Hepatoid thymic carcinoma is an extremely rare subtype of primary thymus tumor resembling “pure” hepatoid adenocarcinomas with hepatocyte paraffin 1 (Hep-Par-1) expression. A 53-year-old man presented with voice change and a neck mass. Multiple masses involving the thyroid, cervical and mediastinal lymph nodes, and lung were detected on computed tomography. Papillary thyroid carcinoma was confirmed by biopsy, and the patient underwent neoadjuvant chemoradiation therapy. However, the anterior mediastinal mass was enlarged after the treatment whereas the multiple masses in the thyroid and neck decreased in size. Microscopically, polygonal tumor cells formed solid sheets or trabeculae resembling hepatocytes and infiltrated remnant thymus. The tumor cells showed immunopositivity for cytokeratin 7, cytokeratin 19, and Hep-Par-1 and negativity for α-fetoprotein. Possibilities of germ cell tumor, squamous cell carcinoma, and metastasis of thyroid papillary carcinoma were excluded by immunohistochemistry. This report on the new subtype of thymic carcinoma is the third in English literature thus far.

Hepatoid thymic carcinoma is an extremely rare subtype of primary thymus tumor resembling “pure” hepatoid adenocarcinomas with hepatocyte paraffin 1 (Hep-Par-1) expression. A 53-year-old man presented with voice change and a neck mass. Multiple masses involving the thyroid, cervical and mediastinal lymph nodes, and lung were detected on computed tomography. Papillary thyroid carcinoma was confirmed by biopsy, and the patient underwent neoadjuvant chemoradiation therapy. However, the anterior mediastinal mass was enlarged after the treatment whereas the multiple masses in the thyroid and neck decreased in size. Microscopically, polygonal tumor cells formed solid sheets or trabeculae resembling hepatocytes and infiltrated remnant thymus. The tumor cells showed immunopositivity for cytokeratin 7, cytokeratin 19, and Hep-Par-1 and negativity for α-fetoprotein. Possibilities of germ cell tumor, squamous cell carcinoma, and metastasis of thyroid papillary carcinoma were excluded by immunohistochemistry. This report on the new subtype of thymic carcinoma is the third in English literature thus far.

BACKGROUND: An aggressive skin cancer on the nose, tends to have poorly defined clinical margins, and has a higher recurrence rate. A small tumor on the nose is usually easily treated by any of the standard methods. However, removal and reconstruction with preserved cosmesis is more laborous in a basal cell carcinoma larger than 10 mm in diameter. This is because the nose has complex contoures, unique skin color and texture, and the limited availability of mobile adjacent skin. When available Mohs micrographic surgery is the preferred treatment for these large tumors. OBJECTIVE: Our purpose was to investigate the preferred reconstruction method(especially, local flap reconstruction) by the cosmetic unit of the nose after Mohs micrographic surgery. METHODS: From March 1991 to February 1997, twenty-one patients were diagnosed with basal cell carcinoma on the nose at our department. All the tumors were removed with Mohs micrographic surgery, and then the defects were reconstructed with a primary closure, skin graft, and local flap.
Carcinoma, Basal Cell* ; Humans ; Mohs Surgery* ; Nose* ; Recurrence ; Skin ; Skin Neoplasms ; Transplants

Herpes zoster virus (HZV) infections are caused by reactivation of the varicella zoster virus. Reactivation symptoms commonly affect the thoracolumbar trunk, and rarely affect the mandibular branches of the trigeminal nerve. When the mandibular branches are involved, lesions appear proximal to the innervation area. This condition may be associated with exfoliation of the teeth and osteonecrosis of the jawbone. We report a case of mandibular osteomyelitis after herpes zoster infection and we present a review of the literature on mandibular-branch involvement of HZV-related osteonecrosis.
Herpes Zoster* ; Herpesvirus 3, Human ; Osteomyelitis ; Osteonecrosis* ; Tooth ; Trigeminal Nerve*

PURPOSE: The importance of postoperative management of those who have undergone intracardiac repair for congenital heart diseases has increased in recent years. In this study, we investigated postoperative complications and their relations to preoperative age or duration of the intubation and artificial ventilation in infants with large symptomatic ventricular septal defect. METHODS: Between January, 1993 and December, 1996, sixty infants underwent primary closure of a ventricular septal defect (VSD). The patients were divided into two groups based on preoperative age : group 1, infants aged 6 month or less (n=40), and group 2, infants aged more than 6 month (n=20). And, another three groups were divided into 3 groups due to the duration of the intubation and artificial ventilation including < 24 hour and 24-48 hour, >48 hour, respectively. We compared the incidence of complications such as infection, respiratory or cardiovascular complications among each group. RESULTS: No specific differences between two age groups were found, but the incidence of right bundle branch block was high in age group of 6 month or less (P<0.05). The incidence of sepsis was high in group of >48 hour (P<0.05). And also, arrhythmias, atelectasis, toxic hepatitis were more frequently observed in the former group. CONCLUSION: These results indicate that early weaning of the artificial ventilation in infants with large symptomatic ventricular septal defect could protect them from development of severe life- threatening infection such as sepsis. We suggest 48 hours or less as the optimal duration of artificial ventilation. Additionally, earlier weaning could provide earlier oral feeding or earlier ambulation, which is improve respiratory homeostasis.
Arrhythmias, Cardiac ; Bundle-Branch Block ; Drug-Induced Liver Injury ; Heart Diseases ; Heart Septal Defects, Ventricular* ; Homeostasis ; Humans ; Incidence ; Infant* ; Intubation ; Postoperative Complications* ; Pulmonary Atelectasis ; Sepsis ; Ventilation* ; Walking ; Weaning

