Malignant pyoperma is a rare, chronic, progressive, destructive ulcerating skin disease of unknown cause that affects the head and neck region of young adults. The disease is progressive but responds to high doses of systemically administered steroids. We present a case of malignant pyoderma developed on the left retroauricular area in 67 year-old male. The patient died of rapidly progressive, desructive, 15cm x 20 cm sized, phagedenic ulcer on the left retroauricular and neck area despite of various extensive local and systemic treatment. Histopathologic findings of tissue from the edge of the ulcer were non-specific, showing upper dermal necrosis and mixed inflammatory cell infiltrate in the deep dermis.
Aged ; Dermis ; Head ; Humans ; Male ; Neck ; Necrosis ; Pyoderma* ; Skin Diseases ; Steroids ; Ulcer ; Young Adult

Accessory auricle is a relatively rare congenital anomaly arised from the abnormaI development of the auricular tubercles or from the tissues surrounding the second, third and fourth branchial clefts. Clinically this anomaly is a small akin-colored tag or nodule, soft and globular or cartilaginous consistency on or near the tragus along a line drawn from the tragus to the angle of the mouth or along the anterior margin of the sternomastoid muscle. The lesion is usually solitary and located in the preauricular area but may be multiple and rarely bilateral. We present a typical caae of accessory auricles in 4-day-old female infant. The patient had two skin-colored firm nodules on the left preauricular area and well pedunculated one on the Ieft buccal area near the angle of the rnouth. Histopathologic find.ings showed numerous pilosebaceous units, abundant subcutaneous fat and cartilage tissue in the center of the lesion.
Branchial Region ; Cartilage ; Female ; Humans ; Infant ; Mouth ; Subcutaneous Fat

BACKGROUND: Dermatologists frequently see morbilliform rash in the clinic, drug eruptions and viral eruptions. Due to close clinical similarities, it is difficult to differentiate them. OBJECTIVE: The purpose of this study was to review the histopathologic differences between drug eruption and viral eruption. METHOD: In this study, 13 patients diagnosed as rubella and 13 patients diagnosed as drug eruption in Department of Dermatology, Presbyterian Medical Center from 1995 to 1997 were included. We reviewed the epidermal changes such as vacuolopathy, dyskeratotic cells, spongiosis and exocytosis and dermal changes by light microscopy. RESULTS: 1. Vacuolopathy of basal layer was observed in 92.3% of patients in both diseases. 2. Dyskeratotic cells, spongiosis and exocytosis were observed significantly highly in drug eruption. 3. Perivascular lymphohistiocytic infiltration was mild in both diseases, but eosinophilic infiltration was significantly higher in drug eruption(84.6%) than viral eruption(15.4%). 4. Atypical lymphocytes were observed in both diseases. 5. Red blood cell extravasation was observed only in viral eruption. 6. Perivascular edema was significantly higher in drug eruption(76.9%) than viral eruption(38.4%) CONCLUSION: There were statistically significant differences in dyskeratotic cells, spongiosis, dermal eosinophilic infiltration and Red blood cell extravasation. Considering these observation, histopathologic findings may be helpful in differentiating between drug eruption and viral eruption.
Dermatology ; Drug Eruptions* ; Edema ; Eosinophils ; Erythrocytes ; Exanthema ; Exocytosis ; Humans ; Lymphocytes ; Microscopy ; Protestantism ; Rubella*

PURPOSE: The optimal surgical technique for inguinal hernia repair continues to be debated. This study was designed to investigate optimal surgical procedures in inguinal or femoral hernia. METHOD: We analyzed 153 cases of herniorrhaphy on inguinal or femoral hernias between August 1996 and November 2000. We divided patient into four groups according to the methods of hernia repair, i.e., 1) 78 cases of laparoscopic herniorrhaphy, 2) 42 cases of Lichtenstein herniorrhaphy, 3) 24 cases of Bassini herniorrhaphy and 4) 9 cases of McVay herniorrhaphy. RESULTS: The patient in the laparoscopic and Lichtenstein herniorrhaphy groups needed shorter hospital stays than those in the Bassini or McVay herniorrhaphy groups. The severity of pain was assessed by the total amount and duration of nonsteroidal anti-inflammatory drug injections, which was minimal in the laparoscopic group. There were no differences in complications between the groups. One patient in the laparoscopy group had a hernia recurrence and was reoperated with Lichtenstein herniorrhaphy. We compared two tension-free herniorrhaphies with each other. The numbers of patients not needing analgesic injections were more in the laparoscopic than the Lichtenstein herniorrhaphy group, reflecting less pain in the former group. Hospital stays were also shorter in the laparoscopic than the Lichtenstein herniorrhaphy group. CONCLUSION: We concluded that tension-free herniorrhaphy is superior to tension herniorrhaphy in terms of postoperative pain & recovery. Of the tension-free herniorrhaphies, laparoscopic herniorrhaphy is associated with less postoperative pain and shorter hospital stays than Lichtenstein herniorrhpahy.
Hernia ; Hernia, Femoral ; Hernia, Inguinal ; Herniorrhaphy* ; Humans ; Laparoscopy* ; Length of Stay ; Pain, Postoperative ; Recurrence

