Narcolepsy is a sleep disorder, which is characterized by excessive daytime sleepiness (EDS) that is typically associated with cataplexy, sleep fragmentation and other REM sleep-related phenomenon such as sleep paralysis and hypnagogic hallucination. Narcoleptic symptoms can be developed from various medical or neurological disorders. A 17-year-old male patient admitted for the evaluation of EDS which started three-month ago. He slept more than 18 hours a day with cataplexy and hypnagogic hallucination. He was obese with body mass index (BMI) of 30.4 kg/m2. After admission he was newly diagnosed to the thyrotoxicosis. T3 391.2 ng/dL (60-181), free T4 4.38 ng/dL (0.89-1.76), TSH <0.01 microIU/mL (0.35-5.5) were measured. His pulse rate ranged 70-90 beats per minute and blood pressure ranged 150/100-120/70 mmHg. Polysomnography revealed many fragmentations in sleep with many positional changes (81 times/h). Sleep onset latency was 33.5 min, sleep efficiency was 47.9%, and REM latency from sleep onset was delayed to 153.6 min. REM sleep percent was increased to 27.1%. Periodic limb movement index was 13.4/h. In the multiple sleep latency test (MSLT), average sleep latency was 0.4 min and there were noted 3 SOREMPs (Sleep Onset REM sleep period) on 5 trials. We couldn't discriminate the obvious sleep-wake pattern in the actigraph and his HLA DQB1 *0602 type was negative. His thyroid function improved following treatment with methimazole and propranolol. Vital sign maintained within normal range. Cataplexy was controlled with venlafaxine 75 mg. Subjective night sleep continuity and PLMS were improved with clonazepam 0.5 mg, but the EDS were partially improved with modafinil 200-400 mg. Thyrotoxicosis might give confounding role when we were evaluating the EDS, though sleep fragmentation was one of the major symptoms of narcolepsy, but enormous amount of it made us think of the influence of thyroid hormone. The loss of sleep-wake cycle, limited improvement of EDS to the stimulant treatment, and the cataplexy not supported by HLA DQB1 *0602 should be answered further. We still should rule out idiopathic hypersomnia and measuring CSF hypocretin level would be helpful.
Adolescent ; Benzhydryl Compounds ; Blood Pressure ; Body Mass Index ; Cataplexy ; Clonazepam ; Cyclohexanols ; Extremities ; Hallucinations ; Heart Rate ; HLA-DQ beta-Chains ; Humans ; Hypersomnolence, Idiopathic ; Intracellular Signaling Peptides and Proteins ; Male ; Methimazole ; Narcolepsy ; Nervous System Diseases ; Neuropeptides ; Polysomnography ; Propranolol ; Reference Values ; Sleep Deprivation ; Sleep Paralysis ; Sleep, REM ; Thyroid Gland ; Thyrotoxicosis ; Vital Signs ; Orexins ; Venlafaxine Hydrochloride

Lymph nodes, one of peripheral lymphoid organs, are the sites, where the lymphocytes receive their initial instructions for producing effector functioning resulting in humoral or cell-mediated immunity. Each lymph node consists of an outer cortex in which there are aggregates of cells constituting the follicles, B-cell areas. Some follicles have central areas called germinal centers, which stain lightly. Germinal centers are B lymphoblast cell areas arising eccentrically in primary lymphoid follicles in response to T-cell dependent antigenic stimulation and are the generally accepted sites of generation of memory B cells and undergoing isotype switching and somatic mutation. We observed the morphologic, cellular, protein and molecular events arising in mouse popliteal lymph nodes in response to T-cell dependent antigenic stimulation. In this study mice were immunized into footpads with TNP-chicken ovalbumin. The germinal center formation in primary follicles of popliteal lymph nodes was first observed 6 days after immunization and germinal centers persisted until 24 days of immunization. Lymph node cells were stained with PE-labeled anti-B220 antibody and/or FITC labeled PNA and analyzed by using FACScan. B cells (B220(+) cell) in lymph node increased after 3 days and peaked between 6 and 18 days after immunization. The proportion of germinal center B cells (B220, PNA(high) cells) among lymph node B cells was low (2%) before immunization but increased at day 6 (9%) and reached the peak (30%) at day 18. The expression of IgG1 productive mRNAs and germline transcripts were observed by using RT-PCR. The expression of IgG1 productive mRNA was detected at day 10 and continued until 24 days after immunization. The expression of IgG1 germline transcripts was observed 10 days after immunization and rapidly declined over the next one week. IgG1 anti-TNP antibody, main isotype of anti-TNP antibodies, was first detected at day 14 and reached the peak level 24 days after immunization. Taken these data together, we can conclude that the first immunological event observed from mouse popliteal lymph node in response to T-cell dependent antigenic stimulation is the increase in the number of B cells, and this event is followed by appearance of germinal center B cells and at the same time by the formation of germinal center in primary lymphoid follicles. Once the germinal center is formed, the process of isotype switching to IgG1 occurs in lymph node and antigen-specific IgG1 antibody is produced.
Animals ; Antibodies ; B-Lymphocytes ; Fluorescein-5-isothiocyanate ; Germinal Center ; Immunity, Cellular ; Immunization ; Immunoglobulin Class Switching ; Immunoglobulin G ; Immunoglobulins* ; Lymph Nodes* ; Lymphocytes ; Memory ; Mice ; Ovalbumin ; RNA, Messenger ; T-Lymphocytes

