BACKGROUND: Portable devices for measuring peak expiratory flow(PEF) are now of proved value in the diagnosis and management of asthma and many lightweight PEF meters have become available. However, it is necessary to determine whether peak expiratory flow rate(PEFR) measurements measured with peak flowmeters is accurate and reproducible for clinical application. The aim of the present study is to define accuracy, agreement, and precision of mini-Wright peak flow meter(MPFM) against standard pneumotachygraph. METHODS: The lung function tests by standard pneumotachygraph and PEFR measurement by MPFM were performed in a random order for 2 hours in 22 normal and 17 asthmatic subjects and also were performed for 3 successive days in 22 normals. RESULTS: The PEFR measured with MPFM was significantly related to the PEFR and FEV1 measured with standard pneumotachygraph in normal and asthmatics(for PEFR, r=0.92 p<0.001; for FEV1, r=0.78 ; p<0.001). The accuracy of MPFM was within 10%(limits of accuracy recommeded by NAEP) in all the subjects or 22 normal, mean difference from standard pneumotachygraph being I 6.5L/min(percentage of difference being 2.90%) or 1 0.6L/min(percentage of difference being 1.75%), respectively. According to the method proposed by Bland and Altman, the 95% limits of the distribution of differences between MPFM and standard pneumotachygraph after correction of PEFR using our regression equation were +38.2 and -71.5L/min in all the subjects or -20.49~ + 9.49L/min in 22 normal and was similar to the intraindividual agreements for 3 successive days in normal. There was no statistically significant difference of PEFR measured with MPFM and standard pneumotachygraph among three days(p>0.05) and the coefficient of variation(2.4 1.2%) of PEFR measured with MPFM was significantly lower than that( 5.2 3.5%) with standard pneurnotachygraph in normal (p<0.05). CONCLUSION: This results suggest that the MPFM was as accurate and reproducible as standard pneumotachygraph for monitoring of PEFR in the asthmatic subjects.
Asthma ; Diagnosis ; Flowmeters ; Peak Expiratory Flow Rate ; Respiratory Function Tests

Airway hyperresponsiveness is a consistent feature of asthma. Since the airway smooth muscle is hyperresponsive to a number of different stimuli operating through many different mechanisms, it is attractive to speculate that the abnormality may reside in the airway smooth muscle itself. Animal model of asthma is needed to unravel possible mechanisms underlying airway hyperresponsiveness and also to develop new therapeutic approaches. However, there are few reports showing that airway smooth muscle from animal asthma model is indeed hyperresponsive. In addition, sensitizing and provoking doses of allergen were different each other ambng the studies on animal asthma model. The aim of this study was to determine an appropriate sensitizing and provoking dose of allergen to induce a maximum airway hyperresponsiveness. Eighty-four male Sprague-Dawley rats were actively sensitized with a subcutaneous injection of 0, 10, or 1000/gg ovalbumin(OA) and 14 days later they were provoked with 0, 1, or 5 % OA aerosols. One day after the provocation, serum levels of OA-specific IgE, cell numbers in bronchoalveolar lavage fluid (BALF), and in vitro isometric contractile responses of the isolated tracheal smooth muscle(TSM) to 120 mM KC1, acetylcholine(ACh, 0.1~ 1000/micro meter), electrical field stimulation (EFS, 0.5~100Hz), serotonin(5-HT, 0.014 100/micro meter), and OA(10, 50, or 250 micro gram/ml) were measured. The results were as follows; 1) When 38 OA-sensitized rats were exposed to OA aerosols in vivo early asthmatic responses(EAR) were observed in 20(52.6%) rats. In vitro isometric contractile forces of TSM from rats with EAR were stronger than those from rats without EAR. 2) The maximal contractile responses to KC1 and EFS were significantly higher in rats only sensitized with OA compared with those in controls. The maximal response to ACh was significantly related to OA-specific serum IgE level(r=0.40, p%0.05), and the latter was in turn significantly related to the BALF eosinophil count(r=0.67, p<0.01). 3) When 10 microgram OA-sensitized rats were analyzed, the maximal response to KC1, ACh, EFS, and 250 micro gram/ml OA were lower in OA-provoked rats compared to those in saline-provoked control rats, in which 5% OA-provoked rats had a lower response than 1% OA-provoked rats. 4) The sensitivity of TSM to ACh was significantly higher in 10/micro gram OA-sensitized & OA-provoked rats, and the sensitivity to EFS was also significantly higher in 10/~g OA-sensitized & 5% OA-provoked rats compared to that in controls(p<0.05). 5) There was a significant correlation between the sensitivity of TSM to EFS and the counts of eosinophil or of lymphocytes in BALF(for eosinophil, r=-0.30; p<0.05, for lymphocyte, r=-0.35; p<0.05), or OA-specific serum IgE level(r=-0.46, p<0.01) in OA-sensitized & OA-provoked rats. This relationship was maintained in the data obtained only from 10 micro gram OA-sensitized & 5% OA-provoked rats. 6) The ratio of EFS-sensitivity to ACh-sensitivity was significantly lower in OA-sensitized & OA-provoked rats compared to that in controls or rats only sensitized with OA(p%0.05). 7) The Schultz-Dale phenomenon occurred in an in vitro dose-dependent manner. However, the inhaled provocation with OA in vivo resulted in a decrease in the contractile response to OA in vitro. There was a significant correlation between OA-specific serum IgE level and isometric response to 250 micro gram/ml OA(r=0.36, p<0.01). These results suggest that sensitization and provocation in vivo with OA in rats induces hypersensitivity of airway smooth muscle to cholinergic stimuli through an allergic inflammatory mechanism. The sensitivity was highest when sensitized to 10 micro gram OA and exposed to 5% OA aerosols.
Aerosols ; Animals ; Asthma* ; Bronchoalveolar Lavage Fluid ; Cell Count ; Ear ; Eosinophils ; Humans ; Hypersensitivity ; Immunoglobulin E ; Injections, Subcutaneous ; Lymphocytes ; Male ; Models, Animal ; Muscle, Smooth* ; Rats* ; Rats, Sprague-Dawley

