A case of 30 years old male with acne conglobata was reported. The skin lesions were characterized by numerous papules, pustules, abscesses, discharging sinuses and resultant hypertrophic scars on the buttocks, back, face, chest, abdomen, neck, and the both extremities. Physical examination shows chronic tonsillitis, caries, and missing of the teeth, and periodontitis. Pus culture shows only coagulase negative Staphylococcus. He was treated with tetracycline, predlnisolone and vitamin B-complex for four weeks with favorable effect.
Abdomen ; Abscess ; Acne Vulgaris* ; Adult ; Buttocks ; Cicatrix, Hypertrophic ; Coagulase ; Extremities ; Humans ; Male ; Neck ; Palatine Tonsil ; Periodontitis ; Physical Examination ; Skin ; Staphylococcus ; Suppuration ; Tetracycline ; Thorax ; Tonsillitis ; Tooth ; Vitamins

PURPOSE: Critical limb ischemia (CLI) is equated with a need for limb salvage. We studied whether measurement of skin perfusion pressure (SPP) can be used to accurately identify the ampuation level of those patients with CLI who require major amputation and predict the patients whose foot ischemic ulcer would heal or not after vasodilator treatment for over 4 weeks. METHODS: Fifty-one patients with a nonhealing foot ulcer were studied prospectively at Yeungnam university hospital. Age range was 46 to 78 years old with average 68 years old and male to female ratio was 3.3:1. Patients were included in the study if informed consent for medication of vasodilators was obtained, and patients were excluded if there was uncontrolled sepsis or if they required imminent amputation. We used PGE1 (Opalmon(R), 6 tablets/day #3 for 6 weeks, 100 mg/tablet) in 20 cases, PGI2 (Beraprost(R), 6 tablets/day, #3 for 6 weeks, 20 mg/tablet) in 16 cases and Argatroban (antithrombin: Novastan(R) 2 amples/day #2 IV for 4 weeks, 10 mg/ample) in 15 cases. The ankle pressure was checked for each limb. Measurements of SPP were made with photoplethysmography (Life Sciences MVL Modulab(R)) at the metatarsal level which were mostly located at the proximal site of ulcer in viable tissue. The SPP measuements were compaired with the clnical results of therapy (group I: stop medication and major amputation in 7 cases, group II: failed to heal in 18 cases, group III: ulcer healed in 26 cases) in group II & III. We calculated overall acuracy of SPP measurement for prediction of limb ischemic ulcer healing. RESULTS: The ankle pressure or Ankle Brachial Index (ABI) was not predictive of the need for the outcome of drugs therapy. Average SPPs were 12+/-6 mmHg in group I,27+/8 mmHg in group II and 45+/-7 mmHg in group III. The overall predictive accuracy of SPP over 40 mmHg for ulcer healing was 80%. CONCLUSIONS: SPP measurement with PPG is an objective, easy and effective noninvasive method that can be used to predict ischemic ulcer healing.
Aged ; Alprostadil ; Amputation ; Ankle ; Ankle Brachial Index ; Epoprostenol ; Extremities ; Female ; Foot ; Foot Ulcer ; Humans ; Informed Consent ; Ischemia ; Limb Salvage ; Male ; Metatarsal Bones ; Perfusion ; Photoplethysmography ; Prospective Studies ; Sepsis ; Skin ; Ulcer ; Vasodilator Agents

No abstract available.
Breast* ; Humans*

Though the occurrence of multiple primary malignant tumor is a rare finding but the reported cases of it has increased in recent years. We collected multiple primary cancer of different organ, tissue and the multicentric origin of bilaterally paired organs. This paper reports 6 cases of multiple primary malignant tumors which were experienced at Yeungnam university hospital in Taegu during the past 2 years with review of journals. The results were as follows. 1. The incidence of multiple primary cancer was 0.31% for 2 years (1987-1988). 2. The ratio between male and female was 1:1 and mean age of incidence was 54.1 years. 3. The ratio between synchronous and metachronous (interval more than 6 months) was 1:1. 4. The time interval between first and second cancer was average 2.7 years in metachronous cases. 5. The most frequent involved organ was stomach, breast and colon in order of frequency. 6. The incidence of familial cancer associations was found in one out of 6 cases. 7. The test of DNCB, multitest CMI and ratio of T4 to T8 were performed in 4 cases but there was no definitive evidence of abnormality. We concluded that every effort should be made to discover the presence of synchronous malignancies in the patients who are being treated for a known tumor, and also special care should be given to detect new metachronous lesions is required.
Breast ; Colon ; Daegu ; Dinitrochlorobenzene ; Female ; Humans ; Incidence ; Male ; Neoplasms, Second Primary ; Stomach

