Keratoacanthoma(KA) is a rapidly growing benign cutaneous neoplasm, usually occurring on sunexposed sites in elderly people, and it has a close clinical and pathologic resemblance to squamous cell carcinoma. Giant KA of the lower lip is extremely rare. Various treatment modalities have been reported including radiation therapy, systemic oral retinoids, and the intralesional application of 5-fluorouracil(5-FU), methotrexate(MTX) or interferon alpha-2a. Excisional surgery, however, remains the treatment of choice for the majority of KA. The disadvantages of excision are the possible requirement for extensive reconstructive surgery and the resultant cosmetic or functional deficit. Recently, we experienced a case of giant KA of the lower lip in a 60-year-old male, and he was treated successfully with intralesional methotrexate. Now we report the case with a brief review of literature.
Aged ; Carcinoma, Squamous Cell ; Humans ; Interferons ; Keratoacanthoma* ; Lip* ; Male ; Methotrexate* ; Middle Aged ; Retinoids

PURPOSE: The purpose of this study is to compare the prognostic efficacy of the number and location of positive lymph nodes (LN), LN ratio (LNR), and log odds of positive LNs (LODDs) in high-risk cervical cancer treated with radical surgery and adjuvant treatment. MATERIALS AND METHODS: Fifty high-risk patients who underwent radical hysterectomy and pelvic node dissection followed by adjuvant treatment were analyzed retrospectively. The patients had International Federation of Gynecology and Obstetrics (FIGO) stage IA2-IIB. Upper LN is defined as common iliac or higher LN, and LNR is the ratio of positive LNs to harvested LNs. LODDs is log odds between positive LNs and negative LNs. Radiotherapy was delivered to the whole pelvis with median 50.4 Gy/28 Fx± to the para-aortic regions. Platinum-based chemotherapy was used in most patients (93%). The median follow-up duration was 80 months. RESULTS: The 5-year disease-free survival (DFS) rate was 76.1%, and the overall survival (OS) rate was 86.4%. Treatment failure occurred in 11 patients, and distant failure (DF) was the dominant pattern (90.9%). In univariate analysis, significantly lower DFSwas observed in patients with perineural invasion, ≥ 2 LN metastases, LNR ≥ 10%, upper LN metastasis, and ≥ -1.05 LODDs. In multivariate analysis, ≥ -1.05 LODDs was the only significant factor for DFS (p=0.011). Of patients with LODDs ≥ -1.05, 40.9% experienced DF. LODDs was the only significant prognostic factor for OS as well (p=0.006). CONCLUSION: LODDs ≥ -1.05 was the only significant prognostic factor for both DFS and OS. In patients with LODDs ≥ -1.05, intensified chemotherapy might be required, considering the high rate of DF.
Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Gynecology ; Humans ; Hysterectomy ; Lymph Nodes* ; Multivariate Analysis ; Neoplasm Metastasis ; Obstetrics ; Pelvis ; Prognosis ; Radiotherapy ; Retrospective Studies ; Treatment Failure ; Uterine Cervical Neoplasms*

OBJECTIVE: Compared to elderly men, elderly women have substantially reduced performance of postural balance and greater risk of falls. To investigate the effect of age and sex on electromyographic (EMG) reaction time of tibialis anterior muscle contraction. METHOD: Fifty-nine elderly subjects and 29 young subjects participated in this study. Subjects were instructed to dorsiflex the ankle of the dominant leg as forcefully and quickly as possible in response to audible beeps. EMG activity was recorded over the tibialis anterior muscle and delays in initiation and termination of EMG signal were measured by two examiners. Mean and intrasubject variability of each delay were used as outcome measures. RESULTS: Both the intra-examiner and inter-examiner reliability of delay variables were above 0.97. Delays in initiation and termination of muscle contraction, as well as their intrasubject variability, were significantly greater in the elderly (p<0.01). However, there were no sex differences or interaction in all outcome measures. CONCLUSION: These results demonstrate that the EMG reaction time and their variability increase in the elderly population with no sex difference.
Aged ; Animals ; Ankle ; Electromyography ; Female ; Humans ; Leg ; Male ; Muscle Contraction ; Muscles ; Oxazoles ; Postural Balance ; Reaction Time ; Sex Characteristics

Liposarcoma is a relatively common malignant tumor that can be originated from adipose tissue in the body, especially in the lower extremity and in the retroperitoneal space. But it is extremely rare in the head and neck region. Liposarcoma can be classified histopathologically into four subtypes; well differentiated, myxoid, round cell, and pleomorphic type. The prognosis of liposarcoma is known to be generally poor due to the high local recurrence rate in spite of complete resection. We report a case of myxoid liposarcoma of the neck in a 41-year old male, who was treated with primary excision of tumor and postoperative radiation therapy. The histopathology, clinical appearance, management and prognosis of this rare condition are discussed.
Adipose Tissue ; Adult ; Head ; Humans ; Liposarcoma ; Liposarcoma, Myxoid* ; Lower Extremity ; Male ; Neck* ; Prognosis ; Recurrence ; Retroperitoneal Space

