A case of generalized pustular psoriasis in a 12 year-old girl is described. She had generalized pustular eruptions on erythematous base, presenting lake of pus, yellowish brown crusts and denudation associated with high fever and chills. With the administration of oral etretinate at a dose of 0.8mg/kg/day for 1 week, rapid and dramatic remission was achieved. About 3 months after her discharge, there developed another wave of new pustules with fever. She was again placed on etretinate therapy. However, there was no expected response as before with developing new pustules continuously. At that time, we tried combination therapy with etretinate and methotrexate. the pustules and erythema began to remit, with eventual clearing of the skin in 6 weeks.
Acitretin* ; Child ; Chills ; Erythema ; Etretinate* ; Female ; Fever ; Humans ; Lakes ; Methotrexate* ; Psoriasis ; Skin ; Suppuration

Iatrogenically developed immunosuppression-associated Kaposis sarcoma is the result of immunosuppressive therapy after an organ transplantation, particularly after a renal transplantation. Since the advent of powerful immunosuppressive agents such as cyclosporine, recently the incidence of Kaposis sarcoma has been increased. In addition to immunosuppression, other factors, such as genetic predisposition, environmental and geographic factors, and oncogenic viruses, may play a role in the pathogenesis of this tumor. Ilerein we report a case of Keposis sarcoma with multiple organ involvement of the skin, lung, small intestine and mesenteric lymph node in a renal allograft recipient who received cyclosporine and prednisolone. Reduction of the dosage of immunosuppressant for 1 month resulted in improvement of the cutaneous lesions.
Allografts* ; Cyclosporine ; Genetic Predisposition to Disease ; Geography ; Immunosuppression ; Immunosuppressive Agents ; Incidence ; Intestine, Small ; Kidney Transplantation ; Lung ; Lymph Nodes ; Oncogenic Viruses ; Organ Transplantation ; Prednisolone ; Sarcoma ; Sarcoma, Kaposi* ; Skin ; Transplants

PURPOSE: To assess long-term anatomic and visual outcomes and associated complications of lens-sparing vitrectomy (LSV) for treatment of tractional retinal detachments (TRDs) associated with stages 4B and 5 retinopathy of prematurity (ROP). METHODS: We performed a retrospective review of medical records and data analyses of consecutive patients who presented with stages 4B and 5 ROP and underwent LSV from 1999 to 2007. Retinal reattachment status, visual acuity and postoperative complications were evaluated. RESULTS: Twenty-one eyes of 20 patients, including 13 eyes with stage 4B ROP and 8 eyes with stage 5 ROP, were examined. The mean follow-up period was 5.6 years. In 9 (43%) out of 21 eyes, retinas were eventually reattached. The anatomic success rates were 62% in stage 4B and 13% in stage 5 ROP. In eyes with reattached retinas, visual acuity better than form vision was shown in 7 eyes (78%), whereas no light perception was present in 10 eyes (83%) among eyes with TRD on final examination. Postoperative intraocular hemorrhage occurred in nine eyes (43%). Long-term complications of cataract, corneal opacity, glaucoma and strabismus developed in 4 (19%), 6 (29%), 7 (33%) and 8 (38%) eyes, respectively, and were more common in eyes with TRD. CONCLUSIONS: After following-up for a mean of 5.6 years, the anatomical success rate of LSV was encouraging for the correction of TRD associated with stage 4B ROP but not for stage 5 ROP. Retinal reattachment is important for obtaining better visual outcomes and preventing the development of late complications.
Female ; Follow-Up Studies ; Humans ; Infant, Newborn ; *Infant, Very Low Birth Weight ; Lens, Crystalline/*surgery ; Male ; Retinopathy of Prematurity/diagnosis/physiopathology/*surgery ; Retrospective Studies ; Severity of Illness Index ; Time Factors ; Treatment Outcome ; Visual Acuity ; Vitrectomy/*methods

