Authers observed one case of typical reactive perforating collagenosis (RPC) which did not seem to have been described in the Korean literature. A 19 year old male patient complained of a skin eruption involving his face, upper and lower extremities, and trunk in June 1973. The skin eruption appeared at the age of 10 and consisted of discrete papules of which the earliest lesion was a pinhead-sized, skin-colord papule, but it became older, it increased in size and developed a small central area of umbilication containing keratinous material. As new papules continued to develop, the older lesions regressed and disappeared with residual scar. No subjective symptom was obtained except intermittent, mild itching sensation which probably due to a irritation. The Keobner's phenomenon was observed on the dorsum of hands. He has acne vulgaris on the face with many of the individual comedones showing development into RPC. He also had a chronic maxillary sinusitis which was seemed to aggravate the skin eruption. In follow up period (about 5 months), the sinusitis was cured with operation, but the skin eruption was not improved. The family history was negative. Histopathological studies revealed typical RPC, i.e., a cup-shaped epidermal depression of which center was lacked the epidermis was noted, and through it, necrobiotic connective tissue, degenerating inflammatory- cells and collagen bundles are extruded to form a plug. Diagnosis was confirmed by clinical appearance and typical histopathologic features. The patient did not responed to topical application of 0. 1% Retinoic acid solution and Vitamin A and D.
Acne Vulgaris ; Cicatrix ; Collagen ; Connective Tissue ; Depression ; Diagnosis ; Epidermis ; Follow-Up Studies ; Hand ; Humans ; Lower Extremity ; Male ; Maxillary Sinus ; Maxillary Sinusitis ; Pruritus ; Sensation ; Sinusitis ; Skin ; Tretinoin ; Vitamin A ; Young Adult

Various dermatological complications have been reported following the BCG vaccination although this vaccination has been recommended to all healthy infants in our country. A 4-months-old boy, who had a BCG vaccination three weeks after birth, developed erythematous papules and pustules on the whole body, especially on the face and upper extremities. Two erythematous subcutaneous soft nodules were also noted on the left side of the neck. A biopsy specimen from the right forearm revealed caseous necrosis surrounded by a granulomatous inflammation consisting of epithelioid cells and lymphocytes. It was centered along the axis of the damaged pilosebaceous follicle. No acid-fast bacilli could be demonstrated by AFB stain. A marked improvement of his skin eruptions was observed after anti-tuberculosis medication. However, nod-ules in the cervical area perforated spontaneously and healed leaving scars several months after the cutaneous eruptions subsided. The clinical and histologic findings and a good response to anti-tuberculous therapy support the diagnosis of papular tuberculid and suppurative lymphadenitis after BCG vaccination.
Axis, Cervical Vertebra ; Biopsy ; Cicatrix ; Diagnosis ; Epithelioid Cells ; Forearm ; Humans ; Infant ; Inflammation ; Lymphadenitis* ; Lymphocytes ; Male ; Mycobacterium bovis ; Neck ; Necrosis ; Parturition ; Skin ; Tuberculosis, Cutaneous* ; Upper Extremity ; Vaccination*

A 17 year old female with Klippel-Trenaunay-Weber Syndrome is presented. Of particular interest was presence of congenital heart anomaly. The nevus flarnmeus invoIved her entire right leg and foot with hypertrophy, elongation and partial ulecration. Elongation of the right leg Iead cornpensatory vertebral scoliosis (Fig.1,2). The cutaneous temperature of affected side was higher than the other side, and. was larger on somatometry and osteometry (Table 1). On auscultation, grade III systolic blowing murmur was heard on left upper sternal border with second heart sound splitting. Electrocardiograrn revealed complete right bundle branch block (Fig. 3). Chest X-ray revealed cardiomegaly, increase 3 hilar shadaws and rnild pulmonary congestion (Fig. 4). Above mentioned signs suggests strongly secundum type of atrial septal defect. Femoral angiography didnt show arteriovenous malformation (Fig. 5). Authors experienced this rare variant of Klippel-Trenaunzy-Weber Syndrome acco- mapanying with congenital heart anamaly, and report this with review of literatures.
Adolescent ; Angiography ; Arteriovenous Malformations ; Auscultation ; Bundle-Branch Block ; Cardiomegaly ; Estrogens, Conjugated (USP) ; Female ; Foot ; Heart Septal Defects, Atrial ; Heart Sounds ; Heart* ; Humans ; Hypertrophy ; Klippel-Trenaunay-Weber Syndrome* ; Leg ; Nevus ; Scoliosis ; Thorax

