BACKGROUND: Experience of awareness and recall during general anesthesia would be most distressing for patients. Especially for the cesarean section, medical team must consider both maternal awareness and fetal safety. Authors tried to know the possibility of propofol use as induction and maintenance agent of anesthesia for the cesarean section in respect of maternal awareness, recall and fetal safety. METHODS: Forty patients (ASA physical status 1, 2) were allocated randomly to either propofol (n=20) (P) or thiopental-enflurane (n=20) (T-E) group. We checked B.P, pulse rate, and the incidence of maternal awareness using the isolated forearm technique (IFT). The postoperative interview was conducted between 12~24h after operation. RESULTS: The incidence of maternal awareness signaled by flexing fingers in response to voice commands were significantly lower in the T-E group (20% after induction, no response during other times) than the P group (45% after induction, then 35%, 30%, after 5, 10 min delivery respectively). Seven patients had postoperative recall of introspective awareness in the P group but no patients in the T-E group. The 1 min Apgar score of the newborn were significantly lower in the P group than the T-E group but both groups were within normal range. CONCLUSIONS: Our date indicated that, in comparison with thiopental-enflurane, propofol infusion (6 mg/kg/h) were associated with a greater incidence of awareness during surgery and recall.
Anesthesia* ; Anesthesia, General ; Apgar Score ; Cesarean Section* ; Female ; Fingers ; Forearm ; Heart Rate ; Humans ; Incidence ; Infant, Newborn ; Pregnancy ; Propofol ; Reference Values ; Voice

A small proportion of diabetics treated with exogenous insulin, reportedly ranging from 0.1% to 2%, experience systemic allergic reactions to insulin. We saw a 55-year-old male patient with insulin-dependent diabetes mellitus who had developed an anaphylatic reaction immediately after subcutaneous injections of neutral protamine Hagedorn (NPH) human recombinant insulin. Skin tests with insulins and a passive transfer test demonstrated that his reaction was IgE mediated. Since there were no therapeutic alternatives, desensitization with insulin was done following a slow protocol. It was successful and he was able to resume insulin therapy. During two year follow-up period, he did not developed any adverse reaction to insulin.
Anaphylaxis* ; Diabetes Mellitus, Type 1 ; Follow-Up Studies ; Humans ; Hypersensitivity ; Immunoglobulin E ; Injections, Subcutaneous ; Insulin* ; Insulins ; Intradermal Tests ; Male ; Middle Aged ; Skin Tests

We report a case of a skin problem induced by a visual display t rminal in a 24-year-old female. The patient had erythematcn.is rashes, crusts on both zygomatic areas and upper eyelids with itching, burning and pain sensations after she had been exposed to her visual display terminal. After the cassation of exposure, her skin lesions were markedly improved. A proioction test with her own visual display terminal was positive.
Burns ; Exanthema ; Eyelids ; Female ; Humans ; Pruritus ; Sensation ; Skin* ; Young Adult

Bullae and sweat gland necrosis have been often described in patients with mental ges, whieh commonly alanifested as erythematous or vesicobullaus lesions on pressure sites. Histopathologically, the aecrosis of sweat glands is a characteristic 6nding. Generalized and/or loca1 tlssue bypoxia due to prolonged ieamobihxation may have resulted in these clinical and histopakological manifestations. To date, we have experielwed 15 cases with bulla and sweat gland necrosis. On admission, about half the patients had carbon monoxide poisoning, and the remainders had alcohol overdosage, drug inioxication, and others. A11 our patients had menfal changes caused by carbon wonoxide poisening, aleohol intoxication, and others. Abrupt erythematous swelling and/or vesicobullous lesione affected pressure sites in all patients. Three patietns had erythematoias lesiqms on non-pressure sites simuhtaneously. Histopathologic examinatians of 12 biopsy specimes showed the necrosis of the epidermis, intra- or sub-epidermal bulla, and/or sweat gland necrosis.
Biopsy ; Carbon ; Carbon Monoxide Poisoning ; Epidermis ; Humans ; Necrosis* ; Sweat Glands* ; Sweat*

Benign symmetric lipomat,osis is a rare disease of undetermined cause characterized by symmetric deposits of adipose tissue o:n the neck, upper trunk and abdomen. We report three cases of kienign symmetric lipomatosis, one of which is associated with alcoholic liver disease and the patient complained of a diffieulties in neck motion, All of them are about sixty year old men with history of frequent alcohol consumption. In histopathologic findings, the reticular dermis was completcly replaced by mature fat cells and there was a slight increase in vascular and fibrous elements.
Abdomen ; Adipocytes ; Adipose Tissue ; Alcohol Drinking ; Dermis ; Humans ; Lipomatosis* ; Liver Diseases, Alcoholic ; Male ; Neck ; Rare Diseases

