We present 2 cases of invasive extramammary Paget disease occuring in the vulva area of a 60 year old female, and in the scrotal and penile area of a 63 year old male patient. The histologically typical Paget cells were not only seen in the surface epithelium but were also involved in the outer root sheath of the hair follicles. Stromal infiltration of tumor cells into the upper dermis were present in both cases, however, no underlying primary sweat gland carcinoma was present. Metastatic foci of inguinal lymph nodes showed apocrine-type epithelium with abundant eosinophilic granular cytoplasm, which were positive for anti-CEA and GCDFP-15, as well as eccrine-type epithelium containing mucinous secretory materials in the lumen and the cytoplasm. Ultrastructural findings showed interdigitating plasma membranes with prominent desmosomes between the Paget cells, intracytoplasmic tonofibrils, intracellular tubules, lipid vacuoles, and enlarged mitochondria. Histological, immunohistochemical, and ultrastructural findings suggested that Paget cells showed both eccrine and apocrine differentiation.
Female ; Male ; Humans ; Neoplasm Metastasis

BACKGROUND: Androgenetic alopecia is considered to be a genetically determined disorder influenced by age and androgen. The proportion of patients with androgenetic alopecia among the total number of patients with alopecia seems to be gradually increasing. OBJECTIVE: The purpose of this study was to find the family history, clinical and endocrine status of the patients with androgenetic alopecia. METHOD: 736 patients with androgenetic alopecia who had visited the Department of Dermatology, Yongsan and Pil-dong Hospital, College of Medicine, Chung-Ang University during the last 2 years(1999.1-2000.12) were examined. RESULTS: 1) Incidence of androgenetic alopecia among the total number of alopecia patients was 75.8%. 2) There were 571 male and 165 female patients being most prevalent in the 3rd decade in male patients and in the 4th decade in female patients. 3) In male androgenetic alopecia, Norwood-Hamilton's type II was the most common and following IIIv, II, IV, IIIa, and in female patients, Ludwig's type I was most common. 4) There was a family history of baldness in 59.5% of first degree relatives in male patients and 30.9% in female patients. 5) The most common associated disorder is seborrheic dermatitis. 6) Serum testosterone levels were increased in 78 males(13.7%) and 23 females(13.9%). CONCLUSION: Based on these results, the number of young patients who visit dermatologists tends to be increasing and genetic factor, ages and abnormal androgen metabolism in scalp are affecting the development of androgenetic alopecia.
Alopecia ; Dermatitis, Seborrheic ; Dermatology ; Female ; Humans ; Incidence ; Male ; Metabolism ; Scalp ; Testosterone

PURPOSE: There has been considerable disagreement regarding the most appropriate dosage of gonadotropin-releasing hormone agonist in cases of central precocious puberty. The aim of this study was to determine the appropriate dosage for suppression of the puberty in girls with central precocious or early puberty. METHODS: Twenty-two girls with early puberty were randomly subjected to 3 types of dosages of leuprolide acetate for at least 6 months. The number of cases in groups 1, 2, and 3 were 7, 7, and 8, and dosages were 70, 90, and 110 microgram/ kg/-month, respectively. Height, weight, bone age, Tanner stage of breast development, and serum levels of LH, FSH, estradiol, and progesterone were measured before treatment and after 6 months of treatment. The number of cases of puberty suppression was compared using a modified puberty suppression score with a nonparametric chi-square test. RESULTS: There were no significant differences of chronologic and bone ages among the groups. There was a significant decrease in height SDS gain after 6 months in group 3 (P<0.05) compared with groups 1 and 2. Serum levels of LH, FSH, estradiol and progesterone were all significantly decreased after treatment in all 3 groups (P<0.05). The number of cases of puberty suppression in each group were 4 (57%), 5 (71%), and 8 (100%). There was a significantly increased proportion of suppression of puberty in group 3 (P<0.05). CONCLUSION: It was necessary to use a higher dose of gonadotropin-releasing hormone agonist to suppress early puberty in girls; however further longitudinal study will be needed for their prognosis of final adult height.
Adult ; Breast ; Estradiol ; Gonadotropin-Releasing Hormone ; Humans ; Leuprolide ; Longitudinal Studies ; Progesterone ; Prognosis ; Puberty ; Puberty, Precocious