OBJECTIVE: Previous studies have demonstrated that axon regeneration or remyelination after spinal cord injury occurs when provided with a suitable substratum such as fetal spinal cord (FSC). We carry out this study to determine whether FSC transplants can reduce the glial scar at the interface between host and graft. METHODS: Hemisectioned spinal cord injury was made by aspiration at T3 or T4 spinal cord level in rat. Cell suspension of E-14 FSC was introduced into the injured cavity contaning glial scar tissue. To indentify the transplanted cells from host tissue, FSC cells were labeled with DiI. Rats were sacrificed at 1, 2, 3, and 8 weeks after transplanation and spinal cord was undergone serial sections for immunocytochemistry and histological observation. The observation by electron microscope was carried out too. RESULTS: We could observe that the FSC transplants survived in host spinal cord and generally occupied most of the neuron-depleted area. Examination of serial sections through the graft-host interface which had been immunoreacted for glial fibrillary acidic protein demonstrated that the glial scar was no longer a continuous wall separating the graft and host tissues at eight weeks after injury. We could observe oligodendrocyte and the reformed myelin at the interface by electron microscope. CONCLUSION: The fetal spinal cord transplant can reduce an established glial scar or restrict the reformation of a scar following surgical manipulation, and that the FSC transplant can promote remyelination.
Animals ; Axons ; Cicatrix ; Glial Fibrillary Acidic Protein ; Immunohistochemistry ; Myelin Sheath ; Oligodendroglia ; Rats* ; Regeneration ; Spinal Cord Injuries ; Spinal Cord* ; Transplants

PURPOSE: To evaluate the clinical usefulness of binocular multifocal electroretinography (mfERG) by comparing results with conventional monocular mfERG in patients with monocular macular disease. METHODS: mfERG testing was conducted on 32 patients with monocular macular disease and 30 normal subjects. An initial mfERG was simultaneously recorded from both eyes with two recording electrodes under binocular stimulation. A second mfERG was subsequently recorded with conventional monocular stimulation. Amplitudes and implicit times of each ring response of the binocular and monocular recordings were compared. Ring ratios of the binocular and monocular recording were also compared. RESULTS: In the macular disease group, there were no statistical differences in amplitude or implicit time for each of the five concentric rings between the monocular and binocular recordings. However, with binocular simulation, the ring ratios (ring 1 / ring 4, ring 1 / ring 5) were significantly reduced in the affected eye. In the normal control group, there were no statistical differences in any parameters between the monocular and binocular recordings. CONCLUSIONS: Binocular mfERG could be a good alternative to the conventional monocular test. In addition, given that the test needs stable fixation of the affected eye during the binocular test, the reliability of the test results could be improved, especially for patients with monocular macular disease.
Adult ; Aged ; Aged, 80 and over ; Electroretinography/*methods ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Vision, Binocular/physiology ; Vision, Monocular/physiology ; Visual Acuity/*physiology ; Wet Macular Degeneration/*diagnosis/*physiopathology

The appearance of a tumor in the chest wall is rare compared to that in any other part of the body. It can be classified into benign and malignant types and can be located in the rib, clavicle, sternum, cartilage and soft tissues. Tumors that are metastatic are commonly located in the lung, breast, bone and pleura. But, the soft tissue mass of anterior chest wall is rarely metastasized from a distant organ that is not confined to the thoracic cavity. This and thus has rarely been described. A 68-year-old man was admitted to our hospital with a chief complaint of resting dyspnea. A huge non-tender mass of about 10*15 cm in size was visible on his left lower anterior chest wall. We pathologically confirmed that the mass was a metastatic renal cell carcinoma of clear cell type by incision biopsy. Through an incision biopsy, the mass was pathologically confirmed as a metastatic renal cell carcinoma of the clear cell type.
Aged ; Biopsy ; Breast ; Carcinoma, Renal Cell* ; Cartilage ; Clavicle ; Dyspnea ; Humans ; Lung ; Neoplasm Metastasis* ; Pleura ; Ribs ; Sternum ; Thoracic Cavity ; Thoracic Wall* ; Thorax*

