No abstract available.
Acanthosis Nigricans* ; Vitiligo*

We report a case of malignant histiocytosis which began with intermittent fever and scaly skin lesions. A 3-year-old girl presented with erythematous scaly papules on the face and the trunk, and high fever for 3 months. The cutaneous lesions consisted of widespread coin-sized erythematous scaly papules with marginal brownish pigmentation. She was anemic and thrombocytopenic and had impairment of the liver function. Histopathologic study of the skin lesions showed non-specfic findings except for hyperkeratosis. However, bone marrow examination revealed an increased number of histiocytes, mostly immature with active phagocytosis of erythroid cells, myeloid cells, and platelets. She was diagnosed as having malignant histiocytosis and treated with cyclophosphamide and vincristine. She died the next day after the treatment had begun.
Bone Marrow Examination ; Child, Preschool ; Cyclophosphamide ; Erythroid Cells ; Female ; Fever* ; Histiocytes ; Histiocytic Sarcoma* ; Humans ; Liver ; Myeloid Cells ; Phagocytosis ; Pigmentation ; Skin* ; Vincristine

No abstract available.
Erythema* ; Leukemia, Myelomonocytic, Juvenile*

No abstract available.
Epidermis* ; Psoriasis

PURPOSE: Simple renal cysts are common in older patients and they are usually left untreated, yet only a few studies have been done on the natural history of simple renal cysts. We investigated the sequential changes in their size and number in 103 patients. MATERIALS AND METHODS: From January 1993 to August 2003, we followed 103 patients who were suffering with simple renal cysts. Their mean age was 55.8+/-18.72 years old (M:F=58:51). Using Abdominal USG and CT, the annual changes in renal cysts were analyzed through the follow-up period, and the mean follow-up period was 52.3+/-17.58 months. The values of the parameters were compared with using a 2-tailed Student's t-test, multivariate logistic regression analysis and the chi-square test. RESULTS: At the time of diagnosis, the mean number and size of simple renal cyst were 1.5+/-1.31 cysts per each kidney and 25.3+/-12.42mm, respectively. On the consecutive imaging study, the size of the renal cysts was increased 4.4+/-1.54mm per year. The average size increase was significantly greater in the individuals younger than 50 versus the patients 50 years or older (5.7+/-2.14mm/year vs 3.7+/-1.45mm/year, respectively). The multiple cysts showed a significantly larger size increase than did the single cysts (8.1+/-3.27mm/year vs 3.6+/-1.64mm/year, respectively). The size increase of the bilateral renal cysts was significantly larger than that of the unilateral renal cysts (5.6+/-1.48mm/year vs 4.1+/-1.02mm/year, respectively). No significant difference was observed for the average size increase with regard to gender or the initial cyst size. Only the number of cysts was a significant predictor of aggressiveness on the multivariate logistic regression analysis. CONCLUSIONS: The simple renal cysts progress in size and they appear to grow with aging. They seem to grow more rapidly in patients with a younger age, and for multiple and bilateral renal cysts.
Adult* ; Aging ; Diagnosis ; Follow-Up Studies ; Humans ; Kidney ; Logistic Models ; Natural History*

PURPOSE: Tumor volume has been thought to be an important predictive factor for significant prostate cancer. We assessed the impact of the tumor volume(TV) and the tumor percentage(TP) of radical prostatectomy specimens on the pathological variables and the oncological outcome. MARERIALS AND METHODS: The tumor percentage and tumor volume were calculated for 525 cases by a single pathologist who determined the volume based on the surface area of the slides involved by tumor of the prostate. Univariate and multivariate logistic regression analyses were used to characterize the association of TP categories(<5%, 5-10%, 11-20% and >20%) and TV(<1.8cc, 1.8-3.7cc, 3.8-7.5cc, >7.5cc) with the clinicopathological variables. Biochemical recurrence(BCR) was estimated using Kaplan-Meier analysis and Cox's hazard regression model. RESULTS: The mean prostate cancer volume was 6.5+/-8.5cc(median: 3.8, range: 0.04-73.8) and the mean percent tumor composition was 0.17+/-0.19 (median: 0.1, range: 0.01-0.95). A higher tumor volume and a higher tumor percentage were associated with extra-capsular extension(ECE), a positive surgical margin(PSM), a higher pT stage and a higher prostate-specific antigen(PSA) Gleason score(all p<0.05). In addition, TP was the independent predictor of ECE(adjusted odds ratio(OR): 22.66, 95% confidence interval(CI): 1.801-285.079, p=0.016), but the tumor volume was not associated with ECE on the multivariate logistic analyses. On the Kaplan-Meier analysis, but not on the Cox-hazard analyses, the TP did demonstrate a significant association with biochemical recurrence(p=0.035), yet the TV did not reach statistical significance(p=0.190). CONCLUSIONS: Our data indicates that the tumor percentage had a significant effect on the BCR on the Kaplan-Meier analysis. The tumor percentage rather than the tumor volume might be more useful to predict the prognosis of prostate cancer.
Kaplan-Meier Estimate ; Logistic Models ; Prognosis ; Prostate ; Prostatectomy ; Prostatic Neoplasms ; Recurrence ; Tumor Burden

