Several Problems of Growth Hormone Stimulation Test in Clinical Application / 대한소아내분비학회지

PURPOSE: We investigated properness of growth hormone stimulation test (GHST) to diagnose growth hormone deficiency (GHD) in comparison with clinical characteristics. METHODS: For twenty five GHD children classified by GHST criteria during the recent 5 years, clinical characteristics and laboratory findings were correlated retrospectively through medical records. RESULTS: Seventeen were idiopathic GHD and 8 were secondary GHD. 1) Among the idiopathic type, 8 had complete GHD (maximal stimulated GH 5, and <10 ng/mL). For this group, IGF-1, height SDS, and degree of delayed bone age were not correlated with maximal stimulated GH level, while the IGFBP-3 and growth velocity before GH treatment were significantly correlated (P<0.05). Growth velocity was significantly increased from 5.1 to 8.6 cm/yr during treatment (P<0.0001). 2) Variable results were obtained in 5 patients with multiple GHST. One idiopathic patient changed from non GHD to complete GHD during 5 years. One patient operated for craniopharyngioma showed from non to partial, then non GHD. Diffuse brain atrophy patient showed from partial to complete GHD. Two secondary form patients showed from non to partial GHD. 3) Three patients among idiopathic type showed growth velocity more than 5 cm/yr even without GH treatment. CONCLUSION: IGFBP-3 and growth velocity before treatment might be possible indicators to predict maximal stimulated GH level. In view of the variable results from multiple GHST, auxological and biological data should also be considered in diagnosis.

Correlation of Serum Chemokine Levels with SCORAD Index in Children with Atopic Dermatitis / 소아알레르기및호흡기학회지

PURPOSE:CCL17, CCL27 and CCL18 have attracted significant interest with regard to understanding the mechanisms of T cell trafficking. We tested whether levels of serum CCL17, CCL27 and CCL18 would be useful markers for atopic dermatitis (AD) in children. METHODS:Serum concentrations of CCL17, CCL27, CCL18, total IgE and eosinophil cationic protein (ECP) in AD (n=40) and healthy control (n=40) children were compared. The correlation between the studied parameters and activity of AD was investigated. The severity of AD was assessed according to the SCORAD (scoring atopic dermatitis) index. The serum concentrations of CCL17, CCL27 and CCL18 were measured by means of ELISA. RESULTS:The levels of all studied parameters were significantly higher in children with AD than those of control subjects. A positive correlation was found between the levels of CCL17, CCL18 and CCL27 and the SCORAD index in AD children (P<0.05, P<0.001 and P<0.001) The correlation of CCL17 and CCL27 concentrations with severity appears to be age-dependent because a stronger correlation was found in AD children over the age of 2 years than those with younger than 2 years of age. A weaker correlation in AD children younger than 2 years may be attributed to higher concentrations of these chemokines because higher concentrations of these chemokines were detected in control subjects younger than 2 years (CCL17=205+/-281 pg/mL, CCL27=999+/-783 pg/mL) than those of older than 2 years.(CCL17=49+/-54 pg/mL; P= 0.012, CCL27=630+/-820 pg/mL; P=0.041, respectively) CONCLUSION:Our findings suggest that levels of serum CCL17, CCL27 and CCL18 can be used as useful markers for the severity of AD.

Colonization Rate, Risk Factor for Acquisition and Genetic Diversity of Vancomycin-Resistant Enterococci (VRE) Isolated from Rectal Culture of Patients in Intensvie Care Units from Ten Large Hospitals in Korea / 감염

