PURPOSE:Craniopharyngioma is one of the most common causes of organic growth hormone deficiency leading to pituitary hormonal insufficiency. However, some growth hormone(GH)-deficient children with craniopharyngioma may grow normally or even show accelerated growth. This study was designed to evaluate several factors associated with growth of patients with craniopharyngioma. METHODS:Forty children operated on for craniopharyngioma were evaluated for their pituitary function, serum insulin like growth factor-I(IGF-I), serum insulin like growth factor binding protein-3(IGFBP-3) and serum prolactin levels. We also observed their growth status and corresponding changes with or without GH treatment. RESULTS:Among 40 patients, one had normal pituitary hormonal status and one had isolated GHD(GH deficiency). The other patients showed multiple pituitary hormone deficiency including GH(98%), LH, FSH(75%), TSH(65%), ACTH(62%), and ADH(38%) deficiencies. Patients with GHD were categorized into 2 groups. Group 1 consisted of children who showed normal growth, thus had not received GH treatment(n=14) and Group 2, those who showed subnormal growth(n=25). Patients in Group 2 were subdivided into Group 2A, when the patients had not received GH treatment in spite of subnormal growth(n=9) and Group 2B, when GH treatment had been added later on(n=16). There were no differences in the age at diagnosis of GHD, initial height standard deviation score(Ht SDS), body mass index(BMI), peak GH concentration between Group 1 and Group 2. Height velocities in Group 1, 2A, and 2B were 8.1+/-.2 cm/yr, 2.4+/-.2 cm/yr, 2.7+/-.2 cm/yr during the first year of endocrinologic follow-up, 7.1+/-.8 cm/yr, 1.2+/-.1 cm/yr, 7.6+/-.7 cm/yr during the second year, 5.9+/-.0 cm/yr, 2.8+/-.9 cm/yr, 7.3+/-.7 cm/yr during the third year, respectively. BMI changes during the first year of endocrinologic follow-up and postoperative prolactin levels were not significantly different between Group 1 and Group 2A. Postoperative IGF-I and IGFBP-3 levels in Group 1 were significantly higher than those in Group 2A(P<0.05). Both IGFBP-3 and prolactin levels correlated significantly with height velocity in Group 1 and 2A(P=0.004 r=0.64 and P= 0.035 r=0.74 , respectively). CONCLUSION: In this study, growth in children with craniopharyngioma was likely to be associated with IGF-I, IGFBP-3 and prolactin levels. Further studies are needed to unravel other growth promoting factors related to GH independent growth.
Child* ; Craniopharyngioma* ; Diagnosis ; Follow-Up Studies ; Growth Hormone ; Humans ; Insulin ; Insulin-Like Growth Factor Binding Protein 3 ; Insulin-Like Growth Factor I ; Prolactin

Postoperative colonoscopy is an effective tool for management of colonic adenomas. Authors analyzed the pattern of colonic adenomas detected during follow-up colonoscopy after colorectal cancer surgery and evaluated the characteristics of adenornas, risk groups, and effective fo1low-up schedule. Study group were 222 patients and colonoscopy was performed 389 times. Patterns of adenornas were analyzed by variables as age, sex, preoperative serum CEA level, location of primary colorectal cancer, Borrmann type, Duke's stage, histologic differentiation, DNA ploidy, recurrence and histology. Metachronous adenomas were detected in 79 patients(35.6%) and both metachronous and syachronous adenomas were observed in 29 cases(13.1%). High risk variables for adenomas were male, old age and presence of synchronous adenoma. There were 2 patients with maligant change of adenomas. Yearly follow-up by complete colonoscopy over 3 years or more is recommended and follow-up interval should be shortened in the high risk groups.
Adenoma* ; Appointments and Schedules ; Colon ; Colonic Neoplasms ; Colonoscopy ; Colorectal Neoplasms* ; DNA ; Follow-Up Studies ; Humans ; Male ; Ploidies ; Recurrence

