The purpose of this study was to identify the effect of follow-up care for stroke survivors on primary caregivers' quality of life. Quasi-experimental research was conducted in which an experimental group and a control group-each of 15 stroke survivors and their primary caregivers-were consecutively sampled. Data collected from July to September, 1999 by interview using a structured questionnaire with both the experimental and the control groups. After a month, the two groups were given the same questionnaire. The experimental group was also given a telephone follow-up every week for a month, as well as a home visit. The survey instruments used in this study were Saha and Cooper's Modified Barthel index (11 items) for checking the stroke survivors' level of activities of daily living, and a modified form of Jeong's Quality of life (18 items) for primary caregivers' QOL level. The obtained data were analyzed by percentage, t-test. chi-test. Kruscal-Wallis test, Spearman correlation coefficient by SAS/PC program. The results were as follows: 1. There was no significant difference in the stroke survivors' ADL level. though the level of the experimental group was higher than that of the control group. 2. There was a statistical difference in the before and after treatment of the primary caregivers' QOL level. In conclusion. the follow-up a care program had useful effect on the quality of life of primary caregivers.
Activities of Daily Living ; Caregivers ; Follow-Up Studies* ; House Calls ; Humans ; Quality of Life* ; Surveys and Questionnaires ; Stroke* ; Survivors* ; Telephone

CD44 is a hyaluronic acid receptor that exists as a standard 90-kd form (CD44H) as well as several CD44 variants isoforms are produced through alternative splicing. Alternatively spliced variants of the CD44 molecule have been found to be associated with invasive and metastatic potential of cancer cells and poor prognosis in several types of carcinoma. The purpose of the present study is to define the expression of CD44H and CD44v6 in ovarian tumors and to investigate whether the expression of these molecules is associated with adverse prognosis. We evaluated the expression of CD44 isoforms in 58 ovarian tumors by means of immunohistochemistry, and correlated between CD44 expression and the histologic types, tumor grade, peritoneal implants, pseudomyxoma peritonei and FIGO stage. While the CD44H was commonly expressed in ovarian tumors, the CD44v6 was expressed in a minor proportion of serous tumors in comparison with frequent expression of v6 isoform in mucinous tumors. The CD44H expression was significantly higher in stage I/II than in stage III. However, there was no correlation between the expression of CD44 and the presence of peritoneal implants or pseudomyxoma peritonei. These results suggest that CD44H could play an important role in the adhesive function in the lower stage of the ovarian tumor and reduced expression in the higher stage might be related to the metastasis and widespread invasion of ovarian carcinoma cells.
Adhesives ; Alternative Splicing ; Female ; Hyaluronic Acid ; Immunohistochemistry ; Mucins ; Neoplasm Metastasis ; Ovary ; Prognosis ; Protein Isoforms ; Pseudomyxoma Peritonei

Over the past 30 years, there has been an increase in the incidence of multifetal pregna-ncies, primarily because of the introduction of ovarian stimulants for ovulation induction and assisted reproductive technology ( ART ) in infertile patients. It is well established that multifetal pregnancies are associated with an increased frequency of the maternal complications and gre-ater perinatal morbidity and mortyality. The adverse outcome of multifetal pregnancies is dire-ctly proportional to the number of fetuses, primarily as an consequence of prterm delivery. Re-duction in the number of fetuses in multifetal pregnancies has been proposed as a way to impr-ove the perinatal outcome in this situation. Therefore, selective fetal reduction ( SFR ) is sugges-ted as a therapeutic option for continuation of pregnancy with fetuses mature enough to survi-ve. In this paper, we report our infertility clinic experiences with 6 patients who carried mult- ifetal pregnancies including 1 quintuplet, 1 quadruplet, and 4 triplets. from January, 1991 to May, 1996, transabdominal SFR was accomplished by fetal intrathoracic KCl injection at 9~10 weeks of gestation. After the prcedure, 4 patients remained as twin pregnancies, and 2 patients as single pregnancy. There have been 3 sets of twin deliveries and the 2 sets of single delivery. One case was aborted. Two patients were delivered after 37 weeks of gestation, 2 patients were at 35 weeks, and 1 patient at 24 weeks. All babies have been healthy after birth in patients after 35 weeks gestation. There was no fetal anomaly related to the procedure in the 6 cases. We concluded that transabdominal SFR is a rather safe and useful procedure that may improve the outcome of multifetal pregnancies.
Fetus ; Humans ; Incidence ; Infertility ; Ovulation Induction ; Parturition ; Pregnancy Reduction, Multifetal* ; Pregnancy* ; Pregnancy, Twin ; Quadruplets ; Quintuplets ; Reproductive Techniques, Assisted ; Triplets ; Twins

