Atypical cutaneous fibrous histiocytoma (ACFH) is not well known and only a small number of cases have been reported. Characteristically, ACFH is found on the trunk and limbs of middle-aged women. Although considerable cellular atypia may be present, it occurs focally, the remainder of the tumor representing more classical cutaneous fibrous histiocytoma. A 37-year-old woman presented with a solitary brownish firm nodule on her right forearm. No other abnormalities were found in her personal or family history. Clinically, the tumor simulated a benign fibrous histiocytoma. Histologic examination revealed a poorly delineated intradermal tumor with the usual appearance of benign cutaneous fibrous histiocytoma, but a variable pro-portion of cells in the tumor were scattered atypical cells or bizarre multinucleated giant cells. We report upon a rare case of ACFH.
Adult ; Extremities ; Female ; Forearm ; Giant Cells ; Histiocytoma, Benign Fibrous* ; Humans

BACKGROUND: Gastric cardia cancers are relatively rare neoplasms althougth it is reported that their relative incidence among gastric cancers is increasing. At the time of diagnosis, gastric cardia cancers in many cases are already in a more advanced stage in terms of depth of invasion or metastasis to lymph nodes. The purpose of this study was to evaluate the effect of the proximal resection margin on the survival rates for cardia cancer patients who underwent a total gastrectomy without a thoracotomy. METHODS: We retrospectively analyzed 87 patients who had undergone operations for gastric cardia cancers at Eulji College Hospital during the 8 years from Jan. 1988 to Dec. 1995. RESULTS: The most prevalent age group was in the 6th decade (34.5%) and the male-to-female ratio was 2.2:1.0. The TNM classification showed stage I (13.8%), II (10.3%), III (54%) and IV (21.8%). The overall 5-year survival rate was 35.6%, and the survival rates according to the stage were 83.3% in stage I, 87.5% in stage II, 27.1% in stage III, and 0% in stage IV. The 5-year survival rates according to the length of the proximal resection margin (PRM) for all patients were as follows: 22.0% for PRM< or =2 cm (N=34) and 44.0% for PRM>2 cm (N=52) 44.0% (p=0.0783). The 5-year survival rates according to the length of the PRM for stage III cancers were as follows: 19.7% for PRM< or =2 cm (N=18) and 31.7% for PRM>2 cm (N=28)(p=0.4090). CONCLUSIONS: These results suggest that the length of the proximal resection margin is not significant as a prognostic factor. We believe a total gastrectomy without a thoracotomy is a reasonable and safe alternative to a thoracotomy approach to the dissection of the mediastinal lymph node in cases of gastric cardia cancer.
Cardia* ; Classification ; Diagnosis ; Gastrectomy* ; Humans ; Incidence ; Lymph Nodes ; Neoplasm Metastasis ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate ; Thoracotomy

BACKGROUND: The bioincompatability of the conventional peritoneal dialysis can be partly attributed to the presence of GDPs, which are generated during the heat sterilization. Formation of GDPs can be significantly reduced by the use of multi-chamber bag systems because high concentrated glucose is separated from alkaline lactate. In order to investigate whether multi-chamber bag system can improve the in vivo biocompatibility, we performed a randomized, prospective study comparing the multi-chamber bag system with the conventional PD system, measuring CA125 and PIIINP levels in the effluent dialysates as well as the other clinical and biochemical parameters. METHODS: Forty five patients who were stable on CAPD were enrolled randomly assigned to experiment group (n=27), and control group (n=18). Overnight effluent was collected for measurement of CA125 and PIIINP and the other clinical, biochemical parameters were compared including the number of peritonitis, the ultrafiltration volume. RESULTS: In patients treated with the multiple chamber bag system, there were significantly higher levels of CA125 and PIIINP from 1 month. No clinical and biochemical parameters influenced on their levels. The incidence of peritonitis or ultrafiltration volume did not differ between the two groups. CONCLUSION: Using the low GDP solution resulted in a better preservation of peritoneal mesothelial mass and an improvement of local peritoneal homeostasis, which are supposed to contribute to the biocompatibility of peritoneal dialysis fluid.
Dialysis Solutions ; Glucose ; Guanosine Diphosphate* ; Homeostasis ; Hot Temperature ; Humans ; Incidence ; Lactic Acid ; Peritoneal Dialysis* ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Prospective Studies ; Sterilization ; Ultrafiltration

