No abstract available.
Candidiasis* ; Humans ; Infant, Newborn ; Infant, Premature*

Van Wyk-Grumbach Syndrome is an advanced sexual development in association with primary hypothyroidism. The clinical feature in this syndrome is more consistent with stimulation of the FSH receptor by the markedly elevated TSH levels. Treatment of the hypothyroidism results in a rapid return to normal of the biochemical and clinical manifestations. We experienced a case of Van Wyk-Grumbach Syndrome and report with the brief review of related literature.
Hypothyroidism ; Puberty, Precocious ; Receptors, FSH ; Sexual Development

A 38-year-old man, with recurrent oral ulcers for 10 years, was admitted because of recent aggravation of odynophagia and sore throat. About 4 years earlier, he had been performed abdominal surgery for intestinal perforation. Gastrofiberscopic examination showed small round ulcers at hypiopharynx and 6cm sized longitudinal linear ulcer at mid esophagus. Biopsy specimens at mid-esophagus showed chronic inflammation. Besides oral ulcer, he had perianal ulcers and skin rashes. He was managed with steroid, colchicine and sulfasalazine under the diagnosis of esophageal involvement in Behcet's disease. After 3 months from discharge, esophagogram and gastrofiberscopic examination showed some improved appearance, but symptoms recurred for steroid tapering. He has been followed in much improved status for 8 months after discharge.
Adult ; Biopsy ; Colchicine ; Diagnosis ; Esophagus ; Exanthema ; Humans ; Inflammation ; Intestinal Perforation ; Oral Ulcer ; Pharyngitis ; Sulfasalazine ; Ulcer*

Human parvovirus(HPV) B19 infection causes erythema infectiosum in children, sometimes red cell aplastic crisis with hemolytic anemia and chronic bone marrow failure in immunocompromised hosts. HPV B19 is directly cytotoxic for erythroid progenitor cells and inhibits erythropoiesis. Infrequently, HPV B19 inhibits hematopoiesis of three cell lineages and causes transient pancytopenia in patients with hemolytic disorders. We report three patients with hereditary spherocytosis who developed transient aplastic crisis. A HPV B19 infection was confirmed by IgM anti-B19 parvovirus titers and characteristic findings of bone marrow examination as the causative agent associated with severe pancytopenia. Three patients recovered spontaneously after a short period of supportive care with red cell transfusions and intravenous immunoglobulin.
Anemia, Hemolytic ; Bone Marrow ; Bone Marrow Examination ; Cell Lineage ; Child ; Erythema Infectiosum ; Erythroid Precursor Cells ; Erythropoiesis ; Hematopoiesis ; Humans ; Immunocompromised Host ; Immunoglobulin M ; Immunoglobulins ; Pancytopenia ; Parvovirus*

The treatment of massive bone and soft tissue defect in the lower leg has a high complication rate of nonunion, chronic infection, and amputation without well-vascularized tissue coverage of the open fracture. Despite adequate free soft tissue coverage, massive skeletal defect may result in segmental bone defects, angulation deformity, and limb length discrepancies. In the last decade, major advances have occurred in the Ilizarov method of distraction osteogenesis in lower leg salvage as a delayed procedure or simultaneous distraction after free-tissue transfer. The authors have performed Ilizarov transport in conjunction with muscle and musculocutaneous flap coverage in nine cases of lower leg salvage. The flaps consist of rectus, gracilis, latissimus dorsi, parascapular, and serratus muscle or musculocutaneous fashioning using ipsilateral or contralateral pedicle in consideration of vessel condiation. Revision, recorticotomy and flap elevation were also used as a secondary procedure for satisfactory results. The conclusions, were as follows: 1) Multidisciplinary team approach with conjoining departments at the time of preoperative evaluation, postoperative care and rehabilitation care; 2) Muscle flap covered with split-thickness skin graft was preferred to musculocutaneous flap; 3) To reduce the total reconstructive period, simultaneous free tissue transfer with Ilizarov distraction should be considered.
Amputation ; Congenital Abnormalities ; Extremities ; Fractures, Open ; Ilizarov Technique ; Leg* ; Myocutaneous Flap ; Osteogenesis* ; Osteogenesis, Distraction ; Postoperative Care ; Rehabilitation ; Skin ; Superficial Back Muscles ; Transplants

