We reviewed 37 skin biopsies obtained from 35 patients with secondary syphilis during the period of 9 years from January 1980 to June 1988, which had been diagnosed by dark field examination, serologic tests for syphilis, and identification of spirochetes by immunoperoxidase method (avidin-biotin complex) in the skin biopsies. We investigated the histologic features of the skin lesions in secondary syphilis according to the types and patterns of inflammatory cell infiltration in the dermis, vascular reactions and epidermal changes. We matched these histologic findings with the clinical features of the skin lesions. The results were as follows; 1) The histologic patterns of dermal infiltrate in order of frequency were as follows; junctional pattern in 14 biopsies (38%), lichenoid pattern in 10 biopsies (27%), diffuse pattern in 5 biopsies (14%), patchy pattern in 3 biopsies (8%), normal pattern in 3 biopsies (8%) and undertermined in 2 biopsies (5%). 2) The dermal infiltration of plasma cells was found in 24 biopsies (65%). All the biopsies of diffues and lichenoid patterns, 7 biopsies of junctional and one biopsy of patchy pattern showed plasma cells but none in normal pattern. 3) Eosinophils were observed in the dermis in 11 biopsies (30%). There was no difference in incidence of eosinophils in the dermis among morphologic patterns. However, they were frequently seen in the dermis and epidermis of condyloma lata (4 of 7 biopsies). 4) The vascular changes in the dermis included endothelial cell swelling in 23 biopsies (62%), endothelial cell proliferation in 22 biopsies (60%) and vascular dilatation in 10 biopsies (27%). They were most commonly observed in the lichenoid pattern followed by diffuse and junctional patterns. Three cases showed lymphocytic vasculitis. 5) Epidermal changes were seen in all of the biopsies exocytosis, parakeratosis, hydropic change of basal cells, acanthosis, spongiosis, keratinocyte necrosis and hyperkeratosis in the order of frequency. 6) In relation to the clinical manifestations, junctional pattern (14 biopsies) consisted of 6 papulosquamous lesions, 5 macules and 3 papules. Lichenoid pattern (10 biopsies) consisted of 7 papulosquamous lesions and 3 papules. All the biopsies showing diffuse pattern (5 biopsies) appeared in condyloma lata. Patchy pattern (3 biopsies) consisted of 2 macules and 1 papule. All of the normal pattern (3 biopsies) appeared in macules. In conclusion, with dermal and epidermal changes, the acknowlegement of the 5 basic histologic patterns in secondary syphilis seems to be very helpful for the diagnosis of syphilis.
Incidence ; Biopsy

Pain is one of the most complex human experience and the commonest cause of stress and the most frequent symptom that makes people seek medical help. The mechanism of its production and perception are poor understood. Since the past, various procedures have been tried to control or relieve pain. It had been observed that acupuncture stimulation has been effective in the relief of painful conditions. However, up to the present there had been no definite proof that acupuncture treatment has cured any pathological condition. Work is at present proceeding to make this a practical possibility. Recently, in modern medical science, several experiments are in progress and in some cases, cure had been obtained but until these studies are completed and proved to be effective, it is impossible at the present stage to evaluate whether these occasional cures are statistically significant. So, we launched studies and observations at our pain clinic at St. Paul's Hospital employing the "Somatosensory evoked Potential",(SEP) responses for chronic pain patient to relieve pain with acupuncture. The median and sural nerve of patients with chronic pain were stimulated and recorded using the SEP. Recordings were made before and after the acupuncture therapy was initiated. We analyzed the recorded SEP responses to see if ther are any physiological effects of the acupuncture therapy in patients with chronic pain. Findings: The important changes of the SEP responses recorded during acupuncture therapy in patients with chronic pain were the suppression of the amplitude of the SEP waves and delayed latency of the responses, similar to those manifested by patients, who are under morphine therapy. Then, naloxone an antagonist to morphine was administered. The effects were the same, that is the SEP responses were reversed in both the patients under morphine therapy and those under acupuncture therapy. So, we postulated that, since the meridian system is closely connected to the posterior column of the spinal cord conducting system, which is concerned in the somatosensory conducting system, peripheral stimulation by acupuncture may bring about the so called "pain suppression of descending system", which is closely connected to the meridian system of acupuncture. Though it is quite early to draw positive and definite conclusions, the results are very encouraging. More cases and further observations are advocated.
Acupuncture Therapy ; Acupuncture* ; Chronic Pain* ; Humans ; Morphine ; Naloxone ; Pain Clinics ; Spinal Cord ; Sural Nerve

