Bacteriological index(BI) was calculated by slit-skin smears taken from the earlobe and the dorsal surfaces of the proximal phalanges of the index finger and of the great toe in 110 lepromatous leprosy patients who have been treated regularly by antileprosy chemotherapy. The bacteriaI indices from the three sites were compared, and the results were as follows. 1) Sixteen patients whose BI of the earlobe smear was 4. 0 in average shawed the highest degree of positivity of M. leprae in the smears taken from the finger and the great toe. 2) ln seventy-four patients whose BI of the earlobe smear was l. 0 or higher, eight (10.8%) showed higher BI in smears taken from both the finger and the great toe, fifteen (20. 3%) and twenty-seven(36. 5%) showed approximately the same BI in smears taken from the finger and the great toe, respectively, 3) In thirty-six patients whose BI of the earlobe smear was negative, twelve (33. 3%) showed higher BI in smears taken from both the finger and the great toe. 4) The mean value of BI of the three sites was 3.7 in the earlobe, 3. 2 in the finger and 3. 0 in the great toe. Comparing the BI of the three sites, the finger and the great toe were found to have comparable BI with the earlobe, although the BI of the earlobe was highest. The authors concluded that it was quite reasonable to include the finger and the great toe in slit-skin smears for M. leprae identification, particularly when the BI of the earlobe was negative. A follow-up investigation seems mandatory.
Drug Therapy ; Fingers* ; Follow-Up Studies ; Humans ; Leprosy, Lepromatous ; Mycobacterium leprae* ; Mycobacterium* ; Skin* ; Toes*

Soft tissue coverage of heel defects has long been a difficult problem. In 1982, Iron reported eight cases of heel defects in children using an ipsilateral posterior thigh flap with use of the Hoff-man's skeletal fixation apparatus for immobilization. We report three cases of heel defects treatment in children using ipsilateral posterior thigh flap and detach flap in an average 13 days with aid of single photon emission computed tomography(SPECT) for evaluation of circulation status of flap.
Child ; Fracture Fixation ; Heel ; Humans ; Immobilization ; Iron ; Thigh ; Tomography, Emission-Computed, Single-Photon

We have experienced a 50-year-old male patient, who died of multiple metastatic nodular melanoma which had the primary lesions on the right hallux and forefoot with eventual involvement of skin and internal organs. An autopsy was performed for the evidence of metastatic features of the internal organs and their spreading routes, with concurrent histopathologic findings. The autopsy findings revealed diffuse metastases to the ipsilateral femoral and inguinal lymph nodes via ascending vascular channels and to the internal organs: 1. The heart had multiple metastatic lesions on the pericardium and right ventricular wall. And the mediastinal, periaortic and periesophageal lymph nodes were also involved. 2. The both lungs were moderately indurated and focally discolored, and showed metastatic lesions in the right lower lobe and hilar areas, Melanoma cells were diffusely invaded to the interstitia and alveoli. 3. The right 5th and 6th ribs showed the invsion of melanoma cells on their bone marrows, periostia, and Haversians canals. 4. The liver was enlarged and showed multiple various sized nodules on the surface with adesion to the parts of peritoneum, omentum and diaphragm. Melanoma cells were seen mostly on and around the sinusoidal spaces and parenchyma. 5. The stomach wall had an ulcerated metastatic lesion and the melanoma cells invaded deeply into the muscle layer. 6. The pancreas was normal in its size and shape but had multiple metastatic lesions on the head and body with melanoma celi infiltration. 7. The both kidneys were grar ular surfaced and showed two metastatic lesions on the right renal cortex and two on the left. Renal tubules and parenchyma were widely invaded by melanoma cells but the glomerular tufts were intact. 8. The adreral and thyroid glands showed four and two metastatic lesions respectively and diffuse invasion of melanoma cells into the parenchyma. 9. The brain was normal in gross appearance, but the cortex was edematous and showed settered melanoma cell infiltration.
Autopsy* ; Bone Marrow ; Brain ; Diaphragm ; Hallux ; Head ; Heart ; Humans ; Kidney ; Liver ; Lung ; Lymph Nodes ; Male ; Melanoma* ; Middle Aged ; Neoplasm Metastasis ; Omentum ; Pancreas ; Pericardium ; Peritoneum ; Ribs ; Skin ; Stomach ; Thyroid Gland ; Ulcer

