Calciphylaxsis is a rare and life-threatening condition of progressive cutaneous necrosis secondary to calcification of small and medium-sized blood vessels. It is seen almost exclusively in patients with end-stage renal disease, in a setting of secondary hyperparathyroidism and hypercalcemia resulting in metastatic vascular calcification, We experienced a case of calciphylaxsis manifested with chara- cteristic cutaneous lesions that began as tender violaceous livedoid discolorations and subsequent ulceration on the proximal aspect of the extremities and on the lower part of the abdomen. Histologically, calcification is found in small and medium-sized blood vessels in the deep dermis and subcutaneous tissue. The patient had been treated for hypercalcemia, not complicating renal failure, but the cause of hypercalcemia was not found. However, the hypercalcemia was contolled and the skin lesions also improved after oral prednisolone therapy. Our case is a rare presentation of calciphylaxsis in the absence of renal failure, reversibly improved.
Abdomen ; Blood Vessels ; Dermis ; Extremities ; Humans ; Hypercalcemia ; Hyperparathyroidism, Secondary ; Kidney Failure, Chronic ; Necrosis ; Prednisolone ; Renal Insufficiency ; Skin ; Subcutaneous Tissue ; Ulcer ; Vascular Calcification

This study was aimed to examine whether biological characteristics of the cancer cell lines have any correlation with distinctive movement of the reconstituted basement membrane in modified Boyden chamber. The in vitro model consists of a chamber and basement membrane filter. Matrigel was applied on the upper surface of the filter and type IV collagen, fibronectin and laminin were also applied to the lower surface of the filter, respectively. The cancer invasiveness was measured by the number of the moved cells through basement membrane differing in component, thickness and incubation time. For chemoattractant study, serum free medium, medium supplemented with 10% fetal bovine serum and medium supplemented with 10% fetal bovine serum and 0.1% bovine serum albumin were used. The invaded cancer cells were counted under high-power field microscope and the morphologic feature of invading cancer cells on reconstituted basement membrane was examined with scanning electron microscopy. The effects of the tissue inhibitor of metalloproteinase-2 (TIMP-2) and wild type tumor necrosis factor-alpha (wTNF-a) on invasiveness of three prostate cancer cell lines (hormone intermediate sensitive ALVA 101, and hormone refractory ALVA 41 and PPC-1) were investigated. The rate of movement of the cancer was reduced increasing thickness of the matrigel but increased in proportion to the incubation time (p<0.05). The components applied on the lower surface of the filter did not affect cancer cell invasiveness (p>0.05). TIMP-2 reduced the invasiveness of three kinds of cancer cell line at both the high and low concentration, indicating that this agent interferes the movement of the cells. Furthermore, this result suggests that TIMP-2 might repress metal-dependent enzymes, which are thought to elicit the invasiveness of the cancer cells. The wTNF-a did not show any effects on the invasiveness of three cell lines. The additive chemoattractant effect of 0.1% bovine serum albumin was not observed and serum free medium also did not induce the cancer cell invasion across the reconstituted basement membrane. The migration of the ALVA 41 and PPC-1 were more than the ALVA 101. The scanning electron microscopic examination showed the figures of migration of cancer cells through the pores on filter, supporting our experiments are performed in validness. The effect of protease inhibitor was distinct in different cancer cell lines studied. From this experiment, we conclude that the rate of movement of both ALVA 41 and PPC-1 cells with shorter doubling time and the hormone refractory was faster than that of ALVA 101 cells with longer doubling time and the hormone sensitive, suggesting biological characteristics of the cells are implicated in degree of cancer cell invasiveness and their malignancies.
Basement Membrane* ; Cell Line ; Collagen Type IV ; Fibronectins ; Laminin ; Microscopy, Electron, Scanning ; Population Characteristics ; Prostate* ; Prostatic Neoplasms* ; Protease Inhibitors ; Serum Albumin, Bovine ; Tissue Inhibitor of Metalloproteinase-2 ; Tumor Necrosis Factor-alpha

