A Case of Generalized Hyperhidrosis Complicated with Acute Renal Failure / 대한내과학회지

Hyperhidrosis is a disorder characterized by perspiration in excess of the physiologic amount necessary to maintain thermal homeostasis. It is categorized as either a primary condition or a condition occurring secondary to a number of diseases and the use of prescribed drugs and is further classified according to anatomical distribution as being focal, regional, or generalized. Severe generalized hyperhidrosis is extremely rare but significantly inhibits social activities in those affected. A 48-year-old female with oliguria was admitted to our hospital. Both a physical examination and a starch-iodine test showed generalized hyperhidrosis, suggesting that excessive loss of body fluid via sweating had led to prerenal acute renal failure (ARF). To our knowledge, severe cases of generalized hyperhidrosis causing ARF have not previously been reported. The present case is reported with a review of the literature on the etiology and management of generalized hyperhidrosis.

A Case of Prosthetic Knee Joint Infection Caused by Streptococcus agalactiae

Recently the incidence of Group B streptococcus (Streptococcus agalactiae) infection has been increased in nonpregnant adults, especially including the elderly and those with underlying diseases. One year ago, a 72-year-old diabetic woman underwent both total knee replacement and then received intermittently acupuncture due to both knee pain. Five days ago, she developed painful swelling on right knee joint. The synovial fluid showed leukocytosis (WBC 8,200/mm3), she was diagnosed as prosthetic joint infection, and treated with cefazolin. Her condition was rapidly aggravated despite of antibiotics therapy, open debridement and drainage was performed. But she expired due to sepsis. Both blood and synovial fluid culture yielded S. agalactiae. We reported a case of prosthetic knee joint infection caused by S. agalactiae.

A Case of Rituximab Use in Rheumatoid Arthritis Following Anti-TNF-Associated Tuberculosis

Rituximab has been shown to be effective in rheumatoid arthritis (RA) and is recommended for patients exhibiting an inadequate response to tumor necrosis factor (TNF) inhibitors. To date, there have been no reports of tuberculosis in RA patients treated with rituximab. We report the use of rituximab in a TNF inhibitor-refractory RA patient who had developed tuberculosis. A 52-year-old man with RA had been treated with adalimumab for 3 months, but failed to respond well to the treatment. He reported fever, coughing, sputum, and weight loss. He was diagnosed with pulmonary tuberculosis and started anti-tuberculosis medication. His arthritis was not controlled for despite increasing the dose of prednisolone. He was treated with rituximab without serious adverse effects. Sixteen weeks later, he demonstrated improvement with both arthritis and tuberculosis.

A Case of Rituximab Use in Rheumatoid Arthritis Following Anti-TNF-Associated Tuberculosis

Rituximab has been shown to be effective in rheumatoid arthritis (RA) and is recommended for patients exhibiting an inadequate response to tumor necrosis factor (TNF) inhibitors. To date, there have been no reports of tuberculosis in RA patients treated with rituximab. We report the use of rituximab in a TNF inhibitor-refractory RA patient who had developed tuberculosis. A 52-year-old man with RA had been treated with adalimumab for 3 months, but failed to respond well to the treatment. He reported fever, coughing, sputum, and weight loss. He was diagnosed with pulmonary tuberculosis and started anti-tuberculosis medication. His arthritis was not controlled for despite increasing the dose of prednisolone. He was treated with rituximab without serious adverse effects. Sixteen weeks later, he demonstrated improvement with both arthritis and tuberculosis.

