Cryptococcosis is a disease caused by the Cryptococcus neoformans, occcuring most frequently in immunocompromised hosts. Cutaneous involvement is seen in 10-15 % of disseminated cases and its manifestation is variable. A 52 year old man presented with a subcutaneous neck mass and severe headache which had lasted for 2 months and 1 month respectively. Initially cutaneous involvement was monomorphic and localized and a CSF study failed to reveal any organisms. After several weeks of herb medication, however, multiple skin lesions occurred with varied morphology and a CSF study confirmed cryptococcosis by culture. The Urine cortisol was markedly elevated, suggesting an exogenous intake of steroid.
Cryptococcosis* ; Cryptococcus neoformans ; Headache ; Humans ; Hydrocortisone ; Immunocompromised Host ; Middle Aged ; Neck ; Skin

PURPOSE: We wanted to evaluate the usefulness of three-dimensional reconstructive images using multidetector computed tomography (MDCT) for thoracic traumatic patients visiting emergency room. MATERIALS AND METHODS: 76 patients with fractures of the 105 patients who visited our emergency room with complaints of thoracic trauma were analyzed retrospectively. All the patients had thoracic MDCT performed and the three-dimensional reconstructive images were taken. The fractures were confirmed by axial CT, the clinical information, whole body bone scanning and the multiplanar reformation images. Plain x-ray images were analyzed by the fractured sites in a blind comparison of two radiologists' readings, and then that finding was compared with the axial CT scans and the three-dimensional reconstructive images. RESULTS: The fracture sites were rib (n=68), sternum (n=14), clavicle (n=6), scapula (n=3), spine (n=5) and combined fractures (n=14). Plain x-ray and axial CT scans had a correspondency of 0.555 for the rib fractures. Axial CT scans and the three-dimensional reconstructive images had a correspondency of .952. For sternal fractures, those values were 0.692 and 0.928, respectively. The axial CT scans and three-dimensional reconstructive images showed sensitivities of 94% and 91% for rib and other fractures, respectively, and 93% and 100% for sternal fracture, respectively. Three-dimensional reconstructive image had an especially high sensitivity for the diagnosis of sternal fracture. CONCLUSION: While evaluating thoracic trauma at the emergency room, the three-dimensional reconstructive image was useful to easily diagnose the extent of fracture and it was very sensitive for detecting sternal fracture.
Clavicle ; Diagnosis ; Emergency Service, Hospital ; Humans ; Multidetector Computed Tomography ; Reading ; Retrospective Studies ; Rib Fractures ; Ribs ; Scapula ; Spine ; Sternum ; Tomography, X-Ray Computed

PURPOSE: We wanted to evaluate the usefulness of three-dimensional reconstructive images using multidetector computed tomography (MDCT) for thoracic traumatic patients visiting emergency room. MATERIALS AND METHODS: 76 patients with fractures of the 105 patients who visited our emergency room with complaints of thoracic trauma were analyzed retrospectively. All the patients had thoracic MDCT performed and the three-dimensional reconstructive images were taken. The fractures were confirmed by axial CT, the clinical information, whole body bone scanning and the multiplanar reformation images. Plain x-ray images were analyzed by the fractured sites in a blind comparison of two radiologists' readings, and then that finding was compared with the axial CT scans and the three-dimensional reconstructive images. RESULTS: The fracture sites were rib (n=68), sternum (n=14), clavicle (n=6), scapula (n=3), spine (n=5) and combined fractures (n=14). Plain x-ray and axial CT scans had a correspondency of 0.555 for the rib fractures. Axial CT scans and the three-dimensional reconstructive images had a correspondency of .952. For sternal fractures, those values were 0.692 and 0.928, respectively. The axial CT scans and three-dimensional reconstructive images showed sensitivities of 94% and 91% for rib and other fractures, respectively, and 93% and 100% for sternal fracture, respectively. Three-dimensional reconstructive image had an especially high sensitivity for the diagnosis of sternal fracture. CONCLUSION: While evaluating thoracic trauma at the emergency room, the three-dimensional reconstructive image was useful to easily diagnose the extent of fracture and it was very sensitive for detecting sternal fracture.
Clavicle ; Diagnosis ; Emergency Service, Hospital ; Humans ; Multidetector Computed Tomography ; Reading ; Retrospective Studies ; Rib Fractures ; Ribs ; Scapula ; Spine ; Sternum ; Tomography, X-Ray Computed

