In order to emphasize the possibility of acquiring childhood candidal vulvovaginitis by sexual abuse, we report two cases of childhood candidal vulvovaginitis due to sexual abuse. The case 1 was a 6-year-old girl and the other case was a 7-year old girl. In these cases, the vulvas and vaginal walls were erythematous, edematous, pruritic and eroded. The diagnoses were confirmed by clinical picture and the 10% KOH preparation of vaginal discharge. The treatment of these patients were done by oral itraconazole for 1 week with successful results.
Child ; Cytochrome P-450 CYP1A1 ; Diagnosis ; Female ; Humans ; Itraconazole ; Sex Offenses* ; Vaginal Discharge ; Vulva ; Vulvovaginitis*

No abstract available.
Humans ; Stomach Neoplasms* ; Stomach* ; T-Lymphocytes*

No abstract available.
Humans ; Inpatients*

BACKGROUND: Preservation of antigen determinants while retaining morphological detail is prerequisite for high quality immunohistochemistry. Conventional formalin fixation and paraffin embedding procedures are useful in preserving tissue architecture and cytologic detail. However, they destroy the antigenicity of many proteins is tissue samples. On the other hand, fresh frozen section preserve the antigenicity of most proteins, but vield poor morphological preservation. OBJECTIVE: The purpose of this study is to evaluate the AMeX method as to the ability to preserve both antigenicity and morphologic details of the skin basement membrane zone so that precise localization of antigens can be attained in immunohistochemistry. METHODS: Tissues were fixed in acetone at -20degrees C over night, then cleared in methyl benzoate and xylene, consecutively, and embedded in ordinary paraffin at 58-60degrees C. Sections made from this paraffinembedded tissue were stained with hematoxylin and eosin for a morphologic study and immunolabelled with antibodies against major basement membrane antigens to evaluate antigenic preservation. The staining intensity and preservation of the morphology by the AMeX method were compared with conventional formalin processed tissues and frozen tissues. RESULTS: Morphological preservation of the AMeX method-processed sections was good throughout the epidermis, basement membrane, and dermis, and as good as that of routinely formalin-fixed paraffin-embedded sections. Frozen sections usually revealed revealed various degrees of damage by ice crystal formation throughout the epidermis to the dermis. The AMeX method-processed sections showed better or same antigenic preservation comparing the frozen sections when the sections were immunolabelled with specific monoclonal antibodies. But, when the sections were immunolabelled with patient's sera, the AMex method showed less antigenic preservation than the frozed sections. The anti-type IV collagen monoclonal antibody exhibited immunoreactivity only conventional formalin-fixed paraffin-embedded skin sections, but the intensity of the staining was weaker than the AMeX processed sections and the frozen sections. CONCLUSION: The AMeX method can be utilized for the demonstration of skin basement membrane antigens and is superior to the fresh-frozen method in that the histologic figures are more distinct and antigencity can be preserved for a long time.
Acetone* ; Antibodies ; Antibodies, Monoclonal ; Basement Membrane* ; Benzoates* ; Collagen ; Dermis ; Eosine Yellowish-(YS) ; Epidermis ; Formaldehyde ; Frozen Sections ; Hand ; Hematoxylin ; Ice ; Immunohistochemistry ; Paraffin ; Paraffin Embedding ; Skin* ; Xylenes*

