We present a case of pemphigus vulgaris developed during pregnancy. The clinical features of this patient were similar to those of hetpes gestationis. By immunofluorescence studies we found that the patient's serum contained autoantibodies to intercellular substance of epidermis. Direct immunofluorescence microscopy of a perilesional skin also demontrated immunoglobulin deposition in the intercellular areas. Additionally we did in vitro C3 staining for further confirmation of the diagnosis but it was negative in basement membrane zone. This patient was initially treated with corticosteroid and azathioprine. Several months later gold compound was given instead of azathioprine and corticosteroid with good therapeutic response.
Autoantibodies ; Azathioprine ; Basement Membrane ; Diagnosis ; Epidermis ; Fluorescent Antibody Technique ; Fluorescent Antibody Technique, Direct ; Humans ; Immunoglobulins ; Microscopy ; Pemphigus* ; Pregnancy* ; Skin

PURPOSE: This study examined the relation of BMI to lipid metabolism and health promoting behavior in middle-aged women. METHODS: The subjects were 113 women between 40 to 60 years of age. The data was collected from April 2003 to July 2004. BMI was measured using body composition analyzer and lipid metabolism were measured using automatic biochemical analyzer. Health promoting behavior was collected using a structured questionnaire. The SPSSWIN(10.0 version) program was used to analyze the data and get the descriptive statistics and Pearson's correlation coefficients. RESULTS: BMI was negatively correlated with HDL-c and positively correlated with triglyceride, but there was no significance between BMI and total cholesterol. There was no significance of correlation between BMI and total health-promoting behavior. CONCLUSION: This study showed that BMI is meaningful in the identification of the high risk women to prevent HDL-c & triglyceride metabolism disturbance, but additional research is needed to study the correlation between BMI and health promoting behaviors in middle-aged women.
Body Composition ; Cholesterol ; Female ; Humans ; Lipid Metabolism* ; Metabolism ; Triglycerides ; Surveys and Questionnaires

Eosinophilic leukemia is a rare variant of granulocytic leukemia. It has distinct clinical features to involve central nervous system, heart, lung and skin more frequently than other leukemia and laboratory findings to reveal persistent eosinophilia with immature tendency, leukocytosis, anernia, thrombocytopenia and usually negative philadelphia chromosome in cytogenetic study. We describe a 33 year-old male patient who has suffered from generalizid weakness exertional dyspnea and has had well defined, hen eggs ized, oval shaped and non-in-durated ulcerative lesions on the right thigh since about 4 months prior to admission. The laboratory findings were persistent leukocytosis, eosinophilia and immature tendency in peripheral blood, nearly 100% cellularity and eosinophilic tendency (70%) in bone marrow aspiration and biopsy, and negative philadelphia chromosome in cytogenetic study. A biopsy specimen from ulcer margin showed relatively intact epidermis and heavy cellular infiltration composed of eosinophilic cytoplasm, dark and indented nucleus in entire dermis. Normal appearing skin also revealed same cellular infiltration in dermis with perivascular and periadnexal pattern.
Adult ; Biopsy ; Bone Marrow ; Central Nervous System ; Cytogenetics ; Cytoplasm ; Dermis ; Dyspnea ; Eggs ; Eosinophilia ; Eosinophils* ; Epidermis ; Heart ; Humans ; Hypereosinophilic Syndrome* ; Leukemia ; Leukemia, Myeloid ; Leukocytosis ; Lung ; Male ; Ovum ; Philadelphia Chromosome ; Skin ; Thigh ; Thrombocytopenia ; Ulcer

