Purple glove syndrome (PGS) is a rare complication of intravenous phenytoin use that is poorly understood and potentially serious. The characteristic features of PGS are pain, edema, and discoloration at the injection site that spreads to the distal limbs. Diagnosis of PGS can be made from clinical presentation, and treatment is usually restricted to conservative therapy. A 7-year-old girl was treated with phenytoin for epilepsy and was referred to our department for violaceous color change and edema on intravenous injection site of the left hand. It was consistent with PGS, and to our knowledge, it is first report in Korea.
Child ; Edema ; Epilepsy ; Extremities ; Hand ; Humans ; Injections, Intravenous ; Korea ; Phenytoin

Leukocytoclastic vasculitis is a small vessel inflammatory disease mediated mostly by deposition of immune complexes. Etanercept (Enbrel(R)) is widely used not only for rheumatic disorders such as ankylosing spondylitis but also for dermatological diseases including psoriasis. Adverse drug reactions including pruritus, angioedema, and skin cancer have been reported. A 35-year-old female presented with palpable purpuric patches that developed on both lower legs 10 months after etanercept administration. A skin biopsy showed characteristic features of leukocytoclastic vasculitis, including perivascular infiltration of neutrophils and lymphocytes with leukocytoclasia and fibrinoid necrosis of the vessel wall. The patient was treated with oral and topical steroids, and the response was excellent and rapid. The patient was administered etanercept to control underlying ankylosing spondylitis. The skin lesions disappeared gradually after 4 weeks, and no other lesions were seen. The number of patients using etanercept has been increasing thus, the possibility of leukocytoclastic vasculitis in patients using etanercept should be considered.
Adult ; Angioedema ; Antigen-Antibody Complex ; Biopsy ; Drug Toxicity ; Female ; Glycosaminoglycans ; Humans ; Immunoglobulin G ; Leg ; Lymphocytes ; Necrosis ; Neutrophils ; Pruritus ; Psoriasis ; Receptors, Tumor Necrosis Factor ; Skin ; Skin Neoplasms ; Spondylitis, Ankylosing ; Steroids ; Vasculitis ; Vasculitis, Leukocytoclastic, Cutaneous ; Etanercept

Sclerotic fibroma is a rare skin neoplasm that can occur seen sporadically or in association with Cowden's disease. Clinically, it presents as asymptomatic flesh-colored or pinkish slow-growing papules or nodules with a wide anatomical distribution. We report a rare case of pedunculated type of sclerotic fibroma resembling soft fibroma, which has not been reported in Korea.
Fibroma ; Hamartoma Syndrome, Multiple ; Korea ; Skin Neoplasms

BACKGROUND: Pulsatile pumps for extracorporeal circulation have been known to be better for tissue perfusion than non-pulsatile pumps but be detrimental to blood corpuscles. This study is intended to examine the risks and benefits of T-PLS(TM) through the comparison of clinical effects of T-PLS(TM) (pulsatile pump) and Bio-pump(TM) (non-pulsatile pump) used for coronary bypass surgery. MATERIAL AND METHOD: The comparison was made on 40 patients who had coronary bypass using T-PLS(TM) and Bio-pump(TM) (20 patients for each) from April 2003 to June 2005. All of the surgeries were operated on pump beating coronary artery bypass graft using cardiopulmonary extra-corporeal circulation. Risk factors before surgery and the condition during surgery and the results were compared. RESULT: There was no significant difference in age, gender ratio, and risk factors before surgery such as history of diabetes, hypertension, smoking, obstructive pulmonary disease, coronary infarction, and renal failure between the two groups. Surgery duration, hours of heart-lung machine operation, used shunt and grafted coronary branch were little different between the two groups. The two groups had a similar level of systolic arterial pressure, diastolic arterial pressure and mean arterial pressure, but pulse pressure was measured higher in the group with T-PLS(TM) (46+/-15 mmHg in T-PLS(TM) vs 35+/-13 mmHg in Bio-pump(TM), p<0.05). The T-PLS(TM)-operated patients tended to produce more urine volume during surgery, but the difference was not statistically significant (9.7+/-3.9 cc/min in T-PLS(TM) vs 8.9+/-3.6 cc/min in Bio-pump(TM), p=0.20). There was no significant difference in mean duration of respirator usage and 24-hour blood loss after surgery between the two groups. Plasma free Hb was measured lower in the group with T-PLS(TM) (24.5+/-21.7 mg/dL in T-PLS(TM) versus 46.8+/-23.0 mg/dL in Bio-pump(TM), p<0.05). There was no significant difference in coronary infarction, arrhythmia, renal failure and morbidity rate of cerebrovascular disease. There was a case of death after surgery (death rate of 5%) in the group tested with T-PLS(TM), but the death rate was not statistically significant. CONCLUSION: Coronary bypass was operated with T-PLS(TM) (Pulsatile flow pump) using a heart-lung machine. There was no unexpected event caused by mechanical error during surgery, and the clinical process of the surgery was the same as the surgery for which Bio-pump(TM) was used. In addition, T-PLS(TM) used surgery was found to be less detrimental to blood corpuscles than the pulsatile flow has been known to be. Authors of this study could confirm the safety of T-PLS(TM).
Arrhythmias, Cardiac ; Arterial Pressure ; Blood Cells ; Blood Pressure ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Extracorporeal Circulation ; Heart-Lung Machine ; Humans ; Hypertension ; Infarction ; Lung Diseases, Obstructive ; Mortality ; Perfusion* ; Plasma ; Pulsatile Flow ; Renal Insufficiency ; Risk Assessment ; Risk Factors ; Smoke ; Smoking ; Transplants ; Ventilators, Mechanical

