We describe the case of a 45-year-old woman who had self-regressing livedo reticularis on the lower extremities. Examination of a biopsy specimen from the mottled area revealed myxomatous emboli in the deep dermal arterioles. Echocardiography showed a myxoma in the left atrium. After the tumor was surgically excised, the patient had no further evidence of the disorders during the 3-year period of follow-up. Livedo reticularis caused by an peripheral arterial embolism, which in turn was caused by the tumor fragments in our patient with left atrial myxoma, is considered to be unusual.
Arterioles ; Biopsy ; Echocardiography ; Embolism ; Female ; Follow-Up Studies ; Heart Atria ; Humans ; Livedo Reticularis* ; Lower Extremity ; Middle Aged ; Myxoma*

OBJECTIVES : The primary purpose of this study was to investigate the effects of computerized cognitive rehabilitation training on inpatients with schizophrenia in the rehabilitation unit. METHODS : Thirty-eight patients with schizophrenia from the Yongin Mental Hospital Rehabilitation Ward were randomly assigned either to a computerized cognitive rehabilitation group or to a control group. The rehabilitation group received 12 sessions of computerized cognitive rehabilitation training (Cog-Trainer) over 3 months. This training program consisted of ten units, each of which consisted of 3 levels, practice, application, and advanced. Neurocognitive functions were assessed at the beginning and end of the training period. Cognitive measures included Span of Apprehension (SPAN), Continuous Performance Test (CPT), Digit Span, Trail Making Test, and the Stroop Test. RESULTS : Compared to controls, subjects receiving computerized cognitive rehabilitation training experienced a significant improvement in attention, concentration, and working memory. CONCLUSION : These results indicate that computerized cognitive rehabilitation training can contribute to improvement in cognitive function of patients with schizophrenia. Further study to generalize these results is required.
Hospitals, Psychiatric ; Humans ; Inpatients ; Memory, Short-Term ; Pilot Projects ; Schizophrenia ; Trail Making Test

It is well known that proper gender assignment and treatment to a neonate born with ambiguous genitalia are extremely important. We reviewed seven patients with ambiguous genitalia who were surgically managed at our department during recent 5 years. The median age was 12.1 years (from 3 to 24 years) and patients consist of three female pseudohermaphroditism (adrenogenital syndrome), one true hermaphroditism, one male pseudohermaphroditism and two mixed gonadal dysgenesis. Three patients were managed with clitoral recession and vaginoplasty, each of them with clitoral recession vaginoplasty and gonadectomy, with clitoral recession and gonadectomy, with clitoral recession, with gonadectomy and bilateral mastectomy. One patient with adrenogenital syndrome was raised as male, but re-assigned and surgically corrected as female at her age of 16 years. Another one patient with true hermaphroditism was raised as male who underwent excision of female internal genitalia, gonadectomy and bilateral mastectomy in considering of patient's gender identity, appearance of external genitalia and parent's proposal although the karyotype was 46 XX. We suggest that gender assignment and surgical correction must be done as early as possible after full evaluation of fertility feasibility, karyotype, sex ability and patient and parent's proposal.
46, XX Disorders of Sex Development ; 46, XY Disorders of Sex Development ; Adrenogenital Syndrome ; Disorders of Sex Development* ; Female ; Fertility ; Gender Identity ; Genitalia ; Gonadal Dysgenesis, Mixed ; Humans ; Infant, Newborn ; Karyotype ; Male ; Mastectomy ; Ovotesticular Disorders of Sex Development

Between July 1988 and June 1993, nine patients with renal and perirenal abscess were treated using the percutaneous management. Percutaneous abscess drainage was done under ultra- sound guidance and local anesthesia. Among the nine patients, two patients were managed by percutaneous aspiration only and the other seven patients were managed by continuous drainage using the 8.3F pig-tail or 14F Malecot catheter. The catheters were placed in the abscess cavity during the period from 4 days to 19 days (average 8 days). On the abscess culture, the organisms were identified in 9 cases ( 100%) ; E.coli was in 4 cases, S. aureus was in 2 cases, Proteus, Enterobacter, unidentified gram negative bacilli in 1 case, respectively. After catheter removal, all patients have remained free of symptoms during followup from 2 months to 32 months (average 20 months). We suggest that proper antibiotic therapy combined with ultrasound guided percutaneous drainage of renal and perirenal abscess is a choice of reasonable, safe and effective management in selected patients.
Abscess* ; Anesthesia, Local ; Catheters ; Drainage ; Enterobacter ; Follow-Up Studies ; Humans ; Proteus ; Ultrasonography