The occurrence of the colonic obstruction secondary to colorectal carcinoma (CRC) has been reported in 7~30% of the CRC patients. It is generally believed that obstructive CRC is associated with a poor prognosis with respect to operative mortality and five-year survival. A series of 1064 cases of the CRC treated surgically at Asan Medical Center from June 1989 to December 1996 has been analyzed to compare clinicopathological findings between obstructive and non-obstructive CRC and to evaluate surgical treatment options in obstructive CRC. Complete obstruction was present in 49 cases (4.6%). There were no differences between obstructive and non-obstructive CRC in tumor location, size, Dukes' stage, and differentiation. In forty-nine obstructive CRC cases, primary resections were performed in 29 cases after peri-operative bowel decompression. In this group, right colon cancer was more prevalent than staged operation group (45% vs. 5%, P<0.05) and hospital stay was significantly short (16 days vs. 38 days, P<0.05). Postoperative complication rate was higher in staged operation group (65% vs. 28%, P=0.01). It may be due to stoma related wound complication. In obstructive left colon cancer, there was a significant difference in complication rate between primary resection and staged operation (P<0.05). Overall 5-year survival rate were 66% and 53% in non-obstructive and obstructive group, respectively. Survival rate according to the Dukes' B and C stages did not show statistical differences, either. Conclusively, primary resection is preferred to the obstructive CRC when supportive care, preoperative bowel decompression, and intraoperative colonic irrigation were performed adequately.
Chungcheongnam-do ; Colon ; Colonic Neoplasms ; Colorectal Neoplasms* ; Decompression ; Humans ; Length of Stay ; Mortality ; Postoperative Complications ; Preoperative Care ; Prognosis ; Survival Rate ; Wounds and Injuries

Most insects including the honeybee cause erythema and edema at the site of a sting in non-allergic individuals. This reaction usually resolves within a few days. However, in certain cases, the persistence of inciting materials in the cutaneous tissue may promote a local inflammatory foreign body reaction. Localized nodular lesions were seen in our two patients and erythemstous patches were present in one patient due to rarely encountered complications induced by retained sting materials. In these cases histopathology showed multiple foci of foreign body granuloma containing yellow refraetile material in the center surrounded by histiocytes and foreign body giant cells. The granulomatous skin lesions in these patients were treated with intralesional injections of triamcinolone acetonide and partial excisions of the nodular masses were performed.
Bites and Stings ; Edema ; Erythema ; Foreign-Body Reaction ; Giant Cells, Foreign-Body ; Granuloma* ; Granuloma, Foreign-Body ; Histiocytes ; Humans ; Injections, Intralesional ; Insects ; Skin ; Triamcinolone Acetonide

We describe the case of a 45-year-old woman who had self-regressing livedo reticularis on the lower extremities. Examination of a biopsy specimen from the mottled area revealed myxomatous emboli in the deep dermal arterioles. Echocardiography showed a myxoma in the left atrium. After the tumor was surgically excised, the patient had no further evidence of the disorders during the 3-year period of follow-up. Livedo reticularis caused by an peripheral arterial embolism, which in turn was caused by the tumor fragments in our patient with left atrial myxoma, is considered to be unusual.
Arterioles ; Biopsy ; Echocardiography ; Embolism ; Female ; Follow-Up Studies ; Heart Atria ; Humans ; Livedo Reticularis* ; Lower Extremity ; Middle Aged ; Myxoma*

No abstract available.
Reye Syndrome*

The incidence of recurrence and anal stricture after surgical hemorrhoidectomy were reported in about 5% and 2.5~13%, respectively Generally, complete and adequate surgery for hemorrhoids was not infrequently neglected because the treatment of hemorrhoids was based on symptoms rather than pathogenesis. This study was performed to analyze the clinical features of recurrent hemorrhoids and to assess the adequate surgical management for the prevention of recurrence. From June 1989 to December 1997, we reviewed 222 (10.6%) recurrent hemorrhoids of surgically treated at Asan Medical Center. Median follow-up period was 38 months (range, 4 months~8 years 9 months). The most common symptom was prolapse (37%). Previous treatment for hemorrhoids was surgical hemouhoidectorny in 99 cases (45%) and sclerotherapy in 111 cases (50%). The most common location and associated complication of recurrent hemorrhoids were sites of major piles (83%) and anal stricture (37%), respectively. Anal stricture was more prevalent in patients with previous sclerotherapy (P<0.05). In respect to the numbers of combined surgical procedures, one procedure was more frequently performed in the non-complicated recurrent hemorrhoids group (P<0.05) whereas over four in the complicated group (P<0.05). Internal sphincterotomy and anoplasty were frequently needed in the complicated recurrent hemorrhoids (P<0.05). Mean hospital stay and healing time were 5 days (range, 2~26 days) and 21 days (range, 6~180 days), respectively. We had excellent or satisfactory results in 175 of 197 patients (89%). Conclusively, multiple combined surgical procedures in accordance with individual status might be useful in treating the recurrent hemorrhoids. An adequate and complete surgical procedure must be applied during the initial operation of hemorrhoids, especially on major piles.
Chungcheongnam-do ; Constriction, Pathologic ; Follow-Up Studies ; Hemorrhoidectomy ; Hemorrhoids* ; Humans ; Incidence ; Length of Stay ; Prolapse ; Recurrence ; Sclerotherapy

