Multiple satellite pyogenic granuloma developed on the left upper back of a 14-year-old boy after excision of a hemangioma-like lesion. He has had nevus flammeus on the left upper arm since birth with fine linear telangietasiae around the main lesions. Histopathology showed the capillary proliferation in the dermis, and transmission electron microscopy revealed multiple Weibel-Palade bodies, considered an early endothelial cell marker, in the cytoplasm of the endothelial cells. We believe this patient may have the propensity to develop different angiomatous lesions.
Adolescent ; Arm ; Capillaries ; Cytoplasm ; Dermis ; Endothelial Cells ; Granuloma, Pyogenic* ; Humans ; Male ; Microscopy, Electron, Transmission ; Parturition ; Port-Wine Stain ; Weibel-Palade Bodies

Backgound: The placement of stents in coronary arteries has been shown to reduce acute closure and restenosis in comparison to balloon angioplasty. However, clinical use of intracoronary stents is impeded by the subacute stent thrombosis and hemorrhagic complications associated with the anticoagulant regimen. It's known that the complete stent deployment with high pressure inflation and new antiplatelet agents are effective in reduction of subacute thrombosis and hemorrhage. So we evaluated initial results (success and complication rate) after high pressure-stent deployment with new anticoagulation protocol. METHODS: One hundred and ninety one patients with 201 lesions were treated with 231 stents of various types. The high pressure balloon inflation and antiplatelets agents were used in all cases. Final high pressure balloon inflation guided by IVUS were performed in 23 consecutive cases with incomplete stent deployment according to angiographic findings. RESULTS: 1) The indications of stenting (n=210) were De novo in 124 (59%), bailout procedure in 57 (27%), suboptimal result after PTCA in 19 (8%), and restenosis after PTCA in 14 (6%). The location of lesions were LAD in 101, RCA in 67, circumflex in 28, ramus intermedius in 3, and LMT artery in 2 lesions. Angiographic morphologic characteristics were type A in 2, type B in 158 (B1: 57, B2: 101), and type C in 22 lesions. 2) The angiographic and clinical success rate was 96% (192/201) and 92% (186/201) respectively. 3) In angiographic analysis, the baseline average reference vessel dirmeter was 3.33+/-0.35 mm. Baseline minimum lumen diameter (MLD) was 0.58+/-0.29 mm, with baseline percent diameter stenosis of 82.86+/-8.64%. The final stent diameter was 3.37+/-0.29 mm, with mean final percent stenosis of 0.63+/-8.25. The mean MLD after stenting was significantly increased (p<0.001). The mean MLD within stent increased 14%, from 2.91+/-0.39 mm at the nominal balloon inflation (inflation pressure=7 atm) to 3.37+/-0.29 mm at high pressure balloon inflation (inflation pressure <0A65B>12atm) (p<0.001). The length of lesions in GR I (cook), GR II, and Micro II stents were significantly longer than ones in PS, Cordis, Wiktor, Nir (p<0.001). 4) In intravascular ultrasound analysis, the mean lumen CSA at the tightest point within stent increased 11%, from 8.4+/-2.4 mm2 at the intial intravascular ultrasound to 9.4+/-2.1 mm2 at the final intravascular ultrasound (p<0.001). 5) The procedural and postprocedural complications were 2 acute closures associated with AMI and emergent CABG, 1 subacute closure which was revascularized by bail out stenting, 5 major hemorrhage requiring transfusion associated with 1 CVA and 2 metabolic acidosis induced by acute renal failure, and 5 death. CONCLUSION: The high pressure stent deployment procedure and new anticoagulation protocol associating tidopidine and aspirin without coumadin or prolonged heparin infusion allow us to obtain an acceptably low subacute thrombosis or bleeding complication rate. These results are encouraging and allow a wide use of coronary stenting.
Acidosis ; Acute Kidney Injury ; Angioplasty, Balloon ; Arteries ; Aspirin ; Constriction, Pathologic ; Coronary Vessels* ; Hemorrhage ; Heparin ; Humans ; Inflation, Economic ; Platelet Aggregation Inhibitors* ; Stents* ; Thrombosis ; Ultrasonography ; Warfarin

