Membranous glomerulonephropathy (MGN) is the most common primary cause of the nephrotic syndrome in adults, accounting for about 20% of the cases in most series. MGN is idiopathic in the majority of cases, however approximately 25% of adults have identifiable causes (secondary MGN). To evaluate the clinical and pathologic characteristics of MGN, we reviewed the clinical data and renal biopsies from 141 cases of MGN. The mean age of the patients at biopsy was 43 years old, but patients of all age were seen (range from 3 to 76 years of age). There were 88 males and 53 females. There were 99 idiopathic MGN cases and 42 secondary MGN cases. The associated causes of secondary MGN included hepatitis B infection (18 cases), SLE (10 cases), drugs (4 cases), post-transplantation MGN (5 cases), diabetes mellitus (4 cases), syphilis (1 case) and hepatitis B infection associated with rheumatoid arthritis. The prevalence of histologic stages by Ehrenreich and Churg was as follows. Stage I was 24 cases, stage II was 72 cases, stage III was 35 cases, and stage IV was 9 cases. All patients had proteinuria. Nephrotic syndrome was observed in 39%, edema in 73%, microscopic hematuria in 49%, gross hematuria in 28%, hypertension in 13%, and the serum creatinine level above 1.5 mg/dl was in 13%. Cases with glomerulosclerosis was observed in 45 cases with an increased percentage of glomerulosclerosis in the higher grade. Immunofluorescence (IF) examination showed predominantly granular IgG (118 cases) and C3 (84 cases) stainings along the glomerular capillary wall. In idiopathic MGN, sparse mesangial IF staining was noted up to 10% of the cases. However, mesangial IF staining in SLE was observed in 33%, hepatitis B infection in 28% and diabetes mellitus in 50%. An electron microscopic examination revealed subepithelial electron dense deposits of immune complex in all cases. The prevalence of mesangial and subendothelial electron dense deposit in idiopathic MGN was present in 19% and 6%, respectively. In SLE cases, mesangial and subendothelial deposits were observed in 78% and 56%, respectively. In hepatitis B infection, mesangial and subendothelial deposits were observed in 54% and 69%, respectively. In conclusion, immune deposits in the mesangium are scanty in idiopathic MGN, and if pronounced this should increase suspicion of underlying systemic diseases, such as SLE or other infectious diseases.
Adult ; Antigen-Antibody Complex ; Arthritis, Rheumatoid ; Biopsy ; Capillaries ; Communicable Diseases ; Creatinine ; Diabetes Mellitus ; Edema ; Female ; Fluorescent Antibody Technique ; Glomerulonephritis, Membranous* ; Hematuria ; Hepatitis B ; Humans ; Hypertension ; Immunoglobulin G ; Male ; Nephrotic Syndrome ; Prevalence ; Proteinuria ; Syphilis

BACKGROUND: The extracellular matrix constitutes the dermis supporting an overlying epidermal lining. A small portion of the cell component includes fibroblasts and mast cells, a large amount of fibrous tissue as struct ural proteins, intra-and extracellular adhesive molecules, and extracellular macromolecules, glyccsarninoglycan(GAG) and proteoglycan make up the dermal connective tissue. GAGs, polysacchavide chains secreted by fibroblasts, are the main macromolecules of the extracellular matrix. GAG chains occupy large amounts of extracellular space and form hydrated gels. The various manifestations observed during the cutaneous intrinsic aging process reflect the age-related changes of dermal connective tissue. OBJECTIVE: This study was directed to observe the age-related changes of GAG in human abdominal skin without the influences of photoaeging. MaTERIALS AND METHODS: The subjects involved in this study were grouped according to the age span of 10 years. A minimum of 3 skin samples were included in each age group. After permission, three to five grams of skin samples without known underlying skin diseases were obtained from the pat,ients who were subjected to open abdominal surgery under general anesthesia. GAGs were extracted and purified by repeated cetylpyridium chloride-ethanol precipitation from each skin sample. The qualitative and quantitative analysis of GAGs was carried out with the action of specific GAG degradirig enzymes. RESULTS: The amount of GAGs per gram skin tissue decreased slowly until the 4th decade and thereafter. A statistically- significant reduction in the amount of GAGs was noted between the age groups of under 10 and that of 51-60. This pattern of decline was similar with tte change of the hyaluronic acid content in gram skin tissue. The content of chondroitin sulfate and heparan sulfate also decreased as a function of ageing. The compositional ratio of GAGs showed no age related changes. The water content measured by acetone dehydration was reduced to a significant level up to the age group of over 30 years. CONCLUSION: These results imply that the wrinkling and laxity of skin during the chronological ageing process reflect the age-related reduction of GAGs and the water content of the skin.
Acetone ; Adhesives ; Aging ; Anesthesia, General ; Cellular Structures ; Cetylpyridinium ; Chondroitin Sulfates ; Connective Tissue ; Dehydration ; Dermis ; Extracellular Matrix ; Extracellular Space ; Fibroblasts ; Gels ; Heparitin Sulfate ; Humans* ; Hyaluronic Acid ; Mast Cells ; Proteoglycans ; Skin Diseases ; Skin* ; Water

No abstract available.
Occlusal Splints* ; Temporomandibular Joint*

No abstract available.

