A 14-year old boy presented with myoclonic seizure with rightward deviation of eyeballs. Three years ago, he was diagnosed as diabetes necessitating insulin injection. At that time, his blood glucose was 448mg/dl, HbA1c 27.8%, serum C-peptide rose from 0.4 to 1.1ng/ml after glucagon, and 24 hour urine C-peptide was 6.7microg/day. Eye examination was normal. His maternal grandmother died of diabetes at 50 years old, and his mother's sister and his elder sister had NIDDM with oral hypoglycemics. But, he didn't control hyperglycemia himself since that time. On physical exam, his grasping power was decreased in right hand, and cataract was detected at the posterior pole of lenses in both eyes requiring surgery. EEG showed partial seizure disorder in left frontoparietal area, and MRI revealed cerebral infarction in left frontoparietal cortex. Sensory-motor polyneuropathy was noted in nerve conduction velocity. His neurologic symptom was improved gradually with insulin therapy, but nerve conduction velocity and MRI abnormalities did not improved after 6 months of follow-up. Although long-term diabetic complication is common in poorly controlled diabetes, very early manifested eye and nervous system complications like this case is extremely uncommon.
Adolescent ; Blood Glucose ; C-Peptide ; Cataract ; Cerebral Infarction ; Diabetes Complications ; Diabetes Mellitus, Type 2 ; Electroencephalography ; Epilepsies, Partial ; Follow-Up Studies ; Glucagon ; Hand ; Hand Strength ; Humans ; Hyperglycemia ; Hypoglycemic Agents ; Insulin ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Nervous System ; Neural Conduction ; Neurologic Manifestations ; Polyneuropathies ; Seizures ; Siblings

Prurigo pigmentosa is a peculiar pruritic pigmented dermatosis characterized by the sudden appearance of reddish papules accompanied by severe pruritus. The etiology still remains unknown but environmental factors may play a role, in which physical trauma or friction from wet clothing induces the skin lesions. It has a seasonal preference for spring to summer when there is increased sweating. We report a case of prurigo pigmentosa which may be triggered by sweating and cured with minocycline.
Clothing ; Friction ; Minocycline ; Prurigo* ; Pruritus ; Seasons ; Skin ; Skin Diseases ; Sweat* ; Sweating*

BACKGROUND: Allergen-specific immunotherapy ( IT ) can be an important adjunctive therapy in the treatment of allergic disorders. Although a number of studies have shown that cytokine production by T cells may be modified by IT, IT-induced chsnges at the single cell level in allergen -specific Th ( T helper ) and Tc ( cytotoxic T ) responses have not been reported. Objective : The objectives of the present study were ( 1 ) to demonstrate differences in the house dust mite(HDM)-induced cytokine production patterns of Th and Tc cells between untreated and treated HDM allergic patients and ( 2 ) to determine whether there are differences between child and adult patients in Th and Tc cell responses to HDM. METHOD: This study included twenty Dermatophagoides farinae (Df)-sensitive asthmatics ( ten children and ten adults ), of which five children and five adults received immunotherapy to Df over a 1.5- to 3-year period. Peripheral blood mononuclear cells ( PBMC ) were isolated from peripheral blood of each patient and cultured in the presence of IL-2 ( 10ng/ml ) and Df extract (100ug/ml) for 6 days. After harvesting cultured cells, Th and Tc cell frequencies were determined by a multiparameter cytokine flow cytometric assay that allows simultaneous determination of intracellular IFN-r and IL-4 in CD4+ or CD8+ cells. RESULTS: Predominant Th2 responses to Df were observed in all untreated child patients, three untreated adult patients, and two treated adult patients. On the other hand, predominant Thl responses to Df were observed in all treated child patients, two of untreated adult patients, and three of treated adult patients. Predominant Tcl responses to Df were observed in all groups of patients. However, Tcl responses were more prominent in adults than in children and in treated adult patients than in untreated adult patients. In children, there were no differences in predominant Tcl responses except in one treated child, in whom more prominent Tcl response was observed.
Adult ; Cells, Cultured ; Child ; Dermatophagoides farinae ; Dust ; Hand ; Humans ; Immunotherapy* ; Interleukin-2 ; Interleukin-4 ; T-Lymphocytes