A Case of Generalized Hyperhidrosis Complicated with Acute Renal Failure / 대한내과학회지

Hyperhidrosis is a disorder characterized by perspiration in excess of the physiologic amount necessary to maintain thermal homeostasis. It is categorized as either a primary condition or a condition occurring secondary to a number of diseases and the use of prescribed drugs and is further classified according to anatomical distribution as being focal, regional, or generalized. Severe generalized hyperhidrosis is extremely rare but significantly inhibits social activities in those affected. A 48-year-old female with oliguria was admitted to our hospital. Both a physical examination and a starch-iodine test showed generalized hyperhidrosis, suggesting that excessive loss of body fluid via sweating had led to prerenal acute renal failure (ARF). To our knowledge, severe cases of generalized hyperhidrosis causing ARF have not previously been reported. The present case is reported with a review of the literature on the etiology and management of generalized hyperhidrosis.

Pallidal Deep Brain Stimulation in Primary Cervical Dystonia with Phasic Type : Clinical Outcome and Postoperative Course

OBJECTIVE: The purpose of this study was to analyze in detail the relationship between outcome and time course of effect in medically refractory primary cervical dystonia (CD) with phasic type that was treated by bilateral globus pallidus internus (Gpi) deep brain stimulation (DBS). METHODS: Six patients underwent bilateral implantation of DBS into the Gpi under the guide of microelectrode recording and were followed for 18.7 +/- 11.1 months. The mean duration of the CD was 5.8 +/- 3.4 years. The mean age at time of surgery was 54.2 +/- 10.2 years. Patients were evaluated with the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) and relief scale using patient self-reporting. RESULTS: The TWSTRS total scores improved by 64.5%, 65.5%, 75.8%, and 76.0% at 3, 6, 12 months, and at the last available follow-up after surgery, respectively. Statistically significant improvements in the TWSTRS scores were observed 3 months after surgery (p = 0.028) with gradual improvement up to 12 months after surgery, thereafter, the improvement was sustained. However, there was no statistically significant difference between the scores at 3 and 12 months. Subjective improvement reported averaged 81.7 +/- 6.8% at last follow-up. Mild dysarthria, the most frequent adverse event, occurred in 3 patients. Conclusions: Our results show that the bilateral Gpi-DBS can offer a significant therapeutic effect from 3 months postoperatively in patients with primary CD with phasic type, without significant side effects.

Deep Brain Stimulation of the Subthalamic Area for Dystonic Tremor

The stereotactic surgical target for dystonic tremor is the subject of ongoing debate. Targeting the subthalamic area using deep brain stimulation has been regaining interest as a therapy for various types of involuntary movements. We describe the efficacy of stimulation of the subthalamic area in a patient with intractable dystonic tremor. Excellent control without neurological complications was achieved. This case report demonstrates that the subthalamic area is a valuable target for the control of dystonic tremor.

Proliferation of Tricholoma matsutake Mycelial Mats in Pine Forest Using Mass Liquid Inoculum

Two isolates of Tricholoma matsutake T-008 and T-034, preserved in Entomopathogenic Fungal Culture Collection (EFCC) of Korea, were used in the present study. The isolates had 100% Bootstrap homology with Tricholoma matsutake U62964 and T. matsutake AB188557 and AF309538 preserved in Gene Bank of NCBI. Mycelial growth of T. matsutake was highest in TMM and MYA at 25degrees C. The highest dry wt. of mycelium was obtained after 65 days of culture, when 6 mycelial discs were inoculated in 100 ml of broth in 250 ml shaking flask. Mycelial mats were observed in clumped condition at the inoculation sites of pine forest after two weeks of inoculation. After 5 months of inoculation, mycelia mats were observed growing inside soil and walls of a few inoculation sites, while mycelial mats growth up to 5~8 cm were observed in the roots of pine tree after 6 months. The survival rate of the inoculum was about 40% of the total inoculation sites. The survival rate was found below 20% when the mycelium was inoculated in the summer. The reasons for low survival rates of the mycelium were mainly due to dry season and the soil-borne small animals such as earthworm and mole. After one year of inoculation, no external difference was observed between the artificially inoculated mycelia and the naturally existing mycelia of T. matsutake. The present study showed that fruiting bodies of T. matsutake could be produced by artificial inoculation under the appropriate environmental conditions.

