Plasma col1 leukemia with motility-related morphological behavior is rarely studied. The plasma cells have variable degrees of cytoplasmic morphologies as dairy Projections, long extensions and pseudopods. These morphological evidences show the papa bility of wide spread and dissemination of disease itself. We present a case of a 38 year old woman who had back pain for 4 months and was diagnosed as a solitary plasmacytoma of the third lumbar vertebra. In spite of resection of the tumor and chemotherapy, the plasmacytoma was disseminated into both breasts and ovaries within less than a year. On her blood examination, we counted 34% of plasma cells in peripheral blood and 91.6% of plasma cells in bone marrow aspiration. Most of them resealed hairy projections and pseudopods of the cytoplasm.
Adult ; Back Pain ; Bone Marrow ; Breast ; Cytoplasm ; Drug Therapy ; Female ; Humans ; Leukemia ; Leukemia, Plasma Cell* ; Ovary ; Plasma Cells* ; Plasma* ; Plasmacytoma ; Spine

Gossypiboma is the foreign body granuloma that's due to retained surgical gauze after an operation. The reports of gossypiboma are not infrequent after thoracic, abdominal and pelvic operation, but they are rare after operation on the extremities. Some patients with gossypiboma may remain asymptomatic for several months or several years, but others experience complications such as abscess formation, chronically infectious fistulae formation, neighboring bone erosion and vessel occlusion and sepsis; physicians may suffer some serious legal problems if they are responsible for this condition. We experienced the gossypiboma that developed in the proximal thigh; a 60 year-old patient experienced pathologic fracture of the femoral neck due to this gossypiboma.
Abscess ; Extremities ; Femur Neck* ; Fistula ; Fractures, Spontaneous* ; Granuloma, Foreign-Body ; Humans ; Middle Aged ; Sepsis ; Thigh*

BACKGROUND: Under hypoxia, hypoxia-inducible factor-1alpha (HIF-1alpha) is known to activate the expression of various genes, including angiogenesis-related genes. The aim of this study was to evaluate the expression of HIF-1alpha protein and its relationship with p53 protein expression and angiogenesis in the squamous cell carcinoma (SCC) of the uterine cervix. METHODS: Using immunohistochemical methods, the expression of HIF-1alpha protein, p53 protein, vascular endothelial growth factor (VEGF), and microvessel count were evaluated in seventy cases of FIGO stages I and II SCC; and their results were compared with age, stage, and pelvic lymph node metastasis. RESULTS: Positive nuclear staining for HIF-1alpha protein was noted in 19 cases (27.1%). Carcinoma in situ or dysplastic lesions also revealed positive nuclear reaction along the lower part of the epithelium. The expression of HIF-1alpha protein was significantly related with those of p53 protein and VEGF (p<0.05), but not with other clinicopathologic parameters. The microvessel count showed a significant difference regarding stage and VEGF expression (pand<0.05). CONCLUSION: These findings suggest that HIF-1alpha expression in SCCs of the uterine cervix might be the early event of carcinogenesis and could be associated with p53 protein and VEGF expression. However, the prognostic significance of HIF-1alpha expression in stages I and II SCCs is undetermined.
Anoxia ; Carcinogenesis ; Carcinoma in Situ ; Carcinoma, Squamous Cell* ; Cervix Uteri* ; Epithelium ; Female ; Lymph Nodes ; Microvessels ; Neoplasm Metastasis ; Vascular Endothelial Growth Factor A*

