Diabetes mellitus is one of troublesome disorder for the orthopaedic patient who should be operated on some other problems. Internist will advice and take care of them as far as diabetic problem is concern. However, orthopaedic surgeon should fully understand and follow every details about the condition of his own patient. Gamerin-Davalos hadclassified the diabetes mellitus into four types of potentiate, chemical and clinical diabetes. Potentiate form is not detectable at present method. The chemical and latent chemical forms are subclinical types and will be detected by the special examinations. In the orthopaedic practice, surgeon should keep in mind and perform proper tests for any suspecious symptomes or histories related to diabetes mellitus. Administration of insulin for the diabetes should be full doses but nerve be over-dosed. Neuropathy, vascular changes and infections are the common complications to diabetic patient and closely influence to the prognosis of major surgery. Ellenbery et al. had emphasized that the neuropathy is not a complication but rather a concomitant feature of diabetes mellitus. It may appear nerve root symptome to confuse with the herniated intervertebral disc. Vascualr change of the thickening of capillary basement membrane will causes gangrene of extremities and unexpected massive bleeding during surgery. Susceptibility of infection on diabetic patient is well known fact and in case of chronic osteomyelitis or tuberculosis of bone persist for long time without specific reason, surgeon should check once for the posibility of diabetes mellitus. Administration of any general anesthetic agents will elevate blood sugar level especially the ether, however, fluothane is a selective one at present. In case of surgery on diabetic patient, aceton uria and CO2 combining power should be checked closely for four to five days post-operatively. Blood sugar level should be kept slightly elevated during and post-operative period for diabetic patient. Surgeon should check his patient for any complications in case of increased dose of insulin is required post-operatively.
Anesthetics ; Basement Membrane ; Blood Glucose ; Capillaries ; Diabetes Mellitus ; Ether ; Extremities ; Gangrene ; Halothane ; Hemorrhage ; Humans ; Insulin ; Intervertebral Disc ; Methods ; Osteomyelitis ; Prognosis ; Tuberculosis

No abstract available.
Compliance*

To ease the convinience of indentification of common dermatophytes in Korea and to check the possibility of diseovering new species not yet reported in Korea, several species of dermatophytes were cultured on potato dextrose agar(PDA) at the room temperature. They were 46 strains isolated from Korea and 6 domestic strains from a foreign country. Gross and microscopic findings of their colonies were examined. The colonial morphology and microscopic appearance were compared with those of the same strains on Sabouraud dextrose agar(SDA) and corn meal agar(CMA). The results were as follows Typical T. rubrum and its varisnts showed characteristic wine red pigmentation which was rapid, diffuse and uniform, typically arrsnged microconidia were better on PDA. T. mentagrophytes showed yellow-brown pigmentation which were more rapid and darker in the center with gradual fading to the periphery. The mscroconidia, grape-like clusters of microconidia and spiral hyphae were seen better on SDA. T. tonsurans showed characteristic mahogsny colored pigmentation, ballooned microconidia and macroconidia which were seen better on PDA, but diffusible pigmentation of agar were present on SDA only. The gross morphology of T. verracosum were similar on PDA and SDA, but macroconidia were seen better on PDA and CMA, and tortuous hyphae with antler-like branching were seen better on SDA. T. rnegninii showed green-brown pigmentation which appeared rapidty and prominently on PDA. T. rubrum-like microconidia were seen better on PDA and CMA, but in SDA only hyphae were seen. The gross morpholgy of M. canis was similar on PDA and SDA, but spindle shaped macroconidia were seen more typically on PDA. The gross morphology and microscopic appearance of M. gypseum were very similar in all three media. M. ferruginenm showed characteristic rust colored pigmentation and bamboo hyphae which were seen more typically on PDA. The gross morphalogy of E floceosum were similar on PDA and SDA, but cluster formation of club shaped macroconidia were seen more prominently on PDA and CMA. These findings suggest that PDA is a mare convincing media t6Cifferentiate among dermatophytes belonging to genus Trichopkyton.
Agar* ; Arthrodermataceae* ; Glucose ; Hyphae ; Korea ; Meals ; Pigmentation ; Solanum tuberosum* ; Wine ; Zea mays