No abstract available.
Lymphomatoid Papulosis* ; Mycobacterium* ; Tuberculosis*

No abstract available.
Lymphomatoid Papulosis* ; Mycobacterium* ; Tuberculosis*

PURPOSE: Many articles have proposed that osteonecrosis of the femoral head (ONFH) is caused by fat embolism or intravascular coagulation linked to hyperlipidemia. To determine whether hyperlipidemia is an associated factor for ONFH, serum lipid levels were measured. MATERIALS AND METHODS: Nighty-eight patients presenting with ONFH and 110 controls were investigated. We compared the average value of serum lipid levels and the incidence of hyperlipidemia of the two groups. RESULTS: ONFH group showed generalized increase in lipid level and statistically significant difference in the average value of total cholesterol (P=0.0001), HDL-cholesterol (P=0.0261) and phospholipid (P=0.0465) compared with the control. The incidence of hyperlipidemia of the two groups showed statistically significant difference in HDL-cholesterol (P=0.019) and triglyceride (P=0.024). CONCLUSION: Hyperlipidemia seems to be associated with pathogenesis of ONFH. We speculated that hyperlipidemia might be a contributing factor of ONFH. Hyperlipidemia may play a role as a triggering factor in the pathogenetic process that results in osteonecrosis. However, it can not be ruled out that secondary hyperlipidemia might be a finding following ONFH.
Cholesterol ; Embolism, Fat ; Head* ; Humans ; Hyperlipidemias ; Incidence ; Osteonecrosis* ; Triglycerides

To clarify the exact role of endomyocardial biopsy in the diagnosis and monitoring of adriamycin-induced cardiotoxicity and to observe the actual relationship between pathologic changes and cardiac dysfunction, a cross-sectional clinical study was conducted. Echocardiography was used to evaluate cardiac dysfunction in 18 patients who had received chemotherapy including adriamycin(mean dose : 410mg/m2 of B.S.A.) without clinical evidence of congestive heart failure, and in 19 normal controls. Six patients receiving adriamycin underwent 7 transfemoral endomyocardial biopsy procedures, and the specimens were evaluated by light and electron microscopy for evidence of drug-related cardiotoxicity. Indexes of cardiac systolic function obtained by M-mode echocardiography(left ventricular dimension, excursion of interventricular septum and left ventricular posterior wall, shortening fraction and ejection fracton) did not show any statistically significant difference between patients who received adriamycin and normal controls. In transmitral flow-velocity curves recorded by Doppler echocardiography with a 2.25MHz probe, the patients showed less E peak velocity and decreased E/A ratio compared with normal controls, which suggests left ventricular diastolic dysfunction in the patients who received adriamycin. All the specimens of the endomyocardial biopsy showed significant pathologic changes of adriamycin indnced cardiotoxicity which was characterized by myofibrillar loss and vacuolization of the cytoplasm. In 2 specimens, pathologic grade was II, while 5 specimens showed pathologic changes of grade III and further chemotherapy with adriamycine was not done in thse 5 cases. From these results it is suggested that pathologic changes precede the clinical onset of congestive cardiomyopathy in the patients receiving adriamycin and left ventricular diastolic dysfunction occurrs before ejection fraction falls to subnormal levels. We conclude that sequential endomyocardial biopsy is absolutely indicated for exact diagnosis and monitoring of adrinamycin-induced cardiotoxicity to prevent the development of irreversible and often fatal cardiomyopathy.
Biopsy ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Cytoplasm ; Diagnosis ; Doxorubicin* ; Drug Therapy ; Echocardiography ; Echocardiography, Doppler ; Heart Failure ; Humans ; Microscopy, Electron

We experienced a case of achondroplasia in 34 month old male infant. Diagnosis was suspected by clinical features and radiologic examination. A review of literature was made briefly.
Achondroplasia* ; Child, Preschool ; Diagnosis ; Humans ; Infant ; Male

Carotid (angioplasty and) stenting is alternative treatment modality to carotid endartectomy, due to potential benefits in several indications. However, there are the diverse complications associated with this. We report a rare case of central retinal artery occlusion associated with carotid stenting.
Angioplasty ; Retinal Artery ; Retinal Artery Occlusion ; Retinaldehyde ; Stents

A case of pulmonary alveolar proteinosis is reported. Most of the alveolar spaces were filled with amorphous deep eosinohilic material which revealed strong positive reaction to periodic acid-Schiff staining. Electron microscopic observation of this material showed numerous lamellar bodies in the alveolar spaces and cytoplasms of alveolar macrophages. A part of them were concentric multilamellated type A lamellar bodies and the other were finger printlike type B bodies. Combined type A and type B lamellar bodies were rarely present. From the above features it is suggested that both type A and B lamellar bodies could be transformed one another and those lamellar bodies may be originated from pulmonary surfactant.