Eccrine nevus is a rare benign cutaneous lesion, frequently present at birth or at an early age. Herein we report on a 1-year-old girl with erythematous papules in a zosteriform arrangement associated with hyperhidrosis on the left side of her trunk.
Female ; Humans ; Hyperhidrosis ; Nevus* ; Parturition

PURPOSE: The purpose of this study was to compare the validity of Onen's alternative grading system (AGS) with that of the APDRP and SFU grading systems in patients with isolated and complicated congenital hydronephrosis. METHODS: We retrospectively reviewed the medical records of 153 patients (204 renal units) diagnosed with congenital hydronephrosis between January 2002 and December 2011. We classified patients into 2 groups; isolated or complicated hydronephrosis. All renal units were graded according to anterior-posterior diameter of renal pelvis (APDRP), Society for Fetus Urology (SFU) and Onen's grading systems. We analyzed the prognosis of hydronephrosis, according to each grading system, at 2 years of age. RESULTS: There were 152 renal units with isolated hydronephrosis and 52 renal units with complicated hydronephrosis. The isolated hydronephrosis group had a lower grade according to Onen's AGS, and showed more frequent spontaneous remission by 2 years of age. There was more frequent obstruction (P=0.000) and surgical treatment (P=0.000) of units with high-grade hydronephrosis according to Onen's AGS. In the complicated hydronephrosis group the frequencies of spontaneous remission (P=0.015) and renal dysfunction (P=0.013) were significantly higher than those in high-grade hydronephrosis, as indicated by Onen's AGS. There were no significant differences in clinical outcomes among the highest grade groups, according to the 3 systems, in either isolated or complicated hydronephrosis. CONCLUSION: Onen's AGS reflects the prognosis of hydronephrosis as well as other grading systems in those with isolated hydronephrosis. It was better predictor of renal dysfunction in those with complicated hydronephrosis. However, Onen's AGS was not superior to the other grading systems in terms of predicting prognosis, especially in high-grade hydronephrosis.
Fetus ; Humans ; Hydronephrosis* ; Kidney Pelvis ; Medical Records ; Prognosis ; Remission, Spontaneous ; Retrospective Studies ; Ultrasonography ; Urology

Purpose: To establish age/sex-specific reference intervals for serum uric acid and to examine the associations between serum uric acid level and metabolic syndrome (MetS) and its components in Korean children and adolescents. Methods: We analyzed data for 1,349 subjects aged 10 to 19 years from the Korea National Health and Nutrition Examination Survey 2016–2017. Results: The mean uric acid levels were 5.9±1.3 mg/dL (interquartile range, 5.0–6.8 mg/dL) in males and 4.6±0.9 mg/dL (interquartile range, 3.9–5.2 mg/dL) in females. The mean uric acid level increased significantly from 10–13 years of age in males, but not in females. The overall prevalence of MetS was 5.9% (7.3% in males and 4.3% in females; P=0.022). The prevalences of MetS in the lowest, second, third, and highest quartiles of uric acid level were 4.4%, 3.3%, 6.1%, and 15.2%, respectively, in males (P for trend <0.001) and 1.9%, 0.0%, 4.1%, and 10.9%, respectively, in females (P for trend <0.001). Compared with the lowest quartile of uric acid level, the odds ratio (with 95% confidence interval) for MetS in the highest quartile was 2.897 (1.140–7.361) in males and 5.173 (1.459–18.342) in females. Subjects in the highest quartile exhibited increased risk for abdominal obesity and low high-density lipoprotein cholesterol in both sexes. Conclusion Serum uric acid level is positively associated with MetS and its components abdominal obesity and low high-density lipoprotein cholesterol.

