The multiple lentigines syndrome or LEOPARD syndrome is an autosomal dominantly inherited disorder with a variety of abnormalities and a familial occurrence. This syndrome is characterized by the presence of numerous dark brown macules on the skin but not the mucous surface, and by a marked increase in the number of lentigines from birth to puberty. The eponym LEOPARD stands for lentigines, EKG abnormalities, ocular hypertelorism, pulmonary stenosis, abnormalities of the genitalia, retardation of growth and deafness. We report a case of multiple lentigines syndrome in 7-year-old boy. He had numerous pinhead to pea sized, dark brownish macules scattered on the entire body and also had pulmonary stenosis, EKG abnormality, ocular hypertelorism and right exotropia. Interestingly, he also had a labial melanotic macule on the lower lip, which is usually spared in the multiple lentigines syndrome. Histologically, the biopsy specimen taken from the macule revealed an elongation of rete ridges, an increase of melanin pigments in the basal layer and mild inflammatory infiltrates intermingled with the melanophages in the upper dermis.
Adolescent ; Biopsy ; Child ; Deafness ; Dermis ; Electrocardiography ; Eponyms ; Exotropia ; Genitalia ; Humans ; Hypertelorism ; Lentigo ; LEOPARD Syndrome* ; Lip ; Male ; Melanins ; Panthera ; Parturition ; Peas ; Puberty ; Pulmonary Valve Stenosis ; Skin

No abstract available.
Blood Pressure* ; Humans ; Infant, Newborn*

Endonasal DCR has been reported for the advantages of lack of a cutaneous scar and short operating time but that the surgical success rates were lower than conventional method. We have performed endonasal DCR and had follow-up of at least 6 months in 107 patients who had been diagnosed with lacrimal pathway obstruction, and also surveyed the age, sex, sac size and nasal cavity abnormality to evaluate the factors related to success rate. Primary success rates were 82.2%(88eyes) and higher success rates were noted in younger age, man and large sac but not significant. But. the cases associated with nasal cavity abnormality as septal deviation, middle turbinate hypertrophy, ethmoiditis and polyp showed poor surgical results due to membranous ostium closure, formation of granuloma within the ostium, and formation of cicatrix with the middle turbinate.(P<0.05) Improvement of success rate may be owing to appropriate preoperative evaluation, proper management of nasal cavity abnormality preoperatively and intraoperatively, and show consider the conventional method in cases of that lower success rate are predict.
Cicatrix ; Dacryocystorhinostomy* ; Follow-Up Studies ; Granuloma ; Humans ; Hypertrophy ; Nasal Cavity ; Polyps ; Turbinates

No abstract available.
Anesthesiology* ; Education* ; Publications*

The purpose of this study was to develop a dental communication course in dental hygiene schools that included theory, practice, and skill for effective dental communication. Thirty-six senior dental hygiene students in a dental hygiene school took a dental communication course and responded to a questionnaire. The instrument used in the study was a modified form of Kim's communication skill self-assessment sheet. The self-assessment questionnaire about communication competencies was administered before and after the class, and the difference between scores at each time point was analyzed using the Wilcoxon signed rank sum test. Among seven elements of dental communication competencies, the competency of “information gathering” was significantly improved (p=0.008). Students' scores on perception of the importance (p=0.019) and necessity (0.016) of a communication course significantly increased after the course. Competencies in communication are essential requirement for dental hygienists. This study showed the possibility of communication skill training. An objective evaluation tool regarding students' communication competencies should be developed. Further studies with larger samples size are needed to develop a standardized comprehensive communication course in dental hygiene schools.
Curriculum ; Dental Hygienists ; Health Communication ; Health Education ; Humans ; Learning* ; Oral Hygiene* ; Self-Assessment

BACKGROUND: The reduction in hematocrit (Hct) by hemodilution tends to cause an increase in cardiac output and a proportional decrease in arterial oxygen content. Additionally the reduction of systemic oxygen delivery (DO2) leads to significant differences in regional blood flow. It is therefore important to characterize the effects of hemodilution on regional oxygen metabolism in individual organs. This study was undertaken to evaluate and compare the effects of acute normovolemic anemia induced by hemodilution. METHODS: Six dogs were anesthetized and mechanically ventilated. Catheters were inserted in the right femoral and pulmonary arteries for blood sampling, and a gastric tonometer catheter was inserted into the gastric lumen. Baseline measurements of systemic hemodynamics, arterial ketone body ratio (AKBR), gastric intramucosal pH (pHi) and arterial lactate were recorded. Hemodilution was then begun by 6% pentastarch and was made in four levels of hematocrit values of 20%, 15%, 10% and 6%. RESULTS: Mean arterial pressures of Hct 10% and 6% was decresaed (P < 0.05) and Hct 15% and 10% increases in cardiac output and pulmonary capillary wedge pressure (PCWP) were observed. Central venous pressure and mean pulmonary arterial pressure were incresed (P < 0.05) at Hct 15%, 10% and 6%. DO2 progressively decreased (P < 0.05). AKBR and pHi began to decreased at Hct 15%. Arterial lactate decrease at Hct 15% and was above 7.4 mmol/L at Hct 6%. CONCLUSIONS: By the measurements of AKBR and pHi, the disturbance of splanchnic oxygenation can be detected early compared to those of O2 in terms of oxygen metabolism and the critical point of DO2 during acute normovolemic anemia induced by hemodilution.
Anemia* ; Animals ; Arterial Pressure ; Cardiac Output ; Catheters ; Central Venous Pressure ; Dogs* ; Hematocrit ; Hemodilution* ; Hemodynamics ; Hydrogen-Ion Concentration* ; Hydroxyethyl Starch Derivatives ; Lactic Acid* ; Metabolism ; Oxygen Consumption* ; Oxygen* ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Regional Blood Flow

