Utilization of Ultrasonography in Dermatology: Two Case Reports of Calcinosis Cutis

Development of newer generation of cost-effective ultrasonic devices in recent years has increased the use of ultrasonography in dermatology. Several lesions can be diagnosed and managed using ultrasonography. Calcinosis cutis involves the deposition of insoluble calcium salts in the cutaneous and subcutaneous tissues. On ultrasonography, it specifically presents as hyperechoic deposits with a posterior acoustic shadowing artifact due to the acoustic properties of calcium. A 62-year-old female patient presented with a solitary, skin-colored, palpable nodule on the inner side of the right lower leg. The lesion was beneath the intact skin and detectable only on palpation. However, ultrasonography demonstrated a clear delineation of the lesion, showing hyperechoic deposits with a posterior acoustic shadow (15 MHz, linear probe). Skin biopsy and curettage were performed, revealing histological features consistent with calcinosis cutis. Four weeks after the procedure, ultrasonography performed to evaluate the outcome of treatment, showed recurrence. Another 18-year-old female patient presented with a skin-colored deep-seated nodule on the left temple. On ultrasonography, linear hyperechoic deposits with a posterior acoustic shadow were visible. Skin biopsy was performed, and histopathologic features showed calcified material in the subcutaneous tissue. These two cases of calcinosis cutis highlight the diagnostic value of ultrasonography in dermatology.     

抗核抗体核型检测与特异性抗核抗体谱检测的对比分析

目的：探讨抗核抗体核型与特异性抗核抗体谱的相关性。方法回顾分析本院检验科检测的974例抗核抗体结果,分别用间接免疫荧光法（IIF）检测抗核抗体核型,用条带酶免分析法（LIA）检测特异性抗核抗体谱,分析199例 IIF 与 LIA 同时阳性的结果,比较抗核抗体核型与特异性抗核抗体谱的相关性。结果974例标本中 IIF 阳性249例（阳性率25．6％）,LIA 阳性237例（阳性率24．3％）,两种方法检测阳性率差异无统计学意义（P ＞0．05）,IIF 与 LIA 单项或两项阳性287例（29．5％）,高于IIF 或 LIA 单项检测阳性率,差异有统计学意义（P ＜0．05）。249例 IIF 阳性中 LIA 阳性199例（79．9％）,725例 IIF 阴性中 LIA阴性687例（94．8％）。核颗粒型多见抗 Ro-52抗体,胞浆颗粒型多见抗线粒体 M2抗体,核均质型以抗 dsDNA 抗体、抗核小体抗体多见,着丝点型多见抗着丝点抗体,核仁型多见抗 PM-Scl 抗体。结论IIF-ANA 与 LIA-ANA 有较好的相关性,但也有一定差异,两者联合检测能降低漏检率,对自身免疫性疾病的诊断、病情监测及预后判断有重要意义。     

老年病人术后谵妄相关因素分析及其护理

[目的]探讨引起老年病人术后谵妄的原因及相应的护理对策。[方法]统计1998年1月—2009年6月60岁以上病人,记录68例术后谵妄病人的术前疾病、手术种类、术中及术后用药等,并控制环境因素、心理因素、疼痛因素、药物因素、体位因素等,在术前、术后、出院后进行全方位的护理。[结果]发生术后谵妄的老年病人中术前有各种内科疾病的占100%,术前用药中阿托品占95.6%,甲硝唑占86.8%,胃肠外营养(TPN)占63.2%。针对这些影响因素采取护理措施后,68例病人24h至1周内好转,绝大多数3d内好转。[结论]老年术后谵妄与术前已存内科疾病、术前使用阿托品、甲硝唑等用药及胃肠外营养等有关。应明确各种高危因素并采用相应细致的护理措施。     

A trial for a DNA diagnosis of Plasmodium vivax malaria recently reemerging in the Republic of Korea using microtiter plate hybridization assay

The polymerase chain reaction-based microtiter plate hybridization (PCR-MPH) assay was utilized for a DNA diagnosis of Plasmodium vivax malaria, which has recently reemerged in the Republic of Korea. The subjects were 18 parasite-proven patients and 5 healthy controls. Follow-up blood samples were collected from 4 patients after a standard course of treatment. Polymerase chain reaction and electrophoresis of all the patients' blood showed a prominent band at the 138 base pair area, but not in the controls or after treating the patients. Hybridization of the PCR products with known species-specific probes of the 18S rRNA of various malaria species revealed strong positive reactions against the Plasmodium vivax-specific probe (absorbance 1.30-1.90 at 405 nm) in all of the patients. The absorbance was positively correlated with the degree of blood parasitemia, but with a borderline significance. Sequencing of the probe region of the Korean P. vivax revealed no significant variations from the typical P. vivax. The results show that the PCR-MPH is a highly useful technique for the DNA diagnosis of Korean vivax malaria.     

Allelic dimorphism in the merozoite surface protein-3alpha in Korean isolates of Plasmodium vivax

To study the genetic diversity of re-emerging Plasmodium vivax in the Republic of Korea, nucleotide sequence variations at the merozoite surface protein-3alpha (PvMSP-3alpha) locus were analyzed using 24 re-emerging isolates and 4 isolates from imported cases. Compared with the well known Belem strain (Brazil), a large number of amino acid substitutions, deletions, and insertions were found at the locus of the isolates examined. The Korean isolates were divided into two allelic types; type I (15 isolates), similar to the Belem strain, and type II (9), similar to the Chess strain (New Guinea). Isolates from imported cases were classified into three types; type III (1 from Malaysia), similar to type B from western Thailand, type IV (1 each from Indonesia and India), and type V (1 from Pakistan), both being new types. Our results have shown that the MSP-3alpha locus of re-emerging Korean P. vivax is dimorphic with two allelic types coexisting in the endemic area.     

