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

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 determine if D-dimer level is a supportive marker in the prediction of myocardial infarction in patients with acute coronary syndrome and non-ST elevation ECG, who arrive in the emergency room. METHODS: We conducted a prospective, observational study of patients with acute chest pain that had occurred within 24 hours and who had non-ST elevation on ECG. They were managed according to the 2005 ACLS guidelines; the following clinical tests were performed: D-dimer, cardiac markers, and CAG. Final diagnoses were divided into 3 groups: myocardial infarction (MI), unstable angina (UA), and others (non-specific or angina). RESULTS: Ninety-three (93) patients were included in this study. The mean D-dimer value was higher in patients diagnosed with MI (1.04+/-2.12 ug/dl) than in those patients diagnosed with UA (0.48+/-0.51 ug/dl) (p=0.026). At the 0.38 ug/dl diagnotic threshold estimated by ROC curve analysis, corresponding to the cutoff for diagnosis of myocardial infarction then in this value sensitivity and specificity of D-dimer were 70.6% and 62.7%. In cardiac enzymes, sensitivity and specificity of Tn-I were 47.1% and 98.3, respectively, and for CK-MB were 35.3% and 98.3%, respectively. CONCLUSION: D-dimer value may be at higher levels in AMI and the sensitivity of D-dimer was higher than that of TnI andCK-MB in patients with acute coronary syndrome and non- ST elevation ECG. However, because of relatively lower sensitivity and specificity of the D-dimer test, this test may useful as supporting marker for predicting myocardial infarction.
Acute Coronary Syndrome ; Angina, Unstable ; Chest Pain ; Electrocardiography ; Emergencies ; Fibrin Fibrinogen Degradation Products ; Humans ; Myocardial Infarction ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity

PURPOSE: There are conflicting results surrounding the prognostic significance of epidermal growth factor receptor (EGFR) status in glioblastoma (GBM) patients. Accordingly, we attempted to assess the influence of EGFR expression on the survival of GBM patients receiving postoperative radiotherapy. MATERIALS AND METHODS: Thirty three GBM patients who had received surgery and postoperative radiotherapy at our institute, between March 1997 and February 2006, were included. The evaluation of EGFR expression with immunohistochemistry was available for 30 patients. Kaplan-Meier survival analysis and Cox regression were used for statistical analysis. RESULTS: EGFR was expressed in 23 patients (76.7%), and not expressed in seven (23.3%). Survival in EGFR expressing GBM patients was significantly less than that in non-expressing patients (median survival: 12.5 versus 17.5 months, p=0.013). Patients who received more than 60 Gy showed improved survival over those who received up to 60 Gy (median survival: 17.0 versus 9.0 months, p=0.000). Negative EGFR expression and a higher radiation dose were significantly correlated with improved survival on multivariate analysis. Survival rates showed no differences according to age, sex, and surgical extent. CONCLUSION: The expression of EGFR demonstrated a significantly deleterious effect on the survival of GBM patients. Therefore, approaches targeting EGFR should be considered in potential treatment methods for GBM patients, in addition to current management strategies.
Adult ; Aged ; Brain Neoplasms/metabolism/*mortality/radiotherapy/surgery ; Female ; *Gene Expression Regulation, Neoplastic ; Glioblastoma/metabolism/*mortality/radiotherapy/surgery ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Proportional Hazards Models ; Radiotherapy ; Receptor, Epidermal Growth Factor/*metabolism ; Treatment Outcome

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