BACKGROUND: A definition of granuloma is a focal chronic inflammatory response to tissue injury evolved by a poorly soluble substwice characterized by the accumulation and proliferation of the mono-nuclear histiocytic cells. The accuracy with which rnononuclear cells may be identified in skir. is much improved by the use of both heteroantisera and monoclonal antibodies directed against selected cellular antigens, OBJECTIVE: Our purpose was to examine the staining patterns of anti-lysozyme, anti-a-1-antitrypsin, anti-S-100 protein antibodies, and MAC-387 monoclonal anibody in granulomatous skin diseases. METHOD: We performed imminoperoxidase staining(the labelled str prvidin-biotin peroxidase complex method on the formalin-fixed, paraffin-embedded tissue specimens of granulomatous skin diseases. RESULTS: S-100 protein positive dendritic cells were demonstrated in the granulomatous infiltrates as scattered pattern and MAC-387 positive cells were predominantly found in the center of granulomas, The staining pattern and percentage of positively stained cells of a--antitrypsin were similar to those of lysozyme. A1Pha-1-antitrypsin and lysozyme positive cells w re present in the center as well as lymphohistiocytic infiltrates of granulomas. CONCLUSION: These data sugget that histiocytes are composed of heter igeneous groups of cells such as the mononuclear-phagocyte system and dendritic cell system.
Antibodies ; Antibodies, Monoclonal ; Dendritic Cells ; Granuloma ; Histiocytes ; Muramidase ; Peroxidase ; S100 Proteins ; Skin Diseases ; Skin*

In normal hurnan dermis, factor XIIIa positive dermal dendrocyte are located in the papillary areas closely associated with blood vessels and the upper reticular dem These cells represent a specific type of bone marrow derived dermal cells, distinct from Langerhans cells having some features in common with rnonocyte/macrophage lineage and with potential antier presenting activity. Although the significance of these cells has not yet been fully established, it been suggested that they play a major role in skin immune iesponses, in collagen synsthesis regultic and in wound repair. We report a case of acaqired fibrokeratoma which is studiec conventional histopathology and immunohistochemistry. Histopathologic findings of this case showed ovascular proliferation and the increased presence of fibroblast like cells as a common fe;ture of these benign tumors. Immunohistochemical staining with anti factor XIIIa antibody deiaoi strates increased numbera of positive dendritic cells in the upper dermis. There finding supports the fat that some fibroblagt like cells in the upper dermis of acquireid fibrokeratoma may be factor XIIIa positive dermal dendritic cells.
Blood Vessels ; Bone Marrow ; Collagen ; Dendritic Cells ; Dermis ; Factor XIIIa* ; Fibroblasts ; Immunohistochemistry ; Langerhans Cells ; Skin ; Wounds and Injuries

BACKGROUND: Despite concern about information of neuropeptide, the has been no baseline study of neuropeptide in Koreans. OBJECTIVE: The purpose of the study was to investigate the skin sinsitivity of substance P and VIP in normal healthy persoas. METHODS: We prepared 1000pM, 100pM, 10pM solution of substan P 1-11, substnace P 1-7, substnace P 7-11, and VIP. We injected intradermally 50ul of the br ve solutions on 12 sites of both forearms in addition plaebo. We measured the size of the area of flare and wheal along time. We repeated the same test after antihistamine intake. RESULTS: Flare and wheal respinses were dose dependent. Injection of substance P 1-7 did not evoke wheal responses and injection of substance P 7-11 did not wake flare responses. Flare responses of substance P 1-11, ubstance P 7-11, VIP were inhibiteb antihistamine and wheal responses of VIP were inhibitedly antihistamine. CONCLUSION: N-terminal of subtance P is responsible for flarers onses and C-terminal of substnace P is responsible for wieal responses. Flare responses of sisance P were mediated by histamine but wheal responses osubstance P were direct effect on postcapillary venule. Flare and wheal responses of VIF were mediated by histamine.
Forearm ; Histamine ; Humans ; Neuropeptides ; Skin ; Substance P* ; Venules