Purpose: This study aimed to describe the desperate situation where the clinician should make decisions to further manage patients having experienced adverse drug reaction (ADR) to lamotrigine that is indicated to not easily controlled neuropsychiatric diseases. Methods: A descriptive analysis was done by thoroughly reviewing medical records of patients who were reported to have ADR to lamotrigine in a regional drug-safety center between 2010 and 2018. Results: Eighty-four cases of lamotrigine-related ADRs occurred in 80 patients. Skin lesions were most commonly observed in 70 cases (83.3%) and 14 cases (16.7%) had severe ADRs. Sixty-three subjects (78.8%) discontinued lamotrigine, while 17 (21.3%) continued it.At the time of discontinuation, 30.0% were prescribed aromatic antiepileptic drugs. Among 4 subjects who were eventually prescribed lamotrigine again after a period of discontinuation, 3 (75.0%) experienced its recurrence. Among patients who had taken alternative medications, the incidence of ADRs was higher in those being prescribed aromatic antiepileptic drugs than in the others being prescribed other than aromatic antiepileptic drugs (P = 0.013). Regarding the control of underlying diseases, as many as 65 (86.7%) and 68 (90.7%) failed to reach maintaining the resolved state from 6 months and 12 months after the substitution, respectively. Conclusion Patients can be easily trapped between the recurrence of ADRs and the treatment failure to a certain drug like lamotrigine, in which we can hardly find a reasonable alternative to manage them.

BACKGROUND: The management of postoperative pain with traditional narcotic analgesic regimen is associated with an unacceptably high failure rate and at best has represented a cautious compromise between adequate analgesia and the risk of complications, particularly that of respiratory depression. The purpose of this investigation was to compare the efficacy and safety of nalbuphine given by patient-controlled analgesia (PCA) with differential dosages after total knee replacement. METHODS: A double-blind clinical trial of 75 patients who received intravenous nalbuphine with patient- controlled analgesia during the postoperative first 48 hours after total knee replacement, was carried. Patients were assigned to three groups by the concentration of nalbuphine: Group 1 (n = 25), 2 mg/ml; Group 2, 4 mg/ml; Group 3, 6 mg/ml. The settings of PCA in three groups were same. RESULTS: Visual analog scale (VAS) scores were used to assess pain. Group 2 and 3 patients reported significant lower VAS over the postoperatively 6 hours and 12 hours at either rest or movement compared to group 1. PCA demands, delivered doses and PCA nalbuphine dosage per hours except supplemental analgesic doses in the first 48 hours were lower in group 2 and 3 compared to group 1. There were significant differences among groups at postoperatively 6 and 12 hours in nausea, vomiting and sedation of the side effects. CONCLUSIONS: IV PCA with nalbuphine is thought to be potent and safe for postoperative pain relief without the major morbidity like respiratory depression, in addition, the careful observation and treatment on the side effect like nausea, vomiting and sedation, is surely needed.
Analgesia ; Analgesia, Patient-Controlled* ; Arthroplasty, Replacement, Knee ; Humans ; Nalbuphine* ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Respiratory Insufficiency ; Visual Analog Scale ; Vomiting

Erlotinib (Tarceva(R)) is a new anti-cancer agent which acts by inhibiting epidermal growth factor receptor (EGFR) signal transduction. It is currently used in the treatment of advanced stage non-small cell lung cancer and pancreatic cancer. We report a case of acneiform eruption and paronychia induced by erlotinib in a 69-year-old man. The patient visited our clinic with multiple erythematous papules and pustules on the face, periungual erythema and pus discharge, xerosis, fissures on the sole. He had taken erlotinib for the treatment of recurred lung cancer for 4 weeks. The skin lesions were partially improved with oral pyridoxine, corticosteroid and topical antibiotics.
Acneiform Eruptions* ; Aged ; Anti-Bacterial Agents ; Carcinoma, Non-Small-Cell Lung ; Erythema ; Humans ; Lung Neoplasms ; Pancreatic Neoplasms ; Paronychia* ; Pyridoxine ; Receptor, Epidermal Growth Factor ; Signal Transduction ; Skin ; Suppuration ; Erlotinib Hydrochloride