BACKGROUND: Nevus sebaceus of Jadassohn is a complex anomaly involving the epidermis, dermis, apocrine glands and hair follicles, as well as the sebaceous glands, and a variety of benign and malignant tumors and neurologic abnormalities may be associated with it; however, only a few studies on it have been reported in the Korean literature. OBJECTIVE: The objectives of this study was to document clinical and histopathologic features of nevus sebaceus in Koreans and compare them to those in the previously reported studies. METHOD: Clinical records and histopathology of 53 cases of nevus sebaceus diagnosed at Ewha Womans University Tongdaemun Hospital during a period of 18 years were reviewed and analyzed. RESULTS: The average incidence rate of nevus sebaceus among new patients was 0.03%. The male-to-female ratio was 1.04 and the average age at visit, 16.5 years. The lesions had been present since birth or had developed before age 10 in 85% of the cases. A11 lesions were situated on the head, and the most common site was the scalp. Linear 1esions (20.8%) were mostly facial lesions. Histopathologically, the incidence of sebaceous and apocrine glandular hyperplasia was most notable in the 13-18 and over-18 age groups. The sebaceous glands showed small punched out defects or "holes" in 24.5%; ectopic apocrine glands were found in 24.5 %. Mature hair follicles were absent or greatly reduced in number in 75.5%. Acanthosis nigricanslike pattern of acanthosis and mild papillomatosis were the dominant changes in the epidermis. Hyperplasias and neoplasms were associated in 15.1%, which included 5 cases of primitive follicular induction and 1 trichoblastoma. CONCLUSION: In this series, no examples of malignant neoplasms were identified; however, an early total excision before age 13 is recommended since a variable "deficit malformation" of the follicles with hyperplasia of the epidermis and sebaceous glands becomes more prominent after that age.
Apocrine Glands ; Dermis ; Epidermis ; Female ; Hair Follicle ; Head ; Humans ; Hyperplasia ; Incidence ; Nevus* ; Nevus, Sebaceous of Jadassohn ; Papilloma ; Parturition ; Scalp ; Sebaceous Glands

Wells' syndrome or eosinophilic cellulitis is an uncommon cutaneous disorder characterized by recurrent erythematous and edematous plaques that often resemble acute cellulitis. The characteristic microscopic findings are diffuse dermal eosinophilia with marked edema, and flame figures consisting of amorphous or granular eosinophilic material around collagen bundles of the dermis. Etiology and pathogenesis are unknown, but the disease has been found to be associated with infections, arthropod bites, drug administration, surgery and hematologic disorders. We report the case of a 55-year-old man with pancreatic carcinoma who was presented with an asymptomatic erythematous to brownish subcutaneous nodule on the left buttock of several days' duration. A biopsy specimen taken from the erythematous to brownish nodule showed many flame figures and diffuse infiltration of eosinophils in the dermis and subcutaneous fat tissue. The rapid resolution of the skin lesion with chemotherapy of the pancreatic carcinoma supports a relationship between the two conditions.
Arthropods ; Biopsy ; Buttocks ; Cellulitis ; Collagen ; Dermis ; Drug Therapy ; Edema ; Eosinophilia ; Eosinophils ; Humans ; Middle Aged ; Skin ; Subcutaneous Fat

A case of acute febrile neutrophilic dermatosis (Sweet's syndrome) characterized by tender erythematous plaques on the face, neck, and limbs was reported. This 43-year-old male patient has been suffering from fever and sore throat prior to development of skin lesions. Positive laboratory findings were polymorphonuclear leukocytosis and elevated erythrocyte sedimentation rate. The symptoms well responded to corticosteroid therapy.
Adult ; Blood Sedimentation ; Extremities ; Fever ; Humans ; Leukocytosis ; Male ; Neck ; Pharyngitis ; Skin ; Sweet Syndrome*

A 22-year-old woman with no history of trauma or other diseases presented with a slowly enlarging firm nodule with a central pointed opening on the right chest. An excisional biopsy revealed a pilomatricoma associated with an epidermoid cyst. Histopathologically, an epidermoid cyst located in the deep dermis was lined mostly by keratin-forming stratified squamous epithelium but focally had columns of shadow cells that projected from the epithelial lining of the cyst into the lumen. The lumen also contained masses of shadow cells, unattached to the epithelial lining. In the stroma surrounding the cyst, numerous masses of shadow cells with giant cell reaction and focal calcification were seen, which were in turn surrounded by a connective tissue capsule. These features are similar to those seen in infundibular cysts associated with Gardner's syndrome. Since epidermoid cysts and pilomatricomas originate in common from the pilosebaceous unit and pilomatricomas begin as infundibular matrix cysts, we suggest that they can occur simultaneously, although rarely, in a healthy person.
Biopsy ; Connective Tissue ; Dermis ; Epidermal Cyst* ; Epithelium ; Female ; Gardner Syndrome ; Giant Cells ; Humans ; Pilomatrixoma* ; Thorax ; Young Adult

