Comparison of effects of intraoperative nefopam and ketamine infusion on managing postoperative pain after laparoscopic cholecystectomy administered remifentanil / 대한마취과학회지

BACKGROUND: Although intraoperative opioids provide more comfortable anesthesia and reduce the use of postoperative analgesics, it may cause opioid induced hyperalgesia (OIH). OIH is an increased pain response to opioids and it may be associated with N-methyl-D-aspartate (NMDA) receptor. This study aimed to determine whether intraoperative nefopam or ketamine, known being related on NMDA receptor, affects postoperative pain and OIH after continuous infusion of intraoperative remifentanil. METHODS: Fifty-four patients undergoing laparoscopic cholecystectomy were randomized into three groups. In the nefopam group (N group), patients received nefopam 0.3 mg/kg at the induction of anesthesia followed by a continuous infusion of 0.065 mg/kg/h. In the ketamine group (K group), patients received ketamine 0.3 mg/kg at the induction of anesthesia followed by a continuous infusion of 3 µg/kg/min. The control group did not received any other agents except for the standard anesthetic regimen. Postoperative pain score, first time and number of demanding rescue analgesia, OIH and degrees of drowsiness/sedation scale were examined. RESULTS: Co-administrated nefopam or ketamine significantly reduced the total amount of intraoperative remifentanil and postoperative supplemental morphine. Nefopam group showed superior property over control and ketamine group in the postoperative VAS score and recovery index (alertness and respiratory drive), respectively. Nefopam group showed lower morphine consumption than ketamine group, but not significant. CONCLUSIONS: Both nefopam and ketamine infusion may be useful in managing in postoperative pain control under concomitant infusion of remifentanil. However, nefopam may be preferred to ketamine in terms of sedation.

Relapse in Two Couples Among Longterm Smear Negative Leprosy Patients / 나학회지

All registered inactive leprosy patients were treated with multidrug regimen since 1985. We experienced two couples of relapsed leprosy patients among them. Three were relapsed as multibacillary type and one paucibacillary type. They were given the regimen regularly but taken irregularly. The spouse cases were relapsed 6months and 4years after index cases relapsed. Three patients were elevated PGL1 ELISA titer after relapse

Tinea Barbae due to Trichophyton verrucosum: Report of 3 Cases / 대한의진균학회지

Although there has been recently noted a nation-wide spread of Trichophyton verrucosum infection in cattle associated with promoted stock raising and dairy farming, there were no case reports in Korean dermatologic literature describing the characteristic clinical features of tinea barbae caused by that particular fungus. We report 3 cases of tinea barbae due to T. verrucosum that developed in male stock farmers breeding cattle. One Patient acted 37, experienced acutely inflamed bo99y tumors on the chin and sub-mandible. The others aged 43 and 46 experienced inflammatory lesions with multiple follicular pustules, crusts and loss of hairs on their upper lips. They were successfully treated with oral griseofulvin and local antifungal ointment combined with short-term oral antibiotics or corticosteroid for about one month.

Clinical Investigation and Distribution of Pityrosporum in Patients with Seborrheic Dermatitis of the Scalp / 대한피부과학회지

BACKGROUND: Seborrheic dermatitis is a very common chronic inflammatory disease. Previous studies suggested that, Pityrosporum, lipophilic fungi, may play an important role in the pathogenesis of the disease. OBJECTIVE: The purpose of this study was to investigate the disease clinically and mycologically for better understanding of the pathogenesis. METHODS: Two hundred and one new patient.s with seborrheic dermatitis of the scalp and 67 norrnal subjects were obs!,rved clinically by the dermatologist and studied stat,istically by questionnaires. A mycologic study of Pityrosporum was also performed by direct smear. RESULTS: Among a total of 201 patients wit,h seborrheic dermatitis, 72.6% had pityriasis sicca, 10.5% had pityr iasis steartoides and 16.9% had inflammatory seborrheic dermatitis. On clinical grading by the Kligman.. scale, grade III(slightly scaling) was the most common in the patients and 52.6% of the norma. subjects were below grade II (no scaling). Spores of Pityrosporum were observed in 76.7% of the patients and 91.5% of the normal subjects. The incidence of Pityrosporum was lower particularly in t,he patients with inflammatory seborrheic dermatitis t,han in other pa~tients groups. CONCLUSION: According to the results of the study, it, is difficult to conclude that Pityrosporum is a main causative ager t of seborrheic dermatitis. In addition, it is thought t.hat further studies of the role of Pityrosporum in seborrheic dermatitis are needed.

