Pelvic actinomycosis with hydronephrosis and colon stricture simulating an advanced ovarian cancer / 부인종양

Pelvic actinomycosis is an uncommon disease in humans. It has nonspecific and variable clinical features, and thus it is difficult to diagnose. Moreover, appropriate management is delayed or overlooked because it can sometimes simulate advanced ovarian cancer. We report a case of pelvic actinomycosis which manifested with hydronephrosis and bowel stricture, lymph node enlargement and increased level of tumor marker caused by a large pelvic mass. Since this case showed clinical findings mimicking an advanced ovarian carcinoma, it was surgically diagnosed as actinomycosis after neoadjuvant chemotherapy.

Evaluation of Implicit Emotion of Alcohol-Related Cues in Alcohol Dependence / 신경정신의학

OBJECTIVES: To study the mechanism of alcohol craving is difficult because it involves both cognitive and emotional processes, which are discordamtly influenced by patients' avoidance and denial. The objective of this study is to examine the mechanism of craving by evaluating responses of emotional component of alcohol-related stimuli, explicitly and implicitly. METHODS: The subject group was composed of 19 patients with alcohol dependence, 25 heavy drinkers, and 20 social drinkers. An implicit association test (IAT) measuring differential association of 2 target concepts (alcohol versus beverage) with 2 attribute dimensions (positive versus negative) was completed. Explicit evaluation of emotional valence and arousal for alcohol-related and control stimuli was also completed. RESULTS: The patient group reported alcohol-related stimuli more negatively on both implicit and explicit evaluation. In explicit arousal evaluation, they evaluated alcohol-related stimuli more arousing than control stimuli, whereos control groups did not. While the strength of alcohol-negativity association was not related to any clinical variables, the strength of alcohol-positivity association was related to the arousal level of alcohol related stimuli, the severity of alcohol dependence, and the mean drinking amount per occasion. CONCLUSION: Alcohol craving can be regarded as negative emotion on both explicit and implicit levels in alcoholics. It seems that craving induced by alcohol-related stimuli may not be recognized by the patients but related to increased arousal or positive implicit evaluation of alcohol.

Prediction of the Development of Alcohol Withdrawal Delirium / 신경정신의학

OBJECTIVES: Alcohol withdrawal delirium is a serious clinical condition with high mortality rate if not treated. This study was to examine whether readily available clinical variables can predict the development of alcohol withdrawal delirium. METHODS: The authors performed a retrospective study by reviewing charts of 566 patients who had been admitted for alcohol dependence. The cases were divided into two groups: delirium group (n=40) and control group (n=40). We compared baseline characteristics and serum analysis data at admission between two groups. We used logistic regression to predict risk factors for alcohol withdrawal delirium among potential risk factors. RESULTS: The delirium group had significantly lower hemoglobin, hematocrit, platelet counts, and potassium level than countrol group. Presence of previous withdrawal delirium history, AST, GGTP, and bilirubin level of delirium group were significantly higher than those of control group. Among potential risk factors, past history of withdrawal delirium, decreased hemoglobin, elevated bilirubin level, and number of previous detoxification were predictable factors of the development of alcohol withdrawal delirium by 72.5%. CONCLUSION: Our results suggest that the infomation obtained at admission can be useful to predict the development of alcohol withdrawal delirium. Also, it makes the individualization of detoxification strategies possible.

Prediction of the Development of Alcohol Withdrawal Delirium / 신경정신의학

OBJECTIVES: Alcohol withdrawal delirium is a serious clinical condition with high mortality rate if not treated. This study was to examine whether readily available clinical variables can predict the development of alcohol withdrawal delirium. METHODS: The authors performed a retrospective study by reviewing charts of 566 patients who had been admitted for alcohol dependence. The cases were divided into two groups: delirium group (n=40) and control group (n=40). We compared baseline characteristics and serum analysis data at admission between two groups. We used logistic regression to predict risk factors for alcohol withdrawal delirium among potential risk factors. RESULTS: The delirium group had significantly lower hemoglobin, hematocrit, platelet counts, and potassium level than countrol group. Presence of previous withdrawal delirium history, AST, GGTP, and bilirubin level of delirium group were significantly higher than those of control group. Among potential risk factors, past history of withdrawal delirium, decreased hemoglobin, elevated bilirubin level, and number of previous detoxification were predictable factors of the development of alcohol withdrawal delirium by 72.5%. CONCLUSION: Our results suggest that the infomation obtained at admission can be useful to predict the development of alcohol withdrawal delirium. Also, it makes the individualization of detoxification strategies possible.

