Syringoma is not a uncommon tumor of the skin. It is a benign adenoma, of intraepidermal eccrine ducts. It occurs predominantly in women at puberty or adolescence. The lesions usually are multiple and small, skin colored or slightly yellowish payules, usually only 1 or 3mm in size. The lesions usually are limited to the lower eyelids but may occur on cheek, axilla, abdomen, neck, anterior chest and vulva. Rarely these are generalized in distributior. A 23 years old healthy man has had widespread lesions over the face, anterior chest and abdomen. The lesions appeared at the age of 13 on the anterior chest and abdomen. These increased in number and extended slowly to the face On visiting our department, there were numerous, angular or round, skin colored papules on his face and anterior chest as well as yellowish brown colored papules on his abdomen. Diagnosis was confirmed by clinical and histopathological findings as generalized syringoma.
Abdomen ; Adenoma ; Adolescent ; Axilla ; Cheek ; Diagnosis ; Eyelids ; Female ; Humans ; Neck ; Puberty ; Skin ; Syringoma* ; Thorax ; Vulva ; Young Adult

BACKGROUND: This study was performed to determine the effect of a endotracheal intubation & induction of anesthesia using propofol 2.0 mg/kg or 2.5 mg/kg and fentanyl 2 g/kg without succinylcholine chloride. Also we have compared this method with technique using succinylcholine 1.5 mg/kg and thiopental sodium 5 mg/kg. METHODS: They were divided into 3 groups as follows: group 1, succinylcholine 1~1.5 mg/kg and thiopental sodium 5 mg/kg; group 2, propofol 2 mg/kg and fentanyl 2 microgram/kg; group 3, propofol 2.5 mg/kg and fentanyl 2 microgram/kg. Systolic arterial pressure (SAP) and diastolic arterial pressure (DAP), and heart rate (HR) were measured before induction, after induction, after tracheal intubation immediately, at 1, 2, 3, and 5min. after tracheal intubation in all patients. The incidence of adverse effects and the quality of condition for intubation were measured in all patients. RESULTS: There were significant increases in SAP, DAP, HR after intubation in group 1 but significant decreases in SAP, DAP after induction and at 5min. after intubation in group 2 and group 3. The incidence of adverse effects, and the quality of condition for intubation were no significant difference between group 1 and group 3. CONCLUSIONS: From the above result, use of propofol 2.5 mg/kg and fentanyl 2microgram/kg provided a satisfactory alternative to succinylcholine and thiopental sodium for rapid sequence induction of anesthesia.
Anesthesia ; Arterial Pressure ; Fentanyl ; Heart Rate ; Humans ; Incidence ; Intubation* ; Intubation, Intratracheal ; Propofol ; Sodium* ; Succinylcholine ; Thiopental

PURPOSE: To prospectively assess the diagnostic potential of computed tomography urography (CTU) as a prior examination in the detection of bladder cancer. MATERIALS AND METHODS: A total of 3280 CTU examinations were assessed in 3050 consecutive patients. Patients who were over 35 years of age, with gross hematuria, persistent microhematuria, or a history of urothelial tumor, were included in our study. Our study investigated the diagnostic capability of CTU over the course of two prior examinations. After the first examination, patients with a definite lesion observed by CTU were referred directly for rigid cystoscopy (RC) and patients with negative or probable lesion were referred for flexible cystoscopy (FC). After the second examination, patients with a definite lesion observed by CTU were referred directly for RC, patients with probable lesion were referred for FC, and patients with negative lesion were referred for clinical follow-up. Performance characteristics for the two prior examinations were determined by using pathologic findings or clinical follow-up as the reference standard. RESULTS: The overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for detecting bladder cancer were 95.2%, 95.4%, 95.4%, 69.1%, and 99.2%, respectively, for the first prior examination, and 93.4%, 93.3%, 93.3%, 61.1%, and 98.4%, respectively, for the second prior examination. CONCLUSION CTU as a prior examination is accurate for the early detection of bladder cancer. Notably, when used as a second prior examination, CTU could help to avoid the unnecessary use of FC in patients with negative lesions.

OBJECTIVES: Changes of GABAergic neurotransmission in response to the application of different types of environmental stress have been the subject of research for over two decades. However, the nature of the changes induced by stress appear to show a dependent phenomena on the type and duration of stressor agent employed. METHODS: For this reason, this study was performed to observe the effects of repeated stress on the radioligands binding to GABA A/benzodiazepine receptors of discrete brain regions. The author also examined the activity of GABA transaminase and the concentration of endogenous GABA. Male Sprague-Dawley rats, weighing 150-200g were forced to suffer an immobilization stress for 2 hours during 14 consecutive days. RESULTS: Repeated immobilization stress decreased the binding of [3H]flunitrazepam on the benzodiazepine receptor in the cortex, hippocampus and hypothalamus. Saturation experiments followed by scatchard analyses of the results showed decreased density of benzodiazepine receptor and the affinity remained unchanged. Repeated immobilization stress did not affect the binding of [3H]muscimol on the GABAA receptor, the activity of GABA transaminase, and the concentration of endogenous GABA in the brain regions. CONCLUSIONS: From these results, it can be concluded that repeated immobilization stress modulated GABAergic neurotransmission via downregulation of the benzodiazepine receptor in the brain.
4-Aminobutyrate Transaminase ; Animals ; Brain ; Down-Regulation ; gamma-Aminobutyric Acid ; Hippocampus ; Humans ; Hypothalamus ; Immobilization ; Male ; Rats* ; Rats, Sprague-Dawley ; Receptors, GABA ; Receptors, GABA-A ; Synaptic Transmission*