Atrial septal defect is one of the most common congenital heart diseases in adult, of which absolute causes is not confirmed, but explained by multifactorial inheritance. In Korea, there has been no case report of atrial septal defect in identical twins in spite of some reports of atrial septal defect in relatives and twins in other countries. We present a first case of atrial septal defect in identical twins whose mother had no infection or medication history during pregnancy.
Adult ; Heart Diseases ; Heart Septal Defects, Atrial* ; Humans ; Korea ; Mothers ; Multifactorial Inheritance ; Pregnancy ; Twins ; Twins, Monozygotic*

Clothing dermatitis is a rare disease. The distribution of the eruption coincides with the places on the skin where the garment fits most snugly. It is developed by the chemicals and the dyes rather than textile itself. We experienced 2 cases of clothing dermatitis, one of which was caused by formaldehyde in clothing.
Clothing* ; Coloring Agents ; Dermatitis* ; Formaldehyde ; Rare Diseases ; Skin ; Textiles

The clinical analysis of cranial nerve injuries was performed on 435 cases with cranoicrerbral trauma. This prospective study included the correlation between cranial nerve injuries and risk factors such as intracranial hematoma, initial Glasgow Coma Scale(GCS) score, pneumocephalus, and other combined injuries. The results were revealed as follows : 1) 133 cranial nerve injuries(on 97 patients) were noted among 435 craniocerebral trauma victims(97/435=22.2%). 2) The order of frequent cranial nerve injuries was facial nerve(7.3%), olfactory nerve(6.9%), oculomotor nerve(4.4%), abducens nerve(3.9%), optic nerve(3.2%), etc. 3) Bilateral involvment of cranial nerve injuries was noted in 16.5%(22/133). 4) The incidence of immediate onset of cranial nerve injuries was 66.9%(89/133). 5) The incidence of cranial nerve injuries was significantly high in patients with pneumocephalus and low initial GCS score. 6) The functional recovery of injured cranial nerve within 3 months was noted in 30.1%(40/133).
Coma ; Cranial Nerve Injuries* ; Cranial Nerves* ; Craniocerebral Trauma* ; Hematoma ; Humans ; Incidence ; Pneumocephalus ; Prospective Studies ; Risk Factors

In order to evaluate contamination of the topical eye drugs, 112(36 kinds) medications used over 1 month by the patients and 80(25 kinds) medications used at OPD(outpatient department) were studied by culturing the caps, the tips and the contents. Coagulase-negative staphylococcus was mainly isolated from the caps and the tips(p<0.05). But the other gram-positive bacteria, gram-negative bacteria and fungi were isolated from all medication sites. The most frequent site of contamination was the tips of the medications. Frequency of contamination based on detail of medications and preservatives of medications was not statistically significant(p>0.05). The medications used by the patients for a long time in comparison with the medications used at OPD were significantly more likely to be contaminated(p<0.0001). Therefore, we think that the topical eye durgs should be used with proper instillation and storage for a short period because of increase risk of contamination.
Fungi ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Humans ; Staphylococcus