PURPOSE: To assess long-term anatomic and visual outcomes and associated complications of lens-sparing vitrectomy (LSV) for treatment of tractional retinal detachments (TRDs) associated with stages 4B and 5 retinopathy of prematurity (ROP). METHODS: We performed a retrospective review of medical records and data analyses of consecutive patients who presented with stages 4B and 5 ROP and underwent LSV from 1999 to 2007. Retinal reattachment status, visual acuity and postoperative complications were evaluated. RESULTS: Twenty-one eyes of 20 patients, including 13 eyes with stage 4B ROP and 8 eyes with stage 5 ROP, were examined. The mean follow-up period was 5.6 years. In 9 (43%) out of 21 eyes, retinas were eventually reattached. The anatomic success rates were 62% in stage 4B and 13% in stage 5 ROP. In eyes with reattached retinas, visual acuity better than form vision was shown in 7 eyes (78%), whereas no light perception was present in 10 eyes (83%) among eyes with TRD on final examination. Postoperative intraocular hemorrhage occurred in nine eyes (43%). Long-term complications of cataract, corneal opacity, glaucoma and strabismus developed in 4 (19%), 6 (29%), 7 (33%) and 8 (38%) eyes, respectively, and were more common in eyes with TRD. CONCLUSIONS: After following-up for a mean of 5.6 years, the anatomical success rate of LSV was encouraging for the correction of TRD associated with stage 4B ROP but not for stage 5 ROP. Retinal reattachment is important for obtaining better visual outcomes and preventing the development of late complications.
Female ; Follow-Up Studies ; Humans ; Infant, Newborn ; *Infant, Very Low Birth Weight ; Lens, Crystalline/*surgery ; Male ; Retinopathy of Prematurity/diagnosis/physiopathology/*surgery ; Retrospective Studies ; Severity of Illness Index ; Time Factors ; Treatment Outcome ; Visual Acuity ; Vitrectomy/*methods

The authors experienced a case of atypical type of idiopathic central serous chorioretinopathy that has bullous retinal pigment epithelium detachment and multiple leaking points. So, we report this case with the review of the literatures.
Central Serous Chorioretinopathy* ; Retinal Pigment Epithelium

The authors experienced a case of atypical type of idiopathic central serous chorioretinopathy that has bullous retinal pigment epithelium detachment and multiple leaking points. So, we report this case with the review of the literatures.
Central Serous Chorioretinopathy* ; Retinal Pigment Epithelium

PURPOSE: To assess the long-term anatomic and visual outcomes and associated complications of lens-sparing vitrectomy (LSV) in infants with progressive posterior-type tractional retinal detachment (TRD) associated with stage 4A retinopathy of prematurity (ROP). METHODS: In a retrospective case series, the medical records of consecutive patients who presented with progressive posterior-type stage 4A ROP and underwent LSV between 1999 and 2007 were reviewed. Retinal attachment status, visual acuity, and development of postoperative complications were assessed. RESULTS: Eleven eyes of 9 patients were included. The mean follow-up period was 4.6 years. In 8 eyes (73%), plus disease was present at the time of LSV. In 3 eyes (27%), 2 (66%) without plus disease and 1 (13%) with plus disease, the retina remained reattached in the end, while 8 eyes (73%) had TRD on final examination. Two eyes with reattached retinas showed favorable visual acuity. In those eyes with detached retinas, 5 (68%) showed no light perception. When surgery for ROP was unsuccessful, development of cataract, corneal opacity, or glaucoma was common. CONCLUSIONS: The long-term anatomic success rate of LSV for progressive posterior-type stage 4A ROP was low, especially in the presence of plus disease at the time of LSV. Anatomical reattachment is very important for preventing complications and gaining better visual outcomes.
Disease Progression ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Postoperative Complications/epidemiology ; Retinal Detachment/epidemiology ; Retinopathy of Prematurity/*surgery ; Retrospective Studies ; Treatment Outcome ; Visual Acuity ; Vitrectomy/*methods

