We describe herein a case of tick bite ocurring to a 23-year-old man who has a characteristic lesion clinically and histopathologically. The tick(Ixodes sp.) was still attached to the brownish and erythematous, indurated skin of the scrotum. The engorged tick which was carefully removed from the skin with a scalpel was 8.7mm in length and 5. 5 mm in width. Histopathologically, characteristic amorphous eosinophilic materigl is deposited around a round space where the hypostorne of the tick was inserted. Heavy inflammatory cell infiltratton in the mid and lower dermis is composed mainly of neutrophils and eosinophils. A certain area of the lower dermis shows edema and capillary dilatation along with the mixed inflammatory cell infiltration, TVide excision of the indurated lesion including the tick was done. The clinical and hsitopathological findings of the tick bite was discussed.
Capillaries ; Dermis ; Dilatation ; Edema ; Eosinophils ; Humans ; Neutrophils ; Scrotum ; Skin ; Tick Bites* ; Ticks* ; Young Adult

In the real-time two-dimensional Doppler flow mapping(2DD) system, Doppler signals are processed using auto-correlation technique, so that the direction, velocity and turbulence of the intracardiac blood flow are displayed by coloration on the B mode image of the heart in real time. Aortic regurgitant flow is imaged as a mosaic jet spurting out from the aortic valve orifice to cardiac chamber. Dynamic features in the direction and extent of regurgitant flow and the site of regurgitation on the aortic valve orifice are readily obtained. Feasibility of the 2DD system in the assesment of aortic regurgitation was examined in 30 cases documented by angiography. In 30 cases, there were 20 cases with aortic regurgitation(AR) aged 16 to 57 years(mean 34) and 10 cases without AR aged 17 to 39 years(mean 30). The underlying disorders of AR were rheumatic in 15 cases, bicuspid aortic valve in 1, ventricular septal defect in 1, aortitis in 1, Marfan's syndrome in 1 and unknown in 1. The results are as follows : 1) In 19 out of 20 cases with AR the 2DD showed regurgitant jet spurting out from valve orifice(sensitivity=95%). One case missed by the 2DD had 1+AR. None of the 10 cases who had no AR manifested the evidence of AR on the 2DD(specificity=100%). 2) There was an excellent positive correlation between the maximal jet length of regurgitant flow on the 2DD and angiographic severity of regurgitation(r=0.998, p<0.001). The maximal jet length was less than 3cm for cases with 1+, 3-4.9cm for 2+, 5-5.9cm for 3+, and 6cm or more for 4+AR. 3) In 19 out of 20 cases with AR, the 2DD identifed the anatomic valvular site of regurgitation(sensitivity=95%, specificity=100%). 4) The regurgitant aortic valvular area was measured as 0.6cm2 or less in all of 12 cases with 2+ or less AR, while 0.9cm2 or more in 6 out of 7 cases with 3+or more AR. Thus, a less or greater than 0.8cm2 regurgitant aortic valvular area provides to discriminate between mild(< or = 2+) and severe(> or = 3+) AR. 5) In all 8 cases with fluttering of anterior mitral leaflet and 8 out of 9 cases with fluttering of interventricular septum, a regurgitant jet impinged on them. The results of this investigation indicate that the 2DD system is a very useful and unique noninvasive technique in the detection, estimation of severity and spatial orientation of AR.
Angiography ; Aortic Valve ; Aortic Valve Insufficiency* ; Aortitis ; Bicuspid ; Equidae ; Heart ; Heart Septal Defects, Ventricular ; Marfan Syndrome

