Lemierre syndrome is an uncommon disease which commonly arise from acute bacterial oropharyngeal infection. This disease was first described in 1900 by Courmont and Cade Lemierre. It is commonly caused by Fusobacterium necrophorum1. Lemierre syndrome has been reported to be serious and potentially fatal in the preantibiotic era1. It is characterized by an oropharyngeal infection leading to secondary septic thrombophlebitis of the internal jugular vein with embolization to the lungs and other organs. The incidence has become relatively rare at present and is usually only diagnosed when unsuspected culture results are available1. We report a case of Lemierre syndrome which was recently diagnosed in our centre.

Nerve sheath myxoma(NSM) is a rare cutaneous neoplasm of uncertain histogenesis. NSM can be divided into two groups; NSM1 (a myxoid NSM) and NSM2 (a cellular neurothekeoma). NSMs are characterized histologically by well-defined, lobular or plexiform dermal proliferation of stellate, spindle-shaped cells embedded in abundant myxoid stroma. A variable amount of nerve fascicles are entrapped within and around the tumor. Two variants of NSM share the same features to a certain degree but differ in cellularity and mucin deposition. We report two cases of NSMs with different clinical and histopathologic features.
Mucins ; Neurothekeoma*

BACKGROUND: Recent clinical observation reported that there was a significant correlation between change in circulating vascular endothelial growth factor (VEGF) levels and the occurrence of severe acute graft-versus-host disease (GVHD) following allogeneic hematopoietic stem cell transplantation (allo-HSCT), but the action mechanisms of VEGF in GVHD have not been demonstrated. METHODS: This study investigated whether or not blockade of VEGF has an effect on acute GVHD in a lethally irradiated murine allo-HSCT model of B6 (H-2b)-->B6D2F1 (H-2b/d). Syngeneic or allogeneic recipient mice were injected subcutaneously with anti-VEGF peptides, dRK6 (50 microg/dose) or control diluent every other day for 2 weeks (total 7 doses). RESULTS: Administration of the dRK6 peptide after allo-HSCT significantly reduced survival with greaterclinical GVHD scores and body weight loss. Allogeneic recipients injected with the dRK6 peptide exhibited significantly increased circulating levels of VEGF and expansion of donor CD3+ T cells on day +7 compared to control treated animals. The donor CD4+ and CD8+ T-cell subsets have differential expansion caused by the dRK6 injection. The circulating VEGF levels were reduced on day +14 regardless of blockade of VEGF. CONCLUSION: Together these findings demonstrate that the allo-reactive responses after allo-HSCT are exaggerated by the blockade of VEGF. VEGF seems to be consumed during the progression of acute GVHD in this murine allo-HSCT model.
Animals ; Body Weight ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells ; Humans ; Mice ; Oligopeptides ; Peptides ; T-Lymphocyte Subsets ; T-Lymphocytes ; Tissue Donors ; Vascular Endothelial Growth Factor A

Hyperinsulinism caused by a functioning islet cell tumor of the pancreas is an uncommon but well established metabolic entity which can usually be diagnosed accurately. We treated a patient with functioning insulinoma recently. The outline of the particular management given for the course of the anesthesia of the patient was as follows: 1) Control of blood glucose a) pre- and intraoperative hypoglycemia; Glucose was administered through intravenous drip or orally. b) postoperative transient hyperglycemia; Insulin was administered if necessary and a small amount of glucose uptake, occurred. 2) Anesthetics, and supplemental drugs Drugs with no or little effect in increasing blood glucose were used. 3) Beta-adrenergic blockers These drugs were not used in the hypoglycemic state because of potentiating insulin activity.
Adenoma, Islet Cell ; Adrenergic beta-Antagonists ; Anesthesia* ; Anesthetics ; Blood Glucose ; Glucose ; Humans ; Hyperglycemia ; Hyperinsulinism ; Hypoglycemia ; Infusions, Intravenous ; Insulin ; Insulinoma* ; Pancreas

Fixed drug eruption is a distinctive and clinically recognizable entity that is characterized by well-demarcated erythematous plaques recurring in exactly the same sites as on previous occasions. Unlike the pigmenting form of fixed drug eruption, nonpigmenting fixed drug eruption leaves no pigmentation when it resolves. We now report the case of a 44-year-old man who presented with diffuse ill-defined erythematous patches on both hands, feet and lower legs with a burning sensation, which is considered an atypical manifestation for fixed drug eruption. The patient had a history of similar skin lesions developing after medications on the corresponding regions. The patch test with suspected drugs showed negative reactions on both lesions and unaffected sites. The lesions were reproduced on the oral provocation test with codeine and resolved without pigmentation. The patient was diagnosed with nonpigmenting fixed drug eruption due to codeine.
Adult ; Burns ; Codeine ; Drug Eruptions ; Foot ; Hand ; Humans ; Leg ; Patch Tests ; Pigmentation ; Sensation ; Skin

