Pretibial myxedema is a condition in which there is loeal thickening of the skin by a mucin-like deposit; it is nearly always asosciated with ophthalmopathy and thyrotoxicosis, not infrequently becomes more pronounced after treatrnent of thyrotoxicosis. The precise cause of pretibial myxedema is not known, but it appears that IgG LATS represents an autoantibody against a thyroid antigen, retroorbital tiesue and tbe skin, so, pretibial myxedema is presumed to be the result of a local antigen-antibody tissue reaction. A 57-year-old man had the history of diabetes since 1964 and Graves disease since May 1980, he was treated with metimazole for 1 month, with improving thyrotoxicosis but developed the pretibial myxedema. The histologic findings showed considerable amount of mucin, especially hyaluronic acid with toluidin blue stain at PH 3.0. The lesions were improved by local application of 0.01 x fluocinolone acetonide ointment with occlusive dressing technique.
Fluocinolone Acetonide ; Graves Disease ; Humans ; Hyaluronic Acid ; Hydrogen-Ion Concentration ; Immunoglobulin G ; Long-Acting Thyroid Stimulator ; Middle Aged ; Mucins ; Myxedema* ; Occlusive Dressings ; Skin ; Thyroid Gland ; Thyrotoxicosis

No abstract available
Dermatitis, Atopic* ; Eczema* ; Humans ; Nipples*

A case of chronic granulomatous infection of Fsarium solani had decreased response to recalled antigens and lacked of dinitrochlorobenzene(DNCB) sensitization in vivo. He has had frequent attacks of common cold-like symptoms and same attacks were very suggestive of pneumonia but he relatively healthy until he developed cutaneous Fusarium infection. Recently he also developed herpes zoster.
Fusariosis ; Fusarium* ; Herpes Zoster ; Pneumonia

BACKGROUND: In the western hemisphere, resistance to activated protein C (APCR) is the most common risk factor for venous thromboembolic disease. A one-point mutation in the coagulation factor V that renders it APCR is found in more than 90% of patients with APC-resistant venous thrombosis. In Hispanic and Caucasian patients with arterial ischemic stroke, the prevalence of APC-R is approximately 10%. To determine the prevalence of APC resistance and its causative factor V mutation (Arg 506 Gln) in Koreans, we screened a group of Korean ischemic stroke patients. METHODS: We evaluated 60 Korean patients with arterial ischemic stroke diagnosed by either magnetic resonance neu-roimaging, conventional angiogram, or both, after 2 weeks of symptom onset. The mean age of the subjects was 59.2 years (13-82 years). APC resistance was expressed as a ratio of the activated partial thromboplastin time (aPTT) with and without adding APC to the subject's plasma. The presence of the factor V Leiden (Arg 506 Gln) mutation was determined by a direct polymerase chain reaction-based assay on peripheral blood leukocytes. RESULTS: Only one patient (n=1/60, 1.6%) had APC resistance and none were found to have the factor V Leiden (Arg 506 Gln) mutation. CONCLUSIONS: APCR and the factor V Leiden mutation do not seem to be a significant genetic risk factor for arterial ischemic stroke in Koreans.
Activated Protein C Resistance* ; Factor V* ; Hispanic Americans ; Humans ; Leukocytes ; Partial Thromboplastin Time ; Plasma ; Prevalence ; Protein C ; Risk Factors ; Stroke* ; Venous Thrombosis

BACKGROUND AND OBJECTIVES: Nitric oxide (NO) production in the respiratory epithelium and the demonstration of inducible nitric oxide synthase in ciliated epithelium of the upper airway have recently been reported. The aim of this study was to investigate the expression of inducible nitric oxide synthase in the nasal epithelium after capsaicin treatment, which stimulates the substance P innervation. MATERIALS AND METHODS: In vivo treatment -Capsaicin (112 nM) was applied to the nasal cavities of the rat and guinea pig, and 30 nl of normal saline was applied for the control groups. After 2 hours, animals were sacrificed with cardiac perfusion of 4% paraformaldehyde and septal mucosa were removed. The 8 nm serial frozen tissue sections were made, and the expression of inducible nitric oxide synthase was determined using nicotinamide adenine diphosphate-diaphorase histochemistry. In vitro treatment- The nasal septum of the rats and the trachea of the guinea pigs were incubated in DMEM culture media with or without 112 nM capsaicin for experimental or control groups. After 0, 30 or 120 minutes of incubation, the tissues were fixed and processed for nicotinamide adenine diphosphate-diaphorase histochemistry. RESULTS: Both in vivo and in vitro studies demonstrated that the strong positive histochemical reactivity were observed in the respiratory epithelium of the rats and guinea pigs after capsaicin treatment compared to control groups. CONCLUSION: These data imply that capsaicin induces the expression of inducible nitric oxide synthase and that the substance P innervation of the nasal mucosa may have a protective role in the airway defense mechanism through nitric oxide production.
Adenine ; Animals ; Capsaicin* ; Culture Media ; Epithelium* ; Guinea Pigs ; Guinea* ; Mucous Membrane ; Nasal Cavity ; Nasal Mucosa ; Nasal Septum ; Niacinamide ; Nitric Oxide ; Nitric Oxide Synthase Type II* ; Perfusion ; Rats* ; Respiratory Mucosa ; Substance P ; Trachea