Effect of Preservation Periods and Subcultures on Fruiting Body Formation of Cordyceps militaris In Vitro

Effects of various preservation periods and subcultures on fruiting body formation of Cordyceps militaris were investigated using EFCC C-10995 single ascospore strains. Fruiting body formation by original strains was profuse when preserved at 4degrees C for 5~6 months. Fruiting from subcultures was stable till second to sixth subcultures, after which it decreased sharply. The more the colony color of subcultures changed, the less the fruiting bodies formed. Liquid inoculum preparation of single ascospore strains in the same or separate broths did not affect fruiting body formation. Similarly, two strains C-10995-3 and C-10995-6 in different numbers during liquid inoculum preparation produced similar fruiting bodies.

Observations on Some of the Mycelial Growth and Pigmentation Characteristics of Cordyceps militaris Isolates

Characteristic growth patterns of Cordyceps militaris isolates on various media, under varying light conditions and at varying incubation periods were examined. Light was found to be the most critical single factor in determining the density, texture, and pigmentation of the mycelial culture of the fungus. However, under the light condition, the degree of pigmentation and mycelial density were found to be affected by the incubation period and type of medium. Irrespective of the variations in medium type or incubation period, there was no pigmentation of the mycelium under dark condition. Radial growth of the mycelium was faster under dark incubation rather than under light incubation. Abundant mycelial density and darkest pigmentation of C. militaris isolates were produced in nutritionally rich media like SDAY, SMAY and CZYA, suggesting that these media may fulfill all the requirements for vegetative growth of the fungus. Growth characteristics of C. militaris isolates could be easily observed by the simple agar culture method, which would be useful to characterize the phenotypic characteristics of large number of pure cultures of the fungus under given conditions of growth factors such as medium, light and temperature.

Selection of Superior Strains of Cordyceps militaris with Enhanced Fruiting Body Productivity

In vitro fruiting bodies were produced from ten different isolates of Cordyceps militaris EFCC C-5736, EFCC C-5941, EFCC C-5976, EFCC C-6040, EFCC C-6849, EFCC C-7268, EFCC C-7342, EFCC C-7992, EFCC C-8027 and EFCC C-8549. Single ascospores were isolated from in vitro grown fruiting bodies and used for fruiting body production in brown rice medium by both intra-strain crossing and out-crossing. Length and dry wt. of stromata grown in vitro were measured. Strains producing highest dry wt. of stromata were selected. Both intra-strain crossings and inter-strain crossings of single ascospore strains were found to produce profuse fruiting bodies of C. militaris.

Distribution and in vitro Fruiting of Cordyceps militaris in Korea

Cordyceps militaris specimens were continuously collected by Entomopathogenic Fungal Culture Collection (EFCC), Kangwon National University from different mountains, national parks and recreation parks of Korea from 1986 to 2002, mainly from late May to October of each year. Dry specimens of C. militaris along with their isolates have been preserved in EFCC. Fruiting of C. militaris was induced from single ascospore isolates as well as their combinations in brown rice medium. Fruiting experiments showed that combinations of single ascospore isolates produced fertile fruiting bodies, but single isolates could not produce any fruiting bodies. It was shown that two isolates of the opposite mating types were required to produce fertile stromata. However, combinations of the same mating type isolates produced no fruiting body, showing that C. militaris is a bipolar, heterothallic fungus.