Lichenoid drug eruption is lichenoid skin eruptions caused by certain drugs and compounds, and can be identical or similiar to lichen planus. A 75-year-old woman who had taken antituberculosis medication(INH, ethambutol, rifampin) for 4 months developed pruritic generalized erythematous papular eruptions on the trunk and extremities, alopecia and nail dystropy. Histopathologic findings were hyperkeratosis, hypergranulosis, hyc rophic degenaration of basal layer, band like lymphohistiocytic infiltration in the upper dermis and perivascular lymphohistiocytic infiltration in the deep dermis. She was treated with systemic corticosteroid, and then skin lesion were slightly improved. After termination of antituberculosis medication, skin lesions were markedly improved with residual hyperpigmentation. Alopecia and nail dystrophy were also improved.
Aged ; Alopecia ; Dermis ; Drug Eruptions* ; Ethambutol ; Extremities ; Female ; Humans ; Hyperpigmentation ; Lichen Planus ; Skin

BACKGROUND: thermotherapy has been shown to be effective in the treatment of some fungal infections. Dermatophyte are well grown at 25degrees C rather than 37degrees C or high temperature. OBJECTIVE: An vitro test was done to assess the complemental effect and optimal conditions of local heating on the susceptability of t. rubrum to systemic antifungal agents. METHODS: Microdilution susceptability test to ketoconazole and itraconazole was done using 96 well microplate. Eight strains of T. rubrum were isolated from patients withtinea pedis and were cultured at 25degrees C, 37degrees C and 42degrees C for 1, 8 or 24 hours per day. MIC were checked at 4th, 7th, 9th day after inoculution. RESULTS: The growth without antifungal agents at 37degrees C and 42degrees C were decreased by 805 and 50% of the growth at 25degrees C respectively. Seven day after inoculation was the proper time to check the MIC. MIC50 of ketoconazole was the lowest at 42degrees C for 24hours per day in value of 0.006microgram/ml, and 0.09microgram/ml at 37degrees C for 24hours per day, 0.37microgram/mlat 42degrees C, for 8hours per day and 37degrees C for 8hours per day. MIC at 42degrees C for 1 hours er day, 37degrees C for 1 hyours and 25degrees C for 24hours per ady MIC were the same in value of 0.05microgram/ml. MIC50 of itraconazole was the lowest at 42degrees C for 24hours per day in value of 0.006microgram/ml, 0.01microgram/ml at 37degrees C for 24hours per day, 0.02microgram/ml at 37degrees C for 8hours per day. MIC at 42degrees C for 8hours per day, 42degrees C for 1hours per day, 37degrees C for 24hours per day MIC were the same in value of 0.05microgram/ml. CONCLUSION: Incubation at 37degrees C for 24 hours per day or 42degrees C for 24 hours per day increased the susceptability of T. rubrum to ketoconazole and itraconazole.
Antifungal Agents* ; Arthrodermataceae* ; Complement System Proteins ; Heating ; Hot Temperature ; Humans ; Hyperthermia, Induced ; Itraconazole ; Ketoconazole

In the present study soap chamber test was carried out for assessing irritancy of toilet soaps and soap ingredients. The results obtained in the present study are summarized as follows; This chamber test can discriminate the differences of irritancies between various soaps and soap ingredients. 2. Soap irritancy is not directly related with its alkalinity. 3, Erythema score and scaling score tend to parallel each other with weak correlation(r=p 46), but erythema score and fissuring score show strong correlation (r=p77) Scaling score and fissuring score show moderate correlation(r=p.64), 4. In the eighteen kinds of toilet soaps, two soaps are most irritating, harsh soap and the total irritancy scores of all soaps are within 1. 9 5. 1. Baby soaps are not milder than the common toilet soaps. 5. Generally, total irritancy score of soap ingredients is concentration dependent. Average total irritancy scores of five main soap ingredients in 4 times of recommended allergen concentration are as follows; Builders 5. 30, Perfumes l. 88, Color 0. 70, Fatty acids p. 35 and Superfat p.
Erythema ; Fatty Acids ; Soaps*