BACKGROUND: Streptococcus viridans group (SVG) is the normal flora of the upper respiratory tract, skin and genitourinary tract, and is the major causative agent isolated in 30-40% of bacterial endocarditis patients. However, SVG has not been properly identified to the species level for lack of diagnostic system which enables the accurate identification of SVG. Poyart et al. have recently described the identification of SVG to the species level by DNA sequencing of superoxide dismutase gene (sodAint). Using this method, we report here the identification of SVG isolated from the patients in Seoul National University Hospital within recent 2 years. METHODS: According to the method by Poyart et al., a set of two oligonucleotides, D1 (5 '-CCI TAY ICI TAY GAY GCI YTI GAR CC-3 ') and D2 (5 '-ARR TAR TAI GCR TGY TCC CAI ACR TC-3 ') were used as PCR primers, and PCR products of 480-bp size were obtained. The PCR products purified by MicroSpin S-400 HR Column were sequenced using ABI-PRISM 3700 Sequence Analyzer. D1 and D2 were used as sequencing primers. The clinical isolates were respectively identified as the species showing the greatest sequence homology which was demonstrated by the BLAST program provided by NCBI(USA). RESULTS: Clinical strains isolated from 26 patients who had shown two or more positive blood cultures were analyzed by DNA sequencing of superoxide dismutase gene, which showed 6 strains of S. salivarius, five S. oralis, four S. sanguis, three S. pasteuri, three S. equisimilis, two S. gordonii, one S. constellatus, one S. luteciae, and one S. mitis. S. salivarius and S. sanguis were clearly discriminated, while S. equisimilis and S. pyogenes were not. Species identification results by conventional method seldom corresponded to those by DNA sequencing. Among 7 patients suspected to have bacterial endocarditis, S. sanguis were isolated in 4 patients, and S. gordonii, S. oralis, S. pasteuri in one, respectively. Among 17 patients with liver cirrhosis or cancer, S. salivarius were isolated in 6 patients, and S. oralis in four. CONCLUSIONS: In this study, we could identify the species of SVG isolated from the patients with bacteremia; S. sanguis were frequently isolated from patients with bacterial endocarditis, while S. salivarius from ones with malignancy. These results imply that a different group of underlying diseases could show correspondingly different group of SVG species which cause bacteremia, and we suggest that further pathophysiological study on the correlations between underlying disease and the species of SVG be performed.
Bacteremia ; Endocarditis, Bacterial ; Homosexuality, Male ; Humans ; Liver Cirrhosis ; Male ; Oligonucleotides ; Polymerase Chain Reaction ; Respiratory System ; Seoul ; Sequence Analysis ; Sequence Analysis, DNA ; Sequence Homology ; Skin ; Streptococcus* ; Superoxide Dismutase ; Viridans Streptococci*

