Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare malignancy-related complication causing severe pulmonary hypertension, right heart failure, and death. PTTM is characterized by diffuse fibrocellular intimal proliferation and multiple thrombi formation in the pulmonary arteries and arterioles, which result from invasion of the pulmonary blood vessels by tumor cells. Establishing the diagnosis of PTTM is very difficult and few cases are diagnosed ante mortem. We report the case of a 48-year-old woman diagnosed with PTTM before death who developed breast cancer and presented with persistent dyspnea on exertion.
Ants ; Arterioles ; Blood Vessels ; Breast ; Breast Neoplasms ; Dyspnea ; Female ; Heart Failure ; Humans ; Hypertension, Pulmonary ; Middle Aged ; Pulmonary Artery ; Thrombotic Microangiopathies

Herein, we report a rare case of hemolytic anemia with reticulocytopenia following intravenous immunoglobulin therapy in a young infant treated for Kawasaki disease. A 2-month-old boy presented with fever lasting 3 days, conjunctival injection, strawberry tongue, erythematous edema of the hands, and macular rash, symptoms and signs suggestive of incomplete Kawasaki disease. His fever resolved 8 days after treatment with aspirin and high dose infusion of intravenous immunoglobulin. The hemoglobin and hematocrit decreased from 9.7 g/dL and 27.1% to 7.4 g/dL and 21.3%, respectively. The patient had normocytic hypochromic anemia with anisocytosis, poikilocytosis, immature neutrophils, and nucleated red blood cells. The direct antiglobulin test result was positive, and the reticulocyte count was 1.39%. The patient had an uneventful recovery. However, reticulocytopenia persisted 1 month after discharge.
Anemia ; Anemia, Hemolytic* ; Anemia, Hypochromic ; Aspirin ; Coombs Test ; Edema ; Erythrocytes ; Exanthema ; Fever ; Fragaria ; Hand ; Hematocrit ; Hemolysis ; Humans ; Immunization, Passive* ; Immunoglobulins* ; Infant* ; Male* ; Mucocutaneous Lymph Node Syndrome* ; Neutrophils ; Reticulocyte Count ; Reticulocytes ; Tongue

Most type I and II perforations are predominately caused by hydrophilic and stiff wires, often presented in the delayed form, and do not require pericardial drainage or surgical interventions. However, we report a type III delayed coronary artery perforation at the site of stent implantation after intervention without any evidence of immediate perforations. To the best of our knowledge, this is the first case report of angiographic documentation and treatment of delayed coronary perforation at the site of stent, presented as a cardiac arrest.
Angioplasty, Balloon, Coronary ; Cardiac Tamponade ; Coronary Vessels ; Drainage ; Drug-Eluting Stents ; Heart Arrest ; Stents

Purpose: The objective of this study was to analyze the results of several noninvasive prenatal tests (NIPTs) from a single center and confirm their efficacy and reliability. In addition, we aimed to confirm the changes in the number of invasive tests performed after introducing NIPT. Materials and Methods: NIPT data from a large single center from March 2014 to November 2018 were analyzed. Karyotyping was confirmed based on chorionic villus sampling, amniocentesis, or postnatal cord/peripheral blood sampling. Data on maternal age, gestational age, fetal fraction, and ultrasonographic results were analyzed. As the secondary outcome, the number of amniocentesis cases before and after the introduction of NIPT was compared. Results: Overall, 1,591 single pregnancy cases that underwent NIPT were enrolled. The mean maternal age was 36.05 (22-45) years. The average gestational age and fetal fraction were 12+1 (9+3 to 27+1) weeks and 10.95% (3.6% to 31.3%), respectively. A total of 1,544 cases (97.0%) were reported to have negative NIPT results and 40 (2.5%) had positive NIPT results. The sensitivity and specificity of the overall abnormalities in NIPT were 96.29% and 99.36%, respectively. The positive predictive value (PPV) and negative predictive value were 72.22% and 99.93% respectively. The mean number of amniocentesis cases were 21.7 per month (21.7±3.9), which significantly decreased from 31.5 per month (31.5±4.8) before conducting NIPT as a screening test. Conclusion NIPT is currently a useful, powerful, and safe screening test. In particular, trisomy 21 is highly specific due to its high PPV. NIPT can reduce the potential risks of procedure-related miscarriages during invasive testing.