BACKGROUND: VRE have become an emerging nosocomial pathogen in Korea, but there has not been nationwide study on the colonization of VRE among high risk groups of hospitalized patients. The purpose of this study was to determine the prevalence of rectal colonization of VRE among patients hospitalized in the intensive care unit (ICU), to study the risk factors for nosocomial acquisition of VRE among those patients, to define the genetic diversity of VRE strains in major hospitals in Korea. METHODS: Between January the 20th and 30th of 2000, a point surveillance study was conducted in the ICU of the ten large hospitals, which were located nationwide. Surveillance rectal swab cultures for detecting VRE were obtained among 214 patients admitted to the ICU during the study period. To isolate VRE, rectal swab cultures were performed on Enterococcosel(R) agar that containing 6 microgram/mL of vancomycin. Minimal inhibitory concentrations (MICs) of vancomycin and teicoplanin were determined by agar dilution method. For the genotyping of VRE isolates, the detection of vanA, vanB, vanC1 and vanC2 gene by polymerase chain reaction was done. Pulsed-field gel electrophoreis (PFGE) was used for elucidating the genetic relatedness of VRE isolates. To identify the risk factors for rectal VRE colonization, patients harboring VRE were compared to patients who were not colonized with this organism. RESULTS: The rectal colonization rate of VRE was variable from 9.7% to 51.9% according to hospital. 64 VRE strains which were isolated from 63 patients included 37 E. feacium. 26 E. gallinarum and 1 E. casseliflavus isolates. Therefore the colonization rate of clinically significant vanA type VRE was 17.3% (37/ 214). 37 E. feacium. 26 E. gallinarum and 1 E. casseliflavus isolates were presented as vanA, vanC1 and vanC2 genotypes, respectively. Risk factors for rectal VRE colonization included the presence of chronic illness, previous use of broad spectrum antibioitcs es-pecillay vancomycin, and prolonged stay in ICU. Various PFGE patterns are noted among vanA type VRE isolates, so individual acquisition of VRE during stay in the majority of ICUs were suggested. But there is some evidence of focal VRE spread within the ICU and between hospitals. CONCLUSION: This study demonstrated the high rectal colonization rate (17.3%) of clinically significant vanA type VRE among patients admitted to the ICUs of ten large hospitals located nation-widely. This study suggested that practicing HICPAC guidelines, restricted vancomycin usage and periodic surveillance cultures in patients with high risk factors are important in preventing the emergence and spread of VRE infection among ICU patients.

A case of Sulfone syndrome hypersensitivity associated with dapsone / 천식및알레르기

Sulfone hypersensitivity syndrome, which is characterized by fever, skin rash, hemolytic anemia, atypical lymphocytosis, and acute hepatic injury, is a potentially fatal variant of dapsone hypersensitivity. A 62-year-old woman with a history of arthralgia developed sulfone syndrome while receiving dapsone 100 mg/day for 20 days. Fever, malaise, prominent rashes, hepatitis, eosinophilia and hemolytic anemia developed and she which required hospitalization. The patient's symptoms reversed following discontinuation of dapsone and administration of steroid (0.5 mg/kg). A case of sulfone syndrome and a brief review of the literature were presented.

Imported tertian malaria resistant to primaquine

In Plasmodium vivax and Plasmodium ovale malaria, some of the liver stage parasites remain dormant. The activation of these dormant forms (called hypnozoite) can give rise to relapse weeks, months or years after the initial infection. To prevent relapses, a course of primaquine may be given as terminal prophylaxis to patients. Different strains of Plasmodium vivax vary in their sensitivity to primaquine and, recently, cases of relapse of Plasmodium vivax after this standard primaquine therapy were reported from various countries. We reported a case of primaquine resistant malaria which initially was thought to be relapsed caused by loss of terminal prophylaxis.

