OBJECTIVES: The differentiation of tuberculous effusion from the other causes of exudative pleural effusion remained difficult even with aids of biochemical analyses and pleural biopsy. As the pathophysiology of tuberculous pleural effusion is an enhanced cell mediated immunity, Adenosine deaminase(ADA) and various cytokines including Inteferon-γ, tumor necrosis factor alpha(TNF-α) are considered as useful diagnostic tools in differentiating exudative pleural effusion The author would like to demonstrate the diagnostic usefulness of TNF-α in the differentiation of exudative pleural effusion, and compared the discriminating ability of TNF-α with ADA. METHODS: Pleural fluids obtained from 80 patients (tuberculous : 39, malignant : 31, parapneumonic : 10) with exudate pleural effusions were processed for cell counts and biochemical analysis including ADA and TNF-α RESULTS: Tuberculous pleural fluid showed higher levee of ADA and TNF-α, 48.7α 32.7U/L and 184.1±214.2pg/mL than that of non-tuberculous effusion 26.0α41.3U/L and 44.1α114.2pg/mL, respectively (ADA, TNF-α : p<0.05, p<0.01). Receiver operating characteristics(ROC) curves were generated for ADA and TNF-α, and the best cut-off value for adenosine deaminase and TNF-α were considered as 30U/L and 15pg/ml, respectively. Comparing the area under the ROC curves, there was no significant difference between ADA and TNF-α CONCLUSION: For the differential diagnosis of tuberculous pleural effusion from the other causes of exudative pleural effusions, TNF-α as well as ADA was considered as useful diagnostic method. However adding TNF-α to ADA has no further diagnotic benefit than ADA alone.
Adenosine ; Adenosine Deaminase ; Biopsy ; Cell Count ; Cytokines ; Diagnosis, Differential ; Exudates and Transudates ; Humans ; Immunity, Cellular ; Pleural Effusion* ; ROC Curve ; Tuberculosis ; Tumor Necrosis Factor-alpha*

Liposarcoma is a rare mesenchymal tumor that occurs most commonly in the soft tissue of the extremities. It develops deeply in the intramuscular fatty tissue and consists of lipoblasts. We experienced a case of well-differentiated liposarcoma on the thigh of a 48-year-old female, who presented with a skin-colored, child fist-sized mass. Liposarcoma is rare in the dermatologic field, so we herein report a case of well-differentiated liposarcoma.
Adipose Tissue ; Child ; Extremities ; Female ; Humans ; Liposarcoma* ; Middle Aged ; Thigh

Clear cell sarcoma is a rare malignant tumor representing about 1% of soft tissue tumors. It usually presents in the distal extremities of young adults, frequently attached to tendons or aponeuroses. This slowly progressive tumor tends to recur and results in eventual development of metastatic growth. Early recognition of the disease and prompt wide excision of tumor are essential to get a favorable outcome. We report a rare case of clear cell sarcoma in a 57 year-old female who presented with an erythematous hard nodule on her abdomen.
Abdomen ; Extremities ; Female ; Humans ; Sarcoma, Clear Cell ; Tendons ; Young Adult

Cutaneous horn is a clinical description for a cohesive mass of cornified material protruding from the surface of the skin. These lesions may arise from a bulging erythematous base, and their shape is usually described as conical. Such lesions generally occur on sun exposed areas such as the face, ear or the dorsum of the hand. Cutaneous horn is not a pathological diagnosis and a variety of primary underlying processes can cause this lesion. We report an 85-year-old female who presented with a bean-sized, hyperkeratotic nodule on the right lower leg. Clinical and histopathologic examination confirmed the nodule to be squamous cell carcinoma presenting as cutaneous horn.
Aged, 80 and over ; Animals ; Carcinoma, Squamous Cell* ; Diagnosis ; Ear ; Female ; Hand ; Horns* ; Humans ; Leg ; Skin ; Solar System

Leiomyosarcomas are uncommon malignant smooth muscle tumors, mainly derived from vessels or viscera. Superficial leiomyosarcomas are a rare soft tissue sarcoma arising from the dermis or subcutaneous tissue in the skin. According to tumor origin and location, they are divided into cutaneous and subcutaneous leiomyosarcoma. They have distinctly different histologic and prognostic features from each other. Superficial leiomyosarcomas show a predilection for the proximal extremities and tend to be slow growing. We report one rare case of superficial cutaneous leiomyosarcoma on the right temporal area of face, which showed an extremely rapid growing mass within 3 months.
Dermis ; Extremities ; Leiomyosarcoma ; Sarcoma ; Skin ; Smooth Muscle Tumor ; Subcutaneous Tissue ; Viscera

