A 63-year-old Korean man presented with generalized, asymptomatic, discrete papules and coalescent annular plaques for one year. Interestingly, the patient complained of conjunctival congestion, concurrently with aggravation of the skin lesion. Histopathologic findings of the skin lesion and conjunctiva revealed giant cells engulfing fragmented elastic fibers, and a diagnosis of actinic granuloma with ocular involvement was made. Ten months later, the patient revisited with a two-week history of bilateral temporal headache, neck pain, intermittent jaw claudication, and blurred vision. Biopsy of the temporal artery confirmed the clinical diagnosis of temporal arteritis. Both actinic granuloma and temporal arteritis show similar pathologic process, and this case supports the hypothesis that actinically degenerated elastic tissue is likely to be the antigenic basis of actinic granuloma of the skin and temporal arteritis.
Actins* ; Biopsy ; Conjunctiva ; Diagnosis ; Elastic Tissue ; Estrogens, Conjugated (USP) ; Giant Cell Arteritis* ; Giant Cells ; Granuloma* ; Headache ; Humans ; Jaw ; Middle Aged ; Neck Pain ; Skin ; Temporal Arteries

The distribution of GABA and/or glycine like immunoreactive nerve terminals on the soma of the masseteric gamma motoneurons were investigated using retrograde tracing of WGA-HRP (wheat germ agglutinin conjugated horseradish peroxidase) and postembedding immunogold labeling methods in serial ultrathin sections. Quantitative analysis of 140 nerve terminals apposing on somata of gamma motoneuron size less than 21 mm in average diameter was performed. The results obtained were as follows. 1. Synaptic covering % of apposing nerve terminals was 21.45+/-11.48% and packing density was 12.85+/-6.17. 2. Nerve terminals immunoreactive (IR) to GABA or glycine were F type containing pleomorphic vesicles with round shape predominant. Majority of nerve terminals immunonegative to GABA or glycine were S type containing spherical vesicles and few of them were F type. 3. 11.42+/-10.00% of examined nerve terminals were IR to GABA only, and 12.71+/-9.85% were IR to GABA and glycine, and 15.21+/-9.58% were IR to glycine only. 4. Synaptic covering % of nerve terminals IR to glycine only was highest (4.58+/-4.50%), followed in order by GABA and glycine (3.18+/-2.77%), and GABA only (2.38+/-2.06%). 5. Among all terminals, immunonegative nerve terminals (60.66+/-14.65%) were much more than nerve terminals immunoreactive to GABA and/or glycine (39.34+/-14.65%) These results show that inhibitory synaptic input and synaptic organization of the masseteric gamma motoneurons reveal characteristic features in contrast to that of alpha motoneurons and which may correlated to the electrophysi-ological characteristics of masseteric gamma motoneurons.
Animals ; Armoracia ; Carisoprodol ; gamma-Aminobutyric Acid* ; Glycine* ; Jaw* ; Presynaptic Terminals* ; Rats* ; Wheat Germ Agglutinin-Horseradish Peroxidase Conjugate

Angiomyxolipoma is a rare variant of lipoma, which is described by Mai, 1996, at first. The nine cases of which have been reported to date. Microscopically, the lesion consists of adipose tissue with the paucicellular myxoid areas and fat tissue with numerous thin, dilated, and congestive blood vessels. The reported cases mostly located to the superficial layer on the scalp, subungual, extremities in adults. We report one case of angiomyxolipoma located in the submuscular and parosteal area in the distal femur around knee joint in a child.
Adipose Tissue ; Adult ; Blood Vessels ; Child ; Estrogens, Conjugated (USP) ; Extremities ; Femur ; Humans ; Knee Joint ; Lipoma ; Scalp

