PURPOSE: In small portion of patients with Hirschsprung's disease, the aganglionic stagment extends only up to the mid-rectum. This report describes an innovative and effective posterior sagittal anorectal myectomy for curative repair of ultrashort segment Hirschsprung's disease in neonates. METHODS: The procedure was performed on ten patients with ultrashort segment Hirschsprung's disease between 1995 to 1998. The procedure was performed by making a sagittal incision in midline posterior perineum to expose the posterior rectum.4 longitudinal strip of muscular layer is removed from the aganglionic portion of the anorectum from the upper rectum to the internal sphincter. The patients were followed postoperatively to determine the effectiveness of the procedure and to observe the presence of any complications. RESULTS: Seven patients (70.0%) were under three months old. Operative biopsy showed that four patients had aganglionosis in the upper rectum, three patients in the middle rectum and three patients in the lower rectum. The posterior sagittal anorectal myectomy was successful in the treatment of ultrashort segment Hirschsprung's disease- symptom recurred for one patient due to total aganglionosis and for another patients due to rectosigmoid aganglionosis. These two patients received the staplingprocedure after colostomy. Some transient complications included mucosal perforation during surgery (30.0%) and incisional wound infection (20.0%). CONCLUSION: For those neonates with ultrashort segment Hirschsprung's disease, the posterior sagittal autorectal myectomy should be considered a safe and effective method for treatment and confirmatory diagnosis. In addition, preliminary colostomy is not required prior to this procedure.
Biopsy ; Colostomy ; Diagnosis ; Hirschsprung Disease* ; Humans ; Infant, Newborn ; Perineum ; Rectum ; Wound Infection

Bowens disease is an intraepithelial squamous cell carcinoma. It occur s anywhere on the surface of the body. Bowens disease involving the nail bed epithelium is very rate. Recently, some literatures showed that human papillomavirus is sssociated with squamous cell carcinoma of the finger by in situ hybridization or polymerase chain reaction. A 30-year-old housewife deve]oped longitudinal melanonychia with as imptomatic fissured nail plate on her right third finger. The hiat,ologic specimen showed diffuse anaplastic change confined to the nail bed epithelium. The subungual eyithelium was found to contain human papillomavirus DNA type 31/33/35 with the use of in situ hybridization.
Adult ; Bowen's Disease ; Carcinoma, Squamous Cell ; DNA ; Epithelium ; Fingers ; Humans ; In Situ Hybridization ; Polymerase Chain Reaction

The potential for sebaceous nevi to evolve into secondary benign or malignant EuIror is well recognized. In general, malignant transformation does not occur until postpubertal life. We experienced a case of basal cell epithelioma arising in a nevus sebaceous on a 12-year-old boy´s parietal scalp. We recommended that surgical excision should be undertaken as early as possible to detect the malignant transformation of nevus sebaceous.
Carcinoma, Basal Cell* ; Child ; Humans ; Nevus* ; Rabeprazole ; Scalp

OBJECTIVES: Chromosomal anomalies are common disease entity among genetic diseases. But there are scanty reports about the status of chromosomal abnormalities in Korean. In addition, the comprehensive multi-center study of chromosomal abnormalities in Korean has never been performed. METHODS: We have collected 1,793 cases (394 abortuses; 198 chorionic villi; 1,060 amniotic fluid cells; 141 fetal blood), which showed abnormal karyotype results from twenty three cytogenetic centers in Korea from the year of 1977 to 1999. RESULTS: In abortuses, numerical chromosomal abnormalities was 85%, and structural abnormalities was 13% and the most frequent anomaly was trisomy 16. In chorionic villi, numerical anomaly was 60.0% and structural anomaly was 31.3% and the most frequent karyotype was Down syndrome. In amniotic fluid cells, structural anomaly exceeded the number of numerical anomaly and the most frequent anomaly was Down syndrome. In fetal blood, numerical anomaly was 63.8% and the most frequent karyotype was trisomy 18 (23.4%) CONCLUSIONS: This may be the first comprehensive and multi-center study in Korea. The proportion of the abnormal karyotypes in each specimens was different from each other. Based on this study, the more comprehensive study should be performed to all the Korean population.
Abnormal Karyotype ; Amniotic Fluid ; Chorion* ; Chorionic Villi* ; Chromosome Aberrations ; Cytogenetics ; Down Syndrome ; Female ; Fetal Blood* ; Karyotype ; Korea ; Trisomy

