Acral lentiginous melanoma is a rare variant of malignant melanoma and is characterized by a lentiginous (radial) growth phase that evolves over months or years to a dermal (vertical) invasive stage. Clinical and pathological features were reviewed in 3 cases of acral lentiginous melanoma of the soles. The first case was a 59-year-old female. On gross examination, there was a black, nodular, round, and ulcerated mass, 1.5 x 1.5 cm, on the posterior portion of the left sole. This mass was accompanied by peripheral pigmented macules. Histologically, the macular lesion revealed the pattern of a lentiginous growth phase, with a diffuse hyperplasia of atypical melamocytes in the basal layer of the epidermis. In the vertical growth component, atypical melanocytes (predominantly spindle cell) infiltrated the dermis, showing level 3 invasion. The second case was a 47-year-old male. On gross examination, there was a dark brown to black, nodular, hemorrhagic and ulcerated mass, 7x7 cm, on the middle portion of the right sole. This mass grew radially into neighboring tissue. Histologically, the radial growth component revealed atypical melanocytes which were distributed in the basal portion of epidermis. In the vertical growth component, atypical melanocytes (spindle, round, or polygonal cells) infiltrated the dermis, showing level 4 invasion. The third case was a 87-year-old female. There was a formation of satellite pigmented macules, up to 2x0.5 cm, on the right sole. The color of macules was usually not uniform but was likely to be scattered radially, being grayish brown, bluish black, or black. Histologically, the peripheral, macular, hyperpigmented lesion revaled the pattern of a lentiginous growth phase. In the vertical growth component, atypical melanocytes (predominently polygonal cells) infiltrated the dermis, showing level 13 invasion.
Female ; Humans

PURPOSE: We reviewed the results of endoureterotomy and balloon dilation for benign ureteral strictures to determine the efficacy of these procedures. MATERIALS AND METHODS: We treated 19 patients who had benign ureteral stricture by retrograde endoureterotomy or balloon dilation followed by placement of a 6-8Fr stent for 6 weeks. Mean follow up period was 14 months (6-27 months). Eight patients were treated by endoureterotomy using cold knife under direct vision and 11 patients were treated by balloon dilation. The causes of ureteral strictures were abdominal surgery in 8 patients, urinary tuberculosis in 6 patients, radiation therapy in 2 patients, rigid ureteroscopy in 2 patients and periureteral abscess in 1 patient. The length of strictures was shorter than 1cm in 14 patients and over 1cm in 5 patients. The etiology of strictures was ischemic origin in 11 patients and nonischemic in 8 patients. One patient had poor ipsilateral renal function (<25%). RESULTS: The overall success rate was 78.9% (15/19). The success rate of balloon dilation was 81.8% (9/11) and that of endoureterotomy was 75% (6/8). No significant complication such as high fever or sepsis was observed. Strictures shorter than 1cm had 92.9% (13/14) success rate while strictures over 1cm had 40% (2/5) success rate (p <0.05). The nonischemic strictures had better success rate (87.5%) compared to ischemic strictures (72.7%) without statistical significance. CONCLUSIONS: We would suggest the use of balloon dilation or endoureterotomy as the initial treatment of benign ureteral stricture regarding the safety and efficiency. The better outcome would be expected in the strictures shorter than 1cm in length.
Abscess ; Constriction, Pathologic* ; Fever ; Follow-Up Studies ; Humans ; Sepsis ; Stents ; Tuberculosis ; Ureter* ; Ureteroscopy

Cauda equina syndrome(CES) and disc rupture have been implicated as a potential complication of spinal manipulation. A review of the literature from 1911 to 1996 received 61 reported cases of cauda equina syndrome or disc rupture in patients undergoing manipulation. This article presents four new cases, where a temporal association was found between the onset of cauda equina symptoms or disc rupture and lumbar manipulation. The type of manipulation administered and the relationship between the treatment and symptoms is reviewed. Our patients symptoms suggest that acute herniation was caused, or at least precipitated by spinal manipulation. In each of these cases the chiropractitioner failed to comprehend the nature of the problem and take appropriate action. As a consequence, the patient went untreated for several days. Many chiropractic therapists assumed the incidence of CES caused by manipulation to be approximately one in many millions of treatments. However, we assumed that CES or disc rupture is far more common than the literature would reflect. It is therefore essential that persons practicing or prescribing manipulation would be aware of these complications.
Cauda Equina ; Chiropractic ; Humans ; Incidence ; Manipulation, Spinal ; Polyradiculopathy ; Rupture ; Spine*