Atypical fibroxanthoma is an uncommon spindle cell tumor that has a clinically benign course despite the presence of bizarre xanthoma cells. A 90-year-old female presented with a 2-month history of an ulcerative plaque on the right cheek. The initial punch biopsy revealed a benign histological appearance with prominent xanthomatous cells, but the specimen excised afterwards showed malignant features with a spindle and epithelioid cell proliferation with pleomorphism and atypia. The tumor cells stained positively for vimentin and CD68, they were partially positive for CD99 and CD10 and they were negative for CD34, S100, p63, desmin and actin. We report here on a case of atypical fibroxanthoma masquerading as xanthogranuloma.
Actins ; Aged, 80 and over ; Biopsy ; Cheek ; Desmin ; Diagnosis, Differential ; Epithelioid Cells ; Female ; Humans ; Ulcer ; Vimentin ; Xanthomatosis

Pacinian neuroma, also known as hyperplasia and/or hypertrophy of pacinian corpuscles is a rare skin condition usually occurring in the hand. Although it is known to cause pain and tenderness on the affected skin, asymptomatic cases have also been reported. We report a 46-year-old male monk who presented with asymptomatic skin lesions of paler color than the adjacent normal skin on the tips of the fingers of both hands. The 3 mm punch biopsy conducted on the lesion showed an increased number of onion bulb-like structures with a nerve fiber in each center. The patient was diagnosed with pacinian neuroma and has been under regular follow up without treatment.
Biopsy ; Fingers ; Follow-Up Studies ; Hand ; Humans ; Hyperplasia ; Hypertrophy ; Male ; Middle Aged ; Nerve Fibers ; Neuroma ; Onions ; Pacinian Corpuscles ; Skin

Vitiligo is an acquired cutaneous disorder of pigmentation with no definite etiology. Although there are a number of treatment modalities including phototherapy, topical corticosteroids and topical immunomodulators, few studies on the effect of systemic cyclosporine for the treatment of vitiligo have been conducted. We have experienced the improvement of vitiligo lesions after 8 months of systemic administration of cyclosporine (2.5~3.3 mg/kg/day) in a patient with vitiligo and atopic dermatitis. We believe this case report warrants further investigations of cyclosporine for the treatment of vitiligo in terms of mechanisms and clinical outcomes as well.
Adrenal Cortex Hormones ; Cyclosporine ; Dermatitis, Atopic ; Humans ; Immunologic Factors ; Phototherapy ; Pigmentation ; Vitiligo

OBJECTIVE: Infants of diabetic mothers have higher incidence of congenital malformations compared with those of non-diabetic mothers. We investigated the usefulness of prenatal level II or "targeted" ultrasonography (TUS) as a diagnostic tool to identify congenital abnormalities in infants of diabetic mothers. METHODS: We retrospectively reviewed the medical records of 218 mothers diagnosed as pregestational or gestational diabetes in whom prenatal TUS was performed in Asan Medical Center between 2004 and 2009. The prenatal TUS findings were compared with the congenital abnormalities found in the infants (n=226) of the diabetic mothers by physical examination and ultrasonography (including echocardiography). Maternal risk factors associated with congenital anomalies were also investigated. RESULTS: The incidence of congenital anomalies was 14.2% (n=32) in prenatal TUS and 15.5% (n=35) postnatally, respectively. Only 7 cases (3.6%) out of the 194 infants with normal prenatal TUS findings were found to have congenital abnormalities diagnosed postnatally. All of the abnormalities in these 7 infants could be detected or suspected by physical examination after birth. Maternal fasting glucose level >120 mg/dL and insulin therapy were significant risk factors for predicting congenital abnormalities in infants of diabetic mothers. CONCLUSION: Prenatal TUS performed by experienced obstetricians had a good reliability in the diagnosis of congenital anomalies in infants of diabetic mothers. Need for universal screening of ultrasound or echocardiography in these infants should be questioned especially in the cases in which prenatal TUS was performed.
Collodion ; Congenital Abnormalities ; Diabetes, Gestational ; Echocardiography ; Fasting ; Female ; Glucose ; Humans ; Incidence ; Infant ; Insulin ; Mass Screening ; Medical Records ; Mothers ; Parturition ; Physical Examination ; Pregnancy ; Retrospective Studies ; Risk Factors ; Ultrasonography, Prenatal