No abstract available.
Pituitary Neoplasms*

BACKGROUND: Women sometimes have eyebrows tattooed for cosmetic purpose. But until recently, the removal of tattoos has been difficult. Several laser techniques have been proposed for the removal of tattoos. The lasers that have been used most successfully are the Q-switched systems because of their ability to target tattoo pigment selectively with minimal risk of adverse tissue response. OBJECTIVE: The objective of this study was to determine the clinical effectiveness of the newest Q-switched system, the alexandrite laser, in removing both eyebrow tattoos and to observe side effects such as scarring or permanent pigmentary changes. METHODS: Forty seven patients with both eyebrows tattooed were treated with the Q-switched alexandrite laser (755 nm, 100 ns) at eight week intervals and clinically evaluated.
Cicatrix ; Eyebrows* ; Female ; Humans ; Lasers, Solid-State*

To investigate whether anti-Candida proteinase antibody could be a diagnostic marker, we examined seroreactivity to proteinase in sera from 90 healthy controls and 8 of C. albicans culture-positive patients. Previously we purified proteinases of C. albicans, C. tropicalis, and C. parapsilosis using a series of chromatographic steps consisting of DEAE- Sepharose, Sephacryl S-200, and size-exclusion HPLC. ELISA and Western blot technique were adopted to examine seroreactivity of C. albicans proteinase with sera. On ELISA, the seroreactivities of healthy controls and C. albicans-cultured patients were 0.601 +- 0.014 (mean+SEM), and 0.695 +- 0.079, respectively (P=0.084, t-test). In C. albicans-cultured patients, the positive rate was 62.5% (5/8) and the positive rate of healthy controls was 39% (35/90). On Western blot analysis, C. albicans proteinase molecule was blotted by all sera tested. But the intensity of blotted band was different with the same dilution of sera; the intensity of C. albicans proteinase molecule band blotted by 2 sera of 3 healthy control's sera was distinctively lower than that by C. albicans-cultured patients sera. However, all sera including C. albicans-cultured patient's sera did not blot the proteinase secreted by C. tropicalis and C. parapsilosis. It is necessary to collect sequential sera of patients with candidiasis and to establish a cut-off value for ELISA or serum dilution for Western blot analysis that will give reliable test sensitivity and specificity.
Blotting, Western ; Candida albicans* ; Candida* ; Candidiasis ; Chromatography, High Pressure Liquid ; Enzyme-Linked Immunosorbent Assay ; Humans ; Peptide Hydrolases ; Sensitivity and Specificity ; Sepharose

No abstract available.
Breast* ; Mucinoses*

Hyperthyroidism is seen in 3.5-26% of subjects with acromegaly. Hyperthyroidism can be developed by thyroid stimulating hormone (TSH) dependent mechanism in TSH-secreting adenomas with acromegaly or by TSH independent mechanism through the stimulation of thyroid cells by growth hormone (GH). So, confirming the cause of hyperthyroidism is important to treat that. We report a case of a 56-year-old man who had acromegaly with iodine-induced thyrotoxicosis. He took the sea tangle for 4 years because he had constipation. His face and hands indicated acromegaly. Thyroid function test showed that T3 and free T4 were increased and TSH was decreased. Ultrasonography of neck showed diffuse enlargement of thyroid gland and thyroid scan showed decreased uptake of thyroid gland. So we could confirm iodine-induced thyrotoxicosis due to excessive iodine intake. Serum GH and insulin-like growth factor (IGF)-1 were markedly increased and brain MRI showed heterogenous 1 cm sized pituitary mass in right side. Acromegaly was confirmed by brain MRI, pituitary stimulation test and increased level of GH, IGF-1. He stopped iodine intake. After 6 months, T3, free T4 and TSH were normalized and he is waiting for the surgical removal of pituitary adenoma.
Acromegaly* ; Adenoma ; Brain ; Constipation ; Growth Hormone ; Hand ; Humans ; Hyperthyroidism ; Insulin-Like Growth Factor I ; Iodine ; Magnetic Resonance Imaging ; Middle Aged ; Neck ; Pituitary Neoplasms ; Thyroid Function Tests ; Thyroid Gland ; Thyrotoxicosis* ; Thyrotropin ; Ultrasonography

