratio, logHOMA-IR and QUICKI. G/I ratio was well correlated with logHOMA-IR and QUICKI, which suggests that G/I ratio could be used as an bedside index of insulin resistance. The changes of G/I ratio were more correlated with changes of BMI than those of logHOMA-IR and QUICKI.
Body Mass Index ; Child* ; Fasting ; Glucose ; Humans ; Insulin Resistance* ; Insulin* ; Obesity*

30 cases of distal femur fracture were treated with cast-brace for 2 years and 6 months from Feb., 1977 till July, 1979 at the department of Orthopaedic Surgery, Presbyterian Medical Center, in Jeon Ju. The results were obtained as follows: 1. In 9 cases, cast-brace were applied initially and other 21 cases were treated with cast-brace secondarily after operation. 2. 20 cases were male and 10 cases were female. 3. 12 cases were on mid 1/3 fracture and 18 cases were distal 1/3 fracture involving 2 condylar fractures. 4. The average duration of fracture healing was 14.7 weeks in the cases with cast-brace which is compared with 20.7 weeks of hip-spica cast control group. 5. A.G.F. of knee joint was 80–115 degree at removal of cast-brace, otherwise merely 50–65 degree at dlscarding of hip-spica cast. 6. There were no complication such as nonunion or delayed union in the cases with cast-brace.
Braces ; Female ; Femur ; Fracture Healing ; Humans ; Jeollabuk-do ; Knee Joint ; Male ; Protestantism

While the microbiology of cellulitis in the pediatric population and systemic diseases(DM, Cirrhosis, etc) is well known,the causative bacteria and clinical aspect of cellulitis in young adults are less descrihed. this study was undertaken to identify the causative organisms and clinical aspect of adult cellulits. We analysed 121 medical records of 115 young adult patients with cellulitis who had been admitted at the department of orthopaedic surgery, National Police hospital from Jan. 1994. to Dec. 1996. The results were as follows. 1. The age of patient was between 21 yrs and 25 yrs, and the sex of all patients was male. 2. The lower leg and foot were the most frequently involved site of cellulitis as 92 cases(74.2%). 3. The potals were suspected in 65 cases(56.5%),of them, traumas were detected in 43 cases(66.1%), non-traumatic skin lesions in 23 cases(33.9%). 4. In most cases, initial systemic symptoms (fever, chill, headache, etc.) and local symptoms (local heating, tenderness, etc.) were found. 5. The laboratory findings revealed leukocytosis in 19%, elevated ESR in 94%, positive CRP in 80%. 6. Microorganism were detected in 16 of 38 pus cultures. Gram positive microorganisms were detected in 15 of 16 cases culture positive. 7. 6.7% of patients with cellulitis experienced recurrence in same lesions. In conclusion, the retrospective analysis of 115 young adult patients with cellulitis showed that primary cause of young adult cellulit was circulatory disturbance and lymphatic obstruction of the lower extremities most often involved by trauma. therefore, supportive treatments such as rest,elevation,ice packs are considered prior to antibiotic treatment.antibiotic treatment aimed at gram-positive cocci appears to be sufficient.
Adult ; Bacteria ; Cellulitis* ; Fibrosis ; Foot ; Gram-Positive Cocci ; Headache ; Heating ; Hot Temperature ; Humans ; Leg ; Leukocytosis ; Lower Extremity ; Male ; Medical Records ; Police ; Recurrence ; Retrospective Studies ; Skin ; Suppuration ; Young Adult*

Cobb syndrome is a rare neurocutaneous angiomatosis characterized by a vascular skin nevus associated with a spinal cord angioma of the same metamere. A 14-year-old girl had an asymptomatic large cutaneous hemangioma distributed from the TI dermatome downward to the L3 dermatome since birth and complained of a gait disturbance and urination difficulty for 1 year. A biopsy specimen in the skin lesion revealed the findings of capillary hemangioma. From C7 downward to L4 posterior epidural hemangioma composed of arteriovenous and cavernous components was diagnosed by radiological examination and surgical exploration. Because of very extensive cord hemangioma, only partial removal of the tumor at T11, T12 and L1 level was performed and postoperatively she was transferred to a special facility for rehabilitative therapy.
Adolescent ; Angiomatosis ; Biopsy ; Female ; Gait ; Hemangioma ; Hemangioma, Capillary ; Humans ; Nevus ; Parturition ; Skin ; Spinal Cord ; Urination

