The cause of pemphigus vulgaris is autoimmune. The serum containes antibodies against the intercellular substance of stratified epithelium, as demonstrated by means of immunofluorescent staining. Therefore antigen-antibody reaction takes place in the intercellalar spaces of squamous epithelium and leads to acantholysis. The association of pemphigus with malignant conditions was frequently reported. Thus there is now increasing evidence of an association between malignaney and the production of pemphigus antibodies by a tumor itaelf. By the evidence that pemphigus is autoimmune disease, it is used to treat with corticosteroid and immunosuppressive drugs, such as methotrexate. Very high doses of corticosteroid appear to he necesaary for an adequate control of the disease. Even though large doae repersents an effective treatment of pemphigus vulgaris, side effects from thia form of therapy have heen quite significant. Two cases of pemphigus vulgaris are reported. .First patient, a 33 year-old housewife, with flaccid bullae and rupture to form erosions of 3 months duration especialIy on buccal mueosa and genitlia. Second patient, a 66 year-old female, with above skin lesions of 6 months duration on buccal mucosa and whole body. Clinically and histopathologically their eruptions were consistent with pemphigus vulgaris. Large initial dose of predniaolone was employed in these treatment. These patients were improved with treatment prednisolone. Prednisolone therapy gave rise to a large numbar of side effects of varying degrees of severity, such as iatrogenic diabetea mellitus, oral candidiasis, hypokalemia, and pychosis etc. At admission 57days, first case complained of lower abdominal pain and tenderness. At this point it was found clinically that the mass on vaginal vault is present. Punch biopsy was p rformed and confirmed epidermoid carcinoma poorly differentiated (stage V). Cystoscopy showed tumor mass of cervix with extension to bladder posterior wall. We advised. External radiation therapy for carcinoma for about 5 weeks (5,000 Rads) but hopeless she was discharged. Second. Patient was much improved without recurrence. Side effects of prednisolone were also controlled.
Abdominal Pain ; Acantholysis ; Adult ; Aged ; Antibodies ; Antigen-Antibody Reactions ; Autoimmune Diseases ; Biopsy ; Candidiasis, Oral ; Carcinoma, Squamous Cell ; Cervix Uteri ; Cystoscopy ; Epithelium ; Female ; Humans ; Hypokalemia ; Methotrexate ; Mouth Mucosa ; Pemphigus* ; Prednisolone ; Recurrence ; Rupture ; Skin ; Urinary Bladder

Pretibial myxedema is a rare condition whieh may occur following the active or treated hyperthyroidism. The preeise cause of pretibial myxedema is not known, but it is now established the Long Acting Thyroid Stimulator(LATS) is 7S-gammaglobulin, that it is present in the serum of 80% of patients with hyperthyroidism and that its activity is as being an autoantibody against a thyroid antigen, retroorbital tissues and in the skin. A 28-year old pregnant housewife was well until age 24 when she developed hyperthyroidism with swelling of the thyroid gland, exopbthalmos and clubbing of the fingers. She was treated with subtotal thyroidectomy 2 years ago at other clinic. The skin lesions revealed circumscribed, firm, and elevated nodules with excess hair growth on shin and dorsum of feet since their onset of one and half years to visit to our hospital. The hiatologic findings showed considerable amounts of mucin especially in the midportion of the dermis. The leaions were improved by the local application of 0.01% Fluocinolone acetonide(Synalar') ointment with occlusive dressing technique.
Adult ; Dermis ; Fingers ; Foot ; Hair ; Humans ; Hyperthyroidism ; Mucins ; Myxedema* ; Occlusive Dressings ; Skin ; Thyroid Gland ; Thyroidectomy

We herein report two cases of systemic contact dermatitis probably due to inhalation of mercury. The first case is a 13 year-old boy who developed generalized erythema and dyspnea following the use of a coin-bleaching solution of unknown ingredient in his room. And the second case is a 10 year-old boy who developed generalized scarlatiniform eruptions on his trunk and flexural aspect of his extremities after hreaking a clinical thermometer. The typical clinical feature, the inverted triangular shaped erythema on flexural aspect of inner thigh, were appeared in both patients. On patch testing, they showed positive reactions to mercury and other mercury compounds.
Adolescent ; Child ; Dermatitis, Contact ; Dyspnea ; Erythema ; Exanthema* ; Extremities ; Humans ; Inhalation ; Male ; Mercury Compounds ; Patch Tests ; Thermometers ; Thigh

Dermatitis Herpetiformis rarely in childhood, and certain features of the disease in children differ from its manifestations in adults. Juvenile dermatitis herpetiformis appears not to be the same disease as the typical dermatitis herpetiformis of adults. Juvenile dermatitis herpetiformis has been described as a predomimantly bullous disease, but rarely papulovesicular eruptions. This bullous eruption in children must be considered in the several entities such as bullous pemphigoid and erythema multiforme. Juvenile bullous dermatitis herpetiformis has not responded routinely to sulfapyridine and sulfone therapy. A 15-month-old child whose skin lesions fulfilled clinical, histologic, and therapeutic criteria for Juvenile dermatitis hepetiformis is reported. The skin lesions showed bullous eruptions and also complained of severe itching sensation different from bullous Juvenile dermatitis herpetiformis.
Adult ; Child ; Dermatitis Herpetiformis* ; Dermatitis* ; Erythema Multiforme ; Humans ; Infant ; Pemphigoid, Bullous ; Pruritus ; Sensation ; Skin ; Sulfapyridine

