BACKGROUND: Melanin pigment plays a major role in the expression of normal human skin color as well as in the photoprotection against ultraviolet damage. Melanin produced in melanocytes is transferred via dendrites to surrounding keratinocytes, and this anatomical relationship is termed as epidermal melanin unit. The rates of pigment synthesis and transfer by melanocytes appear to be influenced by ultraviolet light, though the precise factors regulating human epidermal pigmentation remain unelucidated. It has been reported that keratinocytes in vitro release factors that could modulate melanocyte behavior. Ultraviolet irradiation was also been known to enhance the release of various kinds of cytokine from keratinocytes in vivo and in vitro. OBJECTIVE: We postulated that keratinocytes rather than melanocytes could play a primary role in UVB-induced pigmentation, and keratinocytes, when irradiated with UVB, release substances that could modulate or stimulate melanin synthesis from melanocytes. The fact that keratinocytes are located efficiently for direct sunlight irradiation at the top of melanocytes, that they release various biological factors known to simulate melanin synthesis from melanocytes and that they constitute the majority of epidermal cells supported this possibility. To investigate this possibility, we evaluated the effect of supernatant from UVB-irradiated cultured keratinocytes on the growth, melanin content, and tyrosinase activity of human melanocytes. METHODS: Human cultured keratinocytes were irradiated with UVB(30, 60, or 120mj/cm2)once, and after 24 hours, supernatant of the keratinocytes were collected and added to a growth medium of melanocytes for 5 days in concentration of 15, 25 or 35%, We observed numeric and morphologic changes as well as melanin content and tyrosinase activity in situ of cultured human melanocytes. RESULTS: 1. When cultured melanocytes were incubated with supernatant of non-irradiated keratinocytes, the number of melanocytes, amount of melanin and tyrosinase activity increased in groups added with 25% or35% concentration of supernatant. 2. The number of melanocytes incubated with 15% or 25% concentrations of supernatant from cultured keratinocytes irradiated with UVB increased in both 30 and 60mj/cm2 of UVB irradiated groups and decreased in 120mJ/cm2of UVB irradiated groups. 3. The melanin content of melanocytes incubated with 15% concentration of supernatant from UVB-irradiated cultured keratinocytes increased in 120mJ/cm2 of UVG irradiated groups. 4. The tyrosinase activity of melanocytes incubated with 15% concentration of supernatant from UVB-irradiated cultured keratinocytes increased in 120mJ/cm2 of UVB irradiated groups and the tyrosinase activity of melanocytes incubated with 25% concentration of supernatant from UVB-irradiated cultured keratinocytes increased with 35% supernatant concentration of supernatant from UVB-irradiated keratinocytes, the tyrosinase activity increased in 30mJ/cm2of UVB irradiated groups. CONCLUSION: The above results suggest that UVB-irradiated kerationcytes release soluble or photoactivated factors which could modulate the growth and melanization of melanocytes, and that keratinocytes play an important or primary role in the regulation of UVB induced pigmentation.
Biological Factors ; Dendrites ; Humans* ; Keratinocytes* ; Melanins* ; Melanocytes* ; Monophenol Monooxygenase* ; Pigmentation ; Skin ; Sunlight ; Ultraviolet Rays

PURPOSE: The purpose of this study is to evaluate the clinical effect of antithrombin lll concentrates in disseminated intravascular coagulation (DIC) of neonates. METHODS: We reviewed the clinical records of 11 newborn patients who had been admitted and diagnosed as DIC at the neonatal intensive care unit of Sanggye Paik Hospital from November, 1995 to September, 1996. RESULTS: There were 6 males and 5 females. In 9 cases (81.8%), gestational age was less than 37 weeks and birth weight was less than 2,500g. Sepsis was the most common underlying disease in 9 cases (81.8%), followed by respiratory distress syndrome, necrotizing enterocolitis, and fulminant hepatitis. The etiologic organisms of sepsis, were gram negative organisms, fungus, and gram positive organisms in decreasing order. There were signs of gastrointestinal tract hemorrhage, pulmonary hemorrhage, and intracranial hemorrhage as a result of DIC. In the clinical outcome of DIC patients, 6 out of 11 patients survived (54.5%). CONCLUSION: Administration of antithrombin lll concentrates in DIC of neonates produces improvement of clinical course and survival.
Birth Weight ; Dacarbazine ; Disseminated Intravascular Coagulation* ; Enterocolitis, Necrotizing ; Female ; Fungi ; Gastrointestinal Tract ; Gestational Age ; Hemorrhage ; Hepatitis ; Humans ; Infant, Newborn* ; Intensive Care, Neonatal ; Intracranial Hemorrhages ; Male ; Sepsis

