Giant condyloma and carcinoma-like condyloma is relatively rare. Although it has histological similarities to condyloma acuminata, it is believed by most authorities to be a clearly defined variant of epidermoid carcinoma. Clinically it is easily mistaken for the more aggressive metastasing epidermoid carcinoma. The legion was first described by Buschke in the German literature in 1896. as a varient of condyloma acuminata. A case of malignancy of the penis which have apparently been transformed from giant condyloma acuminata of the penis are herein presented with review of literature.
Carcinoma, Squamous Cell ; Male ; Penis

Predisposing factors for venous thrombosis can be identified in the majority of patients with established venous thromboembolism (VTE). However, an obvious precipitant may not be identified during the initial evaluation of such patients. In the present case, a 47-year-old female presented to the emergency department of our hospital after ingesting multiple drugs. She had no VTE-related risk factors or previous episodes, nor any family history of VTE. After admission to the intensive care unit sudden hypoxemia developed, and during the evaluation cerebral, renal, and splenic infarctions with pulmonary embolisms were diagnosed. However, the sources of the emboli could not be identified by transthoracic echocardiography or computed tomography angiography. Protein C deficiency was identified several days later. We recommend that hypercoagulable states be taken into consideration, especially when unexplained thromboembolic events develop in multiple or unusual venous sites.
Angiography ; Anoxia ; Causality ; Echocardiography ; Emergency Service, Hospital ; Female ; Humans ; Infarction* ; Intensive Care Units ; Middle Aged ; Protein C Deficiency ; Pulmonary Embolism ; Risk Factors ; Splenic Infarction ; Thrombophilia ; Venous Thromboembolism ; Venous Thrombosis

BACKGROUND: Peripheral arterial disease is frequently accompanied with systemic arteriosclerosis and more than half of the cause of deaths is due to the development of coronary arterial disease. Moreover, it is known that the most frequent cause of death after a bypass surgery of chronic arterial obstruction is heart related complications. Especially in patients with atherosclerotic arterial obstruction in the lower extremities who had no history of heart disease or had no presenting symptoms of ischemic heart disease showed a high rate of postoperative mortality and for this reason we suggest preoperative evaluation in these patients to evaluate whether or not coronary arterial disease is accompanied. MATERIAL AND METHOD: Since Feb. 2001 to Oct. 2004, we analyzed 52 patients who were operated on for atherosclerotic arterial obstruction in the lower extremities, with the exception of patients with a past history of heart disease or symptoms of ischemic heart disease. They underwent on the same day a coronary and femoral angiography for evaluation of accompanying coronary arterial disease. Of among these patients, we compared those who received bypass surgery of the arteries of the peripheral extremities alone to those who underwent combined coronary artery bypass surgery. RESULT: 63% of the reported cases of atherosclerotic arterial obstruction in the lower extremities were accompanied with coronary arterial disease. Old age, hypertension, diabetes mellitus, smoking, and hypercholesterolemia are known risk factors for arteriosclerosis and of these, only old age and hypertension had statistically significance in patients with severe atherosclerotic arterial obstruction in the lower extremities accompanied with coronary arterial disease. Diabetes, smoking, and hypercholesterolemia showed no statistical significance in this group. With the increase in severity of the range and the degree of atherosclerotic arterial obstruction, coronary arterial disease is frequently accompanied and its severity also increased. Patients who received both peripheral artery and coronary artery bypass surgery showed no difference in the period of hospitalization and ICU stay period compared with patients who received bypass surgery of the arteries of the lower extremities alone. CONCLUSION: Patients with atherosclerotic arterial obstruction in the lower extremities without symptoms of ischemic heart disease should undergo a preoperative coronary angiography to evaluate coronary arterial disease for active treatment, especially in the patients with old age, hypertension and high AVD scores.
Angiography ; Arteries ; Arteriosclerosis ; Atherosclerosis ; Cause of Death ; Coronary Angiography* ; Coronary Artery Bypass ; Diabetes Mellitus ; Extremities ; Heart ; Heart Diseases ; Hospitalization ; Humans ; Hypercholesterolemia ; Hypertension ; Lower Extremity* ; Mortality ; Myocardial Ischemia ; Peripheral Arterial Disease ; Peripheral Vascular Diseases ; Risk Factors ; Smoke ; Smoking

