We report a case of atrophoderma vermiculata with an unusual location. Besides symmetrical small pitted macules and linear atrophic depressions on both cheeks, there were unilateral atrophic depressed macules on the forehead, the right popliteal fossa and left up-per arm in our case. The histopathologic findings of these lesions showed a slight degree of epidermal atrophy with follicular pluggings and flattened rete ridges. In the dermis, there were mild perivascular in-filtrations of mononuclear cells. In addition, we could find out no pilosebaceous unit and other adnexal structures were diminished in number.
Arm ; Atrophy ; Cheek ; Depression ; Dermis ; Forehead

Marjolins ulcer is a special type of skin malignancy arising from previous scar site. We report two cases of Marjolins ulcer arising from chronic deg enerating burn scar. A 65-year-old male had a 9 x 15cm sized ulcer on his right popliteal fossa. He had a history of burn when he was seventeen years old and an ulcerati 1g tumor developed at the site of burn scar about 1 year ago. The ulcer became progressively penlarged in size and also painful. Skin biopsy revealed squamous cell carcinoma and,subsequently Above-Knee amputation was done. Another 54-year-old male had a painful coin sized ulcer on his right popliteal fossa where he had burn at the age of thirty-four. The ulcer was developed at the site of burn scar about 2months ago. The pathologic diagnosis was squamous cell carcinoma. He was recommended to get his leg amputated, but it was refused.
Aged ; Amputation ; Biopsy ; Burns ; Carcinoma, Squamous Cell ; Cicatrix ; Diagnosis ; Humans ; Leg ; Male ; Middle Aged ; Numismatics ; Skin ; Ulcer*

Typhlitis or neutropenic enterocolitis is a life-threatening, necrotizing process of the cecum whose incidence is increasing. Typhlitis presents as fever, abdominal pain, and diarrhea in neutropenic patients. As the incidence of typhlitis increases, emergency physicians must be aware of this rapidly progressive and potentially fatal disease. The definitive management of typhlitis is controversial. The most prudent course for the emergency physician is to initiate aggressive medical management early in the ED. We describe a 25-year-old man with severe neutropenia presented to the emergency department with fever, abdominal pain, diarrhea that began 2days earlier. Abdominal computerized tomography(CT) demonstrated diffuse concentric thickening of the cecal wall, intramural edema, inflammatory bowel changes but no free air and abscess formation. He was recovered by early diagnosis and aggressive medical therapy. We report a case of typhlitis with literature reviews.
Abdominal Pain ; Abscess ; Adult ; Cecum ; Diarrhea ; Early Diagnosis ; Edema ; Emergencies* ; Emergency Service, Hospital ; Enterocolitis, Neutropenic ; Fever ; Humans ; Incidence ; Neutropenia ; Typhlitis*

Isolated infernal iliac artery aneurysms and rupture are relatively infrequent, often difficult to detect and therefore rarely considered in the differential diagnosis for abdominal pain. The consequences can be grave, The incidence of isolated iliac artery aneurysm is 1~2% of that of abdominal aortic aneurysm(AAA). The natural history is of gradual enlargement, with rupture the most common clinical presentation. The signs and symptoms of such an aneurysm are influenced by its concealed location within the bony pelvis. Awareness of these special characteristics improves the chances of early diagnosis and proper surgical treatment before possible rupture. Here is a case of ruptured aneurysm of left internal iliad artery. A 73-year-old man was presented to our emergency center with severe abdominal pain and voiding difficulty Abdominal Computed Tomography(Cf) and angiography showed ruptured aneurysm of left infernal iliad artery. Emergency operation was successfully performed for the ruptured internal iliad artery aneurysm.
Abdominal Pain ; Aged ; Aneurysm* ; Aneurysm, Ruptured ; Angiography ; Arteries ; Diagnosis, Differential ; Early Diagnosis ; Emergencies ; Humans ; Iliac Artery* ; Incidence ; Natural History ; Pelvis ; Rupture ; Rupture, Spontaneous*

Total anomalous pulmonary venous return(connection) is a congenital heart disease. Especially, the reports of the patients with double connections of all pulmonary veins were rare. An infant who underwent operation for total anomalous pulmonary venous return had double drainge of all pulmonary veins to both left vertical vein and anomalous descending vein. This second lesion was not diagnosed preoperatively, but in operative field. Operative treatments were performed by ligation of left vertical vein and central pulmonary vein-to-left atrium anastomosis without ligation of the descending anomalous vein. For these less common variants fo total anomalous pulmonary venous return,a more detailed and precise understanding of morphology can facilitate accurate surgical repair. And also, early detection of the disease is an another issue for a good prognosis.
Heart Defects, Congenital ; Humans ; Infant ; Ligation ; Prognosis ; Pulmonary Veins ; Scimitar Syndrome* ; Veins

Trichorhinophalangeal syndiome, a rare genetic disease, is characterzed by the triad of slow growing, brittle hair with early loss, a pear-shaped nose with bulbous tip and long philtrum, and coneshaped phalangeal epiphyses wiith resultant shortening and. deformity of hands and feet. A 24-year-old female visited our department for the evaluation of lalopecia. She had had sparse, thin, and brittle hair since birth. She also complained of short fingers ar d a pear-shaped nose with bulbous tip. The X-ray findings of her hands and feet showed cone-shaped epiphyses with shortening of the phalangeal bones. There was no family history of hair, nasal, or palnkoplantar phalangeal abnormality. Chromosomal study did not reveel any abnormal finding. Shortened phalangeal bones of her index and middle fingers were slightly improved by lengthening procedure with iIlizarov apparatus.
Congenital Abnormalities ; Epiphyses ; Female ; Fingers ; Foot ; Hair ; Hand ; Humans ; Lip ; Nose ; Parturition ; Young Adult

