Relatively little is known about the neurobiology of insomnia, despite its wide prevalence and broad medical impact. Although much is still to be learned about the pathophysiology of the disorder, identification, systematic assessment, and appropriate treatment are clearly beneficial to patients. Recent research, using quantitative EEG, polysomnography (PSG), multiple sleep latency test (MSLT) and neuroimaging techniques, suggests that some broad areas can be identified as possible pathophysiological models. Sleep-wake homeostat model hypothesizes a failure in homeostatic regulation of sleep, an attenuated increase in sleep drive with time awake, and/or defective sensing of sleep need. Circadian clock model hypothesizes a dysfunctional circadian clock, resulting in changes in the timing of sleep-wake propensity that are incompatible with normal sleep. Intrinsic sleep-wake state mechanism model suggests that abnormal function of insomnia comprises the systems responsible for expression of the sleep states themselves. Extrinsic over-ride mechanism (stress-response) model suggests that insomnia reflects the consequences of overactivity of one of the systems considered "extrinsic" to normal sleep-wake control. Many current therapies for insomnia are based on these physiological models. Several attempts have been made to create a physiological model that would explain this disorder and could be used as a foundation for treatment. However, it appeared that no model can fully explain and clarify all aspects of insomnia. Future research should be necessary to expand our knowledge on the biological dimensions of insomnia.
Circadian Clocks ; Electroencephalography ; Humans ; Neurobiology ; Neuroimaging ; Polysomnography ; Prevalence ; Sleep Initiation and Maintenance Disorders

BACKGROUND: Bacteriokiller system(BKS) produces disinfectant which is generated by the mixture of active oxygen and hypochlorous acid with tap water. Previous studies showed that BKS disinfectant is highly bacteridal against clinical isolates in in vitro testings and more effective than general soap and water for the disinfecttion of contaminated handa. This study was performed to evaluate ling-trem effects of BKS as a handwasing agent in clinical settings. METHODS: Five BKS were installed for the 9-month period from June 1995 to February 1996 in 16-bed Neurosurgery Intensive Care Unit. Handwashing was frequency was observed after 1, 6, and 8 month of BKS use. Six-month incidences of nosocomial infecrion before and after BKS installation were compared to evaluate the possible effect of handwashings on nosocomial infection rates. A self-administered questionaire was used to collect data on handwashing frequency and their opinions of the BKS disinfectant at 2 and 8 months after the installation. RESULTS: Handwashing frequency of healthcare workers(HCWs) before and after patient contacts was increased from 34.1%(137/402) to 50.3%(193/384) (p<0.00001). At the same time, the 6-month nosocomial infection rate was down to 10.5%(43/411) from the pre-BKS rate of 13.0%( 51/431) and the patient-day rate was also decreased from 18.3(56/3068) to 15.1(43/2,844). Most (80.5%) of HCWs thought that BKS promote handwashing and "convenience" was the main reason for more frequent handwashing. Ninety three percent of HCWs would recommend the replacement of tne existing sinks and handwashing disinfectants with BKS. NO adverse skin reaction were reported after 8 months. Conclusions: BKS appears to promote handwashing because it is easy to use with no skin irritation and may contribute toward the prevention of nosocomial infections.
Cross Infection ; Delivery of Health Care ; Disinfectants ; Hand Disinfection ; Humans ; Hypochlorous Acid ; Incidence ; Intensive Care Units ; Neurosurgery ; Reactive Oxygen Species ; Skin ; Soaps

No abstract available.
Animals ; Babesiosis* ; Clindamycin ; Humans ; Male* ; Quinine

No abstract available.
Animals ; Babesiosis* ; Clindamycin ; Humans ; Male* ; Quinine

When the hypopharynx is examined in the frontal view during modified Valsalva maneuver after barium swallow anoutpouching of the lateral wall of the hypopharynx resembling a deverticulum is commonly observed. Review of theliterature however fails to disclose provious documentation of systematic prospecative observation of this phenomenon. The present study has been undertaken to detemine the incidence and degree of outpouching according tothe age and sex and to assess the clinical implication of the outpouching. The clinical materials consist of 100 consecutive cases of routine upper GI series with a particular effort directed to induce hypopharyngeal out pouching by a modified Valsalva maneuver at the Department of Radiology, St. Mary's Hospital, Catholic Medical College during 6 months period from Jan. 1982. Technically, outpouching was best demonstrated in the erectposition with a slight extension of the neck during the pharyngeal phase of barium swallowing while the subjectwas instructed to blow through the closed lips. Observation were made ofhhte incidence and intensity of theoutpouching by an arbitrary line drawning to measure the depth of outpouchings. Our study revealed thathypopharyngeal outpouchings occure bilaterally in every case studied. There was definite dominancy on the rightside(p<0.01) and the outpouching was greater in intensity in male (p<0.05) and the depth varied from a few to 15mm. And there was no statistically significant difference according to the age. Outpouchings collapsed and disappeared completely after release of Valsalva maneuver and did not appear to produce any clinical symptoms. The reason of right-side dominancy should further be investigated.
Barium ; Deglutition ; Humans ; Hypopharynx ; Incidence ; Lip ; Male ; Neck ; Spectinomycin ; Valsalva Maneuver