BACKGROUND: Peripheral arterial disease is frequently accompanied with systemic arteriosclerosis and more than half of the cause of deaths is due to the development of coronary arterial disease. Moreover, it is known that the most frequent cause of death after a bypass surgery of chronic arterial obstruction is heart related complications. Especially in patients with atherosclerotic arterial obstruction in the lower extremities who had no history of heart disease or had no presenting symptoms of ischemic heart disease showed a high rate of postoperative mortality and for this reason we suggest preoperative evaluation in these patients to evaluate whether or not coronary arterial disease is accompanied. MATERIAL AND METHOD: Since Feb. 2001 to Oct. 2004, we analyzed 52 patients who were operated on for atherosclerotic arterial obstruction in the lower extremities, with the exception of patients with a past history of heart disease or symptoms of ischemic heart disease. They underwent on the same day a coronary and femoral angiography for evaluation of accompanying coronary arterial disease. Of among these patients, we compared those who received bypass surgery of the arteries of the peripheral extremities alone to those who underwent combined coronary artery bypass surgery. RESULT: 63% of the reported cases of atherosclerotic arterial obstruction in the lower extremities were accompanied with coronary arterial disease. Old age, hypertension, diabetes mellitus, smoking, and hypercholesterolemia are known risk factors for arteriosclerosis and of these, only old age and hypertension had statistically significance in patients with severe atherosclerotic arterial obstruction in the lower extremities accompanied with coronary arterial disease. Diabetes, smoking, and hypercholesterolemia showed no statistical significance in this group. With the increase in severity of the range and the degree of atherosclerotic arterial obstruction, coronary arterial disease is frequently accompanied and its severity also increased. Patients who received both peripheral artery and coronary artery bypass surgery showed no difference in the period of hospitalization and ICU stay period compared with patients who received bypass surgery of the arteries of the lower extremities alone. CONCLUSION: Patients with atherosclerotic arterial obstruction in the lower extremities without symptoms of ischemic heart disease should undergo a preoperative coronary angiography to evaluate coronary arterial disease for active treatment, especially in the patients with old age, hypertension and high AVD scores.
Angiography ; Arteries ; Arteriosclerosis ; Atherosclerosis ; Cause of Death ; Coronary Angiography* ; Coronary Artery Bypass ; Diabetes Mellitus ; Extremities ; Heart ; Heart Diseases ; Hospitalization ; Humans ; Hypercholesterolemia ; Hypertension ; Lower Extremity* ; Mortality ; Myocardial Ischemia ; Peripheral Arterial Disease ; Peripheral Vascular Diseases ; Risk Factors ; Smoke ; Smoking

Predisposing factors for venous thrombosis can be identified in the majority of patients with established venous thromboembolism (VTE). However, an obvious precipitant may not be identified during the initial evaluation of such patients. In the present case, a 47-year-old female presented to the emergency department of our hospital after ingesting multiple drugs. She had no VTE-related risk factors or previous episodes, nor any family history of VTE. After admission to the intensive care unit sudden hypoxemia developed, and during the evaluation cerebral, renal, and splenic infarctions with pulmonary embolisms were diagnosed. However, the sources of the emboli could not be identified by transthoracic echocardiography or computed tomography angiography. Protein C deficiency was identified several days later. We recommend that hypercoagulable states be taken into consideration, especially when unexplained thromboembolic events develop in multiple or unusual venous sites.
Angiography ; Anoxia ; Causality ; Echocardiography ; Emergency Service, Hospital ; Female ; Humans ; Infarction ; Intensive Care Units ; Middle Aged ; Protein C Deficiency ; Pulmonary Embolism ; Risk Factors ; Splenic Infarction ; Thrombophilia ; Venous Thromboembolism ; Venous Thrombosis