We report a case of recurrent subacute necrotizing lymphadenitis with pancytopenia in 21-years-old-woman. She was admitted to our hospital 4-years interval with fever and abdominal pain. Laboratory findings of the last admission showed pancytopenia, such as WBC 700/microliter, hemoglobin 6.0mmol/L (9.7g/dL), hematocrit 28.8%, and platelet 54,000/microliter. Abdominal CT showed hepatosplenomegaly, enlarged conglomerated lymph nodes in splenic hilum, lesser sac, celiac root, and paraaortic areas. Bone marrow biopsy showed hypocellular marrow (20%) with increased number of megakaryocyte, myeloid hyperplasia, and hemophagocytic histiocytes suggesting infectious process. We performed exploratory laparotomy, and pathologic finding revealed subacute necrotizing lymphadenitis-Kikuchi disease-. She was recovered on 26th hospital day with conservative treatment.
Abdominal Pain ; Biopsy ; Blood Platelets ; Bone Marrow ; Fever ; Hematocrit ; Histiocytes ; Histiocytic Necrotizing Lymphadenitis ; Hyperplasia ; Laparotomy ; Lymph Nodes ; Lymphadenitis* ; Megakaryocytes ; Pancytopenia* ; Peritoneal Cavity ; Tomography, X-Ray Computed

PURPOSE: To evaluate the usefulness of functional MR imaging(fMRI) for determination of language dominance compared with Wada test and to assess the lateralization of activated signals according to stimulation task of activated area. MATERIALS AND METHODS: Functional maps were obtained during word generation task and reading task in twenty patients(16 epilepsy, 4tumor; 17 right-handed, 1 left-handed, 2 ambidextrous). MR examinations were performed at 1.5T scanner with EPI BOLD technique during word generation and word reading tasks. We used SPM program for the postprocessing of image. The threshold for significance was set at p<0.0001 or p<0.001. A lateralization index(LI) was calculated from the number of activated pixels in three hemispheric areas(whole hemisphere, frontal lobe, and temporoparietal lobe. The LIs of fMRI and Wada test were compared according to stimulation task and area for calculation of LI. RESULTS: During the Wada test, sixteen patients had the left language dominance and four patients had right dominance. The language dominance determined by LI of fMRI in each hemisphere was concordant with the result of Wada in 19(95%) by word generation task and in 15(75%) by reading task. At word generation task, the concordance rate was higher with LI calculated on whole hemisphere than that on frontal(80%) or temporoparietal lobe(90%). Correlation between the LIs of Wada and fMRI was significant(r=0.74) CONCLUSION: In fMRI word generation task produced stronger activation of language areas and showed more accurate lateralization reading task. The concordance rate of and Wada test was higher with LI calculated on whole hemisphere than on frontal or temporoparietal lobe.
Brain ; Epilepsy ; Frontal Lobe ; Humans ; Magnetic Resonance Imaging*

