Angiomatoid fibrous histiocytoma is a rare soft tissue tumor that generally affects children and young adults. We report a case of angiomatoid fibrous histiocytoma in an 11-year-old boy who complained of a back mass for 3 years. Surgical excision was performed. The excised specimen showed a 4.0 x 3.6 x 3.0 cm, well circumscribed, grayish white tumor, with multicystic changes. Histological examination showed proliferation of spindle or round shaped tumor cells. There was a dense fibrous pseudocapsule with prominent chronic inflammatory cell infiltrates.
Child ; Histiocytoma, Benign Fibrous* ; Humans ; Immunohistochemistry ; Male ; Young Adult

To evaluate the role of epidermal growth factor receptor(EGF-R) and transforming growth factor alpha (TGF-alpha) in transitional cell carcinoma of the urinary bladder, immunohistochemical studies using monoclonal antibodies to the human EGF-R and TGF-alpha were performed on formalin fixed,paraffin-embedded tissue with the urothelium extracted from patients with TCC(59 cases) and non-TCC(13 cases). EGF-R was expressed in the outer, middle and basal layers of TCC and non-TCC urothelium. The staining intensity of EGF-R in the outer layer was not different between TCC and non-TCC urothelium. The strong staining intensity of EGF-R in the outer, middle and basal layers was noted in 5(14%), 4(11 %) and 5(14%) cases, respectively in the low grade TCC(35 cases of grade I and II ), however all the layers of 13(54%) cases of the high grade TCC(24 cases of grade III and IV) showed strong staining intensity. The strong staining intensity of EGF-R in the three layers of the superficial tumors(34 cases of Ta and T1) was noted in 6(18%), 5(15%) and 5(15%) cases, whereas 12(48%), 12(48%) and 13 (52% ) cases in the invasive tumors(25 cases of T2, T3, T4). TGF-alpha was expressed in 27(46%) cases of TCC and 11(85%) cases of non-TCC urothelium. TGF-alpha was expressed in 24(69%), 15 (43%) and 12(34% ) cases in the three layers of low grade TCC, respectively and only 3(12 %) cases in the high grade TCC. TGF-alpha expression in the outer, middle and basal layers of the superficial TCC was noted in 22(65 %), 14(41%) and 12(35%) cases, respectively, whereas that of the invasive TCC was 6 (20%), 4(16%) and 3(12%) cases, respectively. These results suggest that the distribution of EGF-R in the tumor cells are not an important factor. However, the binding capacity of EGF-R to EGF and TGF-alpha may be an important change in the carcinogenesis of the bladder TCC and the expression intensity of EGF-R and TGF-alpha in TCC cells may be an important factor to determine the biological behavior of the bladder TCC.
Antibodies, Monoclonal ; Carcinogenesis ; Carcinoma, Transitional Cell* ; Epidermal Growth Factor* ; Formaldehyde ; Humans ; Receptor, Epidermal Growth Factor* ; Transforming Growth Factor alpha ; Urinary Bladder* ; Urothelium

PURPOSE: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been proposed for controlling peritoneal seeding metastasis in some kinds of cancers, including those of colorectal origin, but their safety and oncological benefits are subjects of debate. We present our early experience with those procedures. METHODS: Data were retrospectively collected from all patients with peritoneal carcinomatosis (PC) and pseudomyxoma peritonei (PMP) treated using CRS and HIPEC at Yonsei Cancer Center between July 2014 and July 2015. Short-term outcomes and risk factors for postoperative complications were analyzed. RESULTS: Twenty-three patients with PC (n = 18) and PMP (n = 5) underwent CRS and HIPEC. Median follow-up and age were 2 months and 54 years, respectively. The median peritoneal carcinomatosis index score was 15, and CC0-1 was achieved in 78.3% of all patients. The median operation time and bleeding loss were 590 minutes and 570 mL, respectively. Grade-IIIa/grade-IIIb complications occurred in 4.3% (n = 1)/26.1% (n = 6) of the patients within 30 days postoperatively, and no 30-day mortalities were reported. Factors related to postoperative complications with CRS and HIPEC were number of organ resection (P = 0.013), longer operation time (P < 0.001), and amount of blood loss (P = 0.003). All patients treated with cetuximab for recurred colorectal cancer had grade-III postoperative complication. CONCLUSION: Our initial experience with CRS and HIPEC presented about 30% grade-III postoperative complications. Therefore, expert surgeons need to perform those procedures with great caution in selected patients who might benefit from it.
Carcinoma ; Cetuximab ; Colorectal Neoplasms ; Cytoreduction Surgical Procedures ; Drug Therapy* ; Follow-Up Studies ; Hemorrhage ; Humans ; Mortality ; Neoplasm Metastasis ; Postoperative Complications ; Pseudomyxoma Peritonei ; Retrospective Studies ; Risk Factors ; Surgeons