BACKGROUND: Resistance of Mycobacterium tuberculosis to anti-tuberculosis (TB) drugs is almost exclusively due to spontaneous chromosomal mutations in target genes. Rapid detection of drug resistance to both first- and second-line anti-TB drugs has become a key component of TB control programs. Technologies that allow rapid, cost-effective, and high-throughput detection of specific nucleic acid sequences are needed. This study was to develop a high-throughput assay based on allele-specific primer extension (ASPE) and MagPlex-TAG microspheres to detect anti-TB drug resistance mutations. METHODS: DNA samples from 357 M. tuberculosis clinical isolates and H37Rv were amplified by multiplex PCR using four primer sets, followed by multiplex ASPE using 23 TAG-ASPE primers. The products were sorted on the TAG-ASPE array and detected by using the Luminex xMAP system. Genotypes were also determined by sequencing. RESULTS: Genetic drug susceptibility typing by the TAG-ASPE method was 100% concordant with those obtained by sequencing. Compared with phenotypic drug susceptibility testing (DST) as a reference method, the sensitivity and specificity of the TAG-ASPE method were 83% (95% confidence interval [CI], 79-88%) and 97% (95% CI, 90-100%) for isoniazid. For rifampin testing, the sensitivity and specificity were 90% (95% CI, 86-93%) and 100% (95% CI, 99-100%). Also, the sensitivity and specificity were 58% (95% CI, 51-65%) and 86% (95% CI, 79-93%) for ethambutol. CONCLUSIONS: This study demonstrated the TAG-ASPE method is suitable for highly reproducible, cost-effective, and high-throughput clinical genotyping applications.
DNA ; Drug Resistance* ; Ethambutol ; Genotype ; Isoniazid ; Microspheres ; Multiplex Polymerase Chain Reaction ; Mycobacterium tuberculosis ; Rifampin ; Tuberculosis ; Viperidae

PURPOSE: Current diagnostic modalities frequently carry false negative evaluations, especially in micro-metastasis. Some metastases are identified incidentally during the operation for primary colorectal cancer. Our study was performed to assess the clinicopathological characteristics of intraoperatively diagnosed liver metastases, to analyze the survival and the prognosis, to compare the results with those for preoperatively diagnosed liver metastases. METHODS: Between July 1989 and December 2001, the cases of 78 patients who underwent treatment for intraoperatively diagnosed liver metastasis at our hospital were analyzed retrospectively. There were 375 patients who were diagnosed with liver metastasis preoperatively during the same period. Metachronous liver metastases were excluded. RESULTS: Intraoperatively diagnosed liver metastases mostly showed clinicopathological characteristics of primary colorectal cancer similar to those for preoperatively diagnosed liver metastases. On the other hand, the preoperative serum CEA level was significantly lower in the intraoperatively diagnosed group than it was in the preoperatively diagnosed group (P<0.001). For the metastatic lesion, the size of the metastasis was smaller in the intraoperatively diagnosed group than it was in the preoperatively diagnosed group (P=0.03). The two-year survival rate of the intraoperatively diagnosed group was significantly better than that of the preoperatively diagnosed group (71.6% vs. 58.4%; P=0.031). Prognostic factors of the intraoperatively diagnosed group were the number of liver metastases, a curative operation for the primary cancer, and an operation for the metastatic lesion. CONCLUSIONS: Intraoperatively diagnosed liver metastases had biologic features similar to those of preoperatively diagnosed liver metastases. The survival rate of the intraoperatively diagnosed group was better than that of the preoperatively diagnosed group, possibly due to the curative resection for the hepatic metastases. Therefore, aggressive treatment for primary and metastatic lesions is the therapeutic choice to improve patient's survival for intraoperatively diagnosed synchronous liver metastases.
Colorectal Neoplasms* ; Hand ; Humans ; Liver* ; Neoplasm Metastasis* ; Prognosis ; Retrospective Studies ; Survival Rate