OBJECTIVES: The aim of this study is to evaluate the polysomnographic characteristics and prescription status of restless legs syndrome (RLS) patients in naturalistic setting. METHODS: We reviewed medical record of the patients over 18 years olds who (i) satisfied the clinical RLS diagnostic criteria and (ii) had the polysomnography and got treatment related thereto. As a baseline, we evaluated the four diagnostic criteria of the International Restless Legs Syndrome Study Group (IRLSSG) and the International Restless Legs Scale (IRLS) of the subjects. Then the polysomnography and the suggested immobilization test (SIT) were conducted and, after one month of pharmacotherapy using dopamine agonist, the IRLS was evaluated again. RESULTS: A total of 211 subjects participated in this analysis and 94 (44.5%) of them were male and the other 117 (55.5%) were female and the average age of the 211 subjects was 46.9+/-14.2. Out of such 211 subjects, 136 subjects (64.5%) also had the obstructive sleep apnea (OSA), and 53 subjects (25.1%) also had the periodic limb movement disorder (PLMD). 185 subjects (87.7%) out of the 211 subjects had some other sleep disorders except RLS. The results of the polysomnography were as follows : 78.0% of sleep efficiency, 86.8 min of wake after sleep onset, and 3.4% of N3. More specifically, 12.4/h of the average apnea hypopnea index, 14.8/h of the periodic limb movement during sleep (PLMS), 41.2/h of the periodic limb movement during wake during SIT and 21.6/h of total arousal index during sleep. Out of the total subjects, 149 (70.6%) of them took the ropinirole and 47 (22.3%) of them took the pramipexole, and the average dosage of ropinirole was 0.9mg(dosage range 0.125-5 mg) while the average dosage of pramipexole was 0.5 mg (dosage range 0.125-4 mg). The dosage of the ropinirole showed a significant positive correlation with the age (r=0.25, p=0.002) and also with the IRLS (r=0.23, p=0.038). The IRLS at the baseline was 24.9 while the same was decreased down to 13.4 after one month. CONCLUSIONS: Analyzing the result of this study, a majority of clinical RLS subjects demonstrated comorbidity with some other sleep disorder such as the OSA or PLMD. 25.1% of the subjects showed a PLMD, which was less than in previous researches and the average PLMS was not very high as 14.8/h. The dosage of dopamine agonist taken was often a bit more than the amount recommended in Korea. A prospective research using a large scale controlled subjects will be necessary with respect to this topic.
Apnea ; Arousal ; Benzothiazoles ; Comorbidity ; Dopamine Agonists ; Extremities ; Female ; Humans ; Immobilization ; Indoles ; Isothiocyanates ; Korea ; Male ; Medical Records ; Nocturnal Myoclonus Syndrome ; Polysomnography ; Prescriptions ; Restless Legs Syndrome ; Sleep Apnea, Obstructive ; Sleep Wake Disorders

BACKGROUND: Although there are no known gender-related differences in permeability barrier function in adults, estrogen accelerates whereas testosterone retards barrier development in fetal skin. However, there have been few studies concerning the effects of testosterone on the skin barrier. OBJECT: We evaluated the effects and mechanisms of testosterone on the skin barrier. METHODS: In this experiment, hairless mice were divided into three groups; sham-operated, castrated and testosterone-replacement castrated group. Testosterone was administered subcutaneously once a day for 7 days. We performed a skin biopsy at 7 days and performed hematoxyline-eosin staining, calcium-ion capture cytometry and the immunohistochemical examination of involucrin, loricrin, filaggrin and proliferating cell nuclear antigen (PCNA). The specimens were prepared for electron microscopy using RuO4 and OsO4 postfixation. RESULTS: The results were summarized as follows 1. Light microscopic findings of the testosterone-replacement castrated group showed apparent hyperkeratosis and acanthosis, not present in the sham-operated and castrated group. 2. Whereas the expression of involucrin, loricrin and filaggrin of immunohistochemical staining and in situ hybridization of the sham-operated and castrated group were normal, it was abnormal in the testosterone-replacement castrated group. 3. Labelling indices for PCNA in the sham-operated and castrated group were not statistically different, but the testosterone-replacement castrated group showed a marked increase of PCNA labeling index. 4. Wherease the calcium gradient was normal in the sham-operated and castrated group, it was distorted in the testosterone-replacement castrated group. Calcium deposition was increased through all layers of the epidermis and the calcium gradient disappeared in the testosterone-replacement castrated group. 5. Normal looking membrane structure was observed in the sham-operated and castrated group, but a membrane structure which appeared fragmented, incomplete lipid bilayer structures and prominent dilatation of lacunar domains were observed only in the testosterone-replacement castrated group. CONCLUSION: From the above results, it is concluded that there is a functional alteration of the epidermal barrier induced by testosterone, including the formation of an abnormal cornified envelope and also incomplete lipid synthesis.
Adult ; Animals ; Biopsy ; Calcium ; Dilatation ; Epidermis ; Estrogens ; Humans ; In Situ Hybridization ; Lipid Bilayers ; Membranes ; Mice ; Mice, Hairless ; Microscopy, Electron ; Permeability ; Proliferating Cell Nuclear Antigen ; Skin* ; Testosterone*

