Epidermolytic hyperkeratosis is a rare disease which is extremely variable in its severity. In some patients it may be so severe and generalized during the neonatal period as to be lifethreatening, in others, it is relatively inconspicuous. A bullous eruption is the characteristic finding of the epidermolytic hyperkeratosis The bullous episodes soon become less frequent and more localized and may eventually cesse, but continue into adult life after the age of 20 years in at least 20% of cases. A case of epidermolytic hyperkeratosis is represented. The patient was a 25-year-old male who had ichthyosiform erythroderma and the frequent episades of bullous eruption. The bullous eruption had been subsided under the treatment with oral penicillin administration. The histopathological features of the bullous lesion on his abdomen revealed the features of epidermolytic hyperkeratosis.
Abdomen ; Adult ; Blister ; Dermatitis, Exfoliative ; Humans ; Hyperkeratosis, Epidermolytic* ; Male ; Penicillins ; Rare Diseases

The basic pathophysiology of vitiligo is still obscure. Most researchers emphasized that poasible immunologic role is very important in pathophysiology of vitiligo. Also the type of vitiligo is classified by various type baaed on clinical manifestations. These facts promoted us to analyse the immunologic state in each type of vitiligo in order to verify whether there is present any immunologic alteration in this permatosis or any differences of immune state in each type of vitiligo. The following immune cells were analysed, T cell, B cell, and T cell subsets such as helper T cell and suppresaor T cell. Vitiligo vulgaris in our study showed alteration of immune cell such as low level of T cell and helper T cell.
B-Lymphocytes* ; T-Lymphocyte Subsets* ; Vitiligo*

PURPOSE: To correlate SOhographic and pathologic findings of gallbladder adenoma, and to evaluate the clinical significance of sonographic findings. MATERIALS AND METHODS: Ultrasound findings of twenty gallbladder adenomas were retrospectively reviewed to evaluate the size, shape and echogenicity of the adenoma, and was correlated with the pathological finding. RESULTS: Among 14 patients, 11 patients had single lesion and 3 patients had multiple lesions. Three patients showed 2, 3 and 4 adenomas, respectively. Nine of 20 lesions showed focal dysplasia pathologically. Among the nine adenomas with dysplasia, two adenomas showed focal cancerous change. The nine adenomas showing focal dysplasia measured 25.6mm (14-35mm) in mean diameter, while the mean diameter of adenomas without dysplasia was 8.7 mm (3-13mm). The echogenicity of adenoma with focal dysplasia were hyperechoic in 8, isoechoic in 1. The echogenicity of adenomas without dysplasia were hyperechoic in 7, isoechoic in 4. Sessile(7/9) and papillary shape(6/9) were predominant in adenoma with dysplasia, but smooth shape(8/11) and stalked type(9/11) were predominant in adenoma without dysplasia. Two adenomas with focal cancerous change showed histological transition from cancer to dysplasia and to adenomatous tissue. In adenoma with dysplasia, the diameter more than 14 mm on sonography was statistically significant (p<0. 005). Also age of patient was significantly different between the two groups (p<0.01), while echogenicity and associated stone were not statistically significant. CONCLUSION: As gallbladder adenoma more than 14ram in diameter on US is suggestive of dysplasia on pathology, so, close follow up US or surgery is recommended.
Adenoma* ; Follow-Up Studies ; Gallbladder* ; Humans ; Pathology ; Retrospective Studies ; Ultrasonography

No abstract available.
Carcinoma, Basal Cell*

OBJECTIVES: Numerous studies have revealed the adverse health effects of acute and chronic exposure to particulate matter less than 10 mum in aerodynamic diameter (PM10). The aim of the present study was to examine the spatial distribution of PM10 concentrations and cardiovascular mortality and to investigate the spatial correlation between PM10 and cardiovascular mortality using spatial scan statistic (SaTScan) and a regression model. METHODS: From 2008 to 2010, the spatial distribution of PM10 in the Seoul metropolitan area was examined via kriging. In addition, a group of cardiovascular mortality cases was analyzed using SaTScan-based cluster exploration. Geographically weighted regression (GWR) was applied to investigate the correlation between PM10 concentrations and cardiovascular mortality. RESULTS: An examination of the regional distribution of the cardiovascular mortality was higher in provincial districts (gu) belonging to Incheon and the northern part of Gyeonggido than in other regions. In a comparison of PM10 concentrations and mortality cluster (MC) regions, all those belonging to MC 1 and MC 2 were found to belong to particulate matter (PM) 1 and PM 2 with high concentrations of air pollutants. In addition, the GWR showed that PM10 has a statistically significant relation to cardiovascular mortality. CONCLUSIONS: To investigate the relation between air pollution and health impact, spatial analyses can be utilized based on kriging, cluster exploration, and GWR for a more systematic and quantitative analysis. It has been proven that cardiovascular mortality is spatially related to the concentration of PM10.
Air Pollutants ; Air Pollution ; Gyeonggi-do ; Incheon ; Mortality* ; Particulate Matter ; Seoul ; Spatial Analysis*