The anatomical variations and shapes of the hymen with congenital anomalies of the external genitalia were investigated prospectively during the routine physical examination of 1,500 female infants born between March, 1992, and July, 1992, at the Taegu Fatima Hospital. All underwent a very careful inspection of external genitalia within the first 24 hours of life, and their external genitalia were photographed for confirmation. Abundant hymenal tissue that appeared redundant was observed in nearly all neonates. The annular hymen (89.1%) was the most common type. Of the annular hymens, 91.9% had a central orifice and the remainder had a ventral orifice. External ridges, intravaginal ridges, and clefts were the most frequent anatomical variations, representing 71.5%, 50.7%, and 40.5%, respectively. Congenital anomalies of the external genitalia were detected in 20 patients (1.4%). The anomalies were one case of imperforate hymen, one case of Skene's duct cyst, sixteen cases of hymenal cyst, and two cases of hymenal polyp. Imperforate hymen was incised and drained, and Skene's duct cyst was successfully treated with needle aspiration. Of 16 hymenal cysts, seven with a stalk were excised and the others without a stalk were managed with needle aspiration. Hymenal polyp, a larger form of tag with polypoid shape, was excised. All procedures were performed at the nursery without anesthesia. All the patients so treated were compeletely asymptomatic and had normal genitalia at follow-up. In conclusion, routine physical examination of the female newborn infant should include a careful inspection of the external genitalia with the knowledge of shapes and anatomical variations of the hymen. Longitudinal studies are necessary to understand developmental changes and the effects of estrogens.
Anesthesia ; Daegu ; Estrogens ; Female ; Female* ; Follow-Up Studies ; Genitalia* ; Humans ; Hymen* ; Infant ; Infant, Newborn* ; Longitudinal Studies ; Needles ; Nurseries ; Physical Examination ; Polyps ; Prospective Studies

BACKGROUND: Lichen nitidus and lichen striatus are often confused because they are thought to share similar clinical and histopathologic features. OBJECTIVE: The purpose of this study was to histopathologically and immunohistochemically evaluate the characteristic differences and common features between the two disorders. METHOD: Histopathological and immunohistochemical slides of 14 patients with lichen nitidus and 14 patients with lichen striatus were reviewed. Immunohistochemical staining with anti CD45RO, CD68, CD4, CD8 and CD20 antibodies was performed. RESULTS: 1) In lichen nitidus, the frequent histopathologic findings were liquefaction degeneration of the basal layer (100%), edema of the dermis within the areas of the infiltate (100%), and claw-like rete ridges (96.8%). 2) In lichen striatus, the frequent histopathologic findings were edema of the dermis within the areas of the infiltate (100%), liquefaction degeneration of the basal layer (92.9%), and perivascular inflammatory cell infiltrate (92.9%). 3) The majority of the cells in the infiltrate of lichen nitidus were T lymphocytes mixed with histiocytes. In most cases, CD4+ T lymphocytes predominated CD8+ T lymphocytes. 4) However, in lichen striatus, infiltrating cells in the dermis were composed dominantly of T lymphocytes, with a minority of histiocytes. CD8+ T lymphocytes were also found to outnumber CD4+ T lymphocytes. CONCLUSION: Our study did differentiate each disease as having distinctive characteristics and differences. Furthermore, the immunologic pathophysiology of lichen nitidus and lichen striatus was proved to be distinctive. Therefore, we conclude that these two diseases are not in the spectrum of the same disease, but separate disease entities which are indeed different from each other.
Antibodies ; Dermis ; Edema ; Histiocytes ; Humans ; Lichen Nitidus* ; Lichens* ; T-Lymphocytes