Heat stroke is a potentially fatal disorder that's caused by an extreme elevation in body temperature. We report here an unusual case of multiple organ failure that was caused by classical, nonexertional heat stroke due to taking a warm bath at home. A 68 year old diabetic man was hospitalized for loss of consciousness. He was presumed to have been in a warm bath for 3 hrs and his body temperature was 41 degrees C. Despite cooling and supportive care, he developed acute renal failure, disseminated intravascular coagulation (DIC) and fulminant liver failure. Continuous venovenous hemofiltration was started on day 3 because of the progressive oligouria and severe metabolic acidosis. On day 15, septic ascites was developed and Acinetobacter baumanii and Enterococcus faecium were isolated on the blood cultures. In spite of the best supportive care, the hepatic failure and DIC combined with septic peritonitis progressed; the patient succumbed on day 25.
Multiple Organ Failure/*etiology ; Male ; Liver Failure/*etiology ; Kidney Failure/*etiology ; Humans ; Heat Stroke/*complications/etiology ; Fatal Outcome ; Baths/*adverse effects ; Aged

PURPOSE: inflammation is a common feature in chronic kidney disease patients, and it could contribute to long-term morbidity and mortality related with malnutrition and atherosclerosis. In this study, we aimed to investigate the effect of initiating dialysis on inflammatory state, nutritional parameter, and immune response in end-stage renal disease (ESRD) patients. METHODS: 57 ESRD patients who initiated hemodialysis (HD, n=31) or continuous ambulatory peritoneal dialysis (CAPD, n=26) were enrolled. Pro-inflammatory cytokine, tumor necrosis factor (TNF)-alpha, and anti-inflammatory cytokines, interleukin (IL)-10 and adiponectin were measured before and 3 months after initiation of dialysis. Inflammatory marker, highly sensitive C-reactive protein (hs-CRP), and nutritional parameter, albumin, were also checked. Lipopolysaccharide (LPS)-stimulated production of TNF-alpha and IL-10 were measured for the evaluation of immune response by external stimuli. RESULTS: As uremia was reduced by initiating dialysis, serum level of TNF-alpha was decreased and adiponectin was increased. These changes were accompanied by the decrease of hs-CRP and the increase of serum albumin. LPS-stimulated cytokines production was increased after initiating dialysis. There differences in these parameters comparing HD and CAPD patients except more increase of serum adiponectin level in CAPD patients. CONCLUSION: Our study demonstrated that initiation of dialysis results in decrease of inflammation, improvement of nutritional status, and restoration of proper immune responsiveness in ESRD patients. These results suggest that correction of uremic milieu through dialysis has beneficial effects. Therefore, initiation of dialysis might have the advantage of improving inflammatory and nutritional status, and correcting immune dysfunction in ESRD patients.
Adiponectin ; Atherosclerosis ; C-Reactive Protein ; Cytokines ; Dialysis* ; Humans ; Inflammation ; Interleukin-10 ; Interleukins ; Kidney Failure, Chronic* ; Malnutrition ; Mortality ; Nutritional Status ; Peritoneal Dialysis, Continuous Ambulatory ; Renal Dialysis ; Renal Insufficiency, Chronic ; Serum Albumin ; Tumor Necrosis Factor-alpha ; Uremia

