We report an uncommon case of sebaceous adenoma in a 36-year-old male who had a solitary, well-de6ned, 0.5×0.8cm sized, round, erythematous nodule on the right side of his forehead. Microscopically, the nodule was composed of poorly developed sebaceous lobules that were irregular in size and shape in the deep reticular dermis. The lobules were composed of mature sebaceous cells in the center and undifferentiated basaloid cells at the periphery. In most lobules, the two types of cells occured in approximately equal proportions. We excised the lesion completely and no evidence of recurrence was observed for 2 years.
Adenoma* ; Adult ; Dermis ; Forehead ; Humans ; Male ; Recurrence

BACKGROUND: Dimethyl sulfoxide (DMSO) is a strong urticariogenic agent and a primary irritant. A DMSO test which measures erythema and wheal responses in skin after exposure for 5 min could be a simple and easy method in evaluating cutaneous irritation. Several non-invasive bioengineering methods for the evaluation of skin irritancy have been developed in recent decades. OBJECTIVE: To evaluate whether the DMSO test using filter paper discs instead of the open well with measurements of transepidermal water loss (TEWL) and erythema index (E-index) could be useful to study skin irritancy. METHODS: Twenty healthy volunteers (19-29 years, 10 males and 10 females) with no history of atopic dermatitis were included. DMSO solutions (90%, 95%, and 100%) of 60l were applied to the left volar forearm for 5 min using filter paper discs (12mm) for large Finn chamber. Visual scores (whealing scores and erythema), TEWL and E-index were measured at 30 min after removal of the filter papers. RESULTS: The number of subjects showing erythema and wheals after DMSO exposure were: 6 (30%), 8 (40%) with 90% DMSO solution; 14 (70%), 15 (75%) with 95% DMSO solution; and 20 (100%), 20 (100%) with 100% DMSO solution, respectively. Whealing scores were 0.5±0.6 (90%), 1.4±1.1 (95%), 3.5±0.9 (100%), and erythema ones were 2.9±4.9 (90%), 7.7±7.2 (95%), 20.0±6.5 (100%). E-index results were 10.0±3.4 (90%), 10.9±3.1 (95%), 12.3±2.7 (100%), and TEWL values were 14.6±4.9 (90%), 21.0±8.8 (95%), 44.9±15.3 (100%). As the DMSO concentrations were increased, there were significant increases in whealing scores, and erythema and TEWL values. E-index results were not significant, but showed a rising score tendency. There were no significant differences between the males and the females. CONCLUSION: DMSO testing may be a quick and simple method to assess cutaneous irritation. Also, TEWL measurements may be more accurate and sensitive than those of E-index measurement in the assessment of erythema and wheals. DMSO testing using filter paper discs with TEWL measurement could be a useful method in the study of cutaneous irritation.
Bioengineering ; Dermatitis, Atopic ; Dimethyl Sulfoxide* ; Erythema ; Female ; Forearm* ; Healthy Volunteers ; Humans* ; Male ; Methods ; Skin* ; Water

Cephalosporins are B-lactam antibiotics. They are usually bactericidal in action and act by inhibiting mucopeptide synthesis in the bacterial cell wall. Cephalosporins have been used widely in Korea. However, allergic contact dermatitis to cephalosporins has not been reported in the Korean dermatologiy literature. We report a case of allergic contact dermatitis due to cephalosporins in a 23-year-old nurse who suffered from itchy, erythematous patches and plaques with numerous fissures on both hands. A patch test with ceftriaxone and a prick test with cefotiam were positive.
Anti-Bacterial Agents ; Cefotiam ; Ceftriaxone ; Cell Wall ; Cephalosporins* ; Dermatitis, Allergic Contact* ; Hand ; Humans ; Korea ; Patch Tests ; Young Adult

