BACKGROUND: The distribution of Malassezia yeasts on normal human skin was varied according to the age and race of the volunteers and the methodologies used. In Korea, most reports of Malassezia yeast distribution have relied on direct skin smears rather than culture methods. OBJECTIVE: The aim of this work was to perform a comprehensive survey of the distribution of Malassezia yeasts on normal human skin to provide a base line for a companion study of Malassezia yeasts in patients with various dermatoses. METHODS: Malassezia yeasts were cultured using the swabbing technique from the scalp, forehead, chest, upper back, upper arm and upper thigh in 137 subjects, infancy to 80 years of age. RESULTS: Malassezia yeasts were present in the lowest incidence(0-30%) on six sites of infants and present in 60.0-66.7% on the sebum-rich sites (scalp, forehead, chest, upper back) of children aged 1-9. Malassezia yeasts were present in 80.0-86.7% on the sebum-rich sites of the elderly group(over 60 years of age), about the same frequency as in the middle-aged groups. The population density of these organisms was significantly higher on the upper back than on the forehead, chest, upper arm and upper thigh in all age groups except the infant group and the group aged 1 to 9 (p<0.05). There were no regular quantitative variations in the distribution of Malassezia yeasts on a given site between age groups. On Leeming and Notman media, besides three morphotypes of Malassezia yeasts reported by Cunningham et al(1990), one additional type was identified. CONCLUSION: The results showed regional variations in the distribution of Malassezia yeasts in all ages except infancy and no regular age variations on a given site. Additionally, four colony types of Malassezia yeasts were found. The findings of our study coold help to investigate the role of Malassezia yeasts in related disorders.
Aged ; Arm ; Child ; Continental Population Groups ; Forehead ; Friends ; Humans* ; Infant ; Korea ; Malassezia* ; Population Density ; Scalp ; Skin Diseases ; Skin* ; Thigh ; Thorax ; Volunteers ; Yeasts*

BACKGROUND: Cutaneous vasculitis associated with viral hepatitis seems to occur as a hypersensitivity reaction against the circulating viral antigens. Hepatitis B virus(HBV)-encoded X antigen(HBxAg) is known to participate in the carcinogenesis of hepatocellular carcinoma(HCC) by the inactivation of p53. However, HBxAg has been found in chronic infiammatory lesions without the overexpression of p53. Accordingly, not only EBsAg and HBcAg but also HBxAg may be involved in HCC-associated cutaneous vasculitis, regardless of the alteration of p53. OBJECTIVE: This study was conducted to investigate the expression of HBV-encoded antigens in cutaneous vasculitis accompanied by HBV hepatopathy. Additionally, we have compared the expression of 3 HBV antigens and p53 between vasculitic patients with HCC and in others showing HCC-non-associated vasculitis. METHODS: Immunohistochemically, we examined the expression of HBsAg, HBcAg, and HBxAg in the tissue specimens taken from the vasculitic lesions of the 33 HBsAg-positive enrolled patients with cutaneous vasculitis proven by skin biopsy. RESULTS: 1. The immunohistochemical positivity rate to HBsAg in vasculitic patients with HBV hepatopathy was 66.7% overall. It was 90% in HCC-associated vasculitic subjects and 56.5% in the vasculitic subjects without HCC, respectively. 2. We found the expression of HBxAg in 80% of the vasculitic subjects showing HCC. The vasculitic patients without HCC showed 17,3% of the positivity rate to HBxAg. 3. We could not find the overexpression of p53 in the vasculitic tissue specimens of the HCC patients without the cutaneous metastasis from primary HCC. CONCLUSION: HBsAg, HBcAg and HBxAg may participate in the pathogenesis of cutaneous vasculitis with HBV hepatopathy, regardless of tumorigenesis.
Antigens, Viral ; Biopsy ; Carcinogenesis ; Hepatitis ; Hepatitis B ; Hepatitis B Core Antigens ; Hepatitis B Surface Antigens ; Humans* ; Hypersensitivity ; Malassezia* ; Neoplasm Metastasis ; Skin* ; Vasculitis ; Yeasts*

