BACKGROUND: Stress has long been known to play a role in many dermatologic disorders and can affect the onset and course of the disorder in some patients. Stress-induced exacerbation or onset of symptoms has been reported in chronic urticaria, alopecia areata, herpes simplex, herpes zoster, and psoriasis vulgaris, and these diseases can be classified as stress-associated dermatoses. Beta beta-endorphin is one of the most important mediators of stress, which is known to be generated upon stimulation of the pituitary-adrenal axis, and its secretion increases during periods of stress. OBJECTIVE: In order to see wheather beta-endorphin might be related to the onset or recurrence of stress-associated dermatoses, we compared the plasma concentration of beta-endorphin in patients with stress-associated dermatoses with those of healthy subjects. METHODS: The concentration of beta-endorphin. In sera was quantified by radioimmunoassay, using the INCSTAB 125I RIA Kit for plasma beta-endorphin, Each patient was asked to indicate if they believed that their skin problem began after an important stressful event in their lives. RESULTS: There was no significant difference in plasma beta-endorphin levels between patients with chronic urticaria, alopecia areata, herpes simplex, and herpes zoster and healthy subjects(p>0.05), whereas in patients with psoriasis vulgaris, plasma level of beta-endorphin was significantly increased (p<0.001). There was no relationship between the stressful events and plasma beta-endorphin concentrations. CONCLUSIONS: The plasma beta-endorphin level is not correlated with the onset or recurrence of stress-associated dermatoses such as chronic urticaria, alopecia areata, herpes simplex, and herpes zoster. The increase in beta-endorphin in psoriasis vulgaris is more likely that this peptide is generated by the lymphocyte infiltrated in the skin and/or by lymphocytes when they recirculate rather than by the activation of the pituitary-adrenal axis by stress.
Alopecia Areata ; Axis, Cervical Vertebra ; beta-Endorphin ; Endorphins* ; Herpes Simplex ; Herpes Zoster ; Humans ; Life Change Events ; Lymphocytes ; Plasma* ; Psoriasis ; Radioimmunoassay ; Recurrence ; Skin ; Skin Diseases* ; Urticaria

BACKGROUND: There are reviews with regard to the treatment of pigmented nevi present on the palms, soles, and genitalia. One advocated that pigmented nevi on thesa locations should be prophylactically removed to avoid their tuture development into malignant melanoma, while the other believes that this is not practicable. OBJECTIVE: Our purpose was to determine the incidence rates and clinical characteristics and to discuss the management of pigrnented nevi, developed on these areas of the Korean men. METHOD: We examined 1,537 Korean men, between 19 and 21 rears old, to evaluate the pigmented nevi on their palms, soles, and genitalia. RESULTS: Atleast 1 pigmented nevus appeared in 314(20.4%) men on the palms, 189(12.3%) on the soles, and 117(7.6%) on the genitalia. The sizes(mean diameter) of nevi on genitalia, soles, and palms were 4.5mm, 3.1mm, and 2.3mm respectively. The color of the nevi was darkest on the penile shaft(4.3 point) and then glans penis(3.9 points), soles(3.2 points), palms(2.5 points) in decreasing orders of the points. Most of the nevi was consistent with type 1 by Levers clinical classification and their incidence were 357 on palms, 211 on soles, and 128 on genitalia. Among the 21 nevi of type 2, 13 nevi appeared on the soles, and noine of type 3 and type 5 were found. The distribution of the nevi on the palms was of a rather uniform and scattered pattern, whereas, on the soles, they were distinctly concentrated in the midfoot. Tkie nevi on the glans penis appeared larger and more irregular in outline than those on the penile shaft. CONCLUSION: The plantar nevi were larger, darker, and had greater incidence of elevated type compared with the palmar nevi. From this observation, particular attenticn should be paid to the presence of pigmented nevi on the soles.
Classification ; Genitalia* ; Humans ; Incidence ; Male ; Melanoma ; Nevus* ; Nevus, Pigmented ; Penis

