The vermilion border of the lips has a modifed epithelium, which is much more likely to develop allergic contact sensitivity reactions than oral mucosa. Allergens in contact with both the oral mucosa and the lips oftens produce only cheilitis. Allergic contact cheilitis may result from topical medicaments, dentifrices, cosmetics, foods, plants or metals. We present six cases of allergic contact cheilitis confirmed by patch test. The toot4paste was incriminated in 2 cases, the lipstick in 3 cases and the bubble gum in one rase as producing chelitis respectively.
Allergens ; Cheilitis* ; Dentifrices ; Dermatitis, Contact ; Epithelium ; Gingiva ; Lip ; Metals ; Mouth Mucosa ; Patch Tests

We report a case of type V hyperlipoproteinemia and xanthoma eruptivum associated with diabetes mellitus in a 12-year-old female. She had diffuse erythematous yellowish papules on the extremities and trunk with itching. The laboratory findings showed increased serum blood glucose, cholesterol and triglyceride, increasing pre- and chylomicron bands on electrophoresis of lipoprotein. The biopsy specimen of an erythematous yellowish colored papule on the trunk showed characteristic findings of xanthoma.
Biopsy ; Blood Glucose ; Child ; Cholesterol ; Diabetes Mellitus* ; Electrophoresis ; Extremities ; Female ; Humans ; Hyperlipoproteinemia Type V* ; Lipoproteins ; Pruritus ; Triglycerides ; Xanthomatosis*

A 42 year-old male with a history of multidrug-resistant pulmonary tuberculosis suddenly developed massive hemoptysis. Embolization of a bronchial artery branch and the collateral systemic arteries did not resolve the recurrent bleeding. Spiral computerized tomography(spiral CT) of the chest showed contrast enhanced nodules within a large cavity at the left lower lobe in the arterial phase suggesting a Rasmussen aneurysm. A pulmonary angiogram showed abnormal vascular nodules at that site. Coils were deployed at both the proximal and distal vessels of this aneurysmal sac for embolization. Transcatheter arterial embolization is a safe and effective means of controlling bleeding from this pulmonary arterial pseudoaneurysm. Here we report a case of a Rasmussen aneurysm diagnosed by spiral CT, which was successfully treated by pulmonary arterial embolization with a coil.
Aneurysm* ; Aneurysm, False ; Arteries ; Bronchial Arteries ; Embolization, Therapeutic ; Hemoptysis ; Hemorrhage ; Humans ; Male ; Respiratory Insufficiency ; Thorax ; Tomography, Spiral Computed ; Tuberculosis, Pulmonary

No abstract available.
Pulmonary Embolism*

PURPOSE: To evaluate the CT and MR findings of bronchial anthracofibrosis. MATERIALS AND METHODS: Forty-one patients with ronchoscopically confirmed bronchial anthracofibrosis were included in this study. Thirty-six were female and five were male, and all were aged between 53 and 89 (mean, 70) years. The CT (n=41) and MR findings (n=5) were retrospectively analysed with regard to bron-chostenosis, atelectasis, air-space consolidation, lymph node enlargement, calcified lymph node, mass and bronchial wall thickening, as seen on CT, and signal intensity of the mass and lymph nodes, as seen on MR. RESULTS: CT scans revealed the presence of bronchostenosis (n=34, 83%), atelectasis (n=24, 59%), pneumonic consolidation (n=26, 63%), enlarged mediastinal lymph node (n=39, 95%), calcified lymph node (n=22, 54%), mass (n=4,10%), and thickening of bronchial wall (n=1, 2.4%). Multifocal involvement of bron-chostenosis, atelectasis, and air-space consolidation occurred in 61%, 50% and 30% of cases, retrospectively. MR imaging showed low signal intensity of mass (n=3) and lymph nodes (n=10) on T1WI and T2WI. but in one case, mass and lymph node showed central high signal intensity on T2WI. CONCLUSION: A multiplicity of bronchostenosis, atelectasis, air-space consolidation and enlarged mediastinal lymph nodes were characteristic CT findings of bronchial anthracofibrosis. Most MR findings included relatively low signal intensity of masses and lymph nodes on T2WI, possibly indicating the benign nature of the diseases
Female ; Humans ; Lung ; Lymph Nodes ; Magnetic Resonance Imaging ; Male ; Pneumoconiosis ; Pulmonary Atelectasis ; Retrospective Studies ; Tomography, X-Ray Computed