Eosinophilia is a common finding in premature babies during the neonatal period. Serial eosinophil counts were determined in 94 hospitalized, appropriately grown premature in fants whose gestational ages ranged form 28 to 36 weeks. The incidence, severity and etiologic factors of eosinophilia were retrospectively studied in premature infants, who were divided into three groups according to their gestational age. The results were as follows: 1) Absolute eosinophilia (>700/mm3)was documented in 46.8%(44/94). 2) The duration of TRN and antibiotics was cignificantly higher in infants with eosinophilia than withour eosinophilia (p<0.05). The gestational age of the infants with eosinophilia was significantly shorter than that of the infants without eosinophilia (p<0.05). The infants with eosinophilia started with bottle feeding significantly earlier than the infants without eosinophilia (p<0.05). 3) The infants younger than 30 weeks of gestational age have greater incidence of eosinophilia (75%) than the infant with the gestational age between 34 and 36 weeks (34.3%)(p<0.05). 4) The incidence of mild eosinophilia was higher in the group with gewtational age 30 weeks or below(37.5%)than in the group with gestational age between 34 and 36 weeks(17.1%)(p<0.05).Also, the incidence of severe eosinophilia was significantly higher in the group with gestational age 30 weeks or below(37.5%)than in the group with gestational age between 34 and 36 weeks(17.1%)(p<0.05). 5) Eosinophilia was more prevalent in the infants who received parenteral nutrition composed of glucose, amino acid and lipid(77.8%) than the infants who received only glucose(34.1%)(p<0.05). 6) Gestational age and birth weight were significantly lower in infants with severe eosinopilia than those of mild or moderate eosinophilia. The duration of TRN and antibiotics were significantly longer in infants with severe eosinophilia than those of mild or moderate eosinophilia (p<0.05). 7) The peak eosinophil count was observed significantly later in severe eosinophilic group (26.5 13.1 days)than in non-eosinophilic group(14.4 9.0 days)(p<0.05). The above results suggest that eosinophilia in premature infants may be the effecto of immature immunologic responses to the intravenous administration of extemal antigens like amino acid, lipid and antibiotics.
Administration, Intravenous ; Anti-Bacterial Agents ; Birth Weight ; Bottle Feeding ; Eosinophilia* ; Eosinophils ; Gestational Age ; Glucose ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature* ; Parenteral Nutrition ; Retrospective Studies

We report a case of atypical eruption due to chemotherapeutic agent in a 60-year-old man who presented with asymptomatic, erythematous, 0.5cm in diameter, confluent, and elevated papules and plaques confined to the face. The patient was previously diagnosed with small cell carcinoma of the lung with liver metastasis. Two months after the diagnosis, a first course of chemotherapy including etoposide was started. Five days after starting the chemotherapy, the patient developed a facial eruption. Histopathologic examination demonstrated increased epidermal mitotic figures, cells in metaphase arrest, basal cell layer hyperpigmentation, prominent dyskeratosis, and squamous atypia. The most distinctive histologic feature was the presence of starburst cells, which are markedly enlarged pale staining keratinocytes containing small basophilic fragments of nuclear debris haphazardly scattered throughout the cytoplasm in a starburst pattern.
Basophils ; Carcinoma, Small Cell ; Cytoplasm ; Diagnosis ; Drug Therapy ; Etoposide ; Humans ; Hyperpigmentation ; Keratinocytes ; Liver ; Lung ; Metaphase ; Middle Aged ; Neoplasm Metastasis

Primary Cutaneous Neuroendocrine Carcinoma(CNEC : or Merkel Cell Tumor) usually occurs as a solitary tumor in middle aged to elderly individuals. This tumor may occur on any layer of the skin but the most frequent location is in the dermis. Electron microscopic studies reveal that the tumor cell contains round, dense core granules similar to epidermal Merkel cell and other cells of the neural crest derived APUD system. We describe the clinical, histological, electron microscopic, immunohistochemical observation of a case of primary CNEC in a 66-year-old female and discuss the theories regarding the histogenesis of this unusual tumor.
Aged ; Carcinoma, Neuroendocrine* ; Dermis ; Female ; Humans ; Middle Aged ; Neural Crest ; Skin

