Disseminated superficial actinic porokeratosis (DSAP) has an autosomal dominant mode of inheritance with reduced penetration at young age, characterized by multiple superficial keratotic lesions surrounded by a slightly raised border. The aggrevation of the lesion by exposing UV light indicates that phenotypic expression of gene regluating DSAP is related to sun light. We observed a family of which 13 members had DSAP in 3 successive generations. They were grandrnother, two sons of her 3 offsprings, 2 grandsons and 8 granddaughters. Lesions of all cases were found on the sun exposed areas, especially, face, extremities and upper trunk but exceptionally one had a lesion on the unex posed area, abdomen below the iliac crest. The number of lesions of the individual patient were 12-116, and there appeared to be increasing number of lesions with age.
Abdomen ; Extremities ; Family Characteristics* ; Humans ; Porokeratosis* ; Solar System ; Ultraviolet Rays ; Wills

BACKGROUND: The measurement of nonspecific bronchial hyperreactivity is valuable for diagnosis and management of bronchial asthma. Methacholine or histamine is used for the pharmacologic provocation test. Usually a methacholine bronchial provocation test is performed by a dosing technique with counted number of breaths. A dosimeter is indispensable in the dosing technique. Recently a timed tidal breathing technique which dose not need an expensive dosimeter was introduced. We measured the degree of nonspecific bronchial hyperreactivity to histamine using a simple timed tidal breathing technique. METHOD: Forty two healthy volunteers, 12 patients with bronchial asthma(BA), 10 patients with rhinitis(RH) and 10 patients with upper respiratory infection(URI) participated in the study. The subject's nose was clipped and inhalation continued during tidal breathing for 2 minutes via a face mask. FEV1 was measured at 30 seconds, 90 seconds after inhalation and inhalation of next solution was continued until there was a fall in FEV1 of 20%. Histamine PC20 was defined as the concentration at 20% fall of FEV1 and it was obtained from the log dose-response curve by linear interpolation. RESULTS: Inhalation of serial dilution of histamine could be performed in all patients without significant side of effects. The geometric mean±standard deviation of histamine PC20 in healthy volunteers is 8.27±2.22mg/ml, BA group 0.33±3.02mg/ml, RH group 0.85 ±3.24mg/ml, and URI group 1.47±1.98mg/ml. CONCLUSION: Histamine bronchial provocation test using timed tidal breath method is a simple and suitable tool for management of patients with bronchial hyperreactivity.
Asthma ; Bronchial Hyperreactivity ; Bronchial Provocation Tests* ; Diagnosis ; Healthy Volunteers ; Histamine* ; Humans ; Inhalation ; Masks ; Methacholine Chloride ; Nose ; Respiration*

The association rate of antibody with antigen has been reported to be greatly increased by lowering ionic strength. Low-ionic strength salt solution(LISS) method has been used for the detection of various alloantibodies. To investigate the sensitivity of LISS in indirect antiglobulin test, a comparison study of LISS with saline and albumin methods was conducted. A total of 32 patients' samples requested for indirect antiglobulin test were evaluated. Out of 32 patients with clinical immune hemolytic anemia, 11(34.3%) were positive in 37 degrees C saline antiglobulin test, 18(56.2%) in albumin antiglobulin test, 23(71.8%) in LISS antiglobulin test respectively. These results were statistically analyzed using non parametric Page's test for ordered alternatives. LISS method is more sensitive than 37 degrees C saline method or albumin method significantly (p<0.01).
Anemia, Hemolytic ; Coombs Test* ; Humans ; Isoantibodies ; Osmolar Concentration

BACKGROUND: Hypotension occurs frequently after epidural anesthesia. Intravenous fluid or vasopressors are among treatment methods to many suggested causes. This study was undertaken retrospectively to determine if the age, weight and height of parturients are related to the local anesthetic dosage in epidural anesthesia for the cesarean section, and if the dosage of local anesthetic influence the change of blood pressure and the requirement of fluid or epherine. METHODS: Sixty-nine parturients were studied by reviewing patients' anesthetic records. During lumbar epidural anesthesia to T4 sensory level, all patients were monitored with mean arterial blood pressure, and prevented from hypotension by administration of Ringer's lactated solution. But if hypotension has been sustained in spite of rapid fluid loading, intermittent ephedrine was injected. We studied the correlation of local anesthetic dosage, decrement of mean blood pressure and total required intravenous fluid volume, and difference of these variables between cases using ephedrine and not using. RESULTS: The volume of local anesthetic to achieve a T4 sensory level was 21.20 3.81ml, which did not correlate with age, weight and height, and did not influence the decrease of mean blood pressure and the volume of administered fluid. But the patients (n=30) who needed ephedrine were adminstered significantly larger dose of the local anesthetic and showed more decrease in the mean blood pressure than those (n=39) who did not. CONCLUSIONS: The dose requirement of local anesthetic during epidural anesthesia for the cesarean section is not determined by the age, weight and height of parturients. But when larger dose of local anesthetic is administered, the patients seem to be more hypotensive and need ephedrine as well as intravenous fluid administration.
Anesthesia, Epidural* ; Arterial Pressure ; Blood Pressure ; Cesarean Section* ; Ephedrine* ; Female ; Humans ; Hypotension ; Pregnancy ; Retrospective Studies