Cowden's disease, also known as a kind of phosphatase and tensin homolog (PTEN) hamartoma tumor syndrome, is an uncommon autosomal dominant inherited complex disorder with various hamartomatous growths of multiple organs involving all three germ cell layers. It usually manifests with polyps throughout the gastrointestinal tract, ranging anywhere from 30% to 85%, and more common extra intestinal findings. Mucocutaneous lesions like facial trichilemmomas, acral keratoses, papillomatous papules and macrocephaly, and malignancies including breast, thyroid and endometrial carcinoma are the hallmark of the disease. Here we report on familial Cowden's diseases case of a 52-year-old male proband with mucocutaneous lesions and mutation on the PTEN gene obtained by extrapolating from gastrointestinal polyposis as a starter and his daughter who developed thyroid cancer.
Breast ; Endometrial Neoplasms ; Female ; Gastrointestinal Tract ; Germ Cells ; Hamartoma ; Hamartoma Syndrome, Multiple ; Humans ; Intestinal Polyposis ; Keratosis ; Macrocephaly ; Male ; Microfilament Proteins ; Nuclear Family ; Papilloma ; Polyps ; Thyroid Gland ; Thyroid Neoplasms

BACKGROUND: Using biochemical and immunohistochemical studies, alterations of cytokeratin expression has been reported in seborrheic keratosis. OBJECTIVE: To further investigate the cytokeratin expression in seborrheic keratosis, we have done immunohistochemical staining using a panel of specific anti-keratin antibodies in this study. We also observed the cytokeratin expression in the hair, sebaceous gland and sweat gland of the some epidermis. METHODS: Twenty cases of seborrheic keratosis were collected from the pathologic files. The histological types included acanthotic type (13 cases), hyperkeratotic type (5 cases), and pigmented type (2 cases). All tissues had been fixed in formalin and then paraffin-embedded according to conventional procedures. Each section was mounted on a gelatin-coated glass slide, and incubated with various anti-keratin antibodies. The sections were then immunostained using the avidin-biotin-peroxidase complex system. The peroxidase reaction was visualized with diaminobenzidine (DAB). RESULTS: 1. Cytokeratin expression in seborrheic keratosis lesions On staining with 34βB4 (K1), several staining patterns in the suprabasal layers of the epidermis were observed in 10 out of 20 cases. Using the AE1 (K10,14,15), we observed focal staining in 2 cases. We observed several positive staining patterns in 5 cases with K13,16 antibody. On staining with K10 antibody, we observed focal or irregular staining patterns in 14 cases. Focal staining was also observed with K5,8 antibody in one case. 2. Cytokeratin expression in the hair, sebaceous gland and sweat gland On immunoperoxidase staining of hair, there were positive reactions with CAM5.2 (K8,18) in 2 cases. There were positive reaction with K13,16 antibody in one case, with 34βB4 (K1), and K10 antibody in 3 cases, and with K17 antibody in 2 cases. On immunoperoxidase staining of sebaceous glands, there was one positive reaction with CAM5.2 (K8,18) in the suprabasal cells of sebaceous glands and with K13,16 antibody in sebaceous ducts. There were positive reactions with K17 antibody in the sebaceous ducts in 2 cases, and with K1 antibody in the sebaceous glands in one case. Using 34βB4 (K1), 4 out of 20 cases showed positive reactions in sweat glands. On staining with AE1 (K10,14,15), positive reactions were observed in 8 cases. Staining with CAM5.2 (K8,18) showed positive reactions in 14 cases. There were positive reactions with K19 antibody in 9 cases. CONCLUSION: Our data suggests that the predominant keratin expression in the tumor cells of seborrheic keratosis is high molecular weight keratin (K1/K10) rather than other lower molecular weight keratin. Tumor cells show some proliferative activity and monoclonal antibody K19 could be a marker for eccrine sweat glands like CAM5.2 (K8,18).
Antibodies ; Epidermis ; Formaldehyde ; Glass ; Hair ; Keratins* ; Keratosis, Seborrheic* ; Molecular Weight ; Peroxidase ; Sebaceous Glands ; Sweat Glands

