We report a case of subcutaneous panniculitic T-cell lymphoma (SPTCL) which occurred in a 10-year-old Korean girl. Her disease presented as multiple erythematous subcutaneous nodules on the right cheek, left chest, abdomen, left flank, both calves, and left shin with systemic symptoms. She had a protracted course of multiple erythematous subcutaneous nodules for 2 months often with spiking fever. Histopathologic findings for the subcutaneous nodules revealed lobular panniculitis-like findings composed of atypical small, bland lymphocytes and histiocytes. Characteristically, atypical lymphocytes rimmed individual fat cells in a lace-like pattern and some histiocytes occasionally phagocytosed WBCs. Bone marrow findings revealed increased phagocytic histiocytes with engulfed hematopoietic cell. The immunophenotypic studies showed CD45RO (UCHLl)+, CD20-, CD4-, CD8+ and CD56+ (focal), lysozyme+, CD45 (LCA)+ and EBV-. She received three cycles of high-dose cyclophosphamide, adriamycin, vincristine, prednisolone (CHOP) and methotrexate, intrathecal methotrexate and one cycle of fludarabine, mitoxantrone and dexamethasone (FND) chemotherapy. She died of acute renal failure during multiple chemotherapy.
Abdomen ; Acute Kidney Injury ; Adipocytes ; Bone Marrow ; Cheek ; Child* ; Cyclophosphamide ; Dexamethasone ; Doxorubicin ; Drug Therapy ; Female ; Fever ; Glycogen Storage Disease Type VI ; Histiocytes ; Humans ; Lymphocytes ; Lymphoma, T-Cell* ; Lymphoma, T-Cell, Cutaneous ; Methotrexate ; Mitoxantrone ; Prednisolone ; T-Lymphocytes* ; Thorax ; Vincristine

BACKGROUND: Uterine leiomyoma is the most common pelvic tumor, occurring in 20-25% of women in reproductive age. Gonadotropin releasing hormone agonist (GnRHa) has been reognized as a temporary medical management for this disorder. The etiology of these tumors is unknown but it has been shown that the insulin-like growth factors (IGF-I, IGF-II) are promoters of growth in nongynecologic tumors. Several recent studies have suggested the possible role of IGFs in human leiomyoma growth. The IGF binding proteins (IGFBPs) are believed to modulate actions of IGF and to have IGF-independent actions. The purpose of this study was to evaluate the type of IGF and IGFBP which may be involved in leiomyoma growth and to investigate a possible IGF related mechanism of action of GnRHa. METHOD: The IGFs and IGFBPs were measured by double antibody radioimmunoassay, western ligand blot and immunoprecipitation in the tissue cytosols of normal uterine myometria (n=15), nontumorous myometria adjacent to a leiomyoma and leiomyoma from patients nontreated (n=15) and treated (n=10) with GnRHa. RESULTS: The mean IGF-I and IGF-II level were significantly higher in leiomyoma from untreated patients than in the adjacent myometrium and normal myometrium but no significant differences in these IGF levels between normal myometrium and adjacent myometrium were noted. The IGFBP-2, IGFBP-3 and 26kDa IGFBP were detected variably but IGFBP-4 was consistently present in all tissues. There were no significant differences in the relative intensity for IGFBP-4 and the frequency of IGFBPs between leiomyoma, adjacent myometrium and normal myometrium from untreated patients. The IGF-I, IGF-II levels and the relative intensity of IGFBP-4 in leiomyoma from GnRHa-treated patients were significantly lower than those in untreated patients, but these levels in the adjacent myometrium were comparable. The frequency of each IGFBP in leiomyoma and the adjacent myornetrium from GnRHa-treated patients did not significantly differ from untreated patients. CONCLUSION: Both IGF-I and IGF-II are involved in the growth of leiomyoma and GnRHa may in part act to decrease size of leiomyoma by regulating the local levels of IGF-I, IGF-II and IGFBP-4.
Animals ; Cytosol ; Female ; Gonadotropin-Releasing Hormone ; Humans ; Immunoprecipitation ; Insulin-Like Growth Factor Binding Protein 2 ; Insulin-Like Growth Factor Binding Protein 3 ; Insulin-Like Growth Factor Binding Protein 4 ; Insulin-Like Growth Factor Binding Proteins ; Insulin-Like Growth Factor I ; Insulin-Like Growth Factor II ; Leiomyoma* ; Mice ; Myometrium ; Radioimmunoassay ; Somatomedins*