PURPOSE: Diabetic foot ulcer is a representative disease of chronic would with multiple defects of wound healing factors. Many nutrition factors have been known to be essential for wound healing, but objective data are lacking. The purpose of this study is to determine those factors essential for wound healing, and to find out which of those factors are lacking in diabetic foot ulcer patients through this pilot study. METHODS: We studied 100 patients who visited our clinic from March 2005 to February 2006 for treatment of diabetic foot ulcers with a duration of more than 6 weeks. We checked serum levels of protein, albumin, vitamin A, C, E, iron, magnesium, zinc, copper and hemoglobin by drawing 23cc blood after 8 hours of fasting. Protein, albumin, iron, magnesium levels were measured by colorimetry; hemoglobin levels were measured by auto analysis. Vitamin levels were measured by high performance liquid chromatography (HPLC), copper and zinc levels were measured by Inductively coupled plasma (ICP). They were compared with normal values. The patients were divided by transcutaneous oxygen pressure levels, age and sex to study the effects of these parameters. RESULTS: 76% and 61% of patients had within-normal range serum protein and albumin levels, respectively. Among vitamins, only the level of vitamin C was low in 55% of the patients. Levels of vitamin A, E were normal or high in 93% and 100% of patients. As for trace elements, levels of iron and zinc were low in 63% and 60% of patients, but levels of magnesium and copper were usually normal or high. Levels of vitamin C, iron and zinc were lower in the low-transcutaneous oxygen pressure group. There were no definite differences according to age and sex. CONCLUSION: Serum levels of Hb, vitamin C, iron, zinc were low in most diabetic foot ulcer patients. The deficit was very severe in the low-transcutaneous oxygen pressure group.
Ascorbic Acid ; Chromatography, Liquid ; Colorimetry ; Copper ; Diabetic Foot* ; Fasting ; Humans ; Iron ; Magnesium ; Oxygen ; Pilot Projects ; Plasma ; Reference Values ; Trace Elements ; Ulcer* ; Vitamin A ; Vitamins ; Wound Healing* ; Wounds and Injuries* ; Zinc

PURPOSE: Since its introduction into clinical practice, a laparoscopic radical prostatectomy (LRP) has been performed at a growing number of centers. LRP can be performed by either a transperitoneal or extraperitoneal approach. The perioperative morbidities were evaluated in two groups of patients; retropubic radical prostatectomy (RRP) or extraperitoneal laparoscopic radical prostatectomy (ELRP). MATERIALS AND METHODS: Between December 2003 and March 2006, 45 patients were treated with a RRP, and between September 2005 and May 2006, 30 patients underwent an ELRP. The same surgeon performed both types of operation. The perioperative data, including operative time, transfusion rates, hospitalization length and duration of catheterization were analyzed. The pathological parameters, including Gleason score, pathological stage and positive surgical margin rates were also analyzed. RESULTS: There were no significant differences in the preoperative characteristics between the two groups, with the exception of the mean age. The average operative time was significantly shorter in the RRP group (p<0.001). The other perioperative data showed no significant differences between the two groups (p>0.05). After gaining experience of 15 cases, the ELRP group showed significantly shorter catheterization time (p<0.005) and hospital stay (p=0.098). The pathological parameters of the two groups were comparable. RRP group were more likely to larger amount of postoperative analgesia (p=0.072). CONCLISIONS: The ELRP procedure showed comparable perioperative results to those of a RRP, with the exception of operative time. After our initial experience, the ELRP showed favorable outcomes with regard to catheterization time and hospital stay. Considering our results, ELRP can be recommended as one of the primary options for managing localized prostate cancer.
Analgesia ; Catheterization ; Catheters ; Hospitalization ; Humans ; Laparoscopy ; Length of Stay ; Neoplasm Grading ; Operative Time ; Prostatectomy* ; Prostatic Neoplasms

Alternaria species are common plant pathogens and saprophytic fungi. Cutaneous alternariosis is rare and an opportunistic infection in both healthy and immunosuppressed hosts. We report a case of cutaneous alternariosis developed in a 60-year-old female with iatrogenic Cushing syndrome. She had several various sized confluent suppurative ulcers on erythematous plaques on the both forearm clinically. Histology showed mixed-cell granulomatous infiltration with epithelioid cells, lymphocytes, neutrophils and a few plasma cells in the dermis. Many branching septate hyphae and spores were noted within the granulomatous tissue stained with PAS. A fungal culture from biopsy specimen revealed Alternaria species; pigmented hyphae and cornidia which had both transverse and longitudinal septae. The cutaneous lesions treated with terbinafine, 250 mg daily, for 3 months and 1 year later there is no evidence of recurrence.
Alternaria ; Alternariosis* ; Biopsy ; Cushing Syndrome ; Dermis ; Epithelioid Cells ; Female ; Forearm ; Fungi ; Humans ; Hyphae ; Immunocompromised Host ; Lymphocytes ; Middle Aged ; Neutrophils ; Opportunistic Infections ; Plants ; Plasma Cells ; Recurrence ; Spores ; Ulcer