BACKGROUND: The pathogenic role of the hair follicle mite in rosacea is still a matter of debate. Although the hair follicle mite may induce a pathologic condition by dermal invasion or excessive number of mites, the number of mites necessary to induce a pathologic condition has not been established in Korea. OBJECTIVE: The purpose of our study was to know the causative role of the hair follicle mite in rosacea and the threshold value between 'normal' and 'abnormal' density of the hair follicle mite on Korean facial skin. METHODS: We applied skin surface biopsy to investigate the population density and distribution of hair follicle mites in the facial skin of 50 patients with rosacea (9 with episodic erythema, 29 with stage I, 12 with stage II), 7 patients with demodicidosis and 54 control subjects. The mites were counted in measured skin surface biopsy specimens obtained from three standard facial sites(2cm on cheek and chin, 1cm on nose) with cyanoacrylate glue. RESULTS: 1. The mean mite count per 5cm was 3.4+/-0.7 in control subjects and 10.7+/-1.9 in patients with rosacea(p<0.05) The density of Demodex(mite count/ 5cm) was significantly higher in patients with demodicidosis (115+/-14.2) than in the control (p<0.001) and rosacea patients(p<0.05). 2. The highest density of mites was found on the cheek in the control and diseased subjects. The incidence of hair follicle mites was higher on the nose than on the cheek in the control subjects and rosacea patients. In demodicidosis, the incidence of the hair follicle mites was higher on the cheek than on the nose. 3. The distribution of hair follicle mite was not significantly different among the three clinical stages of rosacea. The mite counts in stage II rosacea were higher than those of control subjects (p<0.05). 4. The distribution of the hair follicle mite in the control subjects was related to a increase of age but not related to sex. The distribution of the hair flooicle mites in rosacea patients was not related to age or sex. 5. Hair follicle mites were found in 33 out of 54 control subjects(61%) and in 40 out of 50 rosacea patients (80%). The mite counts of all control subjects and all rosacea patients were less than 5/cm and 10/cm, respectively. The mite counts of all demodicidosis patients were more than 10/cm. CONCLUSION: These results suggest that the increased nomber of mites play a part in the pathogenesis of rosacea and demodicidosis is a specifio disease entity differentiated from rosacea. When the density of the hair follicle mites is above 5 /cm2, a pathologic condition of the skin, such as rosacea and demodicidosis, would have to be considered. Demodicidosis should be suspected when the density of the hair follicle mites is above 10 /cm. In addition, skin surface biopsy is recommended as the most simple and useful clinical method in search of the distribution of the distrbution of the hair follicle mites.
Adhesives ; Biopsy* ; Cheek ; Chin ; Cyanoacrylates ; Erythema ; Hair Follicle* ; Hair* ; Humans ; Incidence ; Korea ; Mites* ; Nose ; Population Density ; Rosacea ; Skin*

Histiocytosis X(Langerhans cell histiocytosis) is a rare prolifertive disorder of Langerhans cells that includes Lettere-Siwe disease, Hand-Shiiller-Christian his ase and eosinophilic granuloma. Since many authors have reported in anintermediate and poarl classified form histiocytosis X has a namenclatural had nosologic problem. We report a case benign cutaneous variant of histiocytisis X. A four-month-old boy had shown multiple skin-colour papules on the trunk, head and nik for one month. Extensive in- vestigations failed to detcct any systemic involvement. The clixron microscopic findings of the skin biopsy specimen were Qefinitely diagnostic for histiocytosi. X Since he did not sbow evidence of internal organ involvernent and any further progression of he skin lesion, no therapy was given. Over the next two months the disease underwent spontane us and complete remission.
Biopsy ; Eosinophilic Granuloma ; Head ; Histiocytosis* ; Histiocytosis, Langerhans-Cell* ; Humans ; Langerhans Cells ; Male ; Remission, Spontaneous* ; Skin

No abstract available.
Humans ; Interferon-beta* ; Interferons* ; Multiple Sclerosis ; Multiple Sclerosis, Relapsing-Remitting*

No abstract available.
Humans ; Interferon-beta* ; Interferons* ; Multiple Sclerosis ; Multiple Sclerosis, Relapsing-Remitting*

No abstract available.
Brain Stem* ; Encephalitis* ; Humans ; Optic Neuritis*

We report a patient who was diagnosed as subacute combined degeneration (SCD) with elevated homocysteine and methylmalonic acid levels in the situation of a spurious elevation of the vitamin B12 concentration. A false-positive elevation of the vitamin B12 level could lead to a delayed diagnosis and cause irreversible changes in the nervous systems. We therefore suggest that the homocysteine and methylmalonic acid levels should be checked in patients with a normal or elevated vitamin B12 level for whom there is a high clinical suspicion for vitamin B12 deficiency, as a further evaluation for SCD.
Delayed Diagnosis ; Gastritis, Atrophic* ; Homocysteine ; Humans ; Methylmalonic Acid ; Nervous System ; Subacute Combined Degeneration* ; Vitamin B 12 Deficiency ; Vitamin B 12* ; Vitamins*

No abstract available.
Chediak-Higashi Syndrome* ; Hyperpigmentation*

Complications related to a broken stylet during endotracheal intubation have been infrequently reported. In most cases, broken stylets have been recognized by chest radiography. We report a case of unrecognized iatrogenic aspiration of a broken stylet. A 37-year-old man, who underwent explo-laparotomy two days previously, was reintubated with an uncoated stylet in the intensive care unit because of dyspnea and pulmonary congestion. He was on artificial ventilation for one day and was extubated one week later. We could not find the broken stylet on serial chest x-ray films until a metallic substance was expectorated while the patient was coughing 28 days after extubation. During the intervening period the patient did not complain of any chest discomfort and we did not realize that the broken stylet remained. The use of a plastic coated stylet and its careful observation after intubation are recommended to avoid this complication.
Adult ; Cough* ; Dyspnea ; Estrogens, Conjugated (USP) ; Humans ; Intensive Care Units ; Intubation ; Intubation, Intratracheal ; Plastics ; Radiography ; Thorax ; Ventilation ; X-Ray Film

