Nevus comedonicus is a rare skin abnormality characterized by a unilateral and usually linear distribution of groups of comedones, Histologically, local epidermal invagination and keratin material plugging in invaginated pouch and immatured hair follicles on lower part of the pouch were seen. Two cases are reported at first in the Korean literature. Case 1: A 24 year old man has had black colored comedolike skin lesions on left cheek with 16 years duration without any subjective symptoms. Case 2: A 19 year old girl has had multiple comedolike lesions on right buttock with 2 years duration, acompanied by recurrent suppuration and moderate itching. Our 2 cases, all are typical Nevus Comedonicus Unilateralis case in clinically and histopathologically. Treatment with local application of steroid cream and dermoabrasion resulted good effect, but essentially there is no need to treat untill complication deveoped.
Buttocks ; Cheek ; Female ; Hair Follicle ; Humans ; Nevus* ; Pruritus ; Skin ; Skin Abnormalities ; Suppuration ; Young Adult

Pain relief becomes a major concern when treating patients with rib fractures so adequate ventilation must be maintained. Many techniques have been described for the management of frectured ribs, including systemic analgesics, intercostal nerve blockade, intrathecal morphine, epidural bupivacaine and epidural morphine. This case report illustrates the successful use of epidural narcotics in a patient with multiple fractured ribs.
Analgesics ; Bupivacaine ; Humans ; Intercostal Nerves ; Morphine ; Narcotics* ; Rib Fractures ; Ribs* ; Ventilation

The popular term malignant hyperthermia syndrome (MHS) refers to a clinical syndrome classically observed during general anesthesia. It is characterized by a rapidly increasing .temperature and a high mortality rate. A case of MHS was experienced which developed 60 minutes after induction of general anesthesia with thiopental sodium, succinylcholine, halothane, N2O and 02. High fever, muscle rigidity and cyanosis developed and were followed by arrythmia and unstable blood pressure. Anesthesia was terminated and vigorous emergency treatment was attempted. The patient died about 6 hours after induction of anesthesia.
Anesthesia ; Anesthesia, General ; Arrhythmias, Cardiac ; Blood Pressure ; Cyanosis ; Emergency Treatment ; Fever ; Halothane ; Humans ; Malignant Hyperthermia* ; Mortality ; Muscle Rigidity ; Succinylcholine ; Thiopental

Two hundred cases of surgically repaired hypospadias at Pusan University Hospital in the past sixteen half years were surveyed and analyzed. Of 200 patients, 99(49.5%) were corrected in their preschool age. The number of patients with the distal type and proximal type of hypospadias performed in 134(67%) of 200 and the success rate was 84.3 per cent(113 of 134). One stage repair was performed in 66(33.0%) of 200 and the success rate are as follows : King, 100%(7 of 7), MAGPI, 100.0% (4 of 4), Mathieu, 100.0%(5 of 5), Hodgson ( I , III), 75%(12 of 16), and preputial island flap including Duckett, Hodgson XX and double faced technique, 67.6% (23 of 34). The most common postoperative complication was fistula.
Busan ; Female ; Fistula ; Humans ; Hypospadias* ; Male ; Postoperative Complications

BACKGROUND: We studied the interaction between Succinylcholine (SCh) and mivacurium when mivacurium was administered during early and late recovery from SCh block was investigated. METHODS: Eighty patients undergoing elective surgery under general anesthesia were studied. General anesthesia was induced and maintained with propofol under TCI control. Neuromuscular function was measured in response to TOF stimulation of the ulnar nerve using an electromyographic method. The patients were allocated randomly to the following four groups; group 1 (n = 20): a bolus intravenous injection of 0.08 mg/kg mivacurium; group 2 (n = 20): intravenous injection of 0.08 mg/kg mivacurium after 2 minutes of 1 mg/kg SCh injection; group 3 (n = 20): intravenous injection of 0.08 mg/kg mivacurium after 25% recovery of initial twitch height from twitch height depression induced by 1 mg/kg SCh; group 4 (n = 20): intravenous injection of 0.08 mg/kg mivacurium after 75% recovery of initial twitch height from twitch height depression induced by 1 mg/kg SCh. The onset and duration of neuromuscular blockade, recovery rate and TOF ratio at T75% were measured. RESULTS: The onset of block in groups 3 and 4 were slower than in group 1 (5.2 +/- 0.7 and 2.3 +/- 0.6 vs 2.5 +/- 0.4 min P < 0.05). The clinical duration in groups 2 and 3 were longer than in groups 1 and 4 (12.5 +/- 2.1 min and 11.3 +/- 1.7 min vs 17.0 +/- 3.0 min and 18.5 +/- 2.6 min, p < 0.05). There was no difference in recovery index all groups. The TOF ratio of groups 2, 3 and 4 were smaller than for group 1 (38.2 +/- 5.3, 32.3 +/- 5.6 and 31.5 +/- 4.2 vs 56.0 +/- 7.3, P < 0.05). CONCLUSIONS: The Previous 1 mg/kg SCh injection was affected the time course of action of mivacurium 0.08 mg/kg-induced neuromuscular block.
Anesthesia, General ; Depression ; Humans ; Injections, Intravenous ; Neuromuscular Blockade* ; Propofol ; Succinylcholine* ; Ulnar Nerve