KOH examination is a simple, rapid and diagnostic procedure to confirm dermatophytic infections. It is important to select a proper examination site of the lesion. To determinate the proper examination site of the lesion, mycologic studies were done with multiple specimens collected from the center, margin and out of margin of the ring-shaped dermatophytic skin lesion on the 58 patients. The results were as follows. Positive rate of KOH wet smear was 94.8% at the center and 100% at the margin of the lesions, 22.4% at the 1 cm and 5.2% at the 2 cm out of the lesions. The more hyphae were found in the lesion, the more hyphae were found out of the lesion. Culture was done on the Sabouraud's glucose agar from the highest KOH positive area and the positive culture was 48 strains (82.8%) of 58 patients. These findings suggested that the ring-shaped active margin was the best site to examine mycologic studies.
Agar ; Glucose ; Humans ; Hyphae ; Skin*

We report a case of kerion celsi caused by Trichophyton verrucosum in a 4-year-old male. He presented painful, tender, indurated, boggy masses discharing pus on the vertex and occiput. Kerion celsi caued by T. verrucosum was diagnosed by the characteristic gross and microscopic findings of the colony on the Sabourauds glucose. agar. The possible source of infection was searched and wq found that he raised the cattles in his house. They had multiple, scaly, whitish plaques on the skin and T. verrucosum was identified from the hairs of the lesions. He had been treated with griseofulvin and prednisolone, and all lesions were cleared leaving partial alopecia in 2 months.
Agar ; Alopecia ; Child, Preschool ; Glucose ; Griseofulvin ; Hair ; Humans ; Male ; Prednisolone ; Skin ; Suppuration ; Tinea Capitis* ; Trichophyton*

T. verrucosum Infection has been reported for the first time in 1986 in Korea and has been increasing progressively. To evaluate the progress of clinical and histopathological change of dermatophytosis caused by T. verrucosum, inoculation study, using T. verrucosum isolated from infected human (human strain) and from infected cattle (cattle strain), was done in 24 male albino Hartley guinea pig. Their clinical and histopathological changes were evaluated. In addition, comparison for the growth rate between human strain and cattle strain on Sabouraud's glucose agar was made. The results were as follows: 1. Growth rate on Sabouraud's glucose agar: Cattle strain showed significantly more rapid growth rate than human strain on Sabouraud's glucose rate at 25℃ and 37℃. And cattle strain showed more rapid growth rate at 37℃ than 25℃. But human strain showed no significant difference of growth rate at both temperature. 2. Clinical findings: Initial erythema, scale and crust were developed about 8th after inoculation. All three findings reached maximum severity about 12th to 16th day and disappeared about 30th to 34th day after inoculation. There was no significant difference in progress of erythema, scale and crust between cattle strain and human strain. 3. Histopathological findings: Although mild acanthosis was noticed on the 3rd day after inoculation, the other findings including parakeratosis, intraepidermal abscess, spongiosis and vascular change, cellular infiltration were found on 9th day after inoculation. They reached maximum severity on the 12th day and lasted to the 25th day after inoculation. After that, all three findings were decreased gradually between 29th day and 33th day. On the PAS staining, hyphae and spores were found on the 6th day and disappeared on the 21th day after inoculation. 4. In trichophyton skin test, all of the 24 guinea pigs became positive within average 9.83±1.17 days These findings suggested that dermatophytosis caused by T.verrucosum induced rapid cell mediated immunity and contributed to rapid resolution of the lesion.
Abscess ; Agar ; Animals ; Cattle ; Erythema ; Glucose ; Guinea Pigs* ; Guinea* ; Humans ; Hyphae ; Immunity, Cellular ; Korea ; Male ; Parakeratosis ; Skin Tests ; Spores ; Tinea ; Trichophyton*

Cutaneous leishmaniasis (oriental sore) is usually a self-limited infection of the skin caused by the protozoan Leishmania tropica. The disease is endemic to the Mediterranean, Asia, Africa, and the Middle East. It has been seen in this country among many Korean technical experts and labourers working in the endemic areas of the disease. Our patient had acquired cutaneous leishmaniasis in Saudi Arabia and it had remained active for six months. He had been treated with antimony and metronidazole but failed because of severe side effects. And then we treated the patient witb cryosurgery and the skin lesions were followed by resolution with cosmetically acceptable scar in 4 months. The brief review of literature on the treatment of cutaneous leishmaniasis was undertaken.
Africa ; Antimony ; Asia ; Cicatrix ; Cryosurgery* ; Humans ; Leishmania tropica ; Leishmaniasis, Cutaneous* ; Metronidazole ; Middle East ; Saudi Arabia ; Skin