No abstract available.
Biological Products*

Aneurysmal benign fibrous histiocytoma(ABFH) is a relatively rare variant and has a distinctive histopathological features, that is collections of capillaries, foci of hemorrhage, siderophages, and foamy macrophages surrounding cleft-like and cavernous blood filled spaces in the tumor. But, in spite af the distinctive features, it is not infrequently confused with malignant melanoma, angiomatoid malignant fibrous histiocytoma, and vascular tumors such as spindle cell hemangioendothelioma, nodular Kaposi's sarcoma and angiosarcoma. We report a case of ABFH developed on the left upper extremity of a 41-year-old man.
Adult ; Aneurysm* ; Capillaries ; Hemangioendothelioma ; Hemangiosarcoma ; Hemorrhage ; Histiocytoma, Benign Fibrous* ; Histiocytoma, Malignant Fibrous ; Humans ; Macrophages ; Melanoma ; Sarcoma, Kaposi ; Upper Extremity

No abstract available.
Leg

Myocardial infarction is almost regularly associated with severe and widespread obstructive coronary artery disease. Recently, there have been some reports of myocardial infarction with normal of near normal coronary arteries on cineangiography. The following report concerns 6 cases (4% of a series of 142 consecutively studied patients with myocardial infarction) of myocardial infarction proved on clinical grounds with normal or near normal coronary arteries at coronary angiography obtained several months later. The clinical data was shown in Table 1 and Table 2. All 6 patients were male. Three were in the fifth, two in the sixth, and one in the seventh decade. Multiple risk factors were present in only one patient. Areas of localized dyskinesia or hypokinesia were demonstrated in five on the left ventricular cineangiography. The left ventricular end-diastolic pressure was greater than 12 mmHg in all 6 patients. One patient had hypertrophic cardiomyopathy and the remaining 5 patients had no underlying heart diseases. One patient had moderate congestive heart tailure. It is possible that prolonged, localized coronary artery spasm or platelet thrombi that subsequently resolved are a part of the pathogenic mechanism.
Blood Platelets ; Cardiomyopathy, Hypertrophic ; Cineangiography ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels* ; Dyskinesias ; Estrogens, Conjugated (USP) ; Heart ; Heart Diseases ; Humans ; Hypokinesia ; Male ; Myocardial Infarction* ; Risk Factors ; Spasm

Coronary arterivenous fistula(CAVF) is an uncommon congenital coronary anomaly-Bilateral CAVFs that originate from both coronary arteries are very rare. Coronary arteriography performed in recent years has clarified the incidence and various features of this lesion. Baim et al.1) reported that only 5% of the coronary artery fistulas arose from bilateral coronary arteries. In this report, we present a case of bilateral coronary artery pulmonary artery fistulas associated with atypical chest pain.
Angiography ; Arteries* ; Chest Pain ; Coronary Vessels ; Fistula* ; Incidence ; Pulmonary Artery

To determine the effect of percutaneous transluminal coronary angioplasty on the left ventricular diastolic filling in patients with coronary artery disease, diastolic filling was serially examined before, early(within 2 days) and late(5~15 days) after PTCA using pulsed Doppler echocardiography in 14 patients(12 unstable angina; 2 stable angina). The Control group was consisted of 20 normal persons with similar age and sex distribution. The left anterior descending artery was dilated in 10 patients, the right coronary artery in 3 patients, and the circumflex artery in 1 patient. Peak velocity of early diastolic rapid inflow(E), peak velocity of late diastolic inflow (A), A/E ratio, and deceleration time of E wave were measured by pulsed Doppler echocar diography. 1) LVangiogram was performed in 10 patients, and showed normal wall motion in 7 cases and regional hypokinesia in 3 cases. Delta area decreasing rate was 59+/-10%, and LVEDP was 11+/-4 mmHg. 2) A/E ratio was greater in patient group(1.00+/-0.28) than in normal control (0.64+/-0.10) (p<0.05). There was no significant difference in A and E values between two groups. 3) A/E ratio decreased significantly from 1.00+/-0.28(pre-PTCA) to 0.85+/-0.24 (late post-PTCA) (p<0.01), but there was no significant change at early post-PTCA(0.94+/-0.32). Deceleration time also decreased significantly from 213+/-56 msec(pre-PTCA) to 177+/-34 msec (late post-PTCA) (p<0.05), but there was no significant change at early post-PTCA (199+/-34 msec). In conclusion, there was impairment of left ventricular diastolic filling in patients with coronary artery disease which gradually improved after PTCA, and this result probably is related to post-ischemic "stunned" myocardium.
Angina, Unstable ; Angioplasty, Balloon, Coronary ; Arteries ; Coronary Artery Disease* ; Coronary Vessels* ; Deceleration ; Echocardiography, Doppler, Pulsed* ; Humans ; Hypokinesia ; Myocardium ; Sex Distribution

