Spindle cell lipoma was first described in 1975 by Enzinger and Harvey as a variant of lipomas. Histopathological findings show the lipomatous tissue to be replaced by a mixture of uniform spindle cells and mature fat cells closely associated with a mucoid matrix and a varying number of collagen fibers. Immunohistochemical staining is reported to give assistance in the differential diagnosis af spindle cell lipoma from other fibrous or neural tumors. Also, it can be used to investigate the origin of the spindle cells. We report a case of spindle cell lipoma in a 41-year-old female. She had a solitary, normal skin colored, bean sized, subcutaneous mass on the forearm. Most of the spindle cells were strongly positive for vimentin, CD34 and NSE, but negative for actin, factor VIII, S-100 protein and neuro- filaments. The tumor was excised. No recurrence was recognized in a 10 month follow up period.
Actins ; Adipocytes ; Adult ; Collagen ; Diagnosis, Differential ; Factor VIII ; Female ; Follow-Up Studies ; Forearm ; Humans ; Lipoma* ; Recurrence ; S100 Proteins ; Skin ; Vimentin

No abstract available.
Biomarkers* ; Carcinoma, Hepatocellular* ; Hepatitis B* ; Hepatitis* ; Humans ; Korea* ; Prevalence*

The nasal ala is a challenging area for surgical reconstruction, with thick sebaceous skin, the lack of an ample tissue reservoir, and an adjacent free margin. Numerous flaps have been reported for the repair of alae defects. A 71-year-old woman with simultaneous basal cell carcinomas involving both nasal alae was treated by Mohs micrographic surgery. The surgical defects measured 1.5x1.5 cm on the center of the right nasal ala and 1.0x1.0 cm on the left nasal ala, including the alar crease and rim. The right nasal ala was used as a nasolabial transposition flap and the left nasal ala was reconstructed by an island pedicle flap. The final shape and texture were satisfactory. The flaps survived and nasal symmetry was preserved. Combined nasolabial transposition and island pedicle flaps thus offer a superior esthetic and functional result owing to minimized tension. This may be a valuable reconstructive option in the repair of bilateral nasal alae defects.
Aged ; Carcinoma, Basal Cell ; Female ; Humans ; Mohs Surgery ; Skin ; Succinates

BACKGROUND: These days, narrowband-UVB (NB-UVB) phototherapy is used worldwide for treating psoriasis. Some evidence allegedly suggests that, in contrast to broadband UVB therapy, near- erythemogenic doses are not required as starting doses for NB-UVB phototherapy to decrease the risk of burning. However, a recent study has proved that the near-erythemogenic dose to start NB-UVB phothotherapy was preferable to the far-erythemogenic dose method. OBJECTIVE: We compared the therapeutic effects between 70% MED (MED70%) and 50% MED (MED50%) methods in NB-UVB phototherapy of psoriasis. In addition, to elucidate the action mechanism of NB-UVB in psoriasis treatment, we also investigated the immunosuppresive effects of Langerhans cells, macrophages and chemokine/chemokine receptors. METHOD: We compared the near-erythemogenic NB-UVB protocol (initial 70% MED+delta10% increase at each visit, twice per week) with the far-erythemogenic protocol (initial 50% MED+delta10% increase at each visit, twice per week). We performed skin biopsies after 4 times of 1 MED, once of 4 MED and once of 1 MED, along with corresponding controls from the lesional and non-lesional sites. Immunohistochemistry was also performed with anti-CD1a, anti-CD11b, anti-MCP-1 and anti-CCR2 antibodies. RESULTS: The results of immunohistochemcial experiments were as follows; 1. NB-UVB irradiation decreased the number of CD1a+ Langerhans cells in the epidermis, but increased CD11b+ macrophages in the dermis. CD11b+ macrophages were increased more in the dermis in single high-dose irradiation than repeated small dose irradiations of equivalent total doses. 2. MCP-1 was expressed only in the entire epidermis of the psoriatic lesion, and was especially high in proliferating keratinocytes of basal and suprabasal layers. It was also expressed in the papillary dermis to a lesser extent. CCR2, a receptor for MCP-1, was also found to be expressed in a similar pattern to MCP-1. Single high-dose irradiation reduced MCP-1 and CCR2 to a moderate degree, especially in the basal layer, more than the repeated low-dose irradiation of an equivalent total dose. CONCLUSION: The near erythemogenic NB-UVB protocol (MED70%) showed an earlier resolution of the psoriatic lesions and a lower recurrent rate than the far-erythemogenic NB-UVB protocol. Higher NB-UVB reduced the number of CD1a+ Langerhans cells in the epidermis, and increased CD11b+ monocytes/macrophages in the dermis. A higher dose of NB-UVB downregulated CCR-2 and MCP-1 expression. The expression patterns of epidermal and dermal APCs and chemokines in this study indicate that NB-UVB in psoriasis treatment has immunosuppressive properties. For better NB-UVB protocols in psoriasis treatment, higher starting doses and incremental doses may be desirable.
Antibodies ; Biopsy ; Burns ; Chemokines* ; Dendritic Cells* ; Dermis ; Epidermis ; Immunohistochemistry ; Keratinocytes ; Langerhans Cells ; Macrophages ; Phototherapy* ; Psoriasis* ; Skin

