Drash syndrome, which was first reported by Denys et al. in 1967 is a complex disorder which associates a nephropathy, Wilms' tumor, and male pseudohermaphroditism. The common denominator is a nephropathy. The nephropathy may be associated with either genital abnormalities or Wilms' tumor, and these associations are called incomplete form of Drash syndrome. This syndrome appears early in life and the first sign usually is genital ambiguity. The nephropathy presents with proteinuria, hematuria and hypertension, and eventually progresses to end stage renal failure. Renal biopsy may reveal a variety of glomerular and interstitial changes. Wilms' tumor may appear as s mass on ultrasound or it may not be recognized until nephrectomy or even autopsy. We report on a boy with nephropathy and genital abnormalities. A nephrotic syndrome with hypertension was present when first seen at 15 days of age. The karyotype was 46, XY and external genitalia was ambiguous. The nephrotic syndrome and signs of renal insufficiency persisted and he died at the age of 40 days. Histopathologic findings of kidney at autopsy revealed those of diffuse mesangial sclerosis. The case was presented with brief review of literatures.
46, XY Disorders of Sex Development ; Autopsy ; Biopsy ; Denys-Drash Syndrome* ; Disorders of Sex Development ; Genitalia ; Hematuria ; Humans ; Hypertension ; Karyotype ; Kidney ; Male ; Nephrectomy ; Nephrotic Syndrome ; Proteinuria ; Renal Insufficiency ; Sclerosis ; Ultrasonography ; Wilms Tumor

PURPOSE: To compare the efficacy and availability of foot pump and active ankle exercise for preventing deep vein thrombosis after total knee arthroplasty with hemodynamic evaluation using a color doppler duplex ultrasonography. MATERIALS AND METHODS: Thirty-six patients who underwent total knee arthroplasty between Oct. 2005 and Apr. 2006 were enrolled in this study. Retrospective analysis of 36 patients(Group 1 - foot pump after TKA, 18; Group 2-passive ankle exercise, 18) was conducted and all patients underwent color doppler duplex ultrasonography preoperatively and postoperative 7 to 14 days at femoral, popliteal and calf vein and the hemodynamic status was assessed. RESULTS: The mean baseline velocity was decreased postoperatively in both group, at all veins, but the mean peak velocity was increased only in Group. In Group 1, mean flow ratio was increased, but in Group 2, mean flow ratio was decreased except femoral vein. There were significant differences between Group 1 and Group 2(p<0.05). CONCLUSION: This study demonstrated that foot pump may be more effective than active ankle exercise in preventing postoperative deep vein thrombosis due to more increased venous flow rate and foot pump may be more compliable than active ankle exercise due to less painful, more convenient, so foot pump can be one of the available method for preventing DVT after total knee arthroplasty.
Ankle ; Arthroplasty* ; Femoral Vein ; Foot* ; Hemodynamics ; Humans ; Knee* ; Retrospective Studies ; Ultrasonography, Doppler, Color ; Ultrasonography, Doppler, Duplex ; Veins ; Venous Thrombosis*

BACKGROUND: There have been many studies about concurrent infection with tinea cruris and tinea pedis as a part of dermatophytosis in Korea. However, few studies have been reported about actual percentage regarding the frequency of tinea pedis in patients with tinea cruris and comparison of the causative organisms in the groin and foot. OBJECTIVE: The purpose of this study was to investigate the frequency of tinea pedis in patients with tinea cruris and the causative organisms in the groin and foot. METHODS: We examined clinical characteristics, frequency of tinea cruris, and causative organism on one hundred and eight nine cases with tinea cruris at the department of dermatology, Dongguk University Hospital from September 2000 to August 2005. RESULTS: The ratio of male to female patients was 10.8:1. Besides most of them were between the twenties and forties. Most (74.6%) of them involved both sites of the groin. Duration of tinea cruris was the most common within one year. The frequency of tinea pedis in patients with tinea cruris was 85.7%. Most of them (69.1%), duration of tinea pedis was longer than that of tinea cruris. One hundred and thirty nine dermatophytes were isolated from 189 patients with tinea cruris. They were Trichophyton(T.) rubrum (89.2%), T. mentagrophytes (7.2%), and Epidermophyton floccosum (3.6%). Of one hundred and sixty two patients with both tinea cruris and tinea pedis, 52 patients (32.1%) had same species and only four patients (2.5%) had different species in the groin and foot. CONCLUSION: Because of the high incidence of concurrent infection with tinea cruris and tinea pedis, we suggest the need of a careful mycological examination for foot in patients with tinea cruris.
Arthrodermataceae ; Dermatology ; Epidermophyton ; Female ; Foot ; Groin ; Humans ; Incidence ; Korea ; Male ; Tinea Pedis* ; Tinea*

