BACKGROUND: Desmosomes are adhesive intercellular junctions that form an important component of the junction complexes of epithelial cells. They provide intercellular links between the intermediate filament cytoskeletons of adjacent cells and are thus involved in maintaining the structural integrity of tissues. OBJECTIVE: Calcium and retinoids are major regulators of epidermal differentiation and their role on keratin proteins are well known. However, their effects on desmosome moleucles are unknown. To address this question we initiated a study of the effects of these epidermal differentiation regulators on desmosomal components, i.e., desmoplakin, desmoglein, and pemphigus antigens. METHODS: We used monoclonal antibodies against desmoplakin(DP) and desmoglein(DG), and sera from patients with pemphigus vulgaris(PV), pemphigus foliaceus(PF) and paraneoplastic pemphigus (PNP) to study the effects of calcium and retinoic acids, which are major regulators of epidermal differentation, on desmosomal protein formation in human cultured deratinocytes. We performed immunofluorescence, immunoblotting and immunoprecipitation study using human keratinocytes cultured in high calcium media with or without retinoic acid and in low calcium media with or without retinoic acid. RESULTS: 1. In low calcium (0.15mM) media, PV antigen and DG were produced in a small amount and it appeared that these desmosomal proteins were located in cytosol. Whereas in high calcium (1.8mM) media, production of these desmosomal proteins was increased not they were assembled at the desmosomal structures located in cell-cell contact margins. 2. PF antigen, which was identical to the DG, were not produced or expressed in cultured keratinocytes even when cultured in high calcium media. 3. PNP antigen and DP were produced in cultured keratinocytes grown in both high low calcium media but their production was increased in high calcium media and only in high calcium media they were assembled at the desmosomal structures. 4. Retinoic acids induced loosening of cell-cell contacts of cultured keratinocytes and decreased the production of desmosomal proteins. CONCLUSION: Our results suggests calcium is a major regulator of the production and assembly of desmosomal proteins including pemphigus antigens, but PF sera and monoclonal antibodies against DG show different antigen binding characteristics. It appears that retinoic acids inhibit production of desmosomal proteins.
Adhesives ; Antibodies, Monoclonal ; Calcium* ; Cytoskeleton ; Cytosol ; Desmogleins ; Desmoplakins ; Desmosomes* ; Epithelial Cells ; Fluorescent Antibody Technique ; Humans ; Immunoblotting ; Immunoprecipitation ; Intercellular Junctions ; Intermediate Filaments ; Keratinocytes ; Pemphigus ; Retinoids ; Tretinoin*

No abstract available.
Ear, Middle*

PURPOSE: To assess how accurately computed tomography (CY) can demonstrate the abnormal findings which are believed to cause the clinical signs and symptoms of hearing loss (HL), vertigo and facial paralysis (FP) in patients with temporal bone trauma. MATERIALS AND METHODS: The authors studied CT scans of 39 ears in 35 patients with temporal bone trauma. CT scans were performed with 1-115 mm slice thickness and table incrementation. Both axial and coronal scans were obtained in 32 patients and in three patients only axial scans were obtained. We analyzed CT with special reference to the structural abnormalities of the external auditory canal, middle ear cavity, bony labyrinth, and facial nerve canal, and correlated these findings with the actual clinical signs and symptoms. As to hearing loss, we evaluated 32 ears in which pure tone audiometry or brainstem evoked response audiometry had been performed. RESULTS: With respect to the specific types of HL, CT accurately showed the abnormalities in 84% (16/19) in conductive HL, 100% (2/2) in sensorineural HL, and 25% (2/8) for mixed HL. When we categorized HL simply as conductive and sensorineural, assuming that mixed be the result of combined conductive and sensorineural HL, CT demonstrated the abnormalities in 89% (24/27) for conductive HL and 50% (5/10) for sensorineural HL. Concerning vertigo and FP, CT demonstrated abonormalities in 67%(4/6), and 29% (4/14), respectively. CONCLUSION: Except for conductive HL, CT seems to have a variable degree of limitation for the demonstration of the structural abnormalities resulting sensorineural HL, vertigo or facial paralysis. It is imperative to correlate the CT findings with the signs and symptoms in those clinical settings.
Audiometry ; Audiometry, Evoked Response ; Brain Stem ; Ear ; Ear Canal ; Ear, Inner ; Ear, Middle ; Facial Nerve ; Facial Paralysis ; Hearing Loss ; Humans ; Temporal Bone* ; Tomography, X-Ray Computed ; Vertigo