Murine typhus is an infectious disease caused by Rickettsia typhi, an intracellular parasite that lives in the cytoplasm of host cells. Rickettsia typhi infection can induce lymphohistiocytic vasculitis leading to pulmonary, cardiovascular, central nervous system and renal complications. We experienced a case of acute renal failure resulting from acute tubulointerstitial nephritis associated with murine typhus infection. A 67 year old man was transferred from local hospital due to fever, confusion, oliguria with renal failure. Laboratory finding showed elevated liver enzyme with hypoalbuminemia and progressive azotemia. Despite supportive care, his azotemia progressed with anuria and acute hemodialysis was started. Kidney biopsy showed acute tubulointerstitial nephritis with vasculitis and indirect immunofluorecent antibody to murine typhus was 1: 3, 200. Doxycyclin was started and his renal function recovered. We report a case of acute renal failure resulting from murine typhus infection induced acute tubulointerstitial nephritis.
Acute Kidney Injury* ; Aged ; Anuria ; Azotemia ; Biopsy ; Central Nervous System ; Communicable Diseases ; Cytoplasm ; Fever ; Humans ; Hypoalbuminemia ; Kidney ; Liver ; Nephritis, Interstitial* ; Oliguria ; Parasites ; Renal Dialysis ; Renal Insufficiency ; Rickettsia typhi ; Typhus, Endemic Flea-Borne* ; Vasculitis

PURPOSE: CHF is a life threatening acute complication in ESRD populations. An intensive hemodialysis (HD) has been effective in reducing intravascular volume and in removing uremic toxin with improved systolic function. Although recent progress has identified an inflammation as an important contributor to the pathogenesis of CVD, the effect of intensive HD on inflammatory parameters and left ventricle (LV) systolic dysfunction is not clear. The purpose of this study is to examine the effect of intensive HD on LV systolic function and serum cytokines levels. METHODS: Among ESRD patients who underwent dialysis and developed acute pulmonary edema due to LV systolic dysfunction were enrolled. Intensive HD consisted of daily 4 hours HD for 7 consecutive days. Data were prospectively collected and 2-D echocardiography was done before and after intensive HD. Serum levels of TNF-alpha and IL-10 were compared and lipopolysaccharide (LSP)-stimulated of these cytokines were measured. RESULTS: After intensive HD, weight and mean arterial blood pressure decreased significantly and ejection fraction (EF) increased significantly. Serum IL-10 and TNF-alpha levels decreased significantly after intensive HD. In contrast, LPS stimulated production of these cytokines increased significantly after intensive HD. The difference of CRP between after HD and before HD was negatively correlated with the difference of EF. CONCLUSION: In ESRD patients with acute LV dysfunction, intensive HD significantly improved EF and restored the immune responsiveness. These results suggest that intensive HD has the advantage of improving EF through modulating inflammation and correcting immune dysfunction in ESRD patients with acute LV dysfunction.
Arterial Pressure ; Cytokines ; Dialysis ; Echocardiography ; Heart Failure ; Heart Ventricles ; Humans ; Imidazoles ; Inflammation ; Interleukin-10 ; Kidney Failure, Chronic ; Nitro Compounds ; Prospective Studies ; Pulmonary Edema ; Renal Dialysis ; Stroke Volume ; Tumor Necrosis Factor-alpha

PURPOSE: Depression is associated with increased inflammation and cardiovascular disease. And in patients with end stage renal disease (ESRD), depression is a common problem and cardiovascular disease is the main cause of death. The aim of this study is to investigate the association of depression with various inflammatory markers and with some cardiovascular risk factors in ESRD patients on hemodialysis METHODS: 53 patients with ESRD on maintenance hemodialysis were divided into depressive symptom (BDI> or =11) group and control (BDI < 11) group by the 21-items Becks depression inventory (BDI). We collected patients characteristics and laboratory measurements by medical records. And then, we measured the levels of IL-10 and TNF-alpha a and analyzed the genotype of IL-10 and TNF-alpha a promoter area. RESULTS: The levels of TNF-alpha, CRP and ferritin were significantly higher in depressive symptom group (p=0.001, 0.04, 0.02) and IL-10 concentration tended to be lower in depressive symptom group (p= 0.05). The prevalence of left ventricular hypertrophy was higher in depressive symptom group than in the control group (44% vs 9%, p=0.01). GG genotype known as high IL-10 producer was less common in depressive symptom group than in control group (8% vs 36%, p=0.039). CONCLUSION: Increased inflammation, high left ventricular hypertrophy prevalence and low ejection fraction were observed in depressive hemodialysis patients. Further prospective study is needed to clarify the role of depression in the development of inflammation and cardiovascular disease in ESRD patients.
Cardiovascular Diseases ; Cause of Death ; Depression ; Ferritins ; Genotype ; Humans ; Hypertrophy, Left Ventricular ; Inflammation ; Interleukin-10 ; Kidney Failure, Chronic ; Medical Records ; Prevalence ; Renal Dialysis ; Risk Factors ; Tumor Necrosis Factor-alpha