BACKGROUND: This study was performed to compare the effectiveness of cholesterol-lowering diet therapy instructed by physicians with that instructed by dieticians using techniques that remove regression to the mean. METHODS: 118 patients who visited the office of Family Medicine department in Pusan Paik Hospital from February to November, 1996 and had serum total cholesterol(TC) concentrations greater or equal to 200mg/dL from two measurements were enrolled. The patients were divided into two groups randomly according to the cholesterol-lowering dietary education methods : the one was educated by physicians(Group I), and the other by dieticians(Group II). We evaluated the differences of lipid levels after education in consideration of regression to the mean. RESULTS: The mean reduction in TC concentrations achieved by dietary therapy was 10.7 % and 7.3%(without and with adjustment for regression to the mean) in Group I, and 9.8 and 6.5%(without and with adjustment, for regression to the mean) in Group II. The baseline TC concentrations and TC concentrations after dietary therapy were significantly different in individual group regardless of adjustment for regression to the mean. However, the reduction degrees of TC concentrations were not significantly different between two groups. CONCLUSIONS: The results indicate that even after adjustment for regression to the mean, dietary therapy will achieve the expected reduction. And it seems that the diet education by physicians will be effective as much as that by dieticians.
Busan ; Diet Therapy ; Diet* ; Education ; Humans ; Nutritionists*

OBJECTIVE: Internal carotid artery (ICA) trunk aneurysms are rare constituting about 0.9 to 6.5% of all ICA aneurysms. They may arise from medial, lateral, ventral (posterior) or dorsal (anterior) walls of ICA. The most frequent site of origin is dorsomedial, followed by dorsal, dorsolateral and ventromedial wall. ICA dorsal wall aneurysms can be divided into the saccular type and blister type, which have different shapes, wall histological features and surgical tactics. The authors report an analysis of 27 cases of ICA trunk aneurysms treated with surgical clipping or GDC embolization. METHODS: Of 145 cases of ICA aneurysms from May 1998 to December 2005, we found 27 cases (17.5%) of such unusual aneurysms located at nonbranching sites of the intradural ICA. Features of neuroimagings and medical records were analyzed. RESULTS: Out of 27 aneurysms, 10 were located at ICA dorsal wall, 8 aneurysms were developed at ICA medialwall. Seven aneurysms originated from ICA ventral wall. Seven cases presented with subarachnoid hemorrhage and 20 cases were found unruptured. Two patients had blister-like aneurysm, and the others had saccular aneurysms. All patients were treated successfully with microsurgical clippings or GDC embolization. Microsurgical clipping were performed in 14 cases and among them, removal of anterior clinoid process was done in 12 cases. Eleven aneurysms were occluded with detachabel coil. Two patients underwent balloon occlusion of ICA. Blister aneurysm was clipped including a portion of the normal ICA wall. Good outcomes were obtained in 25 patients, and two patients were dead. CONCLUSION: ICA trunk aneurysms are developed at any site of ICA circumference. Therefore we consider a variety of treatment strategies. On clipping of aneurysms at proximal ICA trunk, removal of anterior clinoid process is important. Endovascular treatment may be good an alternative. However, surgical treatment is essential for blister like aneurysms.
Aneurysm* ; Balloon Occlusion ; Blister ; Carotid Artery, Internal* ; Humans ; Intracranial Aneurysm ; Medical Records ; Subarachnoid Hemorrhage ; Surgical Instruments

BACKGROUND: Keloids may occur at any age, but tend tend velop between the ages of 10 and 30. The incidence and median age of onset are equal for both sexes. Keloids are common among the darker pigmented rices, but there have been a few clinia studies of keloids in Korea. OBJECTIVE: The purpcse of this study was to evaluate the variable clinical characteristics of keloids in Korea. METHODS: This clinical investigation was made with 223 of patients of keloid who had visited the Department of Derrnatology, Chonnam University Hosptal from January 1984 to December 1993. RESULTS: 1.The annual incidenie averaged over 10 years was 0.831 (361 cases of total 43,752 outpatients). 2.The ratio of male to female was 1: 0.94(Male. 115, Feila 108). 3.The mean age of the onset and at the first visit to our hospital were 24.5years and 29.2 years respectively. 4.In our series tte presternal area was the most commor saes, the shouder region next. Most keloids on the shoulder were related to BCG vaccination in ifoncy or chilhood. 5.The precipitating fa ctors associated with keloid were riaeeding dermatologic diseases(33.2 %), unknown(17.9%) rejection & vaccination(15.2%), operation(13.9%), burn(13.9%) and laceration(5.8%) in descending order. 6.Among preceeding as, iociated dermatologic diseases, acne w s the most common. 7. A positive family history is more likely in cases of mitile keloidal (p<0,001), and severe keloidal formation. 8.Most patients did not. complain of any symptorns(45.3%) nd a symptom of pain or tenderness(40.8%) was piesert rather than pruritus(13.9%). 9.The most prevaent tr eatment modality was intralesional injection with triamcinolone acetonide (84.3%). CONCLUSION: According, to this study, usually keloids occore in patients between 10 and 29 years of age, and most keloids were located on the antetio partion of the chest, shoulders, and face and scalp. A positive family history is more likely in as of multiple, severe keloidal for mation.
Acne Vulgaris ; Age of Onset ; Female ; Humans ; Incidence ; Injections, Intralesional ; Jeollanam-do ; Keloid* ; Korea ; Male ; Mycobacterium bovis ; Scalp ; Shoulder ; Thorax ; Triamcinolone Acetonide ; Vaccination

