We report herein a case of lymphomatoid papulosis in a 23-year-old female who had recurrent erythematous pinhead to pea sized papules and nodules on the both inner thighs and forearms for 4 years. Some lesions showed central hemorrhagic necrosis or scale formation. Individual lesions persisted for several months and showed spontaneous regression leaving pigmentation or depigmented atrophic scar. Histopathologically, there was marked cell infiltration, especially in the dermoepiderrnal junction and perivascular area. Infiltraled cells consisted of sorne ncutrophils and numerous atypical cells that had variable sized and irregular shaped nuclei. Electronmicroscopically, some atypical cells had cerebriform nuclei with marked peripheral condensation of chromatin and cytoplasm contained a few organelles, many polyribosomes and some dense bodies.
Chromatin ; Cicatrix ; Cytoplasm ; Female ; Forearm ; Humans ; Lymphomatoid Papulosis* ; Necrosis ; Organelles ; Peas ; Pigmentation ; Polyribosomes ; Thigh ; Young Adult

We report herein a case of dysplastic nevus, which developed on the snterior chest and abdomen in a 48-year-old American Catholic priest. Clinical features present as brownish to pinkish patches with irreguar border fading into surrounding skin, ranging from 0.5 to 1.5cm in diameter. Histopathological findings show disordered proliferation of slightly atypical melanocytes in the epidermis and fusing of epidermal rete ridges, concentric eosinophilic fibrosis along elongated rete ridges, lymphohistiocytic infiltration in the dermis, and extension of intraepidermal melanocytic hyperplasia beyond the shoulders of dermal nevus component. One year follow-up revealed no evidence of recurrence.
Abdomen ; Dermis ; Dysplastic Nevus Syndrome* ; Eosinophils ; Epidermis ; Fibrosis ; Follow-Up Studies ; Humans ; Hyperplasia ; Melanocytes ; Middle Aged ; Nevus ; Recurrence ; Shoulder ; Skin ; Thorax

We report a case of arteriovenous fistula involving the external ear in a 27- year-old male patient, who presented with pruritic erythematous scaly patch with multiple pulsating nodules on the thickened and hypertrophied left auricle.The blood flow, measured by laser Doppler velocimetry, was increased markedly on the affected site comparing with the other (710.33mV vs 8.4mV, 663.33mV vs 107. 33mV). We suggest that macrotia must be considered as the one of the clinical manifestations of cutaneous arteriovenous fistula.
Arteriovenous Fistula* ; Ear, External ; Humans ; Laser-Doppler Flowmetry ; Male

This study has attempted to show general characteristics of health centre directors who have served the post of directorship during the last 40 years. Of 3,000 such health centre directors, information on about 2,500 directors was collected. While average length of service for health center directors has increased, that of vacancy period has decreased. Rural areas have a shorter average length of service than the urban area. Rural areas have twice longer length of vacancy period per health center. Kangwon-do has the longest average length of vacancy period since 1980(2.79 months/year), and Daejeon has the shortest length of vacancy period(0.21 months/year). Chung-buk has no physician directors. The civil servant's rank for the directorship has promoted from the fifth level to the fourth level since 1990. A comparison between the physician director and non-physician director was made as follows : First, the proportion of physician directors had maintained rather high before 1980s ; 62.5% in 1963, 78.3% in 1970, 70.4% in 1980. It decreased to 44.1% in 1990 and 47.6% in 1997. Instead, non-physician directors has abruptly increased since 1980s(12.4% in 1980, 55.4% in 1990 and 50.8% in 1997). Second, physician directors mainly locate in the urban area(58.0% in 1997), but non-physician directors mainly in the rural area(67.2% in 1997). Third, since 1980, the average length of service for physician directors and for non-physician directors has become similar. Fourth, the mean age of physician directors is 45.1 years, and that of non-physician directors 55.7 years. The latter is 10 years older than the former.
Child ; Gangwon-do ; Humans ; Korea*

