We report a case of Trichilemmal carcinoma in a 75-year-old man who was presented with an exophytic nodule on the lower lip. The tumor was composed of glycogen-rich cytoplasmic cells with PAS-positive, diastase-labile and had a characteristic trichilemmal keratinization. The trichilemmal carcinoma is well known to have originated from the outer root sheath of the hair follicle in the hair bearing area. It is interesting that our case had developed on the lip, an exceptional site for a follicular tumor : the hair follicle could not be seen. It might have been developed from an ectopic follicle or at the follicle of vermillion border and grew up into the lip.
Aged ; Cytoplasm ; Hair ; Hair Follicle ; Humans ; Lip*

BACKGROUND: Alternative medicines may be defined as forms of therapy or examination that have no scientific basis and where no effect or diagnostic reliability have been demonstrated by scientific methods. Many patients with atopic dermatitis try various forms of alternative medicine, and several studies about the use of alternative medicine in the patients of atopic dermatitis were performed in western countries but not in Korea. OBJECT: This study was performed to evaluate the use of alternative medicine in atopic dermatitis patients. METHODS: 188 patients of atopic dermatitis attending our outpatient clinic responded to questionnaires on the use of alternative medicine and the past history of atopic dermatitis. RESULTS: 136 of 188 patients(72%) reported previous or current use of one or more forms of alternative medicine. Herbal remedies(32.4%) were used most frequently, and health food preparations, spa therapy, and diet changes were also commonly used. The most common motif of using alternative medicine was "just want to try every possible treatment"(48.6%) and main information sources were people without same skin disease(relatives and friends)(50.0%). The majority(75.2%) reported they do not use the alternative medicine now because of the poor result. The use of the alternative medicine was related to the disease duration, and the cost of the atopic dermatitis treatment. CONCLUSIONS: The use of alternative medicine in atopic dermatitis is commonplace and should be of concern to dermatologists.
Ambulatory Care Facilities ; Complementary Therapies ; Dermatitis, Atopic* ; Diet ; Food, Organic ; Humans ; Korea ; Skin ; Surveys and Questionnaires

PURPOSE: The purpose of this study is to determine predictive MR features for grading of astrocytic gliomas and to evaluate the accuracy of MR grading in these tumors. MATERIALS AND METHODS: We retrospectively reviewed 135 cases of supratentorial astrocytic gliomas in adult (age > 15 years), all of which were proved by open biopsy. Two observers analysed MR images independently with criteria of margin, edema, mass effect, signal heterogeneity, necrcosis, cyst formation, hemorrhage, tumor vascularity, enhancement degree, and enhancement size. The patterns of enhancement were categorized into no, homogeneous, heterogeneous, thin smooth rim, thin irregular rim, and thick irregular rim enhancement patterns. Observers finally diagnosed each case as one of low-grade astrocytoma, anaplastic astrocytoma or glioblastoma multiforme. RESULTS: Statistically significant MR features for grading of these tumors were revealed as necrosis (p < 0. 001), edema (0.008), and signal heterogeneity (p < 0.025). When compared with histopathologic grading, MR graded correctly 76%-77% of cases in two tiered system(low-grade astrocytoma versus high-grade astrocytoma), but only 67%-69% of cases in three tiered system(low-grade astrocytoma, anaplastic astrocytoma, glioblastoma multiforme). No contrast enhancement was seen in 45% and 23% of low-grade astrocytoma and anaplastic astrocytoma respectively. Glioblastoma multiforme frequently showed thick irregular rim enhancement (57%), but no enhancement at all in 8%. CONCLUSION: We have concluded that necrosis and edema are significant predictive MR features for gradomg of supratentorial astrocytic gliomas in adult, and MR was correct in 76%--77% of cases for predicting pathologic grading of astrocytomas in two tiered system.
Adult* ; Astrocytoma* ; Biopsy ; Edema ; Glioblastoma ; Hemorrhage ; Humans ; Magnetic Resonance Imaging* ; Necrosis ; Neoplasm Grading* ; Population Characteristics ; Retrospective Studies

