Syndromal acanthosis nigricans is associated with cellular resistance to the action of insulin and other endocrinopathies. In the insulin resistant state, increased insulin binds to the receptors of insulin-like growth factors (IGFs). IGFs are growth prompting peptides, which act as direct mitogens on cells containing the receptors. Through these actions, increased cellular growth and metabolism cause the skin lesions of acanthosis nigricans. Hyperandrogenism is also found in syndromal acanthosis nigricans patients. When associated with insulin resistance, these states are proportionally related. Increased insulin prompts the synthesis of androgen and conversely, increased androgen elevates the insulin resistance. We present three cases of syndromal acanthosis nigricans with hyperpigmented skin lesions and obesity. Laboratory findings demonstrated normal fasting blood suga levels with increased insulin and C-peptide levels and decreased insulin receptors. The oral glucose tolerance test was normal. We suggest that these patients were in an insulin resistant state. Skin biopsies from the axilla in all three cases showed hyperkeratosis, irregular acanthosis and upward projection of dermal papillae as finger like fashion. Thus all three cases represent syndromal acanthosis nigricans associated with an insulin resistant state based on clinical, histopathological, and laboratory findings. The three patients were treated with dietary control.
Acanthosis Nigricans* ; Axilla ; Biopsy ; C-Peptide ; Fasting ; Fingers ; Glucose Tolerance Test ; Humans ; Hyperandrogenism ; Insulin Resistance* ; Insulin* ; Metabolism ; Mitogens ; Obesity ; Peptides ; Receptor, Insulin ; Skin ; Somatomedins

Aneurysms of peripheral pulmonary arteries are uncommon. It may appear as a coinlesion in a plain chest film. In general, a popular and effective method for pathologic diagnosis of solitary lung lesion is needle aspiration biopsy, a technique which is safe in most instances. Also, ultrasonograhic or fluoroscopic methods are needed for the evaluation of this lesion. If pulmonary artery aneurysm is untreated, the prognosis of this disease is poor. Sixty percents of the patients with pulmonary artery aneurysm died following rupture of the aneurysm. Surgical correction is the preferred treatment. We are reporting a case of pulmonary aneurysm with the review of literature.
Aneurysm* ; Biopsy, Needle ; Diagnosis ; Humans ; Lung ; Needles ; Prognosis ; Pulmonary Artery* ; Rupture ; Thorax ; Tuberculosis

No abstract available.
Aortic Coarctation*

BACKGROUNDS: The first step for the recovery of alcoholics is the formation of true insight which enables them to admit that they are alcoholic. This study was designed to analyze the changes in insight status by treatment programs. METHOD: The subjects were 214 alcohol dependents who participated in the insight-oriented treatment programs for at least 1 week. Their insight status were measured through HAIS before and after treatment. RESULTS: Of 214 subjects, 83 (38.8%) were in poor-, 103 (48.1%) in fair-, and 28 (13.1%) in good-insight before treatment, and 56 (26.2%) in poor-, 97 (45.3%) in fair-, and 61 (28.5%) in good-insight after treatment. Mean HAIS scores of the subjects were 5.35 (SD=8.33) before treatment and significantly increased to 9.00 (SD=8.04) after treatment. The magnitude of insight-improvement was negatively correlated with the HAIS scores before treatment in poor-insight group and positively correlated with the duration of participation in treatment in fair-insight group. CONCLUSION: We confirmed the fact that the insight status of patients could be improved by treatment. It was also suggested that the therapeutic strategy needed an individual approach according to the insight state of a patient.
Alcoholics ; Alcoholism* ; Humans

This study was conducted to evaluate the health hazards and to develop early diagnostic methods of the manganism in experienced welders and to know the meaning of signal intensities on the brain Magnetic Resonance images. It was carried out from December 1996 to February 1997 with 277 male welders, the duration of welding was at least 5 years or more. The study was consisted of a questionnaire, physical examination and measurements of blood and urine manganese concentrations. Brain Magnetic Resonance imaging was done on 19 study subjects by random sampling. As the duration of welding increases, the positive rates of clinical symptoms, neurological examinations and blood manganese concentrations were also increased. However, physical examinations and urine manganese concentrations were not statistically significant with the duration of welding. Authors couldn't observe any Parkinsonism-like diseases. There were statistically significant correlations between duration of welding and blood manganese concentrations(r=0.16, p<0.01). There were not statistically significant correlations between duration of welding and urine manganese concentrations(r=0.06). There were statistically significant correlations between blood and urine manganese concentrations(r=0.34, p<0.01). By viewing brain Magnetic Resonance images, 13 welders(68.4 %) among 19 welders were found to have signal intensities. The positive rates of clinical symptoms, physical examinations, neurological examinations and blood and urine manganese concentrations were not statistically different between those with signal intensities and those without signal intensities. We would like to suggest that some non-specific clinical symptoms and neurological signs are correlated with the duration of welding but any Parkinsonism-like diseases had not been observed with these welders. Next we suggest that the high signal intensities on T1WI of brain Magnetic Resonance images are not the sign of manganese intoxication but the sign of manganese deposition.
Brain ; Humans ; Magnetic Resonance Imaging ; Male ; Manganese* ; Neurologic Examination ; Physical Examination ; Surveys and Questionnaires ; Welding

