BACKGROUND: Although impaired endothelial function is well known in patients with diabetes mellitus, the precise mechanism and the factors that contribute to this dysfunction remain to be clarified. We examined the effect of acute hyperglycemia on patients with impaired glucose metabolism in vivo by plethysmography. METHODS: Seven patients with diabetes mellitus or impaired glucose metabolism were studied. In each patient, endothelial function was examined in the fasting state and at two levels of hyperglycemia, which were achieved by the infusion of glucose, insulin, and somatostatin. Forearm blood flow was measured while acetylcholine was infused in increasing concentrations(7.5, 15, and 30 microgram/min) through the brachial artery. RESULTS: Glucose concentrations increased accordingly at each stage, from 135.3+/-18.4 mg/dl at stage 1(the fasting state), to 239.0+/-15.2 mg/dl at stage 2(the first level of hyperglycemia), and to 378.3+/-25.3 at stage 3 (the second level of hyperglycemia) [p<0.01]. Maximal acetylcholine-dependent vasodilation achieved by infusion of acetylcholine at 30 microgram/min was significantly aftenuated during stages 2 and 3 compared with stage 1(p<0.05 by AVOVA; forearm blood flow ratio was 2.87+/-0.18 and 2.56+/-0.14 versus 3.58+/-0.21, respectively). This was also evident during the infusion of 15 microgram/min and 7.5 microgram/min of acetylcholine. CONCLUSIONS: Endothelium-dependent vasodilation is significantly aftenuated by acute hyperglycemia in patients with diabetes mellitus or impaired glucose metabolism. Our findings suggest that elevated glucose may contribute to the endothelial dysfunction observed in patients with diabetes mellitus or impaired glucose metabolism.
Acetylcholine ; Brachial Artery ; Diabetes Mellitus* ; Endothelium ; Fasting ; Forearm ; Glucose* ; Humans ; Hyperglycemia* ; Insulin ; Metabolism* ; Plethysmography ; Somatostatin ; Vasodilation*

We report a case of multiple agminated Spitz nevi in a 16-year-old boy who presented with multiple nodules on the right side of his face. His past history revealed that there had been erythematous and brown colored papules on the same site at the age of four. At that time one lesion was excised and histopathological findings showed fairly well circumscribed spindle and epithelioid cell nests consistent with a Spitz nevus. Twelve years later, he presented with multiple agminated brown to black colored nodules on the face. Microscopic evaluation revealed nevus cells diffusely distributed throughout the dermis showing no or little junctional activity. In addition, these cells were embedded in a strikingly desmoplastic stroma which consisted of acellular collagen fiber. Immunohistochemical staining for S-100 protein was positive. To our knowledge this is the first report of multiple agminated Spitz nevi in Korea.
Adolescent ; Collagen ; Dermis ; Epithelioid Cells ; Humans ; Korea ; Male ; Nevus* ; Nevus, Epithelioid and Spindle Cell ; S100 Proteins

The major reason for the chronic graft loss is chronic rejection. The only predictive factor for chronic rejection is a prior acute rejection episode resulting in a poorer long-term outcome. Also the number of acute rejection episodes is a strong predictor of long-term allograft failure. This study evaluated the impact of a first acute rejection episode and the severity of the rejection and the number of acute rejection episodes on allograft survival. Total of 136 renal transplant were performed between August 1987 to January 1996 at Wonkwang university hospital, and we studied 108 renal transplants that were followed for a minimum of 1.5 years. Acute allograft rejection was mainly diagnosed by clinical evaluation and laboratory data. Transplant patients were divided into three groups according to the time to the first acute rejection; no rejection (group I, n=44); acute rejection during the first 6 months (group II, n=42), acute rejection after 6 months (group III, n=22) and divided into four groups according to the number of acute rejection episodes; no rejection (Group A, n=44), one time (Group B, n=24), two times (Group C, n=23), and more than three times (Group D, n=17). Five-year allograft survival rate for group I-III was 96.4%, 82.7%, 58.5%, respectively (p<0.05 for each comparison to group I). Later acute rejection episodes were associated with worse response to rejection therapy and Group III had higher serum creatinine concentration after rejection therapy than Group II (2.46 1.13 mg/dl vs 1.19 0.7 mg/dl, p<0.05). Five-year allograft survival rate for group A-D was 93.4%, 73.2%, 57.4%, 74.5%, respectively, Group A shows higher graft survival rate, but there was not significant difference in long-term allograft survival among Group B-D. We conclude that late occurrence of a first acute rejection portends a worse prognosis for long-term allograft survival and decreases response to rejection therapy and results in poor graft function. Prevention of later rejection may require a broader focus, with additional efforts directed at improving patient compliance and renal allograft monitoring.
Allografts ; Creatinine ; Graft Survival* ; Humans ; Kidney Transplantation ; Patient Compliance ; Prognosis ; Survival Rate ; Transplants*

