A case of toxic epidermal necrolysis(TEN) in 20 years old female was presente d. The characteristic skin lesions of toxic epidermal necrolyais developed after oral administration of Aspirin for common cold. The cause of the disease. was probably due to Aspirin, but on the microscopic pathologic findings intraepithelial and subcorneal bullae which is characteristic in the staphylococcal induced TEN were noticed. She was treated with a massive systemic corticosteroids(Dexamethasone 12mg/d), antibiotics(Lincocin l.5grn/d), Fluids with electrolytes, sedatives and topical measures. So she was discharged with excellent results in a week of admission.
Administration, Oral ; Aspirin ; Common Cold ; Electrolytes ; Female ; Humans ; Hypnotics and Sedatives ; Skin ; Young Adult

To identify the developmental characteristics of fetal skin, the expressions of cytokeratine (CK) and epidermal growth factor (EGFR) in fetal skin (12-24 weeks of gestation) were studied immunohistochemically, and the ultrastructure of epidermis was also observed. The Expressions of CK and EGFR were identified in labelled sterptoavidine biotin immunohistochemical method. Primary antibodies used monclonal mouse anti-human CK (DAKO-CK, MF116) and EGFR Ab-4 which is rabbit affinity-purified polyclonal antibody raised against the amino acid residues 1005-1016 (Onc Science). At 12 weeks of gestation the epidermis was composed basal layer and periderm and the cells of both layers were positively stained for CK and EGFR. At 16-18 weeks of gestation, epidermis was composed basal, intermediate, and periderm. The cells of basal layer and periderm were strongly positive for CK, but the cells of intermediate layer showed weak or negative reaction for CK. EGFR immunoreactivity was noted in cells of all three layers, though cells of basal layer were stained relatively weak. At 23-24 weeks of gestation, the epidermis thickened and appeared 6 or more cell layers. Epidermal cells except horny layer were stained positively for CK and EGFR. EGFR immunoreactivity in basal layer, however, was relatively weak compared to those in intermediate layers. Periderm always were reaction-positive for CK and EGFR. The hair follicles, mainly pre-germ stage, were negatively stained for CK and EGFR at 12 weeks of gestation. The hair follicles with various developing stages were positively stained at 16-18 weeks of gestation. At 24 weeks of gestation, inner sheath of hair shaft and sebaceous gland were strongly reacted for CK, but not reacted for EGFR. In electron microscopic study, epidermis was composed of two layers, basal layer and periderm at 12 weeks of gestation. The periderm was composed of basal, intermediate and periderm at 12 weeks of gestation. The periderm was composed of basal, intermediate and periderm layers at 16-18 weeks of gestation. Intermediate cells consisted of 2-3 layers of spinous cells. The granular cells appeared rarely in superficial cells of intermediate layers. At 23-24 weeks of gestation, epidermis consisted of basal, prickle, granular, and horny layers. Periderm cells were locally exfoliated from the hony layer. The results demonstrate the expression of CK and EGFR in skin of human fetus between 12 and 24 weeks of gestation, and suggest that full thickness of epidermis is formed by 24 weeks of gestation.
Animals ; Antibodies ; Biotin ; Epidermal Growth Factor ; Epidermis* ; Fetus* ; Hair ; Hair Follicle ; Humans* ; Keratins ; Methods ; Mice ; Pregnancy ; Receptor, Epidermal Growth Factor ; Sebaceous Glands ; Skin

