Disseminated superficial actinic porokeratosis (DSAP) consists of multiple annular, hyperkeratotic lesions that have a bilateral distribution on sun-exposed areas, particularly the extremities. DSAPs have a wider distribution than porokeratosis of Mibelli and usually develop during the 3rd or 4th decade of life. Squamous cell carcinoma that arises in the classical type of porokeratosis of Mibelli is well-documented, but there are only a few reports of squamous cell carcinoma in DSAP. Here, we describe a 62-year-old man with DSAP who developed squamous cell carcinoma on his right forearm.
Carcinoma, Squamous Cell ; Extremities ; Forearm ; Humans ; Middle Aged ; Porokeratosis

BACKGROUND: The current modality of choice for the treatment of Port-wine stains (PWS) is laser photocoagulation. Laser therapy for the treatment of PWS, especially with a pulsed dye laser (PDL), has been proven safe and effective; however, because penetration of the PDL is too shallow for an effective ablation of the blebs, treatment of blebbed PWS, using PDL, may be insufficient. OBJECTIVE: We demonstrated the clinical efficacy of a 1,064 nm long pulsed Nd:YAG laser with contact cooling device for blebbed PWS. METHODS: Twenty one patients with blebbed PWS (Fitzpatrick skin types II-V) underwent a treatment, using a 1,064 nm long pulsed Nd:YAG laser with a contact cooling device at 8-week intervals. Treatments were done using 5~6 mm spot sizes at 20~30 ms and 95~170 J/cm2. Laser parameters were adjusted in order to meet the needs of each individual patient's lesions. RESULTS: All subjects tolerated the treatments well, and showed clinical improvement from blebs. Of the 21 patients, 18 of them experienced either moderate or excellent response. CONCLUSION: Use of a 1,064 nm long pulsed Nd:YAG laser results in a greater depth of vascular coagulation. A 1,064 nm long pulsed Nd:YAG laser with contact cooling device may be regarded as a promising therapeutic option for the treatment of blebbed PWS.
Blister ; Humans ; Laser Therapy ; Lasers, Dye ; Light Coagulation ; Port-Wine Stain ; Skin

BACKGROUND: Hemodilution reduces the concentration of clotting factors in blood and it may induce some degree of coagulation impairment. The goal of this study is to investigate the changes of coagulation status during progressive hemodilution with several solutions. METHODS: Sixty healthy patients were randomly allocated to six groups according to experimental solution, and each group contained 10 patients. Whole blood was diluted by 0%, 10%, 25%, 50% with 0.9% normal saline, 4% modified fluid gelatin, 10% pentastarch, 10% dextran 40 and two brands of 6% hydroxyethyl starchs (Salinehes(R) , HAES-steril(R) ). At each dilution, thromboelastographic parameters {(r, k, alpha angle, maximum amplitude (MA)} were measured using thromboelastography (TEG) and were compared with those of an undiluted specimen obtained concurrently from the same patients. RESULTS: Hemodilutions of 25% and 50% with 0.9% normal saline decreased r and k times, and increased alpha angle but there was no difference in MA. Hemodilutions of 10% and 25% with modified gelatin solution did not change the parameters. However, 50% hemodilution of the gelatin solution decreased the k time and increased alpha angle. Hemodilutions of more than 10% with 10% pentastarch increased the k time, decreased alpha angle and MA. Hemodilutions of more than 10% with 10% dextran 40 increased r and k times, and decreased alpha angles and MA according to the quantities of this dilutional solution. Hemodilutions of more than 25% with 10% dextran 40 increased k times above 400%. Hemodilutions of more than 10% of 6% HES (Salinehes(R) , M.W: 70,000 dalton) decreased MA. Hemodilutions of more than 10% of 6% HES (HAES-steril(R) , M.W: 200,000 dalton) decreased the alpha angle. CONCLUSIONS: 25% and 50% hemodilutions of 0.9% normal saline induce a hypercoagulable state, but hemodilutions of more than 10% with each colloid solution decreased coagulability of whole blood according to the degree of dilution, except in the case of modified fluid gelatin solution. Hemodilutions of more than 25% with 10% dextran 40 induce a severe coagulation impairment.
Colloids ; Dextrans ; Gelatin ; Hemodilution* ; Humans ; Hydroxyethyl Starch Derivatives ; Starch ; Thrombelastography*

