A case of 49 year-old male with dermatomyositis associated with stomach cancer and Sjogren's syndrome is reported. The skin changes were characterized by the presence of Gottron's sign and dusky erythematous and finely scaling macular eruptions with telangiectasias on the scalp, forehead, butterfly area of the face, both elbows and knees. Dryness of eyes and mouth, nuchaI rigidity, numbness on extremities and epigastric hunger pain were also noted. The family history and past history were not contributory. After that weakness on proximal muscles, nuchal rigidity, dysphagia and walking difficulty were more aggravated. On dental and ophthalmologic examinations, shiny appearance of tongue and oral mucosa, burning and dry sensation in the mouth was noted and diminished tear and saliva production was also discovered. On laboratory findings, ESR, serum enzymes, especially CPK 3 and LDH, urinary creatine excretion were increased. LE cell was not found and RA test was also negative. Electromyographic and nerve conduction studies revealed myopathic EMG and normal nerve conduetion in both motor and sensory. There are gastric ulcer, positive vallecular sign on esophagus and thread like narrowing on almost all main and minor ducts of parotid gland. Histologic findings revealed ulcerative adenocarcinoma of stomach, a mild focal infiltration of lymphocytes and degenerative changes in left deltoid muscle and diffuse and extensive dermal edema associated with inflammatory infiltrates and hydropic degeneration and atrophy on the facial skin. He was treated with prednisolone, aspirin and intravenous methotraxate but no favorable effect was noted. Authors reviewed relevant literature.
Adenocarcinoma ; Aspirin ; Atrophy ; Burns ; Butterflies ; Creatine ; Deglutition Disorders ; Deltoid Muscle ; Dermatomyositis* ; Edema ; Elbow ; Esophagus ; Extremities ; Forehead ; Humans ; Hunger ; Hypesthesia ; Knee ; Lymphocytes ; Male ; Middle Aged ; Mouth ; Mouth Mucosa ; Muscle Rigidity ; Muscles ; Neural Conduction ; Neutrophils ; Parotid Gland ; Prednisolone ; Saliva ; Scalp ; Sensation ; Sjogren's Syndrome* ; Skin ; Stomach Neoplasms* ; Stomach Ulcer ; Stomach* ; Tears ; Telangiectasis ; Tongue ; Ulcer ; Walking

BACKGROUND: Epidermal growth factor receptors (EGFR) have been reported to be absent in melanomas. But recently, the presence of EGFR on melanocytic cells was reported to be a marker of malignant transformation. OBJECTIVE: Our purpose was to investigate the presence of EGFF in melanocytic lesions and to determine whether EGFR presence correlates with the potential or malignant transformation of melanocytic cells. METHODS: We performed the immunohistochemical studies to reveal immunoreactivity of EGFR in 7 compound nevi, 10 intradermal nevi, and four melanomas using the Vectastain ABC immunoperoxidase stain system. RESULTS: Although the intensity of staining was slightly variable, all melanocytic cell types in the studied lesions of compound nevi, intradermal nevi, and melanoms had immunoreactive EGFR. Intense staining far EGFR of all nucleated layers of keratinocytes overlying a melanocytic lesion was also seen. But in the melanoma cells, the staining intensity was modarately deereased. CONCLUSION: Although we found no correlation of EGFR with the potential for malignancy in melanocytic lesions, the high level of expression within nevocytes and lesional keratinocytes suggests EGFR or transforming growth factor a, by acting through the EGFR, plays a role in the pathogenesis, maintenance, or evolution or these lesions.
Epidermal Growth Factor* ; Keratinocytes ; Melanoma ; Nevus ; Nevus, Intradermal ; Receptor, Epidermal Growth Factor* ; Transforming Growth Factors

BACKGROUND: Epidermal growth factor(EGF) usually stimulate she growth and proliferation of a variety of cell types in vitro and in vivo through binding to a peific cell surface receptor, a 170- kilodalton glycoprotein. The EGF receptor (EGFR) may be respansi ile for deranged keratinocyte proliferation and differentiation. OBJECTIVE: Our purpose was to investigate the pattern of EGFR expression in malignant epidermal tumors. METHODS: We performecl immunohistochemical studies to reveal immunoreactivity of EGFR in 7 basal cell carcinomas, 6 squamous cell carcinomas, and five nomal control skin using the Uectastain ABC immunoperoxidase stain system. RESULTS: In normal skin, EGFR showed strong staining of basal cells and lower keratinocytes of the stratum malpighii. As squaous cells matured, staining gradually beame weaker. In all cases of basal cell carcinoma studied, there was loss of membrane labelling of the tumor cells and but in half the cases there was little or no siaining of the lesional cells. In squamous cell carcinomas, variable patterns were seen. The better differentiated tumors showed an essentially no mal pattern of EGFR expression. However, less well differentiated areas showed loss of membrane staining, cytoplasmic accumulation of receptor, and a heterogeneiy of staining intensity. CONCLUSION: Dysregulation of the EGFR may be important in the levelopment, of cutaneous epithelial malignancies but that giossly abnormal forms of the receptor do not occur. The quantitative and qualitative changes in EGFR that we have demonstrated may well be of importance in the pathogenesis of these keratinocyte tumors.
Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Cytoplasm ; Epidermal Growth Factor* ; Glycoproteins ; Keratinocytes ; Membranes ; Receptor, Epidermal Growth Factor* ; Skin