No abstract available.
Kidney* ; Neuroectodermal Tumors, Primitive*

The hindfoot in the human body is known to play an important function for weight bearng, shock absorption and locomotion. The defect of hindfoot presents serious problems of the leg length discrepancy and weight bearing. Therefore, it is essential to reconstruct the defect of hindfoot. Up to date, many surgical modalities from a skin graft to the innervated osteocutaneous flap have been developed, but a completely satisfactory method of reconstruction has not been found. The ideal reconstructive method should provide sufficient padding tissue and sensibility. In the Department of Orthopaedic Surgery, capital Armed Forces General Hospital, two cases of hindfoot defect due to explosion were reconstructed by the midplantar fasciocutaneous flap with free iliac bone graft. The results of our procedure were very acceptable one year after the operations.
Absorption ; Arm ; Explosions ; Hospitals, General ; Human Body ; Leg ; Locomotion ; Methods ; Shock ; Skin ; Transplants ; Weight-Bearing ; Wounds and Injuries

PURPOSE: The most important step for patients who come to the emergency department with ureter stones is acute pain management. There have been insufficient studies on what factors affect acute pain management for ureteral colic the most. In this study, patients with ureteral colic were divided into two groups: one group, in which the pain was first managed with an analgesic, and another group with unmanaged pain, to find factors that most affect additive analgesics administration for ureter stones. METHODS: There were 121 patients, eventually confirmed for the presence of ureter stones through a computed tomography CT scan, included in this study. When ureter stones were suspected after the initial patient evaluation, initial pain was assessed through numerical rating scale (NRS) and the first analgesic was administered once. Pain was reassessed through NRS after 30 minutes. At that time, if the pain was managed, the patient was assigned to Group 1. If the pain persisted, another analgesic was administered for the second and third time, and the patient was assigned to Group 2. Finally, ureter stones were identified through CT scan. RESULTS: There were 58 patients (47.9%) in Group 1 and 63 patients (52.1%) in Group 2. There were no statistically significant differences in average age, serum creatinine, size of ureter stone, and severity of hematuria between the two groups. The differences in NRS measured initially and after 30 minutes were statistically significant (7.6+/-1.4 vs. 8.6+/-1.2, p<0.001; 1.4+/-1.3 vs. 6.6+/-1.9, p<0.001, respectively). The presence of hydronephrosis and perirenal edema were also statistically significant (p<0.001, p=0.007). The affecting factor for the administration of additive analgesics was hydronephrosis (odds ratio 7.213, p<0.001). CONCLUSION: Hydronephrosis is an important factor in the treatment of patients with additive analgesics. It can also be used as a predictive index to assess the severity of pain in patients with ureter stones.
Acute Pain ; Analgesics ; Creatinine ; Edema ; Emergencies ; Hematuria ; Humans ; Hydronephrosis ; Renal Colic ; Ureter ; Urolithiasis

Congenital dyserythropoietic anemia Type II (herditary erythroblatic multinuclearity with positive acidified serum test; HEMPAS) is characterized by binuclearity, multinuclearity, pluripolar mitoses, karyorrhexis of normoblasts, and the presence of abnormal antigens on the red cells. We experienced a case of HEMPAS in a 2 month old girl patient who had an intermittent fever, abdominal distention with palpable liver & spleen, and generalized jaundice. The blood analysis revealed anemia, and thrombocytopenia. Peripheral blood smear showed an averge of 6 mature normoblast per 100 leukocyte count. The red cells showed moderate anisocytosis, poikilocytosis, irregularly crenated, contracted cells and occasional spherocytes. The leukocytes showed relative lymphocytosis, and there were occasional villous lymphocytes. The marrow smear showed abnormality in erythroid series. About ten percent of the erythroblasts showed 2~7 nuclei or lobulated nuclei. The mitotic forms of the erythroid precursors were also increased in frequency. The M:E ratio was 1:3.2. Blood culture on this patient showed a pure growth of Coxiella burnetti. Medical treatment with Doxycycline and Rifampin was performed. After treatment, she became afebrile showing improved general condition with decreased size of liver & spleen. In spite of clinical improvement, she died suddenly 3 weeks after initial treatment.
Anemia ; Anemia, Dyserythropoietic, Congenital* ; Bone Marrow ; Coxiella ; Doxycycline ; Erythroblasts ; Female ; Fever ; Hempa ; Humans ; Infant ; Jaundice ; Leukocyte Count ; Leukocytes ; Liver ; Lymphocytes ; Lymphocytosis ; Mitosis ; Rifampin ; Spherocytes ; Spleen ; Thrombocytopenia