Narcolepsy is a sleep disorder, which is characterized by excessive daytime sleepiness (EDS) that is typically associated with cataplexy, sleep fragmentation and other REM sleep-related phenomenon such as sleep paralysis and hypnagogic hallucination. Narcoleptic symptoms can be developed from various medical or neurological disorders. A 17-year-old male patient admitted for the evaluation of EDS which started three-month ago. He slept more than 18 hours a day with cataplexy and hypnagogic hallucination. He was obese with body mass index (BMI) of 30.4 kg/m2. After admission he was newly diagnosed to the thyrotoxicosis. T3 391.2 ng/dL (60-181), free T4 4.38 ng/dL (0.89-1.76), TSH <0.01 microIU/mL (0.35-5.5) were measured. His pulse rate ranged 70-90 beats per minute and blood pressure ranged 150/100-120/70 mmHg. Polysomnography revealed many fragmentations in sleep with many positional changes (81 times/h). Sleep onset latency was 33.5 min, sleep efficiency was 47.9%, and REM latency from sleep onset was delayed to 153.6 min. REM sleep percent was increased to 27.1%. Periodic limb movement index was 13.4/h. In the multiple sleep latency test (MSLT), average sleep latency was 0.4 min and there were noted 3 SOREMPs (Sleep Onset REM sleep period) on 5 trials. We couldn't discriminate the obvious sleep-wake pattern in the actigraph and his HLA DQB1 *0602 type was negative. His thyroid function improved following treatment with methimazole and propranolol. Vital sign maintained within normal range. Cataplexy was controlled with venlafaxine 75 mg. Subjective night sleep continuity and PLMS were improved with clonazepam 0.5 mg, but the EDS were partially improved with modafinil 200-400 mg. Thyrotoxicosis might give confounding role when we were evaluating the EDS, though sleep fragmentation was one of the major symptoms of narcolepsy, but enormous amount of it made us think of the influence of thyroid hormone. The loss of sleep-wake cycle, limited improvement of EDS to the stimulant treatment, and the cataplexy not supported by HLA DQB1 *0602 should be answered further. We still should rule out idiopathic hypersomnia and measuring CSF hypocretin level would be helpful.
Adolescent ; Benzhydryl Compounds ; Blood Pressure ; Body Mass Index ; Cataplexy ; Clonazepam ; Cyclohexanols ; Extremities ; Hallucinations ; Heart Rate ; HLA-DQ beta-Chains ; Humans ; Hypersomnolence, Idiopathic ; Intracellular Signaling Peptides and Proteins ; Male ; Methimazole ; Narcolepsy ; Nervous System Diseases ; Neuropeptides ; Polysomnography ; Propranolol ; Reference Values ; Sleep Deprivation ; Sleep Paralysis ; Sleep, REM ; Thyroid Gland ; Thyrotoxicosis ; Vital Signs ; Orexins ; Venlafaxine Hydrochloride

These clinical and mycological observations were made on 898 cases of tinea facisle diagnosed by the clinical findings and KOH exsmination among the 137,197 out-patients exsmined for five years from Jaunary 1981 to December 1985 at Chilgok Catholic Skin Clinic, Taegu, Korea. Following results were obtained: 1. The annual number of patients with tinea faciale was 159(0.75% of the total outpatients) in 1981, 174(0.56%) in 1982, 181(0.67%) in 1983, 181(0.67%) in 1984,and 203 (0.83%) in 1985. 2. Of the 898 patients, male patients numbered 395 and female 503. Although the age distribution of patients was highest under age 14 in both sexes, males outnumbered females slightly before age 19 and, as age advanced, female predominance became more marked. 3. Of the 898 patients, 7Z6 organisms composed of 5 species were isolated. The species isolated were in the order of decreasing frequency, Trichophyton(T.) mentagrophytea (296,40.8%), Microsporum(M.) canis (218,30.0%), T. rubrum (189,26.0%), M. gypseam (21,2.9%), and Epidermophyton floccosum (2,0.3%). 4. M. canis was the chief cause of tinea faciale in children under 14. The infection due to T. mentagrophytes and M. canis outnumbered T, rubrum markedly in the young age group before 14, but T. rubrum predominated in the middle age group from 20 to 29. In the old age group after 40, T. mentagrophytes reappeared as a major cause of the disease. 5. T. mentagrophytes predominated in rural area and M. cania in urban area but no sexual variation was found. T. rubrum and M. gypseum prevailed slightly more in urban areas than in rural areas. 6. Eczematous annular ringworm (without central clearing) types were seen most frequently in the cases cssed by T. menagrophytes and clsssic ringworm types were seen most frequently in the cases caused by M. cania 7. Coexistent fungal infections were chiefly T. corporis in the csses of T. mentagrophytes and M. canis, but T. pedis and T. unguium in the cases of T. rubrum. 8. As a result of mating studies, 177 strsins of T. mentagrophytes proved to be Arthroderma vanbreuseghemii (51 of the "+" mating type and 126 of the "-"mating type), 12 strains of M. gypseum proved to be Nannizzia(N) incurvata (4, "-" and 8,"-") and 4 proved to be N. gypsea (2, "+" and 2, "-" ).
Age Distribution ; Arthrodermataceae ; Child ; Daegu ; Epidermophyton ; Female ; Humans ; Korea ; Male ; Middle Aged ; Outpatients ; Skin ; Tinea*

