No abstract available.
Child* ; Humans

BACKGROUND: Rapid adrenocorticotropin (ACTH) stimulation test using 250ug of ACTH (1-24) has been used as a standard test in the initial assessment of adrenal function. However, it has recently been suggested that a rnaximal cortisol response can be achieved with a much lower ACTH dose, and reducing the dose might further enhance the sensitivity of the test in the detection of mild adrenal insufficiency. This study was performed to evaluate the role of low-dose (lug) ACTH stimulation test in the assessment of adrenal function and the diagnosis of subtle adrenal insufficiency. METHODS: Twenty-two subjects with suspected adrenal insufficiency due to long-term corticosteroid use were included in this study. The correlations between clinical features and the serum cortisol responses to low dose (lug) and high dose (250 ug) ACTH stimulation were evaluated. RESULTS: In high dose test, 10 (67%) out of 15 subjects with clinical features of adrenal insufficiency showed decreased serum cortisol response (peak cortisol level <18 ug/dL), but 5 (33%) subjects showed normal response (peak cortisol level > 18ug/dL). On the other hand, 14 (93%) subjects with clinical features of adrenal insufficiency showed decreased serum cortisol response in low dose test, while only one showed normal response. In 7 subjects without clinical features of adrenal insufficiency, 5 subject (71%) showed normal response, and 2 subjects (29%) showed decreased response in both low and high dose tests. CONCLUSION: These results suggest that the 1-ug low dose ACTH stimulation test might be more sensitive than conventional 250-ug test in the detection of mild adrenal insufficiency. Further studies are needed to determine the optimal dose of ACTH and the criteria for normal response to ACTH stimulation.
Adrenal Insufficiency* ; Adrenocorticotropic Hormone* ; Cosyntropin ; Diagnosis* ; Hand ; Hydrocortisone

For many years, the histogenesis of the granular cell tumor was controversial and this resulted in the tumor being given more than 20 synonyms. Abrikossoff, reporting on the fiist granular cell tomor, favored a muscle origin, but other authora have postulated a fibroblastic or a histiocytic origin. Recently, the concept of Schwann cell origin, supported by electron microscopic studies and immunohistochemistry of S-100 protein, has gained wider recognition. Approximately 90 cases of esophageal granular cell tumor have been reported in the literature, representing about 2% incidence of all reported granular cell tumor, In Korea, only four cases of granular cell tumors were reported in the literatures including the cases occuring in the cecum, colon, and anus until now. Recently we experienced 46-years old women with granular cell tumor of the esophagus, which might be the second case in Korean literature.
Anal Canal ; Cecum ; Colon ; Esophagus* ; Female ; Fibroblasts ; Granular Cell Tumor* ; Humans ; Immunohistochemistry ; Incidence ; Korea ; Middle Aged ; S100 Proteins

Xanthomas have been shown to occur in association with underlying lymphoproliferative disease, and sometimes are the result of lipid deposition in damaged or altered skin. Here in, we describe a case of eruptive xanthomas which developed in a patient suffering from mycosis fungoides. A 45-year-old Korean man presented for the evaluation of patches on the glans of his penis and on pretibial areas, which had persisted for a period of 3 years. Three months before the patient's admission, erythematous papules had developed on his trunk and extremities. Biopsies of lesions which had manifested as patches on the patient's pretibial areas and as papules on his right arm showed dermal infiltration of atypical lymphocytes, with epidermotropism and a diffuse infiltration of lipid-laden foamy cells. The histological findings were determined to be consistent with both mycosis fungoides and xanthoma.
Arm ; Biopsy ; Extremities ; Humans ; Lymphocytes ; Male ; Middle Aged ; Mycosis Fungoides* ; Penis ; Skin ; Xanthomatosis*

Detachment of a keratomileusis lenticule or extensive epithelial ingrowth is a difficult complication to amnage. Seven cases of extensive interfacial epithelial ingrowth were occurred following in situ keratomileusis or laser in situ keratoileusis. After the removal of epithelial ingrowth, we tried to reattach the lenticule to the stromal bed by drying the cap with air, or by suturing using interrupted sutures or double running sutures. Three detached cases were applied with air dry, only one case was reattached. Two other cases were failed due to epithelial ingrowth along the interface. In spite of the interupted sutures, the epithelial ingrowth along the interface recurred. In one of them, the edge of the lenticule was burried into the stroma and the lenticule was attached to the cornea leaving a ring-shaped opacity peripherally. In the other four cases, the lenticule was attached to the cornea successfully without epithelial ingrowth along the interface with double running sutures. Detached lenticules with extensive epithelial ingrowth following keratomileusis can be managed successfully by double running suture technique.
Cornea ; Corneal Transplantation* ; Running ; Suture Techniques ; Sutures