Clinical Investigation and Distribution of Pityrosporum in Patients with Seborrheic Dermatitis of the Scalp / 대한피부과학회지

BACKGROUND: Seborrheic dermatitis is a very common chronic inflammatory disease. Previous studies suggested that, Pityrosporum, lipophilic fungi, may play an important role in the pathogenesis of the disease. OBJECTIVE: The purpose of this study was to investigate the disease clinically and mycologically for better understanding of the pathogenesis. METHODS: Two hundred and one new patient.s with seborrheic dermatitis of the scalp and 67 norrnal subjects were obs!,rved clinically by the dermatologist and studied stat,istically by questionnaires. A mycologic study of Pityrosporum was also performed by direct smear. RESULTS: Among a total of 201 patients wit,h seborrheic dermatitis, 72.6% had pityriasis sicca, 10.5% had pityr iasis steartoides and 16.9% had inflammatory seborrheic dermatitis. On clinical grading by the Kligman.. scale, grade III(slightly scaling) was the most common in the patients and 52.6% of the norma. subjects were below grade II (no scaling). Spores of Pityrosporum were observed in 76.7% of the patients and 91.5% of the normal subjects. The incidence of Pityrosporum was lower particularly in t,he patients with inflammatory seborrheic dermatitis t,han in other pa~tients groups. CONCLUSION: According to the results of the study, it, is difficult to conclude that Pityrosporum is a main causative ager t of seborrheic dermatitis. In addition, it is thought t.hat further studies of the role of Pityrosporum in seborrheic dermatitis are needed.

A Case of Primary Subcutaneous Phaeohyphomycosis Caused by Drechslera Dematioidea / 대한피부과학회지

Phaeohyphomycosis refers to subcutaneous and systemic fungal infections characterized by dematiacious septate mycerial elements in tissue, We are discribing the first report of subcutaneous phaeohyphomycosis by Drechslera dematioidea in a 9-year-old boy who presented a slow-growing 4x5.5cm erythematous plaque with somewhat verrucous and eczematous lesion on the dorsal aspect of his right foot after receiving a burn by boiling liquid at 2 years of age. Biopsy of the lesion revealed granulomatous inflammation, brownish spores in chain and planate-deviding sclerotic bodies in the epidermis and upper dermis. Findings by microscopic examination and consecutive cultures of scales and biopsy specimen were consistent with Drechslera dematioidea. The lesion was successfully treated with itraconazole.

A Case of Herpes Zoster in a Normal 3 - Month - Old Infant / 대한피부과학회지

Herpes zoster in infancy occurs very rarely. And it may be the primary clinical manifestation of reactivation of latent varicella-zoster virus infection acquired transplacentally during intrauterine life. We report a case of herpes zoster in right T2 dermatome in a normal 3-month-old boy, The patient had no history of chickenpox and varicella vaccination. And his mother did not recall herself varicella infection, though she was exposured to chickenpox patient at 7 months of pregnancy. Laboratory findings demonstrated that varicella-zoster Ig-G and Ig-M antibodies were 0.94, 0.12 respectively ( EIA method, negative, 1.0) at the second day of vesicular eruption. Fourteen days after vesicular developing, the Ig-G and Ig M titers were rising to 1.92, and 0.47 respectively. His mother's varicella-zoster Ig-G and Ig-M antihodies were 2.64, 0.14 respectively. The baby received acyclovir treatment and the skin lesions healed rapidly without sequela. In this case, although the cause was unclear whether it was a mother-child infection, the patient was suspected subclinical intrauterine varicella-zoster virus infection during pregnancy.

A Decreased Growth Rate of the Great Toe Nail Observed in Patients with Distal Subungual Onychomycosis

BACKGROUND: There are prerequisites for fungal nail infection: fungal organism, susceptible host, and environments with damaged nail. OBJECTIVE: The purpose of this study was to evaluate the growth rate of the great toe nail in distal subungual onychomycosis(DSO). MATERIALS AND METHODS:: The subjects are 60 adult patients with DSO and 19 age- and sex-matched controls with tinea pedis but no DSO. The growth rate of the great toe nail was measured. Data were evaluated with Mann-Whitney U-test and regression analysis using the statistical program for PC. RESULTS: The growth rate of the patients group showed a decrease against that of the controls. The equation for expected nail growth rate of specific age and sex was as follows: the expected nail growth rate(mm/day) = 0.07382 + (0.01498 × G) - (0.00033 × Age) - (0.00669 × S): if a person has DSO, G is 1, and if he has no DSO, G is 2; if a person is male, S is 1, and, female, 2. CONCLUSION: Patients with DSO often have a decreased growth rate of the nail compared with that of the controls. The authors propose the equation of expected nail growth rate in persons with or without DSO, and think that the growth rate of the nail is one of factors in the pathogenesis of onychomycosis.

Two Cases of Eosinophilic Pustular Folliculitis / 대한피부과학회지

We report 2 cases of eosinophilic pustular folliculitis, one in s 29-year-old woman and the other in a 24-year-old man. Crops of papules and pustules developed on well demarcated, walnut-sized, erythematous plsques on the cheeks and forehead. Eruptions were more pronounced on the periphery of the plaques with central clearing. Blood eosinophilia was evident in case 1. Histologic findings showed a dense inflammatory infiltration and abscesses composed mainly of eosinophils in and around hair follicles, sebaceous glands and around blood vessels. We could see beneficial responses by administration of dapsone in both cases, but its effect was just suppressive and temporary.