PURPOSE: To investigate the clinical manifestations and characteristics of extruded conjunctival melanocytic mass. METHODS: A total of 33 patients who had extruded conjunctival melanocytic mass and who underwent excisional biopsy were retrospectively reviewed. RESULTS: Based on the excisional biopsy results, 13 patients (40%) were diagnosed with compound nevus, nine patients (27%) with subepithelial nevus, eight patients (24%) with primary acquired melanosis without atypia, and three patients (9%) with malignant melanoma. Compound nevus was located on the temporal side of the cornea in 54% of affected cases, bulbar conjunctival in 77%, and was partially pigmented (brown) in 61%. The average size of the melanocytic mass was 24 mm when histological analysis showed melanin nevus cells in the conjunctival epithelial layer and subepithelial stromal layer. Subepithelial nevus was located on the temporal side of the cornea (56%) and in the bulbar conjunctival (78%) and had a brown color (78%). The average size of the melanocytic mass was 28 mm when histological analysis showed melanin nevus cells located only in the subepithelial stromal layer and forming nest shapes. Primary acquired melanosis without atypia was located on the temporal side of the cornea (62.5%) and bulbar conjunctival (75%) and had brown color (75%). The average size of melanin nevus cells located only in the basement membrane of the epithelial layer was 30 mm. Three of these masses were malignant melanoma, and all cases were located on the superior side of the cornea and palpebral conjunctiva. All cases were black and had an average size of 53 mm, with malignant cells observed in all layers of the conjunctiva and connective tissue. CONCLUSIONS: A conjunctival melanocytic mass located on the palpebral conjunctiva, extruding onto the surface, and large in size should be suspected as malignant melanoma. In such cases, early biopsy and aggressive resection are required.
Basement Membrane ; Biopsy ; Conjunctiva ; Connective Tissue ; Cornea ; Humans ; Melanins ; Melanoma ; Melanosis ; Nevus ; Retrospective Studies

BACKGROUND: A correct estimation of volume status and dry weight in dialysis patients remains a difficult clinical problem. Clinical status and chest X-ray are not sensitive enough, while invasively measured central venous pressures are not routinely available. Recently, the ultrasonographic determination of the diameter and collapse index of the inferior vena cava has been proposed as a noninvasive method for estimating intravascular volume. We tried to evaluate the clinical relevance of this method in dialysis patients by comparing it with alphahuman-atrial natriuretic peptide (alpha-h-ANP) and cyclic guanosine 3:5-monophosphate (cGMP) levels. METHODS: Using echocardiography, the diameter of the inferior vena cava (VCD) and its decrease on deep inspiration (collapse index : CI) were evaluated in 27 hemodialysis patients. Echocardiography of the inferior vena cava (IVC) was performed in the supine position after 10 minutes rest. The transducer was placed in the subxiphoid region and long and short axis views of the IVC were obtained just below the diaphragm in the hepatic segment. VCD was measured before the P-wave on the electrocardiogram to avoid interference with A-wave and V-wave on the venous pressure curve, and corrected for body surface area. Preand post-hemodialysis levels of the plasma alpha-h-ANP and cGMP were measured by radioimmunoassay. The relationship between VCD, CI determined by echocardiography, and alpha-h-ANP and cGMP concentrations were studied. RESULTS: The levels of alpha-h-ANP and cGMP were markedly elevated before hemodialysis and significantly lower values were found after hemodialysis (alpha-hANP : 162.7 102.6 pg/ml vs 90.6 61.0 pg/ml , cGMP : 35.3 8.8 pmol/ml vs 21.3 6.2 pmol/ml). A significant correlation was found between VCD and alpha-h-ANP before (r=0.81, p < 0.05) and after hemodialysis (r=0.65, p < 0.05). No such significant correlation was observed bet ween CI and alpha-h-ANP levels. Furthermore, a significant correlation was observed between VCD before hemodialysis and the change in alpha-h-ANP during hemodialysis (r=0.64, p < 0.05). The relationship between VCD and cGMP before hemodialysis was not significant (r=0.26, p> 0.05) and also no relation was observed between the decrease of cGMP during hemodialysis and VCD before hemodialysis (r=0.12, p > 0.05). A significant correlation between the percent change in body weight and the percent change in VCD during hemodialysis (r=0.91, p<0.05) and also significant relation was observed between the pecent change in body weight and the percent change in alpha-h-ANP levels (r=0.40, p , 0.05). CONCLUSION: Echocardiography of the inferior vena cava allow an estimation of changes of intravascular volume in ESRDpatients without cardiac filling impairment as shown by the correlation to other indices of intravascular volume, such as alpha-h-ANP. In this study, CI and cGMP levels were less informative. Inferior vena cava echocardiography is noninvasive and easily available and serial measurements of VCD and alphah-ANP levels allow an estimation of chages of intravascular volume in ESRD patients on maintenance hemodialysis.
Axis, Cervical Vertebra ; Body Surface Area ; Body Weight ; Central Venous Pressure ; Dialysis ; Diaphragm ; Echocardiography ; Electrocardiography ; Guanosine* ; Humans ; Kidney Failure, Chronic ; Plasma ; Radioimmunoassay ; Renal Dialysis* ; Supine Position ; Thorax ; Transducers ; Vena Cava, Inferior* ; Venous Pressure