Evaluation of Cerebral Metabolism for Children Undergoing Open Heart Surgery for Atrial Septal Defect Using Proton Magnetic Resonance Spectroscopy

BACKGROUND AND OBJECTIVES: The purpose of this study was to investigate whether a brief cardiopulmonary by-pass, with mild hypothermia and normal flow, would have any deleterious effects on brain metabolism in children. This is the first study using localized in vivo proton magnetic resonance spectroscopy (1H-MRS) in brains of children with ASD undergoing open-heart surgery (OHS). SUBJECTS AND METHODS: Seven children undergoing surgical closure of ASD, with mild hypothermia and normal flow cardiopulmonary by-pass, were studied. Their ages ranged from 18 to 47 months, and body weights ranged from 11 to 17 kg. We performed 1H-MRS before OHS, and 1-3 months after, then compared the values of brain metabolite ratios before and after surgery. The values from our patients were compared to those from 12, age-matched, normal children. All MR imaging, and localized 1H-MRS, were performed using a GE 1.5T SIGNA system (General Electric Medical System, Milwaukee, USA). Image guided STEAM-spectra were obtained from, the parietal white matter (PWM), and occipital gray matter (OGM), with TE of 30 msec, and TR of 3 sec, using a PROton Brain Exam (PROBE) (General Electric Medical System, Milwaukee, USA). RESULTS: All metabolite ratios, measured by 1H-MRS, from patients before surgery showed no significantly difference from postoperative values. However, [choline/creatine] ratios, obtained from PWM, were higher in both pre- and postoperative ASD patients, as compared to those of normal children. CONCLUSION: We concluded, that brain metabolism, measured by 1H-MRS, does not change significantly after OHS, for children with ASD, with mild hypothermia and normal flow.

Minimal Phototoxic Dose for a Vitiliginous Skin Lesion / 대한피부과학회지

BACKGROUND: It is mandatory to measure the minimal phototoxic dose(MPD) in order to determine adequate irradiation of UV-A in photochemotherapy. However, the measurement of MPD is not easy in some cases due to inadequte size and site of lesions, time and manpower. OBJECTIVE: The purspose of this study was to standardize the minimal phototoxic dose for a vitiliginous lesion. METHODS: The minimal phototoxic dose of UV-A was measured in 82 vitiligo patients. Then we analyzed the MPD according to the sex, age, site of the vitiliginous lesions, duration of disease, and administration route of the photosensitizer. RESULTS: 1. There were no significant differences between exposed and unexposed areas in MPD in both cases of topical and systemic administration of the photosensitiser. 2. There was no significant correlation between disease duration and MPD in both cases of topical and systemic administration of the photosensitiser. 3. In the group of topical application of 8-methoxypsoralen cream, MPD for males and females were 0.53+0.38J/cm2 and 0.48+0.32J/cm2 respectively without significant difference in sex. 4. In the group of systemic administration of 8-methoxypsoralen, there was a significant difference between males and females in MPD. The MPD in males and females were 1.38+0.72J/cm2 and 2.51 + 1.40J/cm2, respectively. 5. In the group of topical application of 8-methoxypsoralen cream, the MPD in 2nd decade patients was the highest(0.80+0.55J/cm2). The MPD had a tendency to decrease gradually as age receded from the 2nd decade. 6. In the group of systemic administration of 8-methoxypsoralen, there was a tendency for the MPD to be increased according to age without statistical significance. 7. MPD in the group systemically administrated with 8-methoxypsoaralen was four-fold to that of the topical application group. CONCLUSION: It may be valuable to keep in mind that there was a statistical differrence in MPD between sexes in systemic administration of the photosensitizer, and that MPD was different according to patients age in the topical application group.

A Study on the reproducibility of allergen skin test in type I hypersensitivity / 알레르기

To detect causative allergens in type I hypersensitivity diseases, several methods have been used. Among those, skin prick test is easy to perform and sensitive. Several criteria presenting positive reactions have been used. Therefore, we tried to find out more sensitive and specific criteria for deciding a positive reaction on skin prick test in 57 patients(allergic rhinitis; 39, bronchial asthma ; 5, acute urticaria ; 2, chronic urticaria ; 11) with 69 allergens and compared the reproducibility between each positive criteria. We calculated the ratio of wheal size caused by each allergen to that of histamine and defined as "A" in case of it's ratio was over 0.5, "B" in case of over 0.7, "C" in case of over 1.0. The results were as follows, 1. The positive rate of house dust on skin prick test was the highest, and D. farinae, cat fur, D. pteronyssinus, mixture of cat fur, house dust, horse hair, dog hair in order. 2. Mean reproducibilities of four common allergens in each positive criteria were 91% in criteria A, 88% in criteria B, and 82% in criteria C. 3. Comparing between mean reproducibilities by earth positive criteria, in positive criteria between 0.5 and 0.7 and positive criteria between 0.7 and 1.0, there were no significant differences, but in positive criteria between 0.5 and 1.0, statistical significant difference was noted. In conclusion, it was suggested that the ratio of wheal sizes of allergen to histamine greater than 0.7 might be ideal for a positive skin prick test.

A Case of Tick Bite Caused by Haemaphysalis flava / 대한피부과학회지

We report a case of tick bite caused by Haemaphysalis flava which have never been reported in Korean medical literature. An 31-year-old woman had a asymptomatic erythematous indurated plaque with central crust by tick bite on the left upper back. A excisional biopsy specimen from the skin lesion showed eosinophilic degeneration with thrombosed blood vessels and dense inflammatory cells infiltration mainly composed of eosinophils in the reticular dermis. We could identify this causative tick as Hamaphysalis flava by using the scanning electron microscopic examination.

A Case of Superior Vena Cava Syndrome / 대한피부과학회지

The superior vena cava syndrome can occur when an extrnsc compression or intralurninal occlusion impedes blocxl flow through this vessel. We report a case of superior vena cava syndrome with tirc nbophlebitis on the right forearm in 57 year old male patient who used steroids (p.o) for 25 years.

Pseudo - Kaposi's Sarcoma Associated with Deep Vein Thrombosis / 대한피부과학회지

Pseudo-kaposi's sarcoma is a vasoproliferative disorder that may resemble Kaposi's sarcoma, clinically and histologically. In most cases, it has been associated with congenital or iatrogenic arteriovenous fistula and chronic venous insuffiency. We present a 36-year-old male patient with pseudo-Kaposi's sarcoma caused by a deed vein thrombosis in the absence of any detectable underlying etiologic factors.

A Case of Generalized Granuloma Annulare with Perforating and Subcutaneous Granuloma Annulare / 대한피부과학회지

We present a case of generalized grannuloma annulare with perforating and subcutaneous forms which occurred in a 15-year-old girl. Two years ago, multiple umbilicated, match head to pea sized, erythematous papules were noted on the upper extremities. Then the patient also experienced crusted or ulcerated erythematous papular lesions on the lower legs. Recently, tender, subcutaneous nodules appeared on both soles. The biopsy specimens from the skin lesions of the hand and the sole showed typical findings of granuloma annulare in the dermis and the subcutis, respectively. On the histopathological examination of the calf lesion, palisading granuloma as well as transepidermally eliminating dermal collagenous and necrotic material were seen. The skin lesions were almost completely improved by treatment with dapsone, 100mg a day, for 8 weeks orally.