No abstract available.
Pyoderma Gangrenosum* ; Pyoderma* ; Ulcer*

BACKGROUND: It is well established that vascular contraction is caused by not only an increase in cytosolic Ca2+ level but also activations of Ca2+-sensitizing mechanisms including protein kinase C (PKC) and low molecular GTP binding protein. However, the roles of PKC and RhoA, a low molecular GTP-binding protein, on the receptor agonist-mediated contraction in swine pulmonary artery has not been clarified. In the present study, we examined the contribution of PKC isoform and RhoA to the arterial stimulants-induced contraction in swine pulmonary artery. METHOD: The large (> 5 mm), medium (1-3 mm) and small (< 1 mm in outer diameter) sized pulmonary arteries were excised and the contractions were recorded isometrically. The contents and subcellular distribution of PKC isoforms and RhoA were detected using immunoblotting. RESULTS: In medium pulmonary artery, norepinephrine (NE, 10 nM-30micrometer) led contraction in a dose-dependent manner. In large and small pulmonary arteries, however, NE failed to induce a contraction. Adding of 12-deoxyphorbol 13-isobutyrate (DPB, 1micrometer), a PKC activator, developed muscle force in 1 mM EGTA-contained Ca2+-free physiological salt solution. The expressions of PKC alpha, elsilon were significantly increased in medium pulmonary artery. NE (10micrometer) evoked the translocation of RhoA from cytosol to the membrane but not those of PKC isoforms. In Ca2+-free physiological salt solution, DPB (1micrometer) caused a translocation of PKC isoforms. CONCLUSIONS: These results support that NE induces contraction via RhoA pathway but not PKC pathway in swine pulmonary artery.
Cytosol ; GTP Phosphohydrolases* ; GTP-Binding Proteins ; Immunoblotting ; Membranes ; Norepinephrine ; Protein Isoforms ; Protein Kinase C* ; Protein Kinases* ; Pulmonary Artery* ; Swine*

BACKGROUND: Usually fever subsides within one week in over 90% of pulmonary tuberculosis (TBp) patients after the start of short-course anti-tuberculosis therapy, but occasionally it persists over two weeks after treatment. When the fever persists, drug resistance, combined infection, or drug fever, and so on, are considered as an etiology and, in some cases, drugs are changed. But inadvertent discontinuation of a short-course regimen inevitably will extend the duration of treatment, and the treatment completion may be delayed. This study was performed to investigate the causes of prolonged fever (PF) and to identify the predictors of PF in drug-susceptible TBp patients in Korea. METHOD: five hundred-ninety-eight patients, who were admitted to Asan Medical Center from January 1996 to March 1999, diagnosed with TBp and prescribed short-course, anti-tuberculosis treatment, were reviewed. PF was difined as having fever over two weeks despite treatment. The causes of PF were ansalyzed. Drug-susceptible TBp patients who presented no caussp es for PF, except turberculosis itself, were selected(n=22), and they were compared with those who had no fever at diagnosis(n=22) and those who had fever at diagnosis, which had subsided within two weeks after treatment(n=22). Clinical, laboratory, and radiological parameters were compared among the three groups. RESULTS: Twenty-eight(4.8%) of 598 patients showed PF over two weeks despite short-course treatment. the causes of PF were drug fever (n=2), multi-drug resistant tuberculosis (n=3), disseminated Mycobacterium Kansasii infection (n=1), and drug-susceptible tuberculosis itself (n=22). The patients with PF had more risk factors for tuberculosis, long duration of symptoms before treatment, night sweats, weight loss, numerous acid fast bacilli on sputum smear, anemia, hyponatremia, hypoalbuminemia, over three lung cavity numbers and extensive infiltratoion, indicating that they had prolonged and extensive lung diseases. CONCLUSION: The main cause of PF in TBp despite short-course regimen seems to be drug-susceptible but extensive disease in Korea. Any changes to the drug regiment provided for TBp patients with prolonged fever despite treatment should be carefully considered.
Anemia ; Chungcheongnam-do ; Diagnosis ; Drug Resistance ; Fever* ; Humans ; Hypoalbuminemia ; Hyponatremia ; Korea ; Lung ; Lung Diseases ; Mycobacterium kansasii ; Risk Factors ; Sputum ; Sweat ; Tuberculosis ; Tuberculosis, Multidrug-Resistant ; Tuberculosis, Pulmonary* ; Weight Loss

