We present a case of onychogryphosis of both great toe nails associated with onychomycosis of all toe nails occurring in a 90-year-old female patient. She also had senile dementia. Affected nail plates were thickened, increased in length, and curved like the horn of a ram. The nail plates were removed surgically form the nail bed. Direct microscopic examination revealed many hyphae with potassium hydroxide. Trichophyton rnbrum was isolated from the culture in Sabouraud glucose agar media. On histopathologic examination, we found many hyphae in the nail plate. We suggest an onychomycosis as one of the causes of onychogryphosis.
Agar ; Aged, 80 and over ; Alzheimer Disease ; Animals ; Female ; Glucose ; Horns ; Humans ; Hyphae ; Onychomycosis* ; Potassium ; Toes ; Trichophyton

About 40% of patients with diabetes mellitus develops to diabetic nephropathy, and these patients show increment of glomerular filtration rate and renal volume at early phase. 99mTc-DMSA SPECT (single photon emission computed tomography) can measure a functional renal volume because 99mTc- DMSA it is taken up by the viable proximal tubular cells located in the renal cortex. To evaluate the renal volume in early diabetic nephropathy, we compared functional renal volume between diabetic patients and control, renal transplantation donor. 99mTc-DMSA was injected intravenously and SPECT was done after 2 hours in 15 diabetic patients, 18 renal transplantation donors, and 2 patients with end stage renal disease due to chronic glomerulonephritis. In diabetic patients with creatinine clearance more than 30ml/min and proteinuria, right and left renal volume were 247+/-22ml/BSA(m2), 256+/-37ml/BSA (m2), which were greater than those of diabetic patients with normal renal function and without proteinuria, or renal transplantation donors(P<0.05). In conclusion, we measured the functional renal volume by 99mTc-DMSA SPECT. Renal volume of diabetic patients with proteinuria were larger than the volume of control group or diabetic patients with normal renal function and without proteinuria. 99mTc-DMSA SPECT was thought to be useful test a for the measurement of functioning renal volume.
Creatinine ; Diabetes Mellitus* ; Diabetic Nephropathies ; Glomerular Filtration Rate ; Glomerulonephritis ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation ; Proteinuria ; Succimer ; Technetium Tc 99m Dimercaptosuccinic Acid* ; Tissue Donors ; Tomography, Emission-Computed, Single-Photon*

Skin graft has been widely used for facial skin reconstruction. Inguinal area is the common donor site for full-thickness skin graft of various area. Especially for facial skin graft, retroauricular area or upper eyelid skin has been used as a donor site. But these donor sites have some limitations as perfect ones in terms of size, color and texture when applied onto facial area. Even retroauricular skin shows color and texture differences from normal facial skin after it is grafted. Authors performed expansion of the skin of preauricular area or forehead where minimal scars would come out after final operation. We harvested this expanded skin and performed skin graft following excision of nevus, poor scar, or hemangioma in face.We achieved satisfactory results in terms of color and texture by applying this method in 11 clinical cases; 4 cases of hemangioma, 4 nevus, and 3 cases of traumatic scar. Donor site scars were clinically inspicuous in all these 11 cases.
Cicatrix ; Eyelids ; Forehead* ; Hemangioma ; Humans ; Nevus ; Skin* ; Tissue Donors ; Transplants*

Shiitake (Lentinus edodes) is a kind of mushroom which is cooked and eaten as a food in Chinese, Japanese and Korean meals. It is nowadays the second most commonly produced edible mushroom in the world. In 1985, a case characterized by itchy skin eruptions after the ingestion of raw shiitake mushrooms was reported and was termed as toxicodermia. Here we report five cases of shiitake dermatitis which developed after ingestion of raw or cooked shiitake mushrooms. All patients complained of severe itching and showed linear grouped erythematous papules after scratching(Kobner phenomenon). To our knowledge, this is the first report of shiitake dermatitis in the Korean literature.
Agaricales ; Asian Continental Ancestry Group ; Dermatitis* ; Eating ; Humans ; Meals ; Pruritus ; Shiitake Mushrooms ; Skin