No abstract available.
Pregnancy* ; Round Ligament of Uterus*

OBJECTIVE: To compare maternal characteristics and pregnancy outcomes in a group of women with gestational diabetes mellitus(GDM) diagnosed in our hospital with those of women without this disorder. MATERIALS AND METHOD: This is a retrospective study of 402 gestational diabetic women with singleton cephalic presenting pregnancies delivered at Ilsin Christian Hospital during the period January 1, 1997, through December 31, 1999. National Diabetes Data Group thresholds were used to diagnose gestational diabetes. Women in this group were compared with a nondiabetic control group(n=430) randomly selected and effects of confounding variables were analyzed using stratified analysis. RESULTS: Prevalence of GDM was 2.36%. Women with gestational diabetes were significantly older, heavier, of greater parity and more often had the following risk factors for GDM. Hypertension, cesarean delivery, macrosomia, and large for gestational age(LGA) rate were significantly increased. The adequate treatment group diagnosed before 32wks and received glucose control was compared with a inadequate treatment group. And there was no significant difference in maternal characteristics and pregnancy outcomes between the two groups. Within the adequate treatment group, three groups were subdivided by birth weight as SGA(small for gestational age), AGA(appropriate for gestational age) and LGA. The group with LGA had no difference in age, parity, pregnancy-induced hypertension, 2hr mean postprandial glucose level except body mass index and insulin treatment rate. After adjusting these two factors with stratified analysis, there was no general association between birth weight and glucose level(p=0.342). CONCLUSIONS: Maternal characteristics of gestational diabetes were significantly different compared with those of nondiabetic women. Pregnancy outcomes of gestational diabetic women were not improved by our conventional management and more intensified but acceptable and compliable treatment should be tried.
Birth Weight ; Body Mass Index ; Confounding Factors (Epidemiology) ; Diabetes, Gestational* ; Female ; Glucose ; Humans ; Hypertension ; Hypertension, Pregnancy-Induced ; Insulin ; Parity ; Pregnancy ; Pregnancy Outcome* ; Pregnancy* ; Prevalence ; Retrospective Studies ; Risk Factors

PURPOSE: Pertussis, a respiratory tract infection caused by Bordetella pertussis, is an important cause of morbidity in children. But diagnosis of pertussis is often delayed because of late development of typical symptoms and difficulties in culture. There has been no bacteriologically confirmed case of B. pertussis infection in Korea. Lower respiratoy tract may be involved in pertussis. We performed the polymerase chain reaction(PCR) assay for B. pertussis from children with lower respiratory tract infections. METHODS: One hundred eighty nine nasopharyngeal aspirates were collected from children with lower respiratory tract infections during the period from November 1990 to February 1995. Three 24-mer primers derived from DNA sequences upstream of the structural genes for the porin proteins of Bordetella: P1 is shared by all three species and P2 is specific for B. pertussis and P3 is specific for B. parapertussis and B. bronchiseptica. Amplifications resulted in 159-bp PCR products specific for B. pertussis and 121-bp PCR products specific for B. parapertussis and B. bronchiseptica. A confirmatory cleavage of 159-bp PCR products of B. pertussis by Hae III revealed two bands of 22 and 137 bp. RESULTS: B. pertussis specific PCR products were visualized in 6 patients during 1991 and 5 of these had received appropriate doses of the combined DPT vaccine. They had had cough over 2 weeks in all and high fever in 4. They had been diagnosed as viral pneumonia in 5 and bronchiolitis in 1, but viral cultures for respiratory syncytial virus, parainfluenza virus, influenza virus, adenovirus were negative. There was no PCR product compatible with B. parapertussis or B. bronchiseptica. CONCLUSIONS: PCR assay is effective in diagnosis of B. pertussis infections. We suggest that there was an epidemic of pertussis in 1991 despite high rate of pertussis vaccine coverage in Korea.
Adenoviridae ; Base Sequence ; Bordetella pertussis* ; Bordetella* ; Bronchiolitis ; Child ; Cough ; Diagnosis* ; Diphtheria-Tetanus-Pertussis Vaccine ; Fever ; Humans ; Korea ; Orthomyxoviridae ; Paramyxoviridae Infections ; Pertussis Vaccine ; Pneumonia, Viral ; Polymerase Chain Reaction* ; Respiratory Syncytial Viruses ; Respiratory Tract Infections ; Whooping Cough