Motor loss caused by herpes zoster is less well known but occurs in a significant number of cases, probably far more frequent than is recognized because the weakness is readily obscured by pain. The incidence of herpetic motor involvement was reported to be between 0.5% and 31%. A 65-year-old male patient with herpes zoster on the right lower limb had complained with progressive weakness of the limb, during treatment. We examined the limb using electromyographic(EMG) and motor nerve conduction velocity(MNCV) studies. Thereafter we concluded he had motor paralysis caused by herpes zoster. The weakness progressed to the complete motor loss of the right limb. Presenty, he still suffers from the paralysis of the right limb.
Aged ; Extremities ; Herpes Zoster* ; Humans ; Incidence ; Lower Extremity ; Male ; Neural Conduction ; Paralysis*

BACKGROUND: Ropivacaine is an amino amide local anesthetic that has an advantage of a low-toxicity profile. Clonidine, an alpha2 adrenergic agonist, is known to prolong and intensify anesthesia from epidural local anesthetics. The aim of this study was to evaluate the dose-response effects of added clonidine to ropivacaine-fentanyl epidural anesthesia for lower extremity surgery. METHODS: Forty-five patients undergoing lower extremity surgery were randomly allocated to three groups to be given the following agents by an epidural route: 0.75% ropivacaine 15 ml+fentanyl 50microgram with clonidine 50microgram (group I), 100microgram (group II), or 150microgram (group III). Onset and maximal height of sensory block, and duration of sensory and motor block were assessed. Also, blood pressure, heart rate and sedation score were measured. RESULTS: Duration of sensory and motor block of groups II and III was significantly longer than that of group I, but there was no difference between group II and group III. Two segment regression times were significantly different among the three groups. Onset of sensory block, blood pressure, heart rate, and sedation scores were not significantly different among the three groups. CONCLUSIONS: The addition of Clonidine 100 and 150microgram prolonged duration of anesthesia more than 50microgram with ropivacaine-fentanyl epidural anesthesia for lower extremity surgery.
Adrenergic Agonists ; Anesthesia ; Anesthesia, Epidural* ; Anesthetics, Local ; Blood Pressure ; Clonidine* ; Heart Rate ; Humans ; Lower Extremity*

Two cases of total anomalous pulmonary venous connection(TAPVC) were diagnosed in 18 years old female and 20 years old male. Both of them complained frequent URI and exertional dyspnea from childhood. The chest films of the two cases showed cardiomegaly and increased pulmonary vascularity. Particulary, the film of female case showed a typical snowman appearance. In both cases, the diagnosis of TAPVC was made preoperately by 2-D echocardiography, cardiac catheterization, and cardiac angiography. The postoperative diagnosis was also TAPVC. The correvtive surgery was performed without complications and postoperative course was uneventful. We report two cases of TAPVC which is very rare in adult.
Adolescent ; Adult* ; Angiography ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomegaly ; Diagnosis ; Dyspnea ; Echocardiography ; Female ; Humans ; Male ; Thorax ; Young Adult

PURPOSE: This study was designed to compare the bond regeneratiom effects of treatment using silk fibroin membrane ( Nanogide-S (R)) resorbable barrier with control group treated by polyactic acid / polylacticglycolic acid membrane(Biomesh (R) ) METHODS:44 severe bone loss on extraction socket from 44 patients were used in this study. In experimental group 22 sites of them were treated by silk fibrin membrane as and the other 22 sites were treated by polyactic acid/ polylacticglycolic acid membrane as a control group. Clinical parameters including recovered bone width, length and radiographic parameter of vertical length were evlauated at base line and 3 months after surgery. RESULTS: 1) Severe bone width, length was significantlly decreased in two group. 2) Bone width, length was significantlly decreased in two group. 3) Decreased bone width, length and radiographic examination differences between group. CONCLUSIONS: On the basis of these results, silk fibrin resorbable membrane has similar bone regeneration ability to polyactic acid / polylacticglycolic acid membrane in guided bone regeneration for severe bone loss defect on extraction socket.
Bone Regeneration ; Fibrin ; Fibroins ; Humans ; Lactic Acid ; Membranes ; Polyglycolic Acid ; Regeneration ; Silk