Ectopic nail is characterized by growth of nail-like tissue in a location other than the nail bed. It is an extremely rare disorder that can be either congenital or acquired from incidents such as trauma. An 8-year old female presented with a complaint of a nail-like lesion on the dorsal surface around the center of the right fifth toe. It had been present for 3 years, while the patient continuously clipped it upon growth. The fifth toe was initially injured by a chair that had fallen on that toe 4 years prior to her visit. There was no associated bony deformity or other physical changes in the nail. A clinical diagnosis of ectopic nail was made and it was surgically excised under local anesthesia. The histopathological examination revealed a normal nail unit and there was no recurrence during the 6 month follow-up period.
Anesthesia, Local ; Congenital Abnormalities ; Female ; Follow-Up Studies ; Humans ; Nails ; Recurrence ; Toes

STI571 (imatinib mesylate, Gleevec(TM)), a selective inhibitor of the bcr-abl, c-kit, platelet-derived growth factor receptor tyrosine kinases, is a new anticancer drug used for chronic myelogenous leukemia and gastrointestinal stromal tumors. Cutaneous adverse reactions of periorbital edema and exfoliative dermatitis related to STI571 are rare and there have been no previous reports in the Korean literature. We herein report a case of periorbital edema and exfoliative dermatitis due to STI571 and discuss the possible mechanism of periorbital edema related to STI571.
Dermatitis, Exfoliative* ; Drug Eruptions* ; Edema* ; Gastrointestinal Stromal Tumors ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Mesylates* ; Phosphotransferases ; Receptors, Platelet-Derived Growth Factor ; Tyrosine ; Imatinib Mesylate

Drug-induced hypersensitivity syndrome is a rare, but severe, life-threatening disease with multiorgan failure. Aromatic antiepileptic drugs are frequent causes of this syndrome. The association of the human herpes virus-6 has been recently reported in patients with drug-induced hypersensitivity syndrome. We report two patients who were diagnosed as having antituberculosis drug-induced hypersensitivity syndrome based on clinical course and laboratory data. In addition, human herpes virus-6 DNA was detected by polymerase chain reaction in peripheral blood mononuclear cells and the serum. There was a favorable outcome after discontinuation of the causative drug, plus corticosteroid therapy. After the treatment, human herpes virus-6 DNA was not detected by polymerase chain reaction. This is the first report of antituberculosis drug-induced hypersensitivity syndrome associated with reactivation of human herpes virus-6.
Anticonvulsants ; DNA ; Humans ; Hypersensitivity* ; Polymerase Chain Reaction

BACKGROUND: Acne is a common skin disorder which affects both adolescents and adults. However, there have been few Korean epidemiological studies conducted. OBJECTIVE: The purpose of this study was to analyze the prevalence, demographic factors, clinical features and aggravating factors of acne. We also investigated the relationship of these factors. METHODS: Epidemiological and clinical data was obtained by interviewing 657 acne patients, newly enrolled at Seoul National University Hospital Acne Clinic between 1996 and 2004. RESULTS: Most patients were found to have facial acne, and the forehead and cheeks were the most common sites where acne first developed. Males tended to visit the hospital because of social problems compared to females. We identified some significant correlations with sex, age of onset, disease duration, first affected site, seborrhea, and family history. Acne lesions developed earlier and disease duration was longer in the group with a family history of acne or severe seborrhea. More than 80% of patients were found to have subjective symptoms, including pain and itching which were most frequent. The degree of seborrhea was higher and the aggravation after sun exposure was more frequent in the group where complete remission of acne had not been achieved. Aggravation of acne was most frequent in summer, followed by winter. CONCLUSION: We could investigate the epidemiological and clinical features of acne patients, including the age of onset, motive of treatment, subjective symptoms, plus outcome of treatment according to remission history of acne, as these factors have never been reported in the Korean literature before.
Acne Vulgaris* ; Adolescent ; Adult ; Age of Onset ; Cheek ; Demography ; Dermatitis, Seborrheic ; Epidemiologic Studies ; Epidemiology ; Female ; Forehead ; Humans ; Male ; Prevalence ; Pruritus ; Seoul* ; Skin ; Social Problems ; Solar System