BACKGROUND: The percutaneous pleural needle biopsy have been regarded as cornerstone in the diagnosis of lymphocyte dominant pleural effusions of which acid fast bacilli smear and cytologic exam was negative. However, the complications of percutaneous pleural needle biopsy is not rare arid its diagnostic efficacy is not always satisfactory. Recently, pleural fluid adenosine deaminase (ADA) and carcinoembryonic antigen (CEA) are widely accepted as markers of tuberculous pleurisy arid malignant pleural effusion respectively. We designed this study to re-evaluate the role of percutaneous pleural needle biopsy in the diagnosis of lymphocyte dominant exudative pleural effusions whose APE smear, cytologic exam was negative. METHODS: Retrospective analysis of 73 cases of percutaneous pleural needle biopsy in case of lymphocyte dominant exudative pleural effusions whose AFB smear and cytoloic exam was negative from Jan 1994 to Feb 1996 was done. RESULT: In 35 cases, specific diagnosis was obtained(all cases were tuberculous pleurisy), arid in 3(1 cases specific diagnosis was not obtained in spite of getting adequate pleural tissues, and in the other 8 cases, percutaneous pleural biopsy failed to get pleural tissues. In 9 cases, complications were combined including pneuomothorax and hemothorax. All 49 cases of pleural effusions whose ADA value was higher than 40IU/L and satisfying other categories were finally diagnosed as tuberculous pleurisy, however, the pleural biopsy confirmed only 28 cases as tuberculous pleurisy. In 6 cases of pleural effusions of which CEA value is higher than l0ng/ml, the pleural biopsy made specific diagnosis n no case. Final diagnosis of above 6 cases consisted of 4 malignant of fusions, I malignancy associated effusion and I tuberculous pleurisy. CONCLUSION: In the diagnosis of 73 cases of lymphocyte dominant pleural effusions of which acid fast bacilli smear and cytologic exam was negative, percutaneous pleural biopsy diagnosed only in 35 cases. In the diagnosis of tuberculous pleurisy, the positive predictive value of higher ADA than 40 IU/L in lymphocyte dominant pleural effusion with negative AFB smear and negative cytologic exam was l00%. And the diagnostic efficacy of pleural biopsy was 57%. In cases of effusions with high CEA than 10ng/ml 83% and 0% respectively. Finally, we concluded that percutaneous pleural needle biopsy in the diagnosis of APE smear negative and cytologic exam negative lymphocyte dominant exudative pleural effusion was not obligatory especially in effusions with high ADA and low CEA value.
Adenosine Deaminase ; Biopsy ; Biopsy, Needle* ; Carcinoembryonic Antigen ; Diagnosis* ; Hemothorax ; Hominidae ; Humans ; Lymphocytes* ; Needles* ; Pleural Effusion* ; Pleural Effusion, Malignant ; Retrospective Studies ; Tuberculosis, Pleural

PURPOSE: To report a case of secondary glaucoma and sclerokeratitis after cosmetic eye whitening by regional conjunctivectomy with Mitomycin C application. CASE SUMMARY: A 69 year-old man was referred to our clinic for a left ocular pain and ocular hypertension sustained for 3 months after cosmetic eye whitening by regional conjunctivectomy with Mitomycin C application for chronic conjunctival hyperemia. On first examination, the scleromalacia and large conjunctival epithelium defect in the nasal quadrant of the limbus area and diffuse sclerokeratitis were observed. Conjunctival and episcleral vessel deficit were seen except superior 30% portion in the left eye. The anterior chamber depth in the left eye was very shallow compared to the right eye and cell reaction in the left anterior chamber was detected. Intraocular pressure (IOP) in the left eye was 28 mmHg after Cosopt(R) and 15% mannitol 500 ml use. Glaucomatous cupping was detected. During follow-up, left IOP increased over 40 mmHg despite the maximal medical treatment and the progression of visual field defects was detected, so then left phacoemulsification, Ahmed valve implantation and amnion membrane transplantation were done. After surgery, the conjunctival epithelial defect and sclerokeratitis were improved much and IOP was regulated 20~30 mmHg without medication. Digital massage was done 2 times per day for decreasing IOP and wound remodeling after 1 month. At 3 month after surgery, the conjunctival epithelial defect recurred and scleromalacia was also progressed, so then we performed autoconjunctival flap and amnion membrane transplantation in left eye. The conjunctival epithelial defect were recovered completely, IOP was regulated 24~36 mmHg without medication, and 20~24 mmHg with Cosopt.(R) The compliance of patient is very poor, further management may be needed for IOP control. CONCLUSIONS: Cosmetic eye whitening by regional conjunctivectomy with Mitomycin C application can cause serious complications such as scleromalcia and secondary glaucoma. This case shows that particular care should be taken in order to minimize these complications.
Amnion ; Anterior Chamber ; Compliance ; Cosmetics ; Epithelium ; Eye ; Follow-Up Studies ; Glaucoma ; Glycosaminoglycans ; Humans ; Hyperemia ; Intraocular Pressure ; Mannitol ; Massage ; Membranes ; Mitomycin ; Ocular Hypertension ; Phacoemulsification ; Transplants ; Visual Fields

