BACKGROUND: Definite criteria for the diagnosis and treatment evaluation for different clinical stags of syphilis are not yet present dute to the inability to dultivate Treponema pallidum in vitro. However, as the staining methods and the serological tests currently used have their limitations, a more definite method for its confirmation is needed. Polymerase chain reaction (PCR), due to its high sensitivity and specificity, is currently being applied to the detection of T. pallidum. OBJECTIVE: We have used PCR for the detection of T. pallidum DNA in various clinical specimens in orber to evaluate its potenital as a diagnostic tool. METHOD: Clinical specimens were collected from patients with different stages of syphilis who visited ithe Deparment of Dermatology of Yonsei medical Center for 1 year beginning from May, 1991. Sera from 63 patients, cerebrospinal fluids from 24 patients, amniotic fluids from 3 patients, and 21 tissues from 19 patients were subjected to PCR and the results were analyzed to evaluate its usefulness as a diagnostic and treatment evaluation tool. A portion of the T. pallidum-specific chromosomal DNA, tpp47, which encodes the 47 kDa surface protein, was used as the template DNA to amplify the 658 bp DNA fragment, and the following results were obtained. PCR using primers 47-1 and 47-2 were applied to amplify 658 bp DNA fragments from the T. pallidum-specific tpp47 gene encoding 47 kDa surface protein. RESULT: 1. To evaluate the sensitivity of the PCR, T. pallida and their chromosomal DNA were diluted. The diluents contataining a single organism and 1 fg of the chromosomal DNA showed positive reactions by the amplification. 2. Specificity of the PCR was determined by using T. pallidum, 4 species beloging to genus Treponema, and 9 species of nonpathogenic or pathogenic organisms. A positive reaction was obtained only when T. pallidum chromosomal DNA was used. 3. PCR was positive in 5 of 9 (55%) sera in primary syphilis, 22 of 26(84%) in secondary syphilis, 3 to 15(20%) in early latent syphilis, 1 of 19 (11%0 in late latent syphilis, 2 of 2 (100%) in neurosyphlis, and 0 of 2 (0%) in congenital syphilis. The differences in the positive rates were statistically significant (P<0.01) in all stages except neurosyphilis and congenital syphilis, as their numbers were too smalll to deduce any significant meaning. Despite their high VDRL titers, the positive rate in early latent syphilis was relatively low when compared to the rate in secondary syphilis. 4. Follw-up PCR of sera in some patients showed positive results 9 months after treatment. However, some with negative PCR before treatment showed positive results after treatment. 5. PCR was positive in 1 of 1 (50%) cerebrospinal fluid in primary syphilis, 3 of 14 (21%) in secondary syphilis, 2 of 7 (29%) in early latent syphilis, and 1 of 1(100%) in neurosyphlis. The differences in the positive rates showed no statistical significance in relation to the clinical stages. Cerebrospinal fluid VDRL test, white blood cell count, and protein content showed no correlation to the PCR results in early syphilis patients. 6. Amniotic fluid showed a positive PCR result only in a pregnant woman whose serum showed a high VDRL titer and a positive PCR. 7. PCR positive rates were 90% in frozed tissues and 50% in paraffin embedded tissues. CONCLUSION: From the results, it is suggested that PCR is not suitable for treatment evaluation but is useful for the detection of T. pallidum in sera of secondary syphilis patients and syphilitic lesions, and for the confirmation of the diagnosis the diagnosis in these cases.
Amniotic Fluid ; Cerebrospinal Fluid ; Dermatology ; Diagnosis ; DNA ; Female ; Humans ; Leukocyte Count ; Neurosyphilis ; Paraffin ; Polymerase Chain Reaction* ; Pregnant Women ; Sensitivity and Specificity ; Serologic Tests ; Syphilis ; Syphilis, Congenital ; Syphilis, Latent ; Treponema pallidum* ; Treponema*

An 89-Year-old female patient had had a pea-sized encrusted ulcer on the vermillion border of her right upper lip for 4 years. Histopathological features of the biopsy specimen consisted of tumor islands with peripheral, palisading basaloid cells, some of which had become transformed into atypical, dyskeratotic squamous cells with ample eosinophilic cytoplasm in their centers. Total excision was advised.
Aged, 80 and over ; Biopsy ; Carcinoma, Basal Cell ; Carcinoma, Basosquamous* ; Cytoplasm ; Eosinophils ; Female ; Humans ; Islands ; Lip ; Ulcer

A tender, non-healing ulcer of 3 months' duration developed on the tongue tip of a 51-year-old male with active pulmonary tuberculosis. Acid-fast bacilli were grown in the tissue and sputum cultures. The patient was anergic to PPD skin test before the treatment and IL-2 productivity was significantly decreased. Sections from the tongue tip showed ulceration, infiltration of neutrophils and tuberculoid granulornas accompanying caseation necroses in the dermis. The ulcer healed after administration of anti-tuberculosis medication for 2 months.
Dermis ; Efficiency ; Humans ; Interleukin-2 ; Male ; Middle Aged ; Necrosis ; Neutrophils ; Skin Tests ; Sputum ; Tongue* ; Tuberculosis* ; Tuberculosis, Pulmonary ; Ulcer

No abstract available.
Humans ; Interferon-alpha* ; Interferons* ; Melanoma* ; Ulcer*

No abstract available.