BACKGROUND: The prevalence of pulmonary tuberculosis among the elderly is increasing in Korea and in the developed countries due to the increased elderly population and their predispositions to chronic disease, poverty and decreased immunity. To define the characteristics of pulmonary tuberculosis in the elderly, we evaluated the clinical spectrum of pulmonary tuberculosis. METHODS: We analyzed 92 patients retrospectively that were diagnosed as active pulmonary tuberculosis over the age of 65. The analysis involved patient's profiles, clinical manifestations, coexisting diseases, diagnostic methods, anti-TB medications and their side effects, and treatment outcomes. RESULTS: The results were as follows:- 1) The ratio of male to female was 2.1:1(62:30 cases) 2) Chief complaints were a cough (47.8%),dyspnea(40.2%), sputum(38.0%), chest pain(12.0%), anorexia(10.9%), and fever(9.8%). 3) 38(41.3%) of cases had a past history of pulmonary tuberculosis. 4) The coexisting diseases were:-COPD, 25 cases(27.2%);pneumonia, 17 cases(18.5%);DM, 13 cases(14.1%);and malignancy, 10 cases(10.9%). 5) The positivity of Mantoux test(5 TU, PPD-S) was 82.7%. 6) Pulmonary tuberculosis was diagnosed using the following methods : sputum AFB (Acid Fast Bacillus) smear 42.4%, sputum TB(M.Tuberculosis) culture 15.2%, sputum TB PCR (Polymerase Chain Reaction) 10.9%, bronchial washing AFB smear 2.1%, chest radiology only 25.0%. 7) Locations of radiologic lesions were RULF, 50 cases;RLLF, 50 cases, mostly, then LLLF;26 cases were leastly involved. 8) The coexisting tuberculosis were endobronchial TB(8.7%), TB pleurisy(7.6%) miliary TB(5.4%), intestinal TB(2.2%), renal TB(1.1%) 9) The proportion of treatment regimen with 1st line drug and 2nd line drug were 92.3% and 7.6%, respectively. 10) The outcome of treatment were as follows:cured 31.5%, expired 13.0%, no return 47.8%, follow-up now 7.6%. CONCLUSION: The pulmonary tuberculosis in the elderly has atypical patterns with chronic coexisting diseases. Therefore, the possibility of pulmonary tuberculosis should be considered in elderly patients with pulmonary symptoms.
Aged* ; Chronic Disease ; Cough ; Developed Countries ; Female ; Follow-Up Studies ; Humans ; Korea ; Male ; Polymerase Chain Reaction ; Poverty ; Prevalence ; Retrospective Studies ; Sputum ; Thorax ; Tuberculosis* ; Tuberculosis, Pulmonary

Mixed tumor can be defined as arising from the skin, often from sweat glands, and as being composed of epithelial elements intermingled with cartilage or myxoid tissue in such a way that epithelial cells appear to be continuous with these otber types of cells without separation by a basement membrane. RecentIy, we had opportunity to observe a patient, 34-year-old woman, who had typical mixed tumor of the skin in the central portion of the chin. The tumor developed as a solitary, firm, rice-sized subcutaneous nodule which had been present for 6 months with little increase in size and without any pain and tendemess. The covering skin was normal except mild erythema. Clinically, the lesion was simiIar to sebaceaus cyst, Under local anesthesia, tbe whole tumor mass was removed surgically for histologic study. The histopathologic finding reveals nests of cuboidal or polygonal cells, tubuloalveolar and ductal structures, and homogeneous, faintly bluish chondroid or foamy appearing matrix. (Photo. 1, 2, 3 & 4)
Adult ; Anesthesia, Local ; Basement Membrane ; Cartilage ; Chin ; Epithelial Cells ; Erythema ; Female ; Humans ; Skin ; Sweat Glands

During the course of infectious mononucleosis, intake of ampicillin and its analogues such as amoxicillin may cause hypersensitivity skin rashes. We report herein a case of ampicillin induced skin rash in a 41-year-old female patient with infectious mononucleosis. Infectious mononucleosis was confirrned by datetion of IgM antibody against Epstein-Barr(EB) viral capsid antigen(VCA) in her serum. During the icuteillness, she taked ampicillin for 3 days, and 1 week after the intake of ampicillin, a genertliz:d erythernatous and purpuric maculopapualr eruption developed. Physicians should be careful not to use ampicillin and its analogue if batients are suspected to be infected with EB virus as ampicillin induces severe skin rashes in patients with infectious mononucleosis.
Adult ; Amoxicillin ; Ampicillin* ; Capsid ; Exanthema* ; Female ; Humans ; Hypersensitivity ; Immunoglobulin M ; Infectious Mononucleosis* ; Skin*