The 5'- and 3'-side half of liver type glucose transporter (GLUT2) cDNA was amplified from total RNA or mRNA by reverse transcriptase-polymerase chain reaction (RT-PCR). The amplified 5'-side fragment of GLUT2 cDNA was inserted into pGEM4Z and named pGLGT1, and the 3'-side fragment of GLUT2 cDNA was inserted into the HindIII site of pGLGT1 to construct pGLGT2 which contains an entire open reading frame of GLUT2 cDNA. The GLUT2 cDNA in pGLGT2 was transferred to an eukaryotic expression vector (pMAM) to construct pMLGT, which was expressed in the insulin-sensitive Chinese hamster ovary (CHO) cells. Western blot analysis showed that the GLUT2 gene in pMLGT was expressed in the transfected CHO cells successfully. The GLUT2 content in the plasma membrane fraction of insulin-treated CHO cells expressing GLUT2 increased 3.8-fold compared to that of the control group. This result suggests that GLUT2, which is not subjected to translocation by insulin in the cells of its major distribution, can be translocated if it is expressed in the suitable cells sensitive to insulin action.
Animal ; Base Sequence ; CHO Cells ; *Cloning, Molecular ; Hamsters ; Insulin/*pharmacology ; Liver/*metabolism ; Molecular Sequence Data ; Monosaccharide Transport Proteins/*genetics/*metabolism ; Oligonucleotide Probes/genetics ; Support, Non-U.S. Gov't ; *Translocation (Genetics)

There are many conditions which are associated with neutropenia, such as infections, chemical and physical agents, and hematopoietic diseases. But ticlopidine-induced neutropenis is rarely reported in Korea. We experienced a case of neutropenia which developed after approximately 1 month of ticlopidine administrarion to a stable angina pectories patient. A 59 year-old woman with stable angina pectoris was placed on ticlopidine. Forty days later, she was admitted for high fevers and shaking chills. On admission, leukocyte count was 900/mm (3) (neutrophil 0/mm (3)), hemoglobin was 11.8g/dl, and platelet count was 440.000/mm (3). After confirming ticlopidine-induced neutropenia by bone marrow aspiration and biopsy, we administated rhG-CSF (neutrogen (r), Choongwae. Co. Korea) at a dose of 3-5ug/kg daily. On the 25th day of treatment, leukocyte count reached 2,890/mm (3). She experienced no adverse effects of rhG-CSF treatment and recorved completely. We assume that the rapid recovery of granulocytes was attributable to rhG-CSF, and we suggest that rhG-CSF should be tried in a patients with ticlopidine-induced neutropenia with depletion of myeloid precursors in the hypocelluar bone marrow.
Angina, Stable ; Biopsy ; Bone Marrow ; Chills ; Female ; Fever ; Granulocytes ; Humans ; Korea ; Leukocyte Count ; Middle Aged ; Neutropenia ; Platelet Count ; Ticlopidine