Hepatitis B viral infection which affect about 10% of Korean population manifests asymptomatic carrier, chronic hepatitis and liver cirrhosis and even associates with hepatocellular carcinoma. Clinical manifestations induced by hepatitis B virus vary depending on the degree of immune response by cytotoxic T cells against viral epitope-presenting liver cells. Since hepatitis B virus presents high rate of mutaton that might change the presented epitope and eventually alter immune response, viral mutations, especially in promoters and enhancers, have an important implication in hepatic inflammation and viral replication. To identify mutations related to the hepatic inflammation, we investigated sequence variations of hepatitis B viral promotor regions in the presence or absence of symptoms in hepatitis B carriers. For this, sera from persistently hepatitis B virus-infected mother-child pairs were collected. After PCR amplifiation of all hepatitis B viral promoters (C promoter, S1 promoter, S2/S promoter, X promoter) using serum DNA from each pair, viral promotors were sequenced by automatic sequencer and then sequence data were analyzed by ClustalW. In most cases, the dominant type of maternal virus was transmitted to the child. However, in some children, some new host specific viral variants could be observed in Cp, S1p and S2/Sp. The mutations in C promoter did not seem to be vertically transmitted but arose in new host independently after the wild type had been transmitted. Enhancer I containing X promoter revealed high host specific variations as has been reported before. Two S promoters, S1p and S2/Sp, have shown some point mutations in children, but no deletion mutations were detected as in chronic hepatitis patients in whom deletion mutations are frequently found. In conclusion, the children with the vertically transmitted hepatitis B virus mostly retain the dominant type virus that had been transmitted. However, host specific variants tended to accumulate over time, possibly as clinical symptoms develop.
Carcinoma, Hepatocellular ; Child ; DNA ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Hepatitis, Chronic ; Humans ; Inflammation ; Liver ; Liver Cirrhosis ; Point Mutation ; Polymerase Chain Reaction ; Promoter Regions, Genetic ; Sequence Deletion ; T-Lymphocytes

Pneumoparotitis is a rare cause of enlargement of the parotid gland. Hence, it is often misdiagnosed and therefore incorrectly treated. We report, with the clinical presentation and radiographic findings, a case of pneumoparotitis due to trumpet playing. Swelling of the parotid gland was initiated by air being forced through the Stensen`s duct, resulting in the insufflation of air into the acini of the parotid gland. Recurrent parotid insufflation is not entirely benign and may predispose the parotid gland to sialectasia, recurrent parotitis, subcutaneous emphysema, and even mediastinal emphysema.
Insufflation ; Mediastinal Emphysema ; Parotid Gland ; Parotitis ; Subcutaneous Emphysema ; Wind*

Localized giant cell tumor of the tendon sheath (GCTTS) usually occurs in extensor an tendon sheath of the fingers and toes. It has rarely been observed in the fat pad of the knee joint. We treated a case of a 2.5x3x4 cm mass arising from the infrapatellar fat pad, which presented with extension limitation and knee pain due to lateral femorotibial joint impingement. The tumor was successfully treated using arthroscopic excision with a motorized shaver. Histologic findings were diagnosed as localized GCTTS. Herein we report this case with a literature review.
Adipose Tissue ; Fingers ; Giant Cell Tumors ; Giant Cells ; Joints ; Knee ; Knee Joint ; Tendons ; Toes

Kluyveromyces fragilis KCTC 7260 and Saccharomyces cerevisiae KCTC 7904, which both grew well in pear marc extract, were selected and their growth profiles and physiological functionalities were determined. Both of the selected yeasts established maximal growth by 20 hr of cultivation at 30degrees C in pear marc extract. The cell-free extracts showed high antihypertensive angiotensin I-converting enzyme inhibitory activity of 68.9% and 52.1%, respectively. The extracts also displayed 9.2 U/mL and 12.0 U/mL of protease activity, respectively.
Kluyveromyces ; Peptidyl-Dipeptidase A ; Pyrus ; Saccharomyces cerevisiae ; Yeasts

Delayed pressure urticria is a type of physical urticaria, characterized by the appearance of painful swelling for a few hours after physical stimulus. A 27-year-old woman suffered from pressure urticaria for eight months. The patient was unresponsive to conventional antihistamine, glucocorticoid, cyclosporine and azathioprine. Since the patient was treated with 10 mg/day montelukast and 1 mg/day ketotifen for 10 months, erythema and wheals have not developed. We report a case of pressure urticaria treated with a leukotriene inhibitor.
Acetates ; Adult ; Azathioprine ; Cyclosporine ; Erythema ; Female ; Humans ; Ketotifen ; Quinolines ; Urticaria