Recently, there were many cases which was associated with bone defect in the limb and skin defect. We had performed vascularized osteocutaneous fibular transfer with microsurgical technique and experienced early bone union and simutsneous external wound healing. So we, authers, reviewed 12 cases of vascularized osteocutaneous fibular transfer which were performed to the extensive bone defect of the tibia and associated soft tissue injury. And the following remarkable results were obtained. 1. With the uncontrolled bone infection, the vascularized osteocutaneous fibular transfer was able to be performed and there was no non-union. 2. During the follow up period, the grafted fibula had been hypertrophied. 3. In the cases which the fibula were grafted to the defect after the segmental and partial excision of the tibia, in general, the partial weight bearing was able to be started from 3 months to 5 months after the operation, In the cases with segmental and complete excision of the tibia, the partial weight bearing was able to be started from 5 months to 7 month after the operation. 4. In adult, free fibula can be obtained and grafted as 20cm as long and the fibula was a good donor for extensive long bone defect as a compact bone; the skin flap with fibula can be obtained and grafted as 17 × 9cm as large in our experience. 5. In the vascularized osteocutaneous fibula transfer, the skin flap could be confirmed wheather the vascular anastomosis is patent or not as a monitor.
Adult ; Clinical Study ; Extremities ; Fibula ; Follow-Up Studies ; Humans ; Microsurgery ; Skin ; Soft Tissue Injuries ; Tibia ; Tissue Donors ; Transplants ; Weight-Bearing ; Wound Healing

The acute peripheral neuropathy as one of hypereosinophilic syndrome is known to be a rare disorder. The authors experienced a dramatic case with acute peripheral neuropathy, hypereosinophilia in peripheral blood, and the positive anti-GM1 antibodies. The serum protein electrophoresis showed a diffusely increased gamma-globulin region and the polyclonal gammopathy was found by the immunoelectropheresis. There was no evidence of inflammatory myopathy in vastus lateralis muscle. The sural nerve biopsy was compatible with vascular neuropathy, as there were a few myelin digestion chambers, mild perineuronal fibrosis, and perivascular lymphoplasmocytic infiltration with focal organizing thrombosis. The clinical response to prednisone therapy was excellent.
Acute Disease ; Adult ; Antibodies/*blood ; G(M1) Ganglioside/*immunology ; Humans ; Hypereosinophilic Syndrome/*complications/immunology ; Male ; Peripheral Nervous System Diseases/*etiology

Multiple primary tumors are defined as cases involving primary malignant tumors of different histologic origins in one person. The absolute number of reported cases of double primary malignant tumors has increased in recent years diagnostic procedures. Primary adenocarcinoma of duodenum is a rare disease and represents less than 0.5% of all gastrointestinal malignancies. Therefore, synchronous multiple primary cancers of the stomach and duodenum are very rare. Recently, we experienced a case of triple primary malignant tumors of different site originating from the stomach, duodenum and cervix in 71- year-old woman. She had had radiation therapy and chemotherapy for squamous cell carcinoma of the uterine cervix 8 years previously. We performed subtotal gastrectomy and pancreaticoduodenectomy with radical lymph node dissection. She remained healthy without any evidence of recurrence 12 months after the operation.
Adenocarcinoma ; Carcinoma, Squamous Cell ; Cervix Uteri ; Drug Therapy ; Duodenal Neoplasms* ; Duodenum ; Female ; Gastrectomy ; Humans ; Lymph Node Excision ; Pancreaticoduodenectomy ; Rare Diseases ; Recurrence ; Stomach ; Stomach Neoplasms* ; Uterine Cervical Neoplasms*

It is known that in myasthenia gravis(MG) the plasmapheresis therapy removes the acetylcholine receptor (AChR) antibodies and other toxins in the serum to cause clinical improvement temporarily. To know the effects of plasmapheresis on AChR antibody and clinical courses the authors checked serially the AChR antibody titers and clinical stages in myasthenia gravis. The plasmapheresis were performed for the therapeutic purposes in seven and elective purposes in three MG subjects. After two, three or four cycles of plasmapheresis, the myasthenic symptoms have dramatically improved in all subjects. However the AChR antibody titers decreased in only four out of ten and the decremental ratio in each case uas rather smaller than being expected. Thus the effects of plasmapheresis could not be explained solely by the decreasing phenomena of AChR antibody titers in MG subjects. Therefore the authors assumed that the clinical severities of MG could be correlated with other types of AChR antibodies that are not checked by the routine @-bungarotoxin binding technique, or the AChR antibodies are secondarily produced in large amount by the mechanism of rebound enhancing activity.
Acetylcholine* ; Antibodies ; Myasthenia Gravis* ; Plasmapheresis*