Tracheal invasion is an uncommon complication of thyroid cancer, but it can cause respiratory failure. A rigid bronchoscope may be used to help relieve airway obstruction, but general anesthesia is usually required. Tracheal balloon dilatation and stent insertion can be performed without general anesthesia, but complete airway obstruction during balloon inflation may be dangerous in some patients. Additionally, placement of the stent adjacent to the vocal cords can be technically challenging. An 86-year-old female patient with tracheal invasion resulting from thyroid cancer was admitted to our hospital because of worsening dyspnea. Due to the patient's refusal of general anesthesia and the interventional radiologist's difficulty in completing endotracheal stenting, we performed endotracheal tube balloon dilatation and argon plasma coagulation. We have successfully treated tracheal obstruction in the patient with thyroid cancer by using endotracheal tube balloon inflation and a flexible bronchoscope without general anesthesia or airway obstruction during balloon inflation.
Aged, 80 and over ; Airway Obstruction ; Anesthesia, General ; Argon Plasma Coagulation ; Bronchoscopes ; Bronchoscopy ; Dilatation ; Disulfiram ; Dyspnea ; Female ; Humans ; Inflation, Economic* ; Intubation, Intratracheal ; Neoplasm Invasiveness ; Respiratory Insufficiency ; Stents ; Thyroid Neoplasms* ; Trachea ; Vocal Cords

BACKGROUND: Since endotracheal tube is the most important factor involved in the imposed work of breathing during mechanical ventilation, extubation of endotracheal tube is supposed to reduce respiratory work of patient. However, some patients show labored breathing after extubation despite acceptable blood gases. We investigated the changes of work of breathing before and after extubation and the factors involved in the change of WOB after extubation. METHODS: The subjects were 34 patients(M : F = 20 : 14, mean age = 61 l7yre) who recovered from respiratory failure after ventilatory support and were considered to be ready for extubation. The patients with clinical or radiologic evidences of upper airway obstruction before endotracheal intubation for mechanical ventilation were excluded. Vital sign, physical examination, chest X-ray, work of breathing and other respiratory mechanic indices were measured prior to, immediately, 6, 24 and 48 hours after extubation serially. Definition of weaning failure after extubation was resumption of ventilatory support or reintubation of endotracheal tube within 48 hour after extubation because of respiratory failure. The patients were classified into group I (decreased work of breathing), group 2(unchanged work of breathing) and group 3(increased work of breathing) depending on the statistical difference in the change of work of breathing before and after extubation. RESULTS: Work of breathing decreased in 33%(11/34, group 1), unchanged in 41%(14/34, group 2) and increased in 26% (9/34, group 3) of patients after extubation compared with before extubation. Weaning failure occurred 9%(1/11) of group, 1, 28.67(4/14) of group 2 and 44.4%(4/9) of group 3 after extubation(p = 0.07). The change of work of breathing after extubation was positively correlated with change of mean airway resistance(mRaw). (r = 0.794, p> 0.01) In three cases of group 3 whose respiratory indices could be measured until 48 hr ater extubation, the change in work of breathing paralleled with the sequential change of mRaw. The work of breathing was peaked at 6 hr after extubation, which showed a tendency to decrease thereafter. CONCLUSIONS: Reversible increase of work of breathing after extubation may occur in the patients who underwent extubation, and the increase in mRaw could be responsible for the increase in work of breathing. In addition, the risk of weaning failure after extubatuion may increase in the patients who have increased WOB immediately after extubation.
Airway Obstruction ; Gases ; Humans ; Intubation, Intratracheal ; Physical Examination ; Respiration ; Respiration, Artificial ; Respiratory Insufficiency ; Respiratory Mechanics ; Thorax ; Vital Signs ; Weaning ; Work of Breathing*