No abstract available.
Animals ; Antibiotics, Antifungal/*therapeutic use ; Humans ; Immunosuppression/*methods ; Protein Structure, Tertiary ; T-Lymphocytes/*immunology ; *Transduction, Genetic

BACKGROUND: Healthcare-associated infections (HAIs) are among the most important threats to patient safety. When hospitalized children face these threats, there is morbidity, mortality, prolonged hospitalization, and increased healthcare costs. Research on local healthcare epidemiology is necessary to enhance collective knowledge and evidence formanaging this problem. METHODS: We performed a retrospective analysis of databases of patients who were diagnosed with HAIs at Chung-Ang University Hospital (CAUH) from 2007 through 2011. Cases were selected from the microbiology registry databases. The data on prevalence of HAIs in various wards and its annual trends were compared to previously reported nationwide data. Moreover, we analyzed the patterns of antibiotic susceptibility results for HAI pathogens. RESULTS: A total of 181 HAIs were identified in 122 patients. The HAI rate among pediatric patients at CAUH was 2.4/1,000 person-hospital days. Urinary tract infections (UTIs) (53 episodes, 29.3%) were the most common, followed by pneumonia (33 episodes, 18.2%). Staphylococcus aureus was found to be the most common gram-positive organism, whereas Escherichia coli was the most common gram-negative organism. Methicillin-resistant S. aureus (MRSA) comprised 84% of the S. aureus infections. Imipenem resistance was detected in 58.8% and 55.0% of Acinetobacter baumannii and Pseudomonas aeruginosa isolates, respectively. CONCLUSION: Between 2007 and 2011, UTIs were the most common type of HAIs, and MRSA was the most common pediatric HAI pathogen, both in the general ward and intensive care unit at the CAUH. Further research on the epidemiology and pathogenesis of HAIs is necessary and prevention measures should be implemented to prevent HAIs in children.
Acinetobacter baumannii ; Child ; Child, Hospitalized ; Delivery of Health Care ; Escherichia coli ; Health Care Costs ; Hospitalization ; Humans ; Imipenem ; Intensive Care Units ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Microbial Sensitivity Tests ; Patient Safety ; Patients' Rooms ; Pneumonia ; Prevalence ; Pseudomonas aeruginosa ; Retrospective Studies ; Staphylococcus aureus ; Urinary Tract Infections

We have experienced a case of deflation failure of Inoue balloon in the left atrium during mitral balloon valvuloplasty in a 44 year old male patient with tight mitral stenosis, who died just after emergency open heart surgery for removal of undeflated Inoue balloon and mitral valve replacement because of associated acute hemorrhagic myocardial infarction.
Adult ; Balloon Valvuloplasty ; Emergencies ; Heart Atria ; Humans ; Male ; Mitral Valve ; Mitral Valve Stenosis ; Myocardial Infarction ; Thoracic Surgery