Spinal cord stimulation (SCS) has become an established clinical option for treatment of refractory chronic pain. Current hardware and implantation techniques for SCS are already highly developed and continuously improving; however, equipment failures over the course of long-term treatment are still encountered in a relatively high proportion of the cases treated with it. Percutaneous SCS leads seem to be particularly prone to dislocation and insulation failures. We describe our experience of lead breakage in the inserted spinal cord stimulator to a complex regional pain syndrome patient who obtained satisfactory pain relief after the revision of SCS.
Chronic Pain ; Dislocations ; Equipment Failure ; Humans ; Spinal Cord ; Spinal Cord Stimulation

PURPOSE: The determination of HER-2/neu gene amplification has become necessary for the selection of breast cancer patients to undergo anti-HER-2/neu therapy, using a humanized monoclonal antibody. Chromogenic in situ hybridization (CISH) detection of the HER-2/neu gene, a newly developed method, utilizes a robust and unique-sequence DNA probe labeled with digoxygenin, which is sequentially incubated with antidigoxygenin fluorescein, antifluorescein peroxidase and diaminobenzidine. The aim of this study was to establish a CISH assay for the detection of HER-2/neu amplification. The results were compared with those of the immunohistochemistry (IHC) methods, most frequently used for detecting HER-2/neu alteration. METHODS: CISH was performed in 4 groups of infiltrating breast carcinomas. Each group was comprised of 20 cases in which the HER-2/neu stati had previously been scored on a four value scale: 0, 1+, 2+ and 3+ by IHC. The results of CISH and IHC were compared for each tumor group. The HER-2/neu gene amplification detected by CISH was thpically visualized as large DAB-stained clusters or by many dots in the nucleus. RESULTS: The concordance between the CISH and IHC was 95% (kappa=0.901). Three IHC-positive cases (score 2+) showed no gene amplification and one IHC-negative case (score 1+) showed gene amplification by CISH. CONCLUSION: The current study showed excellent agreement between the CISH and IHC methods. CISH is an accurate, practical and economical approach for determining the HER-2/neu stati in breast carcinomas. It is also a useful methodology for confirming the IHC results in paraffin- embedded tumor samples, so offers a promising alternative to IHC in a routine diagnostic setting.
Breast Neoplasms* ; Breast* ; DNA ; Fluorescein ; Gene Amplification ; Genes, vif ; Humans ; Immunohistochemistry ; In Situ Hybridization* ; Peroxidase

PURPOSE: To investigate the prevalence of amblyogenic risk factors in the primary family members (parents, siblings) of patients with exotropia. METHODS: The authors of the present study examined primary family members including parents and siblings of 58 exotropia patients in our clinic. Best corrected visual acuity, refractive error, and cover-uncover test were performed. A total of 49 normal children's family members (control group) were examined in a similar manner. The prevalence of significant ocular findings were determined and compared to the control group. RESULTS: In 58 eligible families (153 subjects except proband), 65.4% had significant ocular findings: In parents, anisometopia, astigmatism, hyperopia, and strabismus were found at a rate of 18.1%, 31.1%, 2.5%, and 11.2%, respectively. In siblings, anisometropia, astigmatism, hyperopia, and strabismus were found at a rate of 24.3%, 24.3%, 5.4%, and 18.9%, respectively. Compared to the control group, in parents of exotropia patients, anisometropia, astigmastim, and strabismus were observed at a higher rate. In siblings, anisometropia, and strabismus were observed at a higher rate. CONCLUSIONS: Primary family members of exotropia patients have a high prevalence of amblyogenic risk factors. The present study offers rationale for providing comprehensive eye exams for parents and children with a family history of exotropia.
Anisometropia ; Astigmatism ; Child ; Exotropia ; Eye ; Humans ; Hyperopia ; Parents ; Prevalence ; Refractive Errors ; Risk Factors ; Siblings ; Strabismus ; Visual Acuity