To investigate the maternal and child factors associated with early detection of cerebral palsy, 74 mothers of cerebral palsy children who were born since January 1, 1980 and being treated at Taegu Rehabilitation Center for the Handicapped, Rehabilitation Center of Taegu University, St. Paul Children's House and Pusan Welfare Association of Cerebral Palsy Children were interviewed from February to April 1987. There is no association between age of child when parents noticed the child's abnormality and educational level of father but it tend to be detected earlier when education level of mother is college or above compared with high school or under. There is a trend of earlier detection of child's abnormality although statistically not significant in case father is professional or managerial worker, monthly income of father is over 610,000 won, child is first-born, age of the parents is 34 years or under, child is a boy, and child has periodic well-baby check-up. The child's abnormality is detected earlier when mothers had 7 prenatal visits or more compared with those who had 6 visits or less (P<0.05). Parents noticed the child's abnormality first in 85.1% of the case whereas doctors detected it first in 2.7% and this percentage was not different whether the child had periodic well-baby check-up or not. The first physician's diagnosis of the children was cerebral palsy in 36.5% and the rest was normal, need for observation, uncertain, etc. Parents took the child to doctor for diagnosis 2-3 months after they noticed the child's abnormality and after the child was diagnosed as cerebral palsy parents either took no therapeutic measure or brought the child to physiotherapy or acupuncture or gave herb medicine before they started specific rehabilitative therapy. For early detection of the cerebral palsy children, teaching of evaluation method for child development should be reinforced both in medical school and clinical training course and should train the specialist for diagnosis and treatment of crippling conditions. Also, public education needed for the importance of early detection of crippling conditions and currently available methods for diagnosis and treatment.
Acupuncture ; Busan ; Cerebral Palsy* ; Child Development ; Child* ; Daegu ; Diagnosis ; Disabled Persons ; Education ; Fathers ; Humans ; Male ; Mothers ; Parents ; Rehabilitation Centers ; Schools, Medical ; Specialization

BACKGROUND: The characteristic t(15; 17) of acute promyelocytic leukemia (APL) fuses the retinoic acid receptor alpha (RARA) gene on chromosome 17 to the PML gene on chromosome 15. The test of PML-RARA rearrangement is essential for diagnosis and therapy of APL. We analyzed breakpoints of the PML gene as a basic study for PML-RARA rearrangement test. METHODS: PML-RARA rearrangements, breakpoints of the PML gene and junction sequences were analyzed in 41 patients with APL using RT-PCR and direct sequencing. RESULTS: Forty out of 41 cases revealed PML-RARA rearrangement, of which results coincided with cytogenetic data. Breakpoint distribution was 26 cases in burl (65%), one in bcr2 (2.5%), and 13 in bcr3 (32.5%). Sequencing data showed invariable joining of exon 3 of the RARA gene and exon 6 (bcrl type) or exon 3 (bcr3 type) of the PML gene. One case with bcr2 type had breakpoint in exon 6 of the PML gene with 57 bp deletion. CONCLUSIONS: Bcrl Is the most common breakpoint site of APL in Koreans, and bcy1+2/bcr3 ratio is approximately 2.1. PML-RARA junctions were continuous and joined by a correct splicing event. Breakpoint analysis would be useful in quality control of PML-RARA rearrangement test and the fused protein analysis.
Chromosomes, Human, Pair 15 ; Chromosomes, Human, Pair 17 ; Cytogenetics ; Diagnosis ; Exons ; Humans ; Leukemia, Promyelocytic, Acute* ; Quality Control ; Receptors, Retinoic Acid