No abstract available.
Sarcoma*

Solitary plasmacytoma, in contrast to the disseminated neoplastic proliferation of plasma cells with marked infiltration of multiple organ system in multiple myeloma, is plasma cell neoplasm of a single focus occuring either in bone or soft tissue. The association between a solitary plasmacytoma and peripheral neuropathy is rare, and it is a progressive sensorimotorneuropathy, with a raised CSF protein and mixed demyelination and axonal loss in nerve biopsy. Localized radiotherapy indeed proves to be effective of not only arresting the progress of the neuropathy but also allowing a degree of recovery. We experienced a 55-year-old male with a solitary plasmacytoma and peripheral neuropathy confirmed by the radiologic studies, immunohistochemical stain of nasopharyngeal mucosa biopsy and sural nerve biopsy, which has loss of myelinated fiber and axonal degeneration. Until now, the reported cases are very rare in Korea, so we presented a case of solitary plasmacytoma associated with peripheral neuropathy.
Axons ; Biopsy ; Demyelinating Diseases ; Humans ; Korea ; Male ; Middle Aged ; Mucous Membrane ; Multiple Myeloma ; Myelin Sheath ; Neoplasms, Plasma Cell ; Peripheral Nervous System Diseases* ; Plasma Cells ; Plasmacytoma* ; Radiotherapy ; Sural Nerve

OBJECTIVE: Spasticity has been reported to be one of the common complications in patients with spinal cord injury. The purposes of this study were to investigate the proper dosage, the therapeutic and undesirable effects of clonidine with combined used of baclofen for the management of spasticity. METHOD: A prospective study was performed for 17 patients with spinal cord injury who did not improve spasticity with 80 mg baclofen administration. The degree of spasticity was assessed in the more-affected knee by modified Ashworth scale, pendulum test at pre-treatment and at 7 days after receiving clonidine. We also investigated the complications and subjective satisfaction. RESULTS: Seven of 13 patients with spinal cord injury showed subjective improvement in spasticity. We found significant improvement in the relaxation index by pendulum test after administration of more than 0.3 mg of clonidine. There was no significant difference between the subgroups depending on the extent of spinal cord injury. We didn't find any serious complication in adjuvant clonidine therapy. CONCLUSION: Adjuvant clonidine therapy can be effective in spasticity of spinal cord injured patients without serious complication.
Baclofen ; Clonidine* ; Humans ; Knee ; Muscle Spasticity* ; Prospective Studies ; Relaxation ; Spinal Cord Injuries* ; Spinal Cord*