OBJECTIVE: This study was performed to evaluate the effect of cervical cerclage and the clinical characteristics in incompetent internal os of the cervix (IIOC). METHODS: A study was conducted on 170 patients with IIOC, 199 cases of IIOC were admitted and treated with McDonald operation or modified Shirodkar operation at department of Obstetrics and Gynecology Il Sin Christian Hospital from January 1. 1994 to December 31. 1998, of this 14 cases were follow up lost, so 185 cases were analyzed. RESULTS: 1) The incidence of IIOC was 0.43%, 1 in 233 deliveries. 2) The mean age of IIOC patients was 30.54yrs old and the most frequent age group was in 30-34yrs old group (43.78%). 3) The average number of gravida and parity before operation were 4.71 and 1.62. & the success rate of operation was low at high gravida & parity. 4) The predisposing factor was previous history of dilation & curettage (43.75%), Cx. laceration after delivery (6.49%), midtrimester termination (4.32%) etc. 5) The operation methods were McDonald operation (91.35%) and modified Shirodkar operation (8.65%) & the success rate of McDonald operation and modified Shirodkar operation were 85.80% and 87.50%. 6) The successful fetal salvage rate was 85.95% and the highest success rate was 87.50% in 14-16 weeks of gestation group. 7) The more cervix dilate, the more failure occurred. 8) The causes of operation failure were premature rupture of membrane (50.00%), preterm labor (34.62%), FDIU, anomaly, APH etc. 9) The delivery methods after operation were vaginal delivery (65.54%), cesarean delivery (34.46%). CONCLUSION: The 14-16th weeks of gestation group & no cervical dilatation have higher success rate indicating that early diagnosis and appropriate timing of operation is associated with a greater operation success rate.
Causality ; Cerclage, Cervical ; Cervix Uteri* ; Curettage ; Early Diagnosis ; Female ; Follow-Up Studies ; Gynecology ; Humans ; Incidence ; Labor Stage, First ; Lacerations ; Membranes ; Obstetric Labor, Premature ; Obstetrics ; Parity ; Pregnancy ; Pregnancy Trimester, Second ; Rupture

PURPOSE: Cyanotic congenital heart diseases patients are in a state of hypoxia since birth. In general, hypoxia delays atrioventricular conduction. The atrioventricular node in such a hypoxic condition would have a different function, and some possibility for arrhythmia. The authors studied atrioventricular nodal function during hypoxia to elucidate the relationship between hypoxia and arrhythmia, including atrioventricular node in terms of cardiac tissue level. METHODS: After extraction of an adult rabbit heart under pentobarbital anesthesia, the heart was retrogradely perfused through the aorta with graded hypoxic Krebs' solution(100, 70, and 50% oxygen). The intracardiac electrocardiograms were obtained by a custom-made programmed stimulation at basic cyde length 40ms antegradely and retrogradely. All the data was analysed at His-electrogram and conduction time. Refractory periods and Wenckebach cycling length were determined. RESULTS: During antegrade conduction, the fast AV nodal conduction was prolonged and the slow conduction shortened, resulting in decreased compliance of the AV nodal conduction with graded hypoxia. The His-Purkinje system also showed a similar result. Among the refractory periods, only the AV nodal effective refractory period was prolonged with hypoxia. Wenckebach cycle length was sensitive to hypoxia, especially for retrograde conduction. CONCLUSION: Because the AV conduction during hypoxia was characterized by decreased AV conduction compliance, prolonged AV nodal effective refractory period, and sensitive Wenckebach cyding length, hypoxia would not seem to be a special risk for arrhythmia, including AV node.
Adult ; Anesthesia ; Anoxia* ; Aorta ; Arrhythmias, Cardiac ; Atrioventricular Node ; Compliance ; Electrocardiography ; Heart Diseases ; Heart* ; Humans ; Parturition ; Pentobarbital