The Psychiatric Consideration of Torture / 신경정신의학

Torture is an extreme life stressor which increases the risk of serious psychological and physical sequelae of victims. Despite Geneva declaration, Amnesty International reports that torture remains as human rights issue in many sites of the world. Even in Korean peninsula, torture is a serions human rights issue. This paper is a critical review on torture; to describe its methods and effects, the assessment of psychological and physical sequelae, and its treatment. Torture also affects survivor's family. The more prolonged, repeated, and unpredictable the experience of torture is, the more serious psychiatric consequences are likely. Psychological responses and sequelae include not only symptoms of Posttraumatic Stress Disorder (PTSD), but also depression, personality changes, somatoform disorders and others. Diagnositic terms such as complex PTSD or torture syndrome have been used to denote the complexity of torture trauma. Treatment is a combination of pharmacotherapy, cognitive-behavioural therapy, guidance for of socialre readaptation. Ensuring safety and trust between survivors and medical staffs is important. Torture prevention is to expose the facts particularly health data to the public, and collaborate with international organizations fighting against torture. Preventive interventions is linked to a change in the underlying socio-political causes and to the creation of necessary conditions for human rights and development at the level of society.

Anorectal Cancer Undetected at the Time of Hemorrhoidectomy

No abstract available.

Adenocarcinoma Associated with Anal Fistula

PURPOSE: Although adenocarcinoma associated with anal fistula is rare, missed diagnosis may result in progression of the tumor and poor outcome. This study is aimed to determine the clinical features of adenocarcinoma associated with anal fistula. METHODS: The medical records of 8 (0.4%) cases associated with anal fistula, out of 1978 anorectal adenocarcinoma treated at Seoul National University Hospital between 1979 and 2000, were reviewed. RESULTS: The median age at diagnosis of cancer was 57 years (range, 39 to 62 years) and sex ratio was 7 to 1 with male predominance. The median duration of anal fistula before diagnosis of cancer was 8.5 years (range, 4 to 30 years). Major symptoms at diagnosis of cancer were perianal pain (38%) and discharge (38%). Perianal mass was palpable in all patients. All patients except for one case, in which palliative T-colostomy was performed due to extensive invasion despite preoperative radiation therapy, were treated with abdominoperineal resection: 4 in curative resection and 3 in palliative rsection. There were 4 (50%) in stage IV, 3 (38%) in stage III, and 1 (12%) in stage II. On median follow-up of 16 months (range, 3 to 72 months), systemic recurrences of 2 cases at lung or intraperitoneal cavity and 1 local recurrence at posterior vaginal wall were developed after curative resection. CONCLUSIONS: Adenocarcinoma associated with anal fistula had the history of long-standing anal fistula and perianal mass on physical examination. These tumors were detected at advanced stage and their outcomes were poor. Therefore, in the anal fistula combined with long-standing history or perianal mass, a high index of suspicion for malignancy is necessary and a generous biopsy of fistulous tract should be performed to rule out concomitant adenocarcinoma.

Epidermoid Carcinoma of the Anal Canal: Treatment Outcome and Prognostic Factor

PURPOSE: During recent two decades, therapeutic strategy for epidermoid carcinoma of anal canal has been changed on basis of the knowledge of the natural course and biologic features. The current study evaluated the treatment outcome and prognostic factors in epidermoid carcinoma of the anal canal. METHODS: Fifty-seven cases with epidermoid carcinoma of anal canal were treated curatively in Seoul National University College of Medicine from 1976 to 1997. The sex ratio was 1.5 to 1 with male predominance, with a median age of 57.0 years. The histology consisted of 59.6% (34 cases) in squamous cell carcinoma and 40.4% (23 cases) in cloacogenic carcinoma. According to UICC/AJCC staging system, there were 24.6% in stage I, 28.1% in stage II, 31.6% in stage IIIa and 15.8% in stage IIIb. Operation- based treatment was performed in 96.6% of 29 cases during period I (1976~1988) and in 60.7% of 28 cases during period II (1989~1997). Forty-five cases were treated on the basis of operation: 13 cases, operation only; 20, operation plus radiation; 12, operation plus chemoradiotherapy. And 12 cases were managed by combined radiation and chemotherapy. RESULTS: On median follow-up of 52.0 months (range, 1~160 months), there were 19.3% in local recurrence and 8.8% in systemic recurrence. Recurrence rates were not significantly related to therapeutic strategy (P=0.37). The overall 5-year survival rate was 74.9%. The 5-year survival rates according to therapeutic strategy were 73.3% in the operation-based treatment and 80.0% in the combined radiation and chemotherapy. Survival rates were not significantly related to therapeutic strategy (P=0.48). Three cases, whose sizes were 1 cm, 2 cm and 2.5 cm without lymph node metastasis, were excised locally and are still alive without recurrence. In the multivariate analysis, the metastatic status of lymph nodes had the only independent significant influence on survival. CONCLUSIONS: Combined radiation and chemotherapy in epidermoid carcinoma of anal canal is the preferred treatment for sphincter-preservation, and local excision in early lesion have good outcome without morbidity associated with chemotherapy or radiation therapy. In this study, lymph node status was the only prognostic variable.