This study was done to identify the reality in doing the intradermal skin test of injectional antibiotics and to serve a basis to the clinical and educational situations. For the study, the survey was done to the staff nurses who are working at one of the selected 39 hospitals in the capital area, from January 6 to Feburary 8 in 1997. The data analysis was done by mean, standard deviation, Fisher's exact test, t-test, ANOVA through running SAS computer program. The results of the study were as follows : 1.The dilution ratio of the antibiotics was mostly 1 : 10 regardless of what kind of antibitics. Making the contrast was done only for the suspended to the antibiotics. Mostly the reaction was detected after 15 to 20 minutes from its diameter of redness and wheals. Most of the respondents answered they do the intradermal skin test only once for the same antibiotics. 2. In the education on the skin test the 66.7% from the respondents had exposed to the education mostly through the new nurses orientation. The 85.4% from them answered the need of the continuous education which had a significant difference in the number of beds(p=.046). The had experiences of detecting positive reactions(98.3%), and of anaphyaxis(49.5%) which had a significant difference in experience(p=.002) and in their age groups(p=.000). 3. The average score of the confidence on the intradermal skin test was 3.32 form 4-point scale. Also it had a significant difference from the number of beds(p=.010), the year of experiences(p=.016), and their age groups(p=.046). 4. From the general characteristics of respondents, the infection methods had a significant difference in the amounts of injection, whether adopting the contrast pairing, and the repeatable skin tests for the same antibiotics. 5. Only 15 from 39 hospitals had their protocol about the intradermal skin test provided by nursing department which differs in its contents from that provided by the medical information center. From the results of the study, it is suggested that the continuous education on the intradermal skin test and its unified protocol should be provided. Also it is recommended that the drug manufacturer should notice about its anaphylactic cautions and pack its extra skin test use.
Anti-Bacterial Agents* ; Surveys and Questionnaires ; Education ; Information Centers ; Nursing ; Running ; Skin Tests* ; Skin* ; Statistics as Topic

Tuberculosis of the duodenum is rare event in patients with pulmonary or intestinal tuberculoais. It is very difficult to diagnose duodenal tuberculosis because of inconaiatent symptoms and nonspecific duodenal lesioa. Although fiberoptic endoscopy has been used, there is the limitation of fiberoptic endoscopy ia diagnosingthis disease and the diagnoais require laparotomy with biopsy. Recently we experienced a case of duodenal tuberculosis with duodenoscopic findings of the submucosal tumor of duaidenum. We report a case with review of literatures.
Biopsy ; Duodenum* ; Endoscopy ; Humans ; Laparotomy ; Tuberculosis*

BACKGROUND: Herpes zoster with generalized varicelliform eruptions occurs in 2 to 10% of patients with herpes zoster. It occurs mainly in old or debilitated persons especially those who have immunologic defects such as lymphoproliferative diseases, AIDS, or recipients of immunosuppressive therapy. The reported incidence of herpes zoster with generalized varicelliform eruptions is variable. OBJECTIVE: The purpose of this study was to elucidate the incidence and clinical features of herpes zoster with generalized varicelliform eruptions. METHODS: We reviewed the clinical data of 962 patients with herpes zoster by retrospective methods. The annual incidence, age, sex, seasonal variation, predilection sites, and associated conditions of herpes zoster with generalized varicelliform eruptions were analyzed from January 1990 to December 1996 (7 years). RESULTS: 1. Among 962 patients, 8 patients with herpes zoster revealed generalixed varicelliform eruptions (0.83%). 2. The age ranged from 20 to 85 and the majority of cases occurred in the 6th decade. There were 4 females and 4 males. 3. Past histories of malignancy were observed in 2 patients. However, there were no signs of malignancy at the time of diagnosis of herpes zoster with generalized varicelliform eruptions. 4. The most common site of initial lesion was the thoracic dermatome,followed by the lumbar and the cervical ones. CONCLUSION: From our observation, it is suggested that herpes zoster with generalized varicelliform eruptions may occur in patients without underlying malignancy or immunosuppressive disorders. Sudden incidental uprising of herpes zoster with generalized varicelliform eruptions was observed in 1996.
Clinical Study* ; Diagnosis ; Female ; Herpes Zoster* ; Humans ; Incidence ; Male ; Retrospective Studies ; Seasons