PURPOSE: To investigate the applicability of the new three-dimensional overlapped reconstruction MR angiography (3-D ORMRA) technique in patients with hemifacial spasm and to compare the new 3-D reconstruction images with conventional MRA source images. MATERIALS AND METHODS: The study group comprised 27 patients with surgically proven hemifacial spasm. In all patients, conventional MRA source images and 3-D fast imaging employing steady-state acquisition (FIESTA) images were obtained prospectively. After 3-D MR angiographic images were obtained, the 3-D MRA and FIESTA images were overlapped at the workstation by using GE A/W 4.2 add/sub software. We analyzed the relationship between the offending vessels and root exit zone of the facial nerve using both 3-D ORMRA images and conventional MRA source images. RESULTS: In 25 of 27 patients, the offending vessel at the REZ of the facial nerve could be correctly identified on conventional MRA source images. In all patients, the presumed offending vessels depicted by the overlapped 3-D reconstruction MRA image corresponded well with the intraoperative findings. The 3-D reconstruction image showed more clear visualization of the spatial relationship between the offending vessels and the root exit zone of the facial nerve. CONCLUSION: The overlapped 3-D reconstruction MR angiography technique is very useful and informative in patients with hemifacial spasm, as compared with conventional MRA angiography technique.
Angiography ; Facial Nerve ; Hemifacial Spasm* ; Humans ; Prospective Studies

BACKGROUND: Length of stay in ICU after thoracotomy is related to postoperative pulmonary function and complication which are affected by postoperative pain. For the post-thoracotomy pain control, epidural morphine is commonly used. Although total dose-requirement for analgesia of lumbar epidural morphine is more than the thoracic, lumbar epidural morphine could be substituted the thoracic. Our study compared the effect of patient controlled analgesia using thoracic epidural morphine (TEA group) and lumbar epidural analgesia with patient controlled intravenous analgesia using morphine (LEA+IV group). METHODS: Sixty patients were randomly assigned into one of the two groups. The epidural taps were done before the induction. In all the patients morphine 0.2 mg/ml was administered via the epidural catheter at the end of surgery. In TEA group, basal infusion rate was 0.1 mg/hr and bolus dose was 0.02 mg. In LEA+IV group, basal infusion rate of epidural morphine was 0.1 mg/hr, patient controlled intravenous analgesia with morphine started when patients arrived at ICU, and basal infusion rate of intravenous morphine was 1.0 mg/hr and bolus dose was 0.8 mg. Pain score, side effect, postoperative length of stay in ICU and hospital were observed. RESULTS: There were no significant differences between two groups in pain score, side effects, length of stay in ICU and hospital. CONCLUSIONS: Lumbar epidural analgesia with patient controlled intravenous analgesia using morphine showed similar postoperative analgesia and length of stay in ICU and hospital compared to thoracic epidural analgesia with morphine, so that can substitute the thoracic epidural analgesia.
Analgesia* ; Analgesia, Epidural ; Analgesia, Patient-Controlled ; Catheters ; Humans ; Length of Stay* ; Morphine* ; Pain, Postoperative ; Tea ; Thoracotomy

PURPOSE: To assess the usefulness of MRI in the detection of a single ectopic ureteral opening and thelocation and dysplastic change of ipsilateral kidney. MATERIALS AND METHODS: Nine patients (mean age; 4.8 years,M:F=3:6) in whom a single ectopic ureter was suspected clinically and sonographically underwent conventionalradiologic studies ( IVP, VCUG, 99mTc-DM-SA scan, as well as US) and MRI. We evaluated images of the point of theectopic ureteral opening and the location and dysplastic or hydronephrotic change of the ipsilateral kidney, andcompared those findings with the endoscopic, surgical, and pathological findings. RESULTS: Eight patients had aunilateral single ectopic ureter and one had bilateral lesions. Seven normally positioned kidneys in six patientsshowed dysplastic (n=3) or hydronephrotic (n=4) change. In two patients an ectopic dysplastic kidney was locatedin the pelvis and one had ipsilateral renal agenesis. Conventional radiologic studies failed to reveal twoectopic dysplastic kidneys, one renal agenesis, and eight ectopic ureteral openings. In all patients, MRI clearlydemonstrated the location of the kidney and ectopic ureteral opening, and dysplastic or hydronephrotic change ofthe kidney, and in one patient, uterine duplication. Except in two patients whose ectopic ureteral opening was notfound on endoscopy, MRI findings were concordant with endoscopic and surgical findings. CONCLUSION: MRI wasuseful for the detection of a single ectopic ureteral opening and for demonstrating the location and dysplasticchange of ipsilateral kidney.
Child* ; Endoscopy ; Humans ; Kidney* ; Magnetic Resonance Imaging* ; Pelvis ; Ureter*

