A 20-year-old female, who had been treated with topical PUVA therapy for her vitiligo, developed characteristic skin lesions of disseminated superficial artiric porokeratosis(DSAP). All of her three sisters had vitiligo and had been treated with topica PUVA, hut only one developed DSAP lesion. Her mother had had DSAP lesions on expcsec areas for 20 years. DSAP shows an autosomal dominant mode of inheritance, and is charaterized by multiple ciark brownish keratotic papaules surrounded by slightly elevatied order. The exacerbation of the lesion by exposure t.o UV lignt indicates that the regulatingene for DSAP is related to sunlight. 1-lerein we reported a case of DSAP induced by topica] PUVA therapy in one patient during management of familial vitiligo in 3 sisters.
Female ; Humans ; Mothers ; Porokeratosis* ; PUVA Therapy ; Siblings ; Skin ; Sunlight ; Vitiligo* ; Wills ; Young Adult

Mycetoma is a clinical syndrome of localized, indolent, deforming, swollen lesions and sinuses, involving cutaneous and subcutaneous tissues, fascia, and bone. Its lesions. are composed of suppurat.ing abscesses, granulomata, and dra ning sinuses and the etiologic agents are wide variety of bacteria (actinomycotic mycetoma) and fungi(eumcotic mycetoma) from plant and soil. The patient was a 65-year-old female and a farnier. She was referred by the skin lesion loalized on the dorsum of her lefther left hand and wrist for three months. It showed multiple subcutaneclis nodules, abscesses, and discharging fitula based on the erythematous plaque. The skin biopsy frorn the lesion revealed the PAS positive hyphae in the granulocytic infiltration. Fungus cult,ure with a piece of tissue on sabouraud media shows hin, floccose, white colonies. Slide culture and biochemical idcrtification of pathogen led to the final diagnosis as Mycetoma caused by Pseudallescheria boydii(Monosporium apiospermum). The lesions disappeared gradualy following systemic oral administratior of Itraconazole 200mg daily for six weeks.
Abscess ; Aged ; Bacteria ; Biopsy ; Diagnosis ; Fascia ; Female ; Fungi ; Hand ; Humans ; Hyphae ; Itraconazole ; Mycetoma* ; Plants ; Pseudallescheria* ; Skin ; Soil ; Subcutaneous Tissue ; Wrist

An etiologic agent in seborrheic dermatitis is now considered to be due to Pityrosporum ovale. The connection between the yeast and the disease has been clearly dernonstrated in a number of patients treatd with antifungal agents. However, the fact, that Pityrosporum ovale (Pityrosporum orbiculare) belongs to the normal human cutaneou. flora makes it difficult, to explain the role of the organism in seborrheic dermatitis. In this clinical study, twenty eight subjects were divided into two group by treatment regimen of topical 2% ketoconazole shampoo(TKS)and 0.3% prednisolone valerate solution (PVS). Before and during the four weeks treatment periods, the number of Pityrosporum ovale on the scalp were evaluated by scrub Giemsa staining method, which estimat,ed by score scale, under direct. microscopic examination. Also clinical symptoms including erythema, scales and itching were recorded by scores every week and compared between two treatment group. Topical application of 2% ketoconazole shampoo(TKS) is a very effective treatment regimen to reduce the yeasr cell score(from 5.8+1.3 to 1.8+1.4) than PVS(from 6.4+1.3 to 3.5+1.5), significantly(p<0.05). So the results of this study acconsistent with the view that density of Pityrosgourum ovale plays a role in the cause and course of seborcheic derrnatitis on the scalp. And antifungal agent(TKS) shows favorable effects ori tnis disease clinically and mycologically.
Antifungal Agents ; Azure Stains ; Dermatitis, Seborrheic* ; Erythema ; Humans ; Ketoconazole* ; Malassezia ; Prednisolone ; Pruritus ; Scalp* ; Weights and Measures ; Yeasts