BACKGROUND: Community-acquired pneumonia (CAP) is more frequent in the elderly and results in higher morbidity and mortality. Korea is undergoing extraordinary demographic change. Elderly patients constitute an even-increasing proportion of the population but there have been few studies on the epidemiological investigation of the CAP in the elderly. The purpose of this study was to characterize the background, etiology, clinical course and outcome of CAP in elderly compared with younger patients. METHODS: During the study period (from 1st January to 31th December 1997), 214 patients with CAP were reviewed with regard to epidemiological, clinical, laboratory and microbiological data. 119 elderly patients (> or =65 years-old of age) were compared with 95 younger patients (<65 years-old of age). The both groups were compared with each others in terms of variables related to CAP. RESULTS: Comparison of epidemiological data between older and younger patients revealed a high prevalence of alcoholics (40% vs 56%), current smoker (33% vs 56%), malignancy (8% vs 24%) in the elderly. In terms of complication and clinical manifestation, shock (1% vs 6%), intubation (6% vs 20%), mechanical ventilation apply (5% vs 18%), respiratory failure (2% vs 12%), dyspnea (26% vs 56%), altered consciousness (0% vs 13%), extrapulmonary symptom (11% vs 18%) and bilateral infiltration (8% vs 20%) showed higher incidence in the elderly than in the younger patients. Causative organisms are identified in 47% (56/119) of elderly patients: those identified most frequently were S. pneumoniae (25%), K. pneumoniae (20%), S. aureus (16%), other Gram-negative bacilli (13%) and H. influenzae (11%). The overall mortality were significantly higher in the elderly patients (24%) than younger patients (5%). Two independent risk factors, those were related to the mortality of the elderly:higher APACHE II score (RR:3.43, 95% CI=1.43~7.21) and requirement of endotracheal tube (RR:4.73; 95% CI=1.72~16.5). CONCLUSION: CAP in the elderly shows more serious clinical and abnormal laboratory features than younger patients. In elderly, S. pneumoniae was the most common causative organism for CAP but other agents, particularly K. pneumoniae was isolated frequently. The severity of illness at initial presentation such as high APACHE II score and requirement of endotracheal tube were the major variables affecting the outcome.
Aged* ; Alcoholics ; APACHE ; Consciousness ; Dyspnea ; Humans ; Incidence ; Influenza, Human ; Intubation ; Korea ; Mortality ; Pneumonia* ; Prevalence ; Respiration, Artificial ; Respiratory Insufficiency ; Risk Factors ; Shock

Clostridium septicum is a toxin producing anaerobic, motile, spore-forming, spindle shaped Gram positive rod that may cause devastating systemic illness in patients with neutropenia and underlying hematologic or gastrointestinal malignancy. Clostridium septicum sepsis usually have fulminating clinical courses, and unless the appropriate antibiotics are administered soon after admission, the outcome is fatal. We experienced a case of sepsis due to Clostridium septicum, in a 65-year-old woman with peripheral T-cell lymphoma and diabetes mellitus. She was admitted due to abdominal pain, fever, chilling, nausea, vomiting and watery diarrhea, followed by rapidly progressive course. This patient was not improved by intensive care and continuous antibiotic therapy, expired at the 4th hospital day. Clostridium septicum grew from premortem blood cultures.
Abdominal Pain ; Aged ; Anti-Bacterial Agents ; Clostridium septicum* ; Clostridium* ; Diabetes Mellitus ; Diarrhea ; Female ; Fever ; Humans ; Critical Care ; Lymphoma, T-Cell, Peripheral ; Nausea ; Neutropenia ; Sepsis* ; Vomiting

PURPOSE: The purpose of this study was to assess the clinician satisfaction of a newly introduced around-the-clock radiology coverage system for the emergency department. MATERIALS AND METHODS: Seventeen emergency physicians (8 board certified physicians, 9 residents) were invited to fill out a survey pertaining to the newly introduced radiology coverage system for the emergency department. The questionnaire included 10 questions covering three major topics. The first topic related to the around-the-clock radiology coverage by two full-time radiology residents. The second topic focused on the preliminary interpretations of radiology residents. The last topic included the interpretation assistance system by board-certified radiologists. The answers to each question were assessed using a scoring system of 1 to 5. RESULTS: The mean satisfaction score of the around-the-clock radiology coverage system by the two full-time radiology residents was 4.6 (range 3-5). The mean score for the preliminary interpretation system by the radiology residents was 4.8 (range 4-5). The score for the reliability of the preliminary versus the final interpretations was 4.1 (range 4-5). Lastly, the mean score for the interpretation assistance system by board-certified radiologists was 4.9 (range 4-5). CONCLUSION: The results of this study indicate a high satisfaction rating among clinicians' of the new around-the-clock radiology coverage system for the emergency department.
Emergencies ; Emergency Service, Hospital ; Surveys and Questionnaires

