Wegener's granulomatosis is a disease of unknown etiology that is characterized by the clinicopathologic complex of necrotixing granulomatous vasculitis of the upper and lower respiratory tract, glomerulonephritis, and variable degrees of small vessel vasculitis. Recently Antineutrophil Cytoplasmic Antibody (ANCA) has been reported to be a highly specific test for the diagnosis of Wegener's granulomatosis. We have experienced a patient of Wegener's granulomatosis in a 11 year old girl who was admitted with complaints f arthralgia, hematuria, convulsion and associated with otitis media and sinusitis. Serologic test of C-ANCA was positive and histologic findings of the kidney showed crescentic glomerulonephritis with sclerosis and surrounding infiltration of multinucleated giant cells. Patient was treated with pulse methylprednisolone without improvement. The clinical course progressed rapidly and expired due to the renal failure, gastrointestinal bleeding and status epilepticus. A brief review of literatures was made.
Antibodies, Antineutrophil Cytoplasmic* ; Arthralgia ; Child ; Diagnosis ; Female ; Giant Cells ; Glomerulonephritis ; Hematuria ; Hemorrhage ; Humans ; Kidney ; Methylprednisolone ; Otitis Media ; Renal Insufficiency ; Respiratory System ; Sclerosis ; Seizures ; Serologic Tests ; Sinusitis ; Status Epilepticus ; Vasculitis ; Wegener Granulomatosis*

The clinicolaboratory findings, cardiac catheterization, and outcome of operation were analyzed in 78 patients with tetralogy of Fallot, which were diagnosed by echocardiography, cardiac catheterization, and a cardiac angiography and confirmed by operation at Dong San Hospital, Keimyung University, during a 4(1/2)-year period from January 1984 to June 1988. The following results were obtained : 1) Out of the 78 cases, 45 were male and 64 were female. 2) The electrocardiogram showed right axis deviation in 71 cases(91%) and right ventricular hypertrophy in 66 cases(84.6%). 3) Chest X-ray revealed that, the cardiothoracic ratio was normal or decreased in 68 cases(87.3%), and cardiac apex elevation was noticed in 57 cases(73%). 4) Pulmonary stenosis were chiefly valvular and infundibular type(53.8%). 5) The associated heart diseases with TOF were patent foramen ovale(64.1%), right sided aortic arch(19.2%), and secundum ASD(10.3%), in that order. 6) There was an intimate correlation between secondary polycythemia and thrombocytopenia. 7) Among the 78 Cases, 73 cases had total correction, 1 case had shunt operation, and 4cases had total correction after shunt operation. The highest mortality rate occurred in the cases of total correction after shunt operation(25%). The cases with a main pulmonary artery size of 1/3 to 2/3 against, the aorta had a higher mortality than the other group, and no cases expired in the group with a ratio of more than 2/3. The overall surgical mortality was 8.9%.
Angiography ; Aorta ; Axis, Cervical Vertebra ; Cardiac Catheterization ; Cardiac Catheters ; Echocardiography ; Electrocardiography ; Female ; Heart Diseases ; Humans ; Hypertrophy, Right Ventricular ; Male ; Mortality ; Polycythemia ; Pulmonary Artery ; Pulmonary Valve Stenosis ; Tetralogy of Fallot* ; Thorax ; Thrombocytopenia

No abstract available.
Heart* ; Thoracic Surgery*

No abstract available.
Lichens* ; Mucinosis, Follicular*

BACKGROUND: Ketamine use in emergency room has been increased. It has rapid onset of action and appropriate duration of action. It does not need endotracheal intubation and produces potent analgesia, sedation, and amnesia. The object of this study is to determine the safety and the degree of physician's satisfaction in relation to ketamine use. MATERIALS AND METHODS: This is a prospective study using protocol. Pediatric trauma patients who need sedation were given IM ketamine(4mg/kg) and atropine(0.01mg/kg) in a same syringe. Monitoring of patients was done by EM residents and complications of ketamine use were recorded. Physician's satisfaction was also recorded after the procedure. RESULTS: Intramuscular ketamine was administered 54 times, mainly for laceration repair. Physicians completed protocol for 51 of treated children. The median time for onset of sedation was 6.5+/-2.4 min, and duration of action was 32.4+/-10.8 min. Hypersalivation occurred in 9.8%(n=5); random movement 3.9%(n=2), emesis during procedure(n=1), emesis at home(n=1), and transient oxygen desaturation(n=1). All were quickly identified and treated without specific airway management and sequelae. Of 84% of physicians was satisfied with ketamine use for pediatric sedation. CONCLUSION: Intramuscular ketamine can be administered safely and satisfactorily in emergency room to facilitate pediatric procedures in conjunction with a defined protocol and appropriate monitoring.
Airway Management ; Amnesia ; Analgesia ; Child ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Intubation, Intratracheal ; Ketamine* ; Lacerations ; Oxygen ; Prospective Studies ; Sialorrhea ; Syringes ; Vomiting

