Onychomycosis is caused by dermatophytes usually, but some species of nondermatophytic molds and yeasts are also associated with invasion of nails. Aspergillus sydowii is a nondermatophytic mold which is opportunistic filamentous fungus in all environments. We report a case of onychomycosis caused by A. sydowii in a 65-year-old male. The patient showed yellowish discoloration with hyperkeratotic change on the distal and lateral portion of both great toenails. Direct microscopic examination of scraping on the potassium hydroxide preparation revealed dichotomous septate hyphae and repeated cultures on Sabouraud dextrose agar showed the same blue green velvety colonies. Biseriate phialides that cover entire vesicle with conidial structure resembling Penicillium were shown in the slide culture. The DNA sequence of internal transcribed spacer (ITS) region of clinical sample was 99% match to that of A. sydowii strain XWSFJJ1 (GenBank accession number FJ461692). We confirmed A. sydowii by KOH mount, colony, light microscopic morphology and DNA sequence analysis. The patient was treated with 250 mg oral terbinafine daily and topical 5% amorolfine nail lacquer for 3 months.
Agar ; Aged ; Arthrodermataceae ; Aspergillus* ; Base Sequence ; Fungi ; Glucose ; Humans ; Hyphae ; Lacquer ; Male ; Nails* ; Onychomycosis* ; Penicillium ; Potassium ; Sequence Analysis, DNA ; Yeasts

BACKGROUND: The prognosis of patients with lung cancer is still poor. Lung cancer exhibits a variable clinical outcome, even in those patients with same stage Numerous reports suggest that oncogene expression night play a role in explaining the variability of response and survival But many of these reports are still under debete. So we studied the clinical relevance of oncogene expression in Korean lung cancer patients. lmmunohistochemistry of p53, erbB-2, CEA expression was performed. METHOD: From March, 1992 until March, 1997, 120 patients with lung cancer were reviewed. p53, erbB-2, and CEA expression were detected on paraffin-embedded tumor blocks with the use of monoclonal antibodies. The survival arid response has correlated with the expressibility of p53, erbE-2, arid CEA oncoprotein. RESULTS: Overall, the expression rates of p53 erbB-2, and CEA were 33.7%, 59.3%, and 32.6% respectively. Expression rates were not con-elated to cell type or stage. Compared with response to chemotherapy, no correlation was found. The expression of p53, erbB-2, or CEA was not correlated with 2-year survival. With simultaneous applications of p53. erbB-2, and CEA, patients with 2 or more expressions also did not show poor response to chemotherapy. CONCLUISON: We conclude the p53, erbB-2, and CEA expression are clinically less useful in predicting response to chemotherapy or survival.
Antibodies, Monoclonal ; Drug Therapy ; Humans ; Immunohistochemistry ; Lung Neoplasms* ; Lung* ; Oncogenes ; Prognosis

Iliac vein compression syndrome (May-Thurner syndrome) is caused by compression of the left iliac vein against the fifth lumbar vertebra by the right iliac artery, resulting in impaired venous return and left iliofemoral thrombosis. We experienced a case of a 68-year-old woman who showed sudden left lower extremity edema. By the Doppler sonogram, deep vein thrombosis of left lower extremity was detected. It was involved only left side and extended to iliac vein level. In the venogram, spur like projection was noticed on left iliac vein. Through endovascular thrombectomy, thrombolysis and angioplasty, venous return was completely restored. We report a case of May-Thurner syndrome who was treated with various endovascular management successfully.
Aged ; Angioplasty ; Edema ; Female ; Humans ; Iliac Artery ; Iliac Vein* ; Lower Extremity ; May-Thurner Syndrome* ; Spine ; Thrombectomy ; Thrombosis* ; Venous Thrombosis