A Case of Sweet's Syndrome Associated with Myelodysplastic Syndrome / 대한피부과학회지

We report a case of Sweet's syndrome associated with myelodysplastic syndrome in a 48-year-old male patient who presented with high fever, general weakness and tender, erythematous, painful vesiculopapules and plaques with crust on the face, extremities and perianal area. Skin biopsy revealed dense infiltration of neutrophilis in the upper and mid-dermis. Peripheral blood smear showed normocytic normochromic anemic feature with thrombocytopenia. Bone marrow biopsy revealed dyspoiesis of marrow cells, consistent with myelodysplastic syndrome. He was treated with methylprednisolone 50mg/day and general symptoms improved immediately with drop of fever and skin lesions began to improve within 2 days.

A Case of Verrucous Hyperplasia in An Amputee / 대한피부과학회지

Chronic dermatological problems associated with lower limb amputation sites include local maceration, intertrigo, blistering and ulceration, contact dermatitis, tissue atrophy, verrucous hyperplasia, lichenification, callosities, epidermoid cyst formation, and malignant neoplasia. A 60 year-old male was presented with a verrucous oozing eruption of the amputation stump of the left leg. He had been involved in a railroad logging accident 30 years before, resulting in the loss of the left lower limb. He were a below-knee prosthesis (patellar-tendon hearing). We diagnosed him as verrucous hyperplasia by clinical and histological findings and then referred him to the division of rehabilitation for a refitting of his prosthesis, after which his eruption cleared two months later.

A Case of Primary Cutaneous Mucinous Adenocarcinoma / 대한피부과학회지

We report a case of primary cutaneous mucinous adenocarcinotna in a 64-year-old female. The tumor was about 2cm in size, forminga round dome-shaped alopecic scalp mass which had gradually increased in size over about 5 years, Histalogic examination revealed that the tumor was divided into numerous compartments by strands of fibrous tissue. In each compartment, abundant amounts of pale-staining mucin surrounded nests or cords of moderately anaplastic epithelial cells. We couldn't find any evidence of internal neoplasms as a source of metastasis. We resected the tumor with approximately a 1 cm margin and then performed a split thickness skin graft.

Prospective Evaluation of Colorectal Polyps in 1,683 Consecutive Colonoscopies / 대한소화기내시경학회지