Subfalcial herniation secondary to a unilateral supratentorial space occupying lesion is frequently seen on the brain CT scan, however, the development of distal anterior cerebral artery infarction following compression of the terminal branches of the pericallosal artery against the falx during the period of subfalcial herniation is uncommon. For the last three years, we have experienced three cases of distal anterior cerebral artery infarction caused by subfalcial herniation on the brain CT scan. All patitnts had acute subdural hematomas resulting in subfalcial herniation on the first CT scan and subsequently developed focal infarctions in the ipsilateral paracentral lobule. The patients did not improve clinically and died several days after operation. The development of such infarction may reflect severe cerebral injury and portend a poor clinical outcome.
Anterior Cerebral Artery* ; Arteries ; Brain ; Hematoma, Subdural, Acute ; Humans ; Infarction* ; Infarction, Anterior Cerebral Artery ; Tomography, X-Ray Computed

No abstract available.

The cutaneous metastasis of pancreatic carcinoma by this technique is rarely reported in the literature. A 67-year-old woman was evaluated for left-sided abdominal pain and a palpable abdominal mass. Abdominal CT confirmed the presence of a solid mass involving the pancreas. Ultrasonically guided percutaneous aspiration biopsy was performed. About six month later, the patient was readmitted with a tender tumor mass at the site of the previous aspiration biopsy. Physical examination disclosed a 4 × 4 cm sized firm, tender tumor mass on the abdomen. Histopathological findings of the tumor mass are consistent with metasta tic lesions from a pancreatic carcinoma. We report a case that suggests cutaneous metastsis of pancreatic carcinoma by fine needle aspiration biopsy.
Abdomen ; Abdominal Pain ; Aged ; Biopsy* ; Biopsy, Fine-Needle* ; Biopsy, Needle ; Female ; Humans ; Neoplasm Metastasis* ; Pancreas ; Physical Examination ; Tics ; Tomography, X-Ray Computed

Hypohidrotic ectodermali dysplasia is a rare and heterogenous genodermatosis that is characterzed by hypohidrosis, hyptrichosis, dental hypoplasia, and a characteristic facies. A 16-month-old male was evaluated for anodontia and anhidrosis since birth. There was no family history of this disease. His face was characterized by a broad nose and sparse eyebrows and periorbital wrirkling. The skin was dry, and scalp hairs were thin and sparse. Skull X-ray finding revealed noth ing remarkable except de;ayed teeth eruption. His developmental status for which we used DDS'I' was slightly reduced on inental development and showed normal on physical development. A skin biopsy was done on skin from the left palm, which showed a few immature eccrine glands in the dermis. We report a typical form of hypohidrotic ectodermal dysplasia with a review of the literature.
Anodontia ; Biopsy ; Dermis ; Eccrine Glands ; Ectodermal Dysplasia 1, Anhidrotic* ; Eyebrows ; Facies ; Hair ; Humans ; Hypohidrosis ; Infant ; Male ; Nose ; Parturition ; Scalp ; Skin ; Skull ; Tooth

Wells' syndrome or eosinophilic cellulitis is an uncommon cutaneous disorder characterized by recurrent erythematous and edematous plaques that often resemble acute cellulitis. The characteristic microscopic findings are diffuse dermal eosinophilia with marked edema, and flame figures consisting of amorphous or granular eosinophilic material around collagen bundles of the dermis. Etiology and pathogenesis are unknown, but the disease has been found to be associated with infections, arthropod bites, drug administration, surgery and hematologic disorders. We report the case of a 55-year-old man with pancreatic carcinoma who was presented with an asymptomatic erythematous to brownish subcutaneous nodule on the left buttock of several days' duration. A biopsy specimen taken from the erythematous to brownish nodule showed many flame figures and diffuse infiltration of eosinophils in the dermis and subcutaneous fat tissue. The rapid resolution of the skin lesion with chemotherapy of the pancreatic carcinoma supports a relationship between the two conditions.
Arthropods ; Biopsy ; Buttocks ; Cellulitis ; Collagen ; Dermis ; Drug Therapy ; Edema ; Eosinophilia ; Eosinophils ; Humans ; Middle Aged ; Skin ; Subcutaneous Fat