Histochemical and Molecular Genetic Study of MELAS and MERRF in Korean Patients

Mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episode (MELAS) and myoclonic epilepsy and raggedred fibers (MERRF) are rare disorders caused by point mutation of the tRNA gene of the mitochondrial genome. To understand the pathogenetic mechanism of MELAS and MERRF, we studied four patients. Serially sectioned frozen muscle specimens with a battery of histochemical stains were reviewed under light microscope and ultrastructural changes were observed under electron microscope. The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis was performed and the tRNA genes were sequenced to confirm mutations. In two patients with MELAS, strongly succinyl dehydrogenase positive blood vessels (SSVs) and many cytochrome oxidase (COX) positive raggedred fibers (RRFs) were observed, and A3243G mutations were found from the muscle samples. In two patients with MERRF, neither SSV nor COX positive RRFs were seen and A8344G mutations were found from both muscle and blood samples. In the two MERRF families, the identical mutation was observed among family members. The failure to detect the mutation in blood samples of the MELAS suggests a low mutant load in blood cells. The histochemical methods including COX stain are useful for the confirmation and differentiation of mitochondrial diseases. Also, molecular biological study using muscle sample seems essential for the confirmation of the mtDNA mutation.

Effects of Different Concentrations of Isoflurane on Core and Peripheral Temperature during General Anesthesia / 대한마취과학회지

BACKGROUND: Precise temperature monitoring is essential during general anesthesia. Isoflurane induces vasodilation, which is correlated with changes in body temperature. The purpose of this study is to estimate the relationship between core temperature and peripheral body temperature which is usually used during anesthesia to determine changes in isoflurane concentration. METHODS: Temperature measurements were performed in 46 patients of ASA physical status 1 or 2 undergoing oral & maxillofacial surgeries. During general anesthesia using isoflurane, body temperatures were measured every hour at the distal esophagus, the skin above the axillary artery and the rectum. RESULTS: There was a weak linear relation between the changes of delta Teso-axilla and isoflurane concentration, whereas there was no significant relation between the changes of deltaTeso-rectal and the isoflurane concentration. CONCLUSIONS:Axillary temperature was influenced by changes in isoflurane concentration, whereas the rectal temperature represented the core esophageal temperature during general anesthesia irrespective of changes in isoflurane concentration.

Genistein Induced Inginition of Cell Proliferation and Programmed Cell Death in the Human Cancer Cell Lines / 대한암학회지

PURPOSE: Genistein, a natural isoflavonoid phyto-oestrogen present in plant foods including citrus fruits and soybean, is a specific inhibitor of tyrosine kinase and topoisomerase II. In this paper we examined the effect of genistein on cell cycle progression and programmed cell death in the human prostate carcinoma PC-3 and Ewing's sarcoma CHP-100 cells. MATERIAL AND METHODS: Effect of genistein on cell cycle was measured by DNA flow cytometric analysis. In order to understand anticancer effect of genistein on cell cycle, Western blot analysis, immune complex kinase assay, DAPI staining and DNA fragmentation analysis were conducted. RESULTS: DNA flow cytometric analysis indicated that genistein induced cell cycle arrest at the G2/M transition phase. Western blot analyses showed that genistein selectively reduced expression of cyclin B1 and cdk2-dependent kinase activity in both cell lines. Genistein also induced apoptosis that was demonstrated by direct visualization of morphological nuclear changes and confirmed by the production of characteristic ladder patterns of genomic DNA fragmentation. CONCLUSION: The chemopreventive activity of genistein is proven to be related with the induction of cell cycle arrest at the G2/M transition phase by reducing the expression of cyclin B1 and cdk2-dependent kinase activity, and also with the induction of apoptosis in the tested cancer cells.

SURGICAL CORRECTION OF CLASS II OPENBITE WITH TMD ; Report of Cases

PURPOSE: This is to evaulate the efficacy of orthognathic surgical aids to imporve the painful TMJ in Class II open-bite deformites. CASES: Four patients who had been sufferred from temporo-mandibular disorders with open-bite retrognathic deformities underwent orthognathic surgeries. The presurgical orthodontic treatment and conservative management for temporomandibular disorders could not be continued due to progressive pain loading on TMJs and muscle tenderness. Bilateral ramus oseotomy with semirigid internal fixation were followed for 2 years by radiologic changes including MRI, bone scan, clinical examination of jaw opening. pain(VAS) and occlusal changes. RESULTS: Open-bite deformites with painful TMJ showed DJD findings without reduction of disc and hot spots on bone scans. The surgeries helped pain reduction to VAS 0.5 from 8.0 and improved jaw opening to 45 mm. Hot spots of TMJ were decreased or disappeared in one year. There were no signs or evidence of openbite-recurrence. CONCLUSION: In the standpoint of sequential management of TMD, the orthognathic surgery is a good option and modality to treat the class II openbite deformities with temporomandibular disorders with temporomandibular disorders which are not respond to conservative management during orthodontic treatment.