Ten children were selected out of 21 cases diagnosed as ureteropelvic junction obstruction between March, 1989 and March, 1992. The children were evaluated quantitatively using the renal cortical labeling agent, 99m technetium dimercaptosuccinic acid (Tc-DMSA), before and following pyeloplasty. The preoperative residual renal function and the extent of functional recovery were investigated. The children ranged from 15 months to 13 years old (average 6.8 years) and consisted of 8 boys and 2 girls. The obstruction was on the left in 7 cases and the right in 3. Symptoms on admission included pain in 5 cases, abdominal mass in 3 cases, and fever and chill in 2. The subjects divided into two groups. The first group consisted of children who did not have complications or other coexisting diseases, while the second consisted of who had pyonephrosis or vesicoureteral reflux. All patients underwent dismembered pyeloplasty and the results were satisfactory in all. 1. The preoperative differential renal function by Tc-DMSA renal scintigraphy ranged from 0.5% to 46.0% (mean 19.1%) and increased to 3.5% to 46.9% (mean 28.8%) postoperatively. 2. In five of the seven cases with uncomplicated ureteropelvic junction obstruction, differential renal function increased more than 1096 following pyeloplasty. In the two other cases which showed preserved renal function of up to 4096 preoperatively, noticeable changes not observed. 3. In the three cases with complicated ureteropelvic junction obstruction, (two cases associated with pyonephrosis and one case with vesicoureteral reflux) only slight increased differential renal function. In conclusion, we suggest that severely obstructed kidneys in infants and children spare nephrectomy and encourage pyeloplasty, even in cases of non-visualization on excretory urography in hopes of improving relative renal function.
Adolescent ; Child* ; Female ; Fever ; Hope ; Humans ; Infant ; Kidney* ; Nephrectomy ; Pyonephrosis ; Radionuclide Imaging ; Succimer ; Technetium ; Technetium Tc 99m Dimercaptosuccinic Acid* ; Urography ; Vesico-Ureteral Reflux

Various cancer types have been associated with cancer-related cerebral infarction. In this study, we describe the first case of cancer-related cerebral infarction in which the underlying disease was primary bone marrow lymphoma (PBML). A 79-year-old man presented with abruptly developed bilateral lower extremity weakness and confusion. Diffusion-weighted imaging on admission showed multiple cortical and subcortical embolic infarction lesions in multiple vascular territories. Diagnostic evaluations to determine the embolic source revealed no abnormalities. Laboratory testing demonstrated elevated D-dimer (2.59 μg/mL) but no other prothrombotic abnormalities. In suspicion of cancer-related stroke, we performed chest CT, abdomen CT, and FDG-PET to detect the hidden malignancy. Findings revealed no evidence of cancer; however, they did reveal signs of anemia (hemoglobin 9.0 g/dL). Bone marrow aspiration biopsy showed large atypical B cell involvement suggestive of high-grade B cell lymphoma. The patient was diagnosed with primary bone marrow diffuse large B-cell lymphoma initially presenting with ischemic stroke. Our case suggests that primary bone marrow cancer may be a candidate for the differential diagnosis of hidden malignancy in patients with suspected cancer-related stroke. Bone marrow biopsy may be essential for establishing an appropriate differential diagnosis in patients with abnormal hematologic findings.

OBJECTIVE: Pituitary apoplexy (PA) is described as a clinical syndrome characterized by sudden headache, vomiting, visual impairment, and meningismus caused by rapid enlargement of a pituitary adenoma. We retrospectively analyzed the clinical presentation and surgical outcome in PA presenting with cranial neuropathy. METHODS: Twelve cases (3.3%) of PA were retrospectively reviewed among 359 patients diagnosed with pituitary adenoma. The study included 6 males and 6 females. Mean age of patients was 49.0 years, with a range of 16 to 74 years. Follow-up duration ranged from 3 to 20 months, with an average of 12 months. All patients were submitted to surgery, using the transsphenoidal approach (TSA). RESULTS: Symptoms included abrupt headache (11/12), decreased visual acuity (12/12), visual field defect (11/12), and cranial nerve palsy of the third (5/12) and sixth (2/12). Mean height of the mass was 29.0 mm (range 15-46). Duration between the ictus and operation ranged from 1 to 15 days (mean 7.0). The symptom duration before operation and the recovery period of cranial neuropathy correlated significantly (p = 0.0286). TSA resulted in improvement of decreased visual acuity in 91.6%, visual field defect in 54.5%, and cranial neuropathy in 100% at 3 months after surgery. CONCLUSION: PA is a rare event, complicating 3.3% in our series. Even in blindness following pituitary apoplexy cases, improvement of cranial neuropathy is possible if adequate management is initiated in time. Surgical decompression must be considered as soon as possible in cases with severe visual impairment or cranial neuropathy.
Blindness ; Cranial Nerve Diseases ; Decompression, Surgical ; Female ; Follow-Up Studies ; Headache ; Humans ; Male ; Meningism ; Pituitary Apoplexy ; Pituitary Neoplasms ; Retrospective Studies ; Vision Disorders ; Visual Acuity ; Visual Fields ; Vomiting

No abstract available.
Granuloma, Foreign-Body* ; Mesotherapy*

No abstract available.
Iron* ; Skin Pigmentation*

No abstract available.
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