BACKGROUND: It is traditiqnally considered that the non-bullous fonn of impetigo is primarily of streptococcal origin and the bullous form is of staphylococcal origin. However, recent reports have shown that Staphylococcus aureus (SA) has become the predominant cauative pathogen of non-bullous impetigo as well as of bullous impetigo. Objective. Our purpose was to evaluate the predominant causativi. pathogen, and to establish a therapeutic guideline for impetigo. METHOD: We described the characteristics of lesions and gerformed bacterial culture and susceptibility tests in patients with impetigo. Patients were treatecl by one of three frequently used antibiotics(erythromycin, cefuroxime, fusidic acid). RESULTS: Of 77 patients, there were 47 cases of crusted type(61.9%), 18 cases of mixed type with crusted and bullous lesiona(23.3%), 7 cases of mixed type with crusted and pustular lesions(9.1%) and 5 cases of bullous type(6.6%). SA was grown from 90.1% af the cases, in 83.1% of cases it was the only organism to be foind and no gowth of streptococcus was faund even in mixed infections. An antimicrobial susceptibility test of 63 strains of SA demonstrated high susceptibility to vancomycin(98.4%), cefuroxime(97.1%), oxacillin(96.4%), cephalothin(95.2%), fusidic acid(91.7%) etc, and high resistance to penicillin(93.7%), gentamicin(90.5%), tobramycin(88.9%) and erythromicin(80.9%). Of 19 patients treated with erythrornycin, 12(63.1% ) showed treatment failure at a weeks, while no treatment failure occured in groups treated with cefuroxime and usidic acid. There were statistically significant differences iri therapeutic effect between cefuroxirne and erythromycin(P=0.005 by two tailedy test), and betweer fusidic acid and erythromycin(P=0.0040. But there was no significant difference between cefuroxime and fusidic acid. CONCLUSION: The predominant pathogen of non-bullous impetigo a well as bullous impetigo was SA which were highly resistant to erythromycin and highly sensitive to efuroxime and fusidic acid. In the clinical response, cefuroxinie and fusidic acid treatment were most effective and erythromycin was inadequate for treatment of impetigo.
Cefuroxime ; Coinfection ; Erythromycin ; Furosemide ; Fusidic Acid ; Humans ; Impetigo* ; Staphylococcus aureus ; Streptococcus ; Treatment Failure

OBJECTIVE: Estrogen is a major regulator/modulator of bone metabolism, and bone loss in estrogen deficiency is associated with increased bone turnover, But the mechanism for estrogen action on bone metabolism is still unknown. Recent studies have suggested that the increase in bone loss induced by estrogen deficiency is mediated by increased paracrine production of bone resorbing cytokines. Among cytokines, 1nterleukin-6(IL-6) is released from osteoblasts in estrogen deficiency and increases bone resorption by stimulation of osteoclastic activities and recruitment. Thus we performed this study to evaluate the effect of ovariectomies on bone mineral density and IL-6 in cultured monocytes of peripheral blood and bone marrow. METHODS: The experimental animals were 13 female Sprague-Dawley rats that were 8 weeks of age and weighed an average of 188.5 gram at the beginning of the study. Bilateral ovariectomies were performed in all rats from a ventral approach. Bone mineral density(BMD) of the total body, spine and level of IL-6 of cultured monocytes of peripheral blood and bone marrow were measured before and 8 weeks after ovariectomy. RESULTS: 1) BMD of total body and spine were lower after ovariectomy(0.257+/-0.069g/cm2, 0,208+/-0.005g/cm2) than before ovariectomy (0.276+/-0.005g/cm2, 0.229+/-0.011g/cm2), respectively (P<0.01). 2) Although IL-6 level of cultured monocytes in peripheral blood tended to be higher after ovariectomy than before ovariectomy, this difference was not statistically significant (P>0.05). 3) IL-6 level of cultured monocytes in bone marrow was higher after ovariectomy(82.78+/-4.99pg/ml) than before ovariectomy(48.85+/-2.42pg/ml)(P<0.05). CONCLUSION: It is possible that increased production of IL-6 in estrogen deficiency induced by ovariectomy occurs in the local environment of bone or bone marrow rather than in the pheripheral blood and stimulates bone resorption.
Animals ; Bone Density* ; Bone Marrow ; Bone Resorption ; Cytokines ; Estrogens ; Female ; Humans ; Interleukin-6* ; Metabolism ; Monocytes ; Osteoblasts ; Osteoclasts ; Ovariectomy* ; Rats* ; Rats, Sprague-Dawley ; Spine

Predisposing factors for venous thrombosis can be identified in the majority of patients with established venous thromboembolism (VTE). However, an obvious precipitant may not be identified during the initial evaluation of such patients. In the present case, a 47-year-old female presented to the emergency department of our hospital after ingesting multiple drugs. She had no VTE-related risk factors or previous episodes, nor any family history of VTE. After admission to the intensive care unit sudden hypoxemia developed, and during the evaluation cerebral, renal, and splenic infarctions with pulmonary embolisms were diagnosed. However, the sources of the emboli could not be identified by transthoracic echocardiography or computed tomography angiography. Protein C deficiency was identified several days later. We recommend that hypercoagulable states be taken into consideration, especially when unexplained thromboembolic events develop in multiple or unusual venous sites.
Angiography ; Anoxia ; Causality ; Echocardiography ; Emergency Service, Hospital ; Female ; Humans ; Infarction* ; Intensive Care Units ; Middle Aged ; Protein C Deficiency ; Pulmonary Embolism ; Risk Factors ; Splenic Infarction ; Thrombophilia ; Venous Thromboembolism ; Venous Thrombosis