BACKGROUND: Aging is associated with increased cardiovascular risk and firmly established as a risk factor for the development of atherosclerosis. However the exact mechanism of age-related damage to the arterial wall and its relation to the atherosclerotic process are not well known.The endothelium plays an important role for the regulation of vascular tone and the endothelial function is impaired in the presence of risk factors early in the process of atherosclerosis. Assessment of endothelial function appears to be a valuable tool for the diagnosing and therapeutic monitoring of coronary artery disease. Anti-oxidants are known to improve endothelial dysfunction in atherosclerosis patients. The aim of this study was, (1) to evaluate the endothelial function in elderly, (2) to investigate whether vitamin C administration has benefit on the endothelial function in elderly. METHODS: The endothelial function was estimated using venous occlusion plethysmography(VOP) in 7 elderly and 7 young healthy volunteers. The strain guage was connected to plethysmograph to record the forearm volume change. A rapid cuff inflator was used to inflate the arm cuff to 40 mmHg instantaneuosly thus occluding venous return from the forearm. The measurement of forearm volume change was repeated for 7 times each stage. The change of the forearm blood flow(FBF) was measured with the acetylcholine infusion through brachial artery and also with intra-arterial vitamin C. RESULTS: Endothelium-dependent vasodilatation was significantly impaired in the elderly group compared to the young group(321 +/-17% in elderly group vs 509 +/-81%, mean+/-SEM) Forearm blood flow response to acetylcholine was significantly enhanced with inraarterial infusion of vitamin C in elderly group(321+/-17% in elderly group vs 78% in vitamin C) Coinfusion of L-NMMA, an inhibitor of nitric oxide synthase, blunted forearm blood flow response to acetylcholine. CONCLUSIONS: Even though the mechanisms leading to drpressed endothelial function in elderly remains to be elucidated, our study shows that vitamin C result in demonstrable improvement by a mechanism that is probably related to antioxidant activity.
Acetylcholine ; Aged* ; Aging ; Arm ; Ascorbic Acid* ; Atherosclerosis ; Brachial Artery ; Coronary Artery Disease ; Endothelium ; Forearm ; Healthy Volunteers ; Humans ; Nitric Oxide Synthase ; omega-N-Methylarginine ; Risk Factors ; Vasodilation* ; Vitamins*

PURPOSE: The purpose of this study was to assess optimal chest compression depth for infants and children compared with adults, when the simulated compression depth was delivered according to the current guidelines. METHODS: A total of 467 consecutive chest computed tomography scans (93 of infants, 110 of children, and 264 of adults) were reviewed. The anteroposterior (AP) diameter and compressible diameter (CD) for infants and children were measured at the inter-nipple level and at the middle of the lower half of the sternum for adults. Compression ratio (CR) to CD was calculated at simulated one-fourth, onethird, and one-half AP compressions in infants and children and simulated 5-cm, 6-cm compressions in adult. RESULTS: In adults, the CRs to CD at simulated 5-cm, 6-cm compression depth were 41.7±0.16%, 50.0±7.3%, respectively. In children and infants, the CRs to CD at onethird chest compression were, respectively, 55.1±2.4%, 51.8±2.4% and 82.7±3.7%, 77.7±3.6% at one-half chest compression. The CRs to CD of 4-cm compression depth in infants and 5-cm compression depth in children were 74.4±10.9%, 62.5±8.7%, respectively. The CRs to CD for children and infants were significantly higher compared with adults (p<0.001). The CR to CD of 4-cm compression depth in children was similar to that of 6-cm compression depth in adults (50.0±6.9% vs 50.0±7.3%, p=0.985). CONCLUSION: The current pediatric guideline for compression depth was too deep compared with adults. We suggest that one third of the AP chest diameter or approximately 4-cm in children and less than 4-cm in infants is more appropriate.
Adult ; Child ; Humans ; Infant ; Pediatrics ; Sternum ; Thorax*