PURPOSE: Among cell adhesion molecules, serum levels of intercellular adhesion molecule-1 and E-selectin are known to be correlated with the metastatic potential of gastric cancer. In the present study, the authors investigated the expression of intercellular adhesion molecule-1 and E-selectin in gastric cancer tissues and cultured gastric cancer cells, and examined their clinical value in gastric cancer. MATERIALS AND METHODS: The protein was extracted from gastric cancer tissues and cultured gastric cancer cells (MKN-28 and Kato-III) and the expression of intercellular adhesion molecule-1 and E-selectin was examined by western blotting. The clinical significance of intercellular adhesion molecule-1 and E-selectin was explored, using immunohistochemical staining of specimens from 157 gastric cancer patients. RESULTS: In western blot analysis, the expressions of intercellular adhesion molecule-1 in gastric cancer tissues and cultured gastric cancer cells were increased, however, E-selectin in gastric cancer tissues and cells were not increased. Among 157 gastric cancer patients, 79 patients (50%) were intercellular adhesion molecule-1 positive and had larger tumor size, an increased depth of tumor invasion, lymph node metastasis and perineural invasion. The intercellular adhesion molecule-1 positive group showed a higher incidence of tumor recurrence (40.5%), and a poorer 3-year survival than the negative group (54.9 vs. 85.9%, respectively). CONCLUSIONS: Intercellular adhesion molecule-1 is overexpressed in gastric cancer tissues and cultured gastric cancer cells, whereas E-selectin is not overexpressed. Increased expression of intercellular adhesion molecule-1 in gastric cancer could be related to the aggressive nature of the tumor, and has a poor prognostic effect on gastric cancer.
Blotting, Western ; Cell Adhesion Molecules ; E-Selectin ; Humans ; Incidence ; Intercellular Adhesion Molecule-1 ; Lymph Nodes ; Neoplasm Metastasis ; Recurrence ; Stomach Neoplasms

We report a case of Alport syndrome associated with esophageal leiomyomatosis, presenting as recurrent pneumonia. A 5-year old girl who had a history of cataract visited the out patient clinic with a complaint of recurrent wheezing and respiratory difficulty which had started five months previously. Chest magnetic resonance image(MRI) and esophagography, checked on the suspicion of achalasia, revealed esophageal leiomyomatosis and renal biopsy revealed Alport syndrome. In the pediatric population, this tumor is a rare cause of dysphagia and is often misdiagnosed as an esophageal motility disorder. Although a number of Alport syndrome associated with leiomyomatosis were reported in the literature, this is a second case report presented with recurrent pneumonia in Korea.
Biopsy ; Cataract ; Child, Preschool ; Deglutition Disorders ; Esophageal Achalasia ; Esophageal Motility Disorders ; Female ; Humans ; Korea ; Leiomyomatosis* ; Nephritis, Hereditary* ; Pneumonia ; Respiratory Sounds ; Thorax

BACKGROUND: As lack of myocardial perfusion was demonstrated on myocardial contrast echocardiography(MCE) despite angiographic documentation of reflow, patency of infarct related artery (IRA) after acute myocardial infarction(AMI) does not guarantee myocardial tissue perfusion. Myocardial enhancement on MCE is associated with myocardial perfusion and microvascular integrity. We are to assess myocardial perfusion immediately after thrombolysis and to correlate myocardial enhancement with functional recovery of postischemic dysfunctional myocardium. METHODS: MCE was performed by intracoronary injection of hand-agitated Ioxaglate in 17 consecutive AMI patients immediately after thrombolysis. Myocardial enhancement of 37 infarct segment was quantified as corrected peak videointensity(PI) by videodensitometry and the PI ratio of infarct to normal segments was used to assess myocardial reperfusion. Viable myocardium was defined as the presence of functional recovery on follow-up echocardiography. RESULTS: 1) MCE was performed in 37 segments of 17 AMI patient and functional recovery was noted in 28 segments of 12 patients on follow-up echocardiography. 2) Six infarct segments with no reflow on MCE showed severe fixed perfusion defect in thallium scan and no functional recovery in follow-up echocardiography. 3) The peak cardiac enzyme level was significantly higher in patients without functional recovery(p<0.005), but mean PI ratio(p<0.005) and patency of IRA(p<0.05) were significantly higher in patient with functional recovery. Age, sex, time to thrombolysis and stenosis of IRA were not associated with functional recovery. 4) Apical segment(p<0.01), TIMI grade 2 patency(p<0.01) and LAD territory(p<0.05) were significantly associated with nonviable myocardium, and PI ratio(p<0.001) was significantly correlated to viable myocardium. The PI ratio was the most significant predictor of myocardial functional recovery on multiple logistic regression analysis. CONCLUSION: Myocardial contrast echocardiography immediately after thrombolysis can be used for assessment of myocardial reperfusion, decision of revascularization and prediction of functional recovery.
Arteries ; Constriction, Pathologic ; Echocardiography* ; Follow-Up Studies ; Humans ; Ioxaglic Acid ; Logistic Models ; Myocardial Reperfusion* ; Myocardium* ; Perfusion ; Thallium