We reviewed 48 skin bicpsies obtained from 48 patients with epidermal nevus during a 10 year period from January 1981 to December 1990. The results are summarized as follows : 1) Of our 48 patients, 23 were male and 25 were female, and male to female ratio was 1 to 1.1. 2) The average of the patients was 19.8 years at the time of diagnois. 3) Lesions were present at birth in 45.7 percent of patients, and most of the remainder de veloped in childhood. The mean age of onset was 7.7 years. 4) The clinical varieties of the nevi in 48 patients were classified according to caicegories of nevus verrucosus, including systematized epidermal nevus, nevu, unius lateris, ichthyosis hystrix, epidermal nevus syndrome and inflammatory linear veirucous epidermal nevus. The most common type was nevus verrucosus(88.6%). 5) A large variety of histopathologic changes can be seen in epidermal nevi. The most common histopathologic .ype was nonspecific(31.3%), follows by common(12.5%), epidermolytic hyperkertosis(12.5%), and acanthosis nigricans(10.4%). 6) The most commonly affected area was head and neck(48.5%) followed by trunk(28.6%), upper limb(11.4%) and lower limb(2.9%).
Age of Onset ; Female ; Head ; Humans ; Ichthyosis ; Male ; Nevus* ; Parturition ; Porcupines ; Skin

Ankylosing spondylitis (AS) is a chronic inflammatory disease predominantly affecting the axial skeleton. AS treatment aims to reduce pain and inflammation and maintain functional capacity. Nonsteroidal anti-inflammatory drugs are the first-line treatment for those with active AS. While for peripheral arthritis, sulfasalazine or local glucocorticoid injection can be used, these are not recommended for axial symptoms. Twenty years ago, biological products that target the tumor necrosis factor (TNF) were developed. These have been approved for use in rheumatoid arthritis and AS. Since the introduction of these TNF inhibitors, the control of disease activity in AS has improved markedly. TNF inhibitors, including both anti-TNF-alpha monoclonal antibodies and recombinant TNF soluble receptors, can be considered for patients with persistently active disease despite nonsteroidal anti-inflammatory drug treatment. Recently, interleukin-17 inhibitors have also been approved for use in AS patients with insufficient responses to TNF inhibitors. Ongoing clinical trials are exploring the effect of Janus kinase inhibitors against AS. This review summarizes the current pharmaceutical treatment for AS, focusing on the biological products. Recommendations for AS management are also discussed in this review.

PURPOSE: Thallim-201 (201Tl) brain SPECT, which can represent cellular activity of brain lesions, may provide more useful information in differentiating between benign and malignant brain lesions more so than CT or MRI, that merely represents anatomic changes or breakdown of blood brain barrier. We used 201Tl brain SPECT prospectively to evaluate the utility of 201Tl-indices as an indicator of benign or malignant lesions. MATERIALS AND METHODS: We studied 28 patients. There were 13 cases of benign lesions (3: nonspecific benign lesion, 3: meningioma, 2: low grade glioma, 1: tuberculoma, central neurocytoma, hemangioblastoma, radiation necrosis, and choroid plexus papilloma) and 15 cases of malignant lesions (6: glioblastoma multiforme, 5: anaplastic glioma, 2: medulloblastoma, 1: metastasis and lymphoma). In all patients, CT and/or MRI were obtained and then 201Tl brain SPECT was obtained with measuring mean 201Tl index and peak 201Tl index. An unpaired t-test was performed to compare the 201Tl-indices and pathologic diagnoses to evaluate the utility of 201Tl-indices as an indicator of benign or malignant lesions. RESULTS: There were no statistically significant difference in 201Tl-indices between benign and malignant brain lesions (P>0.05). CONCLUSION: These results demonstrated that we could not use 201Tl indices on brain SPECT alone as an indicator of benign or malignant brain lesions.
Blood-Brain Barrier ; Brain* ; Choroid Plexus ; Diagnosis ; Glioblastoma ; Glioma ; Hemangioblastoma ; Humans ; Magnetic Resonance Imaging ; Medulloblastoma ; Meningioma ; Necrosis ; Neoplasm Metastasis ; Neurocytoma ; Prospective Studies ; Tomography, Emission-Computed, Single-Photon* ; Tuberculoma