BACKGROUND: Chronic systemic inflammation in ESRD patients due to uremia and hemodialysis procedure itself comes into notice as a main factor for premature mortality secondary to rapid progressing atherosclerosis. Various pro-inflammatory cytokine, known to mediate these reaction of malnutrition, inflammation and atherosclerosis, are regulated by anti-inflammatory cytokine, such as IL-10. Quantitative production of IL-10 shows interindividual variability determined genetically by polymorphisms of promotor gene. The aim of this study was to measure the degree of IL-10 synthesis in ESRD patients treated with hemodialysis and evaluate the association with genotypes and cardiovascular risk factors. METHODS: The IL-10 genotypes for polymorphic bases at position at -1082 was determined in 66 chronic hemodialysis patients and 98 healthy subjects using highly specific PCR and the lipopolysaccharide (LPS)-stimulated IL-10 (sIL-10) release from whole blood were measured by ELISA. RESULTS: The distribution of the IL-10 genotypes in hemodialysis patients were similar to the general population, but the proportion of A allele in hemodialysis group was significantly higher (72.3% vs 59.8%, p=0.05). sIL-10 concentration were lower in hemodialysis patients compared with normal control (21.1 pg/mg vs 36.1 pg/mg, p=0.001) and both groups showed same relationship of sIL-10 with genotypes, that AA type was low producer. In multiple regression analysis, sIL-10 of normal group correlated negatively with age, creatinine, uric acid and existence LVH, and positively with albumin, hemoglobin. On the other hand, lower albumin, lower ejection fraction on echocardiography and existence of left ventricular hypertrophy were associated with higher sIL-10 in hemodialysis group. CONCLUSION: Polymorphisms by IL-10 genotypes were associated with production of IL-10 by endotoxin stimulation, and sIL-10 was lower in hemodialysis patients than in normal control. According to relation of sIL-10 with cardiovascular risk factors such as existence LVH, ejection fraction and malnutrition, it could be suggested that sIL-10 is useful marker in evaluating the risk of cardiovascular events.
Alleles ; Atherosclerosis ; Cardiovascular Diseases ; Creatinine ; Echocardiography ; Enzyme-Linked Immunosorbent Assay ; Genotype* ; Hand ; Humans ; Hypertrophy, Left Ventricular ; Inflammation ; Interleukin-10* ; Kidney Failure, Chronic ; Malnutrition ; Mortality, Premature ; Polymerase Chain Reaction ; Renal Dialysis* ; Risk Factors* ; Uremia ; Uric Acid

Light chain deposition disease is caused by systemic paraprotein deposition resulting from monoclonal plasma cell dyscrasia. It is usually characterized rapidly progressive renal failure and multiple organ dysfunctions. Besides deposition of light chain, it can lead to multiple organ dysfunctions due to hyperviscosity syndrome. We experienced a case of 54-year-old man who presented as an acute renal failure, and elevation of liver enzyme. Radiologically, there was no abnormal finding except enlargement of both kidney in abdominal sonogram. Globulinuria was noticed on 24 hrs-urine study. The histologic findings of kidney showed lambda chain deposits in basement membrane of tubules and glomeruli, interstitium, and vessel walls. On 10th day of hospitalization, he developed sudden hypoxia that was not corrected by oxygen supplementation, and focal neurologic signs accompanied with a change of consciousness. We report a case of light chain deposition disease manifested as an acute renal failure and liver enzyme elevation with suspicious multiple organ embolic events later.
Acute Kidney Injury* ; Anoxia ; Basement Membrane ; Consciousness ; Hospitalization ; Humans ; Kidney ; Liver ; Middle Aged ; Neurologic Manifestations ; Oxygen ; Paraproteinemias ; Renal Insufficiency