PURPOSE: Septic arthritis of the knee is a relative rare complication of the arthroscopic anterior cruciate ligament reconstruction, but inadequate treatment of this complication may lead to a devastating conse- quence of a chronic infection. Moreover, no guidelines have been proposed for the treatment of patients with knee infections after the anterior cruciate ligament reconstruction. To determine the optimal diagno- sis and treatment recommendation, we performed this study. MATERIALS AND METHODS: We performed retrospective study of the knee joint infections after the arthroscopic anterior cruciate ligament reconstruction between August 1993 and August 1998, Of the 420 patients who reviewed arthroscopic ACL reconstruction during this period from one surgeon, we experi- enced 4 cases(0.95%) of postoperative deep infections of the knee. RESULTS: All 4 patients were male, and the average age was 32 years(range from 19 to 43). Two patients had acute(< 2 weeks), two patients had subacute infections(2 weeks to 2 months). The acute cases had more severe symptoms, and positive cultures from knee joint aspirates. All patients underwent immediate open(1 case), or arthroscopic irrigation and debridement. One patient underwent repeat irriga- tion and debridement. The graft was removed from all patients in acute cases. CONCLUSION: The clinical symptoms, and the infected organism were more helpful than the peripheral blood counts in the diagnosis of a deep infection of the knee. Arthroscopic lavage, and debridement com- bined with intravenous antibiotics were effective treatment options. Clinical symptoms were more severe in acute cases, and early graft removal is an adequate method of surgical treatment.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Anti-Bacterial Agents ; Arthritis, Infectious* ; Debridement ; Diagnosis ; Humans ; Knee Joint ; Knee* ; Male ; Retrospective Studies ; Therapeutic Irrigation ; Transplants

No abstract available.
Humans ; Tibial Nerve*

Brainstem auditory evoked responses(BAERs) were studied in thirty six patients with clinically definite vertebral-basilar transient ischemic attack(TIA). BAEP tests were performed relatively immediately after the ictus (48 hours) of vertebral-basilar TIA in twenty-three inpatients and in seven to fourteen days in thirteen outpatients. Among thirty six patients with vertebral-basilar TIA, abnormal BAER findings were detected in fourteen (38.8%). The abnormal BAEP findings were bilateral in eight (57.2%) and unilateral in six (42.8%). The BAER abnormalities revealed the prolongation of I-III interpeak latencies in eight (57.2%), of III-V interpeak latencies in three (21.4%), and of only I-V interpeak latencies in three (29.4%). The incidence of abnormal BAER findings were much more frequent in patients on whom the tests were studied relatively immediately after the ictus than in the others. The serial BAEP studied in one patient showed mild decrease of prolonged I-V interpeak latencies. Therefore it is concluded hat brainstem auditory evoked responses could be helpful in patients with vertebral-basilar TIA as a diagnostic test to complement the physical examination and differentiate from other diseases of similar symptomatology.
Brain Stem* ; Complement System Proteins ; Diagnostic Tests, Routine ; Evoked Potentials, Auditory* ; Humans ; Incidence ; Inpatients ; Ischemic Attack, Transient* ; Outpatients ; Physical Examination

This study was performed to account for the hyponatremic phenomenon in patients with subarachnoid hemorrhage (SAH) and to discuss the concept of SIADH which has been disputed as a responsible mechanism. The diagnosis of SAH was made by brain CT scans and the patients were managed under the protocol now being used in Seoul National University Hospital. Blood voulmes were measured in six hyponatremic (Na+<135mEq/L) patients with SAH, by using radioiodinated-human serum albumin (125-RIHSA) and claculating with Dilution Method. The same measurements were made in two control groups also. Group-I was composed of six subjects without SAH, who were given no diuretics and were neither fluid-restricted nor bed-ridden. Group-II comprised six eunatremic patients with SAH or ICH, who were managed under the same protocol as in the hyponatremic group. Mean blood volumes (ml/kg) of the hyponatremic group (RCV, 19.5+2.1; PV, 34.2+4.1; TBV, 53.7+4.2) were significantly contracted in comparison with both control groups. As for mean plasma and total blood volume, two control groups showed no significant difference statistically. Therefore the effect of mannitol on natriuresis and water excretion seemed negligible, if normal saline had been replaced as in the protocol. Considering the above findings, the remarkable contraction of blood volumes in the presence of hyponatremia in the patients with SAH could not be explained in the view of SIADH which is usually associated with increased blood volume. In conclusion the suggested mechanism of hyponatremia in SAH in this study seems the primary natriuresis with a resultant contraction of blood volume, which is probably caused by the damaged central nervous system. So, in the aspect of management of hyponatremia in the patients with SAH, both supplement of sodium and expansion of blood volume should be considered.
Blood Volume ; Brain ; Central Nervous System ; Diagnosis ; Diuretics ; Humans ; Hyponatremia* ; Inappropriate ADH Syndrome ; Mannitol ; Natriuresis ; Plasma ; Seoul ; Serum Albumin ; Sodium ; Subarachnoid Hemorrhage* ; Tomography, X-Ray Computed ; Water