BACKGROUND: Perfusion imaging (PI) of magnetic resonance imaging (MRI) uses the signal loss that occurs during dynamic tracking of the first pass of intravenous paramagnetic contrast agent. Then different hemodynamic measurements can be calculated and displayed as perfusion maps. Diffusion-weighted imaging (DWI) measures diffusional movement of water molecules within the brain and it can identify acute ischemic injury or cytotoxic edema. We evaluated clinical usefulness of PI and DWI in acute ischemic stroke. METHODS: Fifteen patients with clinical diagnosis of acute cerebral infarction were imaged with PI, DWI, and magnetic resonance angiogram (MRA) including FLAIR within 24 hours after onset. Comparisons were made between infarct volumes measured by DWI and PI using the parameters including relative mean transit time (rMTT) map, relative cerebral blood volume (rCBV) map, and relative cerebral blood flow (rCBF) map. RESULTS: Two patterns were found. rMTT map in PI lesion is larger than in the DWI lesion (n=7/15), and rMTT map in PI lesion is the same size or smaller than in DWI lesion (n=8/15). The former pattern was shown in cases with severe stenosis or occlusion of the major cerebral artery (MCA, PCA, or ICA) on MRA. The majority of latter pattern was lacunes (n=6/8). Also, we found presence of infarction cores surrounded by hypoperfused areas in rMTT map in acute largearterial territorial infarction. CONCLUSIONS: Perfusion- and Diffusion- weighted MRIs may be useful in differentiating large-arterial territorial infarction from lacunes.
Blood Volume ; Brain ; Cerebral Arteries ; Cerebral Infarction ; Constriction, Pathologic ; Diagnosis ; Diffusion ; Diffusion Magnetic Resonance Imaging ; Edema ; Hemodynamics ; Humans ; Infarction ; Magnetic Resonance Imaging* ; Passive Cutaneous Anaphylaxis ; Perfusion ; Perfusion Imaging ; Stroke*

PURPOSE: In locally advanced head and neck cancer, radiation therapy is currently unsatisfactory because the end result is often limited regional disease control and survival. A clinical study was carried out to compare the effectiveness between the radiation therapy and the combined chemotherapy and radiation therapy. MATERIALS AND METHOD: Thirty-six patients with previously untreated, locally advanced squamous cell carcinoma of the head and neck were treated with radiotherapy alone and combined chemo-radiotherapy. Induction chemotherapy was administered 2~3 cycles, consisting of intravenous cisplatin (100 mg/m2 on day 1) and 5-fluorouracil (1000 mg/m2/day for 5 days as a continuous infusion) every 4 weeks followed by 7~8 weeks of radiation therapy for a total dose of 60~75 Gy. RESULTS: 1) Among 36 locally advanced head and neck cancer, 17 patients received radiation therapy alone and 19 patients received combined chemo-radiotherapy, respectively. 2) Response rate was 47% (complete response 29%, and partial response 18%) in radiation therapy group and 79% (complete response 37%, and partial response 42%) in combined chemo-radiotherapy group (p<0.05). 3) In median survival, radiation therapy group was 13 months and combined chemo- radiotherapy group was 15 months. Both groups were not significantly different (p>0.05). 4) Treatment related mortality was not noted, but the toxic effects were seen on the half cases of the both groups. Grade II toxicities were similar between the two arms. CONCLUSION: Combined chemotherapy and radiation therapy was more effective in local control but not superior in survival than radiation therapy alone. Continuous evaluation and identification of proper sequence for the therapeutic modality is supposed to prolong the survival of patients.
Arm ; Carcinoma, Squamous Cell ; Cisplatin ; Drug Therapy* ; Fluorouracil ; Head and Neck Neoplasms* ; Head* ; Humans ; Induction Chemotherapy ; Mortality ; Neck ; Radiotherapy

OBJECTIVE: In order to investigate the functional brain anatomy associated with verbal and visual working memory, functional magnetic resonance imaging was performed. MATERIALS AND METHODS: In ten normal right handed subjects, functional MR images were obtained using a 1.5-T MR scanner and the EPI BOLD technique. An item recognition task was used for stimulation, and during the activation period of the verbal working memory task, consonant letters were used. During the activation period of the visual working memory task, symbols or diagrams were employed instead of letters. For the post-processing of images, the SPM program was used, with the threshold of significance set at p < .001. We assessed activated brain areas during the two stimulation tasks and compared the activated regions between the two tasks. RESULTS: The prefrontal cortex and secondary visual cortex were activated bilaterally by both verbal and visual working memory tasks, and the patterns of activated signals were similar in both tasks. The superior parietal cortex was also activated by both tasks, with lateralization to the left in the verbal task, and bilaterally without lateralization in the visual task. The inferior frontal cortex, inferior parietal cortex and temporal gyrus were activated exclusively by the verbal working memory task, predominantly in the left hemisphere. CONCLUSION: The prefrontal cortex is activated by two stimulation tasks, and this is related to the function of the central executive. The language areas activated by the verbal working memory task may be a function of the phonological loop. Bilateral prefrontal and superior parietal cortices activated by the visual working memory task may be related to the visual maintenance of objects, representing visual working memory.
Adult ; Brain/*anatomy & histology/physiology ; Echo-Planar Imaging ; Female ; Human ; *Magnetic Resonance Imaging ; Male ; Memory/*physiology ; Photic Stimulation ; Support, Non-U.S. Gov't