Previous studies have shown that inhibitory synaptic inputs are different between in spinal and trigeminal motor systems and activities of jaw closing and opening alpha motoneurons are different during a chewing cycle. This study examined the distribution of inhibitory synapses made on masseter and digastric motoneurons by using retrograde tracing of wheat germ agglutinin conjugated to horseradish peroxides (WGA-HRP) combined with postembedding immunogold labeling on serial ultrathin sections.Many boutons IR (immunoreactive) to GABA and/or glycine were found to appose on two kinds of motoneurons, which were containing pleomorphic vesicles (a mixture of round, oval and flattened vesicles) and exhibited symmetrical synaptic contacts on the somata. Packing density and synaptic covering % were higher in digastric than in masseter motoneurons. Of 703 boutons apposing on 12 masseter motoneurons, 6.08+/-3.51, 29.67+/-8.89 and 17.78+/-5.22% were IR to GABA only, glycine only, and both GABA and glycine, respectively. Of 637 boutons apposing on 11 digastric motoneurons, 6.37+/-4.64, 19.74+/-8.25 and 12.01+/-5.38% were IR to GABA only, glycine only, and both GABA and glycine, respectively. Proportions of glycine IR boutons were higher than that of GABA IR boutons in both masseter and digastric motoneurons. Packing density and proportion of boutons IR to GABA and/or glycine were higher in jaw closing than in jaw opening motoneurons (packing density, 12.03+/-1.58 vs 10.28+/-2.99; proportion of IR boutons, 53.54+/-8.94% vs 38.12+/-9.38% in jaw closing and opening motoneurons, respectively). These results provide ultrastructural evidence that GABA and glycine act as important neurotransmitters for modulation of jaw movement and that proportion of inhibitory synapses is higher in jaw closing than in jaw opening motoneurons.
Animals ; Armoracia ; gamma-Aminobutyric Acid ; Glycine ; Jaw ; Mastication ; Neurotransmitter Agents ; Peroxides ; Rats* ; Synapses ; Triticum ; Wheat Germ Agglutinin-Horseradish Peroxidase Conjugate

Recently, we experienced two advanced gastric cancer (AGC) patients younger than 17 years of age. The first case was a 15-year, 2-month-old male who had suffered from epigastric soreness for 5 weeks. His grandfather died of gastric cancer at 39 years of age. Under the diagnosis of AGC, he underwent a total gastrectomy with D2 lymph node dissection. There was no evidence of distant metastasis. Pathologic examination revealed a 4.5x4 cm, signet ring cell adenocarcinoma with subserosal invasion and with metastasis in 9 of 42 regional lymph nodes (T2bN2M0). The second case was a 17-year, 11-month-old male who had suffered from epigastric pain for 2 years without familial clustering. Under the diagnosis of AGC, he underwent a distal subtotal gastrectomy with D2 lymph node dissection. There was no evidence of distant metastasis. Pathologic examination revealed a 3x2 cm, signet ring cell adenocarcinoma with subserosal invasion and with metastasis in 9 of 45 regional lymph nodes (T2bN2M0). The two patients have been alive without recurrence for 27 months and 4 months, respectively. Even among teenagers, patients with abdominal complaints should be subjected to a thorough examination of the gastrointestinal tract.
Adenocarcinoma ; Adolescent ; Diagnosis ; Gastrectomy ; Gastrointestinal Tract ; Humans ; Infant ; Lymph Node Excision ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Recurrence ; Stomach Neoplasms*

We report a case of vesical endometriosis in a 34 year old female patient and review literature. Managements include partial cystectomy, hormonal treatment and radiation. In this case, we select the hormonal treatrnent because the vesical endometriosis was in the fixed portion of the bladder.
Adult ; Cystectomy ; Endometriosis* ; Female ; Humans ; Urinary Bladder

PURPOSE: During recent two decades, therapeutic strategy for epidermoid carcinoma of anal canal has been changed on basis of the knowledge of the natural course and biologic features. The current study evaluated the treatment outcome and prognostic factors in epidermoid carcinoma of the anal canal. METHODS: Fifty-seven cases with epidermoid carcinoma of anal canal were treated curatively in Seoul National University College of Medicine from 1976 to 1997. The sex ratio was 1.5 to 1 with male predominance, with a median age of 57.0 years. The histology consisted of 59.6% (34 cases) in squamous cell carcinoma and 40.4% (23 cases) in cloacogenic carcinoma. According to UICC/AJCC staging system, there were 24.6% in stage I, 28.1% in stage II, 31.6% in stage IIIa and 15.8% in stage IIIb. Operation- based treatment was performed in 96.6% of 29 cases during period I (1976~1988) and in 60.7% of 28 cases during period II (1989~1997). Forty-five cases were treated on the basis of operation: 13 cases, operation only; 20, operation plus radiation; 12, operation plus chemoradiotherapy. And 12 cases were managed by combined radiation and chemotherapy. RESULTS: On median follow-up of 52.0 months (range, 1~160 months), there were 19.3% in local recurrence and 8.8% in systemic recurrence. Recurrence rates were not significantly related to therapeutic strategy (P=0.37). The overall 5-year survival rate was 74.9%. The 5-year survival rates according to therapeutic strategy were 73.3% in the operation-based treatment and 80.0% in the combined radiation and chemotherapy. Survival rates were not significantly related to therapeutic strategy (P=0.48). Three cases, whose sizes were 1 cm, 2 cm and 2.5 cm without lymph node metastasis, were excised locally and are still alive without recurrence. In the multivariate analysis, the metastatic status of lymph nodes had the only independent significant influence on survival. CONCLUSIONS: Combined radiation and chemotherapy in epidermoid carcinoma of anal canal is the preferred treatment for sphincter-preservation, and local excision in early lesion have good outcome without morbidity associated with chemotherapy or radiation therapy. In this study, lymph node status was the only prognostic variable.
Anal Canal* ; Carcinoma, Squamous Cell* ; Chemoradiotherapy ; Drug Therapy ; Follow-Up Studies ; Humans ; Lymph Nodes ; Male ; Multivariate Analysis ; Neoplasm Metastasis ; Recurrence ; Seoul ; Sex Ratio ; Survival Rate ; Treatment Outcome*