BACKGROUND AND AIMS: The colorectal polyp, particularly the adenoma, has been regarded as a precursor of cancer. The incidence of colorectal polyps has been reported at various rates according to investigation centers in foreign countries. In Korea, the incidence of colorectal polyps has been reported as very low according to the few reports, which was involved a few cases and were partial. Therefore, the aim of this study is to evaluate prospectively the incidence and the clinicopathologic features of colorectal polyps. METHODS: A colonoscope was inserted up into the cecum in 1,889 patients among 2,001 trials from Oct. 1996 to Aug. 1997 (success rate: 94.4%). Of the 1,889 full colonoscopies, the following were excluded; 1) referred patients with suspicious colorectal cancer or polyps, 2) patients with suspicious rectal cancer determined by rectal examination, 3) patients who had follow-up colonoscopy after a polypectomy or cancer surgery, and 4) patients who had periodic colonoscopy due to FAP or HNPCC. There were a total of 1,683 full colonoscopies in this study. The majority of the total cases involved a colonoscopy due to benign anal disease, irritable bowel syndrome, or routinechecks for health. RESULTS: There were 946 men (56.2%) and 737 women (43.8%). The mean age was 48.2 yrs (13~88 yrs) for men and 48.1 yrs (18~89 yrs) for women. 422 patients were found to have 645 colorectal polyps (1.52 polyps per patient). The incidence of polyps was 25.1% (32.0% for men, 16.1% for women) and increased after the 6th decade in men (44.0%) and in women (23.0%). 281 patients were found to have 426 colorectal adenomas. The incidence of adenomas was 16.6% (21.9% for men, 9.9% for women) and increased after the 6th decade, 32.0% in men, and 15.9% in women. Solitary polyps were present in 277 patients (65.6%) while 94 patients (22.3%) had two polyps and 51 patients (12.1%) had between 3 and 8 polyps. The polyp retrieval rate was 96.9%. There were 426 adenomas (66.0%), 75 hyperplastic (11.7%), 120 inflammatory (18.6%), and 24 miscellaneous (3.7%) polyps. Of the 426 adenoma, there were 397 tubular adenoma (93.2%), 18 tubulovillous adenoma (4.3%), 4 villous adenoma (0.9%), 6 in situ carcinoma (1.4%), and 1 invasive carcinoma (0.2%). 6 in situ carcinoma's were detected in tubular adenoma and 1 invasive carcinoma in tubulovillous adenoma. Of 645 polyps, the sessile type was 87.9%. The polyp size varied from 1 mm to 25 mm and 79.2% were under 5mm. Also, 85.7% of adenomas were sessile and 74.7% were under 5mm. 22.0% of polyps were located in rectum, 35.4% in sigmoid colon, 9.5% in descending colon, 13.3% in transverse colon, 19.8% in ascending colon and cecum. The distribution of adenoma was similar to that of polyp. 40.1% of adenoma showed moderate to severe dysplasia. CONCLUSIONS: This study revealed that the incidence of polyp in Korea was higher than that in previous reports and 42.6% of polyps were proximal to rectosigmoid colon. Therefore, we suggest that we should try to detect and remove colorectal polyps by more active colonoscopy.

A Case of Cutaneous T-cell Lymphoma with Total Nail Dystrophy / 대한피부과학회지

We report a case of cutaneous T-cell lymphoma in a 40-year-old man. He has suffered from generalized pruritus for 10 years. Seven months ago, multiple nodules developed over the scalp, face, and thigh. The physical examination showed thickened dystrophic twenty nails with brownish discoloration and lichenified, eczematoid lesions over the trunk and extremities. The skin biopsy revealed diffuse, extensive infiltrates of atypical lymphoid cells in the dermis, which appeared as T lymphocytes by immuno-histochemistry; approximately 90% of the tumor cells were CD3-positive, 80% were CD4-positive, and 60% CD45RO-positive. Laboratory analyses in the peripheral bload showed 18% atypical lymphocytes (Sezary cell), an elevated LDH(746 U/liter), and abnormal lymphocyte subset proportions(ratio of Th/Ts is 4.08). A bone marrow puncture revealed the infiltrations of lymphoid cells and computed tamo-graphy showed no evidence of other organ involvement except the swelling of bilateral inguinal lymph nodes. Spontaneous partial regression of the tumors ensued on the way of oral antihistamines and topical corticosteroids for the relief of the pruritus. The tumorous skin lesions and onychodystrophy disappeared completely with 6 cycles of systemic chemotherapy of CHOP(cyclophosphamide, doxoru-bicin, vincristine, and prednisone).

Comparison of the Concentrations of 8-MOP in both Plasma and Suction Blister Fluid after Oral Ingestion

