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

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.
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*

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

BACKGROUND: Unfractionated heparin (UFH) has unstable pharmacokinetics and requires close monitoring. The activated partial thromboplastin time (aPTT) test has been used to monitor UFH therapy for decades in Korea, but its results can be affected by numerous variables. We established an aPTT heparin therapeutic range (HTR) corresponding to therapeutic anti-Xa levels for continuous intravenous UFH administration, and used appropriate monitoring to determine if an adequate dose of UFH was applied. METHODS: A total of 134 ex vivo samples were obtained from 71 patients with a variety of thromboembolisms. All patients received intravenous UFH therapy and were enrolled from June to September 2015 at Gyeongsang National University Hospital. All laboratory protocols were in accordance with the Clinical and Laboratory Standards Institute guidelines and the College of American Pathologist requirements for aPTT HTR. RESULTS: An aPTT range of 87.1 sec to 128.7 sec corresponded to anti-Xa levels of 0.3 IU/mL to 0.7 IU/mL for HTR under our laboratory conditions. Based on their anti-Xa levels, blood specimen distribution were as follows: less than 0.3 IU/mL, 65.7%; 0.3–0.7 IU/mL (therapeutic range), 33.6%; and more than 0.7 IU/mL, 0.7%. No evidence of recurring thromboembolism was observed. CONCLUSION: Using the conventional aPTT target range may lead to inappropriate dosing of UFH. Transitioning from the aPTT test to the anti-Xa assay is required to avoid the laborious validation of the aPTT HTR test, even though the anti-Xa assay is more expensive.
Heparin* ; Humans ; Korea ; Partial Thromboplastin Time ; Pharmacokinetics ; Thromboembolism

BACKGROUND: Leukemia cutis is regarded as a dissemination of aggressive systemic leukemia to the skin. The presence of leukemia cutis is usually associated with a grave prognosis. OBJECTIVE: We evaluated the differences in the patienta' age and sex, the clinical appearance and distributions of the skin lesions, histopathological characteristics, interval between diagnosis of systemic leukemia and skin involvement, and prognosis according to the type of leukemias. METHODS: We performed a retrospective study of 23 cases of leukemia cutis. We obtained the clinical characteristics from record reviews and we also reevaluateds biopsy materials of 23 patients diagnosed in Asan Medical Center from 1989 to 1999. RESULTS: 1. The male-female ratio was 1.6 to 1. The mean age at diagnosis was 46.6 years. Leukemia cutis occurred in 4.3% of cases of AML(17/396), 0.4% of ALL(1/276), 9.5% of CML(2/21), and 0% of CLL(0/14) in Asan Medical Center from 1989 to 1999. The patients in this study comprised: 3 patients with myelodysplastic syndrome(MDS), 1 acute lymphocytic leukemia(ALL), 17 acute myelocytic leukemia(AML), and 2 chronic myelocytic leukemia(CML). 2. The clinical appearance of leukemia cutis includes macules, papules, nodules, and erythema nodosum-like lesions. The papular lesions were the most common ones. Trunk and extremities were favored sites. There was no specific difference in the clinical findings of each type of leukemias. 3. Histopathological evaluation revealed perivascular and periadnexal infiltration of leukemic cells in the dermis with grenz zone in more than one third of the specimens. There was no specific difference in the histopathological findings of each type of leukemias. 4. In sixteen of the 23 patients (69.6%) with leukemia cutis, skin lesions developed after the systemic leukemia had been diagnosed. Three of the patients (13%) had skin lesions preceding the diagnosis of systemic leukemia and 4 patients (17%) had concomitant involvement. 5. Eighteen patients (78.3%) died after the diagnosis of leukemia cutis. The mean intervals between diagnosis of leukemia cutis and death was 4.8 months. CONCLUSION: Leukemia cutis is an uncommon manifestation of leukemia cutis that is strongly associated with the presence of extramedullary disease at other sites. Although AML was the most common type in this study, leukemia cutis has developed in CML, AML, ALL, and CLL in decreasing order of frequency in this study. The lesions showed varied morphology and could be difficult to distinguish both clinically and histopathologically from nonspecific dermatoses. The presence of leukemia cutis may be a sign of grave prognosis.
Biopsy ; Chungcheongnam-do ; Dermis ; Diagnosis ; Erythema ; Extremities ; Humans ; Leukemia* ; Prognosis ; Retrospective Studies ; Skin ; Skin Diseases