The idiopathic mitral valve prolapse(IMVP) syndrome presents with nonspecific cardiovascular symptoms which need to evaluate those clinical meaning. These symptoms should not necessarily be interpreted as suggesting arrhythmias, conduction abnormalities or myocardial ischemia unless the symptoms and the the electrocardiographic changes documented to occur simultaneously. And it will be that ambulatory electrocardiographic monitoring is a a very sensitive method to detect the transient arrhythmias, conduction abnormalities of ischemic changes in patients with IMVP. Author undertook a study to systemically evaluate the electrocardiographic findings in symptomatic patients with IMVP by means of 24 hour ambulatory Holter electrocardiographic monitoring for the evaluation of the clincal meaning of those symptoms. The following results were obtained; 1) Twenty five subjects, 15 male and 10 female, with IMVP were studied. The subjects ranged in age from 10 to 50 decades. 2) The presenting complaints were palpitation in 20, atypical chest pain in 17, dizziness and syncope in 9, and lyspnea and fatigue in 7 of 25 studied subjects. 3) There were no correlations the presence of complaints with the routine 12 lead electrocardiographic findings, echocardiographic findings, and phonocardiographic findings. 4) The relationship of symptoms recorded in patient diary to Holter monioring electrocardiographic findings is summarized. (1) 20 patients recorded episodes of palpitation. Seven of these patients was associated with sinus tachycardia, 2 with paroxysmal atrial tachycardia, 3 with atrial fibrillation, 2 with atrial premature contractions, 5 with ventricular premature contractions, and 1 with no changes, (2) 17 patients recorded episodes of atypical chest pain. Three of these patients was associated with sinus bradycardia, 2 with sinus tachycardia, 1 with paroxysmal atrial tachycardia, 2 with atrial finbrillation, 2 with ventricular premature contractions, 3 with nonspecific ST segment change, 1 with first degree AV block, and 3 with no changes. (3) 8 patients recorded episodes of dizziness. Three of these patients was associated sinus bradycardia, 2 with paroxysmal atrial tachycardia, 1 with paroxysmal ventricular tachycardia, 1 with ventricular premature contractions, and 1 with no changes. (4) 1 patient recorded episodes of syncope associated with second degree AV block and sinus bradycardia. (5) 3 Patients recorded episodes of dyspnea. One of these patients was associated with sinus bradycardia, 1 with ventricular premature contractions and one with no changes. 5) The prolonged QTc interval revealed in 7 of 25 studied subjects. One of these had frequent ventricular contractions followed by paroxysmal ventricular tachycardia. 6) Ectopic beats associated with bradyarrhythmias tend to decrease in frequency and associated with tachyarrhythmias to increase in frequency in patients with atrial premature contractions during exercise, and with ventricular premature contractions during sleeping, respectively. 7) Bradyarrhythmia accounted for the majority of arrhythmias recorded in 15 of 25 symptomatic IMVP patients. It is concluded that Holter monitoring is of considerable value in assessing the clinical meaning of the nonspecific complaints in patinets with IMVP.
Arrhythmias, Cardiac ; Atrial Fibrillation ; Atrioventricular Block ; Bradycardia ; Chest Pain ; Dizziness ; Dyspnea ; Echocardiography ; Electrocardiography ; Electrocardiography, Ambulatory* ; Fatigue ; Female ; Humans ; Male ; Mitral Valve Prolapse* ; Mitral Valve* ; Myocardial Ischemia ; Syncope ; Tachycardia ; Tachycardia, Sinus ; Tachycardia, Ventricular

No abstract available.
Arthroplasty, Replacement, Knee* ; Humans

Introduction: This study examined the factors related to the amount of blood loss and transfusion after primary total hip arthroplasty. Materials and methods: Sixty THRA patients, who had records of perioperative complete blood counts and transfusion, were enrolled in this study. Age, gender, diagnosis, use of cement, size of an incision, operative time, intraoperative crack, estimated blood loss, use of suction drain and the amount drained were used as possible variables. Results: The decrease in the serum hemoglobin level immediately after and 1 day after surgery was 3.18 and 3.90g/dL respectively. An average of 2.30 units were transfused in 78.3% of cases. The preoperative serum hemoglobin level, the use of a suction drain and the amount drained was related to the total amount of transfusion. Adverse transfusion reactions were found to be associated with the amount of transfusion Discussion: The reduction in the hemoglobin level and total amount of blood transfused showed no relationship with the variances associated with the surgical techniques. The total amount of blood transfused was significantly lower in the groups that had no suction drain. Therefore, a reduction in the volume of intraoperative transfusion and avoiding use of a suction drain can reduce the total amount of blood needed and reduce the adverse reactions of the transfusion.
Arthroplasty, Replacement, Hip* ; Blood Cell Count ; Blood Group Incompatibility ; Diagnosis ; Humans ; Operative Time ; Suction