Most extended care facilities have admitted both the healthy and unhealthy elderly, among which members' average caring demand vary. The Aged Welfare Law, however, currently provides no reasonable basis on the staffing policy for extended care facilities. It just reflects the admitted number of the elderly rather than differences in members' average caring demand among facilities. This study is designed to estimate the need for caring staff on the basis of the correlation between the individual health status measured by various tools including Activities of Daily Living and caring demand by actual service time for each one. The sample included all of the admitted elderly(187 persons) in 4 extended care facilities, two in Seoul and the other two in KangWon-Do over the survey period October 5 through October 20, 1996. The survey process consisted of 3 stages. (1) The current staffing information was collected through self-completed written questionnaires left for head official in each facility. (2) Six graduate students at School of Public Health interviewed all residents to collect information on their health status and sociodemographics. The response rate for the interview was relatively high(85%). (3) Information on direct and indirect caring time consumed for each residents came from self-completed written questionnaires given to nurses and helpers in each target facilities. Analysis of the data was made using Pearson's correlation and multiple regression technique through SAS program. Based on this procedure, the following was found. 1. No facility meet the staffing standard in the Aged Welfare Law completely. 2. It is actual service time that is most correlated with ADL(Activities of daily living). 3. When all of the elderly are divided by four groups based on the level of ADL, the mean values of needed caring time in each group are 15, 21, 36 and 88 minutes respectively. 4. There is no significant difference among facilities in distribution of elderly person by group. 5. No facility meets the estimated number of nurses and helpers which reflects health status of the admitted elderly. Therefore, it is required that severity of the admitted elderly be considered in establishing staffing standard for extended care facility.
Activities of Daily Living* ; Aged ; Gangwon-do ; Head ; Humans ; Jurisprudence ; Public Health ; Surveys and Questionnaires ; Seoul ; Skilled Nursing Facilities*

We report a man who presented anterior chest pain with mild weakness of both hands while swimming. Initially, he was admitted to the department of internal medicine for evaluation and management of suspected myocardial infarction. Cardiac evaluations including coronary angiogram showed the patient to be normal. Spinal MRI showed a hyperintense signal on the sagittal T2-weighted images at the cervical spinal cord (C6-7). When a patient with chest pain shows weakness in both arms, not only cardiac evaluation but also spine work up is needed.
Arm ; Chest Pain* ; Hand ; Humans ; Infarction* ; Internal Medicine ; Magnetic Resonance Imaging ; Myocardial Infarction ; Spinal Cord* ; Spine ; Swimming ; Thorax*

Ictal vomiting is a rare clinical manifestation of temporal lobe epilepsy. This manifestation is considered a clinical lateralizing sign pointing toward seizure activity within the nondominant temporal lobe. However, we have experienced a case of ictal vomiting associated with temporal lobe epilepsy within the dominant hemisphere. The ictal vomiting occurred early in the course of the seizure when rhythmic discharges predominantly involved the left temporal lobe. This patient underwent a left anterior temporal lobectomy and experienced markedly reduced seizure frequency for more than 2 years.
Anterior Temporal Lobectomy ; Epilepsy ; Epilepsy, Temporal Lobe* ; Humans ; Seizures ; Temporal Lobe* ; Vomiting*

