Mycobacteriosis cutis is largely classified to localized forms and exanthematous forms and it is subdivded into five diseases in detail, each. They are 1) primary tuberculous complex, 2) lupus vulgaris, 3) tuberculous verrucosa cutis 4) scrofulo derma, and 5) tuberculosis cutis orificialis in localized ferms and 1) tuberculous miliaris disseminata, 2) lupus miliaris disserninaia faciei, 3) papulonecrotic tuberculid, 4) lichen scrofulosorom and 5) ervthema induratum in exanthematous forms.Rich(1944) insisted on that, the pathogenesis of cutaneous tuberuculosis was essen tially the sarne as that for tuberculosis in general. He said that aII forms of cutaneous tuberculosis were produced by the local action of the bacilus of tuberculosis. In the formerly termed true tuberculosis such as lupus vulgaris, the microorganisrns were found in varing numbers in the lesions, and animal inoculations of tissue were successful, In other forms represented by the tuberculids, the bacillus of tuberculosis was found only in the earilest stages before the true clinical and histological picture had developed, Its short lived existence in this forms was explained by the allergic statc of the tissues and this fact exnlained the failure to find the microorganisms in the lesions, or reproduced the affection by inoculations in animals, in cases sufficiently developed to be recognizable clinically and histologically. The other generally accepted view is that the mycobacteriosis cutis, especially the types in the category of tuberculids are caused by the hematogenous dissemination of tubercle bacilli from a focus, often extrapulmonary in location, into the skin, where they are rapidly destoryed. spiet and Roeckie(1960) agreed with above menitioned plausible theories with the background of their hypothesis, that was the skin was hyperegic, And Miescher(1951) also insisted that, skin had a decreased immunologic resistance. But according to Flegel(1957), if the skin was in a state of hyperegic reaction, the focus from which the dissemination was taking place was also should be in a hyperegic state and vice versa should be right, And moreover, Suizberger(1940) declared that whenever microorganisms or their products were being overcome or neutralized by local lmmunologic reactions, tubercles or tubercles or tuberculoid structures had a tendency to appear. So the theories of different immunologic state between the skin and focus were discarded. After that many authors proposed three factors against a tuberculous etiology of tuberculids. First, inoculation of tissue from lesion into guinea pigs and culturing of such tissue have given no evidence for tuberculosis. Second, active tuberculosis occurs no greater frequency in patients with tuberculids than in the general population. Third, tuberculids does not respond to antituberculous treatment but responds to the adminiatration of corticosteroids. According to Eberhartinger(1963), Schneider and Undeutsch(1965), in erytbema induraturn the primary event is a vasculitis of subcutaneous arteries and veins. And any fat necrosis following vascular damage can develop a tubereuloid appea- rance. Lever(1967) declared with self confidence that it was a relic of the times- when a tuberculoid histology was tantamount to tuberculosis. In this condition we decided to clarify that whether the mycobacteriosis cutis, especially the disease in the category of tuberculids, could be originated from mycobacteria tuberculosis in fact or not. Eleven patients, whose clinical diagnosis were skin tuberculosis or very similar to those diseases such as erythema. nodosum, were biopsied by 5mm puncher after 2% procaine injection on their two of skin lesions, the early one for the culture of tubercle bacilli and the oId one for histopathological study, on the O.P.D. of dermatologic department in Severance Hospital. Those biopsied material of early lesion was digested with proper amount of 4% NaOH and fragmented in tissue grinder about 10 minutes. After that, it was centrifuged in rotating speed of 3,500 r.p.m. for 30minutes, and neutralized by 8% HCl after adding phenol red drop by drop. Again it was centrifuged by same as previous method and its supernatant was discarded. The remnants of precipitin was inoculated on Ogawa's nutrient tuberculous media in incubator at 37C. Finally the acid-fast tubercle bacilli have been grown on the Ogawa's media three months after its first inoculation. The inoculation material was biopsied from the patient of eighteen year-old girl, whose clinical and histopathological diagnosis was erythema induratum. From the result of this study, we got the strong confidence that in spite of many authors powerful countertheories and the extremely poor harvesting of its culture, the erythema induratum can be or in evidently caused from mycobacterium tuberculosis. It may be early days yet to say that erythema induratum is originated fromtubercle bacilli but it is considered to be a truth in Korea, with the result of this study.
Adrenal Cortex Hormones ; Animals ; Arteries ; Bacillus ; Diagnosis ; Erythema ; Erythema Induratum ; Fat Necrosis ; Female ; Guinea Pigs ; Humans ; Incubators ; Korea ; Lichens ; Lupus Vulgaris ; Mycobacterium tuberculosis ; Phenolsulfonphthalein ; Procaine ; Skin* ; Tuberculosis ; Tuberculosis, Cutaneous* ; Vasculitis ; Veins