BACKGROUND: Fear of dental treatment is a very real problem for many people. Very young patients or children that are mentally or physically handicapped have various problems that preclude routine dental treatment in the office and require general anesthesia for extensive dental restoration. In America, outpatient operations are performed in thousands of dental offices annually, but there is no report about outpatient general anesthesia in Korea. METHOD: A review of forty children treated under outpatient general anesthesia for extensive dental treatment between 1994 and 1996 inclusive was carried out to assess the patient selection, anesthetic method, recovery time and complication. RESULTS: The mean age was 8.4 years, and twenty-five percent of the patients were autism. The length of the postoperative observation period before discharge was 3.2 hours, and postoperative fever was major complication. CONCLUSION: For extensive dental treatment in handicapped children, we suggest that outpatient general anesthesia can provide reasonably safe treatment, while reducing its expense and requiring less hospital bed space.
Americas ; Anesthesia, General* ; Autistic Disorder ; Child* ; Dental Offices ; Disabled Children ; Disabled Persons* ; Fever ; Humans ; Korea ; Outpatients* ; Patient Selection

Autogenous costal cartilage graft has been commonly used for reconstruction of auricular deformity. However, the risk of complication and discomfort at the donor site, as well as distortion of the graft due to morphological change in the cartilage have been serious drawbacks to this procedure. Previous studies examining the chondrogenic potential of perichondrium have suggested that perichondrium may be used as graft for cartilage reconstruction. When a perichondrial flap or a free perichondrium was used as graft, new cartilage formed appositional to the grafted perichondrium. However, the neocartilage was often irregular in shape and varied considerably in quantity. In this study, the feasibility of controlling the shape and the mass of neocartilage was investigated using coral, a porous biomaterial, as a template. A coral a template was wrapped with perichondrial flap from the ears of New Zealand white rabbits and placed into a subcutaneous pocket in the rabbits and placed into a subcutaneous pocket in the rabbit's back by incision. A total of 12 animals were used. Formation of new cartilage was later evaluated by gross and histological examination of the perichondrial flap and the coral template. New cartilage was formed in 11 animals. Immature chondrocytes were visible by 3 weeks after the surgery, and by 8 weeks the immature chondrocytes had formed a cartilage. New cartilage was formed only on the surface of the coral template. These results indicated that the shape and the mass of new cartilage may be controlled by using coral template. Therefore, the desired shape of cartilage may be achieved using a coral template of corresponding shape, and this may help in correcting subtle auricular contour defect and in correcting other structural defects that also require new cartilage formation.
Animals ; Anthozoa* ; Cartilage ; Chondrocytes ; Congenital Abnormalities ; Ear ; Humans ; Rabbits ; Tissue Donors ; Transplants

Thirty-nine patients with fixed drug eruption who visited the Department of Dermatology in National Medical Center from January 1g7g to December 1982 were selected. Among them, twentyseven patients performed skin biopsy and were evaluated histopathologically on the basis of duration. The results were as follows; ].In the early stage less than 1 week of duration, hydropic degeneration of basal cells, necrotic keratinocytes with eosinophilic cytoplasm and pknotic nucleus in the epidermis, and mixed cell infiltration with eosinophlis in the upper dermis were prominently. In the late stage more than 20 days of duration, acanthosis, an increased amount of melanin in the basal cell layer and presence of melanophages were found more prominent, however, hydropic degeneration of basal cells, papillary dermal ederna, inflammatory infiltration of mononuclear cells were found less prounced or absent.
Biopsy ; Cytoplasm ; Dermatology ; Dermis ; Drug Eruptions* ; Eosinophils ; Epidermis ; Humans ; Keratinocytes ; Melanins ; Skin

Uterine fibroids are the most common benign tumor of the female genital organ. Menorrhagia is the most common symptom associated with uterine fibroid. Since the first suggestion that embolization of uterine arteries might have a role in the management of fibroids by Ravina et al (France) in 1995,3 uterine artery embolization for management of fibroids has been performed actively in United states, United Kindom and Japan, and excellent therapeutic results have been reported. We have performed uterine artery embolization on patients with symptomatic fibroids or adenomyosis since August 1998. There have been few case reports of expelled fibroids out of vagina after uerine artery embolization, so we present a case in which successful embolization in woman with submucosal myoma resulted in a subsequent vaginal expulsion.
Adenomyosis ; Arteries ; Female ; Genitalia ; Humans ; Japan ; Leiomyoma* ; Menorrhagia ; Myoma ; United States ; Uterine Artery Embolization* ; Uterine Artery* ; Vagina