Recurrent annular erythema associated with anti-Ro/La antibody is a diagnostic term for annular erythemas that usually occurs in the face and the upper extremities of patients with positive anti-Ro/La antibodies. They have been reported in patients with Sjogren's syndrome, lupus erythematosus, or Sjogren's syndrome/systemic lupus erythematosus syndrome. Recently, there have been cases without any underlying autoimmune diseases. We, hereby, report an annular erythema, associated with anti-Ro/La antibody occurring in both soles, which is an unusual location for this disease.
Antibodies ; Autoimmune Diseases ; Erythema ; Humans ; Sjogren's Syndrome ; Skin Diseases, Genetic ; Upper Extremity

Chondromyxoid fibroma (CMF) is a rare, benign tumor of the bone that represents fewer than 2% of all benign tumors of bone. CMF is most often found in the long tubular bones, especially the tibia and femur near the knee joint. Less common sites included the pelvis, fibula, calcaneus and rib. A 54-year-old male patient presented to us with history of swelling and mild, intermittent local pain without any rise in overlying skin temperature in lateral portion of left 7th rib for one-month duration, which was diagnosed as benign rib tumor by plain chest X-ray and CT scan, and treated successfully by excision of rib with good result. Pathologic diagnosis of this tumor was CMF. Without any medical therapy, there was no evidence of recurrence after operation. We report this case and follow-up of the patient.
Calcaneus ; Chondroma ; Diagnosis ; Femur ; Fibroma* ; Fibula ; Follow-Up Studies ; Humans ; Knee Joint ; Male ; Middle Aged ; Pelvis ; Recurrence ; Ribs* ; Skin Temperature ; Thorax ; Tibia ; Tomography, X-Ray Computed

Central venous stenosis or occlusion is a serious complication in end-stage renal disease patients undergoing maintenance hemodialysis. It is mostly secondary to trauma caused by temporary or permanent hemodialysis catheter placement. Venous hypertension may cause pain, edema of the ipsilateral arm and increased venous pressure prevents acceptable flow rates during dialysis. Venous bypass to the internal jugular vein, the external jugular vein, or axillary vein to saphenous vein bypass have been described as alternative options of surgical management. Our patients underwent internal jugular vein bypass. We think it is an effective and low risk surgical option.
Arm ; Axillary Vein ; Catheters ; Constriction, Pathologic ; Dialysis ; Edema ; Humans ; Hypertension ; Jugular Veins ; Kidney Failure, Chronic ; Renal Dialysis* ; Saphenous Vein ; Veins* ; Venous Pressure

Kaposi's sarcoma (KS) is a multifocal proliferative vascular tumor involving cutaneous and extra-cutaneous tissues. KS has been reported in patients treated with immunosuppressive agents for autoimmune diseases. However, KS has rarely been reported in patients with iatrogenic Cushing's syndrome. A 77-year-old woman was evaluated with multiple asymptomatic violaceous nodules and plaques on both lower legs. She had been diagnosed with iatrogenic Cushing's syndrome and had been treated with low-dose corticosteroid replacement therapy for >10 years. A histopathologic study showed extensive vascular proliferation in the dermis with spindle-shaped cells. Immunohistochemical staining for CD31, CD34, human herpesvirus (HHV)-8, and D2-40 was positive. We hereby report a case of KS in a patient with iatrogenic Cushing's syndrome.
Aged ; Autoimmune Diseases ; Cushing Syndrome ; Dermis ; Female ; Humans ; Immunosuppressive Agents ; Leg ; Sarcoma, Kaposi

Hiccups are an involuntary contraction of the diaphragm that may repeat several times per minute. In general, hiccups are very common, transient, and self-limited. However, if the condition persists longer than days or months, it impacts a patient's quality of life. Pharmacologic and non-pharmacologic methods are used for the treatment of persistent or intractable hiccups. Nerve block and stimulation have been shown to be effective through neural pathway interruption or stimulation of the hiccup reflex arc. Stellate ganglion block (SGB) is an injection of local anesthetic adjacent to a group of nerves in the neck known as the stellate ganglion. The authors report a case of SGB as an effective treatment for a patient with intractable hiccups resulting from right lateral medullary syndrome.
Diaphragm ; Hiccup* ; Humans ; Lateral Medullary Syndrome ; Neck ; Nerve Block ; Neural Pathways ; Quality of Life ; Reflex ; Stellate Ganglion* ; Sympathetic Nervous System

Objective: The risk of suicide is assessed by identifying the relationship between alcohol-use patterns and suicidal ideation in Korean employees. Methods: The study involved 13,858 employees who underwent workplace mental health screening at the Workplace Mental Health Institute of Kangbuk Samsung Hospital over a 6-year period between 2014 and 2019. Analysis was performed separately for Alcohol Use Disorders Identification Test-Korea (AUDIT-K) items related to the frequency/volume of alcohol consumption (items 1 to 3, AUDIT-C) and those regarding alcohol dependence/related problems (items 4 to 10, AUDIT-D/P). Subjects were then classified into three groups on the basis of the presence or absence of clinical depression and suicidal ideation. The groups’ sociodemographic factors and clinical features of depression, anxiety, and alcohol-use patterns were analyzed with a chi-square test as well as one-way analysis of variance, followed by a post hoc test using the Bonferroni correction. Results: AUDIT-K and AUDIT-D/P scores were significantly associated with the presence or absence of clinical depression as well as the presence or absence of suicidal ideation (p<0.05). However, no significant differences were found among the three groups with regard to the AUDIT-C score (p=0.054). Conclusion Identifying or treating alcohol dependence/related problems can help lower the occurrence of mental health problems, and suicidal ideation in particular, in employees and reduce social costs.