Angiotensin-converting enzyme(ACE) is a ipeptidyl carboxypeptidase that is a membrane bound mainly on the luminal surface of pulmonary endothelial capillary cells. It functions to inactivate bradykinin, and also converts angiotensin 1 to angiotensin Activity of ACE was first identified in plasma by Skeggs and co-workers in ]956 In 1974 Lieberman discovered that elevated levels of serum ACE were associated with active sarcoidosis and that this assay would be usei to assist a diagnosis of sarcoidosis. The association of sarcoidosis and enhanced ACE activity was subsequently supported by data from other investigators. Increased serum ACE levels have also been observed in patients with nongranulomatous diseases and granulomatous diseases including leprosy. The author studied the serum ACE levels in leprosy patients(fourty-three with tuberculoid type and eighty-nine with lepromatous type) and twenty normal healthy controls by the spectrophotometric method described by Lieberman. Comparative studies of ACE levels in these two types of leprosy with normal healthy controls and relationship among the duration of treatment, age, and sex were also conducted. The results were summarized as follows: Ages of the selected patients were between 3Q to 77 years in tuberculoid leprosy (average 54 1), 23 to 75 years in lepromatous leprosy(average 53. 8) and 14 to 49 years in the control group(average 28 4) The duration of treatment in tuberculoid leprosy was between 1 and 39 years and average was 2p 7 years. Of lepromatous leprosy, duration of treatment was between 2 and 50 years and the average was 25. 4 years.
Angiotensins* ; Bradykinin ; Capillaries ; Diagnosis ; Humans ; Leprosy* ; Leprosy, Lepromatous ; Leprosy, Tuberculoid ; Membranes ; Peptidyl-Dipeptidase A* ; Phenobarbital ; Plasma ; Research Personnel ; Sarcoidosis

BACKGROUND: Mutations in the p53 gene are the most frecjuent genetic alterations found in human cancers to date. Bvidense suggests that wild-type p53 is a tumor suppressor protein, crucial for the negative regulative of cell cycling, and requiring loss of function mutations for tumorigenesis. OBJECTIVE: Our purposr is to investigate the expression pattern of the p53 protein in the squamous cell carcinomas(SCCs) of the human skin. METHODS: We studied p53 protein expression, using DO7 mnoclonal antibody immunohi-stochemistry, in 29 SCCs of the skin. Also, we compared the p53 expression depending upon with or without a history of UV exposure. RESULTS: p53 immunoreactivity was observed in 48% (14 of 29) of SCCs and was not seen in normal skin. In 56% (16/29) SCCs the tumors were developed on UV-light exposure area. SCCs were divided on histopatal biological criteria in to three categories, well, moderately, or poorly differentiated. Although no significant differenie in the prevalence of p53 immunoreactivity was obierved between these groups, positive, strong staining was observed more frequently in poorly differentiated than in well-differe: treated tumors. CONCLUSION: Accumulat,i,on of p53 protein, suggestive in nessary cases of p53 gene mutation and hence loss of tumors upperesor function, may play a role in the tumorigenesis of SCCs.
Amoxicillin ; Carcinogenesis ; Carcinoma, Squamous Cell* ; Genes, p53 ; Humans* ; Prevalence ; Skin*

Melanoma is relatvely uncommon malignant tumor arising in the skin from epidermal melanocytes, from the junctional component of a cellular nevus or, rarely within a blue nevus and frequently metastasizes to regional lymph nodes first, followed by hematogenous spread to lungs, liver, gastrointestinal tract, pancreas, adrenal, heart and brain. All melanoma patients are carefully evaluated according to several parameters. A complete history and physical examination are carried out, with particular attention being devoted to other pigmented tumors that the patient may have. The patient should be further evaluated to determine the presence or absence of metastases by chest X-ray examination, metastatic series or bone scan, liver function studies, liver scan, EKG, etc. Special factors such as age, sex, and race, as well as site, size, and growth rate of lesions are also evaluated. We had a case of 59 year-old male patient with disseminated malignant melanoma. Upon his first visit, we did not find any abnormality in his physical examination and routine laboratory findings except skin tumors on left heel and left leg.
Brain ; Continental Population Groups ; Electrocardiography ; Gastrointestinal Tract ; Heart ; Heel ; Humans ; Leg ; Liver ; Lung ; Lymph Nodes ; Male ; Melanocytes ; Melanoma* ; Middle Aged ; Neoplasm Metastasis ; Nevus ; Nevus, Blue ; Pancreas ; Physical Examination ; Skin ; Thorax