BACKGROUND: The purposes of the study were to examine rotator cuff tendon degeneration with respect to harvesting location, to determine a rationale for debridement of the torn end, and thus, to determine adequate debridement extent. METHODS: Twenty-four patients with a full-thickness rotator cuff tear were included in the study. Tendon specimens were harvested during arthroscopic rotator cuff repair from three locations; from torn ends after minimal regularization of fraying (native end group, NE group), from torn ends after complete freshening of the frayed end (freshened end group, FE group), and from the macroscopically intact portion just distal to the musculotendinous junction (musculotendinous junction group, MTJ group). Control samples were harvested from patients admitted for surgery for proximal humerus fracture. Harvested samples were evaluated using a semi-quantitative grading scale. RESULTS: Mean total degeneration scores in the NE group (13.3 +/- 3.21), the FE group (12.5 +/- 2.30), and in the MTJ group (10.8 +/- 3.10) were significantly higher than those in the normal control group (5.0 +/- 2.87; all P>0.001). Mean total degeneration score in the NE group was significantly higher than that in the MTJ group (p=0.012), but was not from that of the FE group. Mean total degeneration score in the FE group was not significantly different from that of the MTJ group. CONCLUSIONS: Tendon degeneration exists throughout the entire tendon to the macroscopically intact portion of full-thickness rotator cuff tear. Therefore, aggressive debridement to grossly normal appearing, bleeding tendon is unnecessary for enhancing healing after repair.
Debridement ; Hemorrhage ; Humans ; Humerus ; Rotator Cuff* ; Tendons*

Letterer-Siwe disease is a non-lipid reticuloendotheliosis of unknown etiology and usually grouped with Hand-Schuller-Christian disease and eosinophilic granuloma as components of histiocytosis-X. It occurs mostly in infancy and, clinically it is the most generalliaed and serious. In recent years, the prognosis of infants with Letterer-Siwe disease has improved, primarily due to more aggressive therapy with corticosteroids and antimetabolic agents. The 14 months old male patient was admitted into the Severance Hospital on 15th, July 1974 for evaluation of a chronic and refractory skin eruptions, abdominal distension with diarrhea and edema on extremities. He had been well until 3 months old age when he developed seborrhea-like skin eruptions which did not improve on treatment for seborrhea. Vigorous treatment was started for the baby from the beginning of admission day. Routine laboratory tests, skin biopsy, bone marrow aspiration and radiologic studies for bony structures wer done. All those studies had showed severe anemia, thrombocytopenia, multiple bony defects in skull and numerous non-lipid histiocytic infiltration in skin and bone marrow all those were consist with Letterer-Siwe disease.
Adrenal Cortex Hormones ; Anemia ; Biopsy ; Bone Marrow ; Dermatitis, Seborrheic ; Diarrhea ; Edema ; Eosinophilic Granuloma ; Extremities ; Histiocytosis, Langerhans-Cell* ; Humans ; Infant ; Male ; Prognosis ; Skin ; Skin Tests ; Skull ; Thrombocytopenia

Dyskeratosis congsnita is a rare congenital disorder characterized by the triad of reticular pigmentation of the skin. dystrophic naila, and leukoplakia of the mucous membrane, and is often associated with severe pancytopenia. A 9-year-old boy had reticular pigmentation of the skin, dystropbic changes of the finger and toe nails, white patches of the buccal mucosa, mild hyperkeratosia of the palms and soles, excesaive lacrimation, dysphagia and severe pancytopenia, Bone marrow showed hypoplastic anemia and decreased cell mediated immunity was noticed.
Anemia, Aplastic ; Bone Marrow ; Child ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Deglutition Disorders ; Dyskeratosis Congenita* ; Fingers ; Humans ; Immunity, Cellular ; Leukoplakia ; Male ; Mouth Mucosa ; Mucous Membrane ; Pancytopenia ; Pigmentation ; Skin ; Toes

A case of malignant melanoma developed from giant congenital pigmented nevus in a seven year old girl was reported. Since the identification of benign juvenile melanoma, the distinct rarity of true cutaneous malignant melanoma in infants and children has become generally recognized. In giant congenital pigmented nevus, the malignant melanoma as a rule arises deep in the dermis. In this case, the histopathologic finding shows no junctional activity in epidermodermal juction other than ordinary nevocellular nevi, but some nevus cell nests and mild inflammatary cell infiltration in the upper dermis. And in the deep dermis, well marginated but not encapsuIated huge tumor mass, in which variable sized, pleomorphic, several vigorous mitotic figures in predominantly cuboidal cells and bizarre giant cells, which was thought to be developed from giant congenital pigmented nevus. The few recorded cases of fatal cutaneous malignant melanoma in early life are of two types: those arising in giant congenital pigmented nevi and ordinary small nevi, de novo including small nevus. The former account for between 22% and 40% of the total. This case is one of the reported 20 cases in the world.
Child ; Dermis ; Female ; Giant Cells ; Humans ; Infant ; Melanoma* ; Nevus ; Nevus, Pigmented*