Venous island flap has many advantages over other flaps, such as random pattern flap, island flap or free flap. It can cover the defect with wide arc of rotation and does not require vessel anastomosis and arterial pedicle, hence more sites are available for donor. The procedure is a time saving and simple procedure and can be performed even by two operating members. But it is not frequently used because of the poor survival of the flap. In this study, we attempted to allow whether pharmacological or delay procedure can enhance the survival of the venous island flap and the mechanism of the delay flap survival. We devised a model of venous island flap whose pedicle was a branch of central vein on the auricle of Newzeland white rabbit. SOD, allopurinol and SOD and allopurinol were given as pharmacological treatment and delay procedure was carried out to enhance the survival of the flap. For the study of survival mechanism of the delay flap, SOD levels of the delay and non-delay flap were observed by SOD 525 method. The results were as follows: 1. Allopurinol, SOD and, SOD and allopurinol improved the survival of the flap significantly. 2. Delay procedure improved the survival of the flap significantly. 3. The level of SOD in delay flap was higher than that of non-delay flap regardless of the site within the flap or time passage. In conclusion, it is inferred that the administration of allopurinol and SOD and surgical delay can enhance the survival of the venous island flap. In delay venous island flap, increased level of SOD within the flap seem to contribute to the increased survival of the flap.
Allopurinol ; Free Radicals* ; Free Tissue Flaps ; Humans ; Oxygen* ; Tissue Donors ; Veins

We report herein two cases of leukemia cutis. One case is a 54-year-old woman who came to our department with complaints of a solitary ulcerating nodule on her left leg that had been present for 2 months since prior to her visit. Through histopathological studies, the diagnosis of myelocytic leukemia cutis was made before the final diagnosis of acute myelocytic leukemia was made by hematological studies. When combined chemotherapy was finished, she was in a partial remission state and the nodule disappeared after 1 month of chemotherapy. The other case is a 77-year-old man having multiple infiltrative nodules on the right forearm and right thigh for 1 month prior his visit. He was diagnosed as having leukemia cutis for his skin lesions histopathologically. This was redefined as chronic myelomonocytic leukemia of the myelodysplastic syndrome with blastic transfor- mation by hematological examination. He developed septicemia and died 3 weeks after the dermato- logical diagnosis.
Aged ; Diagnosis ; Drug Therapy ; Female ; Forearm ; Humans ; Leg ; Leukemia* ; Leukemia, Myeloid ; Leukemia, Myeloid, Acute ; Leukemia, Myelomonocytic, Chronic ; Logic ; Middle Aged ; Myelodysplastic Syndromes ; Sepsis ; Skin ; Thigh ; Ulcer

A 26 year old female presented complaining of a pea-sized nodule on her left lower eyelid for 10 years duration. Histopathological study showed several cysts in the dermis surrounded by secretory cells. The cysts were filled with decapitatory secretions. Positive staining with carcinoembrynic an tigen(CEA) was detected by immunoperoxidase technique. These clinical and histopathological findings suggest apocrine hidrocystoma developed on the left lower eyelid.
Adult ; Dermis ; Eyelids ; Female ; Hidrocystoma* ; Humans ; Immunoenzyme Techniques

BACKGROUND: The number of nongonococcal urethritis(NGU) cases is exceeding more and more that of Gonorrhea in developeing nations and some of the developing countr es such as Korea. The best evidence for an etiologic role for Trichomonas Vaginalis is in nongonococcal urethritis. OBJECTIVE: We compared the effects of Tetracycline to Tetracycine and Metronidazole in the treatment of male patients with nongonococcal urethritis and wished to find out the incidence of Trichomon-as Vaginalis in male patients with nongonocaccal urethritis indirectly. METHOD: From January, ],989 to December, 1992, three hundred male patients with nongococcal urethritis(NGU) at the Venreal Disease Clinic of Choong-Ku Publi Health Center in Seoul were allocated randomly into one of two treatment regimens. and one hundred sixty eight patients were followed. RESULTS: Eighty(83.4%) of ninty six patients treated with Tetrac; cline, 500mg, PO, q.i.d. for 14 days were cured. Sixty two(86.2%) of seventy two patients treatec with Tetracycline, 500mg, PO, q.i. d. for 14 days and Metronidaole. 2.0gm, PO, for 1 day were cured. There is no significant different between the 2 groups in treated rates(P<0.05). CONCLUSION: It suggests that male patients with nongonococcal ure1hritis due to trichomoniasis are rare in Korea. This may be die to the fact that the incidence of trichorioniasis has been declining since the 1960s. It also suggests not only the need for further studies on tool is disease but also more studies on other causes of nongonocoqeal urethritis, its treatment and epidernio.ogical study.
Gonorrhea ; Humans ; Incidence ; Korea ; Male* ; Metronidazole* ; Seoul ; Tetracycline* ; Trichomonas vaginalis ; Urethritis