BACKGROUND: Chronic actinic dermatitis (CAD) is a rare disease worldwide. It has been defined on the basis of three criteria: 1) clinical - a persistent eczematous eruption on sun- exposed area with possible extension into non-exposed areas, 2) photobiological - a reduction in the minimal erythema dose to UVB irradiation, and possibly longer wavelengths, and 3) histologic - an appearance consistent with chronic eczema, with or without the presence of lymphoma-like changes. However, only a few clinicohistopathologic and photobiological analyses of CAD have been undertaken in Korea. OBJECTIVE: To explore photoallergens and/or allergens causing or thought to be associated with CAD in Korean patients, and to compare the photopatch or patch test results in Korea with those from other countries. METHODS: Thirty-five Korean patients with CAD were enrolled for this study. Photopatch tests were carried out by applying two sets of the Scandinavian photopatch series to each patient. Two days after application, the photopatch tests were analysed, and one set of the photoallergens was irradiated with 50% of the MED-UVA. Both sets of photoallergens were examined 2 days later. A European standard series was used to assess the patch tests. At two and four days after application, patch tests were analysed. RESULT: Twenty-seven of the 35 patients (77.1%) who had photopatch tests showed positive responses; balsam of Peru, promethazine HCl, perfume mix, fentichlor, chlorhexidine digluconate, and chlorpromazine HCl were the common photoallergens that elicited a positive response. Twenty-one of the 35 patients (70%) showed allergy to nickel, chrome, and/or ammoniated mercury. Noticeably, photoallergens such as balsam of Peru, perfume mix, cobalt, and captan revealed positive reactions in the patch tests, too. CONCLUSION: In 77.1% and 74.3% of CAD patients, photoallergens and allergens were identified, respectively. Among them, 57.1% showed positive reactions including both photopatch and patch tests. After the most frequent photoallergens, perfume and spices, and phenothiazines or related antihistamines ranked next and were found to be a unique characteristic to Korea. Photopatch and patchtests are the method for detecting photoallergens and allergens as important initiating agents and are the diagnostic tool for the epidemiologic study of CAD.
Allergens ; Captan ; Chlorhexidine ; Chlorpromazine ; Cobalt ; Eczema ; Epidemiologic Studies ; Erythema ; Histamine Antagonists ; Humans ; Hypersensitivity ; Korea ; Nickel ; Patch Tests* ; Perfume ; Peru ; Phenothiazines ; Photosensitivity Disorders* ; Promethazine ; Rare Diseases ; Spices

BACKGROUND: Recently, the concept of health is being extended to physical, mental and social aspects, which leads people to pursue health positively behavior. But the evaluation of health condition shows a tendency to be biased to functional side. It means the absence of well being sensation that anyone feels like he has poor health. In this case, even if he is in physically good health, he is not rated as healthy. We analyzed the relationship between one's health state and the factors related with health perception including health behavior, mind and social environment. METHODS: For a month of May 1996, we surveyed those who visited for Periodic medical check-up at one general hospital in Seoul. The questionnaire consisted of the total of 25 items ; diet behavior, weight control, coffee, coke, tea, drug use of, smoking, drinking, exercise, leisure, safety belts use, jay walking, sleep, stress, personality, anxiety, depression, occupational satisfaction, relationships with family and friends. Five point scale is used as the answer of each question item with high point as good living behavior. Among 406 who had sincerely answered the questionnaire, we divided them into healthy and unhealthy group and compared with the point of each question item and with the laboratory data(obesity, blood pressure, hemoglobin, fasting blood sugar, cholesterol and ALT). RESULTS: Among 406, the number of those who perceived themselves to be healthy was 175(43.1%, healthy group) and the one of those who did not was 231(56.9%, unhealthy group), The difference between both groups was not significant in distribution of sex, age, academic career, income and religion. In laboratory data and living behavior they showed same results, also. But the points of unhealthy group were significantly lower than those of healthy group in coffee, coke, tee, drugs usage, exercise, leisure, stress, personality, anxiety, depression, occupational satisfaction and relationship with family and friends. So was the total point of all items of unhealthy group in comparison with that of health group. In the case of male, the points of unhealthy group were significantly lower in smoking, safety belt use, fay walking, sleeping as well as the above items. On the contrary, in the case of female, both groups were not significantly different all item except exercise and leisure. CONCLUSIONS: Health perception is influenced by psychosocial factors and living behavior more than by physical health. Therefore family physician must be concerned about patient's living behavior, mental and social problems and must make an effort to change their perception of health as well as physical improvement.
Anxiety ; Bias (Epidemiology) ; Blood Glucose ; Blood Pressure ; Cholesterol ; Coffee ; Coke ; Depression ; Diet ; Drinking ; Fasting ; Female ; Friends ; Health Behavior ; Hospitals, General ; Humans ; Leisure Activities ; Male ; Physicians, Family ; Psychology ; Sensation ; Seoul ; Smoke ; Smoking ; Social Environment ; Social Problems ; Tea ; Walking ; Surveys and Questionnaires