The Korean Neurosurgical Society, with its 62 years of history, has witnessed substantial growth in the field of neurosurgery, producing over 3400 neurosurgeons, establishing 12 divisions and nine regional branches, and advancing in clinical management, diagnostic methods and academic research. Despite these developments, the regulations governing neurosurgical training and evaluation methods for training hospitals have remained largely unchanged, necessitating comprehensive revisions in response to evolving medical environments. To provide balanced participation opportunities for neurosurgery residents, the Korean Neurosurgical Society formed the Training Status Investigation Standard Change Task Force (TF team) under the Training Education Committee. This paper presents the TF team’s findings and proposals for revising training status investigation standards and evaluation criteria. Through the processes including a lot of team meetings, workshops, education programs, official communications with 12 division societies, benchmarking from other societies and analysis of encrypted data from the past 5 years for neurosurgical training hospitals, the TF team created a revised training status investigation proposal, supplemented main surgery criteria. And we applied this revised proposal to the training status investigation data collected from training hospitals in 2022 for simulation. We reduced the score for main surgeries to 10 points, introduced core competency surgery standards, allocating 5 points each for brain core competency surgery and spine and peripheral core competency surgery, for a total of 10 points. We also adjusted the major surgery score to 13 points, expanding the total surgery index score to 33 points. We introduced additional definitions for main surgeries in the areas of spine, pediatrics, and functional surgery. The equipment score was reduced from 17 to 9 points. We specified minimum requirements for resident allocation eligibility, and if a hospital meets all of these criteria, they become eligible to apply for resident allocation. We introduced a new bonus point system for hospitals performing mechanical thrombectomy or stenting and surgery for peripheral nerve diseases. The proposed revisions aim to improve the training and education of neurosurgical residents and overall neurosurgical care in Korea by creating a balanced and differentiated evaluation system for training hospitals. Further monitoring, communication, and adjustments are crucial for successful implementation.

It is generally accepted that 1-3% of all inguinal hernias involve the bladder. However herniation of the bladder deep into the scrotum is rare. We report a case of massive bladder hernia of paraperitoneal type in a 58-year-old male with scrotal pain and palpable scrotal mass. Treatment consisted of partial cystectomy and herniorrhaphy. The postoperative result was good without complications.
Cystectomy ; Hernia* ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Male ; Middle Aged ; Scrotum* ; Urinary Bladder*

Malignant fibrous histiocytoma (MFH) occurs primarily in the extremities and trunk, however primary malignant fibrous histiocytoma of the alimentary tract, particularly of the jejunum, is uncommon. This case report presents a case of malignant fibrous histiocytoma as the primary lesion of the jejunum in a 42-year-old male patient with a 10-day history of melena. A small bowel tumor was resected without complication. The final diagnosis was based on the pathological report of the surgical specimen.
Adult ; Diagnosis ; Extremities ; Histiocytoma, Malignant Fibrous* ; Humans ; Jejunum* ; Male ; Melena

The Japanese encephalitis virus (JEV), a member of the Flaviviridae family and Flavivirus genus, is transmitted by mosquitoes. JEV, of which some 35,000 cases are recorded every year, is a positive RNA virus. Two types of JEV vaccines have been developed to prevent the onset of encephalitis in humans, namely formalin-inactivated and liveattenuated vaccines. JEV inactivated vaccines are usually made using the Nakayama-NIH or Beijing-1 strains of the JEV virus. In this study, the immunological response to the Nakayama-NIH and Beijing-1 strains was analyzed as part of the effort to compile basic data which could lead to the selection of a suitable vaccine strain. To this end, the virus titer of Beijing-1 was found to be two-fold higher than that of Nakayama-NIH by plaque assay. Moreover, Beijing-1-induced neutralizing antibodies showed a higher level of titers when confronted by Korean JEV isolates than Nakayama-NIH-induced neutralizing antibodies (1:320 vs. 1:160, respectively). However, as a minimum ratio of 1:10 neutralizing antibody titers are required to protect against JEV infection, both strains in effect exhibited a sufficient level of neutralizing antibody titers. What's more, Beijing-1 was found to induce a somewhat higher cytotoxic T lymphocyte (CTL) response than Nakayama-NIH. Taken together, this can be taken to mean that Beijing-1 may in fact be a more effective vaccine candidate strain when it comes to inducing a high level of protective immunity against JEV infection.
Antibodies, Neutralizing* ; Asian Continental Ancestry Group* ; Culicidae ; Encephalitis ; Encephalitis Virus, Japanese* ; Encephalitis, Japanese* ; Flaviviridae ; Flavivirus ; Humans ; Lymphocytes* ; RNA Viruses ; Vaccines ; Vaccines, Inactivated ; Viral Load