We herein report a case of Spitz nevus which occurred in a 6-year-old girl with acute lymphocytic leukemia. The lesion was a well delimited, symmetric, 1.0 * 1.0cm sized, dome-shaped light pinkish nodule with a shiny surface on her forehead. The histopathological findings of the excisional biopsy specimen revealed mild epidermal hyperplasia ; numerous uniform nests of spindle cells and epitheloid cells with sparce pigmentation along the dermoepidermal junction; colloid body-like eosinophilic globules ; multinucleated giant nevus cells in the epidermis and edema in the upper dermis. Since the complete excision of her lesion was accomplished, there have been no new lesions over the past year.
Biopsy ; Child ; Colloids ; Dermis ; Edema ; Eosinophils ; Epidermis ; Female ; Forehead ; Humans ; Hyperplasia ; Nevus ; Nevus, Epithelioid and Spindle Cell* ; Pigmentation ; Precursor Cell Lymphoblastic Leukemia-Lymphoma*

Herein we report a case of subungual osteochondroma in a male patient. Although there have been several reports about cases of subungual exostosis in Korea, a case of subungual osteochondroma had not been reported until now. Osteochcndromas are clearly different disease entities from exastosis in that they have diagnostic hyaline cartilaginous caps instead of the fibrocartilages in subungual exostosis. Additioaally, subungual osteochondroma is a very rare type having an incidence rate of less than 1% among all osteochondromas. Our patient was an 18-year-old male with a solitary woody mass on his right great toe that was painfuL A surgical excisional biopsy following a nail plate avulsion showed the characteristic hyaline cattilaginous caps enclosing bony trabecula connected with the inferior cortical bone.
Adolescent ; Biopsy ; Exostoses ; Humans ; Hyalin ; Incidence ; Korea ; Male ; Osteochondroma* ; Toes

riie snbjects werc 269 patients with uncomplicated gonococcal urethritis, who visited the Veiereal Disease Clinic of Choong-Ku Public Health Center in Fieoul from August to Decernber 1984. ()ni hundred and four of 108 patients treated with 1.anamycin, 2 gm, IM plus anipi illin,3.5 gm, p0 plus probenecid, 1 gm, PO regirrien recovered with 65(62. 5 post-gonococcal urethritis(PGlJ) and 4(3.7%) failed, One hundred and seven of III patients treated with kanamycin, 2 gm, IM plus talarnpicillin, 2 gm, PO plus probenecid, 1 gm, po regimen recovered with 71 (66. 4% ) post-goriococcal urethritis and 4(3. 6%) failed. It is suggeste,d that both these antibiotic comlbination regimens have similarly good effect in the treatment. of gonococcal urethritis.
Ampicillin* ; Humans ; Kanamycin* ; Probenecid* ; Public Health ; Talampicillin* ; Urethritis

From August to November 1985 244 bacteriologically proven male uncomplirated goncicoccal urethritis patients at the VD clinic of Choong-Ku Public Health Center form August to November 1985 were divided into group A and group B according to a random number sheet. In group A, treated with kanamycin 2.Ogm, im plus benzyl penicillin-G 5 mega units, im plus probenecid, 1.Ogm, PO; 112 of 121 patients were followed and 10 patients (8.9%) failed to be recovered. In group B, treated with kanamycin, 2,Ogm, im plus trimethoprim-sulfamethoxazole, 9 tahlets, PO; 112 of l23 patients were followed and 7(6.3%) failed. There is no sign.ificant difference between the two groups (p>0. 05) The failure rates in PPNG urethritis were 14.3% and 8.0% in group A and group B respectively. There is a signficant difference in failure rate between the two groups (P<0.05). It is suggested that, because of high rate of PPNG among circulating N.gonorrhoeae, the combinatioin regimen of kanamycin and trime.thoprim-sulfamethoxazole may be used as a first line treatrnent regimen for uncomplicated gonococcal urethritis.
Gonorrhea* ; Humans ; Kanamycin* ; Male ; Penicillin G* ; Penicillins* ; Probenecid* ; Public Health ; Trimethoprim, Sulfamethoxazole Drug Combination* ; Urethritis