We present a case of warty dyskeratoma in a 51-year-old man. He had two, discret, well-defined, skin-colored papules with central depression on the scalp for about 5 to 6 months. Histopathological findings showed hyperkeratosis, acantholytic and dyskeratotic cells in the dilated follicular infundibulum with the villi formation and suprabasilar cleft around them, typical of warty dyskeratoma.
Depression ; Humans ; Middle Aged ; Scalp

We report a case of acrodermatitis enteropathica-like syndrome after long-term parenteral nutrition in a 19-year-old female with a choriocarcinoma metastasized to the lung. Skin lesions consisted of vesicopustular periorificial eruptions, psoriasiform plaques on the knees and elbows, eczamatoid patches on the acral regions, paronychia, alopecia, and of poor wound healing, Severe diarrhea was accompanied. Zinc sulphate was administered 200mg three times daily for one week with improvement of the skin eruptions and diarrhea. The patient, however, died on the 7th day of zinc therapy with the poor general condition.
Acrodermatitis* ; Alopecia ; Choriocarcinoma ; Diarrhea ; Elbow ; Female ; Humans ; Knee ; Lung ; Parenteral Nutrition ; Paronychia ; Pregnancy ; Skin ; Wound Healing ; Young Adult ; Zinc

While a delayed intracerebral hemorrhage at the site of a ventricular catheter has occasionally been reported in literature, a delayed hemorrhage caused by venous infarction secondary to ventriculoperitoneal shunting has not been previously reported. In the present case, a 68-year-old woman underwent ventriculoperitoneal shunting through a frontal burr hole, and developed a hemorrhagic transformation of venous infarction on the second postoperative day. This massive venous infarction was caused by bipolar coagulation and occlusion of a large paramedian cortical vein in association with atresia of the rostral superior sagittal sinus. Thus, to eliminate the risk of postoperative venous infarction, technical precautions to avoid damaging surface vessels in a burr hole are required under loupe magnification in ventriculoperitoneal shunting.
Aged ; Catheters ; Cerebral Hemorrhage ; Female ; Hemorrhage ; Humans ; Hydrocephalus ; Infarction ; Postoperative Complications ; Superior Sagittal Sinus ; Veins ; Venous Thrombosis ; Ventriculoperitoneal Shunt

BACKGROUND: Surgical endarterectomy had been known to be the standard treatment modality in management of carotid stenosis. However, endarterectomy had several limitations in high-risk patients, particulary with coronary artery disease. Carotid angioplasty and stenting has been suggested to be a safer and more cost-effective alternative to carotid endarterectomy in the management of symptomatic carotid artery disease. The purpose of this study is to evaluate the feasibility and safety of elective carotid artery stent implantation in patients with carotid artery stenosis. METHOD: We treated 19 patients with symptomatic and asymptomatic stenosis of >60% in 19 carotid arteries with balloon angioplasty followed by elective stent implantation. Of all carotid stenting procedures, 18 stents were implanted in obstructing atherosclerotic plaques and in one for Takayasu's arteritis. Of all patients, 10 patients were symptomatic with a history of stroke or transient ischemic attacks which were ipsilateral to the treated carotid artery. 12 patients represented a high-risk subset with myocardial infarction, previous coronary artery bypass graft and coronary artery stenosis. 6 months follow up angiogram was done in 7 patients, a patient(Takayasu's arteritis) showed restenosis. Result: Angiographic and procedural success rate were 100%, and there were no acute or subacute stent thrombosis. Immediately after initial carotid stenting, the mean(+/-SD) stenosis was reduced from 74.9+/-13.6% to 10.2+/-8.7% and the minimal luminal diameter was increased from 1.4+/-0.8mm to 5.3+/-1.0mm corresponding to an acute gain of 3.9mm. There were no major or minor stokes during follow-up. CONCLUSION: Percutaneous carotid angioplasty with stenting is a safe and feasible procedure. It is associated with high immediate success rates and relatively low complications in the management of carotid artery stenosis. Carotid stenting seems to be a reasonable alternatives to medical management for the treatment of carotid stenosis in patients deemed to be poor candidates for standard carotid endarterectomy.
Angioplasty ; Angioplasty, Balloon ; Carotid Arteries* ; Carotid Artery Diseases ; Carotid Stenosis* ; Constriction, Pathologic ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Stenosis ; Endarterectomy ; Endarterectomy, Carotid ; Follow-Up Studies ; Humans ; Ischemic Attack, Transient ; Myocardial Infarction ; Phenobarbital ; Plaque, Atherosclerotic ; Stents* ; Stroke ; Takayasu Arteritis ; Thrombosis ; Transplants