Objective: Urgent upper endoscopy is performed to achieve acute hemostasis in patients with high-risk bleeding sources. Emergency physicians must identify patients who require urgent endoscopic treatments. This study assessed the performance of blood urea nitrogen (BUN) for predicting severe bleeding that necessitates urgent endoscopic hemostasis compared to the risk assessment scores in patients with acute non-variceal upper gastrointestinal bleeding (ANVUGIB). Methods: The presumed ANVUGIB patients were classified into endoscopic and non-endoscopic hemostasis groups. Data including historical features, symptoms, signs, and routine laboratory tests were collected and compared. Results: Three hundred and ninety-one patients were analyzed, including 116 patients in the endoscopic hemostasis and 275 patients in the non-endoscopic hemostasis group. In the area under curve (AUC) of the receiver operator characteristic curve, BUN (AUC 0.733; 95% confidence interval [CI], 0.681-0.785) and BUN/creatinine (AUC, 0.727; 95% CI, 0.672-0.783) were superior to total protein, Glasgow-Blatchford score (GBS), modified GBS (AUC, 0.649, 0.623 and 0.646, respectively) for predicting endoscopic hemostasis. Pre-endoscopy Rockall score and AIMS65 were statistically insignificant. The same results were obtained when the patients with liver and chronic kidney diseases were excluded. Conclusion The current results suggest that BUN was an independent predictor of endoscopic hemostasis in patients with ANVUGIB. Further studies will be needed to determine if BUN can be used in clinical practice.

OBJECTIVE: This study compared the prognosis of patients who visited the trauma center directly (direct visit group) with those transferred from the non-trauma center (transferred group). METHODS: The patients, who were 18 or older with Injury Severity Score of 15 or more in the trauma center at Busan, were studied from October 2015 to October 2016. To compare the treatment time between the direct visit and transferred group, first treatment time, final treatment time, and time to visit the trauma center were examined. To compare the prognosis, this study compared the 48-hour, 7-day, and in-hospital mortality rate as well as the duration of intensive care unit (ICU) and total hospital stay. To analyze the factors affecting the outcome of transferred group, the physician's level and procedures that had been performed at the non-trauma center were examined. RESULTS: The mortality was similar in the direct visit and transferred group (48-hour 7.6% vs. 4.6%, P=0.111; 7-day 11.1% vs. 7.2%, P=0.89; and in-hospital 14.6% vs. 11.3%, P=0.214). The length of ICU and total hospital stay were similar in the two groups. The mortality was higher in the patients in the transferred group when using intubation, transfusion, and pressure intensifier. The intubated patients showed higher mortality according to logistic regression. CONCLUSION: The mortality, length of ICU, and hospital stay were similar but the time to visit the trauma center and the final treatment time were longer in transferred group. Stabilizing the patient at the near non-trauma center may be more helpful for some patients.
Busan ; Hospital Mortality ; Humans ; Injury Severity Score ; Intensive Care Units ; Intubation ; Length of Stay ; Logistic Models ; Mortality ; Patient Transfer ; Prognosis ; Trauma Centers