No abstract available.
Pulmonary Embolism*

We report a case of multiple Bowen's disease associated with leprosy. A 68-year-old man was seen because of slightly pruritic multiple erythematous scaly patches and plaques on the trunk and the both extremities for 5 years. He has been treated for leprosy with many kinds of drugs consisting of the herb medications for over 40 years. He also showed decreased cell-mediated immunity in skin tests. It is considered that depressed cellular immunity may be an important predisposing factor in the development of mutiple Bowen's disease in this case, .although arsenics can not be completetly excluded.
Aged ; Bowen's Disease ; Causality ; Extremities ; Humans ; Immunity, Cellular ; Leprosy* ; Skin Tests

A 31-year-old woman had a livedo reticularis of reticulated, bluish discoloration on both arms and legs for 18 months with a burning pain in the right hand and numbness in both lower legs. The findings of the electromyography were consistent with mononeuropathy multiplex and bilateral ulnar-median nerve anastomosis. A biopsy specimen from the right sural nerve showed perivascular lymphocytic infiltration and occasional myelin digestion chambers, which were consistent with vasculitic neuropathy. We present a patient with livedo reticularis idiopathica associated with mononeuropathy multiplex syndrome who also has bilateral ulnar-median nerve anastomosis.
Adult ; Arm ; Biopsy ; Burns ; Digestion ; Electromyography ; Female ; Hand ; Humans ; Hypesthesia ; Leg ; Livedo Reticularis* ; Mononeuropathies* ; Myelin Sheath ; Sural Nerve

Multidirectional shoulder instability is often difficult to diagnose and treat and can be cause of significant disability. Nonoperative rehabilitations and life tyle modifications are the primary treatments. Hiwever, the inferior capsular shift procedure, performed either from an anterior or posterior approach, as described by Neer and Foster, is recommended for symptomatic multidirectional instability that is unresponsive to nonoperative therapy. Twenty-seven shoulders in twenty-seven patients with inferior and multidirectional instability were managed with Neer s inferior capsular shift, through anterior or posterior approach depending on the direction in which the shoulder is most unstable. All of the patients were followed up for an average of 3 years (range one to seven years). The postoperative range of motion of the shoulders was well maintained except 1 patient. Three patients had recurrence of symptomatic and disabling multidirectional instability, but twenty-four (89%) of the shoulders continued to function well with no instability, no pain, no recurrence and no remarkable limitation of motion.
Humans ; Range of Motion, Articular ; Recurrence ; Shoulder*

Bacteroides fragilis is a Gram negative nonsporulating anaerobic rod bacterium that makes up about 1 to 2% of the norrnal human colonic microflora. In 1984, Myer et al. reported that some strains of B. fragilis produce enterotoxin and cause diarrheal disease in cattle and human. Since then it has been termed enterotoxigenic B. fragilis (ETBF). In this study, we tried to detect enterotoxin gene from 37 B. fragilis strains, isolated in Korean patients, to confirm the existence of ETBF and usefulness of PCR as a rapid diagnosis method. By this method, we identified 9 ETBF strains and confirmed their pathogenesis by cytotoxicity test. No significant cross- reactivity with other anaerobes or aerobes was observed. Thus, the PCR method may be considered useful for the sensitive and rapid detection of anaerobic infections. And the entire amplified PCR mixture was ligated into a pT7Blue T-vector and transformed into E. coli. When the nucleotide sequences of cloned PCR products were compared with reported enterotoxin gene, pBF529 inserted DNA sequence was nearly in good agreement with it but pBF570 inserted DNA sequence showed some difference at nucleotide 270-300. A search for nucleotide sequence homologies revealed that pBF529 exhibited 99%, but pBF570 indicated only 90% identity with reported enterotoxin gene. According to these results, it was suggested that ETBF toxin can be differentiated into at least 2 subtypes.
Animals ; Bacteroides fragilis* ; Bacteroides* ; Base Sequence ; Cattle ; Clone Cells ; Colon ; Diagnosis ; Enterotoxins* ; Humans ; Korea* ; Polymerase Chain Reaction*

20-year-old patient presented with the episodes of generalized hyperkeratotic lesions with bullae since her early life, without family history. Histopathological examination by light and electron microscopes showed the characteristic features of epidermolytic hyperkeratosis. Primarily, she failed to respond to the treatment with propylene glycol. Vitamine A palmitate(A-Mulsin) per os appears to be a beneficial remedy for epidermolytic hyperkeratosis, although its availability is limited due to the side effects on a long term therapy. Repeated biopsies in the normal appearing lesions 2 months after treatment of vitarnin .A palmitate showed a substantial reduction of the horny layer on the light microscope and orderly arrangement of the tonofilaments, and properly formed keratohyaline granules on EM, but the underlying disorder of keratinization remained unchanged. Treattnent of 2 months with vitamin A was interrupted by side effects of nasal bleealing, chelitis and xerosis.
Biopsy ; Humans ; Hyperkeratosis, Epidermolytic* ; Intermediate Filaments ; Propylene Glycol ; Vitamin A* ; Vitamins* ; Young Adult