BACKGROUND: The high level of susceptibility of patients with liver cirrhosis (LC) to septicemic infection is thought to be due to decreased reticuloendothelial function and irnpairment of several components of cell mediated and humoral immunity. It is well known that LC may cause many characteristic skin changes including jaundice, spider angioma, palmar erythema, xanthelasrna and nail changes such as clubbing and white nails. OBJECTIVE AND METHODS: During a 7 month period frorn April to October 1995, 100 patients who had been diagnosed as having LC were evaluated for the duration of their LC, the associated diseases they had apart from LC and various skin manifestations. Also, we performed the tuberculin test in 20 patients with LC and evaluated the correlation of the tuberculin test with severity of LC divided into 3 groups according to the Childs classification. RESULTS: The results are summarized as follows ; 1. The most frequent duration of LC was under 5 years (74%). 2. The most common associated disease of patients with LC was upper GI bleeding including esophageal varix (24 cases). Also, diabetes mellitus (13 cases) and hepatic coma (11 cases) were observed. 3. Jaundice (82 cases) was the most frequent skin rnanifestation of patients with LC. In addition, vascular changes (81 cases) and various nail changes (69 cases) were observed. Onychomychosis was the most common nail change of patients with LC. 4. 60% of the patients who were given the tuberculin test showed anergy, and the frequency of anergy increased in proport on to the severity of LC. However, it was not significant statistically (p> 0.05 ). CONCLUSIONS: Some of the skin manifestations help in the diagnosis of LC. Also, increased frequency of tuberculin test anergy in proportion to the severity of LC is thought to be related to decreased cell mediated immunity, although statistically it is not significant.
Child ; Classification ; Diabetes Mellitus ; Diagnosis ; Erythema ; Esophageal and Gastric Varices ; Hemangioma ; Hemorrhage ; Hepatic Encephalopathy ; Humans ; Immunity, Cellular ; Immunity, Humoral ; Jaundice ; Liver Cirrhosis* ; Liver* ; Skin Manifestations* ; Skin* ; Spiders ; Tuberculin Test

BACKGROUND: Generally, there are few problems in the diagnosis of Paget's disease(PD) using the H&E stain. However, the differentiation of PD from the clonal type of Bowens disease and superficial spreading melanoma in situ that shows pagetoid spreading of tumor cells, may present diagnostic difficulties. In addition, the specia1 stains used for demonstrating the presenee of Pagets cells, such as PAS and mucicarmim, are non-specific and not always sensitive. So, inenunohistochemical stains with monoclonal antibodies against various antigens may be helpful for differentiating PD from ather morphologically similar skin lesions. OBJECTIVE: The purpose of this study was to investigate the diagnostic accuracy of immunohisto- chemical staining for diagnostic use in PD. METHODS: Immunohistochemical stains used in the biotin streptavidin amplificxl technique with monoclonal antibodies to several low rnolecular weight cytokeratin(CK)s, EMA and CEA, were performed on formalin-fixed, paraffin-embedded tissue. Twelve cases of PD(10 cases of extranmmmary PD and 2 cases of mammary PD), five cases of superficial spreading melanoma in situ and five cases of Bowens disease were investigated. RESULTS: The results were as follows. 1. Positive reactions with variable intensity using CK7, CKS, CK19 were seen in all cases(100%) of PD and the. staining intensity tor CK7 or CK19 was stronger than that of CKS. 2. Of the 12 cases of PD, both CK18 and CAM5.2 staining showed positivity in 11 cases(92%). 3. EMA and CEA staining showed positivity in 10(83%) and 9(75%) of 12 cases, respectively. 4. Some Pagets cells were negative for CK8, CK18 and EMA, although other positive cells were observed in the same sections. 5. All antigens were consistently negative in all cases of Bowens disease and superficial spreading melanoma in situ. CONCLUSION: The results show that moaoclonal antibodies to low molecular weight CKs are more sensitive than EMA or CEA in the demonstration of Pagets cells. Moreover, among the low molecular weight CK series, CK7 and CK19 are most useful for their high sensitivity and intensity.
Antibodies ; Antibodies, Monoclonal ; Biotin ; Bowen's Disease ; Coloring Agents ; Diagnosis ; Melanoma ; Molecular Weight ; Skin ; Streptavidin

Infantile myofibromatosis is an uncornmon, benign, self-limiting, localized or generalized process, probably of hamartomatous origin, which consists to a large degree of cells having the characteristics of myofibroblasts and sometimes of pericytes. Both solitary and multicentric forms occur. Most lesions are present at birth or in early infancy, and some are familial in origin. A female newborn presented with a firm, round, red colored, 3 x 3 cm sized tumor with central necrosis on the left chest. Histological examination revealed well-circumscribed nodules consisting of short bundles of plump, spindle shaped cells displaying staining characteristics intermediate between fibroblasts and smooth muscle cells. The tumor was immunoreactive for actin but did not stain for desmin. A Follow-up examination at the age of 3 months revealed a moderate degree of spontaneous regressior of the lesion.
Actins ; Desmin ; Female ; Fibroblasts ; Follow-Up Studies ; Humans ; Infant, Newborn ; Myocytes, Smooth Muscle ; Myofibroblasts ; Myofibromatosis* ; Necrosis ; Parturition ; Pericytes ; Thorax