OBJECTIVES: To determine the relationship between stress Factors and work-related musculoskeletal symptoms of assembly line workers in the automobile industry. METHODS: A cross-sectional study was conducted in two Factories of automobile manufacturing companies where inappropriate posture and repetitive motions were required. The total number of subjects was 636, and consisted entirely of men. The Age, length of work duration, marital status, education level, smoking status, drinking status, sleeping time and stress scores were investigated according to subgroups of general characteristics. We divided the subjects into a Reference group and a Stress risk group to compare the frequency of the variables between them. The stress scores of the Positive symptom group were compared with the Symptom free group by the t-test. To measure the stress level, the PWI(Psychosocial Well being Index) which consists of 4 Factors, totaling 45 items, was used. A standardized self-reported questionnaire was used to assess the symptoms in workers. The criteria for positive symptoms were based on Operational Definition of Work-related Musculoskeletal Disorders of the NIOSH. RESULTS: 1) The subgroups of Age, Work duration, Marital status, Education level, Smoking status, Drinking status and Sleeping time revealed no differences in frequencies in musculoskeletal symptoms. 2) Higher PWI(p<0.05), Factor 3(p<0.05) and Factor 4(p<0.01) scores were observed in younger workers compared with older workers. 3) The workers who had work durations between 11-15 years showed higher PWI(p<0.01), Factor 2(p<0.01), Factor 3(p<0.01), and Factor 4(p<0.01), compared with other work duration subgroups. 4) Singles had higher Factor 4 scores(p<0.01). 5) The sleeping time of less than 6 hours a day expressed a higher PWI(p<0.01), Factor 2(p<0.05), and Factor 3(p<0.01), Factor 4(p<0.05). 6) There was no difference in the prevalence of musculoskeletal symptoms between the Reference group and Stress risk group. 7) The subjects who had Positive musculoskeletal symptoms showed a significant difference in Factor 2 scores compared with the Symptom free groups. 8) According to a univariate logistic regression analysis, Factor 2(OR: 1.02, 95% CI: 1.00-1.04, p-value: 0.0291) expressed significant but mild effects on the musculoskeletal symptoms and a multivariate logistic regression showed a statistically significant effect on musculoskeletal symptoms(OR:1.04, 95% CI: 1.01-1.07, p-value: 0.0170). CONCLUSION: Psychosocial stress scores were not higher in symptomatic subjects compared with those who had no symptoms. Sleeping longer showed a protective effect on symptoms but this was not statistically significant. There was no relationship between the stress scores and musculoskeletal symptoms in social performance and self-confidence, general well-being and vitality. Factor 2(Depression) was statistically significant though its effect was mild. Limited to this study, We could find partial relationship between psychosocial stress(Depression) and musculoskeletal symptoms. So it could therefore be suspected that ergonomic or other unknown factors may be more significant causes of musculoskeletal symptoms but we did not investigate these.
Automobiles* ; Cross-Sectional Studies ; Depression ; Drinking ; Education ; Humans ; Logistic Models ; Male ; Marital Status ; National Institute for Occupational Safety and Health (U.S.) ; Posture ; Prevalence ; Questionnaires ; Smoke ; Smoking

PURPOSE: This study analyzed the value of (99m)Tc - M I B I SPECT(Single Photon Emission Com-puted Tomography) in the diagnosis of myocardial contusion after blunt chest trauma . METHODS: We evaluated 24 patients with cardiac contusions after blunt chest trauma who were diagnosed by clinical symptoms, chest x-ray, electrocardiogram(ECG), and Creatine phospho-kinase(CPK). (99m)Tc-MIBI SPECT was performed within 48 hours along with the above tests prospectively. RESULTS: 1. Among the 24 patients, 14 patients were finally diagnosed as having a myocardial contusion by means of ECG, echocardiography, (99m)Tc-MIBI SPECT, and cardiac enzyme. 2. The sensitivity, specificity and accuracy of (99m)Tc - MIBI SPECT were 46.7%, 66.7%, and 54.2%, respectively. The same results for initial ECG were 46.6%, 88.9%, and 62.5%. 3. For those who had positive findings in (99m)Tc - MIBI SPECT, average hospital stay was 14.5 days and abnormal electrocardiogram was found in 90.0%. However, for those who had negative findings, average hospital stay was 11.2 days and abnormal electrocardiogram was found in 35.7%. CONCLUSION: (99m)Tc-MIBI SPECT is not a definite modality in diagnosing myocardial contusion, but can be useful in diagnosing and determining the need for hospitalization after cardiac contusion.
Contusions* ; Creatine ; Diagnosis ; Echocardiography ; Electrocardiography ; Hospitalization ; Humans ; Length of Stay ; Prospective Studies ; Sensitivity and Specificity ; Thorax ; Tomography, Emission-Computed, Single-Photon*