We report a case of 64-year-old female patient who has had factitious skin lesions for 20 years. She complained formification sense and severe itching on her face. These symptoms were improved with squeezing and bleeding. There were scuare shaped ulcerated nodule on the right cheek and white depressed scar on the left cheek. She was treated with wet dressing and occlussive dressing, and skin lesions were nearly cleared within 3 weeks, but new lesion appeared. Pimozide 2mg #1 p.o were given under the diagnosis of delusion of parasitosis from June, 1984. Her symptoms were improved without recurrence till now. Treatment with pimozide in monosymptomatic hypochondriacal syndrome is discussed.
Bandages ; Cheek ; Cicatrix ; Delusions ; Dermatitis* ; Diagnosis ; Female ; Hemorrhage ; Humans ; Middle Aged ; Pimozide* ; Pruritus ; Recurrence ; Skin ; Ulcer

BACKGROUND: The pathogenesis of alopecia areata is still unknown, however autoimmune mechanism is strongly suggested. The topical immunotherapy using potent sensitizer has been used as new therapeutic modality. By this method in one half and to one third of the patients, hair growth is observed. OBJECTIVE: To evaluate the immunological profile between responders and non-responders to dphencyprone (DPCP) topical immunotherapy in alopecia areata patients. METHODS: Aker sensitization, DPCP was applied to the patients' scalp weekly for three months. Before and after treatment the therapeutic effect was evaluated by clinical observation by following items: complete baldness, baldness+vellus, baldness+terminal hair and normal hair. Peripheral T cell and T cell subsets, B cell and delayed hypersensitivity with various antigens were evaluated before and after treatment. RESULTS: The immunologic difference between responders and non-responders was not statistically different. CONCLUSION: It is suggested that no major immunologic difference was observed between responders and non-responders before and after DPCP topical immunotherapy. Local mechanism seems to be related in the response to immunotherapy.
Alopecia Areata* ; Alopecia* ; Hair ; Humans ; Hypersensitivity, Delayed ; Immunotherapy ; Methods ; Scalp ; T-Lymphocyte Subsets

BACKGROUND: The pathogenesis of alopecia areata is still unknown, however autoimmune mechanism is strongly suggested. The topical immunotherapy using potent sensitizer has been used as new therapeutic modality. By this method in one half and to one third of the patients, hair growth is observed. OBJECTIVE: To evaluate the immunological profile between responders and non-responders to dphencyprone (DPCP) topical immunotherapy in alopecia areata patients. METHODS: Aker sensitization, DPCP was applied to the patients' scalp weekly for three months. Before and after treatment the therapeutic effect was evaluated by clinical observation by following items: complete baldness, baldness+vellus, baldness+terminal hair and normal hair. Peripheral T cell and T cell subsets, B cell and delayed hypersensitivity with various antigens were evaluated before and after treatment. RESULTS: The immunologic difference between responders and non-responders was not statistically different. CONCLUSION: It is suggested that no major immunologic difference was observed between responders and non-responders before and after DPCP topical immunotherapy. Local mechanism seems to be related in the response to immunotherapy.
Alopecia Areata* ; Alopecia* ; Hair ; Humans ; Hypersensitivity, Delayed ; Immunotherapy ; Methods ; Scalp ; T-Lymphocyte Subsets

No abstract available.
Purpura, Thrombocytopenic, Idiopathic*

Acute arterial occlusion of the extremity may result from obstruction of an artery by embolism or by thrombosis in situ. This results in the sudden cessation of blood flow to an extremity. So immediate managements are required to prevent propagation of the clot and to restore blood flow to the ischemic extremity promptly. We report a case of a acute arterial occlusion which was developed during prolonged fasting. A 59-year-old male was transferred due to severe ischemic pain, coldness and loss of pulse in left lower extremity during fast. The arteriogram shows a complete obstruction of external iliac artery and non-visualization of femoral artery and popliteotibial artery in the left lower extremity. Selective intra-arterial urokinase thrombolytic therapy and percutaneous transluminal angioplasty resulted in recannulation of obstructed artery and relief of symptoms.
Angioplasty ; Arteries ; Embolism ; Extremities ; Fasting* ; Femoral Artery ; Humans ; Iliac Artery ; Lower Extremity* ; Male ; Middle Aged ; Thrombolytic Therapy ; Thrombosis ; Urokinase-Type Plasminogen Activator