The gout is a hereditary condition of disturbed uric acid metabolism. There are medical and surgical management in tophaceous gout for prevention of recurrence of acute attack and creation of a negative uric acid balance. The surgical management is removal of tophaceous material in the soft tissue and osseous structure. Aditionally, the resection of bone and joint, arthrodesis and bone graft improve the functional capacity of the gouty patients. A 53 years old man was managed by removal of tophaceous materials in both prepatellar area, left olecranon area and both feet and arthrodesis of left first metatarsophalangeal joint with autogenous iliac bone graft and supportive medication with probenecid and indomethacine, and was followed up from March, 1986 to April, 1987. There was no significant difference in duration between the union of nonpathologic fracture and the union of arthrodesis area in this gouty patient. We found the progressive recovery of normal trabeculation in previous destructive bone lesions with drug therapy, but there was no specific change in the soft tissue lesions.
Arthrodesis ; Drug Therapy ; Foot ; Gout ; Humans ; Indomethacin ; Joints ; Metabolism ; Metatarsophalangeal Joint ; Olecranon Process ; Probenecid ; Recurrence ; Transplants ; Uric Acid

Caudal anesthesia for total hip replacement in geriatric patients has been evaluated clinically. The caudal epidural puncture was performed by a 22 G short needle through sacral hiatus with a lateral decubitus position. 1.5% lidocaine 20 mL and 0.5% bupivacaine 15 mL mixed with 1:200,000 epinephrine and 2 mg morphine was used as an anesthetics. The results were follows ; 1) The onset of caudal anesthesia was 7.9+/-4.5 min (2-20 min) and the duration was 4.8+/-3.0 hrs (1-12 hrs). 2) Anesthetic sensory level was not related with the patient's weight or height. 3) The failure rate including systemic toxicity was 13%. 4) The most common complication was hypotension and its incidence was 26.6%. 5) Time to first analgesics was 8.3+/-3.6 hrs. These results indicate that caudal anesthesia in lateral decubitus position is a recommendable anesthetic technique for total hip replacement in geriatric patients. However, the further studies for the determinations of the optimum dose of local anesthetics are needed.
Analgesics ; Anesthesia, Caudal* ; Anesthetics ; Anesthetics, Local ; Arthroplasty, Replacement, Hip* ; Bupivacaine ; Epinephrine ; Geriatrics ; Humans ; Hypotension ; Incidence ; Lidocaine ; Morphine ; Needles ; Punctures

BACKGROUND: Mitral regurgitation is a valvular heart disease that produce complex hemodynamic alternations and myocardial dysfunction occurs subclinically, so result in a high incidence of left ventricular dysfunction that might affect postoperative result. In order to assess preoperative factors affecting the outcome of mitral valve replacement in patients with chronic mitral regurgitaion, we evaluated prognostic factors from preoperative clinical, laboratory, and echocardiographic findings in 71 patients with chronic mitral regurgitation who received mitral valve replacement. METHODS: From 1985 to 1994, 71 patients with chronic mitral regurgitation, who received mitral valve replacement, were included in this study. The patients were defined as group I who had improved symptom and / or decreased left ventricular end-diastolic dimension after operation, and group II who had persistent symptom and / or over 60mm of left ventricular end-diastolic dimension after operation. RESULTS: 1) In clinical findings, preoperative systolic blood pressure was higher in Group I patients(p<0.05). 2) Hemoglobin, serum creatinine, and blood urea nitrogen level were not significantly different in both groups. 3) In echocardigraphic findings, left atrial dimension, left ventricular end-systolic / end-diastolic dimension, and left ventricular volume index of Group II were much higher than those of Group I patients(p<0.05). 4) In the discriminant analysis, left ventricular end-diastolic dimension, age, NYHA functional class, and left ventricular mass index were defined as important prognostic factors. CONCLUSION: According to the above results, preoperative age, NYHA functional class are significant prognostic factors in clinical and laboratory findings. And left atrial dimension, left ventricular end-systolic and end-diastolic dimensions, left ventricular volume index, and left ventricular mass index are significant prognostic factors in echocardiographic findings.
Blood Pressure ; Blood Urea Nitrogen ; Creatinine ; Echocardiography ; Heart Valve Diseases ; Hemodynamics ; Humans ; Incidence ; Mitral Valve Insufficiency* ; Mitral Valve* ; Ventricular Dysfunction, Left