BACKGROUND: Induction of general anesthesia with tracheal intubation and skin incision are potent stimuli that can induce increased sympathetic activity, heart rate and blood pressure. We compared the hemodynamic response and catecholamine concentration during general anesthesia with intravenous clonidine pretreatment, a centrally acting -2 adrenoceptor agonist, and without pretreatment. METHODS: Forty ASA I or II patients aged from 20 to 60 years undergoing elective surgery were randomly allocated to two groups. In group I, 5 ml of 0.9% normal saline as control administered intravenously 10 minutes before induction of anesthesia, and anesthesia was induced with thiopental sodium, succinylcholine and maintained with N2O (2.5L/min)-O2 (2.5L/min)-enflurane (1.3~1.8 vol%). In group II, 4 g/kg clonidine diluted in 5ml of normal saline administered intravenously 10 minutes before induction of anesthesia, and anesthesia was induced with thiopental sodium, succinylcholine and maintained with N2O-O2-enflurane (0.5~1.0vol%) and 2 g/kg/hr clonidine was continuously infused. We measured blood pressure, heart rate and plasma catecholamine at preinduction, 1 minute after intubation (T1), 1 (T2) and 30 minutes after skin incision (T3) and compared with group I. RESULTS: There was statistical significance in systolic and diastolic pressure at T1 between two groups. There was statistical significance in heart rate, epinephrine and norepinephrine at T1, T2 and T3 between two groups. CONCLUSION: The elevation of blood pressure, heart rate and plasma catecholamine accompanying tracheal intubation and skin incision may be prevented by administration of intravenous clonidine.
Adult ; Anesthesia ; Anesthesia, General* ; Blood Pressure* ; Brain ; Clonidine* ; Epinephrine ; Heart Rate* ; Heart* ; Hemodynamics ; Hemorrhage ; Hope ; Humans ; Incidence ; Intubation* ; Larynx ; Male ; Norepinephrine ; Plasma* ; Skin ; Spondylitis, Ankylosing ; Succinylcholine ; Thiopental

Benign symmetric lipomatosis is characterized by massive symmetric fat deposition, predominantly in the neck and shoulder girdle ares. We present a case of benign symmetric lipomatosis with alcoholic liver cirrhosis in a 54-year-old man. About two years ago, solitary skin-colored, non-tender swelling on the right upper arm was developed. The lesion had been aggravsted abruptly and rapidly in size and distribution since about one month ago. Histopathologic findings showed completely replaced reticular dermis and invaded subcutaneous tissue by mature fat cells.
Adipocytes ; Arm ; Dermis ; Humans ; Lipomatosis* ; Liver Cirrhosis, Alcoholic ; Middle Aged ; Neck ; Shoulder ; Subcutaneous Tissue

A 17-year-old woman had an extensive nevus comedonicus affecting the left sides of the breast, trunk, axilla, and upper extremity. Her condition was complicated by episodes of re-current cyst formation, secondary infection, and atrophic scars. We performed various therapeutic approaches include topical keratolytic agents, manual extraction of comedones, excision of smaller lesions, and systemic antibiotics but the response was unsatisfactory. We tried systemic isotretinoin and minocycline and the pustulation of the lesions was reduced. Herein we report a rare case of linearly arranged extensive nevus comedonicus.
Adolescent ; Anti-Bacterial Agents ; Axilla ; Breast ; Cicatrix ; Coinfection ; Female ; Humans ; Isotretinoin ; Keratolytic Agents ; Minocycline ; Nevus* ; Upper Extremity

Angiotensin-converting enzyme (ACE), a dipeptidyl carboxypeptidase, hydrolyzes angiotensin I to the active angiotensin g and also inactivates bradykinin. Activity of ACE was first identified in plasrna by Skeggs et al in 1956. In 1975 Lieberman first reported elevation of serum ACE level in patients with active sarcoidosis and suggested clinical application of the assay to confirm a diagnosis of sarcoidosis and to serve as a guide for therapy. The author studied the serurn ACE levels in 21 syphilitic patients (11 men, 10 women) who showed positive responses in both VDRL and TPHA tests and 20 normal healthy controls (7 men, 13 women) by the spectrophotometric method described by Lieberrnan who modified Cushman and Cheungs method. Comparative studies of ACE levels in syphilitic group with normal control group and relationship among the age, sex and treatment were also conducted. The results were summarized as follows : Ages of the syphilitic patients and normal healthy control group ranged from 18 to 51 years (27 1+-8 98 years) and from 14 to 49 years (28 4+9 08 years) respectively. The mean serum ACE level in syphilitic patients was ll 33+-3 25 p/ml, which was significantly higher than that of normal healthy control group, 6 39+-2 RR p/ml, (p<0001) Of the 21 syphilitic patients, 15(71 4%) had ACE activity higher than the upper limit of normal (mean+1SD). There was no significant correlation between age and serum ACE level. -countinue-
Angiotensin I ; Angiotensins* ; Bradykinin ; Diagnosis ; Humans ; Male ; Peptidyl-Dipeptidase A* ; Sarcoidosis ; Syphilis*