No abstract available.

Syndromal acanthosis nigricans is associated with cellular resistance to the action of insulin and other endocrinopathies. In the insulin resistant state, increased insulin binds to the receptors of insulin-like growth factors (IGFs). IGFs are growth prompting peptides, which act as direct mitogens on cells containing the receptors. Through these actions, increased cellular growth and metabolism cause the skin lesions of acanthosis nigricans. Hyperandrogenism is also found in syndromal acanthosis nigricans patients. When associated with insulin resistance, these states are proportionally related. Increased insulin prompts the synthesis of androgen and conversely, increased androgen elevates the insulin resistance. We present three cases of syndromal acanthosis nigricans with hyperpigmented skin lesions and obesity. Laboratory findings demonstrated normal fasting blood suga levels with increased insulin and C-peptide levels and decreased insulin receptors. The oral glucose tolerance test was normal. We suggest that these patients were in an insulin resistant state. Skin biopsies from the axilla in all three cases showed hyperkeratosis, irregular acanthosis and upward projection of dermal papillae as finger like fashion. Thus all three cases represent syndromal acanthosis nigricans associated with an insulin resistant state based on clinical, histopathological, and laboratory findings. The three patients were treated with dietary control.
Acanthosis Nigricans* ; Axilla ; Biopsy ; C-Peptide ; Fasting ; Fingers ; Glucose Tolerance Test ; Humans ; Hyperandrogenism ; Insulin Resistance* ; Insulin* ; Metabolism ; Mitogens ; Obesity ; Peptides ; Receptor, Insulin ; Skin ; Somatomedins

No abstract available.
Breast Neoplasms* ; Breast*

A 49 year-old male was scheduled for a cholecystectomy, thereafter a 37 year-old female scheduled for removal of a epidural hematoma in the same operating room. Both of them had no specific medical problems and past medical histories for anesthesia. For those reasons, anesthesia was induced with thiopental sodium and succinylcholine with endotracheal intubation. After induction, vital signs including body temperatures were stable. But moisture dew in the unidirectional valves and corrugated tubes, and color changes of soda lime were discovered. At that time, severe hypercarbia was recognized by arterial blood gas analysis in both cases. In both cases, there were no malfunctions in unidirectional valves, expiratory valves, corrugation tubes, soda lime, ventilators and there connection parts in the anesthetic machines. Also there were no abnormalities of blood pressures, electrocardiograms, pulse oxymeters, temperatures and the pulse in the patient monitoring systems except capnography. At first, we thought that medical signs revealed malignant hyperthermias. But vital signs, air way pressures and functions of all kinds of anesthetic machine components including ventilators were normal. After discontinuing N2O gas deliveries in the operation room, hypercarbias disappeared. Thus, anesthetic gas delivery systems via central piping systems were checked and it was discovered that CO2 gas was in the N2O gas tank instead of N2O.
Adult ; Anesthesia ; Blood Gas Analysis ; Body Temperature ; Capnography ; Carbon Dioxide* ; Carbon* ; Cholecystectomy ; Electrocardiography ; Female ; Hematoma ; Humans ; Intubation, Intratracheal ; Male ; Malignant Hyperthermia ; Middle Aged ; Monitoring, Physiologic ; Nitrous Oxide* ; Operating Rooms ; Succinylcholine ; Thiopental ; Ventilators, Mechanical ; Vital Signs

No abstract available.

No abstract available.

A 4 years old Korean male child was presented with delay of regaining consciousness after general anesthesia for the correction of the right hand deformity and limitation of motion. In 1961 Frederich described the failure to regain consciousness after general anesthesia. 1.Hypoxia. 2. Excess of CO2.3. Anesthetic overdose, surgical shock, hypotension. 4. Miscellaneous factors: cerebro-vascular accidents, metabolic acidosis, hypoglycemia, uremia, hemorrhage, cerebral thrombosis, electrolyte imbalance. In this case, we believed that hypoxia was responsible for this complication.
Acidosis ; Anesthesia, General* ; Anoxia ; Cerebral Hemorrhage ; Child ; Child, Preschool ; Consciousness ; Hand Deformities ; Humans ; Hypoglycemia ; Hypotension ; Male ; Shock, Surgical ; Thrombosis ; Uremia