BACKGROUND: Alopecia areata is a common dermatologic disorder and the course is so variable that some patients undergo spontaneous remission and others undergo total hair loss. There is no clearly superior therapy in the treatment of alopecia areata. The theory of autoimmune pathogenesis of alopecia areata suggests a potential therapeutic effect of cyclosporine. OBJECTIVE: We evaluated the therapeutic effect of oral cyclosporine combined with other modalities in severe and refractory alopecia areata. METHOD: 28 patients(M:16, F:12) with severe or refractory alopecia areata were treated with oral cyclosporine 3-4 mg/kg/day, oral prednisolone 5 mg/day, topical steroid and minoxidil for at least 3 months. Subjects were composed of 12 multifocal alopecia areata patients, 10 alopecia totalis patients, and 6 alopecia universalis patients. Blood pressure, CBC/DC, liver function test, BUN/Cr, Na/K/Cl, lipid series, and urinalysis were checked to avoid any side effects. RESULTS: 1. Of the 28 patients, 20 patients(71%) showed new hair growth, 5 patients(18%) did not respond to therapy and 3 patients(11%) were not available for follow up exams. 2. Mean time until new hair growth was 2.5 months. 3. Side effects occurred in 13 patients(47%), and they were as follows: 4 patients with hypertrichosis, 4 patients with gastrointestinal disturbances, 2 patients with abnormal urinalysis, and 3 patients with lipid series abnormality. 4. Three patients discontinued therapy due to side effects of 2 beause hypertrichosis and 1 because of abnormal urinalysis. CONCLUSION: Cyclosporine combination therapy is recommended in severe and refractory alopecia areata. Side effects were observed in 13 patients, but most of them were mild and transient. Severe side effects can be prevented by careful monitoring.
Alopecia Areata* ; Alopecia* ; Blood Pressure ; Cyclosporine* ; Follow-Up Studies ; Hair ; Humans ; Hypertrichosis ; Liver Function Tests ; Minoxidil ; Prednisolone ; Remission, Spontaneous ; Urinalysis

Although rabbits are common domestic pets, severe respiratory allergic reactions to rabbits in households are unusual. Ory c 1, a 17-kDa glycoprotein found in saliva and fur, has previously been identified as a major rabbit allergen. In this report, we describe the cases of three patients with rabbit allergy who presented with asthma and/or rhinitis while living in households with detectable levels of serum-specific IgE and major IgE binding components. Three patients with rabbit allergy and 18 unexposed nonatopic healthy controls were enrolled. Enzyme-linked immunosorbent assays (ELISA) for serum-specific IgE and IgG4 to rabbit epithelium and inhibition ELISA were performed followed by sodium dodecye sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and IgE immunoblotting. All three patients with rabbit allergy had high serum-specific IgE antibody levels compared with controls. The results of the inhibition ELISA showed significant inhibition with the addition of rabbit epithelium, whereas no significant inhibition was noted with the addition of cat and dog epithelia. Two IgE-binding components with molecular weights of 16 kDa and 67.5 kDa were identified by IgE immunoblotting. In conclusion, rabbit exposure may induce IgE-mediated bronchial asthma and/or rhinitis in domestic settings.
Adolescent ; Adult ; Allergens/*blood ; Animals ; Asthma/*immunology/metabolism ; Electrophoresis, Polyacrylamide Gel ; Enzyme-Linked Immunosorbent Assay/methods ; Female ; Humans ; Hypersensitivity/*immunology/metabolism ; Hypersensitivity, Immediate/immunology ; Immunoblotting ; Immunoglobulin E/*blood/*chemistry ; Immunoglobulin G/chemistry ; Male ; Rabbits ; Rhinitis/*immunology/metabolism

Nevus sebaceus is a hamartoma of the skin with the potential to develop benign and maligmant neoplasms. Trichoblastoma is a benign neoplasm that consists of follicular germinative cells. We report a case of trichoblastoma arising from nevus sebaceus in a 22-year old female, who showed a dome-shaped, solitary nodule within yellowish hairless plaque on the occipital area. Histopathologic findings revealed tumoral lobules of basaloid cells affecting the full thickeness of the dermis. Some lobules had at their centers cystic cavities filled with large amounts of melanin. Tumoral lobules of the deeper part of the neoplasm were surrounded by hyalinized collagen bundles with immature fibroblast. The overall architectures was reminiscent of hair bulbs.
Collagen ; Dermis ; Female ; Fibroblasts ; Hair ; Hamartoma ; Humans ; Hyalin ; Melanins ; Nevus* ; Skin ; Young Adult

Hydroxychloroquine, an 4-amino-quinoline, has been used widely for the treatment of lupus erythematosus due to its anti-inflammatory and immuno-modulatory activities, as well as for the treatment of malaria. A 37-year-old woman who was suspected as lupus erythematosus and treated with hydroxychloroquine for 3 weeks was seen with exfoliated annular patches and pustules on the trunk, neck, and extremities. Histological examination showed subcorneal and spongiform neutrophilic pustules with perivascular lymphocytes, eosinophils and neutrophils infiltrations. The patient had been treated with systemic steroid and antihistamine. The pustular lesions had improved 2 weeks later without recurrence. The causative drug was confirmed by a positive patch test.
Acute Generalized Exanthematous Pustulosis ; Adult ; Eosinophils ; Extremities ; Female ; Humans ; Hydroxychloroquine ; Lymphocytes ; Malaria ; Neck ; Neutrophils ; Patch Tests ; Recurrence

It has been widely accepted that the detachable balloon catheter technique is the treatement of choice in thecarotid-cavernous fistula and in the unclippable giant aneurysm at the cavernous or petrous portion of theinternal carotid artery. The authors successfully treated one case of the carotid-carvernous fistula and one caseof giant aneurys, located in petrous portion of the internal carotid artery using Debrun's latex datachableballoon catheter technique. In thecase with carotid-cavernous fistula, the only fistula was occluded with adetachable balloon, presserving the intrenal carotid artery. In the aneurysm case, both internal carotid arteryand aneurysm itself were completely occluded with 3 latex detachable balloons. Both patients have nocomplications. The authors will describe and discuss the Debrun's latex detachable balloon catheter technique.
Aneurysm ; Carotid Arteries ; Carotid Artery, Internal ; Catheters ; Fistula ; Humans ; Latex