BACKGROUND: The value of plasma concentration of 8-Methoxypsoralen(8-MOP) in the supervision of photochemotherapy has been recognized. However, plasma levels of 8-MOP were not proportionate to the degree of PUVA induced erythema and couldn't alone predict the degree of PUVA induced erythemal reaction. We made a speculation that the degree of PUVA induced erythema might correlate better with skin tissue levels of 8-MOP than plasma levels. Suction blister fluid(SBF) has been known to represent tissue fluid in the skin. So we per-formed a study of comparison of 8-MOP concentrations in both plasma and SBF. OBJECTIVE: Our purpose was to evaluate the correlation of the concentrations of 8-MOP in plasma and SBF 2 hours after oral administration of 0.6 mg/kg of 8-MOP. METHODS: Twenty six patients, aged between 16 and 50 years, undergoing suction blister surgery for vitiligo treatment, participated in this open study. Single oral doses of 0.6 mg/kg of body weight of 8-MOP were taken. Blood samples(5ml) and SBF(2ml) were collected at 2 hours after the drug administration, and 8-MOP concentration in plasma and SBF were quantitated by reverse phase high-performance liquid chromatography (HPLC). RESULTS: 8-MOP concentrations in plasma and SBF ranged from 18 to 545 ng/ml and 8 to 179 ng/ml, respectively. On the analysis of linear regression, a close-relation could not be observed between two SBF levels; measured and predicted values which were calculated from measured plasma and SBF concentrations (r²=0.583, P < 0.001). CONCLUSION: The correlation of plasma and SBF concentrations of 8-MOP is weak. So, SBF levels of psoralen are recommended for the study of PUVA erythemal reactions.

A Case of Merkel Cell Carcinoma with Regional Lymph Node and Cutaneous Metastases / 대한피부과학회지

Merkel cell carcinoma is an uncommon malignancy of the skin that was first described by Toker in 1972 and often portends a poor prognosis. We present a case of merkel cell carcinoma in a 69-year-old male who had visited our clinic to evaluate a soft tissue mass without pain or tenderness on the left pretibial area. The mass was diagnosed as a merkel cell carcinoma by excisional biopsy. Metastatic merkel cell carcinorna was found at the left inguinal lymph node and thereafter at the left inguinal area and at the left thigh. Radiotherapy and chemotherapy were used in treating these carcinomas.

Effect of Lidocaine Injected on Lower Rectal Submucosa During Hemorrhoidectomy under Caudal Anesthesia

BACKGROUND/AIMS: The caudal anesthesia for anal surgery is simple and effective. Also, it is relatively safe because there is no headache or other neurologic complications. But, during the operation under caudal anesthesia, the unwanted symptoms such as lower abdominal pain or hypotensive symptoms were experienced in some patients. These unwanted symptoms may occur due to anal and lower rectal dilatation. The precise mechanism is unknown. But we speculated that some sensory nerve endings in rectal submucosa may be involved in this mechanism. So, we think that it is possible to prevent or reduce these symptoms if we block these sensory nerve endings effectively with local anesthetics. Therefore, the aim of this study is to see whether the locally injected lidocaine can reduce or prevent the unwanted symptoms during anal surgery under caudal anesthesia. METHODS: There were 100 consecutive patients in this study who had hemorrhoidectomy with Jack-knife position under caudal anesthesia at our clinic. We divided evenly these 100 patients into two groups, injection and control groups(in each group, 50 patients were included.). In injection-group, We injected 10 cc(100 mg) of 1% lidocaine solution cir cumferentially into the lower rectal submucosa at the beginning of the operation. In control-group, we did not inject lidocaine solution initially, but the lidocaine injection was done during the operation in the same manner in the injection-group if the severe unwanted symptoms occurred. We used Parks-type retractor to dilate the anus and recorded the patient,s complaints. RESULTS: In injection-group, male to female ratio was 33:17, mean age was 42.1 years(20~69) and mean operation time was 38.3 minutes(15~80). In control-group, male to female ratio was 25:25, mean age was 43.7 years(17~65) and mean oeration time was 38.5 minutes(15~80). Lower abdominal pain was present in 11 patients(22%) among injection-group and in 37 patients(74%) among control-group(p=0.000). Hypotensive symptoms such as nausea, vomiting, sweating and dizziness were present in 1 patient(2%) among injection-group and in 8 patients(16%) among control-group(p=0.014). We injected lidocaine solution into lower rectal submucosa during the operation in 18 patients with severe symptoms among control-group. The effect of the injected lidocaine solution in 18 control patients was good in 13(72%) and fair in 5(28%). With regard to factors influencing the occurrence of symptoms, there was a tendency of higher occurrence in male, the younger-aged and the longer-operation groups. CONCLUSION: The lower rectal submucosal lidocaine injection reduced the unwanted symptoms such as lower abdominal pain and hypotensive symptoms during the anal surgery under the caudal anesthesia.