No abstract available.
Erythema Multiforme* ; Erythema* ; Lymphoma*

Apocrine poroma is a benign cutaneous adnexal neoplasm differentiating in the direction of sebaceous and apocrine glands, and follicular germs. The clinical appearance of apocrine poroma is not distinctive, and the histologic finding is similar to that of eccrine poroma, which is typified by proliferation of poroid and luminal cells in continuity with the epidermis. But sebaceous, apocrine or follicular differentiation may also be found in the case of apocrine poroma. We herein report a case of apocrine poroma on the scalp. This case exhibited apocrine and sebaceous differentiation, and connection to an adjacent follicular epithelium.
Apocrine Glands ; Epidermis ; Epithelium ; Phenobarbital ; Poroma* ; Scalp

No abstract available.
Erythrocytes*

No abstract available.
Erythrocytes*

Open tracheostomy has been indicated for patients who require prolonged mechanical ventilation or respiratory care in order to avoid lots of complications during long-term endotracheal intubation. Because there are a number of disadvantages and serious complications in standard open tracheostomy, a simpler, safe and minimally invasive procedure such as percutaneous dilatational tracheostomy (PDT) and translaryngeal tracheostomy (TLT) were introduced as an appropriate procedure that can be administered at bedside. In terms of prevention of complications, minimal invasive tracheostomy techniques are more advisable for post open heart surgery patients. After two failed attempts at respirator weaning, we experienced a successful TLT for a 71-year-old male patient with intractable post CABG pneumonia post-op 15 days in an intensive care unit. During and post-TLT courses were not eventful. The cannula was removed 2 weeks after TLT and the patient was subsequently discharged to ward.
Aged ; Catheters ; Heart* ; Humans ; Intensive Care Units ; Intubation, Intratracheal ; Male ; Pneumonia ; Respiration, Artificial ; Thoracic Surgery* ; Tracheostomy* ; Ventilator Weaning

Plexiform neurofibroma is considered to be pathognomic of neurofibromatosis type 1 (NF1). Herein we report a solitary plexiform neurofibroma which is not associated with NF1. A 61-year-old man presented with asymptomatic skin colored nodules on the medial side of his left great toe. No other abnormalities were found in his personal or family history. Clinically, the tumor was simulating the appearance of mucous cysts. Microscopically,it was a plexiform neurofibroma located in the dermis which seemed to originate from small superficial nerves. This case would seem to confirm that the superficial form of plexiform neurofibroma involving small nerves in the dermis or subcutis is not necessarily pathognomic for NF1.
Dermis ; Humans ; Middle Aged ; Neurofibroma, Plexiform* ; Neurofibromatosis 1 ; Skin ; Toes

As the use of free tissue reconstruction becomes more routine, attention is being focused not only on flap survival, but also on functional refinements in these flaps. One of the more important aspects of improving the outcome of these reconstruction may relate to the return of sensation. The anterolateral thigh free flap is based on the descending branch of the lateral circumflex femoral artery. This fasciocutaneous flap is indicated whenever a relatively thin flap is required in reconstruction. A neurosensory flap can be employed based on the anterior branched of the lateral femoral cutaneous nerve of the thigh. Since 1996, 15 patients with soft tissue defect on various regious were treated by using the anterolateral thigh sensate free falp. All flaps survived without total loss. Anastomosis of the sensible nerve on the recipient site with the anterior branch of the lateral femoral cutaneous nerve of the thigh was performed. All patients showed recovery of sensation in the anterolateral thigh sensate free falp beginning between the 4th and 6th month postoperatively. Follow-up periods ranged from 8 to 34 months and the results of sensory recovery were satisfactory. Therefore, resensitization of an anterolateral thigh free flap should be attempted by a nerve anastomosis in this transplant. The longterm success in this study suggests the benefits of microsurgical neurotization in free tissue transplantation.
Femoral Artery ; Follow-Up Studies ; Free Tissue Flaps* ; Humans ; Nerve Transfer ; Sensation ; Thigh* ; Tissue Transplantation ; Transplants

Tubular apocrine adenoma is a well-circumscribed intradermal benign tumor with tubular structures showing apocrine differentiation. Most of those cases occur on the scalp in middle aged women. Histologically, tubular structure with apparent apocrine decapitation secretion, cystic dilatation of tubule, and connection with epidermis are the characteristic features of tubular apocrine adenoma. We presented a case of tubular apocrine adenoma that had recurred after incomplete excision. It showed apocrine decapitation secretion histologically and both eccrine and apocrine differentiation on immunohistochemical study.
Adenoma* ; Decapitation ; Dilatation ; Epidermis ; Female ; Humans ; Middle Aged ; Scalp