13 cases of salmonella spondylitis were experienced for 4 years since 1973 and are reviewed with follow-up of 12 months period in average. All cases had febrile disease for 1 to 4 weaks and the symptoms of spondylitis started at febrile stage in 4 cases and at convalescent stage in 9 cases. The pathologic lesions found on x-rays involved 2 to 3 vertebral bodies mostly in middle lumbar spines ranging from thoracolumbar junction to lumbosacral junction. Needle aspirations for the spinal lesions were tried in 9 cases and salmonella typhi group “D” was identified in 5 cases. Needle aspiration was safe, simple, and valuable diagnostic method. Diagnosis of the other cases ware made clinically. It was difficult to differentiate from tuberculous spondylitis or pyogenic spondylitis, but there was some differential points in history, physical findings, laboratory and x-ray findings. All cases responded well to conservative treatments with antibiotics and immobilization and no case indicated surgery.
Anti-Bacterial Agents ; Aspirations (Psychology) ; Clinical Study ; Diagnosis ; Follow-Up Studies ; Immobilization ; Methods ; Needles ; Salmonella typhi ; Salmonella ; Spine ; Spondylitis

During the past three years, 110 consecutive cases of intravenous lidocaine anesthesia under tourniquet for surgery in the upper extremities were observed. The cases were simple injuries or diseases which needed simple surgery or closed reduction requiring only a short period of time. A tourniquet with double cuff was utilized. After tourniquet inflation, 0.5% or 0.75% lidocaine was injected intravenously in the amount of 1.5 mg per Kg body weight. Satisfactory anesthesia was performed in all except 18 cases who had some discomfort of tourniquet origin and analgesics were necessary. No significant complication was noticed. The technic was very simple, safe and effective for simple procedures on hands or forearms.
Analgesics ; Anesthesia ; Anesthesia, Conduction ; Body Weight ; Forearm ; Hand ; Inflation, Economic ; Lidocaine ; Tourniquets ; Upper Extremity

The purpose of this study is to compare the diagnostic accuracy and usefulness of three-dimensional CT, two-dimensional CT in case of blow-out fracture. Two-dimensional CT, three-dimensional CT images of twenty-four blow-out fracture and soft tissue incarceration. Two dimensional CT was superior to three-dimensional CT in evaluating orbital bone fracture and soft tissue incarceration. But, three-dimensional CT was more useful to identify of orbital bone fracture than two-dimensional CT in associated facial bone fracture. Coexamination with two-dimensional axial & three-dimensonal CT was useful not only in the detection of fracture but in the evaluation of soft tissue incarcerated blow-out fracture.
Facial Bones ; Fractures, Bone ; Orbit ; Orbital Fractures*

The adult long bone is known to be very rarely infected by the hematogenous route because of the different vascular pattern from the children and the clinical pattern of the primary hematogenous pyogenic osteomyelitis occurred in adult long bones is very different from the well known acute osteomyelitis of the children. The authors studied 16 cases of the hematogenous pyogenic osteomyelitis occurred in the adult long bones without previous history of the bone infection and the diagnosis was confirmed by histological and/or bacteriological examinations. The cases were 8 males and 8 females having ages between 19 years to 50 years old. The involved bones were 6 femurs, 5 tibias, 2 humeri and fibulas and a ulna and the involved sites were 10 in shafts and 6 in ends of long hones. All the cases had insidious onset without acute symptoms and the course was rather subacute form. There were three different types based on x-ray findings and operative findings. 5 cases were cortical type having localized cortical thickening in the shaft around one or several small intracortical ahscesses, 7 cases were medullary localized type having well circumscribed bone abscess and 4 cases were medullary diffuse type having extensive irregular destruction with occasional small sequestrum. The problems of these cases were differential diagnosis because there were no typical symptoms or signs of the infection and the x-ray findings were very confusing, but most of the cases healed well hy simple surgery and antibiotics.
Abscess ; Adult ; Anti-Bacterial Agents ; Child ; Diagnosis ; Diagnosis, Differential ; Female ; Femur ; Fibula ; Humans ; Male ; Osteomyelitis ; Tibia ; Ulna