PURPOSE: This study was performed to evaluate the relationship between glomerular basement membrane (GBM) alterations to epithelial cell (EpC) structure and renal function in Alport Syndrome (AS) patients. METHODS: Fifteen patients diagnosed with AS (4-26yrs) were examined. The GBM in AS was categorized as: C1) normal, C2) minor alterations (widening of lamina rara interna or externa without lamina densa change), C3) nonspecific splitting of lamina densa, C4) basket-weaving pattern of lamina densa splitting. The length of each GBM portion along the epithelial side was measured on the systematically obtained electron microscopic photographs. Furthermore to obtain an objective assessment of the degree of glomerular EpC foot process change, the number of slit pores along 10 microm of peripheral GBM in each category was obtained. RESULTS: The percentage of normal GBM portion (C1) correlated inversely with daily protein excretion (g/day/m2, P <0.05) and sum of the percentage of abnormal GBM portion (C2+C3+C4) had direct correlation with daily protein excretion (g/day/m2, P <0.05). There were no significant relationships between the percentages of other categories of GBM alterations and creatinine clearance or protein excretion. There were no significant relationships between of creatinine clearance in relation to normal GBM(C1) portion as well as that in relation to sum of the percentage of abnormal GBM portion (C2+C3+C4). GBM abnormality did not correlate with age at biopsy. CONCLUSION: The extent of GBM structural abnormality is related to proteinuria in AS but the epithelial response is uniform even though the GBM ultrastructural lesions are not.
Creatinine ; Electrons ; Epithelial Cells ; Foot ; Glomerular Basement Membrane ; Humans ; Nephritis, Hereditary ; Phosphorylcholine ; Proteinuria

Pancreatic tissue is maintained by a simple proliferation of the preexisting cells in adulthood, whereas, they are dynamically derived from precursor/ stem cells from ductal epithelia during prenatal life. It has been known that tissue regeneration rarely occurs in the normal adult pancreas, particularly in the human pancreas. However, regeneration can be experimentally induced in the adult pancreas in response to various tissue injuries such as partial resection, pancreatitis by obstruction of the duct, and chemical insults. Regenerating pancreatic tissue shares a common morphogenic feature of "neogenic regeneration" in all regenerating animal models. Neogenic regeneration occurs at the site of tissue injury by forming small tubular structures with elongated epithelial cells (ductules) which grow to form pancreatic ducts and acini. The endocrine cells, including insulin secreting beta cells, are also derived from these ductules. As a sequential process of neogenesis, the regenerating tissue becomes heterogeneous in composition. Some areas were composed by tubules and ductules in surrounding loose connective tissue while others were denser with differentiating acini derived from tubules or ductules. Such neogenic regeneration mimics tissue development during fetal pancreatic organogenesis. In the process of pancreatic neogenesis, we found unique expressions of bioactive proteins such as nestin and clusterin as morphogenic factors. It is likely that the stem/precursor cells could be recapitulated and regenerated to functional cells, including endocrine and exocrine pancreatic cells with acinar and ductal cells during neogenic regeneration of the pancreas.
Adult ; Candidiasis, Cutaneous ; Clusterin ; Connective Tissue ; Endocrine Cells* ; Epithelial Cells ; Humans ; Insulin ; Models, Animal ; Nestin ; Organogenesis ; Pancreas ; Pancreatic Ducts ; Pancreatitis ; Regeneration* ; Social Change ; Stem Cells ; Tinea

Epidermolysis bullosa (EB) is a rare hereditary disorder characterized by formation of blisters following minor trauma. It has been traditionally categorized by the level of basement membrane zone separation into EB simplex (EBS), junctional EB (JEB), and dystrophic EB (DEB). Recently, hemidesmosomal EB has been proposed as a fourth category, which includes EB with muscular dystrophy and EB with pyloric atresia. We report here on a case of concomitant occurrence of EB and pyloric atresia, a rare form of EB.
Basement Membrane ; Blister ; Ectodermal Dysplasia ; Epidermolysis Bullosa ; Gastric Outlet Obstruction ; Methylmethacrylates ; Muscular Dystrophies ; Polystyrenes ; Pylorus