Dopamine transporter genotype influences the attention deficit in Korean boys with ADHD

Attention appears to be inheritable, stable and influenced by genetic factors. The use of the Continuous Performance Test (CPT), as an endophenotypic measure, is valuable for genetic studies because it may show increased sensitivity to specific dimensions in attention deficit hyperactivity disorder. However, few studies have been designed to examine the influence of the genotype on attention level measured by CPT in ADHD patients. This study examinee the difference between 10/10 and 10/* genotype in the attention deficits measured by the CPT in ADHD patients. Forty-four unrelated ADHD patients were recruited from the psychiatric outpatients' clinic at Kangbuk Samsung Hospital. Two child psychiatrists made the diagnoses of ADHD using the DSM- IV diagnostic criteria. The genomic DNA was extracted from the blood, and analyzed to determine the genotype. A 40- base pair variable number of tandem repeats (VNTR) polymorphism in the 3' untranslated region was amplified. The attention deficits were measured by the test of variables of attention (T.O.V.A.). Between the 10/10 genotype and 10/* genotype, standard scores of the T.O.V.A were compared using a Mann-Whiney test. A comparison with the 10/10 genotype and 10/* genotype showed that those patients with the 10/10 genotype made less omission errors in the first quarter of the test (p < 0.05, by Mann-Whiney test). No significant differences were observed in the errors of commission, response time, variability. This study found that the 10/10 genotype made less omission errors on the T.O.V.A. This suggests that the dopamine transporter genotype influences the attention deficits measured by T.O.V.A.     

Balloon-Occluded Retrograde Transvenous Obliteration for Gastric Variceal Bleeding: Its Feasibility Compared with Transjugular Intrahepatic Portosystemic Shunt

Objective

To assess the feasibility of balloon-occluded retrograde transvenous obliteration (BRTO) in active gastric variceal bleeding, and to compare the findings with those of transjugular intrahepatic portosystemic shunt (TIPS).

Materials and Methods

Twenty-one patients with active gastric variceal bleeding due to liver cirrhosis were referred for radiological intervention. In 15 patients, contrast-enhanced CT scans demonstrated gastrorenal shunt, and the remaining six (Group 1) underwent TIPS. Seven of the 15 with gastrorenal shunt (Group 2) were also treated with TIPS, and the other eight (Group 3) underwent BRTO. All patients were followed up for 6 to 21 (mean, 14.4) months. For statistical inter-group comparison of immediate hemostasis, rebleeding and encephalopathy, Fisher''s exact test was used. Changes in the Child-Pugh score before and after each procedure in each group were statistically analyzed by means of Wilcoxon''s signed rank test.

Results

One patient in Group 1 died of sepsis, acute respiratory distress syndrome, and persistent bleeding three days after TIPS, while the remaining 20 survived the procedure with immediate hemostasis. Hepatic encephalopathy developed in four patients (one in Group 1, three in Group 2, and none in Group 3); one, in Group 2, died while in an hepatic coma 19 months after TIPS. Rebleeding occurred in one patient, also in Group 2. Except for transient fever in two Group-3 patients, no procedure-related complication occurred. In terms of immediate hemostasis, rebleeding and encephalopathy, there were no statistically significant differences between the groups (p > 0.05). In Group 3, the Child-Pugh score showed a significant decrease after the procedure (p = 0.02).

Conclusion

BRTO can effectively control active gastric variceal bleeding, and because of immediate hemostasis, the absence of rebleeding, and improved liver function, is a good alternative to TIPS in patients in whom such bleeding, accompanied by gastrorenal shunt, occurs.     

体外受精-胚胎移植治疗不孕症临床分析

目的 总结与探讨影响常规体外受精－胚胎移植（ＩＶＦ－ＥＴ）妊娠率的因素。方法 对１９９９年１月至８月在我院门诊接爱ＩＶＦ－ＥＴ的３６对不孕夫妇采用促性腺激素释放激素（ＣｎＲＨ－ａ）／高纯促卵泡素（ＦＳＨ－ＨＰ）／绒毛膜促性腺激素（ｈＣＧ）刺激排卵方案,Ｂ超监测卵泡发育情况并旨导经阴道取卵,培养后加入丈夫精子孵育,将高质量胚胎转移至子宫。结果 取卵３５６个,平均第周期取卵１０．２个;受精率６６．５％     

Comparison of virulence and restriction endonuclease cleavage patterns of infectious laryngotracheitis viruses isolated in Korea

Isolates of infectious laryngotracheitis virus (ILTV) obtained from field disease outbreaks in Korea from 1982 to 1998 were compared by virulence testing and by examining restriction endonuclease (REN) cleavage patterns of viral DNA. Based on pathogenicity tests, eight of 11 ILTV strains were classified as virulent, because these strains caused 40 to 80% mortality in specific pathogen free chickens, while three strains were classified as low virulence because these did not cause mortality. The REN cleavage patterns of the low virulence strains were identical with those of two reference vaccine strains, which were of chicken embryo origin. However, the DNA cleavage patterns of the virulent strains differed from those of both the low virulence and the vaccine strains. Furthermore, one virulent Korean strain N87278 had REN cleavage patterns that were clearly different from other virulent strains. In the present study, ILTV strains examined could be classified into two groups (virulent and low virulence strains) by pathogenicity testing, and three groups based on their REN cleavage patterns. These results suggest that most outbreaks of infectious laryngotracheitis were not likely to be associated with vaccine strains, but some were associated with viruses indistinguishable from commercial vaccine strains. At least three genetically distinct groupings of ILTV have been involved in outbreaks of infectious laryngotracheitis in Korea.