Patients suffering from idiopathic or self-induced edema are uniformly characterized by chronic use of furosemide, which leads to vicious cycle of edema. Among chronic furosemide users who don't have any other specific edema forming diseases, 9 patients from the outpatient clinic(OC) and 6 patients examined at the emergency room(ER) used it mainly for weight reduction and for cyclical edema, respectively. All of the ER group patients were presented with severe hypokalemia(2.04+/-0.2mEq/L; range 1.3 to 2.7 mEq/L) and alkalosis(748+/-0.01; range 7.44 to 7.51) but none from the OC group showed such results. Other baseline parameters including Plasma renin activity(PRA) and aldosterone level on recumbency, and FEn(2)were similar in both groups. In contrast, daily working hours(6.1+/-0.5 vs 10+/-0.6hr, p<0.01), average body weight gain between AM and PM(0.4+/-0.1 vs 0.9+/-0.lkg, p<0.01), peak weight gain interval(9+/-0.8 vs 5+/-0.1day, p<0.05), PRA(7.6+/-1.5 vs 23.5+/-7.2ng/ml/h, p<0.05) and aldosterone level(22.1+/-4.2 vs 64.8+/-10.4 ng/dl, p<0.01) on ambulation, and FEk. on normokalemia(ll+/-2A vs 36+/-7.7%, p<0.01) were statistically different between the two groups. In comparison to the OC group, both the amout of urine(617+/-39 vs 358+/-26ml, p<0.01) and the percent change of PRA(-14+/-4 vs -3+/-2%, p<0.05) and al-dosterone level(-17+/-5 vs -4+/-3%, p<0.05) after saline loading(lL over 1hr, IV) following ambulation were smaller in the Elt group. Moat of the ER group patients(5/6) required aldosterone antagonist (spironolactone) added to K+ supplement, but all of the OC group patients were managed to maintain an edema-free status with conservative treatment. In conclusion, patients with idiopathic edema seem to have more fluid transudation out of intravascular space during orthostasis with a prominent degree of deranged renin-aldosterone axis and K+ metabolism than those with self-induced edema.
Aldosterone ; Axis, Cervical Vertebra ; Body Weight ; Dizziness ; Edema* ; Emergencies ; Furosemide* ; Humans ; Metabolism ; Outpatients ; Plasma ; Renin ; Walking ; Weight Gain ; Weight Loss

Castleman disease, or angiofollicular lymph node hyperplasia, is a fairly rare benign tumor of lymphoid origin. Most cases tend to present as a mediastinal mass. We report a 58-year-old man with Castleman disease of the right perirenal space. This case was diagnosed preoperatively as nonconventional renal cell carcinoma (RCC) or renal oncocytoma because the enhancing mass abutted the renal cortex. The patient underwent a radical nephrectomy and a histopathological analysis showed the unicentric plasma cell type of Castleman disease. A preoperative diagnosis of Castleman disease is difficult; therefore, a surgical resection and a histological evaluation can provide an accurate diagnosis of this tumor. Taking this case into consideration, we suggest that Castleman disease should be included in the differential diagnosis of renal tumors.
Adenoma, Oxyphilic ; Carcinoma, Renal Cell ; Diagnosis, Differential ; Giant Lymph Node Hyperplasia ; Humans ; Kidney ; Kidney Neoplasms ; Middle Aged ; Nephrectomy ; Plasma Cells