A Study on the Effect of Topical Indomethacin on Sunburn / 대한피부과학회지

It is generally recognized that several chemical mediators are involved in tbe pathogenesis of sunbum; however, the exact mechanism is still to he resolved. Recently, prostaglandin has been found to be one of the inflammatory mediators in sunbum, particularly in the delayed erythema response and several investigators have shown that the nonsteroidal antiinflammatory drugs inhibit the in vivo synthesis of prostaglandin. On the assumption that the nonsteroidal antiinflammatory drugs might exert a beneficial effect on the sunbum through the antiprostaglandin effect, several authors have reported the effect of indomethacin on sunbum. This study was undertaken to evaluate the effect of topical indomethacin on the delayed erythema response induced by artificial sunlamp and sunlight by clinical and histopathological examination. Indomethacin(2. 5% ointment, 2. 5% solution, 5% solution) was applied immediately after 3 MED irradiation of artificial sunlamp to the shaved back skin of 6 healthy albino guinea pigs weighing 550-850gm and 9 human volunteers and the delayed erythema response was observed at 2, 4, 6, 12, 24 and 48 hours after irradiation respectively. Punch biopsies of the skin were performed on 6 guinea pigs at 6, 12, 24 a.nd 48 hours after irradiation and the histologic changes were observed. Four human volunters were exposed t,o 3 MED of sunlight and indomethacin preparations were applied immediately after irradiation. The delayed erythema response was observed at 2, 4, 6, 12, 24 and 48 hours postirradiation and in one volunteer, the skin was biopsied at 24 hour for histologi.c evaluation. The results were as follows: 1. Topical indomethacin in ointment or solution forms delayed and decreased the appearance and degree of erythema induced by sunlight and artificial sunlamp in both human and animal subjects. 2. Histologically, the number of sunbum cells at 24 hour in the epidermis of one human volunteer was decreased on indomethacin applied sites. The dermis showe6 no difference in histologic changes between control and indomethacin sitea. In animal study, however, no detectable difference in epidermal or dermal changes was observed between control and indomethacin applied sites. The autors confirmed that topical indometha,cin was effective in delaying and blanching of the delayed erythema of sunbum in guinea pigs as well as in human volunteers, though there was no difference in histologic changes between indomethacin and control sites in guinea pigs. The mechanism involvel on this aspect is remained to be resolved.

A Clinical Study of the Therapeutic Effect of Clocortolone on soem Dermatoses / 대한피부과학회지

Cloeortolone (9-a-chloro-6-a fluoro-11-B 21 digydroxy-16 methyl preganl,4-diene) is a newly synthesized corticonsteroid which has been found to have potent antinflammatory action and good tolerance through animal experiment. Several investigators reported its therapeutic affect in various dermatoses by topical application. The present was undertaken to evaluate the therapeutic effect of 0.1% clocortolone cream (Purantix-Sandoz) in patients with eczematous dermatoses and with psoriasis and to compare its effect with that of I% hydrocortisone. Eleven patients with contact dermatitis, 10 with psoriasis entered this study durtin the period of 6 months from January to june, 1977 at the Department of Dermatology, Seoul National University Hospital. All patients were instructed to apply 0.1% Clocortolone cream on one side of their lesion and 1%hydrocortisone cream on the opposite site for two weeks. After wo weeks' period of observation the status of the lesion was evaluated clinically and the tesults were as follows. 1. Ninety one percent of patiens with contact dermatitis, 70% of atopic dermatitis, 60% of nenrodermatitis, 67% of nummular eczema and 60% of psoriasis responded very effectively or moderately effectively. The therapeutic responses were generally similar to that of 1% hydrocortisone. 2. During the ovservation period, there was no systemic of local side effect of 0.1% Clocortolone cream.

A Case of perifolliculitis Capitis Abscedens et Suffodiens / 대한피부과학회지

We presented a case of perifolliculitis capitis abscedens et suffodiens associated with acne conglobata in 40-year-old rnale. He had a sausage-shaped plaque containing many fistular tracts on right temnporal area and cicatrizing alopecia on occiput. On the middle portion of upper back he had a adult fist-sized plaque containing many fistular tracts. Histopathologically epidermis showed mild byperkeratosis and keratotic plugging and in the dermis most hair follicles were destroyed and replacel by fibrous tissue but there were moderxte cellular infiltration composed of neutrophils, lymphocytes a.nd hist.iocytes around the remained hair follicles. On serum electrophoresis alpha,-globulin was elevated and gamna globulin was the upper liviit of nornal variation. Skin tests with murnps vaccine, dinitrochloro benzene (DNCB) and old tuberculin disclosed the evidence of de reased c "ll-mediated immunity(CMI). All th se findings suggest thzt immune rriechanisni r,-ay be concerned ivith the pathogenesis in this case. He wa.s treated with th internal administration of antibiotic and corticosteroid and with surgical opening and curettage of fistular tracts