PURPOSE: To compare MRI appearance between plicae syndrome and normal plicae. MATERIALS AND METHODS: MR images of 60 cases of arthroscopically-confirmed plicae syndrome and 18 of arthroscopically-proven normal plicae were retrospectively analyzed. Sagittal T2-weighted MR images in all cases and MPGR(200) in 37 cases of plicae syndrome were obtained. Statistical analysis was performed using the chi-square test. RESULTS: On the basis of operatingresults, we observed 55 medial plicae, eight combined medial and suprapatellar plicae, four suprapatellar plicae,and one lateral plica. T2-weighted sagittal MR scans of the 60 cases demonstrated 37 medial plicae, 8 suprapatellar and one lateral plica. Joint effusion was found in 26 cases of 55 medial plicae. In T2-weighted sagittal MR scans, the identification of medial plicae was superior in the presence of joint effusion than its absence(plicae syndrome, p < 0.001 ; normal plicae group, p < 0.05). Medial plicae were well demonstrated onMPGR(200) axial images; on T2-weighted sagittal MR scans, they could be more frequently identified in the plicae syndrome group than in the normal control group(p < 0.001). Plicae syndrome-associated pathology included degenerative change of the articular cartilage of the medial femoral condyle in eight cases(14.5%), discoidmeniscus in nine(16.4%), lateral meniscus tear in 12(21.8%), medial meniscus tear in 21(38.1%), anterior cruciate ligament tear in three(5.5%), medial collateral ligament tear and osteochondritis dissecans in one case. CONCLUSION: The present study revealed that synovial plicae were well demonstrated in T2-weighted sagittal images, particularly on the presence of joint effusion. Medial plicae could be more frequently identified in the plicae syndrome group than in the normal control group, especially on T2-weighted sagittal MR scans.
Cartilage, Articular ; Collateral Ligaments ; Humans ; Joints ; Magnetic Resonance Imaging ; Menisci, Tibial ; Osteochondritis Dissecans ; Pathology

A case of nonfunctioning pancreatic islet cell tumor is described. A 34 years old female patient had intermittent epigastric pain and nausea for 6 months and she had nothing suggestive of neuroendocrine symtoms. Physcial examination showed an epigastric mass which wae deepseated, nontender, and well-demarcated. The routine upper endoscopic evatuation was negative. Abdominal ultrasonography and computed tomography showed a well-defined round solid mass with multifocal necrosis but did not revealed the origin of the lesion. Endoscopic retrograde pancreatography showed upward and rightward displacement of the proximal body portion of main pancreatic duct with nonvisualization of the secondary branches of pancreatic duct, suggesting that the mass originated from the pancreas. Resection of the mass with partial pancreatectomy and Roux-en-Y pancreaticojejunostomy was perfomed and the pathology was coafirmed as nonfunctioning pancreatic islet cell tumor containing somatostatin by immunohistochemical technique.
Adenoma, Islet Cell ; Adult ; Female ; Humans ; Immunohistochemistry ; Islets of Langerhans* ; Nausea ; Necrosis ; Pancreas ; Pancreatectomy ; Pancreatic Ducts ; Pancreaticojejunostomy ; Pathology ; Somatostatin ; Ultrasonography

Perivasculitis and endothelial cell abnormalities are prominent histopathologic features of syphilis. Various cutaneous lesions are the main clinical features of syphilis. We examined whether Treponema pallidum 47 kDa antigen regulates the expression of cell adhesion molecules on human dermal microvascular endothelial cells (HDMEC) and the regulation of T-lymphocytes binding to HDMEC. Using immunofluorescence flow cytometry and enzyme-linked immunosorbent assay (ELISA), we demonstrated that T. pallidum upregulated the expression of adhesion molecules, including intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1) and E-selectin. The 47 kDa antigen of T. pallidum also activated endothelium as measured by the upregulation of the expression of adhesion molecules on HDMEC, and it also promoted an increased adherence of T-lymphocytes to HDMEC. The expressions of ICAM-1 and VCAM-1 on HDMEC and the adherence of T-lymphocytes to HDMEC were inhibited by treatment with anti-TNF-alpha antibody or anti-IL-1alpha antibody. These results show that T. pallidum or T. pallidum-specific 47 kDa antigen are capable of stimulating HDMEC to increase the expression of ICAM-1, VCAM-1 and E-selectin and thereby, promote the adherence of T-lymphocytes. The whole process may play an important role in the immunopathogenesis of syphilis and it is likely that TNF-alpha and IL-1alpha are involved.
Antigens, Bacterial/physiology* ; Antigens, Bacterial/chemistry ; Cell Adhesion Molecules/metabolism* ; Cells, Cultured ; Endothelium, Vascular/pathology ; Endothelium, Vascular/metabolism* ; Human ; Microcirculation ; Molecular Weight ; Skin/blood supply* ; T-Lymphocytes/metabolism* ; Treponema pallidum/pathogenicity ; Treponema pallidum/immunology*