To investigate the diagnostic accuracy of ERCP in pancreatobiliary disease, the authors analysed the 1,244 cases of ERCP. The success rate of ERCP was 91.5%. The diagnostic accuracy of ERCP was 93.6% and complications occurred in 2.1%. Complications included pancreatitis,cholangitis and drug reactions. Among the biliary tract disease diagnosed, by ERCP, biliary tract stone was the most common finding. Compared with operative diagnosis of biliary tract stones,the sensitivity of ERCP diagnosis was 92.7% while that of sonographic diagnosis was 81.4%. The specificity of ERCP diagnosis was 94.4% while that of sonagraphic diagnosis was 80.9%. ln the diagnosis of common bile duct stones, ERCP was more accurrate than sonographic diagnosis. The results show that ERCP was a safe and effective diagnostic tool in the assessment of pancreatobiliary tract disease.
Biliary Tract ; Biliary Tract Diseases ; Cholangiopancreatography, Endoscopic Retrograde* ; Common Bile Duct ; Diagnosis ; Sensitivity and Specificity ; Ultrasonography

To investigate the diagnostic accuracy of ERCP in pancreatobiliary disease, the authors analysed the 1,244 cases of ERCP. The success rate of ERCP was 91.5%. The diagnostic accuracy of ERCP was 93.6% and complications occurred in 2.1%. Complications included pancreatitis,cholangitis and drug reactions. Among the biliary tract disease diagnosed, by ERCP, biliary tract stone was the most common finding. Compared with operative diagnosis of biliary tract stones,the sensitivity of ERCP diagnosis was 92.7% while that of sonographic diagnosis was 81.4%. The specificity of ERCP diagnosis was 94.4% while that of sonagraphic diagnosis was 80.9%. ln the diagnosis of common bile duct stones, ERCP was more accurrate than sonographic diagnosis. The results show that ERCP was a safe and effective diagnostic tool in the assessment of pancreatobiliary tract disease.
Biliary Tract ; Biliary Tract Diseases ; Cholangiopancreatography, Endoscopic Retrograde* ; Common Bile Duct ; Diagnosis ; Sensitivity and Specificity ; Ultrasonography

Fiddler's neck was first described by Peachey and Matthews in 1978 to denote a condition characterized by focal lichenification and pigmentation on the left side of violinist and violist neck just below the angle of the jaw. The etiologic facters are friction, local pressure, occlusion, poor hygiene and sweating. In only a few cases has a specific hypersensitivity to one or more of the ch!n rest material(wood, lacquer, dye) or the metallic fixing been found responsible. We report a case of 15-year-old female patient with Fiddler's neck who has played the violin for 8 years.
Adolescent ; Female ; Friction ; Humans ; Hygiene ; Hypersensitivity ; Jaw ; Lacquer ; Neck* ; Pigmentation ; Sweat ; Sweating

We present a case of carcinoma erysipelatoides which or iginated from an internal organ. The patient was a 50 year-old female who had peritoneal carcinomatosis, She presented an erythematous lesion resembling erysipelas on her right breast. Histopathologic findings were consistent with metastatic adenocarcinoma but clinically it was not associated with carcinoma of the breast.
Adenocarcinoma ; Breast ; Carcinoma ; Erysipelas ; Female ; Humans ; Middle Aged

A case of dermatitis herpetiformis associated with bronchogenic carcinoma is reported. The 56 year-old female patient developed cough with expectorants and exertional dyspnea one year ago, and also showed the pinhead to rice sized erythematous papulovesicular eruptions on the back and extremities with severe itching sensation one month ago. Bronchogenic carcinoma was confirmed by chest X-ray and so on. Skin biopsy was performed on the vesicular lesion and reveled subepidermal bullae with eosinophilic and neutrophilic inflammatory cells infiltertaion.
Biopsy ; Carcinoma, Bronchogenic* ; Cough ; Dermatitis Herpetiformis* ; Dermatitis* ; Dyspnea ; Eosinophils ; Expectorants ; Extremities ; Female ; Humans ; Middle Aged ; Neutrophils ; Pruritus ; Sensation ; Skin ; Thorax

The usefulness of microscopic examination of pure bile directly collected from the biliary tract during endoscopic retrograde cholangiography and without hormonal stimulation was evaluated in 86 patients. Cholesterol monohydrate crystal and/or calcium bilirubinate granule were observed in the bile of 64% of GB stones, 88% of CBD stones and l00% of IHD stones. But only 4% of non stone control group were positive crystals examinations. According to this results, microscopic examinations:of bile samples collected during endoscopic retrograde cholangiography exhibited a sensitivity and a specificity for cholelithiasis recognition of 82.3% and 95.8%, respectively, with a positive and negative predictive value of 98.1% and 67.6%, respectively. We conclude that microscopic bile examinations of bile samples collected during ERC is useful to investigate in patients with suspected cholelithiasis.
Bile* ; Biliary Tract ; Bilirubin ; Cholangiography* ; Cholangiopancreatography, Endoscopic Retrograde ; Cholelithiasis ; Cholesterol ; Gallstones ; Humans ; Sensitivity and Specificity