BACKGROUND AND OBJECTIVES: The purpose of this study is to determine the prevalence of abnormalities in the sinuses among the common population, and to correlate this with clinical data. MATERIALS AND METHODS: We retrospectively evaluated a total of five hundred patients who visited the Health Promotion Center, Asan Medical Center, to undergo MRI scan to screen for intracranial pathology from January to April, 2003. Patients who have been treated for nasal or sinus diseases and who had previous history of nasal or sinus operations were excluded. The sinus abnormalities found through the MRI were classified into 2 types as follows; sinusitis group and retention cyst group. RESULTS: Among the five hundred patients studied, ninety-six (19.2%) patients showed abnormality in one or more sinus groups; ninety patients displayed symptoms of sinusitis and nine patients exhibited signs of retention cyst. Three patients showed symptoms of both. Sinus abnormalities were most commonly observed in the maxillary sinus. Seven patients had symptoms of the sinusitis group, and one patient had symptoms of the retention cyst group. CONCLUSION: Incidental sinus abnormalities detected among the common population were relatively common. However, pathologic condition which demanded treatment among these abnormalities were rare. Therefore, it would be important not to overestimate these signs and one should evaluate their clinical correlations carefully through complete physical examinations before applying any treatment for these lesions.
Chungcheongnam-do ; Health Promotion ; Humans ; Magnetic Resonance Imaging* ; Maxillary Sinus ; Pathology ; Physical Examination ; Prevalence* ; Retrospective Studies ; Sinusitis

Autoimmune insulin syndrome is characterized by insulin autoantibody, hyperinsulinemia, and fasting hypoglycemia without previous insulin immunization. This syndrome shows discordant levels between immunoreactive insulin and C-peptide. Negative results of an anatomic study of the pancreas and an inability to reproduce hypoglycemia during a prolonged fast may be helpful in excluding insulinoma. Symptomatic hypoglycemia usually develops during an oral glucose tolerance test. This syndrome is a self-limited disorder. Recently, we experienced one case that developed symptomatic hypoglycemia during both the fasting & oral glucose tolerance test, and another that developed symptomatic hypoglycemia during the oral glucose tolerance test but not the fasting test. Hereby, we present these cases with a review of the literature.
C-Peptide ; Fasting ; Glucose Tolerance Test ; Hyperinsulinism ; Hypoglycemia* ; Immunization ; Insulin* ; Insulinoma ; Pancreas

PURPOSE: To determine the time of magnetic resonance(MR) signal intensity changes in denervated skeletal muscle and to compare MR imaging with electromyography(EMG) in the evaluation of peripheral nerve injury. MATERIALS AND METHODS: We evaluated MR imagings of denervated muscles after experimental transection of the sciatic nerve in five rabbits using 1.0T MR unit. MR imaging and EMG were performed 3 days and 1, 2 and 3 weeks after denervation. T1-weighted images(T1-WI), T2-WI and Short Tau Inversion Recovery(STIR) images were obtained. The signal intensity (SI) of muscles in the denervated and normal sides were visually and quantitatively compared. After measuring the SI of the normal and abnormal areas, the time of SI change was determined when there was significant difference (P<0.05) of SI between the normal and denervated sides. RESULTS: On STIR images, two of the five rabbits showed significant SI changes at the third day(P<0.05) and all showed significant changes(P<0.05)at the first week. On T2-WI, one rabbit showed significant SI changes at the third day, and all showed significant SI changes at the first week. On T1-WI, significant SI changes were seen in one rabbit at the second week and in one at the third. One week after denervation, all showed denervation potential on EMG. CONCLUSION: This study suggests that MR imaging using STIR images is a useful method in the evaluation of denervated muscle, and that MR signal changes of denervated muscle may precede EMG changes after denervation. To localize and to determine the severity of the peripheral nerve injury, future analysis of the distribution of abnormal MR SI in denervated muscles would be helpful.
Denervation ; Magnetic Resonance Imaging* ; Muscle, Skeletal* ; Muscles ; Peripheral Nerve Injuries ; Rabbits* ; Sciatic Nerve