Periodontal-masseteric reflex is implicated in the control of jaw movement and masticatory force during chewing foods. This study is aimed to investigate the synaptic arrangement of mesencephalic periodontal afferents in the trigeminal motor nucleus and to identify the neurotransmitter involved in the presynaptic control of them through the intra-axonal staining of horseradish peroxidase combined with postembedding immunogold methods. Most of the labeled terminals showed synaptic contacts with the small sized dendritic shafts or distal dendrites, while synaptic contacts with the somata or proximal dendrites were not observed. More than one third of the analyzed labeled boutons received presynaptic input from pleomorphic vesicles containing ending (p-ending). About 11% of labeled boutons showed synaptic triads. All the analyzed boutons made synaptic contacts with one to four neuronal profiles and those showing synaptic contact with five or more were not observed. Labeled terminals were larger than presynaptic p-endings. A large number of the analyzed p-endings showed GABA like immunoreactivity. These observations provide evidence that periodontal afferent terminals show very simple and characteristic synaptic arrangements in the trigeminal motor nucleus and that p-endings presynaptic to them may use GABA as a neurotransmitter for presynaptic inhibition.
Animals ; Bite Force ; Dendrites ; gamma-Aminobutyric Acid ; Horseradish Peroxidase ; Jaw ; Mastication ; Neurons ; Neurotransmitter Agents ; Rats* ; Reflex

Osteopoikilosis is an osteosclerotic dysplasia of an unknown origin, and this malady is both extremely rare and hereditary and sporadic in nature. It is sometimes asymptomatic and incidentally diagnosed with radiologic images. A familial history and concomitant disease might also be present. In this study, we report on a 31-year-old woman who suffers from pelvic pain and she was diagnosed as having osteopoikilosis around both hip joints by the radiological images. We also review the relevant medical literature.
Adult ; Female ; Hip ; Hip Joint ; Humans ; Osteopoikilosis ; Pelvic Pain

BACKGROUND AND OBJECTIVES: Oxidative stress plays an important role in the pathogenesis of coronary atherosclerosis and spasm. We investigated whether the polymorphisms in two oxidative stress-related genes, paraoxonase and p22phox, are associated with risks of coronary artery spasm and stenosis. SUBJECTS AND METHODS: The study comprised of 116 patients with variant angina, 118 patients with coronary artery stenosis and 117 control subjects, who were all classified by coronary angiography. In all three groups, the genotype frequencies of the Q192R polymorphism of the paraoxonase gene and C242T polymorphism of the p22phox gene were analyzed, and the serum thiobarbituric acid-reactive substance concentrations measured. RESULTS: The frequency of the RR genotype of the paraoxonase Q192R polymorphism was significantly higher in patients with variant angina and coronary artery stenosis than in the control subjects (40.4% in variant angina and 37.8% in coronary artery stenosis vs. 24.7% in control, p=0.020 and 0.048, respectively). From the multivariate analysis, the odds ratio of the RR genotype was 2.240 for variant angina (95% confidence interval ; 1.012-4.956), and 2.333 for coronary artery stenosis (95% confidence interval ; 1.140-4.777), in relation to the control subjects. The thiobarbituric acid-reactive substance level was significantly higher in the RR type than in the QQ+QR types (RR vs. QQ+QR : 1.106+/-0.420 nmol/mL vs. 0.949+/-0.311 nmol/mL, p=0.028). There was no significant difference in the prevalence of the C242T polymorphism of the p22phox gene between the three groups. CONCLUSION: The RR genotype of the paraoxonase gene Q192R polymorphism was found to be an independent risk factor for both coronary spasm and stenosis.
Angina Pectoris ; Aryldialkylphosphatase* ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis* ; Coronary Vessels* ; Genotype ; Humans ; Multivariate Analysis ; Odds Ratio ; Oxidative Stress* ; Polymorphism, Single Nucleotide ; Prevalence ; Risk Factors ; Spasm