BACKGROUND: Kaposi varicelliform eruption (KVE) is a disseminated viral infection primarily caused by the herpes simplex virus in the setting of an underlying chronic skin disease. Few studies have reported the clinical characteristics and predisposing factors for recurrent KVE.OBJECTIVES: To characterize the clinical features and predisposing factors for recurrent KVE.METHODS: This retrospective comparative study of recurrent vs. single-episode KVE was performed at the Pusan National University Hospital between 2004 and 2017.RESULTS: A total of 84 episodes occurred in 60 patients, and of these, 13 patients developed recurrence (21.7%). No statistically significant intergroup difference was observed in the mean age and sex distribution. The face was the most common site of involvement in both groups, followed by the trunk and the upper and lower extremities. Atopic dermatitis was the most common pre-existing disease in both groups; however, Darier's disease was more common in the recurrent KVE group, and this difference was statistically significant. Most patients with KVE (66.7%) showed aggravation of the underlying skin disease within 3 months of KVE onset. This finding was more prominent in patients with recurrent episodes (91.7%) than in those with single-episode KVE (58.3%), (p=0.040).CONCLUSION: This study can contribute to a better understanding of recurrent KVE and guide clinicians in treating patients with conditions predisposing to KVE.
Busan ; Causality ; Darier Disease ; Dermatitis, Atopic ; Humans ; Kaposi Varicelliform Eruption ; Lower Extremity ; Preexisting Condition Coverage ; Recurrence ; Retrospective Studies ; Sex Distribution ; Simplexvirus ; Skin Diseases

BACKGROUND: Free fibular flap is one of the most useful methods in the hard tissue reconstruction of the maxilla-mandible. Free fibular flap presents some advantages in which the reconstruction of both soft and hard tissues can be done at the same time. It also provides a safe and successful bone graft for the reconstruction, along with a low rate of complications. Despite these advantages and the rarity of a postoperative complication, particularly in oral and maxillofacial surgery procedures, a prolonged operation might exhibit some complications related with rhabdomyolysis. We experienced the rare event of rhabdomyolysis after oral cancer surgery. CASE PRESENTATION: In this article, we report the case of a patient who developed rhabdomyolysis after undergoing free fibular flap surgery. CONCLUSIONS: Despite the advantages of the free fibular flap operation, clinicians must be aware of the risk of complications because there are multiple factors that could result in rhabdomyolysis, such as duration of operation, position of the subject, and pre-existing conditions of diabetes and hypertension. Once the diagnosis of rhabdomyolysis is confirmed, a prompt treatment plan should be made and applied as soon as possible. This will increase the chance of a full recovery for the patient who is exhibiting symptoms of rhabdomyolysis.
Diagnosis ; Humans ; Hypertension ; Mandibular Reconstruction ; Mouth Neoplasms ; Postoperative Complications ; Preexisting Condition Coverage ; Renal Insufficiency ; Rhabdomyolysis ; Surgery, Oral ; Transplants

Classic polyarteritis nodosa (PAN) involves small-to-medium-sized muscular arteries in multiple organ systems. It presents in combination with skin diseases, myalgia, hypertension, abdominal pain, or neuropathy. Although PAN involves the muscles, kidneys, nerves, and gastrointestinal tract, lung involvement presenting as an interstitial pulmonary fibrosis has rarely been reported. A 71-year-old man presented to our clinic complaining of weakness in his lower legs and painful subcutaneous nodules that began to develop a fortnight before he visited the clinic. He had been diagnosed with mononeuritis multiplex, interstitial pulmonary fibrosis, and a cerebral infarction in 2006. All of the preexisting diseases had become aggravated when his lower leg pain began. Laboratory tests for cytoplasmic antineutrophil cytoplasmic antibodies (ANCA), perinuclear-ANCA, and other autoimmune markers were within the normal limits. A biopsy showed mononuclear infiltrations with fibrinoid necrosis involving the medium-sized arteries. Computed tomographic scanning of the chest revealed an increase in parenchymal ground-glass opacity. The histological findings, laboratory tests, and the clinical history were consistent with PAN that was associated with interstitial pulmonary fibrosis. We report this rare case of PAN associated with interstitial pulmonary fibrosis.
Abdominal Pain ; Aged ; Antibodies, Antineutrophil Cytoplasmic ; Arteries ; Biopsy ; Cerebral Infarction ; Cytoplasm ; Gastrointestinal Tract ; Humans ; Hypertension ; Kidney ; Leg ; Lung ; Mononeuropathies ; Muscles ; Myalgia ; Necrosis ; Polyarteritis Nodosa* ; Preexisting Condition Coverage ; Pulmonary Fibrosis* ; Skin Diseases ; Thorax