To evaluate the effect of manganese on the respiratory system, we investigated the respiratory symptoms of 63 male workers exposed to fume containing manganese (Mn), iron (Fe), and silica (Si), and compared them with those of 66 male workers not exposed to the fume in a manganese alloy smelting factory. The prevalence ratios of the seven respiratory symptoms were not different between two groups. The presence of any respiratory symptom was not related with the age, duration of employment, smoking status of workers, and exposure to fume. In furnace workers, it was not related with the airborne Mn, Fe, and Si concentration in the total or respirable fume. Airborne Mn concentrations of all 4 furnaces in the respirable fume were below 1 mg/m(3). There were two suspicious cases of pneumoconiosis among furnace workers and one definite case(1/2) among casting workers who were not exposed to fume. The above results suggest that the exposure to the low airborne Mn concentration is not related with respiratory symptoms and pneumoconiosis. However, it is necessary to study the respiratory effects of Mn using the symptom questionnaire with consideration of the severity and persistence of symptoms and the time interval from exposure.
Alloys ; Employment ; Humans ; Iron ; Male ; Manganese* ; Osmeriformes ; Pneumoconiosis ; Prevalence ; Surveys and Questionnaires ; Respiratory System ; Silicon Dioxide ; Smoke ; Smoking

To report a case of Boucher-Neuhauser syndrome, which is an autosomal recessive disorder characterized by the triad of spinocerebellar ataxia, chorioretinal dystrophy, and hypogonadotropic hypogonadism. An 18-year-old man was seen for visual problems, which had been diagnosed as retinitis pigmentosa at the age of 12 years. His puberty was delayed. At 16 years of age, the patient experienced progressive deterioration of his balance and gait disturbance. Then he was referred to our clinic because Boucher-Neuhauser syndrome was suspected. He had no specific family history; his visual acuity was 0.04 in both eyes. We observed broad retinal pigment epithelium atrophy and degeneration in both fundi. Both fluorescein and indocyanine green angiography showed choriocapillaris atrophy in the posterior pole area and midperiphery. Macular optical coherence tomography showed thinning of the neurosensory retina. An electroretinographic examination showed no photopic or scotopic responses. The Boucher-Neuhauser syndrome should be included in the differential diagnosis of patients with retinitis pigment epithelium atrophy and degeneration.
Adolescent ; Atrophy ; Cerebellum/pathology ; Coloring Agents/diagnostic use ; Electroretinography ; Fluorescein Angiography ; Humans ; Hypogonadism/*diagnosis/genetics ; Indocyanine Green/diagnostic use ; Magnetic Resonance Imaging ; Male ; Photoreceptor Cells, Vertebrate/physiology ; Retinal Degeneration/*diagnosis/genetics ; Retinal Pigment Epithelium/*pathology ; Retinitis Pigmentosa/*diagnosis/genetics/physiopathology ; Spinocerebellar Degenerations/*diagnosis/genetics ; Syndrome ; Tomography, Optical Coherence

Injuries to the menisci occur in a variety of ways, most commonly with a twist, pivot, squat, or valgus stress to the knee. Tear patterns are classified to longitudinal, horizontal, or transverse features according to the mechanism of injury. Work-related meniscal tear usually occurs with a repetitive usage of the foot, hence it can be classified as a cumulative traumatic disorder. We found a 47 year-old female worker who had been taking charge of repetitive foot-switch stepping for 8 years. She suffered from pain in the right knee since 5 months ago. Tenderness along the medial joint line of the right knee was observed and pain was aggravated with full flexion of the right knee. On magnetic resonance imaging, high signal intensity was observed at the posterior horn of the medial meniscus of the right knee. Degenerative longitudinal and transverse complex tear in the medial meniscus was observed on arthroscopy. Arthroscopic partial meniscectomy was performed. We surveyed the work process and the health status of co-workers. It turned out that the work process was compatible to injure the meniscus and nine out of fourteen co-workers(64.3%) complained pain of the knee. No other factors related to her meniscal tear could be found except for the situation at her work. Therefore, we conclude that meniscal tear is related to the repetitive stepping of foot switch.
Animals ; Arthroscopy ; Female ; Foot ; Horns ; Humans ; Joints ; Knee ; Magnetic Resonance Imaging ; Menisci, Tibial ; Middle Aged