PURPOSE: It is known that deficiency of metallothionein (MT) and manganese-containing superoxide dismutase (Mn-SOD), scavengers of reactive oxygen species, results in aging and carcinogenesis by inducing DNA damage. Paraquat can produce reactive oxygen species and induce antioxidants in human. In this study, an attempt was made to verify the relation between gastric carcinogensis and the induction rates of these antioxidants. METHODS: Peripheral blood of 24 randomly selected patients with gastric cancer, who were treated at Chosun University Hospital between Febuuary 1999 and December 1999, was examined. 3 male and 3 female patients in each decade from 40 to 70 years were selected. Twenty-four (24) volunteers with no laboratory, chemical, radiologic and endoscopic abnormalities during the same period were used for the normal control group. White blood cells were isolated from peripheral blood and incubated in culture media, including paraquat, for 18 hours at 37oC. MT and Mn-SOD mRNA expressions were examined using the reverse transcription-polymerase chain reaction (RT-PCR) method. RESULTS: The induction rates of MT and Mn-SOD mRNA in the cancer group due to paraquat were lower than those in the control group. Also, the rates decreased in both groups with age. CONCLUSION: The inducibilities of MT and Mn-SOD mRNA by paraquat may play a role in the carcinogenesis of gastric cancer and in the aging process. Based on this result, patients with a high risk of gastric cancer should be screened actively for early detection.
Aging ; Antioxidants ; Carcinogenesis ; Culture Media ; DNA Damage ; Female ; Humans ; Leukocytes* ; Male ; Metallothionein* ; Paraquat* ; Reactive Oxygen Species ; RNA, Messenger ; Stomach Neoplasms* ; Superoxide Dismutase* ; Superoxides* ; Volunteers

OBJECTIVES: Although outbreak of MDR Tb has been a recent problem in western countries, it has been a longstanding problem in Korea. The poor outcome of MDR Tb is mainly due to poor compliance, high rate of side reaction of secondary drugs, and limitation in number of available drugs. Thus, to improve the outcome of MDR Tb,, it is crucial to make individualized adequate prescription based on the knowledge of the patterns of resistance to each drugs in the community as well as the natural history. The purpose of present study is to evaluate the clinical features of Korean MDR Tb patients including patterns of drug resistance and success rate of treatment which was prescribed according to the sensitivity tests. METHODS: Retroscpective analysis of 71 Korean patients with MDR Tb was made. All strains isolated from patients showed resistence to at least two first line drugs. Patients profile, previous treatment history, patterns of drug resistance, outcome of treatment was analysed. Initial treatment regimen was selected according to the previous treatment history and was modified according to the sensitivity reports. The regimen was composed to include at least 4 sensitive drugs when possible. RESULTS: The patients showed resistance to 4.1 drugs on average. 90% of them were resistant to INH and RFP. Among 71 patients, 35 patients(49%) had cavitary lesions in CXR. Treatment outcome was analysed in 55 patients. 35 patients(67%) were improved after treatment and 18 patients(33%) showed treatment failure. 5 patients showed primary resistance. Treatment outcome could be evaluated in 4 of them and all showed improvement after treatment. 14 patients(20%) had to change their regimens due to drug side effects. The most frequent side effect was elevation of liver enzymes(6 patients). Others included dizziness, hyperuricemia, tinnitus, skin rash, GI troubles. More than 50% of side effects developed within 3 months. In repeated drug sensitivity test, the concordance rate of resistance to INH was 100% and RFP 98%. EMB,PZA showed 80% concordance rate. But in the other drugs, the concordances were less than 50%. Operation was done in 5 patients - 1 patients as a adjunctive means of chemotherapy In that case, negative conversion of sputum AFB was done. CONCLUSION: 2/3 patients of multidrug-resistant tuberculosis were improved by appropriate prescription and regular medication suggesting that more aggressive management and monitoring is indicated in multidrug-resistant tuberculosis.
Compliance ; Dizziness ; Drug Resistance ; Drug Therapy ; Exanthema ; Humans ; Hyperuricemia ; Korea ; Liver ; Natural History ; Prescriptions ; Sputum ; Tinnitus ; Treatment Failure ; Treatment Outcome ; Tuberculosis, Multidrug-Resistant*