PURPOSE: The prognosis of patients with advanced non-small-cell lung cancer (NSCLC) is extremely poor. Many prospective randomized trials on patients with advanced NSCLC suggested systemic chemotherapy improves both the survival and quality of life. A phase II trial was conducted to evaluate the efficacy and safety profile of the combination chemotherapy of gemcitabine and cisplatin in advanced NSCLC. MATERIALS AND METHODS: Forty-four patients with locally advanced or metastatic NSCLC were enrolled. The patients received a cisplatin, 75 mg/m(2), infusion over 30 minutes on days 1, followed by a gemcitabine, 1, 250 mg/m(2), infusion over 30 minutes on days 1 and 8 every 3 weeks. RESULTS: The median age of the patients was 64 years (range: 27~75). Forty-one patients were assessable for response and toxicity analyses. The overall response rate was 53.6%, but with no complete remissions. The median time to progression was 5.6 months (range: 1~15.4). The median survival was 14.2 months (95% confidence interval (CI), 13.8~22.5). A total of 179 cycles were administered, with a median of 4 cycles of chemotherapy, ranging from 2 to 9 cycles. The most common hematological toxicities were NCI grades 3/4 neutropenia (24%) and thrombocytopenia (7.8%). The most common non-hematological toxicity was fatigue (42.4%). There were no life-threatening toxicity or treatment related mortalities. The median duration of follow up was 9.4 months, ranging from 1.6 to 30.3 months. CONCLUSION: In this trial, the combination of gemcitabine and cisplatin showed significant activity, with acceptable and manageable toxicities as a first-line regimen for patients with advanced NSCLC.
Cisplatin* ; Drug Therapy ; Drug Therapy, Combination ; Fatigue ; Follow-Up Studies ; Humans ; Lung Neoplasms* ; Lung* ; Mortality ; Neutropenia ; Prognosis ; Prospective Studies ; Quality of Life ; Thrombocytopenia

OBJECTIVES: Gliomatosis cerebri is an uncommon primary brain tumor characterized by diffuse neoplastic proliferation of glial cells, with the preservation of the underlying cytoarchitecture. The aim of this study is to evaluate clinical features, outcome of surgical treatment and adjuvant therapy of gliomatosis cerebri. METHODS: Between Jan. 1990 and Dec. 2000, 12 patients were diagnosed with gliomatosis cerebri based on characteristic radiological and histological findings. The patients' age ranged from 18 to 77(mean 44) years and the male to female ratio was 7: 5. Nine patients underwent decompressive surgery and three, biopsy only. Postoperative radiation therapy was given in all cases except three. In addition to radiation therapy, four patients received chemotherapy. The mean duration of follow-up period was 18.8 months. RESULTS: The most common presenting symptom were seizure and motor weakness. The mean duration of symptom was 5.9 months. There was 5 bilateral lesions and tumor involved corpus callosum in 5, basal ganglia-thalamus in 4, and brain stem in 2. There was no operative mortality but four patients died during the follow-up. The mean survival period for 11 patients was 20.5 months from the time of diagnosis. In univariate analysis, the lesion involving corpus callosum, basal ganglia-thalamus and brain stem correlated significantly with the short length of survival(p<0.05). Also, postoperative radiation as a adjuvant therapy prolonged the patient's survival(p<0.05). CONCLUSIONS: In the management of gliomatosis cerebri patients, early detection by MR imaging, active management of increased intracranial pressure, decompressive surgical removal and postoperative adjuvant therapy such as radiation is thought to be a good treatment modality.
Biopsy ; Brain Neoplasms ; Brain Stem ; Corpus Callosum ; Diagnosis ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Intracranial Pressure ; Magnetic Resonance Imaging ; Male ; Mortality ; Neoplasms, Neuroepithelial* ; Neuroglia ; Prognosis* ; Seizures

PURPOSE: There are still some debates concerning kidney preserving surgery for ipsilateral renal cell carcinoma and normal contralateral kidney. It has been proposed that about 10 to 20 per cent of the renal cell carcinoma have satellite nodules along with the main tumor mass. But the exact prognostic implication of the satellite nodules has not been clarified yet. In this study, we tried to evaluate whether the presence of the satellite nodules would be an adverse prognostic factor or not after radical nephrectomy. MATERIALS AND METHODS: From January 1987 until June 1991, 81 patierlts underwent radical nephrectomy, and all of the nephrectomized kidneys were serially cut into slices of 5 mm to probe for any satellite nodules. All the satellite nodults found were examined histologically. All the patients were followed regularly for the mean duration of 67 months. RESULTS: The patholologic stage of the primary tumor was T1 in 19 patients, T2 in 38, T3 in 22 and T4 in 2 patients. Overall 5 year survival rate was 89.5%. Fifteen patients(18.5%) had satellite nodules with histologically identical patterns to the primary tumor, The presence of the satellite nodules increased according to the increasing tumor stage and the size of the primary tumor mass. The survival rate was significantly decreased with the increasing tumor stage, with the 5 year survival rate of 100% in T1, 96.6% in T2, 71.3% in T3 and none in T4 patients(p=0.0001). But the 5 year survival rate of patients with primary tumor with a diameter of less than 7cm was 96.4% compared to 81.7% who have primary tumor with a diameter 7cm and more(p=0.16). Additionally the presence of the satellite nodules did not have an impact on the survival. The 5 year survival rate was 89.7% in patients without satellite nodules and it was 90% in patients with satellite nodules(p=0.87). CONCLUSIONS: There was significant correlation between pathological stage of the prima tumor and survival rate. However, the presence of the satellite nodule and the primary tumor size did not appear to have an impact on survival. We suggest that the molecular biological study for satellite nodule is needed to characterize the satellite nodule in addition to histopathological study.
Carcinoma, Renal Cell* ; Humans ; Kidney* ; Nephrectomy ; Survival Rate