No abstract available.
Sympathectomy

PURPOSE: Intimal hyperplasia is an exaggerated proliferating response to arterial injury and can lead to occlusion and thromboses of arteries and bypass graft following arterial surgery or angioplasty. Medial smooth muscle cell activation has been implicated as the final common pathway leading to the development of intimal hyperplasia. Therefore, therapeutic agents that inhibit vascular smooth muscle cell proliferation should be selected to prevent restenosis. Recent laboratory data suggest that heparin and glucocorticosteroid have antiproliferative effects on smooth cells. We studied the effect of dexamethasone and low molecular weight heparin (LMWH: fragmin) on the suppression of intimal hyperplasia after balloon induced arterial injury in a rat model. METHOD: Twenty five rats were underwent aortic intimal denuation with 2F balloon catheter. The rats were divided into four groups: normal control group (sham operation), control group (experimental group without medication), dexamethasone treatment group (experimental group with intramuscular injection of dexamethasone) and fragmin treatment group (experimental group with subcutaneous injection of 60 IU/kg of LMWH (fragmin(R)). The dexamethasone treatment group was divided into 3 subgroups by graded doses of dexamethasone: subgroup 1, 2 and 3 were injected 0.05 mg/kg, 0.10 mg/kg and 0.15 mg/kg of dexamethasone respectively. Injection of drugs were started 1 days before the intimal injury and continued for 4 weeks, dexamethasone were injected six times a week and fragmin injected daily. The aorta were harvested at 6 weeks after injury. Microscopic examination and cross sectional intima to media height ratio (IMHR) were evaluated. RESULT: All treatment groups showed significant suppression of intimal hyperplasia compare to the control group (P<0.05). Mean IMHR were 0.69+/-0.15 in the control group, 0.39+/-0.11, 0.31+/-0.15 and 0.29+/-0.09 in dexamethasone treatment subgroup 1, 2 and 3 respectively, and 0.39+/-0.14 in fragmin treatment group. There were no statistical difference in dexamethasone treatment subgroups. CONCLUSION: Dexamethasone and LMWH were effective in suppression of the intimal hyperplasia to an intimal injury in a rat model. In addition, the minimal effective dose of dexamethasone that required to achieve the suppression of intimal hyperplasia is 0.05 mg/kg in this study.
Angioplasty ; Animals ; Aorta ; Arteries ; Catheters ; Cell Proliferation ; Dalteparin ; Dexamethasone ; Heparin ; Heparin, Low-Molecular-Weight ; Hyperplasia* ; Injections, Intramuscular ; Injections, Subcutaneous ; Models, Animal* ; Muscle, Smooth, Vascular ; Myocytes, Smooth Muscle ; Rats* ; Thrombosis ; Transplants

BACKGROUND: There is experimental evidence that overexpression of cyclin D1 accelerates the entry of cells into the S-phase, but that p16 inhibits the CDK4 and CDK6 by binding in competition with the cyclin D1. Previous attempts to correlate cyclin D1 amplification with prognoses have frequently drawn associations with adverse outcome or a more aggressive phenotype. Recently, overexpression of cyclin D1 has been associated with improved relapse-free survival and overall survival rates. To elucidate whether the expressions of the cyclin D1 and the p16 protein might be of clinical value as prognostic factors, we used the chi-square test to compare the immunoreactivities of the cyclin D1 and the p16 proteins with the histopathologic findings and with such known prognostic factors as the estrogen receptor, progesteron receptor, c-erbB-2, p53 and Ki-67. METHODS: The expressions of the cyclin D1 and the p16 proteins were analysed using immunohistochemical methods in formalin-fixed and paraffin-embedded tissue samples of 340 invasive breast carcinomas accumulated between 1990 to 1997 at Yeungnam University Hospital. Disease-free survival and overall survival were compared to cyclin D1 and p16 status by using the Kaplan-Meier method. RESULTS: Nuclear immunoreactivities of the cyclin D1 and the p16 proteins were detected in 75.6% (257/340) and 70.5% (208/295) cases, respectively. Cyclin D1 was found to have a strong correlation with lower histologic grade, lower nuclear grade, lower mitotic index, and lower Scarff-Bloom-Richardson (SBR) and Modified-Scarff-Bloom-Richardson (MSBR) grade (p<0.05). Cyclin D1 was more common in non-ductal carcinomas than ductal carcinomas, though this difference did not reach statistical significance. Cyclin D1 was also correlated with positive estrogen receptor, negative c-erbB-2, and positive p16 protein. P16 protein expression was found to have a correlation with positive estrogen receptor and progesterone receptor. The expressions of the cyclin D1 and the p16 proteins were not significantly correlated with overall survival and disease-free survival. CONCLUSIONS: These results show that the expressions of the cyclin D1 and the p16 proteins can not be used as prognostic indicators in primary breast carcinomas.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Cyclin D1* ; Cyclins* ; Disease-Free Survival ; Estrogens ; Mitotic Index ; Phenotype ; Prognosis ; Receptors, Progesterone ; Survival Rate

