Extramammary paget's disease is uncommon intraepithelial carcinoma of the skin and frequently associated with a subjacent or a regionally proximate carcinoma. We have experienced a case of extramammary Paget's disease affecting 71 year-old man. The patient has been suffered from a well demarcated, and slowly growing erythematous plaque on the left suprapubic area of 3 years. A biopsy specimen reveals infiltration of typical Paget's cells within the epidermis and the adnexa. We review the literature briefly.
Biopsy ; Carcinoma in Situ ; Epidermis ; Humans ; Paget Disease, Extramammary* ; Skin

No abstract available.
Antifungal Agents* ; Trichophyton*

KOH examination is a simple, rapid and diagnostic procedure to confirm dermatophytic infections. It is important to select a proper examination site of the lesion. To determinate the proper examination site of the lesion, mycologic studies were done with multiple specimens collected from the center, margin and out of margin of the ring-shaped dermatophytic skin lesion on the 58 patients. The results were as follows. Positive rate of KOH wet smear was 94.8% at the center and 100% at the margin of the lesions, 22.4% at the 1 cm and 5.2% at the 2 cm out of the lesions. The more hyphae were found in the lesion, the more hyphae were found out of the lesion. Culture was done on the Sabouraud's glucose agar from the highest KOH positive area and the positive culture was 48 strains (82.8%) of 58 patients. These findings suggested that the ring-shaped active margin was the best site to examine mycologic studies.
Agar ; Glucose ; Humans ; Hyphae ; Skin*

BACKGROUND: PUVA has been used effectively in the treatment of vitiligo, but the mechanism by which PUVA stimulates melanocyte proliferation in vitiligo is not known. Several mechanisms have been suggested to be involved in the process of repigmentation of vitiligo. First, UV light, with or without psoralen, directly stimulates the proliferation of melanocytes. Secondly, PUVA may act. on epidermal keratinocytes or dermal components to stimulate t,hem to release certain melanocyte growth st,inulation factors that enhance the proliferation of melanocytes in depigmented lesions. Thirdly, PUVA irnmunologically leads to the impairment of epidermal Langerhans cell function and alteration of circulating T and B cell function, which results in the suppression of the stimuli is for rnelanocyte destruction during the therapy. OBJECTIVE: To test, th hypothesis that PUVA induced repigmentation in vitiligo results from the stimulation of growth factors that induce melanocyte proliferation, and that PUVA may suppress the immune reacticin to melanocytes, especially in autoantibody synt,hesis, we examined the effects of sera on the growth of epidermal melanocytes and control cells, and the incidence of antibodies to melanocyte and melanoma cells(SK-Mel 2~3) in the sera of patients with vitiligo. We also had normal control individuals and studied the changes of the antibody titer in the sera of patients with vitiligo. METHODS: The rate of H thymidine uptake was estimat,ed in cultured melanocytes and fibroblasts t,reated by patients sera before and after PUVA treatment. SDS-PAGE and immunoblotting analysis were used to idcntify anti pigment cell autoantibodies and were compared to the titers of autoantibodies after PUVA. RESULTS: 1. Melanocyte and fibrablast proliferation was increased by PUVA treated sera. Their proliferation was in proportion to the duration of the PUVA treatment. Melanocytes proliferated more than fibroblasts. 2. Significant differences between vitiligo patients and normal controls were found in the inci dence of anti-pigment cell antibodies. The antibodies were predominantly directed to melanocyte antigens of 110 kD, 65 kD, 45 kD and melanoma cell antigens of 110 kD, 103 kD, 88kD, 70 kD, 56 kD, 41 kD. 3. The titer of anti piment cell antibodies showed a tendency to decrease after PUVA treat- ment in most patients regardless of clinical improvement. Conclusion ; PUVA treated sera induced proliferation of melanocytes and fibroblasts and the production of aut,oantibodies was suppressed against pigment cell antigens through irnmunosuppression, which might help in the repigmentation of vitiligo.
Antibodies ; Autoantibodies ; Candida* ; Classification* ; DNA* ; Electrophoresis, Polyacrylamide Gel ; Fibroblasts ; Ficusin ; Humans ; Immunoblotting ; Incidence ; Intercellular Signaling Peptides and Proteins ; Keratinocytes ; Melanocytes ; Melanoma ; Thymidine ; Ultraviolet Rays ; Vitiligo