PAINFUL DYSESTHESIA FOLLOWED AFTER IMPLANT PLACEMENT IN POSTERIOR MANDIBLE AND THEIR PROGNOSIS

PURPOSE: This study is to examine the painful dysesthesia of lip & gingiva followed after implant surgeries and to evaluate the prognosis of microsurgical epineurotomy & tubulization with e-PTFE tubes. METHOD: Three patients who had been suffered from painful anesthesia and dysesthesia following dental implant surgeries were examined periodically and followed for over 1 year after epineurotomy and e-PTFE tubulization. Neurosensory dysfunctions were examined by Static Light Touch Threshold, Moving Direction Discrimination. Two Point Discrimination, Pin-Prick Nociception. Visual Analog Scales and Tinel sign. The subjective symptoms were confirmed by SSEP and DITI prior to surgical exploration. RESULT: Two patients complained of continuous tearing and lancinating pain disclosed complete avulsion of IAN and degenerative changes with neuroma. One patient complained of mild painful dysesthesia revealed partial adhesion & fibrous epineural changes. Two patients whose IAN were explored after over 1 year resulted in only mild improvement in sensory recovery and moderate reduction of pain score. While the patient to whom decompression & epineural repair were given in 3 months after nerve injuries resulted in satisfactory improvement in sensory function and pain reduction. CONCLUSION: Painful dysesthesias occurred after implant placement were resulted from neurotmesis and disclosed degenerative neuropathy. Therefore, the micro-surgical explorations and repairs (epineurotomy, decompression neurolysis, and neurorrhaphy) can be recommended for known injuries as early as possible. For the delayed painful dysesthesia lasted over year, however, epineurotomy & tubulization could be an option to improve the painful discomfort but not satisfactory.

The Comparison of Effect of Epidural Morphine and of Morphine-Fentany1-Bupivacaine Mixtere for Analgesia Afrer Cesarean Section / 대한주산의학회잡지

The purpose of this study is to demonstrate a new postoperative analgesic which minimize the physiological changes of patients. Recently, it has become popular to administer opioids to epidural space rather than intravenously or by intramuscular administration. However, the side effects of opioids have limited the usefulness of this procedure. We tried to find out a way of providing postoperative analgesia while minimizing the side effects of opioids. This study has tested the effects of administering a mixture of small doses of morphine, fentanyl and bupivacaine and epidural morphine alone. The data of this study has taken from 20 paturients who have scheduled for cesarean section. We have classified into two groups which consist of 10 paturients each. We have administered epidural morphine alone to the first group and a small doses of morphine-fentanyl-bupivacaine mixture to second group. We have evaluated analgesic effects by comparing both groups' pain scores of the operative day and of the first postoperative day and evaluated such side effects as the degree of itching, nausea, vomiting, dizziness and respiratory depression by asking to paturients. This study has found the followings: 1) Pain scores of the first group in the operative day and the first postoperative day are 1.2+/-0.4 and 0.4+/-0.5. The second group's pain scores are 0.2+/-0.4 and 0, and the second group's pain scores have significantly reduced (p<0.05). 2) Frequencies of such side effects as itching, nausea and vomiting are higher in the first group (8) than in the second group(4). In conclusion, small doses of morphine-fentanyl-bupivacaine mixture has demonstrated a more effective postoperative analgesia with minimum side effects in pain controlling after cesarean section than epidural morphine alone.