We report a case of spontaneous carotid cavernous fistula(CCF) showing low flow shunt, which was successfully occluded in the fistular site of CCF by direct surgical approach via anteromedial, paramedial and Parkinson's triangle intradurally through pterional subte mporal petrosal route extradurally after intermitten temporary clipping of internal corotid artery(ICA) in petrosal portion and proximal to the ophthalmic artery without hypotension, hypothermia, extracorporial circulation, or cardiac arrest.
Cavernous Sinus ; Fistula* ; Heart Arrest ; Hypotension ; Hypothermia ; Ophthalmic Artery

BACKGROUND: This study was to investigate the effect of biomechanical stimulation on osteoblast differentiation of human periosteal-derived stem cell using the newly developed bioreactor. METHODS: Human periosteal-derived stem cells were harvested from the mandible during the extraction of an impacted third molar. Using the new bioreactor, 4% cyclic equibiaxial tension force (0.5 Hz) was applied for 2 and 8 h on the stem cells and cultured for 3, 7, and 14 days on the osteogenic medium. Biochemical changes of the osteoblasts after the biomechanical stimulation were investigated. No treatment group was referred to as control group. RESULTS: Alkaline phosphatase (ALP) activity and ALP messenger RNA (mRNA) expression level were higher in the strain group than those in the control group. The osteocalcin and osteonectin mRNA expressions were higher in the strain group compared to those in the control group on days 7 and 14. The vascular endothelial growth factor (VEGF) mRNA expression was higher in the strain group in comparison to that in the control group. Concentration of alizarin red S corresponding to calcium content was higher in the strain group than in the control group. CONCLUSIONS: The study suggests that cyclic tension force could influence the osteoblast differentiation of periosteal-derived stem cells under optimal stimulation condition and the force could be applicable for tissue engineering.
Alkaline Phosphatase ; Bioreactors ; Calcium ; Humans* ; Jaw* ; Mandible ; Molar, Third ; Osteoblasts* ; Osteocalcin ; Osteonectin ; RNA, Messenger ; Stem Cells* ; Tissue Engineering ; Vascular Endothelial Growth Factor A

Cervical vertebral artery fistula is rare arteriovenous malformations between the vertebral artery and veins of the neighborhood. We report a case of traumatic vertebral artery fistula of the cervical spinal canal in a 35-year-old-man who developed posterior neck pain, radiating pain and motor weakness on the left upper arm 25 days after penetrating injury by glass pieces on the anterolateral side of both neck. MRI revealed the signal void on T1-weighted sequence and vertebral angiogram demonstrated the fistula between the left vertebral artery and epidural venous channel at the C4-5 level. Complete occlusion of the fistula was achieved by endovascular embolization with microcoil(Spiral Coil). The patient had improvement of radicular pain and motor weakness and no complications related to the embolization procedure occurred. A brief review of the literature is given.
Arm ; Arteriovenous Malformations ; Fistula* ; Glass ; Humans ; Magnetic Resonance Imaging ; Neck ; Neck Pain ; Residence Characteristics ; Spinal Canal* ; Veins ; Vertebral Artery*

PURPOSE: To describe the characteristic MR imaging findings of dysembryoplastic neuroepithelial tumor(DNT). MATERIALS & METHODS: We retrospectively reviewed MR images and pathologic findings of seven patients(five maleand two female, mean age 22) with surgically proven DNTs. We analyzed the location, size, configuration, signal intensity and contrast enhancement of nodules and accompanying calcifications, surrounding edema and calvarialchanges. RESULTS: All tumors were located in the cortical and subcortical portions of the temporal lobes. Most tumors showed small well-demarcated gyriform cystic nodules with almost the same signal intensity as that of the cerebrospinal fluid. Nodule margins were more sharply delineated on T2 than on T1-weighted images because on the former the peripheral portion of nodules shows high signal intensity. None of the patients showed surrounding edema or mass effect. On contrast-enhanced study, one of five patients showed subtle peripheral enhancement. Two patients showed included dense calcified nodules adjacent to cystic nodules, and two showed overlying calvarial thinning. CONCLUSION: Multiple small gyriform intracortical cystic nodules and occasional dense nodular calcifications are the characteristic findings of DNTs, and these may be differentiated from other focal lesion sin patients with temporal lobe epilepsy with the help of MR imaging.
Edema ; Epilepsy, Temporal Lobe ; Female ; Humans ; Magnetic Resonance Imaging* ; Neoplasms, Neuroepithelial* ; Retrospective Studies ; Temporal Lobe