Anesthesiologists prefer the intemal jugular vein (IJV) for central venous cannulation. Most approaches use the sternocleidomastoid muscle as a landmark but, a new approach for internal jugular venipuncture is using bony rather than soft tissue landmarks that was developed by Nobukata et al. in 1991. The landmarks of Nobukata's method consist of four bony landmarks the notch, which was located just above the medial end of the clavicle; the sternal end of clavicle; the mastoid process; and the cricoid cartilage. In order to compare Nobukata's method with Central approach, we evaluated 100 patients prospectively. We allocated randomly two hundreds ASA physical status 1, 2 and 3 patients to two groups. Central approach was employed for central venous cannulation in group 1 and Nobukata's method was done in group 2. In both group, two attempts were employed to right IJV and one attempt was done left IJV if right venipuncture was failed or hematoma formation occured. Successful cannulation rate on the 2nd attempt was 97% in group 1 and 96% in group 2, and overall success rate was 100% in both groups. Complications included arterial puncture in 3 cases (3%) and in 2 cases (2%) in group 1 and group 2 respectively, and hematoma formation in 2 cases (2%) in group 2. From the above results, in some cases of anesthetized patients, short neck, obese patients whose soft tissue landmarks are less t, and during cardiac arrest, Nobukata's method can be used alternatively to Central approach.
Catheterization* ; Clavicle ; Cricoid Cartilage ; Heart Arrest ; Hematoma ; Humans ; Jugular Veins* ; Mastoid ; Neck ; Phlebotomy ; Prospective Studies ; Punctures

BACKGROUND AND OBJECTIVES: Dobutamine stress echocardiography (DSE) with 2D echocardiography (2DE) is one of the time-consuming procedures in the diagnosis of coronary artery disease (CAD). Moreover, the accuracy of DSE with 2DE depends on the operator's skill or bias during the image acquisition. This study was conducted to determine the feasibility and accuracy of DSE with real-time 3D echocardiography (RT3DE) for the diagnosis of CAD. SUBJECT AND METHODS: 62 patients (RT3DE: 36, 2DE: 26), suspected of angina pectoris and post-revascularization ischemia, underwent DSE and coronary angiography (CAG). Image acquisition was performed at the baseline, and at 4 times during the dobutamine infusion and recovery stages. The procedure time (from the baseline to the end of the peak dose stage) was recorded. Off-line analyses of the volumetric images acquired with RT3DE were performed using 3D computer software (TomTec, Co.). Digitized quad-screen images acquired with 2DE were analyzed using the 2DE review system (ProSolv 4.0). >50% luminal diameter stenosis of any coronary artery on CAG was defined as significant coronary artery stenosis. RESULTS: The procedure time of DSE with RT3DE was significantly shorter than that of DSE with 2DE (25+/-4 vs. 37+/-4 mins, p<0.001). There was no significant difference in the sensitivity (p>0.05) or specificity (p>0.05) between the two procedures. CONCLUSION: DSE with RT3DE seems to be a feasible and less time consuming diagnostic procedure, probably providing comparable sensitivity and specificity for the detection of coronary artery stenosis, than DSE with 2DE.
Angina Pectoris ; Bias (Epidemiology) ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels* ; Diagnosis* ; Dobutamine* ; Echocardiography* ; Echocardiography, Stress* ; Echocardiography, Three-Dimensional* ; Humans ; Ischemia ; Phenobarbital ; Sensitivity and Specificity

During thalamotomy, we have to use the various kinds of brain reference points. From 1989 to 1992, the authors performed streotactic thalamotomy or pallidotomy in 169 patients suffering from tremor. We measured and estimated the important intracerebral reference points. These data were very meaningful for stereotactic functional neurosurgery in the Korean medical community because it is obtained from Korean people. We have also estimated the average location of targets for tremor submission.
Brain ; Humans ; Neurosurgery ; Pallidotomy ; Statistics as Topic* ; Tremor