BACKGROUND: Human cytomegalovirus (CMV) infections are common and occasionally severe in newborns, immunocompromised hosts, cancer patients, and recipients of organ transplant. Consequently, sensitive and rapid methods for CMV detection are of great diagnostic value since antiviral drugs have become available, which might be more effective upon early administration. We evaluated a polymerase chain reaction and enzyme-linked immunosorbent assay (PCR- ELISA) to detect human CMV infection as an aid in making a prompt diagnosis and a determination of therapeutic efficacy. METHODS: CMV DNA was amplified by single PCR, using primers chosen from genomic regions (major immediate-early [MIE] protein coding region), and the microwell plate hybridization assay was performed for specific detection of 5'-biotinylated PCR products using CMV-specific probes labeled with digoxigenin. A total of 35 clinical specimens from 14 patients who were suspected CMV infectious state was analyzed by PCR-ELISA and its results were compared with those of serum anti-CMV IgM, shell vial culture assay and PCR. RESULTS: The sensitivity for detection of PCR-amplified CMV DNA by the ELISA was 102 copies, which was ten-fold greater than ethidium bromide staining of agarose gels. The positive rates of 35 clinical specimens by serology, shell vial culture assay, PCR and PCR-ELISA were 37.9%, 40.0%, 60.0% and 68.6%, respectively. The OD ranges of 24 positive specimens by PCR-ELISA were from 0.042 to above 2.5. In follow-up studies of two patients with bone marrow transplantation, positive CMV results by PCR-ELISA earlier than by other methods including serologic method, shell vial culture assay and PCR. CONCLUSIONS: These results reveal that PCR-ELISA may show higher sensitivity and positive rate than serologic method, shell vial culture assay and conventional PCR. PCR-ELISA can be useful to manage CMV infection rapidly in patients at risk.
Antiviral Agents ; Bone Marrow Transplantation ; Clinical Coding ; Cytomegalovirus* ; Diagnosis ; Digoxigenin ; DNA* ; Enzyme-Linked Immunosorbent Assay ; Ethidium ; Follow-Up Studies ; Gels ; Humans* ; Immunocompromised Host ; Immunoglobulin M ; Infant, Newborn ; Polymerase Chain Reaction ; Sepharose ; Transplants

PURPOSE: This study aims to explore an one-year experience of intensive core clinical clerkship (student internship, subinternship) in Gachon Medical School for junior clinical students, and the immediate outcome of the program was discussed along the with advantages and student load. METHODS: 36 junior medical students (M5) were exposed to 36 weeks of core clinical clerkship including internal medicine (12wks), pediatrics (6wks), obstetrics-gynecology (6wks), general surgery (4wks), psychiatry (4wks), and emergency medicine (4wks). The clinical service team was made of faculty member (1), senior resident (1), intern (1) and M5 students (1-2), and the students who were involved a wide range of baseline responsibilities corresponding to those of regular rotating interns. They were encouraged to participate the various procedures and decision making process, but their participation was restricted by keeping 3 levels of performance policy according to degree of supervision. Questionnaire analysis was carried out immediate after the student internship. RESULTS: Students were proud of themselves being as the subinterns and showed a strong motivation, while they had a difficulty to tolerate a strong psychologic pressure by taking their roles of subinternship. Major responsibilities of clerkship were focused on the clinical information collection (history taking and physical examination), students-directed group conference, faculty-led small group discussion, technical skill learning and ward round in order. Students appreciated well to this internship in terms of acquisition of clinical skills and identification of their role, but shortage of space, frequent on-call, lack of self-directed learning opportunity, unclarified requests from the hospital authority were pointed out. CONCLUSION: It is assumed that student internship is a strong tool to promote the quality of clinical learning process, but requires details of teaching instructions (manuals) aside from solving a series of legal on malpractice, for which critical defining of clinical participation is essential to upgrade the Korean version of clerkship.
Clinical Clerkship ; Clinical Competence ; Decision Making ; Education, Medical ; Emergency Medicine ; Humans ; Internal Medicine ; Internship and Residency* ; Learning ; Malpractice ; Motivation ; Organization and Administration ; Pediatrics ; Program Development* ; Schools, Medical* ; Students, Medical ; Surveys and Questionnaires