Anorectal malignant melanoma (AMM) is a very rare and aggressive disease. The purpose of this article is to review the clinical features of AMM, to understand treatment options, and optimal therapy by reviewing pertinent literature. Traditionally an abdominoperineal resection (APR) sacrificing the anal sphincter has been performed for radical resection of cancer, but recently, wide excision of AMM is attempted since quality of life after surgery is an important issue. Some authors reported that there was no difference in five-year survival between the patient who underwent an APR and wide excision. The goal of both APR and wide excision was to improve survival with R0 resection. Adjuvant chemoradiation therapy can be performed to achieve an R0 resection. AMM shows very poor prognosis. At this time, research on AMM is insufficient to suggest a treatment guideline. Thus, treatment options, and a therapeutic method should be selected carefully.
Anal Canal ; Anus Neoplasms ; Humans ; Melanoma* ; Prognosis ; Quality of Life ; Skin Neoplasms

INTRODUCTION: The practicing of patient-centered medical services means a change in the pattern of the nature of doctor-patient relationship. The doctor oriented relationship is now moving to the pattern that patients resolve problems autonomously and participate in the decision-making in medical services. Authors performed this study to investigate the patient centeredness and influencing variables in medical students. METHODS: Authors recruited 94 medical students before psychiatric clinical clerkship and all subjects were assessed by structured questionales including socio-demographic data, frequency of receiving doctor-patient relationship lectures, Minnesota multiphasic personality inventory (MMPI), Meyers-Briggs type indicator (MBTI), the authoritarian personality scale (AP), job satisfaction scale (JS), patient practitioner orientation scale (PPOS), problem-solving decision-making scale (PSDM), and Beisecker locus of authority in decision-making scale (BLAS), and the questionnaire of JS, PPOS, PSDM, and BLAS were rechecked after psychiatric clinical clerkship. RESULTS: After psychiatric clinical clerkship, the score of JS, PPOS were higher than before. The group who had a good memory for taking a doctor-patient relationship lecture showed higher scores of the BLAS and PSDM than unexposed group. The AP was related with MBTI, correlated with the subscale of MMPI, however, inversely correlated with PPOS after psychiatric clinical clerkship. CONCLUSION: The authoritarian personality trait was related not only with other personality trait including introversion and psychopathic deviation (Pd) but also with patient-centeredness. Taking a lecture in doctor-patient relationship is positively related to the patient-centeredness.
Clinical Clerkship ; Humans ; Introversion (Psychology) ; Job Satisfaction ; Lectures ; Memory ; MMPI ; Surveys and Questionnaires ; Students, Medical*

PURPOSE: The insertion site of K-wire for skeletal traction is proximal part of tibia or distal part of femur. However, people prefer proximal tibia over distal femur due to lower risk of infection rate when change to interlocking IM nailing is needed. We evaluated the infection rate of interlocking IM nailing. MATERIALS AND METHODS: Fourty-seven patients were included in this study who underwent interlocking IM nailing due to femur shaft fracture. Traction was applied at the distal femur in 19 cases and proximal tibia in 10 cases before interlocking IM nailing. No skeletal traction was applied to the remaining 18 cases. Thirty-eight patients were male and 9 were female. The average age at the time of surgery was 36.7 years old (range, 15~17 years). The average traction period was 9.5 days (range, 3~33 days) and the average followed-up period was 17.2 months. RESULTS: In the distal femoral traction group, 8 cases of superficial pin tract infection developed, but no case of deep infection such as osteomyelitis occurred. In the proximal tibia traction group, 2 cases of superficial pin tract infection developed, but no case of deep infection occurred. In the group that received no skeletal traction before interlocking IM nailing, no case of infection developed. CONCLUSION: In femur shaft fracture, the distal femoral skeletal traction followed by interlocking IM nailing of femur, compared to proximal tibia skeletal traction, did not increase the risk of deep infection such as osteomyelitis.
Female ; Femur* ; Fracture Fixation, Intramedullary* ; Humans ; Incidence* ; Male ; Osteomyelitis ; Tibia ; Traction*