Periodic paralysis associated with thyrotoxicosis is characterized by intermittent flaccid paralysis of the skeletal muscle. The paralysis usually involve the skeletal muscle of the limbs, especially lower extrimities. In general, sensory function is intact. Involvement of respiratory, ocular or bulbar muscles is very rare, but bulbar and respiratoy invelvement may prove fatal. It is very rare a case that has severe clinical manifestation such as cardiac arrest. We report a case of thyrotoxic hypokalemic periodic paralysis presenting as cardiac arrest.
Extremities ; Heart Arrest ; Hypokalemic Periodic Paralysis ; Muscle, Skeletal ; Muscles ; Paralysis ; Sensation ; Thyrotoxicosis

Juvenile xanthogranuloma (JXG) is a fibrohistiocytic proliferative disorder predominant in infancy and childhood. It is a benign and transient skin lesion that usually appears in the cephalic area. Recently, the concurrent finding of neurofibromatosis (NF), juvenile chronic myelogenous leukemia (JCML), and JXG has been repeatedly reported. Especially, the family history of NF may represent a risk factor for the development of JCML in patients with NF and in patients with NF and JXG. So, a finding of JXG and NF in infants should alert the physician to a possible development of JCML. We report a case of JXG developed in a neurofibromatosis child with family history.
Child ; Humans ; Infant ; Leukemia, Myelomonocytic, Juvenile ; Neurofibromatoses ; Risk Factors ; Skin ; Xanthogranuloma, Juvenile

BACKGROUND: Tracheal intubation can cause sympathetic stimulation such as hypertension and tachycardia. Many drug are used for reducing the incidence of hypertension and tachycardia induced by intubation. Among these drugs, fentanyl can be used with good result. The purpose of this study was to find the appropriate fentanyl injection time before intubation when a small dose (3 microgram/kg) was used. METHODS: We studied 82 ASA class 1 2 patients, scheduled for gynecological elective surgery, randomized into 5 groups. Group 1 received no fentanyl before intubation, and groups 2, 3, 4 and 5 received 3 microgram/kg fentanyl at 7 min, 5 min, 3 min and 1 min before intubation, respectively. The blood pressure and heart rate were checked at preinduction and post-intubation periods for 5 minutes. RESULTS: The increase of the heart rate was significantly lower in groups 2 and 3 than in group 5 just after intubation. Furthermore the increase of the mean blood pressure was significantly lower in groups 2, 3 and 4 than in group 5 just after intubation. The incidence of tachycardia and hypertension was significantly lower in groups 2, 3 and 4 than in group 5 just after intubation. CONCLUSIONS: When a small dose of fentanyl was used to blunt the intubation induced sympathetic stimulation, the appropriate time was prior to 3 minutes before intubation.
Blood Pressure ; Fentanyl* ; Heart Rate ; Humans ; Hypertension* ; Incidence* ; Intubation* ; Tachycardia*

BACKGROUND AND OBJECTIVES: We investigated in patients with coronary vasospastic angina whether the exercise ECG test results are influenced by the different modes of exercise load and compared the clinical characteristics including coronary risk factors between patients with positive and negative exercise tests. MATERIALS AND METHODS: This study comprised 34 patients with documented coronary artery spasm without significant stenosis (coronary artery luminal diameter narrowing <70%) and treadmill exercise test. Treadmill exercise ECG test was performed based on Bruce's protocol (graded exercise test, GET) and sudden rapid exercise protocol (non-graded exercise test, NGET) in the morning of the same day. RESULTS: 1) Of 29 patients who underwent both GET and NGET, 19 patients manifested positive result by NGET, whereas only 11 patients did by GET (66 vs. 38%, P=0.04). All patients with positive GET had positive NGET and 8 of 18 patients with negative GET had positive NGET. 2) Of 34 patients who underwent GET, there was no significant difference in frequency of hypertension, diabetes, current smoking, presence of effort chest pain by history, mixed disease (fixed stenosis >50%, <70% of luminal diameter) or total cholesterol level between patients with positive and negative results. In 18 typical variant angina patients by clinical history, 8 of 10 patients with high disease activity (5 times or more attack per week) manifested positive result by GET or NGET, whereas 4 of 8 patients with low disease activity (80 vs. 50%, P=NS). CONCLUSION: In patients with coronary vasospastic angina, sudden rapid exercise could induce more frequently coronary artery spasm than multistage exercise. The result of an exercise test may not be correlated with coronary risk factors, coronary anatomy, effort chest pain, and the disease activity.
Arteries ; Chest Pain ; Cholesterol ; Constriction, Pathologic ; Coronary Vessels ; Electrocardiography ; Exercise Test* ; Humans ; Hypertension ; Phenobarbital ; Risk Factors ; Smoke ; Smoking ; Spasm