BACKGROUND/AIMS: Resection of hepatocellular carcinoma in patients with liver cirrhosis and thrombocytopenia is risky. The benefit of concomitant splenectomy in cirrhotic patients is controversial. METHODS: To evaluate the efficacy of concomitant splenectomy in patients with liver cirrhosis and thrombocytopenia, 13 cirrhotic patients with thrombocytopenia (platelet count< or =80,000/mm3) were divided by two groups (Group I: the patients without concomitant splenectomy during hepatectomy, Group II: the patients with concomitant splenectomy). Intraoperative and postoperative parameters were retrospectively reviewed. RESULTS: Group II patients needed less amount of postoperative blood transfusion (Group I: 178.3+/-150 ml PRC in 3 patients, Group II: 107.1+/-100 ml in 2 patients, p=0.012, p= 0.041) and the platelet count was elevated to above 250,000/mm3 (p=0.003) and showed lower serum bilirubin level (p=0.037) within 1 week of operation in group II patients. CONCLUSION: The concomitant splenectomy during in patients of liver cirrhosis with thrombocytopenia may improve liver function and elevate platelet count.
Bilirubin ; Blood Transfusion ; Carcinoma, Hepatocellular ; Hepatectomy* ; Humans ; Liver Cirrhosis* ; Liver* ; Platelet Count ; Retrospective Studies ; Splenectomy* ; Thrombocytopenia*

Mineral trioxide aggregate (MTA) would influence healing of periapical tissues by modulating the production of growth factors and cytokines from PDL fibroblasts, however, the studies are insufficient. Therefore, the purpose of this study was to monitor the expression of transforming growth factor-beta1 (TGF- beta1), fibroblast growth factor-2 (FGF-2), and interleukin-6 (IL-6) from PDL fibroblasts in the presence of MTA. The human PDL fibroblasts were seeded onto the set MTA or IRM at a level of 1 x 10(5) cells per unit well, and further incubated for 6, 12, 24, and 48 hours. The levels of TGF-beta1, FGF-2, and IL-6 from the supernatant were measured by enzyme-linked immunosorbent assay (ELISA). The data were analyzed using one-way ANOVA. The level of TGF-beta1 was down-regulated when the cells were grown in the presence of MTA except at 6 hours. The levels of FGF-2 release were significantly suppressed when PDL fibroblasts were grown in the presence of MTA or IRM at all time intervals (p < 0.05). The expressions of IL-6 from MTA treated cells were comparable to those of untreated control cells throughout the observation periods. We presume that this material inhibits the stimulatory function of growth factors on granulation tissue formation and in turn, it promotes the healing process modulated by other bone-remodeling cells.
Cytokines ; Enzyme-Linked Immunosorbent Assay ; Fibroblast Growth Factor 2 ; Fibroblasts* ; Granulation Tissue ; Humans* ; Intercellular Signaling Peptides and Proteins* ; Interleukin-6 ; Periapical Tissue ; Periodontal Ligament* ; Transforming Growth Factor beta1 ; Pemetrexed