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*

No abstract available.
Antifungal Agents* ; 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

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*

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

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

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*

BACKGROUND: In tinea pedis, the response of treatment and prognosis are different according to clinical types. Positivity in KOH mount and causative agent in culture are also different. OBJECTIVE: Our purpose was to evaluate the clinical characteristics and mycologic findings of tinea pedis according to the clinical type. METHODS: A clinical and mycological study was conducted with 97 cases of tinea pedis among out patients examined for 7 months from June 1994 to December 1994 at Yeungnam University Hospital and Catholic Skin Clizic, Taegu, Korea. RESULTS: 1. Age distribution showed patients in their fourth decade to be most common. The ratio of male to female was 1.2: 1. The distribution of patients by clinical type was interdigital type, interdigital combined with hyperkeratotic type, interdigital combined with vesicular type, hyperkeratotic type, and hyperkeratotic combined with vesicular type, in descending order. One to five years was the most comrrion duration of tinea pedis. Duration of tinea pedis was the shortest in the vesicular type, otherwis was longer in hyperkeratotic type. Rate of family history of tinea pedis was 54.6%. The larger the size of family was, the higher the positivity in family history. The rate of coexistent dermatiophytosis with tinea pedis was 39.1%, and tinea unguium was the most common one. 2. The isolated dermatophytis were T. rubrum, 90.7%, T. mentagrophytes, 7.2%, and T. rubrum rnixed with T. mentagrophytes, 2.1%. T. rubrum showed an even distribution in all clinical types of tinea pedis whereas T. mentanophytes was isolated only in the interdigital type, vesicular type, and interdigital combined with vesicular type. T. rubrum mixed with T. mentagrophytes was isolated in the interdigital combine with vesicular type. Distribution of dermatophytes was relatively even arnong the age groups. T. rubrum showed a relatively even distribution in duration of tinea pedis, but T. mentagrophytes was isolated in tinea pedis with shorter duration.
Age Distribution ; Arthrodermataceae ; Daegu ; Female ; Humans ; Korea ; Male ; Onychomycosis ; Outpatients ; Prognosis ; Skin ; Tinea Pedis* ; Tinea*

Angiosarcoma is a rare malignant vascular tumor of endothelial cell origin, Cutaneous angiosarcoma usually occurs on the scalp and face of the elderly and most frequently in the sixth and seventh decade. We presented a case of angicisarcoma in a 70 year old woman. The patient had a well-demarcated, 3 x 3cm sized, dark brownish-colored, ulcerative nodule on the vertex with hemorrhagic bulla on the right. temporal scalp. Histopathologic examination of the nodule showed a well differentiated tumor with irregular anastomosing scular channels lined by atypical endothelial cells in the dermis and subcutaneous fat. Immunohistochenlical study for factorVlll-related antigen was partially positive in tumor channels. She was treated by wide surgical excision but she expired 5 months after discharge from the hospital.
Aged ; Dermis ; Endothelial Cells ; Female ; Hemangiosarcoma* ; Humans ; Scalp ; Subcutaneous Fat ; Ulcer