Relapsing polychondritis is a systemic disorder characterized by recurrent inflammation and degeneration of cartilaginous tissue throughout the body. The association with HLA-DR4 and the occurrence of antibodies to type II collagen and other antoantibodies suggest that an immunologic mechanism is involved in its pathogenesis. The eyes, oars, nose, larynx, trachea and articular areas are commonly involved. Airway narrowing or collapse from respiratory tract involvement, occurs in up It 50% of patients with relapsing polychondritis. Treatment consists of administration of corticosteroids arid other anti-inflammatory and immunosuppresive drugs. We experienced a case of relapsing polychondritis involving the tracheobronchial tree, nose and ears in a 49-year-old woman. The patient was clinically and histologically diagnosed as relapsing polychondritis according to McAdam's and Damiani's criteria. We report this case with a review of the literature.
Adrenal Cortex Hormones ; Antibodies ; Collagen Type II ; Ear ; Female ; HLA-DR4 Antigen ; Humans ; Inflammation ; Larynx ; Middle Aged ; Nose ; Polychondritis, Relapsing* ; Respiratory System ; Trachea

BACKGROUND: Surgical therapy remains the only curative treatment of localized non-small cell lung cancer(NSCLC). But the efficacy of surgery for patients with NSCLC is limited, although recent studies suggest that neoadjuvant chemotherapy may improve survival. Many studies also demonstrated benefit for neoadjuvant therapy. However very few studies about neoadjuvant chemotherapy were reported in Korea. We conducted this study to examine the possible benefit of neoadjuvant chemotherapy in patients with operable stage IIIA NSCLC. METHODS: Twenty seven patients(25 men and 2 women) with clinical stage IIIA NSCLC were analyzed. The patients received 2 to 4 courses of cisplatin based chemotherapy and followed by surgery. To compare the resection rate and survival, 12 patients(10 men, 2 women) with clinical stage IIIA and initially treated operation were also anayzed. RESULTS: The radiologically assessed response rate to the neoadjuvant therapy was 59.3%. Twelve seven patients underwent gross tumor resection with 24(88.9%) having complete resection and 21(77.8%) having postaperative stage I ar II. Pathologically defined response in nodal staging was more higher(85.2%). There was no difference of relapse free interval in recurred patients between two groups. But in patients treated with neoadjuvant therapy, distant recurrence is less higher than local recurrence. The median period of survival was 42 months in the patients treated with neoadjuvant therapy, and 27 months in the patients initially treated with surgery(p=0.287). CONCLUSION: The neoadjuvant chemotherapy improves local tumor control and lowers the distant recurrence. There was a possible trend improving median survival. So neoadjuvant chemotherapy might be considered as a standard therapy in stage IIIA NSCLC.
Carcinoma, Non-Small-Cell Lung* ; Cisplatin ; Drug Therapy* ; Humans ; Korea ; Lung ; Male ; Neoadjuvant Therapy ; Recurrence