BACKGROUND: Intubation of the trachea frequently results in a rise in respiratory system resistance (Rrs) that is reversed by inhaled bronchodilators. In asthmatics, this reflex may occasionally result in profound bronchoconstriction, and anesthesiologists often try to avoid tracheal intubation if possible in asthmatics. The hypothesis of this study was that insertion of a laryngeal mask airway (LMA) would be less likely to result in reversible bronchoconstriction than would insertion of an endotracheal tube (ETT). METHODS: A total of 52 (45 male, 7 female) patients were randomized to placement of a 7.5 mm (females) or 8.0 mm (males) endotracheal tube or a #4 (females) or #5 LMA (males). Anesthesia was induced with 2 microgram/kg fentanyl and 5 mg/kg thiopental and airway placement facilitated with 1 mg/kg succinylcholine. After ensuring that a seal to greater than 20 cmH2O existed, Rrs was measured immediately following airway placement using the isovolumic method during positive pressure ventilation with oxygen. Correction was made for the resistance of the ETT but not for the resistance of the LMA, which was insignificant at the flows used. Inhalation anesthesia was then begun with isoflurane (ISF) to achieve an end-tidal concentration of 1.0% for ten minutes. Rrs was then measured again under identical conditions. In the LMA patients, fiberoptic laryngoscopy was then performed to ensure that the scope could be passed to the level of the cords without epiglottic obstruction. RESULTS: Among LMA patients, the initial Rrs was significantly lower than among ETT patients (9.2 0.7 vs 13.4 1.9 cmH2O/L/s, P <0.05). After 10 minutes of ISF, the resistance declined to 8.6 0.7 in the ETT group but remained unchanged at 9.1 0.7 cmH2O/L/s in the LMA group. The decline in Rrs in the ETT group of 4.7 1.4 cmH2O/L/s was highly significant compared to the lack of change in the LMA group (P <0.01). CONCLUSIONS: Despite the inclusion of the resistance of the LMA and the laryngeal resistance, Rrs in LMA patients was still clearly lower than in ETT patients. Furthermore, resistance dropped rapidly only in ETT patients after ISF, a potent bronchodilator, suggesting that reversible bronchoconstriction was present in ETT patients but not LMA patients. We conclude that an LMA is a better choice of airway to minimize airway reaction.
Anesthesia ; Anesthesia, Inhalation ; Bronchoconstriction* ; Bronchodilator Agents ; Fentanyl ; Humans ; Intubation ; Intubation, Intratracheal* ; Isoflurane ; Laryngeal Masks* ; Laryngoscopy ; Male ; Oxygen ; Positive-Pressure Respiration ; Reflex ; Respiratory System ; Succinylcholine ; Thiopental ; Trachea

BACKGROUND: Intubation of the trachea frequently results in a rise in respiratory system resistance (Rrs) that is reversed by inhaled bronchodilators. In asthmatics, this reflex may occasionally result in profound bronchoconstriction, and anesthesiologists often try to avoid tracheal intubation if possible in asthmatics. The hypothesis of this study was that insertion of a laryngeal mask airway (LMA) would be less likely to result in reversible bronchoconstriction than would insertion of an endotracheal tube (ETT). METHODS: A total of 52 (45 male, 7 female) patients were randomized to placement of a 7.5 mm (females) or 8.0 mm (males) endotracheal tube or a #4 (females) or #5 LMA (males). Anesthesia was induced with 2 microgram/kg fentanyl and 5 mg/kg thiopental and airway placement facilitated with 1 mg/kg succinylcholine. After ensuring that a seal to greater than 20 cmH2O existed, Rrs was measured immediately following airway placement using the isovolumic method during positive pressure ventilation with oxygen. Correction was made for the resistance of the ETT but not for the resistance of the LMA, which was insignificant at the flows used. Inhalation anesthesia was then begun with isoflurane (ISF) to achieve an end-tidal concentration of 1.0% for ten minutes. Rrs was then measured again under identical conditions. In the LMA patients, fiberoptic laryngoscopy was then performed to ensure that the scope could be passed to the level of the cords without epiglottic obstruction. RESULTS: Among LMA patients, the initial Rrs was significantly lower than among ETT patients (9.2 0.7 vs 13.4 1.9 cmH2O/L/s, P <0.05). After 10 minutes of ISF, the resistance declined to 8.6 0.7 in the ETT group but remained unchanged at 9.1 0.7 cmH2O/L/s in the LMA group. The decline in Rrs in the ETT group of 4.7 1.4 cmH2O/L/s was highly significant compared to the lack of change in the LMA group (P <0.01). CONCLUSIONS: Despite the inclusion of the resistance of the LMA and the laryngeal resistance, Rrs in LMA patients was still clearly lower than in ETT patients. Furthermore, resistance dropped rapidly only in ETT patients after ISF, a potent bronchodilator, suggesting that reversible bronchoconstriction was present in ETT patients but not LMA patients. We conclude that an LMA is a better choice of airway to minimize airway reaction.
Anesthesia ; Anesthesia, Inhalation ; Bronchoconstriction* ; Bronchodilator Agents ; Fentanyl ; Humans ; Intubation ; Intubation, Intratracheal* ; Isoflurane ; Laryngeal Masks* ; Laryngoscopy ; Male ; Oxygen ; Positive-Pressure Respiration ; Reflex ; Respiratory System ; Succinylcholine ; Thiopental ; Trachea