PURPOSE: It is essential to know the functional and morphologic changes of the larynx in the evaluation of laryngeal lesions. Conventional CT which has relatively long examination time is not suitable for this aim. The purposes of this study are to evaluate the capability of spiral CT in the dynamic study of the larynx and to know whether this new technique can replace conventional laryngography or not. MATERIALS AND METHODS: Five healthy volunteers and 20 patients with laryngeal lesions underwent spiral dynamic CT scans with 3-dimensional reconstruction of the mucosal surface. A series of spiral CT scans were done while the volunteers performed various laryngeal positions to obtain the functional and morphologic information. The maneuvers used were:quite breathing, "E" phonation, Valsalva maneuver, modified Valsalva maneuver, and a new method of our own, "modified breath holding" technique. The patients were scanned when in quite breathing. Additioal scans were obtained by using the "modified breath holding" technique. RESULTS: The dynamic study with spiral CT could provide high resolutional images which nicely depicted the mobility of vocal cords and the mucosal changes of the laryngeal cavity in both healthy volunteer and patient groups. In patient group, the new "modified breath holding" technique was easier and more reproducible than other maneuvers. CONCLUSION: Spiral CT allows a dynamic study of the larynx and can be a new alternative of laryngography.
Healthy Volunteers ; Humans ; Larynx* ; Phonation ; Respiration ; Tomography, Spiral Computed* ; Tomography, X-Ray Computed ; Valsalva Maneuver ; Vocal Cords ; Volunteers

PURPOSE: Dynamic liver scan with spiral CT during a single breath hold was performed for To determing the optimal timing of scanning and the degree of the enhancement of liver and vessel. MATERIALS AND METHODS: Liver spiral CT was performed on 143 patients and dynamic sequence scan on 2 normal volunteers. After baseline spiral CT without contrast enhancement, spiral CT was performed after administration of a bolus of 100 ml of nonionic contrast material intravenously with mechanical power injector at the constant injection rate of 2 ml/sec. Cephalocaudal scanning was started 45 seconds after the beginning of injection. In the majority of cases we employed 16-24 continuous scanning with table feed of 10 mm, slice thickness of 10 mm, and reconstructed in 5 or 10 mm section increments. We measured degree of enhancement of aorta, IVC, and liver parenchyma in all images. RESULTS: We have achieved bolus phase at all images from the following measured date; 170-250 H. U at aorta, 110-150 H. U at IVC, 80-125 H. U at liver parenchyma, 100-130 H. U at spleen, which shown contrast difference between aorta and IVC at least 45 H. U. At the dynamic sequence scan, aortic and vascular CT atternuation reaches a peak at 55-60sec and peak hepatic enhancement occurred at 70-75 sec with relative plateau achieve at 45 sec. Spiral CT also showed elimination of variation in diaphragmatic excursion. CONCLUSION: We could get the disirable phase imaging at overall examination from the dynamic liver scan around 45-60 seconds after injection of contrast media.
Aorta ; Contrast Media ; Healthy Volunteers ; Humans ; Liver* ; Spleen ; Tomography, Spiral Computed

PURPOSE: Microangiography is an experimental radiologic technique for evaluation of the morphology and the function of small vessels. The purpose of this study is to introduce a good microangiographic technique and to present the microangiographic appearance of normal hepatic vascular pattern. MATERIALS AND METHODS: Five white rabbits weighing 2.5-2.9Kg were objected. Polyethylene catheters were inserted in portal vein and then in IVC. Heparin mixed normal saline (2cc/1000cc) was infused through portal vein and blood was drained to IVC. Barium suspension was infused via the catheter placed in portal vein untill the liver surface showed satisfactory finding in barium filling. The liver was removed and this preparation was fixed in 10% formaline for 7 days. After fixation, the liver was sectioned on 1-2mm thickeness. The slices were radiographed on high resolution plate using Faxitron. H-E staining of liver tissue was also done. RESULTS: The microbrium was well distributed in all small vessels without filling defect. And we could find the hexagonal shaped classic liver Iobule, in which the central vein was located at central portion and portal vein at periphery. The enlargement was showed numerous sinusoids, but there was less dye in the central portion of Iobule, but the central vein was well filled by microbarium. The peripheral portion of Iobule was well filled with microbarium. So, we could find diamond shaped liver acinus, in which central vein was located at priperal portion and the center of liver acinus was terminal portal vein that growed out from a small portal space. The three acini made the complex acinus and acinar agglomerate was composed of three or four complex acini. CONCLUSION: It is considered that the liver acinus pattern of Rapparport is more acceptable on microangiography than the classic concept of hepatic Iobule.
Barium ; Catheters ; Diamond ; Formaldehyde ; Heparin ; Liver* ; Polyethylene ; Portal Vein ; Rabbits ; Veins