To assess the likelihood of procedural success in patients with multivessel coronary artery disease, 46 consecutive patients (male 34, female 12, mean age 60+/-9 years) umderwent single or multiple site angioplasty. The clinical diagnosis of unstable angina was in 20(44%), stable angina in 10 and acute or old myocardial infarction in 16. Coronary angiographic findings of 2 vessel disease was in 38(83%), triple vessel disease in 8. Left ventricular function was generally well preserved (mean ejection fraction 65+/-12%, range 30-82%) and mean 2.0 stenosis per patient angic, lasty had attempted. Single vessel angioplasty (SVA) was performed in 13 and multivessel angioplasty (MVA) in 33. Procedural success was achieved in 79(86%) out of total 92 stenoses. Sixty-six(88%) out of 75 stenoses in MVA and 13(76%) out of 17 stenoses in SVA had procedural success respectively. According to angiographic morphology of lesions, procedural success of type A stenoses was 17/17(100%), type B stenoses 57/66(86%) and type C stenoses was 5/9(33%). In 13 failures included inability to pass the guide wire cross the lesion in 7, inability to guide the griding catheter in 2 and inability to dilate lesions in 4. Before and after angioplasty, treadmill test (modified Bruce protocol)could be performed in 29 patients. Total duration of exercise and maximal double product improved significantly from 8.5+/-2.3 minute 5188+/-2403 to 12.2+1.3 min., 23,062+/-4111 respectively (p<0.001). 17 out of 24 patients who had positive treadmill test before angioplasty showed negative conversion after procedure. Complications included dissection in 29, prolongd chest pain in 5, acute closure in 3, cardiac tamponade in 1 and ventricular fibrillation due to side branch oclusion in 1. Thus, coronary angioplasty in selected paients with multivessel coronary artery disease might be useful and have relatively good immediate results, but the long-term efficacies with other forms of treatment must be evaluated prospectively.
Angina, Stable ; Angina, Unstable ; Angioplasty* ; Cardiac Tamponade ; Catheters ; Chest Pain ; Constriction, Pathologic ; Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis ; Exercise Test ; Female ; Humans ; Myocardial Infarction ; Ventricular Fibrillation ; Ventricular Function, Left

A 47-year-old woman with stage IV chronic kidney disease developed a fistula between common carotid artery (CCA) and internal jugular vein (IJV) during central catheterization of the right IJV. The patient was treated with a self-expandable graft stent, which achieved successful closure of the carotid-jugular fistula. As demonstrated in our case, self-expandable graft stents could be a feasible treatment option for CCA-IJV fistulas without additional interventional procedures such as balloon angioplasty.
Angioplasty, Balloon ; Carotid Artery, Common* ; Catheterization, Central Venous ; Female ; Fistula* ; Humans ; Jugular Veins* ; Middle Aged ; Renal Insufficiency, Chronic ; Stents* ; Transplants*

BACKGROUND: Psoriasis is characterized by chronic recurrent erythematous skin plaques that exhibit epidermal hyperplasia, inflammatory cell accumulation and abnormalities of the papillary dermal vasculature. Psoriatic skin lesions show enlargement and increased tortuosity of cutaneous microvessels without formation of new vessel sprouts, that is, inflammatory angiogenesis. Placental growth factor (PlGF) and Tie-2 were reported to be up-regulated during inflammatory angiogenesis. Tazarotene is the first receptor-selective retinoid and its effects include normalizing keratinocyte differentiation, reducing keratinocyte proliferation and reducing inflammation. OBJECTIVE: Our study evaluated the clinical efficacy of topical tazarotene treatment and clarified histological changes and possible action mechanisms of this agent in respect of inflammatory angiogenesis. METHODS: We selected patients with symmetric psoriatic lesions and applied 0.1% tazarotene gel (Tazorac(R)) versus calcitriol 3 microgram/g gel (Silkis(R)) twice a day for 12 weeks with a right-left comparison. We grouped the patients with treatment modalities. Clinical efficacy, which was measured by the overall lesional assessment (OLA) scores, was assessed at each visit in 2 week' intervals until treatment closed. Skin biopsies were performed before the treatment started and again at 4 weeks and 12 weeks after treatment. Immunohistochemistry of PlGF, Tie-2 and factor-VIII was performed to elucidate the anti-angiogenetic effect of tazarotene. RESULTS: At the completion of 12 weeks of treatment, the OLA score of tazarotene-treated lesions was more reduced than that of calcitriol-treated lesions combined with phototherapy, it was more effective. Several histologic features such as epidermal hyperplasia, inflammatory cell infiltration and vessel dilation/tortousity were improved with decreased PlGF and Tie-2 expressions. CONCLUSION: These results indicate that tazarotene is an effective topical agent for psoriasis by blocking inflammatory angiogenesis.
Biopsy ; Calcitriol ; Humans ; Hyperplasia ; Immunohistochemistry ; Inflammation ; Keratinocytes ; Microvessels ; Phototherapy ; Psoriasis* ; Skin