The clinical study was performed to 28 patients with the pericardiac effusion who were admitted in Busan university Hospital and Paik Hospital, In-Je Medical College, Busan, korea during March 1976 and July 1981. The results were as following; 1) 12 cases(42.9%) of total 28 pericardiac effusion occured in 3rd decade, 8(28.5%) in 2nd decade and 5 cases(17.9%) in 4th decade. Sex distribution showed male to female 2.5:1. 2) With etiological distribution there were 15 cases(53.6%) tuberculous, 5(17.9%) nonspecific, 3(10.7%) malignant, 2(7.1%) pyogenic, 2 traumatic and 1(3.6%) rheumatic. 3) On admission 28 cases(100%) complained of dyspnea, 24(85.7%) distant heart sound, 20(71.4%) each engorged jugular vein and edema, 18(64.3%) each cough and abdominal fullness, 17(60.7%) each sputum and chest discomfort and pain, 12(42.9%) fever, 11(39.1%) orthopnea, 10(35.7%) chilling, 7(25%) oliguria, 4(14.6%) palpitation and 3(17.2%) headache. Increased cardiac dullness was observed in 26 cases(71.4%), hepatomegaly 18(64.3%), pulmonary rales 17(60.7%), ascites 13(46.1%), fever 12(42.9%), pericardiac friction rub 10(35.7%), splenomegaly 7(25%), paradoxical pulse 6(21.4%) and jaundice 2(7.1%). 4) On amission SGOT and SGPT level was increased each in 15(53.6%) and 13(46.7%), TTT and CCF abnormal in 10(35.7%), and 8(28.5%), serum NPN, BUN, creatinine increased in each 10(35.7%), 11(39.1%), 8(28.5%), WBC increased in 6(21.4%), RBC decreased in 8(28.5%) and ESR increased in 16(57.1%). 5) Characteristics of pericardiac effusion showed hemorrhagic 17(60.7%), serosangeous 6(21.4%), sangeous 3(17.2%) and pyogenic 2 cases(7.1%). 6) The ECG on admission revealed low voltage in 25(89.1%), depressed ST segment in 13(46.1%) and inverted T wave in 12(42.9%). 7) Chest X-ray showing cardiomegaly 28(100%), pleural effusion in 20(71.4%), and pulmonary congestion in 16(57.1%). 8) The m mode and 2-D Echocardiogram showed echo free space in 28 cases and after pericardiocentesis the space was reduced or disappeared. 9) 19 cases of 28(67.5%) were improved clinically, while 5 cases(17.9%) were not improved and 4 cases(14.6%) died.
Alanine Transaminase ; Ascites ; Aspartate Aminotransferases ; Busan ; Cardiomegaly ; Cough ; Creatinine ; Dyspnea ; Edema ; Electrocardiography ; Estrogens, Conjugated (USP) ; Female ; Fever ; Friction ; Headache ; Heart Sounds ; Hepatomegaly ; Humans ; Jaundice ; Jugular Veins ; Korea ; Male ; Oliguria ; Pericardiocentesis ; Pleural Effusion ; Respiratory Sounds ; Sex Distribution ; Splenomegaly ; Sputum ; Thorax

Peripelvic lymphatic cyst or the kidney is a rare case in Korean Urological literature. We have experienced a case of it in 30 years old woman who had a palpable fluctuant mass in the upper right quadrant of the abdomen. The operated cyst was dark-red colored appearance and filled with amber colored fluid about 800cc. We have removed it together with kidney. The cyst measured 200gm. in weight, 10 x 5 x 4.5 cm in size and 0.5cm thickness of the cystic wall. Histological finding of the cystic wall showed a consisting of endometrial cell underlying tissue was collagen fiber and fibrotic change. The fluid of cyst contained 98 % of lymphatic cell.
Abdomen ; Adult ; Amber ; Collagen ; Female ; Humans ; Kidney ; Lymphocele*

No abstract available.
Pancreatitis, Chronic*

The most important prognostic factor of breast cancer is the status of lymph node or distant metastasis, which is resisted by basement membrane and stromal matrix. MMP (matrix metalloproteinase)-2 is a 72-kilodalton type IV collagenase/ gelatinase and degrades the type IV collagen which is a main component of the basement membrane. Therefore, MMP-2 is believed to be one of the key molecule for cancer invasion and metastasis. Enzymatic activity of MMP is inhibited by TIMPs (tissue inhibitors of metalloproteinase). TIMP-2 forms a complex with latent pro-MMP-2 and inhibits the active forms of MMP-2. The balance of MMPs and TIMPs is suspected as the important factor of invasion and metastasis of the tumor cells. We studied the association between the expression of MMP-2/TIMP-2 and growth pattern of tumor border, lymph node metastasis, and estrogen receptor expression in the 57 cases of invasive ductal carcinoma of the breast using immunohistochemical staining methods. The results revealed increased expression of MMP-2 in the infiltrating tumor border and tumors with positive lymph node metastasis and negative estrogen receptor with no statistical significance (p>0.05). But the expression of TIMP-2 was increased in expanding tumor border and tumors with positive lymph node metastasis and negative estrogen receptor without statistical significance (p>0.05).
Basement Membrane ; Breast Neoplasms ; Breast* ; Carcinoma, Ductal* ; Collagen Type IV ; Estrogens* ; Gelatinases ; Lymph Nodes* ; Matrix Metalloproteinases ; Neoplasm Metastasis* ; Tissue Inhibitor of Metalloproteinase-2*

Five adult cases of post-laminectomy swan-neck deformity are reported. The factors causing the deformity, prophylactic measures, and treatment of the deformity are discussed. It is strongly adviced to the neurosurgeons and orthopedic surgeons that they should be aware of this unwanted complication of the multi-level cervical laminectomies, and that they should provide every preventive measures before post-laminectomy swan neck deformity develops. Anterior interbody fusion spanning the entire unstable segments is preferably recommended together with application of pre-fusion traction.
Adult ; Congenital Abnormalities ; Humans ; Laminectomy ; Neck ; Neurosurgeons ; Orthopedics ; Surgeons ; Traction