It has been known that dilated cardiomyopathy(DCM) is characterized by systolic dysfunction of left ventricle(LV), but there were few studies about correlation between LV systolic function, diameter and diastolic function measured by echocardiography and radionuclide ventriculography(RVG) The purpose of this study is to evaluate LV systolic and diastolic function as well as RV function using regional ejection fraction and functional images by RVG in 17 patients with DCM and to compare these variables with echocardiographic data. The results are as follows : 1) DCM showed diffuse systolic and diastolic dysfunction of LV. The systolic impairment is accounted for the diastolic impairment in DCM. 2) The increased standard deviation of phase angle of left ventricle(LVSDph) revealed LV asynchronous contraction in DCM. 3) LVSDph showed significant correlations with other RVG parameters such as LV ejection fraction, and peak ejection rate, peak filling rate and also with LV systolic and diastolic diameter measured by echocardiography. It is concluded that LVSDph may be useful in evaluation of LV systolic and diastolic function in patients with DCM as well as LV asynchronous contraction.
Cardiomyopathy, Dilated* ; Echocardiography* ; Humans ; Radionuclide Ventriculography* ; Ventricular Function, Right*

BACKGROUND: Congenital nephrogenic diabetes insipidus (NDI) is a rare inherited disorder, in which two different hereditary forms, X-linked and autosomal recessive traits, have been identified. The X-linked recessive form, mostly (>90%) congenital NDI, has been known to be caused by mutation of the arginine-vasopressin receptor 2 (AVPR2) gene. AVPR2 mutation sites are different in ethnic groups and recently 72 different mutation sites have been reported among AVPR2 gene. This study aimed to analyze AVPR2 gene in selected members in a Korean family with NDI and provided a report of the existence of a new mutation site in AVPR2 gene. METHODS: Three-generation maternal pedigree of the index patient (21-year old male, patient I) and his younger brother (19-year old male, patient II) with NDI was collected. Genomic DNA was obtained from patient I, II, III (index patient's male maternal cousin with NDI), index patient's mother, three maternal aunts, one female maternal cousin and, for control, one healthy male volunteer. Three coding exons of AVPR2 gene were amplified by PCR using 4 pairs of oligonucleotide primers. After direct sequencing of amplified PCR products, the sequence was compared with whole squence of normal AVPR2 gene and identification of a new site of mutation in this gene was done. RESULTS: 1) all three male patients had transversion of G to C at position 1033 of the AVPR2 gene, resulting in a subsequent change of amino acid from glycine to cysteine in codon 201. 2) Two small peaks of G and T, the result of direct sequencing in five female members in this family, would suggest that they are carriers of G to N transversion. CONCLUSION: These results can demonstrate the significant functional correlation of the mutation in AVPR2 gene sequence with clinical NDI, and suggest the clinical utility of direct mutation testing for congenital NDI in family.
Clinical Coding ; Codon ; Cysteine ; Diabetes Insipidus, Nephrogenic ; DNA ; DNA Primers ; Ethnic Groups ; Exons ; Female ; Glycine ; Humans ; Male ; Mothers ; Pedigree ; Polymerase Chain Reaction ; Receptors, Vasopressin* ; Siblings ; Vasopressins* ; Volunteers

BACKGROUND: The thalamus has multiple connections with areas of the cerebral cortex involved in arousal and cognition. Thalamic damage has been reported to be associated with variable neuropsychological dysfunctions and dementia. This study investigates the changes of regional cerebral blood flow (rCBF) by using SPM analysis of 99mTc-ECD SPECT and examining the neuropsychological abnormalities of 4 patients with anterior thalamic infarctions. METHODS: Four patients with left anterior thalamic infarctions and eleven normal controls were evaluated. K-MMSE and the Seoul Neuropsychological Screening Battery were performed within 2 days after stroke. The normalized SPECT data of 4 patients were compared to those of 11 controls for the detection of areas with decreased rCBF by SPM analysis. RESULTS: All 4 patients showed anterograde amnesia in their verbal memory, which was not improved by recognition. Dysexecutive features were occasionally present, such as decreased word fluency and impaired Stroop test results. SPM analysis revealed decreased rCBF in the left supramarginal gyrus, the superior temporal gyrus, the middle and inferior frontal gyrus, the medial dorsal and anterior nucleus of the left thalamus. CONCLUSIONS: The changes of rCBF in patients with left anterior thalamic infarctions may be due to the remote suppression on metabolism by the interruption of the cortico-subcortial circuit, which connects the anterior thalamic nucleus and various cortical areas. The executive dysfunction and dysnomia may be caused by the left dorsolateral frontal dysfunction of the thalamocortical circuit. Anterograde amnesia with storage deficit may be caused by the disruption of mamillothalamic tract.
Amnesia, Anterograde ; Anomia ; Arousal ; Cerebral Cortex ; Cognition ; Dementia ; Humans ; Infarction* ; Mass Screening ; Memory ; Metabolism ; Seoul ; Stroke ; Stroop Test ; Thalamus ; Tomography, Emission-Computed, Single-Photon*