BACKGROUND: Fixed drug eruptions(FDE) are a cutaneous reaction characterized by one or more circumscribed lesions that recur at the same site in response to a given medication. OBJECTIVE: The purpose of this study was to find the clinical and histopathological characteristics of FDE and to compare early FDE with late FDE histopathologically. METHOD: We clinically investigated 54 cases of FDE that visited the department of dermatology at the Kyunghee medical center from January 1993 to December 1996. Among them, 31 patients had skin biopsies and were evaluated histopathologically on the basis of duration. RESULTS: The results were summarized as follows: 1. Development of FDE did not show any difference according to sex and was evenly distributed over all the ages. 2. The latent periods of FDE were diverse in appearance from 30 minutes to 10 days, but mostly, the skin lesions erupted within 4S hours. 3. The most common skin lesions were erythematous macules. 4. Distribution of the lesions came out as solitary: 20.4%, multiple: 79.6%. S3.7% of the multiple lesions were localized to a part of body, and 16.3% were distributed over the whole body. 5. The areas in which the eruptions developed were (in descending order): upper extremity(37.0%), hand(31.5%), trunk(24.1%), face(24.1%). 6. In most cases(68.6%), the size and the number of lesions were greater in recurrente, rather than in first attacks. 7. The histopathological findings commonly showed perivascular mononuclear cell(MNC) infiltration (100%), pigmentary incontinence(77.4%), basal hydrophic degeneration(71.0%), eosinophil infiltration in dermis(61.3%), etc. 8. The epidermal histopathological findings such as spongiosis, exocytosis of MNC, basal hydrophic degeneration, keratinocyte necrosis and subepidermal vesicles could be seen more frequently in early lesions than in late ones. CONCLUSION: In our study, we were able to obtain meaningful results based on data from the combination of clinical and histopathological investigations. This study may give help to understand the characteristics of fixed drug eruptions and to plan future studies.
Biopsy ; Dermatology ; Drug Eruptions* ; Eosinophils ; Exocytosis ; Humans ; Keratinocytes ; Necrosis ; Skin

BACKGROUND: Pemphigus are chronic autoimmune blistering disorcers characterized by acantholysis. In addition to pemphigus vulgaris(PV), the major clinical variarts are pemphigus foliaceus(PF), paraneoplastic pemphigus(PNP) and drug-induced pemphigus(DP). Detection of pemphigus antigen is important for differential diagnosis as well as research work. Most investigators have identified pemphigus antigens by means of immunoprecipitation using metabolically radiolabeled cultured keratinocytes. However, immunorepitation is generally more expensive, hazardous and time-consuming than immunoblotting. Therefore, establishment of the immunoblotting as a standard technique for the detection of the pemphig us antigens is desirable. OBJECTIVE: To characterized pemphigus antigens by an immunobloting analysis of human epidermal extract and by indirect itnmunofluroscence study using human of cultured keratinocytes as a substraie. METHOD: We performed imrnunoblotting analysis af sera from patieiits with PV, PF, PNP and DP with human epidermal extract as a source of antigen. Indirect immunof uorescence study was also performed using human keratinocytes cultured in high or low calcium media for detection of pemphigus antigens. RESULTS: In an immunoblotting analysis, all(9/9) PV sera showed secific reactivities with a 130-KD protein and all(5/5) FF sera showed reactivities with a 150-KK protein, which is most likely desmoglein 1. Furthermore, one of nine PV serum also reacted with a 150-KD protein, which seems to be the identical antigen detected in PF. All PNP(3/3) sera showed reactivities with two protein bands, 210KD and 190KD. In our indirect imrnunofluorescence study using culltured human keratinocytes as a substrate, when keratinocytes were grown in low calcium media, no pimphigus antigens could be detected. However, when grown in high calciurn media, pemphigus vulga ris and paraneoplastic pernphigus antigens were present t the cell-cell contact areas with a puncta;e pattern, whereas pemphigus foliaceus antigen was not, presint in keratinocytes even when cultured in high calcium media. CONCLUSION: Our results suggests (1) immunoblotting analysis is a reliable technique for defining pemphigus antigen and could be a valuable tool for the differentiation of PV, PF and PNP and(2) PF antigen rnay not be expresseden cultured keratinocytes.
Acantholysis ; Blister ; Calcium ; Desmoglein 1 ; Diagnosis, Differential ; Fluorescent Antibody Technique, Indirect* ; Humans ; Immunoblotting ; Immunoprecipitation ; Keratinocytes* ; Pemphigus* ; Research Personnel