Pulmonary alveolar proteinosis (PAP) is a diffuse lung disease characterized by the accumulation of lipoproteins derived from surfactants in the distal air space. The lack of granulocyte macrophage colony-stimulating factor is believed to contribute to macrophage dysfunction and the impaired processing of surfactants. Because the prevalence of PAP in the general population is less than 1 in 200,000, and the typical age at presentation is 35 to 50 years, PAP is a very rare disease in children. To the best of our knowledge, there has been no Korean report on PAP in children. We describe here a patient who was diagnosed with PAP at the aged 15 years.
Adolescent* ; Child ; Female ; Granulocytes ; Humans ; Lipoproteins ; Lung Diseases ; Macrophage Colony-Stimulating Factor ; Macrophages ; Prevalence ; Pulmonary Alveolar Proteinosis* ; Rare Diseases ; Surface-Active Agents

BACKGROUND: Sarcoidosis is a systemic granulomatous disorder of unknown origin and characterized by accumulation of T cells and macrophages. Various cytokines may play crucial roles In the activation of T cells and macrophages, and thereby in the formation of granulomas. However, little is known about the balance between proinflammatory cytokines and antiinflamatory cytokines in the development of sarcoid granulomas and disease activities. In the present study, we measured IL-6, IL-8 and IL-10 in the bronchoalveolar lavage fluid(BALF) from patients with pulmonary sarcoidosis 13 find out whether there is an imbalance between proinflammatory cytokines and antiinflammatory cytokines in the lung. METHODS: Fourteen subjects with the diagnosis of sarcoidosis and six healthy volunteers were included. BALF was concentrated ten-fold by pressure ultrafiltration and each cytokine levels were measured by ELISA method. Active sarcoidosis was defined by major organ involvement or clinically progressive diseases. RESULTS: The mean IL-6 love]s in the BALF of the active sarcoidosis group were significantly increased than in controls or inactive sarcoidosis group(p < 0.05). Meanwhile, the IL-8 levels were increased and IL-10 levels were decreased in the active sarcoidosis group than in controls or inactive sarcoidosis group without significance(p>0.05). In active pulmonary sarcoidosis patients, the IL-6 love]s in BALF correlated with the BALF CD4/CD8 ratio(r=0.768, p < 0.05) and IL-8 levels(r=0.564, p < 0.05). CONCLUSIONS: The data presented showed that proinflammatory cytokine IL-6 is important in the pathogenesis of sarcoidosis and decreased tendency of anti-inflammatory cytokine IL-10 might also be involved in the development of granulomatous inflammation in sarcoidosis.
Bronchoalveolar Lavage Fluid* ; Bronchoalveolar Lavage* ; Cytokines ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Granuloma ; Healthy Volunteers ; Humans ; Inflammation ; Interleukin-10 ; Interleukin-6 ; Interleukin-8 ; Interleukins* ; Lung ; Macrophages ; Sarcoidosis ; Sarcoidosis, Pulmonary* ; T-Lymphocytes ; Ultrafiltration

We correct the revised date of this article.

Pulmonary arteriovenous fistula (PAVF) is abnormally dilated vessels that provide a right-to-left shunt between pulmonary artery and pulmonary vein and is clinically divided into simple and complex type. Here, we report four cases of surgically resected sporadic PAVFs presenting various clinical and histologic spectrums. Cases 1 (a 57-old-female) and 2 (a 54-old-female) presented as incidentally identified single aneurysmal fistulas and the lesions were surgically removed without complication. On the other hand, case 3 (an 11-old-male) showed diffuse dilated vascular sacs involving both lungs and caused severe hemodynamic and pulmonary dysfunction. Embolization and surgical resection of the main lesion failed to relieve the symptoms. Case 4 (a 36-old-male) had a localized multiloculated cyst clinically mimicking congenital cystic adenomatoid malformation. Microscopically, the lesion consisted of dilated thick vessels, consistent with the diagnosis of fistulous arteriovenous malformation/hemangioma.
Aneurysm ; Arteriovenous Fistula* ; Arteriovenous Malformations ; Cystic Adenomatoid Malformation of Lung, Congenital ; Diagnosis ; Fistula ; Hand ; Hemodynamics ; Lung ; Pulmonary Artery ; Pulmonary Veins

Head and neck dermatitis is a variant of atopic dermatitis often seen in young adults. Pityrosporum is a normal skin commensal. Thus, its importance as a pathogen of atopic dermatitis was neglected in the past. It was found, however, that the treatment of head and neck dermatitis with an antifungal agent results in clinical improvement. At present, although the pathogenesis of atopic dermatitis has not yet been fully elucidated, Pityrosporum is considered one of the triggers of head and neck dermatitis. The case of an 18-year-old male who had a history of head and neck atopic dermatitis with erythematous xerotic patches accompanied by a yellowish colored crust and oozing on the facial area is reported herein. The lesion was treated with itraconazole monotherapy for four weeks, after which its condition improved.
Adolescent ; Dermatitis ; Dermatitis, Atopic ; Head ; Humans ; Itraconazole ; Malassezia ; Male ; Neck ; Skin ; Young Adult