PURPOSE: Deep infection after hip and knee arthroplasty is a serious complication and is difficult to treat due to its toxicity. The aims of our study were to find out the differences of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) infection after hip and knee arthroplasty focusing on clinical course and laboratory findings. MATERIALS AND METHODS: We retrospectively reviewed 61 staphylococcal infection cases after hip and knee arthroplasty (MSSA in 25 patients, MRSA in 36 patients). Vital signs, laboratory tests, microbiology and clinical courses were analyzed. The average follow-up period was 3.8 years (range, 2 to 10.1 years). RESULTS: At initial visit, MRSA group showed significant higher erythrocyte sedimentation rate, C-reactive protein (CRP) and neutrophil percentage. The average duration for the normalization of CRP was longer in MRSA group (MRSA: 36.7+/-25.1 days, MSSA: 24.7+/-13.6 days; P=0.008). The mean interval between staging operation was longer in MRSA group (MRSA: mean 8.7 weeks [range, 6.4 to 21.4 weeks], MSSA: mean 6.8 weeks [range, 6 to 13.1 weeks]; P=0.012). MRSA group (13.9%) revealed higher recurrence rate than MSSA group (4%). Two patients (5.6%) from MRSA group expired by sepsis. One limb amputation (2.7%) was carried out in MRSA group. CONCLUSION: MRSA infection after arthroplasty showed more toxic serologic parameter and poorer prognosis. Aggressive treatment should be considered for MRSA infection following arthroplasty.
Amputation ; Arthroplasty ; Blood Sedimentation ; C-Reactive Protein ; Drug Resistance, Microbial ; Extremities ; Follow-Up Studies ; Hip* ; Humans ; Knee* ; Methicillin-Resistant Staphylococcus aureus* ; Neutrophils ; Prognosis ; Recurrence ; Retrospective Studies ; Sepsis ; Staphylococcal Infections ; Staphylococcus aureus ; Vancomycin ; Vital Signs

Hypoglossal nerve palsy after general anesthesia is an exceptionally rare complication, which has varied etiology. We present a case of unilateral hypoglossal nerve palsy resulting from repeated airway intervention for general anesthesia. A 57-year-old woman was scheduled to undergo modified radical mastectomy. During endotracheal intubation, the patient had Cormack's grade III-a severe airway condition. After the first intubation attempt failed, the intubation was attempted a second time using a stylet inside the endotracheal tube with cricoid pressure; this attempt was successful. In the evening of the operation day, the patient complained of dysarthria and dysphagia. Physical examination revealed deviation of the tongue to the right, which may have been caused by traumatic hypoglossal nerve injury. This case reviews the pathophysiology, prevention, and management of hypoglossal nerve palsy.
Anesthesia, General* ; Deglutition Disorders ; Dysarthria ; Female ; Humans ; Hypoglossal Nerve Diseases* ; Hypoglossal Nerve Injuries ; Hypoglossal Nerve* ; Intubation ; Intubation, Intratracheal* ; Mastectomy, Modified Radical ; Middle Aged ; Paralysis ; Physical Examination ; Tongue

OBJECTIVES: This study was to evaluate the performance of the newly developed information system (IS) implemented on July 1, 2014 at three public hospitals in Korea. METHODS: User satisfaction scores of twelve key performance indicators of six IS success factors based on the DeLone and McLean IS Success Model were utilized to evaluate IS performance before and after the newly developed system was introduced. RESULTS: All scores increased after system introduction except for the completeness of medical records and impact on the clinical environment. The relationships among six IS factors were also analyzed to identify the important factors influencing three IS success factors (Intention to Use, User Satisfaction, and Net Benefits). All relationships were significant except for the relationships among Service Quality, Intention to Use, and Net Benefits. CONCLUSIONS: The results suggest that hospitals should not only focus on systems and information quality; rather, they should also continuously improve service quality to improve user satisfaction and eventually reach full the potential of IS performance.
Electronic Health Records ; Hospitals, Public* ; Information Systems* ; Intention ; Korea ; Medical Records