no abstract available

PURPOSE: Immobilization devices that improve the setup reproducibility of pelvic cancer patients and that provide comfort to patients during radiotherapy were designed and the feasibility of the devices was evaluated. MATERIALS AND METHODS: A customized device was designed to immobilize a knee, thigh, and foot of a patient. Sixty-one patients with prostate cancer were selected and were divided into two groups-with or without devices. The setup errors were measured with respect to bony landmarks. The difference between digitally reconstructed radiographs (DRR) and simulation films, and the differences between DRR and portal films were measured. RESULTS: The left-right (LR), anterior-posterior (AP) and craniocaudal (CC) errors between the DRR and simulation films were 1.5+/-0.9 mm, 3.0+/-3.6 mm, and 1.6+/-0.9 mm, respectively without devices. The errors were reduced to 1.3+/-1.9 mm, 1.8+/-1.5 mm and 1.1+/-1.1 mm, respectively with the devices. The errors between DRR and portal films were 1.6+/-1.2 mm, 4.0+/-4.1 mm, and 4.2+/-5.5 mm, respectively without the devices and were reduced to 1.0+/-1.8 mm, 1.2+/-0.9 mm, and 1.2+/-0.8 mm, respectively, with the devices. The standard deviations among the portal films were 1.1 mm, 2.1 mm, and 1.0 mm at each axis without the devices and 0.9 mm, 1.6 mm and 0.8 mm with the devices. The percentage of setup errors larger than 3 mm and 5 mm were significantly reduced by use of the immobilization devices. CONCLUSION: The designed devices improved the setup reproducibility for all three directions and significantly reduced critical setup errors.
Axis, Cervical Vertebra ; Foot ; Humans ; Immobilization* ; Knee ; Pelvic Neoplasms ; Prostatic Neoplasms ; Radiotherapy* ; Thigh

A 72-year-old diabetic male patient with high grade fever, right upper quadrant abdominal pain and Klebsiella pneumoniae septicemia is reported. He suffered from high fever and abdominal pain in spite of aspiration of liver abscess and antibiotic treatment. A few days later, we found a palpable pulsating abdominal mass on physical examination. Computed tomography and angiography revealed infected abdominal aortic aneurysm associated with pyogenic liver abscess. He was treated by antibiotics and Endovascular stent without surgical resection. He improved without complications and has been followed-up after discharge with excellent condition. To our knowledge, this is the first case of infected abdominal aortic aneurysm as a septic metastatic lesion secondary to liver abscess.
Abdominal Pain ; Aged ; Aneurysm, Infected ; Angiography ; Anti-Bacterial Agents ; Aortic Aneurysm, Abdominal* ; Fever ; Humans ; Klebsiella pneumoniae ; Liver Abscess* ; Liver Abscess, Pyogenic ; Liver* ; Male ; Physical Examination ; Sepsis ; Stents*

Primary care lays the foundation of national healthcare systems, but it has been weak in playing its role correctly because of legal and environmental attributes surrounding the healthcare industry in Korea. This study is conducted to concretize the definition and scope of primary care and to deduce its standard functions to contribute to establishing the healthcare delivery system and appropriate healthcare systems embracing socio-environmental leverage. The term primary healthcare institution was adopted based on literature review to achieve the research goal. The principle diseases appropriate for the primary healthcare institution based on ambulatory care sensitive conditions were analyzed, and the standard functions were deduced by matching these diseases with current procedural terminologies using CrossCoder package. Based on the analysis, the primary healthcare institution-specific diseases were 53 specific diseases under 23 broad disease groups. The standard functions were deduced in three categories of the standard functions of the entire primary healthcare institutions with 100% frequency, common standard functions with 70% frequency, and peculiar standard functions specific to diseases or body systems. These functions included outpatient evaluation and measurement, various factor tests through blood collection, and X-ray. Establishing the standard functions for the primary healthcare institution can promote patient reliability on primary care, alleviate health demand congestion toward large-sized advanced healthcare institutions. Furthermore, it contributes to establishing and reinforcing other healthcare policies related to the healthcare reimbursement system and referral system, and fosters primary care physician education. Most importantly, it reduces the national health expenditures by realizing efficient and effective healthcare delivery.
Ambulatory Care ; Delivery of Health Care ; Estrogens, Conjugated (USP) ; Health Care Sector ; Health Expenditures ; Humans ; Korea ; Outpatients ; Physicians, Primary Care ; Primary Health Care ; Referral and Consultation