Recreational diving is an exciting and adventurous sport, but is also potentially hazardous. Despite its inherent hazards, an increasing number of people enjoy SCUBA (self-contained underwater breathing apparatus) diving; the number of diving-related accidents is therefore also likely to increase. Divers might face physical or psychological stresses from the unfamiliar or hostile underwater environment, which can lead to fatal accidents. To investigate deaths related to SCUBA diving, a forensic pathologist should understand the types and mechanisms of injuries and illnesses unique to SCUBA diving. Postmortem examination of diving fatalities is therefore a formidable task for most forensic pathologists because cases are sparse and the process requires an understanding of diving physiology, diving equipment, and the underwater environment. The primary aim of autopsies in SCUBA diving fatalities is to detect evidence of pulmonary barotrauma, intravascular gas, or pre-existing illnesses. Standard autopsy protocol for SCUBA diving-related deaths should include methods to detect intravascular gas and gas accumulation in the tissue or body cavity through plain radiographs or Computerized Tomography (CT) scans. Analysis of the gas components is also helpful for determining the origin of the gas. Here, the author proposes a practical method for performing an autopsy on a person who died while SCUBA diving.
Autopsy* ; Barotrauma ; Diving* ; Humans ; Methods ; Physiology ; Preexisting Condition Coverage ; Respiration ; Sports ; Stress, Psychological

Charcot spinal arthropathy is a rare, progressive type of vertebral joint degeneration that occurs in the setting of any preexisting condition characterized by decreased afferent innervation to the extent that normal protective joint sensation in the vertebral column is impaired. The authors report on a case of Charcot arthropathy of the lower lumbar spine mimicking a spinal tumor following cervical cord injury.
Joints ; Preexisting Condition Coverage ; Sacrum ; Sensation ; Spinal Cord Injuries* ; Spinal Cord* ; Spine*

BACKGROUND: The importance of comprehensive geriatric assessment(CGA) for the frail elderly can not be overemphasized. Recently, with increasing elderly population and patients, there are increasing need for simplified CGA tool for evaluation of general health and functional status during the limited time in outpatient clinic. This study was conducted to estimate the effectiveness of the 'Short-form Comprehensive Geriatric Assessment' for detecting hidden medical problems beside preexisting diseases. METHODS: 78 outpatients aged 65 or more who revisited to outpatient clinic in a Social Welfare Center answered questionnaires and were examined of the 'Short-form Comprehensive Geriatric Assessment. This screening tool included vision, hearing, arm and leg function, urinary incontinence, nutrition, mental status, depression, ADL, IADL and social support. These results were compared with patients' previous medical records. RESULTS: Among the total 78 subjects, visual difficulty was detected in 63(80.8%)(Rt. eye)/67(85.9%)(Lt. eye). Right hearing difficulty was shown in 8(10.3%) subjects and left hearing difficulty was shown in 4(5.1 %) subjects. There were 2(2.6%) upper extremities dysfunctions and 25(32.1%) lower extremities dysfunctions. 24(30.8%) subjects had depression. The geriatric depression and age and number of disease showed positive correlations. These problems found by assessment tool were not identified on previous medical records. CONCLUSION: Using the 'Short-form Comprehensive Geriatric Assessmen', we could find the new medical problems besides preexisting disease. These findings stress effectiveness and importance of routine application of screening 'Short-form Comprehensive Geriatric Assessment' on daily outpatient clinical practice to improve quality of medical care for the elderly patients.
Activities of Daily Living ; Aged* ; Ambulatory Care Facilities ; Arm ; Depression ; Frail Elderly ; Geriatric Assessment ; Hearing ; Humans ; Leg ; Lower Extremity ; Mass Screening ; Medical Records ; Outpatients* ; Preexisting Condition Coverage ; Surveys and Questionnaires ; Social Welfare ; Upper Extremity ; Urinary Incontinence

In-flight medical emergencies are likely to increase as air travel continues to grow and as more elderly passengers with preexisting diseases fly long distances. Unscheduled landing for a medical reason is a serious situation for commercial air carriers. The common causes of unscheduled landings are cardiac and neurological problems. Physician passengers might be called upon to help ill or injured passengers at any time. Physicians play an important role in in-flight medical emergencies. Most airlines have installed the emergency medical kits and automated external defibrillator (AED), ambu bag, intubation set, etc. The management of in-flight medical emergences requires the assistance from welltrained crew, adequate medical equipments and medications, availability of physician passengers, and ground medical communications. This article summarizes the in-flight resources available for physician passengers when called upon for medical emergencies while on board.
Aged ; Defibrillators ; Diptera ; Emergencies* ; Humans ; Intubation ; Preexisting Condition Coverage