BACKGROUND/AIMS: p53 mutations have been reported to be a poor prognostic indicator in patients with HCC treated by surgical resection because of the association with frequent recurrence and shorter survival periods. Although poor differentiation of tumor has been considered to be associated with p53 mutation more frequently, the exact causes of unfavorable prognosis have not been clarified. METHODS: To evaluate the relationship of p53 mutation and details of histological features, we examined 20 HCCs and surrounding liver tissues from the patients treated with surgical resection using direct sequencing of p53 gene at exons 5, 6, 7 and 8, and analyzed histopathologic features. We also analyzed the clinical, biochemical and radiological characteristics including the recurrences of tumor and survival periods in HCC patients with p53 mutant comparing to those with wild type p53 gene. RESULTS: p53 mutants were found in 9 (45%) out of 20 resected HCC tissues, none from any surrounding tissues. p53 mutations were all point substitutions of a base; 5 in exon 8, 4 in exon 5 and 1 in exon 7. Between patients with mutants and those with wild type of p53 gene, there were no differences in age, sex, serum ALT, albumin, bilirubin and AFP levels, and HBV-ositivity. HCCs with p53 mutants tended to be larger in size (14% in < 5 cm vs 67 % in > 5 cm; p=0.03) and multinodular in type (3/9 vs 0/11; p=0.07). p53 mutants tended to be found in poorly differentiated HCCs comparing to wild types. Even though there was no evidence of vascular or biliary invasion radiologically in all, 5 of 9 p53 mutant (+) (56%) and none of 11 p53-utant (- cases showed vascular invasions microscopically (p<0.01). However, there was no correlation between p53 mutations in tumor tissues and formation of capsules, biliary invasions or association with cirrhosis. During follow-p periods (median: 22;2 -8 mos) recurrences of HCC had been found in 6 of 9 patients with mutants (67%) in contrast to only 2 of 11 with wild types (18%)(p=0.07). Extrahepatic metastases were also common in patients with p53 mutant than those without it (56% vs 9%; p=0.05). Consequently, the 1 year cancer free survival rate of HCC patients with p53 mutant was significantly lower than that with wild type (44% vs 82%; p=0.02). CONCLUSIONS: Thus, it is suggested that p53 mutations tend to be commonly associated with microvascular invasions as well as poor differentiation microscopically, which may result in micrometastasis and frequent recurrences, and consequently shorter survival periods in HCC patents undergoing surgical resection.
Bilirubin ; Capsules ; Carcinoma, Hepatocellular* ; Exons ; Fibrosis ; Genes, p53 ; Humans ; Liver ; Neoplasm Metastasis ; Neoplasm Micrometastasis ; Prognosis* ; Recurrence ; Survival Rate

We have experienced three cases of mucinous ductal ectasia of the pancreas. They showed the characteristic duodenoscopic findings and underlying pathology was hyperplasia in two cases and adenocarcinoma in one case. When endoscopic retrograde pancreatography was performed, bulging ampulla of Vater, patulous ampullary orifice and mucus leakage from papillary orifice were noted. Also cyst-like dilatation of main duct or side branch of the uncinate process were observed.
Adenocarcinoma ; Ampulla of Vater ; Dilatation ; Dilatation, Pathologic* ; Hyperplasia ; Mucins* ; Mucus ; Pancreas* ; Pathology

PURPOSE: The aim of this study is to evaluate the effective role of living-related liver transplantation (LRLT) on posttransplant linear growth in children. METHODS: Thirty six children were enrolled who received LRLT at Asan Medical Center from December, 1994 to February, 1999 and showed more than one-year postoperative survival. Mean height standard deviation score (zH) was analyzed according to medical records including heights during pretransplant and posttransplant follow-up periods. RESULTS: zH of total children showed significant linear growth after LRLT from -1.58 to 0.33 at 24 posttransplant month (p<0.05). zH in children under 6 years of age, to exclude the effect of adolescent linear growth spurt, showed increment in height (p<0.05). Linear growth of children with liver cirrhosis improved and that with fulminant hepatitis was matained same. While stunted children (mean zH=-2.30) achieved good catch-up growth after transplantation, children with normal growth remained same. Children with significant hepatic dysfunction after LRLT such as chronic rejection or posttransplant lymphoproliferative disorder showed retarded posttrasplant linear growth. There was no statistical difference according to the type of immunosuppressants. CONCLUSION: LRLT resulted in adequate or catch-up linear growth in children with acute, chronic and metabolic liver disease. Successful LRLT suggested to be a promising option not only in long term survival but also in normal linear growth.
Adolescent ; Child* ; Chungcheongnam-do ; Follow-Up Studies ; Hepatitis ; Humans ; Immunosuppressive Agents ; Liver Cirrhosis ; Liver Diseases ; Liver Transplantation* ; Liver* ; Lymphoproliferative Disorders ; Medical Records