A total of 120 infants, children, and teenagers, who were admitted to the Department of Pediatrics, Severance Hospital from April 1989 to August 1989, were examined by cross-sectional echocardiography. Right and left atrial and ventricular dimensions and areas were measured in the parasternal, apical, and subcostal views. Dimensions of the inferior caval vein, the pulmonary and the aorta were obtained in the parasternal, suprasternal, and subcostal views. The results were as follows : 1) Statistical analysis showed no difference between boys and girls. 2) For all parameters, a positive linear correlation was found with age, height, weight, and body surface area. The best correlation was with body surface area. 3) The correlation was further improved if the logarithmic values of the measurements and body surface area were considered. 4) Measurements by cross-sectional echocardiography are clinically useful, especially in the study of the right-sided cardiac structures that are difficult to evaluate with M-mode echocardiography, but the problems of reproducibility have to be taken into account.
Adolescent ; Aorta ; Body Surface Area ; Child* ; Echocardiography* ; Female ; Humans ; Infant* ; Pediatrics ; Reference Values ; Veins

The incidence of vector-borne infectious diseases is increasing due to developments in diagnostic techniques, as well as due to economic, environmental, and ecological factors such as global warming, increased rainfall, globalization, and urbanization. Tick-borne infectious diseases occurring in Korea include severe fever with thrombocytopenia syndrome, Lyme disease, anaplasmosis, and Japanese spotted fever. Various skin lesions, such as erythema migrans, tick bite sites, rash, and eschar, are associated with tick-borne infectious diseases. It is necessary to remove ticks immediately to prevent transmission of these tick-borne infectious diseases. Especially for conditions such as Lyme disease, at least 24 to 48 hours of tick attachment to the host is required for transmission of the causative pathogens to the host. Tick-borne diseases are acquired after outdoor activities and have nonspecific symptoms such as fever, headache, and chills, which make them difficult to identify without a diagnostic test. Rapid diagnosis and early treatment can reduce the otherwise significant morbidity and mortality associated with these conditions; therefore, therapy should not be delayed until laboratory confirmation is received.
Anaplasmosis ; Animals ; Asian Continental Ancestry Group ; Chills ; Communicable Diseases* ; Diagnosis ; Diagnostic Tests, Routine ; Erythema ; Exanthema ; Fever ; Global Warming ; Headache ; Humans ; Incidence ; Internationality ; Korea* ; Lyme Disease ; Mortality ; Rickettsia Infections ; Scrub Typhus ; Skin ; Thrombocytopenia ; Tick Bites ; Tick-Borne Diseases ; Ticks ; Urbanization

Hematuria is a important clinical sign that is a consequence of significant fenal. urologic or sytemic disease. Recently the morphology of the red cell in hematuria has been used to indicate a renal or non-renal source and also the measurement of red cell volume by red cell analyzer has been used to distinguish glomerular from non-glomerular hematuria. In this study. the MCV(mean corpsular red cell voume). RDW(red cell distribution width) and HDW (hemoglobin distribution width) were measured using H-1 system in57 children with hematuria to assess the diagnostic usefulness of the urinary red cell analyzer in the differentation of glomerular and non-glomerular hematuria. The patients were divided into two groups as glomerular diseases(40cases)and non-glomerular diseases(17 cases)and the location of the bleeding was confirmed by renal biopsy, radiology and the clinical findings. The results were as follows. 1) The urinary red cell MCV waslower in patients with glomerular diseases than that in patients with non-glomerular diseases (79.89 +/- 12.0fl vs. 90.93 +/- 9.71fl vs. 90.93+/-9.71 fL; p<0.01) 2) The urinary RDW and HDW were significantly higher in glomerular diseases than those in non-glomerular diseases (RDW; 19.86 +/- 11.28% vs 11.34+/-5.88%, HDW; 3.37+/-2.07 gm vs. 1.86+/-1.43gm). 3) The urinary red cell MCV was correlated well with the RDW and HDW while there was no correlation between the urinary red cell MCV and the urinary SG or pH. 4) The sensitivity, specificity and positive predictability of the urinsary MCV were 37.8%, 94.1% and 93.7% and those of RDW were 62.5%, 82.3% and 89.2% 5) The sensitivity, specificity and positive predictability of the urinary HDW were 42.5%, 88.2% and 89.4% We concluded from above date that the measurment of the urinary MCV, RDW and HDW would be useful as a primary non-invasive screening test in differentation of glomerular and non-glomerular hematuria in children.
Biopsy ; Cell Size* ; Child* ; Diagnosis* ; Hematuria* ; Hemorrhage ; Humans ; Hydrogen-Ion Concentration ; Mass Screening ; Sensitivity and Specificity