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*

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*

BACKGROUND: Although there have been many studies on psoriasis, only a few studies have been conducted on pilosebaceous changes and even those results are controversial. While a few studies have been conducted on the morphological changes of the pilosebaceous unit in scalp psoriasis, comparative studies on the morphometric changes of pilosebaceous structures with a normal control group have not been conducted. OBJECTIVE: The purpose of this study is to elucidate the morphological change of the pilosebaecous unit in scalp psoriasis. METHODS: We conducted a comparative study an the morphometric changes of the pilosebaceous structure in 10 cases of scalp psoriasis with a normal control group. Results : The results of this study are summarized as follows : 1. Total hair counts, telogen hair counts, telogen hair counts, and the sizes of hairs and follicles in the lesional scalp showed no statistically significant increase than in the normal control. 2. The intrafollicular hyperkeratosis in infundibulum and sebaceous atrophy were more proininet in the lesional area than in the normal control area. These findings were also significantly prominent in the uninvolved normal-appearing area than in the normal control area. 3. Perifollicular inflammation, squamous metaplasia of the sebaceous gland and telangiectasia in the lesional and uninvolved areas were prominent, and these findings were not found in the normal control areas. Conclusion : The sebaceous atrophy and squamous metaplasia are very important findings of morphologic changes in psoriasis, and this paradoxical change may be an important clue to clarify the pathogenesis of psoriasis.
Atrophy ; Hair ; Inflammation ; Metaplasia ; Psoriasis ; Scalp* ; Sebaceous Glands ; Telangiectasis

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*

OBJECTIVES: The aim of this study was to compare endogenous plasma lithium concentrations among schizophrenic patients classified by DSM-IV subtype and control groups and to investigate the correlation of endogenous plasma lithium concentration and psychotic symptoms in schizophrenia. METHODS: Schizophrenic patients were selected among psychiatric inpatients without lithium medication and then classified by DSM-IV schizophrenia subtype. Schizophrenic patient groups were composed of 15 disorganized type, 15 paranoid type and 15 undifferentiated type schizophrenic patients. The control group was composed of 15 healthy subjects without any psychiatric disease. Endogenous plasma lithium concentrations were estimated by inductively coupled plasma atomic emission spectrometer. The psychotic symptoms in schizophrenic patients were classified as positive symptoms, negative symptoms and disorganized symptoms according to andreasen classification1 about SANS and SAPS items. Endogenous plasma lithium concentration among three subtypes of schizophrenia and control group was compared, and correlation between endogenous plasma lithium concentrations and psychotic symptoms was examined. RESULTS: 1) Schizoprenic patients showed higher endogenous plasma lithium concentration than control groups (p=0.033). Endogenous plasma lithium concentrations were significantly different among three subtypes of schizophrenia (p=0.001). Compared with the control group, disorganized type showed higher endogenous plasma lithium concentration, but paranoid type and undifferentiated type were not significantly different. 2) Disorganized symptoms correlated with endogenous plasma lithium concentration (r=0.416, p=0.004), but negative symptom and positive symptom did not significantly correlate with endogenous plasma lithium concentration (r=0.202, p=0.184. r=-0.216, p=0.155). CONCLUSION: These results suggested that schizophrenic patients with disorganized symptom show the differences in utilization or distribution of endogenous lithium.
Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Inpatients ; Lithium* ; Plasma* ; Schizophrenia*

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: The clinical types of sporotrichosis are generally classified into four groups: lymphocutaneous, fixed cutaneous, and cutaneous disseminated, and hematogenous. Of these, the lymphocutaneous variety is the most frequently encountered pattern, constituting 80% of sporotrichosis patients and the fixed cutaneous sporotrichosis is the next Potassium iodide (KI) was the most commonly used drug for the treatment of sporotrichosis. Many studies about these clinical findings of sporotrichosis have been reported, but comparative study on the changes in clinical findings has not been reported. OBJECTIVE: The purpose of this study is to clarify the changes of the clinical findings in sporotrichosis in Korea. METHODS: A total of 58 patients with sporotrichosis who had visited the Department of Dermatology, Pusan National University were divided into 2 groups according to the period and then the clinical findings of sporotrichosis were compared. RESULTS: The results of study are summarized as follows: 1. During this period, there were 58 cases of sporot.ichosis. In the past period (1967~1979) there were 35 cases of sporot.ichosis, and there were 23 cases in the recent period (1980 ~1997). 2. In the past period, most cases (71.4%) were lymphocutaneous type, however in the recent period, most cases (69.2%) were fixed cutaneous type. 3. The most commonly affected site was right upper extremity in the past period, but face & right upper extremity were the most commonly affected sites in the recent period. 4. In the past period, 2nd and 3rd decades were prevalent age group, but 5th to 7th decades were prevalent age group in the recent period. 5. In the treatment of sporotrichosis, potassium iodide (KI) was the choice of treatment in the past period, however itraconazole is gradually used in the recent period. CONCLUSION: According to this study, many changes in clinical findings of sporotrichosis were noted, especially in the clinical type. We found that conical type of sporotrichosis changed from lymphocutaneous type to the fixed cutaneous type with time. And we suggest that further observation would be necessary to define the meaning of these changes.
Busan ; Dermatology ; Humans ; Itraconazole ; Korea ; Potassium Iodide ; Sporotrichosis* ; Upper Extremity