BACKGROUND: Kaposi's varicelliform eruption (KVE) is a viral infection with disseminated skin involvement, superimposed on a pre-existing dermatosis. A monomorphic eruption of dome-shaped blisters and pustules in the eczematous lesions, along with severe systemic illness, leads to clinical diagnosis. However, there is no data on the clinicopathologic study of KVE in Koreans. OBJECTIVE: The purpose of this study was to identify clinicopathologic features of KVE. METHOD: We reviewed the medical records and biopsy slides of 21 patients who had previously been diagnosed as having KVE at the National Medical Center between 1990 and 2004. RESULTS: The study results are summarized as follows: 1. The most common pre-existing disease was atopic dermatitis, followed by seborrheic dermatitis and Darier's disease. 2.Men were more commonly affected than women, and the mean age at diagnosis of eczema herpeticum was 30.8 years. 3.Face involvement was seen in 4 patients, and systemic involvement in 6 patients. 4. Histopathologically, common findings included ballooning degeneration (76.1%), reticular degeneration (47.6%), multinucleated giant cell (57.1%), and inclusion body (28.6%), and leukocytoclastic vasculitis (47.6%). CONCLUSION: KVE is a secondary viral infection that can affect patients who suffer from a primary dermatologic condition. In many instances, the history and clinical findings may be sufficient for diagnosis of KVE. However, the clinicopathologic features can help also diagnose KVE and pre-existing dermatosis.
Biopsy ; Blister ; Darier Disease ; Dermatitis, Atopic ; Dermatitis, Seborrheic ; Diagnosis ; Female ; Giant Cells ; Humans ; Inclusion Bodies ; Kaposi Varicelliform Eruption* ; Medical Records ; Preexisting Condition Coverage ; Skin ; Skin Diseases ; Vasculitis

BACKGROUND: Nontuberculous mycobacterial (NTM) infections are increasingly being recognized as a cause of chronic pulmonary disease. This study describes the prevalence of NTM species from clinical specimens and the clinical characteristics of NTM pulmonary disease. MATERIAL AND METHODS: The NTM isolated from March 2003 to December 2003 at the Kosin Medical Center were identified using an oligonucleotide chip containing the internal transcribed space (ITS) sequence. The medical records of the patients with the NTM isolates, who fulfilled the 1997 ATS diagnostic criteria for NTM pulmonary disease, were analyzed, retrospectively. RESULTS: Twenty four species (24.2%) of NTM were isolated from 99 cultured AFB specimens. M. avium complex (MAC) (13 isolates), M. szulgai (3), M. kansasii (2), M. malmoense (2), M. abscessus (1), M. chelonae (1), M. scrofulaceum (1), and unclassified (1). Of the 23 patients with isolated NTM, 11 patients were found to be compatible with a NTM pulmonary infection according to the ATS criteria; MAC was found in 6 cases (54.5%), M. szulgai in 2 cases (18.2%), and M. abscessus, M. szulgai, M. kansasii and M. malmoense in 1 case each (9.1%). Ten patients (91%) were male and the median age at diagnosis was 61 years. In the pre-existing diseases, malignant disease was found in 6 cases including 5 patients with lung cancer, and history of old pulmonary tuberculosis was identified in 4 cases. The radiological patterns showed lung destruction lung in 3 cases, a cavitary mass in 3 cases, a nodular pattern in 2 cases, and reticulonodular, consolidation and a bronchiectasis pattern were in 1 case each. CONCLUSION: Various types of NTM pulmonary diseases were`found in a tertiary hospital at Busan, Korea. The NTM pulmonary diseases were caused by MAC, M. szugai, M. kansasii, M. malmoense, M. abscessus, M. chelonae, and M. scrofulaceum in the order of frequency.
Bronchiectasis ; Busan ; Diagnosis ; DNA* ; Humans ; Korea ; Lung ; Lung Diseases* ; Lung Neoplasms ; Male ; Medical Records ; Nontuberculous Mycobacteria* ; Preexisting Condition Coverage ; Prevalence ; Retrospective Studies ; Tertiary Care Centers ; Tuberculosis, Pulmonary

BACKGROUND: 137 anesthesia-related adverse outcome cases were registered by civil courts, criminal courts, police departments, and district health care centers with the Korean Society of Anesthesiologists between November 1994 and October 2002. These cases were analyzed according to type of event causing the adverse outcomes (death, brain damage, disability). METHODS: 137 adverse outcome cases were classified into obstetric and gynecologic, orthopedic, surgical, and other cases. Also, based upon a review of medical records, anesthesia records, autopsy findings, investigation records and the decisions of civil courts and criminal courts, the cases were classified into four categories; e.g. problems due to anesthetic management, preexisting diseases or preoperative patient conditions, anesthetic agents or anesthetic techniques, and operating procedures. RESULTS: 1) 45 cases were associated with problems due to anesthetic management (ventilatory failure, drug overdose, etc). 2) 39 cases were associated with problem due to preexisting diseases (cardiovascular disease, cerebrovascular disease, diabetes mellitus, etc) or preoperative patient conditions. 3) 27 cases were associated with problems due to anesthetic agents or techniques (nerve injury, malignant hyperthermia, etc). 4) 26 cases were associated with problems due to operating procedures (massive bleeding, embolism, etc). CONCLUSIONS: The most common type of damaging event causing an anesthesia-related adverse outcome was connected with anesthetic management. Therefore, it is mandatory to prepare adequate anesthetic monitoring equipment and to monitor patients thoroughly, to ensure safer perioperative anesthetic management.
Anesthesia ; Anesthetics ; Autopsy ; Brain ; Criminals ; Delivery of Health Care ; Diabetes Mellitus ; Drug Overdose ; Embolism ; Hemorrhage ; Humans ; Korea* ; Malignant Hyperthermia ; Medical Records ; Orthopedics ; Police ; Preexisting Condition Coverage