Localized scleroderma(LS) is sclerosis of the skin characterized by one or multiple circumscribed ivory-white, indurated, sometimes confluent plaques. It has been reported that LS might result from the unbalance between synthesis and degradation of collagen in the dermis. Recently, treatment of LS with long wave UVA1, which can induce mRNA of matrix metalloproteinase-1 from dermal fibroblast and can cause apoptosis of infiltrating T lymphocytes, showed promising results. In this case, a 14-year-old girl had a 6 month history of linear, brown colored, indurated plaque on her left thigh compatible with LS histopathologically. UVA1(2.4-10.8J/cm2) was irradiated to the skin lesion at each visit, a total of 68 times for 18 months with the cumulative dose of 533J/cm2 UVA1. Her fibrotic skin lesion was resolved during treatment, but became hardened with cessation of phototherapy. She remains disease free for 11 months. We report a case of LS with improvement with low-dose UVA1 phototherapy.
Adolescent ; Apoptosis ; Collagen ; Dermis ; Female ; Fibroblasts ; Humans ; Matrix Metalloproteinase 1 ; Phototherapy* ; RNA, Messenger ; Scleroderma, Localized* ; Sclerosis ; Skin ; T-Lymphocytes ; Thigh

Pemphigus vulgaris is autoimmune disease characterized by acantholysis and blister formation in the skin and mucosa. The introduction of corticosteroids has greatly reduced mortality, and a number of immunosuppressive agents, such as azathioprine and cyclophosphamide are recommended as adjuncts to oral steroids. A 38-year-old female patient of pemphigus vulgaris has been managed with daily oral cyclophosphamide as adjunct to prednisolone for about 11 months, and then transfered to our department due to amenorrhea for 4 months. Hormonal profile of FSH, LH and estradiol revealed in postmenopausal range and follow-up results of hormonal profile were not changed, and amenorrhea continues for total 13 months until now. So we report a case of premature ovarian failure complicated by long-term oral administration of cyclophosphamide.
Acantholysis ; Administration, Oral ; Adrenal Cortex Hormones ; Adult ; Amenorrhea ; Autoimmune Diseases ; Azathioprine ; Blister ; Cyclophosphamide* ; Estradiol ; Female ; Follow-Up Studies ; Humans ; Immunosuppressive Agents ; Mortality ; Mucous Membrane ; Pemphigus* ; Prednisolone ; Primary Ovarian Insufficiency* ; Skin ; Steroids

Keloid is proliferative fibrous growths that result from an excessive tissue response to trauma. The earlobe is a common site for the formation of keloid and the frequent cause is ear piercing. Many modalities are available for the treatment of earlobe keloid. Surgical excision has been the most commonly used therapeutic modality but recurrence following excision is common. Intralesional triamcinolon, radiation therapy, compression device, cryosurgery, D-penicillamine or any combination of them were reported to be successful in the treatment of earlobe keloid. We report three cases of earlobe keloid treated with partial surgical keloidectomy of upper part and carbon dioxide laser vaporizing the residual keloid tissue. And then the defect was covered with a primary closure with flap. Pressure earrings were fitted 2 weeks after surgery, and were maintained for 3 months. There was no recurrence of keloid for follow-up period at least 9 months. We suggest that combined modality of CO2 laser vaporization and pressure earring after surgical keloidectomy may offer a better cosmetic and functional improvement in the treatment of primary and recurrent earlobe keloid.
Body Piercing ; Carbon Dioxide* ; Carbon* ; Cryosurgery ; Ear* ; Follow-Up Studies ; Keloid* ; Lasers, Gas* ; Penicillamine ; Recurrence ; Volatilization