The proliferation of high-technology infusion devices has greatly influenced the practice of anesthesia by allowing precise delivery intraoperatively and postoperatively of intravenous anesthetics, analgesics, and vasopressors. During continuous drug administration to pediatric patients, unfavorable pharmacologic effects have occured. These effects were attributed to variations in flow from infusion devices. The intent of this investigation was to evaluate the influence of infusion devices on the accuracy and continuity effused fluid. Hartmann's solution was run through eight infusion pump at 5, 10, 15, 20, 25, 30, 40, 60, 80 and 100ml/hr. The volume of the fluid was measured for one hour at each flow rate using a infusion device analyzer(IDA-2) in vitro. Flow accuracy(ml/hr) was calculated by dividing the effused volume by the effusion time ; this value was subsequently expressed as a percentage of the desired flow rate. Flow continuity was expressed by the coefficient of variance(CV); analysis of variance with SAS was used for comparisons. Results were as follows ; 1) The flow accuracy values ranged from 98.8% to 114.2% of the desired rate. 2) Seven infusion pumps had flow rates within 5% of the desired rates at each flow rate but one pump had more than 10% of desired rate. 3) Each of the respective infusion pumps produced various levels of flow continuity and ranged from 0.7% to 2.5%(CV value). Conclusion , further evaluations are needed to differentiate continuity from other infusion devices(e.g., syringe infusion pump) in vitro and evaluations are needed to define the clinical significance in vivo. Future use of flow-rate data will likely be of significant value in establishing policies and procedures for the utilization of infusion devices and guidelines for product selection.
Analgesics ; Anesthesia ; Anesthetics, Intravenous ; Humans ; Infusion Pumps ; Syringes

BACKGREOUND: Mass casualties from organophosphrous inhalation die from respiratory depression. Gas supplies and equipment are limited for mechanical ventilation of multiple subjects. Endobronchial insufflation of air (EIA) requires only a compresssor and airway catheters. We examined clinical usefulness of EIA in a model of apnea produced by tetrodotoxin (TTX) infusion. METHODS: Five anesthetized dogs were applied the conventional mechanical ventilation (CMV) while 12 mcg/kg TTX was infused IV over 90 min to produce apnea. EIA at 1 L/kg/min was delivered through a 35 cm long 0.8 cm I.D. catheter with a forked end placed astride the carina. Measurements of cardiovascular and respiratory function were made after TTX (time=0) on CMV, and then serially for 4 hours of EIA. RESULTS: All dogs survived through 4 hours study. PaO2 decreased significantly within 30 min and then slowly increased significantly after 60 min. PaCO2 increased significantly within 30 min and decreased significantly after 60 min. HR increased significantly after 20 min and MAP increased significantly after 60 min. Mean SD of PaO2, PaCO2, pHa, SaO2, cardiac output, mean pulmonary pressure, mean arterial pressure, systemic vascular resistance, central venous pressure and Qs/Qt are shown in table. Spontaneous respiratory efforts slowly returned after 45 min of EIA and resulted in the improvement of gas exchange. CONCLUSION: EIA is a field ventilatory technique useful when other equipment may not be available. The airway catheter can be placed by cricothyroidotomy. EIA supports life and produces normal survivors in apneic dogs.
Animals ; Apnea ; Arterial Pressure ; Cardiac Output ; Catheters ; Central Venous Pressure ; Dogs* ; Equipment and Supplies ; Humans ; Inhalation ; Insufflation* ; Mass Casualty Incidents ; Respiration, Artificial ; Respiratory Insufficiency ; Survivors ; Tetrodotoxin ; Vascular Resistance

Hemangioma is one of the most common congenital tumors in the region of the face and neck. Although histologically benign, these facial masses are clinically malignant for their deforming and inexorable growth, especially in so-called cavernous hemangioma. Today, hemagiomas have been treated by various methods; steroids, electrocoagulation, injection of sclerosing agent, cryotherapy, radiation therapy, laser therapy, and surgical treatment, etc. The response of treatment varies with the types, surgical skills, regions of hemangioma, the age of patient, but the appropriate method of the treatment has not been yet established. In the case of massive hemangioma, which involves most part of the face and neck, we prefer surgical treatment and consistently obtain better result than other treatment modalities. Wide excision and proper reconstruction of the face helps the patient for their better life aesthetically and functionally.
Cryotherapy ; Electrocoagulation ; Hemangioma* ; Hemangioma, Cavernous ; Humans ; Laser Therapy ; Neck* ; Steroids