We had a case of respiratory difficulty following tracheal extubation due to bilateral vocal cord paralysis. The patient was a 66-year-old woman undergoing craniotomy for cerebellopontine angle meningioma. Anesthesia was uneventful. Spontaneous respiration resumed after reversal of neuromuscular blockade. Following extubation she showed inspiratory stridor, tachypnea, and chest retraction. Reintubation was done and then tracheostomy was performed. Every factor contributing vocal cord paralysis such as pressure on the nerve by an overexpanded endotracheal tube cuff, unique posture of the neck during the operation, and female gender, long operating time(about 11 hours) were seemed to be possible causes and we considered the interaction of these combinations responsible for the bilateral vocal cord paralysis. Eight weeks later, the patient's vocal cord function had returned to normal.
Aged ; Airway Extubation* ; Anesthesia ; Cerebellopontine Angle ; Craniotomy ; Female ; Humans ; Meningioma ; Neck ; Neuromuscular Blockade ; Posture ; Respiration ; Respiratory Sounds ; Tachypnea ; Thorax ; Tracheostomy ; Vocal Cord Paralysis* ; Vocal Cords*

No abstract available.
Female ; Ovarian Cysts* ; Ultrasonography*

BACKGROUND: Mycoses of deep tissues requir e prompt recognition and early institution of treatment. Sometimes, it is quite difficult to find fungal elements in tissue section with special stains and to culture on Sabouraud media. Previously it has been shown that Fungi-Fluor(R) solution (calcofluor white) bind t fungi present in frozen and paraffin tissue sections. Fungi present in such specimens stained with Fungi-Fluor(R) solution have a distinct green-blue fluorescence when examined by fluorescent microscopy. OBJECTIVE: The purpose of this study is to evaluate the diagnostic value of the Fungi-Fluor(R) solution for detecting fungal element in the tissue. METHODS: Fungi-Fluor(R) staining was done with a paraffin-embedded tissue section of several superficial and cutaneous deep mycoses. Then we viewed this through a fluorescent microscope with excitation of 250-400 nm and compared these staining results to PAS staining. RESULTS: The results of this study are summarized as follows : 1. In the several superficial mycoses such as tinea corporis & tinea capitis, Fungi-Fluor(R) staining method revealed more fungal elements with high sensitivity compared to PAS stain. 2. In the several cutaneous deep mycoses such as sporotrichosis, Fungi-Fluor(R) staining method revealed more fungal elements than PAS stain, and revealed some fungal elements which were not detected by PAS stain. CONCLUSION: The Fungi-fluor staining solution is a rapid, inexpensive, highly sensitive method to detect fungal element in the tissue.
Coloring Agents ; Fluorescence ; Fungi ; Microscopy ; Mycoses* ; Paraffin ; Sporotrichosis ; Tinea ; Tinea Capitis