Seborrheic keratosis (SK) is a benign epidermal tumor of unknown etiology. Because of its wart-like morphology, human papillomavirus (HPV) has been suggested as a possible causative agent. Viral involvement, however, has not been confirmed yet despite extensive research. The aim of this study was to evaluate the presence of HPV 6/11, 31, 33 DNA in nongenital SK. We analyzed 40 biopsy specimens taken from patients with nongenital SK using in situ polymerase chain reaction (PCR) and PCR with tissue extracts. The SK specimens (n=40), analyzed by in situ PCR, were negative for all HPV probes tested (types 6/11, 31, 33). Control slides (condyloma acuminatum, n=3) were positive for type 6/11, 31, and 33 HPV probes tested. Melasma samples (n=4), the negative controls, were consistently negative. No HPV DNA band was detected by PCR with the tissue extracts from paraffin-embedded SK samples, while condyloma acuminatum, the positive controls, showed DNA bands of the correct molecular weights. Our results show that HPV type 6/11, 31, and 33 cannot be recognized as causative agents for nongenital SK, which is in contrast to the previous studies. Further studies are required to reveal the presence of other types (more than 90) of HPV DNA.
DNA, Viral/*analysis ; Female ; Human ; Keratosis, Seborrheic/*virology ; Male ; Papillomavirus, Human/*isolation & purification ; Polymerase Chain Reaction

Sexuality education in the period of adolescents need much care and attention. The programs of sexual education through the Internet are excellent resources for adolescents to gain the information related to their sexual health. And systematic program which is necessary for adolescents to manage their sexual health has been rarely found in Korea. The purpose of this study was to offer valuable database for program design and evaluation on sexual education of middle school students through the Internet. Needs assessment for the information of sexual education on the internet among middle school students were carried out. A questionnaire survey was conducted with respondents of 602 middle school students from January to March in 2002. In the sexual counseling center for middle school students, counseling cases through internet were analyzed and evaluated from October, 2001 to September, 2002, We have selected 16 Sexual educational websites in Seoul confirmed Korean Educational Human Resource. Contents which was illustrated in 16 sexual educational websites were analyzed and evaluated by 12 sexual counselors. Design and evaluation of the program on the internet for sexuality education of adolescences was conducted on the basis of this study results by middle school expert teachers, sexual counselors, sexuality education professionals. Data was statistically analyzed using dBSTAT 4.0 for Windows.The extent and phase of the teaching-learning program of the sexuality education on the internet was seen as follows :1. We evaluated to need for sexuality education on the internet by middle school student.2. We assessed the properness of sexuality education curriculum on the internet frequently used by middle school students.3. We designed teaching strategy and learning program for sexuality education of the middle school students. 4. We developed the assessment method for the teaching-learning program of the sexuality education in adolescences on the internet.Middle school students responded that sexual education through Internet is needed in the order of programs related to acquaintances with opposite sex, Sexual culture and ethics, Sexual health, Reproductive health structure and development, Marriage and family, Psychology of Sexuality, Pregnancy and birth. In the internet counseling, cases on the 'reproductive health structure and development' was ranked as the top. In short we have found the most needs as follows; Meaning of the marriage life and having family, Sexes and Love, Human relation, Sexual Culture.We recommend as follows on the basis of this study results: 1. It is necessary for sexuality education program on the internet to specify acccording to age and target the specific individual needs. 2. Sexual educators have to employ various educational materials such as flash, cartoon, multimedia in order to provide effective sexuality education. 3. Internet based sex education need to be evaluated regularly through reassessment of the effectiveness of sexuality education for content quality and richness.
Adolescent ; Counseling ; Curriculum ; Education* ; Ethics ; Friends ; Humans ; Internet* ; Korea ; Learning ; Love ; Marriage ; Multimedia ; Needs Assessment ; Parturition ; Pregnancy ; Psychology ; Surveys and Questionnaires ; Reproductive Health ; Seoul ; Sex Education ; Sexuality*