BACKGROUND: Myocardial contrast two-dimensional echocardiography(MC-2DE) has been known to have the real time capabilities for repeat in vivo assessment of ischemic risk areas and for evaluation of the myocardial perfusion. The aims of this investigation are (1) to evaluate the feasibility of MC-2DE for the delineation and quantitation of the area at risk. (2) to determine the relationship between the extent of the echocontrast defect area(EDA) during reperfusion and the size of myocardial infarction as determined by post-mortem tissue examination, and (3) to observe serial changes in the time echo-intensity characteristics of MC-2DE during coronary occlusion and reperfusion. METHODS: Myocardial contrast echocardiographic images were made by injecting bolus 5mL of two-syringe-agitated mixture of sodium meglumine ioxaglate(Hexabrix(R)) and normal saline(2 : 3 by volume) into the aortic root before and during coronary occlusion of the left anterior descending coronary artery, distal to the first diagonal branch and during reperfusion on eight open-chest dogs. Two-dimensional echocardiographic short axis views were obtained at four anatomic levels : the apex, the low papillary muscle, the high papillary muscle and the mitral valve. The changes in EDA and echo-intensity with its wash-out half time(WHT) at the high papillary muscle level during coronary occlusion and reperfusion were measured every 15 minutes. The total EDA was measured by planimetry at 3 minutes after coronary occlusion and at 60 minutes after reperfusion. Evans blue or methylene blue were used for the measurement of the anatomic area at risk and triphenyl-tetrazolium chloride(TTC) for the measurement of the infarct area. RESULTS: The EDA measured 30 minutes after coronary occlusion(19.6%) was smaller than that at 3 minutes after coronary occlusion(24.0%, p<0.01). Then EDA at 3 minutes occlusion was strongly predictive of the anatomic extent of area at risk(EDA=0.48 Area at risk+16.95, r=0.84, p<0.05). The EDA at 60 minutes after reperfusion, which showed an irregular margin and was located within the subendocardium of the area at risk, also correlated well with the infarct area(IA)(EDA=0.78 IA+3.32, r=0.82, p=0.09). The peak echo-intensity in the ischemic area during coronary occlusion was significantly low(14.2+/-6.5 vs 73.8+/-31.7 in the non-ischemic area, p<0.01) and the WHT was delayed more in the ischemic area than in the non-ischemic area(23.2+/-2.8 sec vs 8.1+/-3.3sec, p<0.01). During the period of reperfusion, WHT in the previously ischemic area was markedly delayed compared to that in the non-ischemic area (p<0.01), although the peak echo-intensity in the ischemic area at 3 minutes after reperfusion increased modestly compared to that in the non-ischemic area(80.9+/-22.8 vs 72.7+/-8.4), suggesting the impairment in the transit of microbubbles is probably due to microvascular damage after reperfusion. There were no adverse hemodynamic or electrocardiographic effects after injection of the contrast agent. CONCLUSIONS: These findings suggest that myocardial contrast echocardiography was useful as a non-invasive technique, first, to delineate the area at risk in vivo during coronary occlusion and, after reperfusion, the infarct area, and secondly, to evaluate indirectly the state of myocardial perfusion during coronary occlusion and reperfusion.
Animals ; Axis, Cervical Vertebra ; Coronary Occlusion* ; Coronary Vessels ; Dogs ; Echocardiography* ; Electrocardiography ; Evans Blue ; Hemodynamics ; Meglumine ; Methylene Blue ; Microbubbles ; Mitral Valve ; Myocardial Infarction ; Papillary Muscles ; Perfusion* ; Reperfusion* ; Sodium

Brugada syndrome is characterized by an ECG pattern of right bundle branch block and ST segment elevation in right precordial leads (V1 to V3), without structural heart disease. However, these ECG manifestations transiently normalize in up to 40% of cases. Brugada syndrome is responsible for up to one half of all sudden cardiac deaths in young adults and they may be worsened by beta blockers. We present the anesthetic management of a patient with Brugada syndrome without the characteristic ECG pattern.
Anesthesia* ; Brugada Syndrome* ; Bundle-Branch Block ; Death, Sudden ; Death, Sudden, Cardiac ; Electrocardiography* ; Heart Diseases ; Humans ; Young Adult