Ectopic pancreas is defined as being the presence of pancreatic tissue outside its usual or habitual location and without anatomic relation either of continuity or of vascularization with the pancreatic proper. The most common developing sites are the stomach(especially greater curvature of antrum), duodenum and proximal jejunum. Most lesions do not cause any clinical symptoms, but sometimes nonspecific significant symptoms appear. We report 2 cases of ectopic pancreas located in the pyloric region in a 13 year-old girl and a 12 year-old boy who had symptoms of epigastric pain, nausea, vomiting and dyspepsia. Gastrofiberscopy revealed 2 cm sized submucosal mass with double circular folds and 0.8 cm sized submucosal polypoid mass with central umbilication in the posterior wall of the pyloric region respectively. Wedge resections were performed, although the 12 year-old boy required a second operation due to pyloric obstruction. Histologic findings showed pancreatic acini and Langerhan's islet within gastric submucosa and muscle layer, and pancreatic acini and duct within gastric submucosa layer respectively. Symptoms disappeared after complete removal of the ectopic pancreas by operation.
Adolescent ; Child ; Duodenum ; Dyspepsia ; Female ; Humans ; Jejunum ; Male ; Nausea ; Pancreas* ; Vomiting

OBJECTIVES: The presence of chronic low oxygen delivery to the tissues (blood flow X Hb concentration X arterovenous oxygen content difference) in patients with chronic lung disease (CLD) leads to a aggravated dyspnea. Therefore, total oxygen delivery to the tissues is a reverse correlation with severity of dyspnea. So far, the treatment of patients with CLD has been limited to only the increase of ventilation and perfusion capacity. However, this study focused on the capacity of oxygen delivery to the tissues in patients with CLD. We measured blood oxygen parameters as one of the extended approaches. METHOD: Simultaneous arterial and venous blood samples from 15 patients with CLD at rest were evaluated for 2.3-DPG, CO-Hb (Carboxy-monohe-moglobin), Met-Hb (methomoglobin), ABGA (Arterial blood gas analysis), VBGA (Venous blood gas analysis) and Hb (Hemoglobin). Smokers and patients with other disease were excluded from the study in order to avoid the factors (2.3-DPG, CO-Hb etc.) which can shift the oxygen dissociation curve. There were 12 men and 3 women, ranging in age from 40 to 75 years. The disease onset varied from 3 years to more than 30 years. RESULTS: 1) As total oxygen delivery to the tissues decreased, Ao2(Arterial oxygen partial pressure) and A-VCb (Arteriovenous oxygen content difference) decreased, while 2.3-DPG increased. Total oxygen delivary to the tissues showed a significant correlation with more A-V and 2.3-DPG than AO2. 2) AO2 had a correlation with A-VO2 but AO2 did not clearly reflect A-VO2. 3) 2.3-DPG activity depended on more A-VO2 than AO2. 4) As A-VO2 decreased, there was more significant relationship among 2.3-DPG, A-VO2 and tissue oxygen delivery. 5) A-VO2 showed a significant reverse correlation with 2.3-DPG as well as Met-Hb % + CO-Hb %. 6) ACO2 (arterial carbon dioxide partial pressure) showed a correlation with 2.3-DPG as well as A-VO2. 7) Arterial PH did not correlate with 2.3-DPG as well as A-V. CONCLUSION: 1) AO2 in patient with CLD correlated with A-VO2 but AO2 did not clearly reflect A-V. 2) Total oxygen delivery (severity of dyspnea) showed a significant correlation with more A-VO2 and 2.3-DPG than AO2. 3) 2.3-DPG activity depended on more A-VO2 than AO2. 4) 2.3-DPG activity had a reverse correlation with A-V in spite that 2.3-DPG shifts the oxygen dissociation curve to the right, because 2.3-DPG shift is secondary change associated with the low oxygen delivery to the tissues, More extensive k prospective investigations are needed to clearly define correlation among A-VO2, 2.3-DPG and prognosis of patients with CLD.
Carbon Dioxide ; Dyspnea ; Female ; Humans ; Hydrogen-Ion Concentration ; Lung Diseases* ; Lung* ; Male ; Oxygen* ; Perfusion ; Prognosis ; Ventilation