Lymphangiectasis(=acquirecl lymphangioma) ate dilated lymph caillaris and may be due to the obstruction of the lymphatic circulation from surgery, irradiation, chronic recurrent infection or trauma. The patient was a 5 years old girl who developed a straw-colcre, asymptomatic grouped vesicular mass resembling frog spawn measuring 9 cm in diameter the left axilla and arm, 2 months after the total excision of a previous lymphangiectatic mass. She had a history of previous open heart surgery at 2 years of age. Histopathologic findings showed large, irregularly shaped cysticalation lined by a single layer of endothelium in the superficial dermis. Immunohistochemical stainig showed vimentin positive and negative results in Factor VIII and HLA-DR antigen which was compatible with a lymphatic vessel.
Arm ; Axilla ; Child, Preschool ; Dermis ; Endothelium ; Factor VIII ; Female ; Heart* ; HLA-DR Antigens ; Humans ; Lymphangioma* ; Lymphatic Vessels ; Thoracic Surgery* ; Vimentin

BACKGROUND: Cytokines such as TNF-a, and IL-1, 6, 8 are thought to mediate many host responses in patients with sepsis through the release of many kinds of inflammatory mediators. Vibrio vulnificus is a virulent, halophilic, marine, and Gram-negative bacterium causing wound infections or primary sepsis with fulminant course. It has been known to produce many exocellular factors, such as cytolysin and exozymes, which are possible causes of shock and tissue damage. OBJECTIVE: Our purpose was to investigate the changes of cytokines(TNF-a, Il-l p, and IL-6) after intravenous administration of V. vulnificus cytolysin which have known to be a major virulent factor for elucidating pathogenesis of septic shock. METHODS: After administration of V. vulnificus cytolysin(20 hemolytic units) and physiologic saline through a mouse tail vein, we obtained blood samples from the heart according to a time course(0, 30, 60, 90, 120, 240, and 360 minutes). We measured serum concentrations of circulating TNF- a, IL-1 p, and IL-6 using commercially available immunoassay kits. RESULTS: The serum concentration of TNF- a peaked at 60 min (1894 pg/ml, as compared with 829 pg/ml after saline administration), began to decrease at 90 min and fell to baseline at 360min. Concentration of IL-6 rose significantly at 90 min(>3,839 pg/ml) and began to decrease at 120 min, whereas the level of IL-1 0 increased slightly and the peaked around 90min(117 pg/ml) after the cytolysin injection. CONCLUSION: We conclude that the host response to cytolysin is associated with a brief pulse of circulating cytokines in the early stage of sepsis caused by V. vulnipcus infection.
Administration, Intravenous ; Animals ; Cytokines* ; Heart ; Humans ; Immunoassay ; Interleukin-1 ; Interleukin-6* ; Mice* ; Perforin* ; Sepsis ; Shock ; Shock, Septic ; Tumor Necrosis Factor-alpha* ; Veins ; Vibrio vulnificus* ; Vibrio* ; Wound Infection

No abstract available.

Pulsatilla koreana is a member of the buttercup familly(Ranuculaceae) which contains the unsaturated lactone, protoanemonin(C3H4O2), formed after injury to the plant by the breakdown of the glycoside ranunculin. It has been prescribed as a herbal medicine or a folk medicine for antipyretic, analgesic, anti-inflammatory, astringent and hemostatic effects in Korea. A 20 year-old famale patient presented with confluent vesicobullae on the erythematous base with a burning sensation on her upper back. This was caused by contact with crushed Pulsatilla koreana, a folk medicine for the treatment of left facial nerve palsy, that had occurred 10 days before her visit. A provocation patch test with Pulsatilla koreana upon a heathy male volunteers upper back showed strong positive reactions with the stalk and leaf in fresh and frozen stat.e and after thaw ing resptively. However no reaction was seen when the folk medicine was used in a dried form or with the root in any state. This case indicates that misadvice and ignorant folk remedies could cause misfortunate results to innocent people.
Burns ; Dermatitis, Irritant* ; Facial Nerve ; Herbal Medicine ; Humans ; Korea ; Male ; Medicine, Traditional ; Paralysis ; Patch Tests ; Plants ; Pulsatilla* ; Sensation ; Volunteers ; Young Adult

Infantile acute hemorrhagic edema of the skin(IAHE) is a benign disease which affects infants between 4 months and 2 years of age and is characterized by palpable ecchymotic purpura and edema on the limb and face. We report a typical case of IAHE, which was presenting a cockade, annular, reticulated, and iris-like purpura and edema on the face and extremities in a 19-month-old male infant. We consider it to be a new disease category because its characteristics different markedly from HenochSchoenlein purpura in several clinical and histopathologic findings.
Edema* ; Extremities ; Humans ; Infant ; Male ; Purpura ; Skin*

No abstract available.
Animals ; Embryonic Structures* ; Mice*