The pat,hogenesis of atopic dermititis(AD) is still undefined. The prominent immunologic abnormalities associated with AD are defective cell-mediated immunity and increased IgE production. Also, the predominant CD4 subset in the skin lesion of AD is a Th2-like. Thymopentin, the active pentapepide of a thymic hormone, promotes differentiation of thymocytes and exhibits immunomodulating function. We experienced 2 case. of severe AD patients who were treated with subcutaneous injection of thymopentin three times a week for 6 weeks or 8 weeks. We compared the effects of cyclosporine A(CsA), FK -506 and thymopentin on the production of IL-2, IL-3, IL-4 and sIL-2R in vitro. In patient 1, there was no clinical response with thymopentin therapy. There was no difference in the serum IgE levels between before and after treatment. The ratio of Th/Ts was increased after treatment. In vitro study, CsA and FK-506 inhibited the production of IL-2, IL-3, IL 4 and sIL-2R, and thymopentin inhibited the production of IL-2, IL-3, IL-4 and sIL-2R. In patient 2, the clinical score of the patient was improved from 15 to 10 after treatment with thymopentin. There was no difference in the serum IgE level. The ratio of Th/Ts was decreased after treatment. In vitro study, the production of IL-2, IL-3 and IL-4 were decreased in lymphocytes added with CsA and FK-506, but the production of sIL-2R was increased by CsA and FK-506. Also, the production of IL-3 and IL-4 were increased in lymphocytes added with thyrnopentin, but the proluction of IL-2 and sIL-2R were increased by thymopentin. Our data suggest that thymopentin could be effective in the treatment of severe AD through the upregulation of Thl-like subset, not via the downregulation of Th2-like subset.
Cyclosporine ; Dermatitis, Atopic* ; Down-Regulation ; Humans ; Immunity, Cellular ; Immunoglobulin E ; Injections, Subcutaneous ; Interleukin-2 ; Interleukin-3 ; Interleukin-4 ; Lymphocytes ; Skin ; Tacrolimus ; Thymocytes ; Thymopentin* ; Up-Regulation

STUDY DESIGN: The analysis was based on the sagittal and coronal correction of 64 cases of thoracic hyphokyphosis that were due to idiopathic scoliosis. PURPOSE: We wanted to compare the three pedicle screws and rod systems (using either a semirigid and rigid rod) from the view points of the coronal and sagittal plane correction during the surgical treatment of idiopathic scoliosis. SUMMARY OF LITERATURE REVIEW: There haven't been any reports that have compared the differences and their significance between the semirigid and rigid rod systems for correcting the thoracic hypokyphosis of idiopathic scoliosis. MATERIALS AND METHODS: After a minimum follow-up of 1 year, the results of the frontal and sagittal correction of each study group were compared. There were a total of 52 females and 12 males. The mean age at the time of surgical intervention was 16.4 (age range: 12~24). CD instrumentation with a rigid stainless steel rod (7 mm in diameter and 1200 N/mm for its stiffness) was used in group I (36 patients), and 4-CI instrumentation with a titanium alloy rod (6.35 mm in diameter and 1200 N/mm for its stiffness) was used in group II (18 patients). Xia instrumentation with a semi-rigid rod (6 mm in diameter and 600 N/mm for its stiffness) was used in group III (10 patients). For all patients undergoing the segmental pedicle screw fixation procedure, pedicle screws were inserted into every vertebra on the concave side, in the end of each vertebra and then alternately in every other vertebra on the convex side. We measured the preoperative and postoperative magnitude of the major and compensatory curves, the thoracic kyphotic angle on the standing radiographs and the flexibility of the curve. We statistically compared the correctability of thoracic kyphotic angle between the rigid and semi-rigid rods. RESULTS: The differences of preoperative and postoperative major curves in groups I, II and III were 47.3 degrees/12.7 degrees, 51.6 degrees/12.3 degrees and 49.6 degrees/13.3 degrees respectively. The thoracic kyphotic angle was 22.6 degrees/26.6 degrees, 22.0 degrees/26.9 degrees and 23.8 degrees/22.8 degrees, respectively. There was no significant difference for the correction of the coronal angle in each group, but groups I and II were superior to group III for the rate of correcting the kyphotic angle. CONCLUSION: The rod should be stiff enough to pull the spine posteromedially when using the derotation technique for the surgical treatment of idiopathic scoliosis.
Alloys ; Female ; Follow-Up Studies ; Humans ; Male ; Pliability ; Scoliosis* ; Spine ; Stainless Steel ; Titanium