PURPOSE: We investigated the significance of bcl-2 and p53 protein expressions as the prognostic factor in metastatic prostate adenocarcinoma. MATERIALS AND METHODS: Nineteen paraffin-embedded prostatic cancer tissues were examined using immunohistochemical staining for bcl-2 and p53 protein. We evaluated correlation of bcl-2 and p53 protein expressions with cancer progression free interval, pretreatment PSA and Gleason score. RESULTS: Seven out of 19 cases (36.9%) were positive for p53 and 3 cases (15.8%) were positive for bcl-2 protein. Mean disease progression free interval in positive patients for bcl-2 and p53 protein expressions was 8.7 months and 10.3 months, respectively. However, it was 18.3 months and 21 months in negative expressions, respectively. The difference of mean disease progression free interval between positive and negative groups for p53 protein expression was statistically significant (p<0.05) but not in bcl-2 protein groups. The rates of positive staining for bcl-2 and p53 protein were 0% (0/8) and 37.5% (3/8), respectively, in Geason score 5-7 groups, 27.3% (3/11) and 36.4% (4/11) in 8-10 groups. Neither of proteins had significant correlation with Gleason score and pretreatment PSA. CONCLUSIONS: The expression of p53 protein was correlated with significant short disease progression free interval but bcl-2 overexpression had relative short disease progression interval without statistical significance. These results suggest that expressions of bcl-2 and p53 have considerable prognostic impact and these gene products would provide useful information about prognosis of metastatic prostate adenocarcinoma.
Adenocarcinoma* ; Disease Progression ; Humans ; Neoplasm Grading ; Neoplasm Metastasis ; Prognosis ; Prostate* ; Prostatic Neoplasms ; Staphylococcal Protein A*

PURPOSE: To investigate the degree and effect of cyclooxygenase (COX)-2 expression on the survival of patients with glioblastoma multiforme (GM). MATERIALS AND METHODS: Between 1997 and 2006, thirty consecutive GM patients treated with surgery and postoperative radiotherapy (dose range: 44~65.1 Gy, median dose: 61.2 Gy) were included in the study. Three patients were excluded that discontinued radiotherapy before receiving a dose of 40 Gy due to mental deterioration. The expression of the COX-2 protein in surgical specimens was examined by immunohistochemical analysis. Survival analysis and verification were performed with respect to sex, age, performance status, resection extent, radiotherapy dose, and degree of COX-2 expression using the Kaplan-Meier method and the log rank test. RESULTS: The median length of follow-up was 13.3 months (range: 6~83 months). Staining for COX-2 was positive in all patient samples. Staining for COX-2 that was positive for over 75% of the tumor cells was found in 24 patients. Staining for COX-2 that was positive in less than 25% of tumor cells was found in 3 patients (10.0%), staining for COX-2 that was positive in 25 to 50% of tumor cells was found in 1 patient (3.3%), staining for COX-2 that was positive in 50 to 75% of tumor cells was found in 2 patients (6.7%) and staining for COX-2 that was positive in 75 to 100% of tumor cells was found in 24 patients (80.0%). The median survival and two-year survival rate were 13.5 months and 17.5%, respectively. The survival rate was influenced significantly by the degree of resection (tumor removal by 50% or more) and radiotherapy dose (59 Gy or greater) (p<0.05). The median survival of patients with staining for COX-2 that was positive in less than 75% of tumor cells and in at least 75% of tumor cells was 15.5 and 13.0 months, respectively (p>0.05), and the two-year survival for these groups was 33.3 and 13.3%, respectively (p>0.05). CONCLUSION: The absence of a statistical correlation between the degree of COX-2 expression and survival in GM patients, despite the high rate of COX-2 positive tumor cells in the GM patient samples, requires further studies with a larger series to ascertain the prognostic value of the degree of COX-2 expression in GM patients.
Cyclooxygenase 2* ; Follow-Up Studies ; Glioblastoma* ; Humans ; Prostaglandin-Endoperoxide Synthases ; Radiotherapy ; Survival Rate

PURPOSE: There is no reliable body index to use in estimating adult body weight. The purpose of the study was to develop a body index that can estimate adult body weight and to perform a regression equation of body weight versus the body index METHODS: We performed a prospective study. We measured body weight and various body indexes, including arm, wrist, calf, and ankle circumference, in the patients who visited our emergency department. A correlation analysis was performed between these body indexes and body weight, and a simple linear regression analysis was used to examine the relationship between the most correlative body index and body weight. RESULTS: Two hundred five patients were enrolled. The correlation coefficient between body weight and calf, arm, wrist, and ankle circumference were, respectively, 0.919, 0.792, 0.546, and 0.432 for males and 0.913, 0.781, 0.476, and 0.430 for females. The body index with the greatest correlation to body weight was calf circumference. The regression equations were: male body weight = 2.510 x calf circumference - 25.673, and female body weight = 2.375 x calf circumference - 22.560. CONCLUSION: The most reliable body index for estimating adult body weight is calf circumference.
Adult ; Animals ; Ankle ; Arm ; Body Weight ; Emergencies ; Female ; Humans ; Leg ; Linear Models ; Male ; Prospective Studies ; Wrist