Polypoid prolapse of mucosal folds can occur at various sites and in various conditions predominantly associated with strain during defecation. There are two well known types of mucosal prolapse syndrome(MPS), the inflammatory cloacogenic polyp(ICP) and the mucosal redundant polyp associated with diverticular disease(N4RPD). ICP is a mucosal prolapse of the anorectal junction and MRPD is a proximal analogue involving the sigmoid colon. We experienced two cases of eroded polypoid hyperplasia(EPH) of the rectosigmoid colon which manifested as a huge gyriform mass simulating the gross features of gastrointestinal lymphomas or other malignant tumors. The EPH consisted of confluent polypoid mucosal folds with rolled-up submucosa to form stalk, The polypoid lesion represented hyperplastic epithelium, erosion of the mucosal surface and congestive vascular ectasia of lamina propria and submucosa. To explain the whole morphologic features, the initial phenomenon should be the mucosal prolapse. Vascular stretching with ischemic erosion of the mucosal surface and compensatory epithelial hyperplasia ensue as the result. The ominous endoscopic and gross features of EPH should be kept in mind to avoid erroneous radical surgery.

BACKGROUND: Pilomatricoma is a rare benign follicular tumor in Asians OBJECTIVE: purpose of this study was to assess the clinical and histopathological features of the tumor. METHODS: The hospital charts and slides of 13 patients with pilomatricoma over a 12-year period at Ewha Womans University Tongdaemun Hospital were retrospectively reviewed. RESULTS: The age of patients ranged from 5 to 76 years with a mean of 21.5 years. The maleto-female ratio was 1:3.3. Seventy-seven percent of the tumors were located on the upper and lower extremities, followed by the face and neck. Most tumors appeared as a pea-sized hard movable skin-colored nodule. At histopathologic level, the most common morphological stage was the early regressive stage (stage 3), followed by late regressive (stage 4), fully developed (stage 2), and early (stage 1) stages. Foreign body giant cells, calci6cation, ossification were seen in 69.2%, 84.6%, and 7.7%, respectively; giant cells and inflammatory infiltrate were mostly seen in stage 3 tumors, calcification in stage 3 and 4 tumors, and ossification, only in the sole stage 4 tumor. Anetodermic changes of overlying dermis were seen in 2 cases (15.4%). CONCLUSION: The various histopathologic features of pilomatricoma can be explained by its chronological, morphological stages.Most pilomatricomas present for longer than 6 months are already in stage 3, and one can expect the histopathological features accordingly.
Asian Continental Ancestry Group ; Dermis ; Female ; Giant Cells ; Giant Cells, Foreign-Body ; Humans ; Lower Extremity ; Neck ; Pilomatrixoma* ; Retrospective Studies

This report describes the pathologic features of 17 cases of Castleman's disease, examined at the Department of Pathology, Seoul National University Hospital during a period from 1973 to 1989. The lesions in 12 cases were hyaline-vascular type and the remainders plasma cell type. The pathologic features favoring the plasma cell type over the hyaline vascular type included a sufficient number to large-sized follicles. However, a histologic overlapping between two types was present. In the hyaline vascular type the age of the patients ranged from 7 to 76 years and they appeared to be no particular sex predominence. The majority of the lesions occurred in the neck and within the chest. Almost all cases presented with a solitary mass except three cases. Neither conventional symptoms nor systemic manifestations were associated. The plasma cell type was characterized by presentation of constitutional symptoms, involvement of intra abdominal and inguinal lymphnodes, in association with unusual clinicopathologic features including IgA nephropathy, diabetes mellitus, systemic progressive sclerosis, peripheral neuropathy, and anemia. Immunohistochemical study was performed in three cases of the plasma cell type. Two cases revealed poly-clonal plasma cell infiltration. In a patient with IgA nephropathy, however, serum IgA was increase and a strong immunoreactivity to IgA heavy chain was found. Another case, associated with systemic progressive sclerosis and neuropathy, revealed monoclonal plasma cell infiltration (IgG and lambda light chain). The above results support a possibility that in some of the plasma cell type an altered immune mechanism is involved in its pathogenesis.