Collateral Circulation and 99m Tc - MIBI Heart SPECT in Patients with Totally Coronary Occlusion / 대한내과학회지

OBJECTIVES: The role of coronary collateral circulation in protecting myocardium after the occlusion of a supplying artery has long been debated. Recent date show that the coronary collateral circulation may partially prevent ischemia and preserve myocardial contractile function. The purpose of this study was to evaluate the relation between the grades of collateral circulation and perfusion scores of 99mTc-Heart SPECT in patients with totally coronary occlusion. METHODS: We studied 44 patients with totally coronary occlusion who had been hospitalized at Kyung Hee University hospital between October, 1989 and May, 1994, Patients were classified into two groups; Group 1: patients with angina pectoris (n=21), Group 2: patients with myocardial infarction (n=23). Angiographic collateral circulation was graded from 0 to 3: 0=none, 1=filling of side branch only, 2=partial filling of the epicardial segment, 3=complete filling of epicardial segment. The perfusion score of dipyridamole stress 99mTc-MIBI Heart SPCET was analyzed with angiographic findings. Resting and stress echocardiography were analyzed to identify left ventricular wall motion abnormalities. RESULTS: 1) When LAD was totally occluded, there were hishevcrgree of collateral circulations from RCA in group 1 and group 2. When RCA was totally occluded, there was higherdesree of collateral circulation from LAD in group 1 and group 2. 2) The degree of collateral development was higher in group 1 than in group 2 (2.5+/-0.7 vs. 1.8+/-1.0, p<0.05). 3) In 99mTc-MIBI Heart SPECT, there was no significant difference of perfusion score at stress but perfusion score was significantly higher in group I than in group 2 at rest. 4) In 99mTc-MIBI Heart SPCET, there was no difference of perfusion score between totally coronary occlusion territories in group 1 and more than 50% coronary artery stenotic territories in group 1 and group 2. 5) In stress echocardiography, ten of the 13 patients showed normal LV wall motion at rest, but 9 of these 10 patients showed LV wall motion abnormalities at stress in group l. In group 2, all 10 patients showed LV wall motion abnormalities at rest and 3 of these patients showed more aggravation of LV wall motion abnormalities. CONCLUSION: Collateral circulation in angina patients can prevent myocardial ischemia and preserve myocardial function at rest, but not at exercise. Collateral circulation in patients with myocardial infarction cannot preserve myocardial function at rest. and exercise. Dipyridamole stress 99mTc-MIBI Heart SPECT is one of the indirect quantification methods to evaluate collateral development and coronary flow reserve.

The Effects of Trendelenburg Position and Intraabdominal CO2 Gas Insufflation on Cardiopulmonary System during Pelviscopic Surgery under General Anesthesia / 대한마취과학회지

BACKGROUND: Pelviscopic techniques have rapidly increased in therapeutic procedures as well as diagnostic procedures because of the many benefits associated with much smaller incisions than traditional open techniques. But the deliberate pneumoperitoneum with carbon dioxide during pelviscopic surgery may cause some problems-hypercarbia, pneumomentum, subcutaneous or mediastinal emphysema, pneumothorax, hypoxemia, hypotension, cardiovascular collapse and cardiac dysrhythmia. METHOD: We observed the changes of blood pressure (systolic, mean, diastolic), pulse rate, PaCO2, PaO2, peak inspiratory airway pressure and expired tidal volume at 10 minute after induction of general anesthesia (control value), 30 minutes and 60 minutes after insufflation of CO2 and Trendelenburg position. RESULTS: The blood pressure, PaCO2 and peak inspiratory airway pressure were increased significantly than control values (p<0.05). The changes of pulse rate and expired tidal volume were not statistically significant in comparison to control values. The PaO2 was decreased significantly (p<0.05). CONCLUSION: To minimize the risk of CO2 retension and unstability of cardiovascular system during pelviscopy under the Trendelenburg position, we must monitor the vital signs and the arterial blood gas status continuously and carefully.