It is difficult to know whether the presence of infection in the plantar ulcer in patients with leprosy or not. Because routine bacteriology is often unhelpful, we need to investigate diagnostic method in this situation. C-reactive protein(CRF) levels have been known to be useful in detecting infection in some diseases. In this study, CRP levels were measured in 20 leprosy patients with plantar ulceration and 14 patients with leprosy alone. The results were as follows : 1. There was no elevation of CRP levels in patients with leprosy alone, and in the majority of patients with ulcers. 2. Of 20 patients with plantar ulcers, four had raised CRP levels one had clinically obvious infection, and three had erythematous skin of uncertain cause surrounding their ulcers. 3. Treatment with an appropriate antibiotics reduced CRP levels to normal, which was associated with clinical improvement. Therefore, it is suggested that increased CRP levels can be a useful probe for detecting significant bacterial infection in plantar ulcers of leprosy patients.
Anti-Bacterial Agents ; Bacterial Infections ; Bacteriology ; Foot Ulcer ; Humans ; Leprosy* ; Skin ; Ulcer*

Clinical study on 62 patients (26 males and 36 females) with neurofibromatosis seen during past ten years at the Department of Dermatology, Pusan National Universitg Hospital, was made the variable clinical manifestations of the disease and Riccardis ciassification were emphasized. The results were as follows . 1) Family history was noted in 32 cases(51.6%) and exhibited autosomal dominant inheritance pattern. 2) Cutaneous neurofibromas were found in 52 cases(83.8%). 3) Cafe-au-lait spots, measuring greater than 1.5cm in its longest diameter, were found in 60 cases(96.8%) and 44 cases(71.0%) had more than 6 in number. 4) Among associated abnormalities were,' mental retardation(20,9%), skeletal abnormalities(11.2%), seizure, severe headache, etc. 5) According to Riccardis classification, 38 cases could be classified as type I, 28 cases(73.7%); type II, 0 case ; type III, 1 case(2.6%); type IV, 3 cases(7, 9%); type V, 1 case(2.6%); type VI, 4 cases(10.5%); type VII, l case(2.6%); and type VIII, 0 case.
Busan ; Cafe-au-Lait Spots ; Classification* ; Dermatology ; Headache ; Humans ; Inheritance Patterns ; Male ; Neurofibroma ; Neurofibromatoses* ; Seizures

Involucrin is a recently recognized structural component of mature squamous epithelial cells and is considered as a marker of normal eratinocyte differentiation and ma.turation. In this study peroxidase-antiperoxidase techniques were used to assess involucrin expression in histologic sections of normal skin and a variety of epidennal tumors including squamous cell carcinomas(25 cases), keratoacanthomas(11 cases), basal cell carcinomas(20 cases), trichoepitheliomas(5 cases), Howens diseases(12 cases), arsenic keratoses(10 cases), actinic keratoses(10 cases) and Pagets diseases(2 cases). The results were as follows : l. In normal skin, the upper third of the viable epidermis showed diffuse cytoplasmic staining for involucrin. In hair follicles, the lower area of inner root sheath and inner area of the outer root sheath stained positively. The sebareous glands did not stain, but the ducts of sebaceous glands were positive. 2. Keratoacanthomas showed a relatively homogeneous staining pattern for inirolucrin ', all cells except basal cells stained with mild to moderate intensity. In contrast, squamous cell carcinomas disclosed a highly irregular involucrin staining pattern with marked variation in staining intensity from cell to cell. 3. Basal cell carcinomas were negative for involucrin except squamous horn cysts, and the epidermis overlying basal cell carcinomas showed the field effect, that is, the epidermis overlying the tumors exhibited diffuse, homogeneous positive staining of cells in all layers of the epidermis. 4. ln trichoepitheliomas, the involucrin reactivity was negative as in basal cell carcinoma.s, but the field effect was not observed. 5. In Elowens disease, actinic keratosis, arsenic keratosis and Pagets disease, the positivit.y for involucrin staining extended deeper into the stratum malpighii than was observed wit,h normal epidermis. And areas showing irregular patchy pattern of involucrin staining were considered to have the potentiality of malignant invasive change much more than the negative or homogeneous areas. Paget's cells were negative for involucrin as the adjoining keratinocytes in the lower portion af epidermis.
Actins ; Animals ; Arsenic ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Cytoplasm ; Epidermis ; Epithelial Cells ; Hair Follicle ; Horns ; Keratinocytes ; Keratoacanthoma ; Keratosis ; Keratosis, Actinic ; Sebaceous Glands ; Secobarbital ; Skin