BACKGROUND: Both Malassezia yeast and Propionibacterium acnes form part of the normal flora of the human skin and hair follicles. The former is the etiological agent of Malassezia(Pityrosporum) folliculitis and the latter is one of the major factors in the pathogenesis of acne vulgaris. These two follicular diseases can coexist on a certain area of the skin, but there have been few reports about their coexistence in the literature. OBJECTIVE: The aim of this work was to investigate the distribution of Malassezia yeasts in the comedones of patients clinically diagnosed as acne vulgaris for elucidation of the coexistence of the two diseases, and for information on the predominance of the colonized Malassezia species and on relationship between certain species and Malassezia folliculitis. METHODS: The spore load in the comedonal plugs of 32 patients with acne vulgaris was graded using direct microscopy of KOH/Parker ink mounts. The comedonal specimens were cultured on Looming & Notman's media and the isolated Malassezia yeasts were identified to species level by their colony morphologies, microscopic morphologies and physiological characteristics. RESULTS: On direct microscopy, 8 of 32 patients (25%) showed a 4+ spore load, which is considered as a diagnostic grading index of Malassezia folliculitis. The predominant Malassezia(M.) species from 32 patients with acne vulgaris were M. restricta, M. globosa, M. furfur in descending order. Three strains of M. restricta, 4 strains of M, globosa, 2 strains of M. furfur and 1 strain of M. obtusa were isolated from the comedones of the 8 patients with 4+ spore load. CONCLUSION: This study shows that Malassezia folliculitis might coexist with acne vulgaris on the face, but there was no relationship between certain species and Malassezia folliculitis. The results suggest that antibiotic resistant acne vulgaris should be examined by direct microscopy of KOH/Parker ink mounts to confirm the coexistence of Malassezia folliculitis and acne vulgaris.
Acne Vulgaris* ; Colon ; Folliculitis ; Hair Follicle ; Humans ; Ink ; Malassezia* ; Microscopy ; Propionibacterium acnes ; Skin ; Spores ; Yeasts*

Microsporum canis is known to be the main causative agent of tines capitis and tinea corporis in children. Contrary to Trichophyton rubrum and Trichophyton mentagrophytes var. interdigitale, it very rarely infects the nail. In the reported cases of tinea unguium due to Microsporum canis, fingernails were usually affected. We report a patient with tinea unguium of thumb and big toe nails caused by Microsporum canis.
Child ; Humans ; Microsporum* ; Nails ; Onychomycosis* ; Thumb ; Tinea* ; Toes ; Trichophyton

Osteoid osteoma is a relatively common benign tumor that most commonly affect the cortex of the long bone, Adolescent and young adult males are most frequently affected. It causes aching pain that worsens at night and commonly is relieved by aspirin. The typical radiographic appearance is a lucent nidus with surrounding dense cortical thickening. If the lesion is located in intra-articular cancellous bone, an osteoid osteoma may present with clinical findings that are more indicative of an inflammatory synovitis, and with atypical radiographic findings such as lack of both surrounding sclerosis and a lucent nidus. Therefore intra-articular osteoid osteoma may pose a diagnostic difficulty. Recently, we experienced 3 cases of intra-articular osteoid osteoma(2 humeral haed, 1 femoral head) and present them in detail.
Adolescent ; Aspirin ; Humans ; Male ; Osteoma, Osteoid ; Sclerosis ; Synovitis ; Young Adult

The most frequently reported neurological complication of a wasp sting is ischemic stroke. We treated a patient with wasp sting with unusual complications. A 52-year-old man was hospitalized for anaphylactic shock after multiple wasp stings. Although the patient recovered consciousness after 2 days, he had global aphasia and right hemiparesis. Brain magnetic resonance imaging and angiography revealed high-intensity signals in the left basal ganglia and cerebral cortex and stenosis of the left middle cerebral artery. After 2 days, the middle cerebral artery stenosis improved. After 5 days, diffusion-weighted imaging showed an enlarged lesion in the left frontal cortex. The infarct in this case was due to a predominantly unilateral vasoconstrictive hypoxic brain injury from wasp stings.
Brain Injuries