No abstract available in English.
Ribs ; Spine ; Transplants

No abstract available.
Colorectal Neoplasms*

An occasional patient has both a pressing need for visualization of the biliary system in spite of a past history of reaction to iodinated contrast media. We report a patient, who had reacted adversely to contrast media, underwent ERCP using barium sulfate in order to opacify the biliary and pancreatic duct without side effect successfully. In conclusion, ERCP using barium sulfate as a contrast material is of value in patients who are intolerant of the iodinated contrast media.
Barium Sulfate* ; Barium* ; Biliary Tract ; Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde* ; Contrast Media ; Humans ; Pancreatic Ducts

To survey the seroprevalence of hepatit!s B virus(HBV) in relation to serologic tests for syphilis(STS), using VDRL and TPHA test, the tests were done in the seri of 1252 institutionalized persons, who lived in Taegu Hope Village for the poor or crippled, and 1831 controls, who had the regular routine physical examination from March to May, 1987. The positive rates nf HBsAg and anti-HBs were 11.7%(146) and 27.0%(338'). compared with 6.25%(ll) and 18.4%(337) in controls, respectively. The prevalence of HBV including HBsAg and anti-HBs was higher in institutionalized persons (38,7+i) than in controls(24.6%)(p<0.0001). The positive rate of STS was higher in institutionalized persons(7.5%) than in controls(2.9%)(p<0.0001). There was a tvend for a higher rate of seropositivity in women than in men of institution- alized persons in the both diseases. The prevalence of HBV among STS-positive cases wa.s 42.6%(40) of instituti- onalized persons and 26.4%(14) of controls, but not, statistically significant, the gre,ater part of them distributing in 4th and 5th decades. The positive rates of I-tBi.Ag in institutionalized persons was 45.5%(5) of STS-positive cases and 25. 9%,'35) of STS-negative cases. No correlation was found between the serologic ma kers of HBV and VDRL titration.
Daegu ; Female ; Hepatitis B Surface Antigens ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Hope ; Humans ; Institutionalization* ; Male ; Physical Examination ; Prevalence ; Seroepidemiologic Studies ; Serologic Tests* ; Syphilis*

Fifteen cases of ventricular septal defect with aortic insufficiency were diagnosed radiographically andconfirmed after operation at Seoul National University Hospital in recent two and half years since 1979.Cineangiographies of ascending aorta and left ventricle were done in those cases and revealed some characteristicfindings. The resuls of the analysis are as follow; 1. Among the 15 cases, 14 cases were male and 1 case wasfemale. Age distribution was from 7 years to 23 years. 2. Those 15 cases were corresponded to 8% among total 193cases of ventricular septal defect, to 11% among total 135 cases of aortic insufficiency and especially to 48%among 48 cases of aortic in sufficiency below age of 20 years. 3. After operation, 11 cases were confirmed assubpulmonary type ventricular septal defect and 4 cases as subcristal type. The sizeds of the ventricular septaldefects were ranged between 0.6 and 2.5cm in diameter. 4. Regurgitation of contrast media was noticed in cineaortography of all cases, and the grades of regurgitation were II-III/IV in 13 cases. 5. Various types ofherniated aortic cusp through ventricular septal defect were seen. In the cases of subpulmonary ventricular septaldefect characteristic saccular aneurysm was found in 7 cases. Asymmetry or mild bulging of aortic sinus was foundin the cases of subcristal ventricular septal defect. 6. Infundibular stenosis was found in 3 cases with rightventriculography and those were caused by the herniated saccular aneurysm of aortic cusp. 7. It is essential forthe diagnosis of ventricular septal defect with aortic insufficiency to undertake biplane cineangiography ofascending aorta and left ventricle in long axial view and right ventriculograhy should be done in suspicion ofinfundibular pulmonary stenosis.
Age Distribution ; Aneurysm ; Aorta ; Cineangiography ; Constriction, Pathologic ; Contrast Media ; Diagnosis ; Heart Septal Defects, Ventricular ; Heart Ventricles ; Humans ; Male ; Pulmonary Valve Stenosis ; Seoul ; Sinus of Valsalva

This study was carried out to determine the effect of long term administration of vitamin A on the changes of lipids in liver tissue and serum in rat. The animals were fed with control diet(200 ug/day) and high vitimin A diet(2, 000 ug/day) for 24 weeks. Vitamin A contents of liver in high vitamin A fed rats were increased linearly accordance with duration of the vitamin A administration, but levels of serum vitamin A showed unremarkable changes during the experimental period. Contents of cholesterol and triglycerides of vitarnin A fed rats were significantly higher than those of controls. Levels of HDL-triglycerides in v:itamin A fed rats were significantly higher than those of control rats during experimental period, while levels of HDL-cholesterol and HDL-phospholipids showed unremarkable changes during experimental period. Levels of individual cholesteryl esters showed undremarkable changes during experimental period in both animal groups.
Animals ; Cholesterol ; Cholesterol Esters ; Liver* ; Rats* ; Triglycerides ; Vitamin A* ; Vitamins*

Acquired digital fibrokeratomas are uncommon, benign, acquired, firm, more or less hyperkeratotic projections, arising most frequently from the fingers but rarely from the nail beds. We experienced a case of acquired digital fibrokeratoma arising from the nail bed of the left 4th toe in a 20-year-old female.
Female ; Fingers ; Humans ; Toes ; Young Adult

No abstract available.
Choriocarcinoma* ; Female ; Pregnancy