Informed consent is the procedure that respects the autonomy of patients ; doctors protect patients' choices and rights through informed consent. Competence and voluntariness are prerequisite for the informed consent. In recent years, the necessity of informed consent from the Psychiatric department has been raised. Regarding informed consent from the Psychiatric department, there is a need to consider from two perspectives : respect for the patient's decision-making ability and the psychiatrist's legal self-protection. In competence and voluntariness, psychiatric patients were excluded due to lack of decision-making ability and willingness. However, not all psychiatric patients were able to perform the given task. Therefore, informed consent is needed in the point of view regarding the decision-making ability of psychiatric patients. Psychotropic medications, particularly antipsychotics, can cause several side effects, including extrapyramidal syndrome and metabolic syndrome. Therefore, preannouncement of these patients for these side effects is needed. However, when the informed consent is only applied to psychiatric hospitals, it may increase prejudices and misconceptions about psychiatric medications and treatment. Therefore, the informed consent should first be considered carefully and thoughtfully.
Antipsychotic Agents ; Hospitals, Psychiatric ; Human Rights ; Humans ; Informed Consent* ; Mental Competency ; Prejudice

BACKGROUND: Malassezia yeasts are normal skin flora of humans. But skin colonization appear to be controversial during neonate. OBJECTIVE: We prospectively studied the distribution of Malassezia yeasts on clinically normal skin of neonates and infants for providing the basic data for proving the relationship of Malassezia yeasts and pathogenesis of the diseases of neonates and infants. METHODS: A total of 200 subjects were studied using the direct smear test with 20% Parker ink/KOH solution. The numbers of the Malassezia yeasts per high power field were counted according to a bacterial index of lepra bacilli in patients of leprosy. In order to identify risk factors for the distribution of Malassezia yeasts, we compared sex, mode of delivery, gestational age, birthweight during the first week of life by statistical method of the logistic regression. RESULTS: Of the 200 neonates and infants under 12 weeks, 121 (60.5%) revealed Malassezia yeasts in at least a part of five examined sites. The prevalence of Malassezia yeasts was increased according to the age. No association was found between the incidence of Malassezia yeasts and sex, mode of delivery, gestational age, birth weight. CONCLUSION: We conclude that Malassezia yeasts colonize on the skin of neonates and infants.
Birth Weight ; Colon ; Gestational Age ; Humans ; Incidence ; Infant* ; Infant, Newborn* ; Leprosy ; Logistic Models ; Malassezia* ; Prevalence ; Prospective Studies ; Risk Factors ; Skin* ; Yeasts*

BACKGROUND: Onychomycosis is common nail problem and requires administration of antifungal agent for long period. But several cutaneous diseases can produce similar nail changes and an inexpensive, quick and sensitive test is essential for screening nail specimens. Recently, there have been several reports of new method for diagnosing onychomycosis and fungi-Fluor(R)stain, which had been used to detect fungal elements in the tissue, was not used for diagnosing onychomycosis. OBJECTIVE: This study was undertaken to evaluate the usefulness of the new method using Fungi-Fluor(R)solution for the diagnosis of onychomycosis, and compare with other methods. METHODS: During the study period, nail samples obtained from 72 patients with onychomycosis were tested for Fungi-Fluor(R)solution and the results of that were compared with those of KOH smear, fungal culture and KONCPA test. RESULTS: The results of this study are summarized as follows: 1. The positive rates of conventional KOH nail scraping preparation, fungal culture, KONCPA and Fungi-Fluor(R)staining were 47.2%,40.3%, 77.8%, and 86.1%, respectively. 2. Fungi-Fluor(R)staining proved to be less time-consuming than KONCPA test. 3. Compared to KONCPA and Fungi-Fluor(R)staining, KOH preparation and fungal culture showed high false positive rate. 4. Though both KONCPA and Fungi-Fluor(R)staining showed higher positive rate in toenail than fingernail, there were no statistic significance. CONCLUSION: The Fungi-Fluor(R)solution staining is rapid, inexpensive, and highly sensitive method to detect fungal elements in the nails.
Diagnosis ; Humans ; Mass Screening ; Nails ; Onychomycosis*

No abstract available.
Foramen Magnum* ; Vertebral Artery*