BACKGROUND: Bone mineral density (BMD) is influenced by genetic, hormonal, and environmental factors. Long-term antiepileptic drug (AED) use also causes osteopenia or osteoporosis that have been most extensively described in institutionalized patients. But, the mechanism of these abnormalities is unclear. The objective of this study is to determine the effect of AED on bone density and to explain the pathophysiologic mechanisms by analyzing bone related factors. METHODS: We prospectively examined BMD by dual-energy X-ray absorptiometry in 45 patients with epilepsy. We measured the serum calcium, phosphorus, protein, alkaline phosphatase (ALP), bone specific ALP, vitamin D and osteocalcin to analyze the factors that influence bone metabolism. RESULTS: BMD was significantly lower in the patient group than in the control group (p<0.05). 13% of patients had osteopenia and 3% of patients had osteoporosis. The level of bone specific ALP was higher in the patient group, but the level of vitamin D was not different, implying that BMD is decreased by the direct effect of antiepileptic drugs. There was a weak negative correlation and marginal significance between BMD and the duration of therapy in the patient group (r=-0.407, p<0.05). CONCLUSIONS: Long-term antiepileptic drug therapy in patients who have seizures causes significant bone loss in the lumbar spine even in the absence of vitamin D deficiency. In addition, the degree of bone mineral density was weakly related with the therapeutic duration of antiepileptic drugs. The regular evaluation of BMD in patients with long-term antiepileptic drugs might be helpful to prevent decreases in BMD.
Absorptiometry, Photon ; Alkaline Phosphatase ; Anticonvulsants* ; Bone Density* ; Bone Diseases, Metabolic ; Calcium ; Drug Therapy ; Epilepsy ; Humans ; Metabolism* ; Osteocalcin ; Osteoporosis ; Phosphorus ; Prospective Studies ; Seizures ; Spine ; Vitamin D ; Vitamin D Deficiency

PURPOSE: It is known that serum thyroid hormones and lipid profiles are affected by the different biotransformation pathways of antiepileptic drugs (AEDs). The aim of this study was to evaluate thyroid functions and lipids in epileptic patients taking AEDs. METHODS: We prospectively examined serum thyroid hormone concentrations and lipid profiles in 45 patients with epilepsy and compared them with 45 healthy age- and sex-matched controls. We measured serum free T4 (FT4), thyroid stimulating hormone (TSH), thyroid peroxidase antibody (TPO-ab), thyroid globulin antibody (TG-ab), total cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL) and triglycerides (TG). To analyze, the patient groups were divided into two groups:36 patients using hepatic enzyme inducing AEDs and 9 patients using non-enzyme-inducing AEDs. RESULTS: Mean age, sex and body mass index (BMI) were not different in both groups. The serum free T4 level of all patients was lower than that of the control group (p<0.05). The serum free T4 level of the patients taking hepatic enzyme inducing AEDs was lower than that of the control group. TSH, TPO-ab and TG-ab levels were not different in both groups. There was no correlation between free T4 levels and the duration of therapy in the patient group. For lipids, LDL, HDL, TG and total cholesterol, levels were not different in both groups. CONCLUSIONS: Hepatic enzyme inducing AEDs led to a decrease in free T4 levels but the TSH level remained normal. These findings seem to be not only due to liver enzyme induction but also hypothalamic interference of regulation of thyroid hormone production by the drugs. Lipid profiles were not significantly influenced by AEDs but further evaluation should be needed.
Anticonvulsants* ; Biotransformation ; Body Mass Index ; Cholesterol ; Enzyme Induction ; Epilepsy ; Humans ; Iodide Peroxidase ; Lipoproteins ; Liver ; Prospective Studies ; Thyroid Gland* ; Thyroid Hormones* ; Thyrotropin ; Triglycerides

Wilson's disease is an autosomal recessive disorder resulting from an excessive accumulation of copper in the liver, cornea, kidneys, and in the basal ganglia of the brain. The prominent speech disturbances of Wilson's disease include monopitch, monoloudness, slow rate, low pitch, delayed in initiating speech and rarely palilalia. A19-year-old woman developed palilalia which was characterized by compulsive repetition of a phrase with increasing rapidity and with a decrescendo of voice volume. Although she had been suffering from liver cirrhosis for the past 8 months, the palilalia was the only neurological sign at initial examination. She showed a low serum ceruloplasmin, low serum copper, increased urinary copper excretion, and Kayser-Fleischer rings. Brain magnetic resonance images showed high signals in the bilateral basal ganglia in T2-weighted images, and slight cortical atrophy.
Atrophy ; Basal Ganglia ; Brain ; Ceruloplasmin ; Copper ; Cornea ; Female ; Hepatolenticular Degeneration* ; Humans ; Kidney ; Liver ; Liver Cirrhosis ; Voice