There has been many researches aimed at reinforcing the strength of resin, and these have led to the development and use of numerous materials in recent years. A case in point, is the recent development of plasma-treated polyyethylene fiber which has been used mainly in fixed provisional restoration to reduce the incidence of fractures. This study aims at assessing whether plasma-treated polyethylene fiber as applied to composite resin is effective in increasing the flexural strength and how applied portions affect this. Twenty-four applied and eight unapplied composite resin bars were fabricated. Twenty-four applied specimens were divided into three groups. Plasma treated polyethylene fiber was applied to the groups each with different portions of composite resin. In the first group, plasma-treated polyethylene fiber was not applied. In the second group, fiber was applied to the compression side of composite resin. Fiber was applied to the tension side in the third group, while fiber was embedded in the tension side of the compositeresin in the fourth group. Each specimen was tested by use of a three-point bending strength test with an instron testing machine, and the flexural strength was calculated. The following results were obtained. : 1. Under the conditions of this study, the third and fourth groups demonstrated a statistically greater flexural strength compared to the first and second groups. 2. But there was no statiscally significant difference, not only between the first group and the second group, but also between the third group and the fourth group. Taken together, it can be concluded that plasma-treated polyethylene fiber applied to composite resin is an effective method in increasing flexural strength, and the best way of increasing the flexural strength is by application of plasma-treated polyethylene fiber to the tension side, or the embedding of same in composite resin. It must be mentioned however that this test used a static single-load test method. This method determined the maximum stresses that could be tolerated, but this might not be valid where the prediction of clinical failure is concerned. In order therfore to clinically utilize plasma-treated polyethylene fiber to reinforce the composite resin, it is suggested that a further study which considers the various loads be undertaken.
Incidence ; Plasma ; Polyethylene*

Malignant small round cell tumor (SRCT) of the thoracopulmonary region appears to originate in the soft tissues of the chest wall or the peripheral lung. A differential diagnosis of poorly differentiated small round cell tumors which include Ewing's sarcoma of bone and soft tissue, embryonal rhabdomyosarcoma, Askin tumor, neuroblastoma, peripheral neuroectodermal tumor, small cell osteogenic sarcoma and lymphoma are after difficult by light microscopy alone. In recent, by the extensive studies electron microscopic examination, histochemical study, immunochemical study, cytogenetics and gene analysis, these tumors may be derived from the primitive and pluripotential cells, differentiating into mesenchymal, epithelial and neural features in variable proportions. Treatment for SRCT of thoracopulmonary regin is not determined because of massive involvement of the lung, pleura or soft tissues of the chest wall resulted in a dismal outcome despite aggressive surgery, irradiation and chemotherapy.
Cytogenetics ; Diagnosis, Differential* ; Drug Therapy ; Lung ; Lymphoma ; Microscopy ; Neuroblastoma ; Neuroectodermal Tumors, Primitive, Peripheral ; Osteosarcoma ; Pleura ; Rhabdomyosarcoma, Embryonal ; Sarcoma, Ewing ; Thoracic Wall

Sebaceous carcinoma is a rare malignant epithelial tumor and has diverse clinical presentations as well as a variety of histologic patterns. Although the overwhelming majority of sebaceous carcinomas occur on the eyelid, they may also arise where sebaceous gland and hair are found together, but they favor the head and neck. We report a case of sebaceous carcinoma of the umbilicus in a 68-year-old man who had suffered from a long standing recurrent Bowen's disease of 23 years. The recurrent Bowen's disease in this patient appeared to be closely related to multiple arsenic medication 49 years and 39 years earlier. The excised specimen of umbilicus revealed a well demarcated, 1.5x1 cm sized tumor with grey-yellow hue. The tumor was identified as sebaceous carcinoma, which was characterized by lobular and comedo-carcinoma patterns. The tumor cells showed cytoplasmic foamy vacuolation, nuclear pleomorphism, and high mitotic activity. On an Oil-Red-O stain, the tumor cells were found to contain fine lipid droplets. The intracytoplasmic lipid vacuoles were demonstrated by an electron microscopic examination.
Aged ; Arsenic ; Bowen's Disease* ; Carcinoma ; Cytoplasm ; Eyelids ; Hair ; Head ; Humans ; Neck ; Sebaceous Glands ; Umbilicus ; Vacuoles

A 53-year-old woman developed a psinful erythematous papular skin eruption around the biting site by a tick on the left lower abdomen. A excision biopsy specimen from the skin lesion showed perivsscular infiltration of inflammatory cells composed mainly of neutrophiles, lymphocytes, and a few eosinophiles and histiocytes throughout the dermis. Some of the vessels were dilated with protruding and proliferated endothelial cells. The tick was identified as an adult female of Ixodes nipponensis by the scanning electron microscopic examination.
Abdomen ; Adult ; Biopsy ; Dermis ; Endothelial Cells ; Eosinophils ; Female ; Histiocytes ; Humans ; Ixodes* ; Lymphocytes ; Middle Aged ; Neutrophils ; Skin ; Tick Bites* ; Ticks*