PURPOSE: This study was to evaluate the accuracy of the implant torque controller used in dental clinics and to investigate whether it was applied appropriately. MATERIALS AND METHODS: Fifty dentists who work in dental clinics were enrolled in this study. Dental (implant) practice career, experience frequency of implant screw loosening and fracture, education of implant torque controller application and infection control methods were included in the survey. 25 Ncm and 30 Ncm of the tightening torque applied to the implant screw were measured by 50 clinicians. After measuring the torque value by using the torque controller, the torque mean according to where education about the implant torque controller was received was analyzed with independent t-test at the significance level of 0.05. RESULTS: The torque controller used in private dental clinics showed 4.78% error ratio. When 50 dentists applied 25 Ncm to the implant screw was 29.0 +/- 8.4 Ncm, and that in 30 Ncm was 34.3 +/- 9.1 Ncm. Statistical significance was found between the group that was educated about implant torque application and the group that was not educated. CONCLUSION: During the prosthodontic treatment with implant, there was difference between actual applied torsion force and the amount torque controller indicated. Clinicians have to not only be well-informed about the accurate usage method of the torque controller, but also keep and manage the torque controller so as to maintain continuous and accurate torque values. Through this, it is considered to achieve clinical results to minimize problems of screw loosening or fracture.
Dental Clinics ; Dentists ; Humans ; Infection Control ; Prosthodontics ; Torque

BACKGROUND: Interleukin-4(IL-4) from the Th2 subset of lymphocytes has been known to have a key role in the pathogenesis of atopic dermatitis. Blood levels of IgE, often reflecting the severity of allergic diseases, are not always elevated in patients with atopic dermatitis due to its homocytotrophic characteristics. OBJECTIVE: We propose that IL-4 can substitute or at least complement the role of IgE as an index of disease severity of atopic dermatitis. METHODS: Eleven patients with atopic dermatitis and five normal controls were included in this study. Before treatment, we evaluated the clinical severity of atopic dermatitis by the method described elsewhere with some modification which employed extent, duration, and intensity of skin lesions. Based on this criteria, we divided patients into 'severe and mild groups. With blood samples drawn from patients and normal controls, we measured IL-4 and IgE values. After a treatment period of I to 2 months, when all of the patients became free of symptoms and signs of atopic dermatitis, patients in each group were re-evaluated for ehanges of IL-4 and IgE values. IL-4 values were determined with a Predicata human interleukin-4 kit from Genzyme diagnostics (Predicta IL-4 kit) and ELISA reader (CRES UV900, Biotek). IgE values were measured .with IMx total IgE assay system from Abott laboratories (model 8389-0). RESULTS: l. Of eleven patients, six were mild and five were severe in clinical severity. 2. IL-4 levels were decreased from the pre-treatment average value of 57.149+/- 40.079 pg/ml to a post-treatment average value of 32.072+/- 16.912 pg/ml (p<0.05) which was similar to average normal control value, 36.690+/- 24.451 pg/ml. 3. IgE levels were similarly decreased from an average value of 230.2 86.4 IU/ml before treatment to one of 171.S+/-79.4 IU/ml after treatment (p<0.05). 4. This tendency of post-treatment lowering of values became more apparent in severe groups (p<0.05) but less obvious in mild groups both in terms of IL-4 and IgE (p>0.1). CONCLUSION: We conclude that IL-4 is not only involved in the pathogenesis but can also be used as a main index of disease severity in atopic dermatitis especially when the clinical severity is more than mild.
Complement System Proteins ; Dermatitis, Atopic* ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunoglobulin E ; Interleukin-4* ; Lymphocytes ; Skin

Fungal infection has been observed with increasing frequency in recent years because the use of combinations of broad spectrum antibiotics, immunosuppressive agents, and antineoplastic agents is increasing and the survival rate of premature baby is increasing. We experienced a 3 month old male infant with anuria due to bilateral ureteropelvic fungus balls. He was born at 31 weeks gestation period and had been treated with broad spectrum antibiotics for 5 weeks after birth. We removed fungus balls surgically and made nephrostomy bilaterally. And then irrigation of amphotericn B through nephrostomy and systemic amphotercin B injection had performed for 3 weeks. Thereafter fungus balls completely disappeared.
Anti-Bacterial Agents ; Antineoplastic Agents ; Anuria* ; Fungi* ; Humans ; Immunosuppressive Agents ; Infant* ; Male ; Parturition ; Pregnancy ; Survival Rate