No abstract available.
Hydronephrosis* ; Teratoma*

PURPOSE: To evaluate outcomes volar T-locking compression plate for treatment of unstable distal radius fractures. MATERIALS AND METHODS: We retrospectively analysed the results in 35 cases, which were treated by volar plating with T-LCP. We evaluated the clinical results according to the Mayo wrist scoring system and radiographic results. RESULTS: The mean score was 83.86 respectively. Between preoperative and immediate postoperative radiographic measurements, averaged radial length was improved from 5.75 mm to 11.53 mm, radial inclination from 12.86 degrees to 22.56 degrees, volar tilt from -3.64 degrees to 9.90 degrees and intraarticular step-off from 1.48 mm to 0.42 mm. Between immediate postoperative and latest follow-up radiographic measurements, mean loss of radial length measured 0.43 mm, radial inclination 0.46 degrees, volar tilt 0.89 degrees. CONCLUSION: Treatment of unstable distal radius fractures using a volar T-LCP showed satisfactory outcomes. We think that it is good surgical option to allow return to daily living, result in early postsurgical wrist motion.
Follow-Up Studies ; Radius ; Radius Fractures ; Retrospective Studies ; Wrist

It is well known that the mortality rate is very high in the patients with cerebrovascular disease (CVD). The most common cause of death in the ischemic CVD patients is myocardial infarction. The purpose of this study is to evaluate the diagnostic significance of myocardial perfusion SPECT for coronary artery disease (CAD) in ischemic CVD. We studied in 64 patients with transient ischemic attack and ischemic stroke diagnosed by means of the clinical history and brain CT and MRI. Electrocardiography, myocardial perfusion SPECT and coronary angiography were performed. We checked hypertension, diabetes, smoking, alcohol drinking and hyperlipidemia as the risk factors in ischemic CVD and CAD. The myocardial perfusion SPECT was abnormal in 37 out of 64 patients(57.8%) with ischemic CVD. There was a increasing tendency in the prevalence of myocardial perfusion abnormality in the elderly patients (more than 65 years old). The incidence of abnormal myocardial perfusion SPECT was not significantly different among TIA, lacunar infarction, minor infarction and major infarction. The long standing hypertension and hyperlipidemia were siginificant risk factors in the ischemic CVD and CAD as having the abnormal myocardial perfusion SPECT (p<0.05). There were not significantly different between resting EKG and myocardial perfusion SPECT results. Coronary artery stenosis was identified in 5 out of 7 patients receiving coronary arteriography. The results suggested that ischemic stroke is frequently associated with coronary artery disease. So myocardial perfusion SPECT as an active investigation for CAD in Ischemic CVD should be considered in order to optimal management.
Aged ; Alcohol Drinking ; Angiography ; Brain ; Cause of Death ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels* ; Diagnosis* ; Electrocardiography ; Humans ; Hyperlipidemias ; Hypertension ; Incidence ; Infarction ; Ischemic Attack, Transient ; Magnetic Resonance Imaging ; Mortality ; Myocardial Infarction ; Perfusion* ; Prevalence ; Risk Factors ; Smoke ; Smoking ; Stroke ; Stroke, Lacunar ; Tomography, Emission-Computed, Single-Photon*