BACKGROUND: PUVA has been used effectively in the treatment of vitiligo, but the mechanism by which PUVA stimulates melanocyte proliferation in vitiligo is not known. Several mechanisms have been suggested to be involved in the process of repigmentation of vitiligo. First, UV light, with or without psoralen, directly stimulates the proliferation of melanocytes. Secondly, PUVA may act. on epidermal keratinocytes or dermal components to stimulate t,hem to release certain melanocyte growth st,inulation factors that enhance the proliferation of melanocytes in depigmented lesions. Thirdly, PUVA irnmunologically leads to the impairment of epidermal Langerhans cell function and alteration of circulating T and B cell function, which results in the suppression of the stimuli is for rnelanocyte destruction during the therapy. OBJECTIVE: To test, th hypothesis that PUVA induced repigmentation in vitiligo results from the stimulation of growth factors that induce melanocyte proliferation, and that PUVA may suppress the immune reacticin to melanocytes, especially in autoantibody synt,hesis, we examined the effects of sera on the growth of epidermal melanocytes and control cells, and the incidence of antibodies to melanocyte and melanoma cells(SK-Mel 2~3) in the sera of patients with vitiligo. We also had normal control individuals and studied the changes of the antibody titer in the sera of patients with vitiligo. METHODS: The rate of H thymidine uptake was estimat,ed in cultured melanocytes and fibroblasts t,reated by patients sera before and after PUVA treatment. SDS-PAGE and immunoblotting analysis were used to idcntify anti pigment cell autoantibodies and were compared to the titers of autoantibodies after PUVA. RESULTS: 1. Melanocyte and fibrablast proliferation was increased by PUVA treated sera. Their proliferation was in proportion to the duration of the PUVA treatment. Melanocytes proliferated more than fibroblasts. 2. Significant differences between vitiligo patients and normal controls were found in the inci dence of anti-pigment cell antibodies. The antibodies were predominantly directed to melanocyte antigens of 110 kD, 65 kD, 45 kD and melanoma cell antigens of 110 kD, 103 kD, 88kD, 70 kD, 56 kD, 41 kD. 3. The titer of anti piment cell antibodies showed a tendency to decrease after PUVA treat- ment in most patients regardless of clinical improvement. Conclusion ; PUVA treated sera induced proliferation of melanocytes and fibroblasts and the production of aut,oantibodies was suppressed against pigment cell antigens through irnmunosuppression, which might help in the repigmentation of vitiligo.
Antibodies ; Autoantibodies ; Candida* ; Classification* ; DNA* ; Electrophoresis, Polyacrylamide Gel ; Fibroblasts ; Ficusin ; Humans ; Immunoblotting ; Incidence ; Intercellular Signaling Peptides and Proteins ; Keratinocytes ; Melanocytes ; Melanoma ; Thymidine ; Ultraviolet Rays ; Vitiligo

Rheumatoid arthritis is considered to be a collagen disease which mainly involves articular structures, sometimes has extraarticular manifestations. It is generally accepted now that periarticular osteoporosis develops in early phase of rheumatoid arthritis and generalized osteoporosis in late period. Of several methods of non-invasive measurement of bone mass, single photon absorptiometry was introduced by Cameron and Sorenson(1963) and it has been used for measuring bone mass by many authors with its precision, reproducibility and objective quantification. We tried to observe the quantitative changes of bone mass in rheumatoid arthritis patients with single photon absorptiometry technique. Through the study of bone densitometry in 30 rheumatoid arthritic women compared with age-matched 60 healthy controls, we obtained follow results. 1. Bone mineral density of the rheumatoid arthritis group was lower than that of the control group, but had no significant statistical difference. 2. Bone mineral density of the 40–49-year-old group and 50–59-year-old group was considerablely different in the rheumatoid arthritis group and control group. 3. Bone mineral density of the group whose rheumatoid arthritis history was over 2 year was lower than that of the group below 2 year.
Absorptiometry, Photon ; Arthritis, Rheumatoid ; Bone Density ; Collagen Diseases ; Densitometry ; Female ; Humans ; Osteoporosis