BACKGROUND: The skin changes of X-linked recessive ichthyosis are cnused by the deficiency of the enzyme steroid sulfatase, which usually results from deletions of this gene in Caucasian populations. OBJECTIVE AND MEHTODS: To disgnose X-linked recessive ichthyosis and detect its carrier, we have investigated distinctive gene deletion and measured gene dosage of steroid sulfatase gene by southern blot hybridization in Korean patients with X-linked recessive ichthyosis. RESULTS: Patients from 8 of 9 unrelated families exhibited deletions, if the steroid sulfatase gene. Of 6 families showing a family history compatible with X-linked recessive inheritance, One family exhibited a normal pattern of hybridization. All but one family showed deletion of steroid sulfatase gene. All three patients lacking a fami1y history of the disease exhibited gene deletions. The ratio of the steroid sulfatsse specific band density to the Factor VIII specific band density was measured in 8 obligate carriers using a laser densitometer. The average ratio exhibited by the car riers was less than half that of normal women. Conclusian: These results suggest that the X-linked recessive ichth osis patient and its carrier can also be diagnosed and detected by Southern blot hybridization of steroid sulfatase gene in Korea.
Blotting, Southern* ; Diagnosis* ; Factor VIII ; Female ; Gene Deletion ; Gene Dosage ; Humans ; Ichthyosis* ; Korea ; Skin ; Steryl-Sulfatase ; Wills

We report herein a. case of angio-Behqets syndrome, arterial occlusion type in a 31 year-old male. He had a history of scrotal ulceration, frequent oral ulceration and ocular pain with decreased visual acuity. About 8 months ago, moderately dull pain developed on the volar aspect of left index finger. Subsequently, a bean sized bluish patch developed on the previous painful area and on the ipsilateral thumb tip. Subungual splinter hemorrhages developed on the distal portions of left thumb and index finger nails at the same time. The result of saline puncture test showed the positive reaction in both intradermal and subeutaneous injections. The hrachial angiography showed an obliteration of digital artery at the second proxirnal phalanx of ulnar side.
Adult ; Angiography ; Arteries ; Behcet Syndrome* ; Fingers ; Hemorrhage ; Humans ; Male ; Oral Ulcer ; Punctures ; Thumb ; Ulcer ; Visual Acuity

No abstract available.
Female ; Nifedipine* ; Obstetric Labor, Premature* ; Pregnancy ; Ritodrine*

We report two cases of malignant lymphoma of mucosa-associated lymphoid tissue arising in the conjunctiva. Case 1, an 18-year-old girl, showed her left lower conjunctival swelling for four months and Case 2, a 29-year-old man, showed similar lesions on both his eyes for one year. Histologically, both cases revealed monomorphous dense lymphoid infiltrates invading the overlying conjunctival epithelium with diffuse patterns. The infiltrates were composed of small lymphocytes admixed with centrocyte-like cells within the conjunctival epithelium and stroma in association with B-cell lineage. No relapse was noted during the period of about 1½ years follow-up in case 1 treated by local excision only and in the follow-up period of 2 months in case 2 treated by local excision and subsequent chemotherapy.
Adolescent ; Adult ; B-Lymphocytes ; Conjunctiva* ; Drug Therapy ; Epithelium ; Female ; Follow-Up Studies ; Humans ; Lymphocytes ; Lymphoid Tissue* ; Lymphoma* ; Recurrence

The incidence of severe hepatitis A virus (HAV) infection has been increasing. However, clinicopathologic features of severe HAV infection that lead to liver transplantation (LT) have not been reported in Korea. We retrieved 16 LT cases with HAV infection during the last 3 years at Asan Medical Center, Seoul, Korea. Fifteen cases progressed to hepatic encephalopathy. Thirteen cases survived with or without complications, and three patients died of sepsis. The explanted liver showed massive or zonal necrosis with moderate to severe cholestasis. The zonal distribution of necrosis was frequently associated with endothelialitis of portal and/or central veins. Degenerative changes of hepatocytes were various in degree and distribution. Viral inclusions were suspected in two cases. Although HAV infection is usually confirmed by serological tests, significant venulitis of central and/or portal veins and viral inclusions, which are rarely observed, can suggest an HAV infection as a cause of massive hepatic necrosis of unknown mechanism.
Cholestasis ; Fluconazole ; Hepatic Encephalopathy ; Hepatitis ; Hepatitis A ; Hepatitis A virus ; Hepatocytes ; Humans ; Incidence ; Korea ; Liver ; Liver Transplantation ; Massive Hepatic Necrosis ; Necrosis ; Portal Vein ; Sepsis ; Serologic Tests ; Veins