Using the FTA-ABS complernent test, 32 skin speciruens from 27 patients with primary and secondary syphilis and a stomach specimen from a patient with suspected gastric syphilis which were confirmed by clinical history, physical examination, VDRL, FTA-ABS, and 19S(IgM)-FTA test, were tested. The following results were obtained. 1. In the darkfield examination, 7 of the 9 specimens(78%) were positive and in the FTA-ABS complernent test, 20 of the 33 specimens(61%) were positive. 2. The ratio of agreement between the darkfield examination and the FTA-ABS complement test was 89%. 3. In the chancres, macular syphilids, and condyloma lata, T. pallida were diffusely scattered in the epidermis, dermoepidermal junction, connective tiasue, and vascular walls, whereas in the papular syphilid T. pallida were mainly aggregated in the the epidermis, dermoepidermal junction, papillary dermis as well as the blood vessel walls in the papillary dermis. From these results, the FTA-ABS complement test can be considered to be a useful method for both the diagnosis and research of syphilis. It is especially helpful in cases where serological or histopathological study can not confirrn the diagnosis as when internal organs are involved.
Blood Vessels ; Chancre ; Complement System Proteins* ; Dermis ; Diagnosis ; Epidermis ; Humans ; Physical Examination ; Skin ; Stomach ; Syphilis ; Syphilis, Cutaneous ; Treponema pallidum* ; Treponema*

Fity-four patients with head and neck cancers were prospectively examined with the CT to determine its valuein staging cervical lymph nodes metastases and to compare with the clinical staging. The CT staging agreed withthe clinical staging in 61%(33/54), upgraded the clinical staging in 22%(12/54) and downgraded in 17%(9/54). Thepost-surgical confirmation was made in only 11 patients, The possible causes of disagreement between the CT andthe clinical staging, and the diagnostic value of the CT in the evaluation of the cervical nodes metastases werediscussed.
Head and Neck Neoplasms ; Head ; Humans ; Lymph Nodes ; Neck ; Neoplasm Metastasis ; Prospective Studies

We describe a 23-year-old man showing typically clinical and histological features of targetoid hemosiderotic hemangioma. About 35 cases of this newly-described entity have been reported since the first description by Santa Cruz and Aronherg in 1988. It is important to distinguish these tumors from patch stage Kaposi's sarcoma, retiform hemangioendothelioma and progressive lymphangioma.
Hemangioendothelioma ; Hemangioma* ; Humans ; Lymphangioma ; Sarcoma, Kaposi ; Young Adult

Buschke-Lowenstein tumor is a rare disease in the category of designated as verrucous carcinoma characterized by its invasive downward penetration of underlying tissues in the perineum and perianal regions. Viruses, unclean sanitation and cytotoxic immune reaction have been proposed as the etiology of the tumor. However, among all the causes, recent studies have emphasized on the associaton of the tumor and human papilloma virus (HPV). Expecially, HPV also has been discovered in several cutaneous and anogenital lesions of solid organ transplant recipients. We herein report a case of Buschke-Lowenstein tumor in a renal transplant recipient with HPV 6 and 16 coinfection proved by HPV genotyping of DNA extracted from the biopsy specimen of the tumor.
Biopsy ; Buschke-Lowenstein Tumor* ; Carcinoma, Verrucous ; Coinfection ; DNA ; Human papillomavirus 6 ; Humans ; Papilloma ; Perineum ; Rare Diseases ; Sanitation ; Transplantation* ; Transplants

Primary varicella infection usuelly runs a benign clinical course in the helthy population. However, hemorrhagic chicken pox presents with a very extensive eruption of hemorrhagic vesicles in patients with decreaed platelets or impaired immunity and is accompanied by severe constitutional symptoms. A 7-year-old male was admi due to abdompal pain for 1 day and peneralized vesicular eruption for 5 days. The eruption first appeared on the trunk and then spread to involved face, scalp and extrsmities. The skin rash was compatable with varicella but despite the administration of acclovir intravenously, the vesicular eruption became hemorrhagic. Ten days after admission, having experienced cardisc arrest twice and with his mental state in coms, he was diseharged as his situation was hopelesa. We have experienced a giatient diagnosed as having hemorrhagie, chicken pox complicated by encephalopathy.
Chickenpox* ; Chickens* ; Child ; Exanthema ; Humans ; Male ; Scalp