Dermatophytoses of newborn infants are known to be very unusual, although cutaneous candidosis in infancy is relatively common. We report two cases of dermatophytoses seen in a 33-day-old infant and a 63-day-old infant. The dorsum of the foot of the former showed an annular lesion with crusty border of about 3 weeks duration and the chin of the latter showed an annular lesion with intensely inflamed border of about 5 weeks duration. From the two patients, Trichophyton rubrum was isolated. The articles describing dermatophytoses in infancy in the Korean literature did not report any cases similar to ours.
Chin ; Foot ; Humans ; Infant ; Infant, Newborn* ; Tinea* ; Trichophyton*

The authors report four cases of ependymal cysts. Among the benign cystic lesions of neuroepithelial origin, ependymal cysts have been reportedly located in the cerebral parenchyme. This usually become symptomatic after 40 years of age, although it is generally thought to be congenital in origin. Symptomatic cases have been treated effectively with resection of the cyst or shunting procedures. Stereotactic removal of the cyst was also a good alternative as management in the authors' cases. Differential diagnosis is mandatory with other benign intraparenchymal cystic diseases.
Diagnosis, Differential

Richer's syndrome is a development of a high grade malignant lymphoma in a patient with preexisting chronic 1ymphocytic leukemia, small lymphocytic lymphoma or Waldenstrom's macroglobulinemia. A rare case of Richer's syndrome arising in the spleen of a 35-year-old-man was studied by morphology, immunohistochemistry and gene rearrangement study. He has had weight loss and night sweat for last 6 months. Hepatosplenomegaly and abdominal lymphadenopathy were noted on CT scanning. Especially an ovoid radiolucent mass was found within the image of splenomegaly. Lymph nodes and liver biopsy, bone marrow aspiration and splenectomy were done. In the lymph nodes, liver and bone marrow, well differentiated small lymphocytic infiltrations were found but, in the spleen, pleomorphic, large cells with occasional multinucleated giant cells formed a nodular mass surrounded by diffuse, extensive infiltration of small well differentiated lymphocytes. The two distinctive areas in the spleen had positive staining for B-cell marker (HLA-DR and L26), negative staining for T-cell marker (UCLH1), and positive staining for IgM heavy chain and kappa light chain by immuohistochemical study. so this case was diagnosed as a diffuse large cell 1ymphoma transformed from small lymphocytic lymphoma. We made an another effort to clarify their clonality. Gene rearrangement method usingcomplementarity.determining region 3(CDR3) of immunoglobulin heavy chain (IgH) gene and T-cell receptor gamma (TCRgamma) gene by polymerase chain reaction (PCR) technique was done. The two lymphomas in the spleen demonstrated the same rearrangement pattern in both IgH and TCRgamma gene. We think these findings strongly suggest that the large cell lymphoma has the same clonality with that of the small lymphocytic lymphoma.
Male ; Humans

Atherosclerotic lesions at the aortic arch are recognized as critical sources of embolic strokes. However, there have been few case reports of aortic arch thrombus occurring without atherosclerotic changes, especially those related to iron deficiency anemia (IDA). A 44-year-old woman was admitted due to rapid-onset right hemiparesis and aphasia. Etiological investigations for cerebral infarction revealed no abnormality other than IDA. This is a rare case of cerebral embolic infarction caused by an aortic arch thrombus with IDA in a middle-aged woman.
Adult ; Anemia, Iron-Deficiency* ; Aorta, Thoracic* ; Aphasia ; Cerebral Infarction ; Female ; Humans ; Infarction* ; Iron* ; Paresis ; Stroke ; Thrombosis*