BACKGROUND: Postoperative pain may be severe after open heart surgery (OHS). High thoracic epidural analgesia may reduce postoperative pain and improve the pulmonary function. We investigated the effect of epidural analgesia after median sternotomy METHODS: Fifty-six patients were randomized to epidural patient controlled analgesia (PCA) or conventional analgesia (control). Patients received OHS with standardized general anesthetic technique. The day before surgery, patients allocated to the PCA group had an epidural catheter inserted at level T4-5. Proper placement was tested with small dose of lidocaine and epinephrine. Epidural catheter was removed 3 days after surgery. Patients in control group received conventional nurse controlled analgesia. Postoperative assessment included daily visual analog scoring (VAS) and pulmonary function test 3 days after surgery. Complication and patients satisfaction were also evaluated. RESULTS: The VAS scores did not significantly differ between the groups, except 12 hours after surgery during coughing. Patients with PCA awoke and were extubated significantly earlier than patients in control group. Significantly higher forced expiratory volume in 1s and peak expiratory flow rate were seen in PCA group than in control group. No significant thoracic epidural related complications occurred. CONCLUSIONS: Thoracic epidural PCA provided better analgesia and allowed earlier extubation. Thoracic epidural PCA yields a slight, but significant, improvement in pulmonary function.
Analgesia ; Analgesia, Epidural ; Analgesia, Patient-Controlled* ; Catheters ; Cough ; Epinephrine ; Forced Expiratory Volume ; Heart* ; Humans ; Lidocaine ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Peak Expiratory Flow Rate ; Respiratory Function Tests ; Sternotomy ; Thoracic Surgery*

PURPOSE: There are so many causes of an altered mental status, including acute stroke and nonorganic causes. Making the differential diagnosis and the diagnostic approach for cases with an altered mental status represent a challenge to all emergency physicians. The serum S-100B protein concentration and the neuron-specific enolase (NSE) concentration have been used to evaluate brain damaged patients. We evaluated the usefulness of the serum S-100B protein concentration and the NSE concentration as screening tests for the patients with an altered mentality METHODS: Seventy-eight patients with an altered mentality were included in this prospective study. The patients were divided in two groups. One was the acute stroke group and the other was the non-organic cause group. We analyzed the serum S-100B protein and NSE concentrations of the two groups. We also assessed the correlation of the serum S-100B protein and NSE concentrations with the clinical and laboratory data of the two groups RESULTS: The serum concentration of S-100B was higher in the acute stroke group (median: 0.376, interquartile range: 0.18-1.05) than that in the nonorganic group (0.123, 0.087-0.307, p=0.000). The NSE level was also higher in the acute stroke group (median: 19.12, interquartile range: 14.42-27.19) than that in the non-organic group (13.71, 10.48-19.29, p=0.002). To differentiate the acute stroke group from the non-organic group, the sensitivity and specificity was 81.1% and 61.0%, respectively, at a cutoff value for the serum S-100B protein concentration of 0.14 microgram/L, and these were 81.1% and 51.2%, respectively, at a cutoff value for the serum NSE concentration of 13.71 microgram/L CONCLUSION: Our study suggests that the serum S-100B protein and NSE concentrations may be useful as screening markers for differentiating acute stroke from non-organic causes. However, further studies are needed to evaluate the relationship between the two proteins and the various diseases that have possibility to alter patients' mental status before these two proteins can be used clinically as screening tests.
Brain ; Diagnosis, Differential ; Emergencies ; Humans ; Mass Screening ; Mentally Ill Persons ; Nerve Growth Factors ; Phosphopyruvate Hydratase ; Prospective Studies ; Proteins ; S100 Proteins ; Sensitivity and Specificity ; Stroke

BACKGROUND: Supraglottic airway devices can be used to maintain stable hemodynamics during intubation, to secure a difficult airway and to administer muscle relaxants at reduced levels for brief operation. We investigated the insertion success rates, hemodynamic stabilities after insertion, intraoperative ventilatory parameters, and postoperative laryngopharyngeal discomforts of three supraglottic airway devices: the ProSealTM laryngeal mask airway (PLMA), the laryngeal tube (LT), and the PAxpressTM (PAX). METHODS: After induction with thiopental 5 mg/kg with fentanyl 1microgram/kg and rocuronuim 0.6 mg/kg as muscle relaxants, manual control ventilation was done with N2O : O2 (1 : 1) and sevoflurane 5-6 vol% for 2 minutes. The supraglottic airway devices were inserted into 94 adult ASA physical status I and II patients. Unblinded observers collected the intraoperative data, and blinded observers collected the postoperative data. RESULTS: The success rates of first-attempts were similar (PLMA: 96.9%, LT: 93.1%, PAX: 96.8%). The time to achieve effective ventilation was shorten for PLMA. Peak inspiratory pressure (PIP) was significant higher for PAX than PLMA. Cuff pressure significantly increased in LT at 60 and 90 minutes after insertion. LT provided the tightest seal for positive ventilation. The incidence of blood-tinged and sore throat was highest for PAX. CONCLUSIONS: These three supraglottic airway devices can be used successfully and effectively without gastric insufflation. We suspected that the incidences of airway complications were proportional to PIP and cuff pressure and that they are dependent upon insertion skill.
Adult ; Fentanyl ; Hemodynamics ; Humans ; Incidence ; Insufflation ; Intubation ; Laryngeal Masks* ; Pharyngitis ; Thiopental ; Ventilation