PURPOSE: Reconstructive surgeries for equinocavovarus foot deformities are quite variable, including hind-midfoot osteotomy or arthrodesis, soft tissue procedure, tendon transfers, etc. Comprehensive evaluation of the deformity and its etiology is mandatory for achievement of successful deformity correction. Few studies in this field have been reported. We report on the clinical and radiographic outcome of reconstruction for cavovarus foot deformities. MATERIALS AND METHODS: The study is based on 16 feet with cavovarus foot deformities that underwent bony and soft tissue reconstructive surgery from 2004 to 2008. We evaluated the etiologies, varieties of surgical procedures performed, pain score, functional scores, and patient satisfaction and measured the radiographic parameters. RESULTS: The average age at the time of surgery was 39.4 years old, with a male/female ratio of 9/4 and an average follow-up period of 23.9 months (range, 12~49 months). The etiologies of the cavovarus deformity were idiopathic 7 feet, residual poliomyelitis 5 feet, Charcot-Marie-Tooth disease 2 feet, and Guillain-Barre syndrome and hemiplegia due to cerebrovascular accident sequela 1 foot each. Lateral sliding calcaneal osteotomies were performed in 12 feet (75%), followed by Achilles tendon lengthening and plantar fascia release in 11 feet (69%), and first metatarsal dorsiflexion osteotomy/arthrodesis and tendon transfer in 10 feet (63%). Visual analogue scale pain score showed improvement, from an average of 4.2 to 0.5 points. American Orthopaedic Foot and Ankle Society ankle-hindfoot score showed significant improvement, from 47.8 to 90.0 points (p<0.05). All patients were satisfied. Ankle range of motion improved from 27.5degrees to 46.7degrees. In radiographic measurements, calcaneal pitch angle improved from 19.1degrees to 15.8degrees, Meary angle from 13.0degrees to 9.3degrees, Hibb's angle from 44.3degrees to 37.0degrees, and tibio-calcaneal axis angle from varus 17.5degrees to varus 1.5degrees. CONCLUSION: We achieved successful correction of cavovarus foot deformities by performing appropriate comprehensive reconstructive procedures with improved functional, radiographic measures and high patient satisfaction.
Achilles Tendon ; Ankle ; Arthrodesis ; Axis, Cervical Vertebra ; Charcot-Marie-Tooth Disease ; Congenital Abnormalities ; Fascia ; Follow-Up Studies ; Foot ; Foot Deformities* ; Guillain-Barre Syndrome ; Hemiplegia ; Humans ; Metatarsal Bones ; Osteotomy ; Patient Satisfaction ; Poliomyelitis ; Range of Motion, Articular ; Stroke ; Tendon Transfer

BACKGROUNDS: As Korea has advanced into the aging society, Acute Coronary Syndrome is increased in number, especially elderly age group. The symptoms of acutecoronary syndrome in eldery were presented in atypical feature frequently. We studied the relation of the first symptom and diagnosis of acutecoronary syndrome and distribution of risk factor and coronary angiographic finding in elderly patient of korea society. METHODS: The subjects who were under went coronary angiography between 2002.5 and 2003.8 were dividedunder 65 years old group and over 65 years old group. And each group described diagnosis, risk factor, first symptom and coronary angiographic finding retrospectively. RESULTS: The diagnosis of unstable angina are more higher(46.5% vs. 26.1%, p<0.01) in the over 65 years old group and the first significant symptom of typical chest pain was more higher(57.4% vs. 47.6%, p<0.01) in the under 65 years old group and dyspnea was more higher(22.8% vs. 9.2%, p<0.01) in the over 65 years old group. The number of abnormal vessel were more higher(66.3% vs. 46.9%, p<0.01) in the over 65 years old group. CONCLUSION: Over 65 years old group compared with younger age group were prewented more frequently angina equivalent symptom than typical chest pain. And at the diagnosis of Acute Coronary Syndrome, over 65 years old group showed more severe coronary angiographic finding. Consequently, early stage of diagnostic approach and treatment need scrupulous attention in the elderly patients.
Acute Coronary Syndrome* ; Aged* ; Aging ; Angina, Unstable ; Chest Pain ; Coronary Angiography ; Diagnosis* ; Dyspnea ; Humans ; Korea* ; Retrospective Studies ; Risk Factors

BACKGROUND: Metabolic syndrome, a concurrence of disturbed glucose and insulin metabolism, over- weight and abdominal fat distribution, dyslipidemia and hypertension, is associated with subsequent de- velopment of type 2 diabetes mellitus and cardiovascular disease, especially coronary heart disease. The aim of the study is to assess the relationship between metabolic syndrome and coronary heart disease in elderly greater than 65 years old. METHODS: Eighty two elderly patients greater than 65 years old who underwent coronary angiography were divided into two groups with metabolic syndrome or without metabolic syndrome, and assessed the association with coronary angiographic finding. The metabolic syndrome factors and cardiovascular risk factors of JNC 7 were investigated to assess the relationship with coronary heart disease in elderly. Coronary heart disease was defined as 50% or greater diameter in stenosis of coronary artery in coronary angiography. RESULTS: In elderly patients with metabolic syndrome, coronary angiographically abnormal findings(p<0.05) and multi vessel disease findings(p<0.05) were presented significantly higher than non metabolic syndrome patients. In elderly patients with 3 and more cardiovascular risk factors of JNC 7, coronary angiographically abnormal findings(p<0.05) and multi vessel disease findings(p=0.059) were presented more than the other patients. Diabetes mellitus was related significantly with coronary heart disease(p value 0.044). CONCLUSION: In elderly patients, metabolic syndrome was significantly related with coronary heart disease and diabetes mellitus had strong relationship with coronary heart disease. Metabolic syndrome and cardiovascular risk factors of JNC 7 should be further evaluated to assess the relationship with coronary heart disease in the future.
Abdominal Fat ; Aged* ; Cardiovascular Diseases ; Constriction, Pathologic ; Coronary Angiography ; Coronary Disease* ; Coronary Vessels ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Dyslipidemias ; Glucose ; Heart ; Humans ; Hypertension ; Insulin ; Metabolism ; Risk Factors