Twenty-one patients undergoing aortic valve replacement for pure aoritic regurgitation were studied retrospectively to evaluate the left ventricular function and internal dimension change before, 1-6 weeks(early postoperative) and 2-36 months after(late postoperative) aortic valve replacement by serial echocardiography. Postoperatively, NYHA function class improved remarkably (from 3.3+/-0.6 to 1.4+/-0.7). Early postoperatively, left ventricular end-diastolic dimension (EDD), left ventricular end-systolic dimension(ESD), left ventricular fractional shortenting(FS) significantly decreased in all patients(7.6+/-1.2cm vs 5.8+/-1.5cm P<0.001, 5.5+/-1.3cm vs 4.7+/-1.3cm P<0.001, 39+/-12% vs20+/-8% P<0.001 respectively). Interventricular septum thickness(IVS) and posterior wall thickness (PW) were slightly thickened before(1.4+/-0.3cm, 1.3+/-0.3cm respectively) and in the early postoperative period (1.3+/-0.4cm, 1.3+/-0.3cm respectively) without significant interval change. Late postoperatively, EDD and ESD decreased significantly (7.8+/-1.2cm vs 5.1+/-0.8cm P<0.01, 5.1+/-1.1cm vs 3.4+/-0.8cm P<0.001. respectively), and FS increased significantly (25+/-9% vs 34+/-9%, P<0.05). Among 3 patients of so called high risk group mentioned by Henry(22,33), ESD and FS improved to normal range in 2 patients, and ESD decreased to 4.4cm and FS increased to 33% in the other one. EDD and ESD decreased significantly in both group I(preoperative ESD<5.5cm) and group II(preoperative ESD<5.5cm), without no decrement difference between two groups, and there was a significant difference of FS decrement between group I and group II at early postoperative period. Preoperative ESD correlated highly with the early postoperative EDD(r=0.89) and ESD(r=0.87) with statistical significance, and moderately high with late postoperative EDD(r=0.45), ESD(r=0.50) and FS(r=0.42) without statistical signiticance. We concluded that there was significant improvement in left ventricular function in pure aortic regurgitation patients postoperatively. Preoperative left ventricular and systolic dimension above 5.5cm and fractional shortenting below 25% are not so reliabel index of poor postoperative prognosis.
Aortic Valve Insufficiency* ; Aortic Valve* ; Echocardiography* ; Humans ; Postoperative Period ; Prognosis ; Reference Values ; Retrospective Studies ; Ventricular Function, Left

Biliary ascariasis is a rare complication of intestinal ascaris infestation. Retrograde migration of the adult worm through the papilla of Vater causes biliary colic, and may give rise to pancreatic and biliary obstruction, choledocholithiasis, cholecystitis, cholangitis, hemobilia, and if the worm lodges in intrahepatic bile ducts, to liver absceases. In the past, treatment of biliary ascariasis has usually involved the direct removal of ascaris throagh a surgical choledochatomy and subsequent saline lavage of the common duct through an indwelling T tube. Recently, the worm in the bile duct can be seen by ERCP and it can be removed during the endoscopic procedure. A 55-year-old woman with intermittent colicky right upper quadrant abdominal pain was admitted to out hospital. Abdominai sonogram disclosed an echogenic structure within a mildly dilated common bile duct and a high ehogenic structure with acoustic shadowing in the distal common bile duct(CBD), which suggests a CBD stone. ERCP after obtaining the sonogram revealed a thick, long, linear, smooth filling defect in the CBD with a distal CBD stone. A distal CBD stone was removed by sphinctetotomy and lithotripsy, then we directly extracted ascaris with a tripod forcep without any complication.
Abdominal Pain ; Acoustics ; Adult ; Ascariasis* ; Ascaris ; Bile ; Bile Ducts ; Bile Ducts, Intrahepatic ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Cholecystitis ; Choledocholithiasis ; Colic ; Common Bile Duct* ; Female ; Hemobilia ; Humans ; Lithotripsy ; Liver ; Middle Aged ; Shadowing (Histology) ; Surgical Instruments ; Therapeutic Irrigation