No abstract available.
Hysterectomy*

Rare cases of lung adenocarcinoma (LUAD) with concomitant epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) translocation have been reported. However, their clonal and evolutional relationship remains unclear. We report a case of early-stage EGFR-mutated LUAD with a focal concomitant EGFR/ALK alteration. A 63-year-old male underwent lobectomy to remove a 1.9-cm-sized lung nodule, which was diagnosed with EGFR-mutated LUAD. ALK immunohistochemistry (IHC) showed focal positivity within the part of the tumor characterized by lepidic pattern, also confirmed by fluorescence in-situ hybridization (FISH). Targeted next-generation sequencing was performed separately on the ALK IHC/FISH-positive and -negative areas. EGFR L833V/L858R mutations were detected in both areas, whereas EML4 (echinoderm microtubule-associated protein-like 4)-ALK translocations was confirmed only in the ALK IHC/FISH-positive area, suggesting the divergence of an EGFR/ALK co-altered subclone from the original EGFR-mutant clone. Our study suggests that concurrent alterations of EGFR and ALK can arise via divergent tumor evolution, even in the relatively early phases of tumorigenesis.

PURPOSE: To evaluate the results of the compression plate fixation and autogenous bone graft in the management of humerus shaft nonunion. MATERIALS AND METHODS: Eighteen cases were treated for humerus shaft nonunion using compression plate fixation and an autogenous iliac bone graft. The mean follow-up period was 28 months. Bony union was confirmed from the serial radiographs and the clinical outcomes were assessed according to ASES scoring system. RESULTS: In 12 cases of initial plate fixation, the causes of nonunion were 6 cases of inadequate plate length, 2 with a broken plate, 2 with screw loosening, 1 infection and 1 noncompliance of a psychiatric patient. In 3 cases of initial intramedullary fixation, the cause of nonunion was a distraction of the fracture site. In 3 cases of external fixation, the cause of nonunion was inadequate fixation. All cases showed bony union after an average of 24 weeks. The clinical outcomes were 11 excellent, 6 good and 1 fair. CONCLUSION: In the treatment for nonunion, compression plate fixation with autogeneous bone graft after complete removal of the fibrous and necrotic tissue is believed to give satisfactory results
Follow-Up Studies ; Humans ; Humerus ; Transplants

BACKGROUND: This study evaluated the benefits and safety of a multimodal pain control protocol, which included a periarticular injection of local anesthetics, in patients undergoing total hip arthroplasty. METHODS: Between March 2006 and March 2007, 60 patients undergoing unilateral total hip arthroplasty were randomized to undergo either a multimodal pain control protocol or a conventional pain control protocol. The following parameters were compared: the preoperative and postoperative visual analogue scales (VAS), hospital stay, operative time, postoperative rehabilitation, additional painkiller consumption, and complication rates. RESULTS: There was no difference between the groups in terms of diagnosis, age, gender, and BMI. Although both groups had similar VAS scores in the preoperative period and on the fifth postoperative day, there was a significant difference between the groups over the four-day period after surgery. There were no differences in the hospital stay, operative time, additional painkiller consumption, or complication rate between the groups. The average time for comfortable crutch ambulation was 2.8 days in the multimodal pain control protocol group and 5.3 days in the control group. CONCLUSIONS: The multimodal pain control protocol can significantly reduce the level of postoperative pain and improve patients' satisfaction, with no apparent risks, after total hip arthroplasty.
Adult ; Aged ; Amides/administration & dosage ; Analgesia/*methods ; *Arthroplasty, Replacement, Hip ; Clinical Protocols ; Female ; Humans ; Injections, Intra-Articular ; Length of Stay ; Male ; Methylprednisolone/administration & dosage ; Middle Aged ; Morphine/administration & dosage ; Narcotics/administration & dosage ; Pain/prevention & control ; Pain Measurement ; Pain, Postoperative/prevention & control