BACKGROUNDS: This study was investigated for assessing of the sedative dose of midazolam and its influence on neonatal Apgar score that intravenously injected immediately before operation during epidural anesthesia for cesarean section. METHODS: Midazolam, 1 mg, was given into a freely running IV line every 30s 2 min after 2 mg of midazolam was initiately injected. Ten seconds prior to each injection patients were asked to open the eye. No response, as determined by the anesthesiologists, to three promptly repeated and increasingly louder commands was considered the end-point for the study and no further midazolam was given. RESULTS: The sedative dose of midazolam in our study was 3.3 1.1 mg and interindividual variation (range: 2~7 mg) were wide. Respiratory depression was occurred in one of pregnant women with midazolam. All of the Apgar scores of the newborn infants at 1 and 5 min in both groups were higher than seven. CONCLUSIONS: When the intravenous injection of midazolam for sedation immediately before operation is required in pregnant women during epidural anesthesia for cesarean section, we would like to suggest that one should initiately administer the small dose and then inject the incremental dose with careful observation of the respiratory status.
Anesthesia, Epidural* ; Apgar Score ; Cesarean Section* ; Female ; Humans ; Infant, Newborn ; Injections, Intravenous ; Midazolam* ; Pregnancy ; Pregnant Women* ; Respiratory Insufficiency ; Running

The birth of conjoined twins remains an extremely rare event. Most of such twins are stillborn and one third of the live births die within first day of life. In Korea, there are only three reports on the anesthesia for separation of different kinds of conjoined twins. In view of anesthesia for separation of such twins prematurity, low birth weight, and anomalous shared organ play the major role on the perioperative morbidity and mortality. Such anesthesia therefore is one of the exceedingly complex fields among the pediatric anesthesia and require mobilization of all possible methods and monitoring devices used for pediatric anesthesia. We performed careful preoperative evaluation of extent of joining, discussion and rehearsal of separation procedure between separation team, and anesthetic care such as all possible monitoring, preservation of body temperature, appropriate fluid therapy, awake intubation, avoid neuromuscular blockers, and thorough separation of duty. The separated twins showed normal weight gain postoperatively and discharged postoperative 31th day without any complications.
Anesthesia* ; Body Temperature ; Fluid Therapy ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Intubation ; Korea ; Live Birth ; Mortality ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Parturition ; Twins, Conjoined ; Weight Gain

A case of sporotrichosis misdiagnosed as lupus vulgaris was presented. A 56-year-old woman had been to pea sized, nontender pustules and a hypertrophic-scar-like nodule on the right thigh. She denied any trauma before the lesions developed. Histopathologic findings from the lesion showed tuberculosis-like granulomatous changes. And she was diagnosed as lupus vulgaris. She also had pulmonary tuberculosis and had been treated with antituberculous drugs for 1 year. But skin lesions was not cleared. We suspected the lesions as one of deep mycoses and could confirm sporotrichosis by mycologic studies. They showed characteristic gross colonies and microscopic findings of Sporothrix schenckii..
Female ; Humans ; Lupus Vulgaris* ; Middle Aged ; Mycoses ; Peas ; Skin ; Sporothrix ; Sporotrichosis* ; Thigh ; Tuberculosis, Pulmonary

We report a case of piroxicam-induced photosensitive dermatitis in a 54-year-old female. She had taken oral piroxicam and was exposed to the sunlight on her way home for a few minutes. Several hours after the sun-exposure she developed well-defined, confluent, erythematous plaques and numerous vesicobullae with pruritus and prickling sensation on the sun-exposed areas. A phototest was done on her first visit. The minimal erythemogenic dose (2 J/cm²) of ultraviolet (UV) A was markedly decreased whereas that of UVB was within a normal limit. Visible light irradiation for 30 minutes did not cause skin lesions. Six months after the initial skin lesions, a photopatch test with 1% and 10% piroxicam solution followed by UVA (10 J/cm²) irradiation showed positive responses on both concentrations.
Dermatitis* ; Female ; Humans ; Light ; Middle Aged ; Piroxicam ; Pruritus ; Sensation ; Skin ; Sunlight