Papular xanthoma is one of the clinicopathologic variants of normolipemic cutaneous non-Langerhans cell histiocytosis. It is a very rare condition that is characterized by non-confluent, yellowish papules located on the face, trunk and mucous membranes with no internal involvement. It has been predominantly reported in adults but childhood cases were also recently seen. We report a typical case of papular xanthoma in a 14-month-old boy who presented numerous yellow-brown papules on the face, arm and buttock. On histologic findings, it showed typical features of papular xanthoma.
Adult ; Arm ; Buttocks ; Histiocytosis ; Humans ; Infant ; Mucous Membrane ; Xanthomatosis

Two-signal models are useful in explaining various types of immune responses. In particular, secondary, so-called costimulatory, signals are critically required for the process of T-cell activation, survival, differentiation, and memory formation. Early studies in rodent models showed that targeting T-cell costimulatory pathways elicits immunological tolerance, providing a basis for development of costimulatory therapeutics in allograft rejection. However, as the classic definition of T-cell costimulation continues to evolve, simple blockade of costimulatory pathways has limitations in prevention of allograft rejection. Furthermore, functions of costimulatory molecules are much more diverse than initially anticipated and beyond T cells. In this mini-review, we will discuss CD137-CD137L bidirectional signals as examples showing that two-signals can be applicable to multiple phases of immune responses.
Adaptive Immunity* ; Allografts* ; Memory ; Rodentia ; T-Lymphocytes

Intravenous leiomyomatosis (IVL) with intracaval mass, cardiac extension, and pulmonary metastasis is rare and it is characterized by nodular masses of smooth muscle proliferation that may extend to variable distances. We experienced a case of the intravenous leiomyomatosis originating from the uterus and extending to the ovarian veins, the iliac veins, the inferior vena cava, the right atrium and the lung. And it was diagnosed from the various preoperative studies and operated successfully through the single-stage approach. So we report it with a brief review of the literature.
Heart Atria ; Iliac Vein ; Leiomyomatosis* ; Lung ; Muscle, Smooth ; Neoplasm Metastasis* ; Uterus ; Veins ; Vena Cava, Inferior

Cytokine production was studied in thyroid fine needle aspirates and peripheral blood and the production of interferon-gamma by peripheral blood mononuclear cell(PBMC) culture in response to interleukin-2(IL-2) stimulation was also studied from patients with hyperthyroidism, non toxic goiter, thyroid nodule. The expression of glycer aldehyde 3-phosphate dehydrogenase(GAPDH), interleukin-1beta(IL-1beta), IL-2, interleukin-8(IL-8), platelet- derived growth factor-A(PDGF-A) and interferon-gamma(IFN-gamma) chain was assessed by RT-PCR(reverse transcriptase polymerase chain reaction) in fine needle aspirates of thyroid and peripheral blood mononuclear cell : the samples were obtained from 7 patients with hyperthyroidism, 6 patients with non toxic goiter, 7 patients with thyroid nodule. A dose of IL-2(25 U/ml) was utilized to induce IFN-gamma production by PBMC from all patients.The results were as follows:1) In case of cytokine expression of fine-needle aspirates, GAPDH and IL-1beta, IL-8 were expressed highly but IFN-gamma, IL-2 were not expressed in hyperthyroidism and non-toxic goiter, thyroid nodule. PDGF-A was expressed in hyperthyroidism and thyroid nodule but not in non toxic goiter. 2) In case of cytokine expression of PBMC, GAPDH, IL-1beta were expressed in hyperthyroidism and non toxic goiter, thyroid nodule and highly expressed after IL-2 stimulation than before. But PDGF-A was more expressed in non toxic goiter and thyroid nodule than hyperthyroidism. Also, IFN-gamma was less expressed in thyroid nodule than hyperthyroidism and non toxic goiter. 3) The incremental increase in IFN-gamma value in supernatants of PBMC culture was significantly higher in patients with non toxic goiter than that in PBMC from hyperthyroidism and thyroid nodule(p<0.05).Therefore it seems that the cytokine production was found in hyperthyroidism and non toxic goiter and thyroid nodule. There were variability in their distribution each other, in general, higher expressed in hyperthyroidism than non toxic goiter. And RT-PCR Method that employed should be sufficiently sensitive to permit the analysis of cytokine gene expression in fine needle aspiration biopsies from patients with thyroid disease.
Biopsy ; Biopsy, Fine-Needle ; Cell Culture Techniques ; DNA-Directed RNA Polymerases ; Gene Expression ; Goiter ; Humans ; Hyperthyroidism ; In Vitro Techniques ; Interferon-gamma ; Interferons ; Interleukin-2 ; Interleukin-8 ; Methods ; Needles ; Thyroid Diseases ; Thyroid Gland ; Thyroid Nodule