Radiotherapy (RT) has been used for decades as one of the main treatment modalities for cancer patients. The therapeutic effect of RT has been primarily ascribed to DNA damage leading to tumor cell death. Besides direct tumoricidal effect, RT affects antitumor responses through immune-mediated mechanism, which provides a rationale for combining RT and immunotherapy for cancer treatment. Thus far, for the combined treatment with RT, numerous studies have focused on the immune checkpoint inhibitors and have shown promising results. However, treatment resistance is still common, and one of the main resistance mechanisms is thought to be due to the immunosuppressive tumor microenvironment where myeloid-derived suppressor cells (MDSCs) play a crucial role. MDSCs are immature myeloid cells with a strong immunosuppressive activity. MDSC frequency is correlated with tumor progression, recurrence, negative clinical outcome, and reduced efficacy of immunotherapy. Therefore, increasing efforts to target MDSCs have been made to overcome the resistance in cancer treatments. In this review, we focus on the role of MDSCs in RT and highlight growing evidence for targeting MDSCs in combination with RT to improve cancer treatment.

OBJECTIVES: In 2002, the Korean Medication Algorithm Project for Major depressive Disorder (KMAP-MD) was published, but there has been a need for a guideline about detailed issues of depressive disorder. We revised KMAP-MDD and reestablished Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) in 2006. METHODS: A questionnaire had been developed by the executive committee for KMAP-DD. The review committee consisted of 101 experienced psychiatrists. From the total of 22 questions in the questionnaire, 7 questions were evaluated for these subjects . We classified the expert opinions to 3 categories according to its confidence interval; first, second and third line. RESULTS: SSRI and venlafaxine were the first line antidepressants (AD) for atypical and melancholic depression. For dysthymic disorder and minor depressive disorder, SSRI was recommended as the first line medications. Only AD medications was a preferred initial strategy for treating premenstrual dysphoric disorder, mild to moderate and severe non-psychotic postpartum depression. In severe psychotic postpartum depression, combination therapy of AD and atypical antipsychotics was the treatment of choice. SSRI was preferred when considering sedation, anticholinergic and cardiovascular adverse effects. Also, experts recommended mirtazapine against gastrointestinal adverse effects and bupropion in avoiding sexual dysfunction. CONCLUSION: These results suggest that clinicians have to consider both clinical situations and drug adverse effects in the choice of antidepressant medications.
Advisory Committees ; Antidepressive Agents ; Antipsychotic Agents ; Bupropion ; Depression* ; Depression, Postpartum ; Depressive Disorder* ; Depressive Disorder, Major ; Dysthymic Disorder ; Expert Testimony ; Female ; Humans ; Psychiatry ; Surveys and Questionnaires

Castleman's disease is a rare disorder of unknown etiology that results in the unregulated growth of lymphoid tissue. It can be classified as unicentric and multicentric based on clinical and radiological findings, and also as hyaline vascular and plasma cell type based on histopathology. Castleman's disease may present as an asymptomatic involvement of one lymph node group or as a multicentric disease with systemic features. However, renal involvement is very rare. Here we report a 50-year old male patient with histopathologically proven multicentric plasma cell type of Castleman's disease who presented with weight loss, palpable cervical lymphadenopathy, azotemia and proteinuria. The finding of a percutaneous needle renal biopsy was compatible with plasma cell type of Castleman's disease. After treated with systemic corticosteroid, azotemia and proteinuria disappeared.
Azotemia ; Biopsy ; Giant Lymph Node Hyperplasia* ; Humans ; Hyalin ; Kidney* ; Lymph Nodes ; Lymphatic Diseases ; Lymphoid Tissue ; Male ; Middle Aged ; Needles ; Plasma Cells ; Proteinuria ; Weight Loss