BACKGROUND/AIMS: Transforming growth factor alpha (TGFalpha) is an important autocrine growth factor of hepatocytes. We were to evaluate the roles of TGFalpha in chronic viral hepatitis (CVH) and hepatocellular carcinoma (HCC). METHODS: We measured the amounts of TGFalpha mRNA in liver tissues from 18 patients with HCC, 31 with CVH and 7 normal controls. 'Hot start' reverse transcription polymerase chain reaction (RT-PCR) using oligo-dT and specific primers detected TGFalpha mRNA in total cellular RNA extracted from liver tissues. The levels of TGFalpha mRNA were determined by the end point titers of serial two-fold dilutions of cDNA. The amounts of HBV-RNA in livers of patients with chronic hepatitis B were also measured by Northern blot hybridization. RESULTS: TGFalpha mRNA levels were significantly higher in HCC than CVH and normal controls; those of CVH were also elevated compared to normal controls. They were overexpressed in the nontumorous livers surrounding HCC compared to CVH, although lower than HCC tissues. They were higher in chronic hepatitis B than in chronic hepatitis C. They were not correlated with serum alanine aminotransferase (ALT) or HBV-RNA levels in liver tissues (in cases of chronic hepatitis B). However, the expression of TGFalpha mRNA tended to be higher in the livers of patients with serum AFP levels raised. CONCLUSION: Overexpression of TGFalpha mRNA in liver seems to be associated with the regeneration of hepatocytes rather than hepatic necrosis or viral replication. Also, it may be closely related to the development or growth of HCC, especially in the livers of chronic hepatitis B.
Alanine Transaminase ; Blotting, Northern ; Carcinoma, Hepatocellular* ; DNA, Complementary ; Hepatitis B, Chronic ; Hepatitis C, Chronic ; Hepatitis* ; Hepatitis, Chronic ; Hepatocytes ; Humans ; Liver* ; Necrosis ; Polymerase Chain Reaction ; Regeneration ; Reverse Transcription ; RNA ; RNA, Messenger ; Transforming Growth Factor alpha* ; Transforming Growth Factors*

BACKGROUND/AIMS: Transarterial chemoembolization (TACE) has been reported to be one of the useful palliative treatments in patients with unresectable hepatocelluar carcinoma. However, Bile duct injuries following TACE have been reported occasionally. In this study, we intended to clarify the incidence, pathogenic mechanisms and clinical implications of bile duct injuries following TACE. METHODS: A total of 950 consecutive patients with hepatocellular carcinoma (HCC) were subjected. 807 patients were treated with TACE. The remaining 143 were treated with transarterial chemoinfusion (TACI) of cisplatin. RESULTS: None of 143 HCC patients treated with TACI revealed to have any ischemic biliary injury radiologically. In contrast, out of 807 with TACE, 17 (2%) appeared to have biliary complications. Twelve out of 17 (71%) had bilomas at subcapsular area, three out of 17 (18%) had focal strictures at common hepatic duct or common bile duct with marked dilatation of intrahepatic bile ducts and two out of 17 (11%) had diffuse mild dilatation of intrahepatic bile ducts. Interestingly, two (17%) out of 12 bilomas were found at the lobe which was not embolized with Gelfoam. The median sessions of TACE to the occurrences of focal strictures tended to be longer compared with those of bilomas (median: 6 vs. 2.5; p=0.08). All three patients with focal strictures and four (33%) out of 12 patients with bilomas were associated with serious bacterial infections at presentation. CONCLUSIONS: Biloma seems to be caused by lipiodol rather than Gelfoam; focal strictures of large bile ducts by Gelfoam. It is suggested that adjustments of the amounts of lipiodol or Gelfoam and the sites or embolization may be required to reduce the ischemic biliary injuries following TACE.
Bacterial Infections ; Bile Ducts* ; Bile Ducts, Intrahepatic ; Bile* ; Carcinoma, Hepatocellular ; Cisplatin ; Common Bile Duct ; Constriction, Pathologic ; Dilatation ; Ethiodized Oil ; Gelatin Sponge, Absorbable ; Hepatic Duct, Common ; Humans ; Incidence ; Palliative Care