BACKGROUND: The photsensitizing effect of quinolones has been recognized since their introdulation as an antibacterial agents. Recently several new second eneration antibacterial agents of this pharmacological class have become available for therapy, and are gaining increasing impotance. OBJECTIVE: To reveal the phototoxic potentials of some new quinolones by photohemolysis test, estimation of fluorescenc spectra, and Candida albicans test. METHODS: Nalidixic acid and four second-generation quinolones(ciprofloxacin, enoxacini, norfloxacin, and ofloxacitid were examined by fluorescence spertra which measured t.he phototoxc potentials by photochemial instability, photohemolsis test for the phototoxic properties against cell membranes and Candida tlbicans test for phototoxic properties against DNA. RESULTS: All drugs showed a fluorescence spectra within 360 nm to 450 nm, and in the photohemolysis test, all studied drug except ofloxacin got above 5% hemolytic value, and all drugs showed clear zone. in Candida albicans test after 48hours. CONCLUSION: These results suggested that all tested drugs were photochemically unstable. According to the mechanisris of cellular phototoxicity, ciprofloxacin, enoxacin, and norfloxacin was phtototoxic to nucleus and cell membrane, whereas ofloxacin was phototoxic to nucleus only.
Anti-Bacterial Agents* ; Candida ; Candida albicans ; Cell Membrane ; Ciprofloxacin ; Dermatitis, Phototoxic ; DNA ; Enoxacin ; Fluorescence ; Nalidixic Acid ; Norfloxacin ; Ofloxacin ; Quinolones

Idiopathic thrombocytupenic purpura is known as an autommune t,hrombocytopenic purpura. It is characterized by either an acute or gradual onset of petechiae or ecchymoses in the skin and mucous membranes, especially in the mouth. Epistaxis, conjunct.ival hemorrhage, hemorrhagic bullae in the mouth, gingival bleeding, melena, and hematemesis may occur. We report a case of idiopathic thrombocytopenic purpura in a 10-year-old male, who showed multiple petechiie and ecchymoses on both lower extremities, and hemorchagic bullae in the mouth. Periheral blood smear showed decreased platlet count, and in the bone marrow megakeyocytes were incraesed. Bleeding time was increased, but coagulation time was normal.
Bleeding Time ; Bone Marrow ; Child ; Ecchymosis ; Epistaxis ; Hematemesis ; Hemorrhage ; Humans ; Lower Extremity ; Male ; Melena ; Mouth ; Mucous Membrane ; Purpura ; Purpura, Thrombocytopenic, Idiopathic* ; Skin

The term malignant mesenchymoma has been applied to those tumors of the soft tissue of mesenchymal origin which are composed of tumor cells differentiating into two or more unrelated malignant forms in addition to the fibrosarcomatous element. Recently authors experienced a case of malignant mesenchymoma in the right axillary area. Microscopically the sarcoma revealed multiple pattern of differentiation, including liposarcoma, malignant schwannoma, fibrosarcoma, malignant fibrous histiocytoma and rhabdomyoblastoma. The presence of rhabdomyblastic cells were proved by immunochemical study utilizing desmin. This patient was treated with surgical excision and radiation.

BACKGROUND: Hypothermia is a condition that can lead to serious complications and even to death in newborn. Although the temperature control is essential in neonatal care, it is often neglected during urgent transfer from local private hospitals. The purpose of this study is to evaluate the incidence and clinical outcomes of transfer induced neonatal hypothermia. SUBJECTS AND METHOD: In this retrospective study, subject is limited to transferred outborn babies with age less than 24 hours from June 1996 to May 1999. A total of 3,086 patients were admitted in NICU during the study period and inborn and outborn babies were 1,743(56%) and 1,343(44%) respectively. Among the 1,343 outborn babies, 212 babies were transferred from the private hospital within 24 hours of birth and were eligible for the study. Rectal temperature on arrival, transfer time, birth weight, gestational age, initial arterial gas study, and clinical outcome were compared. Statistical analysis has been done with chi-sqaure test and multiple logistic regression analysis. RESULTS: There were 84 cases(39.6%) hypothermia(<36degrees C> among the 212 babies and the rate of hypothermia in transfered babies have not decreased over the study period. There were significantly more hypothermia in lower gestational age (less than 28 weeks) and lower birth weight (less than 2,000gm) caused hypothermia significantly more than normal gestational age or normal range of birth weight. And time interval (less than 12 hour) from birth to arrival at emergency department was also significant factor in hypothermia. The mortality rate was three fold higher in hypothermia than normothermic or hyperthermic babies. CONCLUSION: This study shows that hypothermia during neonate transportation is a major cause of neonatal mortality and morbidity in prehopital care. Body temperature control during transport of neonates under 24 hours of age should be emphasized for the better outcome of treatment.
Birth Weight ; Body Temperature ; Emergency Service, Hospital ; Gestational Age ; Hospitals, Private ; Humans ; Hypothermia* ; Incidence ; Infant ; Infant Mortality ; Infant, Newborn* ; Logistic Models ; Mortality ; Parturition ; Reference Values ; Retrospective Studies ; Transportation*