PURPOSE: To evaluate the usefulness of external bandage suture for bleb-related management that follows trabeculectomy with mitomycin C. METHODS: External bandage sutures were performed on 10 patients having hypotony maculopathy, persistent low intraocular pressure (IOP) caused by either hyperfiltration or focal leakage, or a persisting large bleb caused by hyperfiltration and who received trabeculectomy using mitomycin C as an adjuvant treatment. The changes in IOP measured before and 4 weeks after the procedure along with complication incidences were evaluated. RESULTS: The mean IOP 4 weeks after the procedure compared with the mean IOP prior to the procedure increased from 5.8 +/- 2.0 mm Hg (3.0-9.0 mm Hg) to 14.1 +/- 8.5 mm Hg (4.0-32.0 mm Hg), with statistical significance (p = 0.008). After the procedure, improvement in visual acuity was observed but without statistical significance. One patient had persistent focal leakage from an avascular bleb and conjunctival advancement with removal of the avascular conjunctiva was performed. CONCLUSIONS: An external bandage suture can be a good alternative for correction of post-trabeculectomy hypotony and severe chemosis with minimal effect on blebs while correcting focal leakage and hyperfiltration.
Bandages ; Blister ; Conjunctiva ; Humans ; Incidence ; Intraocular Pressure ; Mitomycin ; Sutures ; Trabeculectomy ; Visual Acuity

No abstract available.
Pneumocystis carinii* ; Pneumocystis* ; Pneumonia ; Pneumonia, Pneumocystis*

No abstract available.
Korea ; Latent Tuberculosis

Dermatophytes usually do not invade beyond the epidermis. However, mechanical breakage of the skin resulting from scratching or trauma and immunocompromised state, such as diabetes mellitus, lymphoma, and long term steroid use may allow penetration of the fungi into dermis. We report a case of trichophytic granuloma of the thigh caused by Trichophyton(T.) rubrum in a 21-year-old chinese male, who showed a pruritic, 17x10 cm sized, erythematous to brownish patch with multiple papules on the left thigh for 3 months. Fungal culture of the biopsy specimen grew out typical white cottony colonies of T. rubrum. Histopathologic examination of the skin lesions showed chronic granulomatous inflammation and fungal elements in the dermis. After one month of itraconazole therapy (200 mg/day), lesions were completely cleared.
Arthrodermataceae ; Asian Continental Ancestry Group ; Biopsy ; Dermis ; Diabetes Mellitus ; Epidermis ; Fungi ; Granuloma ; Humans ; Inflammation ; Itraconazole ; Leg ; Lymphoma ; Male ; Skin ; Thigh ; Trichophyton ; Young Adult

We report a case of tinea corporis with unusual clinical features in a 7-year-old boy. He had a 7.5 x 7.0 cm-sized, well-defined, erythematous patch with concentrically arranged rings of scales on the right thigh, and two 2.5 x 2.0 cm and 1.0 x 1.0 cm-sized satellite lesions beside the lesion. Histopathologically, PAS staining revealed fungal hyphae in the horney layer of the epidermis. Fungal culture of scales of the lesions on Sabouraud's dextrose agar showed typical Trichophyton verrucosum. He was treated daily with 125 mg of terbinafine for 1 month and with topical lanoconazole. Skin lesions improved after a month of treatment, and recurrence was not observed.
Agar ; Child ; Epidermis ; Glucose ; Humans ; Hyphae ; Male ; Recurrence ; Skin ; Thigh ; Tinea* ; Trichophyton* ; Weights and Measures