BACKGROUND: Hypopigmentation is one of the complications developed after laser resurfacing. There have been few data about hypopigmentation developed after Er: YAG laser resurfacing, especially in darker skin. OBJECTIVE: The objective of this study was to assess the clinical and histopathologic features of hypopigmentation developed after Er: YAG laser resurfacing. METHODS: One hundred and ninety patients have been included in this study. Ninety seven patients were treated with short pulsed Er: YAG laser, 2mm spot sized handpiece at the setting of 12.5-15.0J/cm2. Fifty two patients were treated with variable pulsed Er: YAG laser, 5mm spot sized handpiece at the setting of 7.0-7.5J/cm2 and 7msec pulse duration. Forty one patients were treated with dual mode Er: YAG laser, 4mm spot sized scanner at the setting of 17.5J/cm2 ablation mode and 3.15J/cm2 coagulation mode. Incidence, time of onset, duration of hypopigmentation were evaluated throughout the medical charts and serially checked photographs. Skin biopsy was performed in four patients at the hypopigmentation site for histopathologic and electron microscopic examinations with informed consents. RESULTS: Hypopigmentation was observed in twenty six patients; eight in short pulsed Er: YAG laser, eight in variable pulsed Er: YAG laser, ten in dual mode Er: YAG laser. According to the time of onset of hypopigmentation, twelve patients developed hypopigmentation within one month, five patients in two months, three patients within three months, three patients within four months, two patients within five months, and one patient within six months. Twenty out of twenty six patients recovered skin coloration within six months, and two patients within twelve months. On the other hand, four patients had persisted hypopigmentation for more than one year. Melanosome appeared to be decreased but melanocytes appeared to be present in normal numbers on the histopathologic and electron microscopic examinations. CONCLUSION: Although hypopigmentation is one of the frequent complicaions of Er: YAG laser resurfacing, it is temporary in most cases. Thermal damage due to long pulse duration of laser seems to be a very important factor in inducing hypopigmentation.
Incidence ; Biopsy

Hypocalcemia is due to Hypoparathyroidism, Vitamin D deficiency, Hypomagnesemia, Inadequate calcium intake. The benefits of breast-feeding are well established. There are no need to supply calcium or Vitamin D in breast-fed infant. We report a case of infantile hypocalcemia caused by Vitamin D deficiency in exclusively breast-fed infant. He had no hypocalcemic symptom and hypocalcemia was found incidentally by routine laboratory tests during pneumonia treatment. He was presented with a low serum calcium level and 1,25(OH)2 Vit D3 level and high PTH. He was improved by Calcium and Vitamin D supplement. After then his mother continued breast feeding exclusively and resisted to feed her baby weaning food. During follow up period, hypocalcemia was recheked after discontinuation of vitamin D supplement. At 11 months of age, the calcium level was normal without vitamin D supplement after he had eaten weaning food. This report describes a case of hypocalcemia induced by vitamin D deficiency in exclusively breast-fed infant, with review of the literature.
Breast Feeding ; Calcium ; Follow-Up Studies ; Humans ; Hypocalcemia* ; Hypoparathyroidism ; Infant* ; Mothers ; Pneumonia ; Vitamin D Deficiency* ; Vitamin D* ; Vitamins* ; Weaning