PURPOSE: A prosthetic graft infection is a rare but often disastrous complication during vascular surgery. Diagnosis of a prosthetic graft infection is not always easy, particularly with a low virulent bacterial infection or in a deeply placed graft in the retroperitoneal space. Recently, fludeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) has been proposed as a diagnostic modality for prosthetic graft infection. However, some reports have indicated that high FDG uptake occur in grafts without infections. This study analyzed FDG uptake patterns in prosthetic grafts of asymptomatic patients. METHODS: We reviewed 14,545 patients who had received PET/CT in a tertiary hospital between July 2007 and March 2010. Of them, 11 patients who had undergone previous bypass surgery with a prosthetic graft were identified. Four underwent an aortic bypass and the others received lower extremity bypass grafting. PET/CT images and patient clinical data were reviewed retrospectively. The maximum standardized uptake value (SUVmax, A) in the graft, the mean SUV (SUVmean, B) of the blood-pool, and the target-to-background ratio (T/B, A/B) were calculated. RESULTS: The mean duration between bypass grafting and the PET/CT scan was 21 months (range, 1~80 months). No clinical evidence of graft infection was observed in any of the patients. PET/CT revealed an uneven, diffuse FDG uptake pattern on the grafts, and the mean T/B was 2.0 (range, 0.9~4.6). T/B was greater than 2.0 in six patients (55%). CONCLUSION: A prosthetic graft without an infection can result in increased FDG uptake during PET/CT. A further prospective study is necessary to evaluate the usefulness of FDG PET/CT for diagnosing a prosthetic graft infection.
Bacterial Infections ; Electrons ; Humans ; Lower Extremity ; Positron-Emission Tomography ; Retroperitoneal Space ; Retrospective Studies ; Tertiary Care Centers ; Transplants

To evaluate the role of internal jugular node sampling in the operation for well-differentiated thyroid cancer, 86 patients received the operation for well-differentiated thyroid cancer from one surgeon. Ipsilateral internal jugular node (level 3 and 4) sampling was done after total thyroidectomy and central compartment neck dissection (CCND) in clinically node negative well-differentiated thyroid cancer. A modified radical neck dissection, type IIIB, was done in the patients proved as metastasis on the frozen biopsy of the sampling. The overall metastatic rate of the internal jugular lymph node was 72.5% (50 of 69), and the metastatic rate of the internal jugular node sampling in clinically negative lymph node metastasis was 57.4% (31 of 54). The most frequent metastatic lymph-node group was level 6. The metastasis of the internal jugular lymph node was more frequent in large tumor and extracapsular involvement, but there was no statistical significance. The rates of internal jugular node metastasis were 50.0% in follicular, medullary, and H rthle cell carcinomas. In conclusion, sampling of the internal jugular node was an important guideline in deciding a modified radical neck dissection in patients with well-differentiated thyroid cancer.
Biopsy ; Humans ; Lymph Nodes ; Neck Dissection ; Neoplasm Metastasis ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

Meningiomas are primarily benign, mesenchymal tumors which in most cases can be surgically removed. Some tumors, however, are inoperable or invasive, and histology alone may be insufficient to characterize their biologic behavior. Thus, there is a need for a more effective means of differentiation between benign and atypical/malignant meningiomas. To determine whether abnormal gene expression correlates with the histologic grade of meningiomas, we immunohistochemically analyzed the expression of multiple oncogenes and p53 protein in 47 meningioma tissue specimens; six were malignant, 14 were atypical, and 27 we randomly sampled were benign. The specimens were on paraffin-embedded tissue sections and monoclonal antibody was used. The results are summarized as follows: 1) among multiple oncogene factors, erb B-2 and bFGF expression was associated with malignancy, 2) p53 protein expression did not correlate with histologic grade. We believe that not only for a better understanding of the mechanism of oncogenesis, but also to justify the prognostic significance of aggressiveness or potential for recurrence, further investigation of the molecular genetics of meningiomas is required.
Carcinogenesis ; Gene Expression ; Meningioma* ; Molecular Biology ; Oncogenes* ; Recurrence