Accidental hypothermia is an uncommon health issue that can cause fatal problems. Mortality related to hypothermia has been reported to be up to 50%. Prognosis of hypothermia depends on the grade of hypothermia, interval of re-warming from the accident and the re-warming rate. Hypothermic patients with injury show worse prognosis. A 66 year-old man with history of cerebrovascular accident was rescued in the mountains. His Glasgow coma scale (GCS) was 3, core temperature was 25.2degrees C and he had a right lateral malleolar fracture. The second patient was a 45 year-old man whose GCS was 8 and core temperature 17.2degrees C. Blood pressure was unmeasurable with only palpable pulse and showed Osborn J wave on electrocardiography for both patients. Active re-warming was performed with forced warm air, warm saline infusion and bladder irrigation. Patient core temperature raised by 1.5degrees C/hour and 3.3degrees C/hour, respectively. The two patients were discharged without any other sequelae and disability.
Blood Pressure ; Electrocardiography ; Glasgow Coma Scale ; Humans ; Hypothermia ; Prognosis ; Stroke ; Urinary Bladder

Total knee arthroplasty is a surgical treatment for end-stage osteoarthritis of the knee. Postoperative lower limb alignment is one of the factors determining the long-term prognosis after total knee arthroplasty. Navigation-assisted surgery can be used to achieve an accurate lower limb alignment. Particular situations, such as severe extra-articular deformity in the femur or tibia and retained hardware, are a good indication for navigation-assisted surgery. On the other hand, thorough preoperative planning and an understanding of each steps of surgery are necessary to perform total knee arthroplasty successfully in these special cases. In this review article, preoperative radiological measurements and surgical planning for extra-articular deformity correction will be elucidated. The surgical steps and necessary instruments for navigation-assisted total knee arthroplasty will be described in cases of extra-articular deformity or retained hardware. A literature review showed that the radiological and clinical results after total knee arthroplasty using navigation in osteoarthritis with extraarticular deformity were good. Therefore, it is essential to use navigation when performing total knee arthroplasty in patients with extraarticular deformity or retained hardware.

PURPOSE: The liver and lung are the most common site of metastases after curative resection of colorectal carcinoma, and only 10 months of median survival is achieved once metastases has occurred in the lung. About 10% of patients have a solitary pulmonary metastasis and surgical resection leads to a 5 year survival rate of 21~43%. We have tried to define ideal candidates for pulmonary resection in a patient with pulmonary metastases from colorectal carcinoma. METHODS: Between March 1990 to Feb. 2001, 25 patients underwent pulmonary resection for metastatic colorectal carcinoma. 15 patients were male, and 10 were female with mean age of 60.0 (range, 36~73) years. The primary sites were colon in 7 patients and rectum in 18 patients. RESULTS: The mean disease free interval was 30.04 19.79 (range, 1~84) months and 19 patients had single metastasis and 6 patients had multiple metastatic lesions. Twenty- one patients had unilateral lesion. Wedge resection was done in 10 patients, lobectomy in 7, pneumonectomy in 2, wedge resection with bilobectomy in 2, segmentectomy and wedge resection in 1, and segmentectomy and lobectomy in 1 patient. Six patients recurred mean 13.7 months after the first operation (range, 1~33 months) and they underwent wedge resection in 4 and one case each of lobectomy and segmentectomy. Seven patients died during follow up with 3 year survival rate of 70.8% and 5 year survival rate of 43.4%. CONCLUSIONS: The disease free interval, number of metastases, type and location of pulmonary resection, level of carcinoembryonic antigen had no correlation with the survival rate. We conclude that surgical resection of colorectal lung metastases is safe and effective, and every patients should be evaluated as a surgical candidate.
Carcinoembryonic Antigen ; Colon ; Colorectal Neoplasms* ; Female ; Follow-Up Studies ; Humans ; Liver ; Lung* ; Male ; Mastectomy, Segmental ; Neoplasm Metastasis* ; Pneumonectomy ; Rectum ; Survival Rate