The clinical findings in the Vogt-Koyanagi-Harada syndrome ae reviewed and eight cases reported emphasizing the cutaneaus changes. The syndrome consists of symptoms of poliosis, vitiligo, alopecia, meningeal irritation sign, nontraumatic uveitis, and dysacousia. Meningeal or ocular symptons usually appear first, but in some patients thc cutanious changes have been observed beforc the uveitis. The etiology rernains unsettied, but an allergic mechanism or a virus infection is favaveci by most observers. Early diagnosis is important because ocular mobidity can be reduced significantly in some patients if treated in the early stages. During the course of treatment of our patients, corticosteroid is appeared to be the most effective drug for this uncertain etiologic syndrome and this fact may eventually support. the theory nf autoimmue mechanisn. The daily does of corticosteroid is prednisolone 60mg and the duration of administration is from 15 days to 2 months, after that the dose is graclually decreased in relation with the degree of symptoms. The ophthalrnologic symptoms were markedly improved 10 days after the administvation of prednisolonc. The purpose of this report is to emphasize the cutaneous findings in this syndrome, to point out that the cutaneous manifestations may lead to establishing tne diagnosis and on the basis of that, those patients can be received prompt, suitable treatment to avoid the grave ocular morbidity.
Alopecia ; Diagnosis ; Dronabinol ; Early Diagnosis ; Humans ; Prednisolone ; Uveitis ; Uveomeningoencephalitic Syndrome ; Vitiligo

The present study evaluates the type, frequency and location of basal cell epithelioma, as well as the age and sex distribution of patients and the recurrence rate of basal cell epithelioma. In this study 116 patients, who visited Severance hospital during the last 15 years from Jan. 1, 1967 to Dec. 31, 1981 and were diagnosed histopathologically as having basal cell epithelioma, were analysed. (countinued..)
Carcinoma, Basal Cell* ; Humans ; Recurrence ; Sex Distribution

Recently tnere have been many reports about scabies aggravated during treatment with topical fluorinated st roid. We describe bere two cases of scabies showing unusual clinical features associated. with topical steroid a.nd morphology of different s.zges of 5arcoptes scabiei coliected from the patient. In first case who was 20 year-old riiale patient treated with topical betamethasone cream and antihistaminics per os for 2 months, we collected 62 mites from 130 burrows: 45 adult females, 5 adult males, 6 deutonymphs, 4 protonymphs and 2 larvae. In second case who was 29 year old male patient treated with topical steroid (Esperson), for one month, we rollected 9 adult female itch mites and two (male & female) Dermatophagoides pteronyssnus from 48 burrows.
Adult ; Betamethasone ; Female ; Humans ; Larva ; Male ; Mites ; Pyroglyphidae ; Scabies* ; Young Adult

The cutaneous metastaaes from carcinoma of breast produce four definite clinical types: inflammatory carcinoma, telangiectatic carcinoma, nodular carcinoma, and carcinoma en cuirasse. We present a case of 51-year-old woman who had purpuric, hard, sclerotic plaque with ulceration, crust and. several pea-sized hemorrhagic papulovesicular eruptions on the right chest wall for one year. Histopathological findings show metastatic ductal carcinoma but, the primary focus was not determined.
Breast ; Carcinoma, Ductal ; Female ; Humans ; Middle Aged ; Thoracic Wall ; Ulcer

A case of primary non-clear-cell adenocarcinoma of the vagina is reported occurring in a 65-year-old woman without exposure to diethylstilbestrol (DES) in utero. The adenocarcinoma did not appear to be associated with vaginal adenosis. It lacked clear cell component and interestingly composed of columnar epithelial cells of endocervical-type. Cytologically round to oval nuclei revealed one or more small nucleoli and fine granular chromatin pattern. Cytoplasm was plump, faintly basophilic and homogeneously stained. Histologically well differentiated columnar epithelial cells were arranged in trabecular pattern mainly, and also occasional glandular lumina and small solid sheets were found. Mitoses were hardly found.
Adenocarcinoma ; Aged ; Basophils ; Cellular Structures ; Chromatin ; Cytoplasm ; Diethylstilbestrol ; Epithelial Cells ; Female ; Glomerulonephritis* ; Humans ; Mitosis ; Purpura, Schoenlein-Henoch* ; Vagina