BACKGROUND: Cold is considered an important environmental factor on the skin's barrier function. It is also known that cold can disrupt the barrier's permeability function. Historically irritant contact dermatitis develops frequently amongst fish processing workers. This means that cold may disrupt the skin barrier function. However, there are only a few studies of the effect of cold on the skin barrier. OBJECTIVE: The aim of our study was to investigate the effects of exposure to the cold on the skin's barrier permeability, calcium gradient and cornified enveloped proteins. METHODS: Hairless mice were classified into four groups as follows; tape-stripping and exposure to cold (4degrees C) for 5 hours group (Group 1), exposure to cold (4degrees C) for 5 hours after tape-stripping and occlusion with Gore-Tex group (Group 2), exposure to cold (4degrees C) for 5 hours after tape-stripping and applying with petrolatum group (Group 3), and tape-stripping and exposure at room temperature (25degrees C) for 5 hours group (Group 4). Next, rate of barrier recovery was measured, and skin of cold exposure site was taken for immunohistochemistry of cornified enveloped protein, calcium inon capture chemistry and in situ hybridization. RESULTS: Rate of barrier recovery of Group 1 was measured at -56.33%, the most delayed rate of all groups. Rate of barrier recovery of other groups were measured as follows; Group 2 (20%), Group 3 (55%) and Group 4 (41.78%). In calcium-ion capture cytochemistry, Group 1 appeared to absent calcium deposit in the entire epidermis. Group 3 appeared to the highest density of calcium in entire epidermis. In immunohistochemical staining of cornified enveloped proteins including involucrin, loricrin and filaggrin, Group 1 resulted in the lowest expression of cornified enveloped proteins. Of all groups, Group 3 appeared to have the highest expressionof cornified enveloped proteins. In situ hybridization of loricrin and filaggrin, expression were similar with results of immunohistochemical staining. CONCLUSION: Our results provide that cold impairs the skin's barrier permeability by having a negative effect on recovery of calcium gradient and differentiation of cornifed enveloped proteins. But occlusion with vapor permeable membranes such as Gore-Tex or petrolatum could improve conditions of skin barrier impaired by cold by restoring the recovery rate of calcium gradient and differentiation of cornified enveloped protein.
Animals ; Calcium ; Cold Temperature ; Dermatitis, Contact ; Epidermis ; Histocytochemistry ; Immunohistochemistry ; In Situ Hybridization ; Intermediate Filament Proteins ; Membrane Proteins ; Membranes ; Mice ; Mice, Hairless ; Permeability ; Petrolatum ; Polytetrafluoroethylene ; Protein Precursors ; Proteins ; Skin

BACKGROUND: Prolonged exposure of topical and systemic corticosteroid to skin can result in well-recognized cutaneous abnormalities including cutaneous atrophy, easy bruisibility, increased skin fragility, and increased risk of infection. Skin barrier impairment is also reported as a steroid-induced side effect. A major function of the skin is the formation of a permeability barrier between the external milieu and the organism. Recent studies have shown that chronic corticosteroid negatively impacts epidermal barrier function. As well as this topical corticosteroid not only has antiproliferative actions but also inhibits the differentiation of the epidermis, resulting in structural defects in the epidermis. OBJECT: We wanted to determine whether high dose systemic steroid injection would display adverse effects, specifically on; epidermal functions, permeability barrier homeostasis and stratum corneum integrity and cohesion. The basis for such changes was also to be determined. MATERIAL AND METHODS: Systemic steroid was administered by injecting each hairless mouse, 8-10 week of age, intraperitoneally with 0.3 mg triamcinolone acetonide, two times per week for five weeks. For the controlled hairless mice, 0.9% normal saline was administered by the same method of injection. Every week, transepidermal water loss (TEWL) was checked and skin biopsies were taken. Skin specimens were prepared for electron microscopy using both 0.25% ruthenium tetroxide and 4% osmium tetroxide postfixation. For light microscopy staining hematoxylin-eosin and ion capture cytochemistry was used. RESULTS: The results were as follows; 1. From about 1 week onwards, high dose systemic steroid usage produced visible cutaneous changes and significantly increased the TEWL in the group of 0.3 mg triamcinolone acetate injected hairless mice compared with the control. 2. Light microscopic observations of the steroid-injected hairless mice showed gradual thinning of the epidermis from about 2 weeks onwards, compared with the control. Loss of stratum corneum was also observed in the steroid injected hairless mice. 3. The ruthenium tetroxide staining of high dose systemic steroid treated specimens revealed that the lipid bilayer was impaired and fragmented from about 3 weeks. Intercellular spaces were widened and the lipid bilayer either disappeared or showed damage when compared with the control. 4. From about 3weeks onwards. electron microscopic studies revealed, not only a marked decrease in the number of lamellar bodies, but also an abnormal transformation of lamellar bodies in the steroid injected hairless mice compared with the control. 5. Throughout the five weeks, the calcium gradient gradually disappeared in the 0.3mg triamcinolone injected hairless mice compared with the control. Consequently, high dose systemic steroid use results in barrier dysfunction and morphological abnormalities.
Animals ; Atrophy ; Biopsy ; Calcium ; Epidermis ; Extracellular Space ; Histocytochemistry ; Homeostasis ; Lipid Bilayers ; Mice ; Mice, Hairless* ; Microscopy ; Microscopy, Electron ; Osmium Tetroxide ; Permeability ; Ruthenium ; Skin* ; Triamcinolone ; Triamcinolone Acetonide