Colchicine poisoning is rare but can cause potentially life-threatening toxic complications such as hypovolemic shock, cardiovascular collapse and multiple organ failure. In this case report, we describe a case of a 20-year-old female who presented to the emergency department after suicidal ingestion of a toxic dose of colchicine. She developed thrombocytopenia, neutropenia and acute respiratory distress syndrome that required blood transfusion and administration of granulocyte colony stimulating factor for the prevention of infectious complications. With regard to the clinical manifestations of colchicine toxicity, we discussed suggested mechanisms.
Blood Transfusion ; Colchicine* ; Colony-Stimulating Factors* ; Eating ; Emergency Service, Hospital ; Female ; Granulocytes* ; Humans ; Multiple Organ Failure ; Neutropenia ; Poisoning* ; Respiratory Distress Syndrome, Adult ; Shock ; Thrombocytopenia ; Young Adult

Angiogenesis is an essential requirement for development, progression, and metastasis of malignant tumors. Vascular endothelial growth factor (VEGF) is one of the important angiogenic factors. Recently the role of angiogenesis has been known in premalignant lesions. This study was performed to determine whether the angiogenesis and VEGF expression were increased in association with histological grade of cervical intraepithelial neoplasia (CIN) and to see the relationship between the angiogenesis and VEGF. Immunostainings for factor VIII and VEGF were performed on 52 cases of cervical neoplasia (12 cases of CIN I, 11 cases of CIN II, 15 cases of CIN III, 7 cases of microinvasive squamous cell carcinoma, and 7 cases of invasive carcinoma) and 5 cases of normal cervix. The results showed a significant increase of microvessel count from normal cervix through CIN grades to invasive squamous cell cacinoma. VEGF expression was increased in proportion to the CIN grades. There was no significant correlation between microvessel count and VEGF expression. In conclusion, the tumor angiogenesis is an early event in tumorigenesis of uterine cervix. In addition, no significant relationship between the microvessel count and VEGF expression in CIN suggests the possibility of other growth factors affecting mainly angiogenesis of premalignant lesion of uterine cervix.
Angiogenesis Inducing Agents ; Carcinogenesis ; Carcinoma, Squamous Cell ; Cervical Intraepithelial Neoplasia* ; Cervix Uteri ; Factor VIII ; Female ; Intercellular Signaling Peptides and Proteins ; Microvessels ; Neoplasm Metastasis ; Vascular Endothelial Growth Factor A*

PURPOSE: To cmpare the clinical results of complex tibial plateau fractures treated by hybrid external fixation and dual plate fixation. MATERIALS AND METHODS: We studied forty patients with Schatzker type V and VI fractures respectively and selected twenty seven patients who were followed at least one year between January 2000 and December 2005. We evaluated the clinical results in which fourteen fractures with hybrid external fixation were compared with thirteen fractures with dual plate fixation. The clinical results were evaluated according to Knee Society Clinical Rating System and the statistical analysis was performed by Student t-test. RESULTS: There were no significant differences in terms of bone union time (average union time: dual plate fixation 13.8 weeks, hybrid external fixation 14.2 weeks). The quality of osseous reduction was superior in the fractures with dual plate fixation than those with hybrid external fixation. There were significant differences in functional score (average functional score: dual plate fixation 73, hybrid external fixation 62), but not in average knee score. CONCLUSION: The hybrid external fixation can be a useful modality for treatment of complex proximal tibial plateau fractures. But the good quality of the fracture reduction by dual plate fixation may be a indicator for favorable prognosis for satisfactory knee function.
Chimera ; External Fixators ; Humans ; Knee ; Prognosis