DPH is a firstlined antiepileptic drug and its toxic symptoms are mainly due to cerebellar and brainstem dysfunction. We tested 22 BAERs in 11 patients with DPH intoxication at the Department of Neurology of Seoul National University Hospital from Nov. 1986 to Oct. 1987. BAER IPLs were measured and analysed, including follow-up tests in 4 patients, and the results obtained were as follows. 1. Nine (81.8%) of 11 patients showed abnormal findings in BAER (biliateral in six, unilateral in three) but 2 showed no abnormal, findings. 2. Prolongation of I-III IPL was noted in 14 of total tests (N=22), III-V in only one. Prolongation of I-V IPL was noted 12 tests but seemed to be due to prolongation of I-III IPL. 3. Follow-up tests in 4 patients showed that abnormal IPLs tended to be normalized by decreasing serum DPH levels in three but persisted in one. In colclusion, 9 of 11 patients with DPH intoxication showed BAER abnormalities and main abnormalities were prolongation of I-III IPL. Considered with the results of follow-up tests, for confirmation of its reversibility, large-scaled and prospective study with strict follow-up seemed to be required.
Brain Stem* ; Evoked Potentials, Auditory, Brain Stem* ; Follow-Up Studies ; Humans ; Neurology ; Seoul ; Sodium*

The authors reviewed the medical records of 78 patients diagnosed as amyotrophic lateral sclerosis (ALS) at the Department of Neurology of Seoul National University Hospital from January 1980 to June 1986. The clinical features, serum CPK value, electromyographic findings and muscle biopsy findings were analysed. Results obtained were as follows: 1. The mean age of onset was 44.4 (17-68) which was about 10 years earlier than that in the reports from other countires. The sex ratio (male to female) was two to one (52:26). 2. The most common from was conventional type (48.7%), followed by pseudopolyneuritic type (30.8%) and bulbar type (20.5%). 3. Muscle weakness (100%), muscle atrophy (97%), hyperreflexia (94%), fasciculations (82%), bulbar signs (67%), frontal release signs (31%), Babinski signs (27%) and sensory deficits (5%) were observed. Four cases with sensory deficits proved that they were accompanied with carpal tunnel syndromes. 4. The mean interval from onset to generalization of symptoms was shorter in bulbar type (10.6 months) than in non-bulbar type (16.6 months), suggesting a more progressive course in the former. 5. Serum CPK value was checked in 62 cases. An increase up to four times the normal value was observed in 17 cases (27%). 6. EMG (N=73) revealed such abnormal findings in 70 cases (95.9%) as increased insertional activities, fibrillations, positive sharp waves, reduced interfernece patterns, fasciculations and giant motor unit potentials. No abnormal findings were found in three cases, however. 7. Muscle biopsy (N=61) showed neurogenic atrophy with various changes in 56 cases (92%), massive fatty infiltration in 4 cases and muscle fascia only in one case.
Age of Onset ; Amyotrophic Lateral Sclerosis* ; Atrophy ; Biopsy ; Carpal Tunnel Syndrome ; Fascia ; Fasciculation ; Generalization (Psychology) ; Humans ; Medical Records ; Muscle Weakness ; Muscular Atrophy ; Neurology ; Reference Values ; Reflex, Abnormal ; Reflex, Babinski ; Seoul ; Sex Ratio

No abstract available.
Ankle*