BACKGROUND/AIMS: Pancreaticoduodenectomy( PD ) is a complicated procedure that carried a very high postoperative mortality and mobidity until 1970s. Since early 1980, motality has been decreased but morbidity is still high now. So this study was conducted to analyze the motality and morbidity as well as survival rates after PD for valiable disease. METHODS: From January 1988 to January 2000, 164 patients underwent PD in the Korea Cancer Center Hospital. Standard pancreaticoduodenectomy was performed in terms of lymph node dissection and main method of pancreaticoenterostomy was end-to-side pancreaticojejunostomy, among which ductto- mucosa anastomosis comprised of about half of cases. Survival rates and the differences were estimated by Kaplan-Meier method and Log-Lank test respectively, and multivariate analysis was done with Cox Regression hazard model using SPSS program for Windows. RESULTS: Median age of all patients was 57 years with slight male predominance(54.8%). Classical Whipple's operation was performed in 113 cases(68.9%), and PPPD in 40 cases(24.3%), hepatopancreaticoduodenectomy in 10 cases(6.1%). Operative mortality was 1.8%( 3/164 ), however no additional in-hospital death occurred. Nine patients underwent reoperation. Postoperative complication occurred in 56 cases(34.2%). The most common complication was pneumonia(11.5%), and delayed gastric emptying( 7.3%), pancreatic fistula(4.8%), intra-abdominal bleeding(4.8%) in orders. No pancreatic leakage occured in duct-to-mucosa anastomosis group. Median survival of 123 periampullary carcinoma was 25 months and better survival was shown in ampulla of Vater cancer. Factors influencing on survival for periampullary carcinoma were origin of tumor, cellular differentiation, lymph node invasion. CONCLUSION: Pancreaticoduodenectomy can be performed safely in the terms of mortality. Bleeding is the most common cause of reoperation and motality, so meticulous bleeding control is very important. And duct-to-mucosa anastomosis is very safe method of pancreaticoenterostomy.
Ampulla of Vater ; Hemorrhage ; Humans ; Korea ; Lymph Node Excision ; Lymph Nodes ; Male ; Mortality ; Mucous Membrane ; Multivariate Analysis ; Pancreaticoduodenectomy* ; Pancreaticojejunostomy ; Postoperative Complications ; Proportional Hazards Models ; Reoperation ; Survival Rate

TGF-beta1 is a potent chemotactic factor for inflammatory cells and fibroblasts. It also stimulates the celluar source and components of extracellular matrix and the production of proteinase inhibitors. Collectively, these biologic activities lead to the accumulation and stabilization of the nascent matrix, which is vital to wound healing. The objective of this study is to investigate production of TGF-beta1 in vitro fibroblast culture in the presence of Staphylococcus enterotoxin B(SEB) and/or lipopolysaccharide(LPS) and to elucidate the role of TGF-beta1 which may be responsible for wound healing The fibroblasts were originated from facial dermis and hypertrophic scar in 26 year-old male patient. In the presence of LPS(0.0l microgram, 0.1 microgram, 1.0 microgram), SEB(0.0l microgram, 0.1 microgram, 1.0 microgram) respectively, cells(5x103ml) were cultivated in vitro. At 1, 3, and 5 days after incubation, cells were counted. Also, cells(2.5x105ml) were cultivated in EMEM with LPS(0.01, 0.1 and 1.0 microgram), SEB(0.01, 0.1 and 1.0 microgram) respectively and LPS(0.1 microgram) and SEB(0.1 microgram) in combination for 24, 48, and 72 hours respectively. Culture supernatants were harvested at 1, 2, and 3 days after incubation period and triplicate culture supernatants were pooled and TGF-beta1 was assayed in duplicate. The results were as follows. 1. In facial dermal fibroblast induced with SEB and LPS respectively or in combination, the suppression of cell proliferation occurred very significantly at 1 day after incubation, compared with the control. In SEB exposure, the production of TGF-beta1 was decreased very significantly at 1 day after incubation, compared with the control. However, in LPS, SEB and LPS exposure, the production of TGF-beta1 was increased very significantly at 1 day after incubation, compared with the control. 2. In hypertrophic scar fibroblast induced with SEB and LPS respectively or in combination, the suppression of cell proliferation did not occur at 1 day after incubation, compared with the control. In SEB and LPS exposure in combination, the production of TGF-beta1 was increased very significantly at 1 day after incubation, compared with the control. However, the production of TGF-beta1 did not occur in SEB and LPS exposure respectively. In conclusion, the concentration of bacterial toxins and the incubation period correlated with cell proliferation and production of TGF-beta1 very significantly and both fibroblasts have different phenotype each other in this regard. This data suggest that the significant production of TGF-beta1 may develope abnormal wound healing associated with tissue fibroproliferative disorder, such as hypertrophic scar and keloid formation.
Adult ; Bacterial Toxins* ; Cell Proliferation ; Cicatrix, Hypertrophic ; Dermis ; Enterotoxins ; Extracellular Matrix ; Fibroblasts* ; Humans* ; Keloid ; Male ; Phenotype ; Staphylococcus ; Transforming Growth Factor beta1 ; Wound Healing