BACKGROUND AND OBJECTIVES: Assessment of left ventricular systolic function is an important clinical variable with respect to diagnosis, prognosis and treatment in various clinical situation. Automatic quantification of ventricular volume and ejection fraction by delineating 3 dimensional endocardial boundaries from the gated perfusion SPECT was validated. The purposes of this study were to assess the agreement of left ventricular ejection fraction determined by two-dimensional echocardiography and automatic quantification of perfusion SPECT and compare different echocardiographic methods with the reference method, automatic quantification of perfusion SPECT. METHOD: Twenty seven patients (20 men, 7 women; mean age 60+/-12) with acute myocardial infarction (anterior: 16, inferior: 7, lateral: 4) and twenty one patients (12 men, 9 women; mean age 60+/-12) without myocardial infarction history and regional wall motion abnormality in echocardiography were studied. All patients had two-dimensional echocardiography and 201Tl perfusion SPECT performed within 5 days of each other. Ejection fraction of left ventricle was calculated by echocardiography using modified Simpson's method and M-mode method. Also, ejection fraction of left ventricle was estimated by 201Tl perfusion SPECT using automatic software (quantitative gated SPECT[QGS]; Cedars-Sinai Medical Center, Los Angels, CA). RESULTS: The agreement of ejection fraction between M-mode method and QGS (limit of agreement -3.48, 3.2; average limit of agreement 6.68) in control group was better than that between modified Simpson's method and QGS (limit of agreement 0.04, 8.42; limit of agreement average limit of agreement 8.38). But, The agreement of ejection fraction between modified Simpson's method and QGS in the acute myocardial infarction group (limit of agreement; -15.31, 10.01; average limit of agreement 12.66) was better than that between M-mode method and QGS (limit of agreement -17.82, 13.86; average limit of agreement 15.84). The agreement of ejection fraction between modified Simpson's method and QGS (limit of agreement; -8.49, 5.74; average limit of agreement 7.12) in the anterior myocardial infarction was more accordancy than lateral and inferior wall infarction (limit of agreement; -12.11, 13.74; average limit of agreement 12.92). CONCLUSION: The M-mode method in patients without regional wall motion abnormality and modified Simpson's method in patients with regional wall motion abnormality, especially in anterior wall infarction seen to be useful method for the assessment of left ventricular ejection fraction.
Diagnosis ; Echocardiography* ; Female ; Heart Ventricles ; Humans ; Infarction ; Male ; Myocardial Infarction ; Perfusion ; Prognosis ; Stroke Volume ; Tomography, Emission-Computed, Single-Photon*

Parkinson's disease animal model was developed by the destruction of the striatonigral dopaminergic system. The morphological changes in the dopamine depleted striatum after the transplantation of the fetal mesencephalic dopaminergic neurons or tyrosine hydroxylase cDNA transfected human neural stem cells (C4-TH cells) were studied. Male Sprague-Dawley rats, weighting 250~300 gm, were used. To make unilateral lesion of nigrostriatal tract, 6-OHDA (6 microgram/microliter) was injected into the medial forebrain bundle. Two weeks after the lesion surgery, the effect of the 6-OHDA lesion was assessed by monitoring apomorphine (0.5 mg/kg, s.c)-induced turning behavior and confirmed by the lack of TH-immunoreactivity on tissue sections. Either cell suspension from ventral mesencephalic tissue obtained from embryonic day 14 fetus or C4-TH cells was grafted into the rostral striatum. After grafting, rats were tested with apomorphine every 2 weeks for 6 weeks. The grafted rats showing behavioral recovery were sacrificed and analysed by TH, neuropeptide Y (NPY), and parvalbumin (PV) immuno- histochemistry. TH-immunoreactive (ir) neurons were located around the graft and their processes extended into the striatum. The TH-ir axon terminals made a symmetrical synapse with the dendrites of the striatal neuron. Cell bodies either NPY- or PV-ir striatal neuron were observed around the graft and extended their processes into the graft. TH-ir C4-TH cells were also distributed along the needle track such as the transplanted fetal dopaminergic neurons, but had smaller soma and fewer processes than those. It is concluded that the grafted dopaminergic cells are survived in the dopamine depleted striatum and recovered the rotational behavior of Parkinson's disease animal model.
Animals ; Apomorphine ; Carisoprodol ; Cell Transplantation* ; Dendrites ; DNA, Complementary ; Dopamine ; Dopaminergic Neurons ; Fetus ; Humans ; Male ; Medial Forebrain Bundle ; Models, Animal* ; Needles ; Neural Stem Cells ; Neurons ; Neuropeptide Y ; Oxidopamine ; Parkinson Disease* ; Presynaptic Terminals ; Rats* ; Rats, Sprague-Dawley ; Synapses ; Transplantation ; Transplants* ; Tyrosine 3-Monooxygenase