Winging of the scapula is characterized clinically by a prominence of the vertebral border and inferior angle of the scapula. Trauma, neuritis, neural injury during surgical procedure and many other causes may develop winging of scapula. When pain and functional impairment persist, surgical intervention may become appropriate. We report two cases of winged scapula. One case was serratus anterior palsy due to blunt trauma, which was treated by transfer of teres major and pectoralis minor elongated with a tensor fascia strip. Another case was trapezius muscle palsy due to iatrogenic spinal accessary nerve injury, which was treated by transfer of the levator scapulae, rhomboid major and rhomboid minor muscle. In the former case, there was no weakness nor deformity of affected shoulder. In the later case, there was some residual pain and limitation of motion.
Congenital Abnormalities ; Fascia ; Neuritis ; Paralysis ; Scapula* ; Shoulder ; Superficial Back Muscles

No abstract available.
Neurilemmoma* ; Neurofibromatoses* ; Neurofibromatosis 2*

The objective of this paper is to introduce the schematic protocol of radiofrequency (RF) ablation for the treatment of varicose veins. Indication: anatomic or pathophysiologic indication includes venous diameter within 2-20 mm, reflux time > or =0.5 seconds and distance from the skin > or =5 mm or subfascial location. Access: it is recommended to access at or above the knee joint for great saphenous vein and above the mid-calf for small saphenous vein. Catheter placement: the catheter tip should be placed 2.0 cm inferior to the saphenofemoral or saphenopopliteal junction. Endovenous heat-induced thrombosis > or =class III should be treated with low-molecular weight heparin. Tumescent solution: the composition of solution can be variable (e.g., 2% lidocaine 20 mL+500 mL normal saline+bicarbonate 2.5 mL with/without epinephrine). Infiltration can be done from each direction. Ablation: two cycles' ablation for the first proximal segment of saphenous vein and the segment with the incompetent perforators is recommended. The other segments should be ablated one time. During RF energy delivery, it is recommended to apply external compression. Concomitant procedure: It is recommended to do simultaneously ambulatory phlebectomy. For sclerotherapy, it is recommended to defer at least 2 weeks. Post-procedural management: post-procedural ambulation is encouraged to reduce the thrombotic complications. Compression stocking should be applied for at least 7 days. Minor daily activity is not limited, but strenuous activities should be avoided for 2 weeks. It is suggested to take showers after 24 hours and tub baths, swimming, or soaking in water after 2 weeks.
Baths ; Catheter Ablation* ; Catheters ; Consensus* ; Heparin ; Knee Joint ; Lidocaine ; Saphenous Vein ; Sclerotherapy ; Skin ; Stockings, Compression ; Swimming ; Thrombosis ; Varicose Veins* ; Walking

PURPOSE: MRI is known to display the anatomy of the larynx in excellent detail with its remarkable soft tissue delineation and multiplanar imaging capability. We evaluate the accuracy of MRI in diagnosis and staging of laryngeal cancer MATERIALS AND METHODS: Sixteen cases with pathologically proved squamous cell carcinoma of the larynx were reviewed, retrospectively. The examination was performed with a 0.5 T superconductive MR system and C1 surface coil. Axial, sagittal and coronal plane with T1WI(TR/TE 450/20) and T2WI(TR/TE 18OO/80) were done. RESULTS: Eleven cases with glottic cancer(5 Tla, 3 Tlb, 1 T3 and 2 T4) and 5 cases with supraglottic cancer (1 T1, 1 T3 and 1 T4) were included. Cancer tissue showed intermediate signal intensity on TIWI and high signal intensity on T2Wl. Among 16 cases, 13 cases were correctly staged and 3 cases were overstaged due to edema caused by previous biopsy, partial volume averaging effect of abutted lesion, or surrounding inflammation. CONCLUSION: MRI is an useful modality for diagnosis of laryngeal cancer, especially in evaluation of paraglottic extention on coronal image and cartilage invasion.
Biopsy ; Carcinoma, Squamous Cell ; Cartilage ; Diagnosis ; Edema ; Inflammation ; Laryngeal Neoplasms ; Larynx ; Magnetic Resonance Imaging ; Retrospective Studies

The origins of medullary carcinoma and papillary carcinoma of thyroid are embryologically different. We report a case of simultaneous occurrence of medullary carcinoma and papillary carcinoma of the thyroid in the same thyroid gland. In this case, the occurrence of the two tumors may be a coincidence, does not have embryological or genetical significance.
Carcinoma, Medullary ; Carcinoma, Papillary* ; Thyroid Gland*