After the stabilization using unreamed intramedullary interlocking nails for the management of fractures of the tibial shaft, a large percentage of patients whose fractures would proceed to delayed bony union may be subject to secondary surgical procedure. The purpose of this study is to determine whether ultrasound, through its potential early assessment of the presence or absence of callus at the fracture site, can be used to predict the need for secondary surgical procedure. Fourteen tibial fractures (5 open, 9 closed) were treated with unreamed interlocking intramedullary nailing. Radiographs were obtained to monitor the maintenance of reduction and fracture healing. The results of ultrasound studies were obtained at two-week intervals for 10 weeks postoperatively and read by a radiologist. In prospective study of 14 patients, tibial fractures treated with unreamed interlocking intramedullary nailing were analyzed from June 1995 to February 1997 and following results were obtained. 1. Ultrasound correctly predicted fracture healing in all 10 fractures that subsequently progressed to fracture union. 2. Of the 4 fractures that did not heal, ultrasound was able to predict delayed union before it was radiographically evident. 3. Ultrasound predicted fracture healing at an average of 42 days (range, 22-70 days). In comparison, the plain radiographs showed fracture healing at an average of 126 days (range, 70 - 180 days). In conclusion, the tibia was ideal for ultrasound study because of the thin overlying soft tissue. Furthermore, the presence of the intramedullary nail facilitated evaluation of the intervening tissue. And there were several advantages of ultrasound over other imaging modalities. It was noninvasive, easy to use, and painless method of evaluation that does not use ionizing radiation.
Bony Callus ; Fracture Fixation, Intramedullary ; Fracture Healing* ; Humans ; Prospective Studies ; Radiation, Ionizing ; Tibia* ; Tibial Fractures ; Ultrasonography*

OBJECTIVES: This study was intended to investigate the differences of job stressors between managers and low level employees among white-collar workers. Another objective of this study was to examine whether the effects of job stressors on mental health differ between the two groups. METHODS: Data was obtained from 204 managers and 251 low level employees who were employed in white-collar jobs. Fourteen job stressors and seven job stress variables were measured. RESULTS: Among the 14 job stressors, role overload, job insecurity, and work-family conflict were higher job stressors for the manager group whereas role conflict, work-aptitude incongruity, participation in decision making, and promotion problems were higher job stressors for the low level of employees. There were no differences in job stress scores between the two groups. However, differences in the effects of job stressors on job stress were found between the two groups. For the manager group, job insecurity, work-aptitude incongruity, and work-family conflict significantly affected in explanation of job stress whereas for the low level employees, role underload, peer satisfaction, and environmental problems significantly explaining the job stress variables. CONCLUSIONS: There were significant differences in job stressors between managers and low level employees among white-collar workers. Additionally there were differences in the effects of job stressors on job stress between the two groups.
Decision Making ; Mental Health

No abstract available.

A 5-month-old male infant was referred by the pediatrician for nontender, left testicular enlarged mass. It was intratesticular round cyst 1.7 cm in diameter without internal echoes on ultrasonogram. After inguinal orchiectomy, pathologic report was intratesticular simple cyst. We report a rare case of intratesticularsimple cyst with a brief review of the literature.
Humans ; Infant ; Male ; Orchiectomy ; Testis ; Ultrasonography

No abstract available.
Aspirin* ; Coronary Aneurysm ; Mucocutaneous Lymph Node Syndrome*

PURPOSE: To assess the relationship between the retinal thickness analyzer (RTA) parameters, and those of the GDx VCC scanning laser polarimeter (GDx VCC), Stratus OCT optical coherence tomography (Stratus OCT), and Heidelberg retinal tomograph II confocal scanning laser ophthalmoscopy (HRT II). METHODS: Twenty-nine primary open-angle glaucoma patients were retrospectively included in this study. Measurements were obtained using the RTA, GDx VCC, Stratus OCT, and HRT II. We calculated the correlation coefficients between the parameters of RTA and those of the other studies. RESULTS: Among the optic disc parameters of RTA, the cup volume was best correlated with Stratus OCT (R=0.780, p<0.001) and HRT II (R=0.896, p<0.001). Among the posterior pole retinal thickness parameters, the posterior pole abnormally thin area (PPAT) of the RTA and the inferior average of the GDx VCC were best correlated (R=-0.596, p=0.001). The PPAT of the RTA and the inferior maximum of the Stratus OCT were best correlated (R=-0.489, p=0.006). The perifoveal minimum thickness (PFMT) of the RTA and the cup shape measurement of the HRT II were best correlated (R=-0.565, p=0.004). CONCLUSIONS: Many RTA optic disc parameters were significantly correlated with those of the Stratus OCT and HRT II. The RTA posterior pole retinal thickness parameters were significantly correlated with those of the GDx VCC, Stratus OCT and HRT II. The RTA optic disc and posterior pole retinal thickness parameters may be valuable in the diagnosis of glaucoma.
Adolescent ; Adult ; Aged ; *Diagnostic Techniques, Ophthalmological ; Female ; Glaucoma, Open-Angle/*diagnosis ; Humans ; Lasers/diagnostic use ; Male ; Middle Aged ; Ophthalmoscopy ; Optic Disk/*pathology ; Optic Nerve Diseases/*diagnosis ; Retina/*pathology ; Retrospective Studies ; Tomography, Optical Coherence

A 43-year-old female patient with a congenital right coronary artery to right atrial fistula presented as congestive heart failure and aortic valve infective endocarditis. The diagnosis was made on the basis of echocardiography, especially TEE and confirmed by tight heart catheterization & aortography. She underwent aortic valve replacement due to severe aortic valve regurgitation with vegetations, fistulectomy and coronary aneurysmorrhaphy. The postoperative course was uneventful. She was treated with antibiotics because of infective endocarditis for 6 weeks. At present she remains well and visits out patient clinic regularly for oral anticoagulation without problem.
Adult ; Anti-Bacterial Agents ; Aortic Valve* ; Aortography ; Arteriovenous Fistula* ; Cardiac Catheterization ; Cardiac Catheters ; Coronary Vessels ; Diagnosis ; Echocardiography ; Endocarditis* ; Estrogens, Conjugated (USP)* ; Female ; Fistula ; Heart Failure* ; Humans