BACKGROUND: Recently, tattooing of the body has become popular, and its associated psychological, sociological, and cultural implications have changed compared to past years. However, little is known about the current clinical features, including motive and satisfaction for having a tattoo, because of societal repulsions toward the practice. OBJECTIVE: To evaluate the clinical manifestations of tattooed young Korean males and to compare the findings with previous studies. METHODS: Between September 2010 and July 2011, 223 patients with tattoos who visited the Eulji Medical Center and Armed Forces Yangju Hospital were selected. The patients were evaluated through a self-administrated questionnaire and physical examinations. RESULTS: The majority of patients were classified into the "did not complete university" education group (56.1%). Most tattooed males had two living parents (83.4%) and were raised in households whose income statuses were not marked by poverty. The average age at which their first tattoo was received was 19.0 years. Most tattooed males had a negative attitude towards their tattoos (67.3%). The most common motivation for getting a tattoo was curiosity, but cosmetic purposes were also important (19.4%). A majority of the tattooing was conducted by a tattoo artist (73.3%). The most common tattoo content was letters. Black-colored tattoos were most frequently observed. The complication rate was 13.9%. The most common motivation for tattoo removal was negative comments that were made at work, in public, and in school (38.2%). CONCLUSION: Recent patterns of tattooing have changed significantly since previous reports. The satisfaction rate in getting a tattoo was not favorable. Understanding the current clinical features related to tattooing is important and it is necessary for dermatologists to provide professional advice regarding tattooing among young males.
Arm ; Cosmetics ; Exploratory Behavior ; Family Characteristics ; Humans ; Male ; Motivation ; Parents ; Poverty ; Tattooing ; Surveys and Questionnaires

Gallbladder (GB) injuries after blunt abdominal trauma are uncommon. An isolated blunt GB injury is extremely rare, due to the anatomic location of the GB that is protected by the liver, intestines, omentum and ribs. A GB injury follows a vague and insidious clinical course, and therefore GB injuries are commonly undiagnosed until an exploratory laparotomy is performed. Early diagnosis is important, as trauma to the GB should be treated surgically and a delay in treatment can result in considerable mortality and morbidity. We encountered a patient who was diagnosed with a GB rupture based on computed tomography that showed a hemoperitoneum, high-density material in the GB lumen and a leakage of contrast material. The patient underwent an exploratory laparotomy. We report a case of isolated GB rupture after blunt abdominal trauma.
Early Diagnosis ; Gallbladder ; Hemoperitoneum ; Humans ; Intestines ; Laparotomy ; Liver ; Omentum ; Ribs ; Rupture

BACKGROUND: Skin prick test has been the primary diagnostic tool used to recognize causative allergens, and there is some evidence that skin reactivity to allergens can be altered by changes in the environment. OBJECTIVE: We performed this study to evaluate whether there are changes in skin reactivity to inhalant allergens among patients with bronchial asthma. MATERIALS AND METHOD: We reviewed the skin prick test results of 384 bronchial asthmatics tested in the early 1990s (June 1992-May 1994) with 52 common inhalant allergens and compared the results of 500 asthmatics tested in the mid 1980s (Jan 1984 - May 1987) with the same kinds of allergens provided by the same manufacturer. RESULTS: Of the 384 subjects tested in the early 1990s, 276 subjects(71.9%) had positive reaction to one or more inhalant allergens and the positive rate was not different from that of the mid 1980s(74%). But, skin reactivity to pollens was significantly increased. In individual allergens, house dust mite(D. farinae and D. pteronyssinus) was the most reactive allergen (52.3%, 43.2% respectively) in the early 1990s. Significant differences in skin reactivity to ragweed (10.0% vs 22.1%, p<0.05) and cockroach (12.7% vs 25.0%, p<0.05) were found when the results of the 1980s and the 1990s were compared. CONCLUSION: House dust mite was the most important allergen in asthmatics from the mid 1980s to the early 1990s. There was increased sensitization to cockroach and ragweed allergen in the early 1990s. Further prospective immunologic and environmental studies are recommended for proper interpretation of the changes in skin reactivity.
Allergens* ; Ambrosia ; Asthma ; Cockroaches ; Dust ; Humans ; Pollen ; Pyroglyphidae ; Skin*