No abstract available.
Humans* ; Polymerase Chain Reaction*

In 1952, Zoon described eight cases of benign circumscribed chronic balanitis characterized by an extensive infiltration of plasma cells with no evidence of dysplasia of the overlying epidermis. Plasma cell balanitis can often be confused clinically with other conditions, such as erythroplasia of Queyrat, fixed drug eruptions, secondary syphilis, candidiasis and Reiters disease. We report a case of plasma cell balanitis in a 65-year-old man. He complained of a single, red, shiny and smooth patch involving the glans penis and adjacent prepuce. This patch was unresponsive to systemic and topical steroid treatment. Laboratory studies were negative or within the normal range. Histopathological findings showed a band-like mainly plasmacytic inflammatory infiltrate of the upper dermis. This patient was treated once daily with 2% fusidic acid cream topically for 5 weeks. The lesions resolved and no recurrence was observed during 2 years of follow-up.
Aged ; Arthritis, Reactive ; Balanitis* ; Candidiasis ; Dermis ; Drug Eruptions ; Epidermis ; Erythroplasia ; Follow-Up Studies ; Furosemide* ; Fusidic Acid* ; Humans ; Male ; Penis ; Plasma Cells* ; Plasma* ; Recurrence ; Reference Values ; Syphilis

No abstract available.
Free Tissue Flaps* ; Maxilla*

Background: Reversal of neuromuscular blockade (NMB) at the end of surgery is important for reducing postoperative residual NMB; this is associated with an increased risk of postoperative pulmonary complications (PPCs). Moreover, PPCs are associated with poor prognosis after video-assisted thoracoscopic surgery (VATS) for lobectomy. We compared the effects of two reversal agents, sugammadex and neostigmine, on the incidence of PPCs and duration of hospital stay in patients undergoing VATS lobectomy. Methods: After VATS lobectomy was completed under neuromuscular monitoring, the sugammadex group (n = 46) received sugammadex 2 mg/kg, while the neostigmine group (n = 47) received neostigmine 0.05 mg/kg with atropine 0.02 mg/kg after at least the third twitch in response to the train of four stimulation. The primary outcome was incidence of PPCs. The secondary outcomes were duration of hospital stay and intensive care unit (ICU) admission. Results: There was no significant difference in the incidence of PPCs for both the sugammadex and neostigmine groups (32.6% and 40.4%, respectively; risk difference = 0.08; 95% confidence interval = [−0.12, 0.27]; P = 0.434). The lengths of hospital (P = 0.431) and ICU (P = 0.964) stays were not significantly different between the two groups. Conclusions The clinical use of sugammadex and neostigmine in NMB reversal for patients undergoing VATS lobectomy was not significantly different in the incidence of PPCs and duration of hospital and ICU stay.

Routine use of the IVP in preoperative evaluation of patients with obstructive bladder outlet symptoms has been questioned on the basis of the chance of incidental finding in the upper tract and the implication of such findings to management. We studied 220 patients who underwent intravenous pyelography before prostatectomy at Department of Urology, Sanggye Paik Hospital from Oct. 1989 to Jun 1992. Of 220 patients, 183( 83.2% ) showed normal upper tract with cystogram compatible with benign prostatic hyperplasia. Abnormalities were found in 37( 16.8% ) patients but treatment plan was altered in only 5(2.25% ) cases. Most of these abnormalities could be detected on KUB or cystoscopy. Only one(0.45% ) malignancy would have been missed without routine IVP. We conclude that IVP in our opinion should not be performed as a routine procedure in patients with benign prostatic hypertrophy, but only in selected cases.
Cystoscopy ; Humans ; Incidental Findings ; Prostatectomy ; Prostatic Hyperplasia ; Urinary Bladder ; Urography ; Urology