Kaposi's sarcoma(KS) is a multicentric proliferative vascular tumor involving cutaneous and visceral tissues. KS was one of the first recognized manifestations of AIDS. A 71-year-old woman was seen with multiple violaceous nodules and painful erythematous cellulitis-like swelling on both lower legs. Easy bruising and senile purpura was also noted on her forearms. She had been suffered from lower back pain for 7 years, and had been treated with corticosteroids. Clinical picture and hormonal study revealed that she had iatrogenic Cushing's syndrome. The histopathologic study from skin lesion showed abnormally proliferated and dilated vessels, vascular slits, spindle shaped cells in the entire dermis. Human herpesvirus 8(HHV-8) was detected by nested polymerase chain reaction(PCR) using the paraffin-embedded skin tissue. She received localized radiotherapy(50 Gray) to both lower legs with favorable response. But five months later, her skin lesions had recurred and progressed into more aggressive pattern mainly on her left lower leg. We report a rare case of human herpesvirus 8 related KS in iatrogenic Cushing's syndrome.
Adrenal Cortex Hormones ; Aged ; Cushing Syndrome* ; Dermis ; Female ; Forearm ; Herpesvirus 8, Human* ; Humans* ; Leg ; Low Back Pain ; Purpura ; Sarcoma, Kaposi* ; Skin

Obesity was characterized in Korean elementary students using different obesity assessment tests on 103 overweight elementary students from three schools of Jeonbuk Province. The body mass index (BMI) and obesity index (OI) were compared, and the data using DEXA and CT were compared with the data using BIA and a tape measure. The results of this study are as follows: first, 27 students who were classified as obese by OI were classified as overweight by BMI, and 3 students who were classified as standard weight by BMI were classified as overweight by OI. Secondly, by DEXA and BIA measurements, there was 1.51% difference in body fat percentage (boys 1.66%, girls 1.17%) and the difference in body fat mass between boys and girls was 0.77 kg (boys 0.85 kg, girls 0.59 kg), but those differences in body fat percentage and mass were not statistically significant. Thirdly, the average total abdominal fat (TAF) measured by CT scans of obese children was more significantly related with subcutaneous fat (r = 0.983, P < 0.01) than visceral fat (r = 0.640, P < 0.01). Also, TAF were highest significant with waist circumference by a tape measure (r = 0.744, P < 0.01). In summary, as there are some differences of assessment results between two obesity test methods (BMI, OI), we need more definite standards to determine the degree of obesity. The BIA seems to be the most simple and effective way to measure body fat mass, whereas waist/hip ratio (WHR) using a tape measurer is considered to be the most effective method for assessing abdominal fat in elementary students.
Abdominal Fat ; Adipose Tissue ; Anthropometry ; Body Mass Index ; Child ; Humans ; Intra-Abdominal Fat ; Obesity ; Overweight ; Subcutaneous Fat ; Waist Circumference

Our previous research demonstrated that calponin-immunoreactivity was localized in myofibroblasts of the periglomerular region of human kidney specimens obtained at the time of transplantation from organ recipients. In the present study we examined calponin expression in two chronic nephropathy models, puromycin aminonucleoside (PAN) nephropathy and subtotal nephrectomy (SNx), to investigate the role of calponin in chronic renal injury. Male Sprague-Dawley rats were used, and both nephropathy models were established at 1, 2, 4, and 8 weeks after surgery. There were no periglomerular calponin-positive cells in sham, PAN 1 and 2 week, and SNx 1, 2, and 4 week groups. In SNx 8 week and PAN 4 and 8 week groups, only a few glomeruli with periglomerular calponin-reactivity, which covered half or a very small part of the periglomerular space, were observed. All glomeruli with periglomerular calponin-reactivity showed sclerotic changes, especially thickening of parietal epithelial cells (PECs). In conjunction with our previous report, this data represents the first documentation of the expression of calponin in renal myofibroblasts. We suggest that interactions between PECs and calponin-positive myofibroblasts may play a key role in the late stage of glomerulosclerosis.
Animals ; Calcium-Binding Proteins ; Epithelial Cells ; Humans ; Immunohistochemistry ; Kidney ; Kidney Failure, Chronic ; Male ; Microfilament Proteins ; Myofibroblasts ; Nephrectomy ; Puromycin Aminonucleoside ; Rats ; Rats, Sprague-Dawley ; Salicylamides ; Transplants