Subclinical Cushing's syndrome is defined as an autonomous cortisol hyperproduction without specific clinical signs of cortisol excess, but detectable biochemically as derangements of the hypothalamic-pituitary-adrenal axis function. We report a case of a 33-year-old woman with subclinical Cushing's syndrome caused by left adrenocortical adenoma, mistaken for Liddle's syndrome. The patient complained of fatigue. Laboratory findings showed metabolic alkalosis, hypokalemia, high TTKG (transtubular K concentration gradient), low plasma renin activity, and low serum aldosterone level, that findings implied as Liddle's syndrome. So we performed further study. Hormonal and radiologic studies revealed subclinical Cushing's syndrome with a left adrenal mass. The adrenal mass was resected and pathologically diagnosed as adrenocortical adenoma. After the resection of the left adrenal mass, patient's hormonal levels showed normal range.
Adrenocortical Adenoma* ; Adult ; Aldosterone ; Alkalosis ; Axis, Cervical Vertebra ; Cushing Syndrome* ; Fatigue ; Female ; Humans ; Hydrocortisone ; Hypokalemia ; Plasma ; Reference Values ; Renin

PURPOSE: This study is a retrospective analysis of patients who had undergone surgical treatment for non-union of distal humerus fracture. We evaluated them in terms of causes of injury, radiologic findings, and clinical outcomes such as prognosis. MATERIALS AND METHODS: Seven consecutive radiologic patients who were confirmed to have nonunion of a distal humerus fracture underwent reoperations. These patients had already undergone operations for distal humerus fractures. This survey was held from 2005 to 2010. The average period up to diagnosis of non-union after the first operation was 7.4 months (4 to 16 months). The mean follow-up period was 24.6 months (12 to 65 months). Each patient was graded functionally according to the Mayo Elbow Performance Score and the Disabilities of the Arm, Shoulder and Hand Score. RESULTS: Osteosynthesis was performed by internal fixation with plates and screws and then a bone graft for non-union of the distal humerus fracture. The average range of motion within the elbow joints was found to be a flexion contracture of 18.8 degrees (0~30 degrees) and further flexion of 120.2 degrees (102~140 degrees). Among postoperative complications, three cases of medium-degree stiffness, two cases of medial column nonunion, and one case of dissociation of the internal fixator were reported. CONCLUSION: Stable internal fixation for maintenance reduction status is essential after accurate initial anatomical reduction. We concluded that nonunion could be prevented by additional surgical treatment such as autogenous bone graft, if it is necessary.
Arm ; Contracture ; Dissociative Disorders ; Elbow ; Elbow Joint ; Follow-Up Studies ; Hand ; Humans ; Humerus ; Internal Fixators ; Postoperative Complications ; Range of Motion, Articular ; Retrospective Studies ; Shoulder ; Transplants

PURPOSE: In the initiation and progression of the atherosclerosis many factors are related each other. The individual variations also complicate the prediction of the atherosclerotic process. The purpose of this study was to investigate the morphologic changes by angiography in iliac arterial segments of the patients who had received bypass operation for the infrainguinal atherosclerotic occlusive disease of the lower extremities. METHODS: Forty-five common iliac artery (CIAs) and forty-two external iliac arteries (EIAs) in twenty nine male patients who underwent angiography for graft failure of lower extremity bypass surgery was included in this retrospective study, and their clinical chart and angiographic findings of iliac arteries were reviewed. Acute arterial occlusive cases were excluded from this study. The mean interval from the previous bypass surgery was 38.9 months (from 6 to 96 months) and the patient ages ranged from 34 to 81 years (average age 59 years). It was considered as change, that is disease progression, when luminal narrowing of iliac artery was more than 25% compared to the previous angiography at bypass surgery. RESULTS: Of 45, fifteen CIAs (33.3%) showed change. In 3 patients, the change was bilateral; in 4, ipsilateral to the failed graft limb; and in 5, contralateral. Considering EIAs, 13 of 42 (31.0%) were changed. In 1 patient, the change was bilateral; in 6, ipsilateral to the failed graft limb; and in 5, contralateral. Therefore the side of the changed iliac arteries had no statistical significance in relation to the side of limb at which graft failure occurred (P<0.05). There was no significant correlation between age or interval between bypass operation and repeat angiography and the progression of atherosclerosis of iliac arteries. CONCLUSION: The progression of atherosclerosis is not dominated in iliac arteries ipsilateral to the side in which bypass surgery was performed and graft failure occurred. In iliac artery, the short-term progression of atherosclerosis observed by angiography may vary among individuals independently withage, interval between operation and repeat angiography, and the hemodynamic change of the infrainguinal arteries.
Angiography ; Arteries ; Atherosclerosis ; Disease Progression ; Extremities ; Hemodynamics ; Humans ; Iliac Artery* ; Lower Extremity* ; Male ; Phenobarbital ; Retrospective Studies ; Transplants