Purpose: To compare efficacy of ultrasound (US)-guided single-injection nerve blocks (SINB) before bipolar hemiarthroplasty (BHA) of the hip in patients with femoral neck fractures. Materials and Methods: Clinical outcomes of 89 patients who underwent BHA between September 2016 and February 2018 were retrospectively compared. Eight patients were excluded according to exclusion criteria and the remaining patients were divided into two groups: patients who received SINB before surgery (Group I; n=40), and patients who did not (Group II; n=41). The femoral, obturator, and lateral femoral cutaneous nerves were each blocked separately under US guidance. Pain scores determined using the visual analogue scale (VAS) were recorded 6, 12, 24, and 48 hours postoperatively, and all use of analgesics were recorded separately for 72 hours after surgery. Duration of hospitalization, general complications, and local complications due to SINB were also compared among the groups. Results: Significant differences were observed between the two groups: I) VAS at 6 hours and at 12 hours after the operation, II) total amounts of analgesics used. VAS at 24 hours and at 48 hours were not significantly different between the two groups. General complications and duration of hospitalization were also not significantly different between the groups. Conclusion US-guided lower limb nerve blocks provide excellent immediate postoperative pain relief and can be used as a safe, and effective method of pain control after BHA.

Carbon-ion radiotherapy (CIRT) is on the rise as a treatment choice for malignant tumor. Compared to conventional radiotherapy, particle beams have different physical and biological properties. Particle beam provides a low entry dose, deposits most of the energy at the endpoint of the flight path, and forms an asymptotic dose peak (the “Bragg peak”). Compared to protons, carbon with its larger mass decreases beam scattering, resulting in a sharper dose distribution border. We report a 50-year-old male who underwent CIRT without surgical resection on osteosarcoma of the mandible. After CIRT, the patient’s pain was gone, and the malignant mass remained stable with accompanying necrosis. Nine months later, however, magnetic resonance imaging demonstrated progression of the left mandibular osteosarcoma with pulmonary metastases. After multidisciplinary discussion, concurrent chemoradiotherapy was conducted. While necrotic bone segments came out of the mandible during subsequent periodic outpatient visits, the tumor itself was stable. Thirty months after his first visit and diagnosis, the patient is waiting for chemotherapy. Although CIRT is superior in treating radioresistant hypoxic disease, CIRT is in its infancy, so care must be taken for its indications and complications.

Carbon-ion radiotherapy (CIRT) is on the rise as a treatment choice for malignant tumor. Compared to conventional radiotherapy, particle beams have different physical and biological properties. Particle beam provides a low entry dose, deposits most of the energy at the endpoint of the flight path, and forms an asymptotic dose peak (the “Bragg peak”). Compared to protons, carbon with its larger mass decreases beam scattering, resulting in a sharper dose distribution border. We report a 50-year-old male who underwent CIRT without surgical resection on osteosarcoma of the mandible. After CIRT, the patient’s pain was gone, and the malignant mass remained stable with accompanying necrosis. Nine months later, however, magnetic resonance imaging demonstrated progression of the left mandibular osteosarcoma with pulmonary metastases. After multidisciplinary discussion, concurrent chemoradiotherapy was conducted. While necrotic bone segments came out of the mandible during subsequent periodic outpatient visits, the tumor itself was stable. Thirty months after his first visit and diagnosis, the patient is waiting for chemotherapy. Although CIRT is superior in treating radioresistant hypoxic disease, CIRT is in its infancy, so care must be taken for its indications and complications.