A Comparison of Oral Sodium Phosphate and Polyethylene Glycol Solution for

BACKGROUND: Polyethylene glycol(PEG) has been the most widely used colonic lavage solution. But large volume and salty taste of PEG solution is a problem which can lead to the noncompliance and the poor bowel cleansing. Recent reports have suggested that sodium phosphate solution of much smaller volume is more effective in colon cleansing ability and more easier to complete. Therefore, this study was designed to compare two solutions for colonoscopy and to determine the differences in either patient compliance or cleansing ability. METHOD: Eighty-two patients were randomized to take either oral sodium phosphate solution or 2 liter of PEG solution. Patient's discomfort and tolerance during ingestion was asessed by questionnaire and one colonoscopist who did not know the type of solution, assessed colonic preparation status. RESULTS: Among 25 patients experiencing two separate colonoscopies with PEG solution and sodium phosphate solution respectively, 19(76%) patients preferred sodium phosphate solution. Sodium phosphate solution was found to be easier to take. Sodium phosphate caused thirst more frequently(p=0.013) than PEG solution. Particulate stool and water retention status were similar in two groups. Gas bubble formation that disturbs luminal observation was more frequently found in sodium phosphate preparation group(P=0.00). Sodium phosphate was more effective in right colon cleansing ability than PEG preparation(P=0.04). The Colonoscopist assessed sodium phosphate as "good" in 47.2% vs 58.6% after PEG preparation as a whole, but there was no statistical difference. CONSLUSION: Sodium Phosphate solution is better tolerated and more easier to take than PEG solution. Gas bubble formation is a correctable problem, but right colonic cleansing effect is not. Our results showed that sodium phosphate is likely to be more effective in colonic cleansing effect comparing to polyethylene glycol solution.

Cutaneous Plasmacytosis with Multiple Nodular Eruptions and Polyclonal Hypergammaglobulinemia

We report two patients with multiple peculiar skin eruptions and polyclonal hypergammaglobulinemia. Both patients visited our hospital for the evaluation of asymptomatic multiple nodular eruptions on almost their entire body except for the lower extremities. Histologic examinations disclosed prominent infiltration of plasma cells and lymphoid follicular hyperplasia in the dermis but these plasma cells showed neither a mitotic figure nor atypicalities. Laboratory examinations showed polyclonal hypergammaglobulinemias and increased erythrocyte sedimentation rates. In spite of various investigations, the cause of the hypergammaglobulinemia remained obscure.

A case of neuroblastoma with multiple skin metastases / 대한피부과학회지

We report a case of neuroblastoma with multiple skin metastases as a chief complaint in a 2-month-old girl. the skin lesions were rnultiple, pea-sized, bluish, nontender, moable subcutaneous nodules on abdomen, back and scalp. Histopathology showed small round or poly gonal tumor cells which have deeply stained, basophilic, hyperchromatic nuclei with some mitoses. Th.se tumor cells showed clumping tendency which is one of early menifestations of rosette formation. Immunohistochemically positive reaction was demonstrated by anti-NSE(neuron specific enolase) antilody but negative reaction by anti-NFP (neurofilament proteiin ) antibody. She has been succesfully treated with combined chemotherapy for 10 months without relapse.

Tinea pedis in sewerage workers / 대한피부과학회지

Tinea pedis is frequently found in those people with poor hygine and in hot and humid environments. The authors investigated the clinical, epidemiologicol a id mycological characteristics of tinea pedis in 138 sewerage workers attending a sewerage plant in Seoul. Tinea pedis was found in 82, with a prevalence of 59.4%. The prevalence of tinea pedis increased with age and the period working at sewerage plant, however, there was no statistical significance. Also there was no difference in the prevalence of tinea pedis between the clerical workers and the field workers. Positive rate for KOH smear was 73.2%, and culture positive rates were 42.7%, producing 35 strains of dermatophytes. Twertyeight strains of Trichophyton Rubrum and 7 strains of Trichophyton mentagrophytes were isolated. Twentyseven yeast-form colonies were isolated, and Trichosporon beigelii was foungl in 19 samples. Most of the yeast forms were found mixed with dermatophytes and moulcis, However, 6 were isolated from direct smear positive cases and yieIded pure colonies of yeast. These included 4 cases of T. beigelii, 1 case of Candida parapsilosis, and 1 case of Candida hormicola. In view of the recent report of these fungi as pathogenic organism, these isolates, rspecially T. beigelii, were considered as a causative agent of tinea pedis in certain groups like sewerage workers.