A 9-year-old girl presented with fever, conjunctival injection, desquamation following erythema and edema of the fingers and toes, strawberry tongue, polymorphous rash and cervical lymphadenopathy. She showed palpable purpura on the lower extremities after 7 days of the onset of the above symptoms. She showed typical Henoch-Schonlein purpura concurrent with Kawasaki disease. There is no known report of a case of Henoch-Schonlein purpura concurrent with Kawasaki disease and evaluation of the same pathogenesis of the two diseases. We've got a clue from the facts that human parvovirus B19 could develope both of the diseases. But Human parvovirus B19 PCR was negative. We, herein, report an unusual case of Henoch-Schonlein purpura concurrent with Kawasaki disease.
Child ; Edema ; Erythema ; Exanthema ; Female ; Fever ; Fingers ; Fragaria ; Humans ; Lower Extremity ; Lymphatic Diseases ; Mucocutaneous Lymph Node Syndrome* ; Parvovirus B19, Human ; Polymerase Chain Reaction ; Purpura ; Purpura, Schoenlein-Henoch* ; Toes ; Tongue

Epidermodysplasia verruciformis(EV) is a rare, often familial disease, associated with human papilloma virus. It is characterized by long-lasting, wide-spread wart-like or pityriasis versicolor-like lesions from early childhood and in about one-third patients, cutaneous carcinomas develop in adult life. We report a case of 57-year-old male with EV, with lesions only on the left forearm and the hand, who had been exposed to Agent Orange during Vietnam War.
Adult ; Citrus sinensis* ; Epidermodysplasia Verruciformis* ; Forearm ; Hand ; Humans ; Male ; Middle Aged ; Papilloma ; Pityriasis ; Vietnam

Lobulated intradermal nevus is an unusual form of regressing melanocytic nevus. Clinically, it shows a lobulated plaque and biopsy specimens display fatty infiltration within nests of nevus cells, dermal fibrosis and neuroid differentiation of nevus cells. We report a case of lobulated intradermal nevus resembling linear epidermal nevus in a 45-year-old female patient.
Biopsy ; Female ; Fibrosis ; Humans ; Middle Aged ; Nevus ; Nevus, Intradermal* ; Nevus, Pigmented

Lichen striatus and linear lichen planus are rare disorders that can be confused because they share similar clinical and histopathologic findings. We report a case of lichen striatus on the left wrist and fingers in a 54-year-old woman, who was initially diagnosed with linear lichen planus. She had overlapping clinico-histopathologic features of both lichen striatus and linear lichen planus. To discriminate between the two disorders, careful histological and clinical evaluations are needed, especially when a lichen striatus-like eruption occurs in adults.
Adult ; Female ; Fingers ; Humans ; Lichen Planus ; Lichens* ; Middle Aged ; Wrist

Morphea is a subclass of localized scleroderma, and this is a connective tissue disorder that is limited to the skin and subcutaneous tissue. We report here on a case of a 43-year-old woman who presented with a solitary skin colored plaque in the vertex area. The histopathologic findings showed basal hydrophic changes of the basal cells, multiple melanophages in the upper dermis and broadened, compact, eosinophilic collagen fibers in the entire dermis. We finally made the diagnosis of morphea in the vertex, and the vertex is an unusual site for this disease.
Adult ; Collagen ; Connective Tissue ; Dermis ; Eosinophils ; Female ; Humans ; Scleroderma, Localized ; Skin ; Subcutaneous Tissue

Condyloma lata is a common manifestation of secondary syphilis, but involvement of the lip mucosa is rare. Nodular lesions, especially solitary nodules, are uncommon manifestations of secondary syphilis, and only a few cases have been described. Failure to recognize condyloma lata of the lip mucosa may delay diagnosis and treatment. A 20-year-old man presented with a 4-month history of a solitary nodule on his upper lip mucosa. A diagnosis of condyloma lata was made on the basis of serologic tests for syphilis and pathological findings. We report an interesting case of condyloma lata on the upper lip mucosa that showed an unusual clinical manifestation of secondary syphilis.
Humans ; Lip ; Mucous Membrane ; Serologic Tests ; Syphilis ; Young Adult