In 1978, Bjornberg and Friis reported 32 patients with persistent pusi ulosis(PP) on distal extremities, of whom 13 patients were initially diagnosed as scabies. In 1984, Elpern described 7 patients with infantile acropustulosis(IA), of whom 4 patients had antecedant scabies. We report herein a case of PP, which was found in a 18 month-old mal who was treated for scabies at the age of 5 month and 12 month. The pruritic vesicopustules dev',lo ed 2 months after the second treatment for scabies and relapsed for 4 months. We also discuss the relationship between scabies and PP and also between PP and IA.
Extremities ; Humans ; Infant ; Scabies*

BACKGROUND: In the course of the study of keratin expression in the epidermis of nevus sebaceus, several cells in the epidermis of nevus sebaceus were positively stained with CAM 5.2 antibody, which is known to be specific for the lower molecular weight cytokeratin and used as a marker of Merkel cell. OBJECTIVE: This study was intended to verify that CAM 5.2 positive cells found in the epidermis of nevus sebaceus are Merkel cells and to understand the meaning of CAM 5.2 positive j cells in the epidermis of nevus sebaceus. METHODS: The immunohistochemical stainings with CAM 5.2 and antibody to epithelial membrane antigen (EMA) performed on specimens of normal skin, epidermal nevus, nevus sebaceus and some appendage tumors. In order to confirm the nature of CAM 5.2 positive cells, the distribution of those were compared to that of Merkel cells and double labeling with CAM 5.2 and neurofilament was performed. RESULTS: CAM 5.2 positive cells were also found in trichilemmoma developed associated with nevus sebaceus and the epidermis of normal paimoplantar skin. CAM 5.2 positive cells were also stained with antibody to EMA on serial sections cut from the same tissue blocks. The association of CAM 5.2 positive cell and nerve fiber was also demonstrated. CONCLUSION: CAM 5.2 positive cells are seemed to be Merkel cells and their presence in the covering epidermis of nevus sebaceus suggests to the epidermis of nevus sebaceus may not be nevoid proliferation of epidermal keratinocytes.
Epidermis* ; Intermediate Filaments ; Keratinocytes ; Keratins ; Merkel Cells ; Molecular Weight ; Mucin-1 ; Nerve Fibers ; Nevus* ; Skin

BACKGROUND: In the course of the study of keratin expression in the epidermis of nevus sebaceus, several cells in the epidermis of nevus sebaceus were positively stained with CAM 5.2 antibody, which is known to be specific for the lower molecular weight cytokeratin and used as a marker of Merkel cell. OBJECTIVE: This study was intended to verify that CAM 5.2 positive cells found in the epidermis of nevus sebaceus are Merkel cells and to understand the meaning of CAM 5.2 positive j cells in the epidermis of nevus sebaceus. METHODS: The immunohistochemical stainings with CAM 5.2 and antibody to epithelial membrane antigen (EMA) performed on specimens of normal skin, epidermal nevus, nevus sebaceus and some appendage tumors. In order to confirm the nature of CAM 5.2 positive cells, the distribution of those were compared to that of Merkel cells and double labeling with CAM 5.2 and neurofilament was performed. RESULTS: CAM 5.2 positive cells were also found in trichilemmoma developed associated with nevus sebaceus and the epidermis of normal paimoplantar skin. CAM 5.2 positive cells were also stained with antibody to EMA on serial sections cut from the same tissue blocks. The association of CAM 5.2 positive cell and nerve fiber was also demonstrated. CONCLUSION: CAM 5.2 positive cells are seemed to be Merkel cells and their presence in the covering epidermis of nevus sebaceus suggests to the epidermis of nevus sebaceus may not be nevoid proliferation of epidermal keratinocytes.
Epidermis* ; Intermediate Filaments ; Keratinocytes ; Keratins ; Merkel Cells ; Molecular Weight ; Mucin-1 ; Nerve Fibers ; Nevus* ; Skin

A case of contact dermatitis due to herb onintment is described in a 24 year-old female patient. After topical application of herb ointment, she developed erythematous papules and plaques on the face and neck. Patch test revealed positive reactions to ammoniated mercury, thimerosal, and the herb ointment. Energy-dispersive X-ray microanalysis of the herb ointment showed a striking peak for mercury.
Dermatitis, Contact* ; Electron Probe Microanalysis ; Female ; Humans ; Neck ; Patch Tests ; Strikes, Employee ; Thimerosal ; Young Adult