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

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

PURPOSE: The aim of this study is to examine whether conventional primary closure of the bile duct without routinely inserting a T-tube could be performed after all the surgeries used to treat choldocholithiasis. METHODS: From April 2002 to July 2005, we retrospectively analyzed 125 bile duct stone disease patients who underwent primary closure of the bile duct. RESULTS: Wound infection was the most frequent surgical complications, and it showed a higher trend in the patients who had a history of previous biliary operation, and it showed a trend to be slightly higher in the recurrent biliary stone cases than that in the de novo cases. However, these findings were not statistically significant. In addition, surgical complications developed in 16 of 100 patients who were older that 60 years, whereas there was only 1 of 25 patients who developed complications for the patients younger than 60 years. The development of complications has a tendency to be higher for the older patients, yet the level was not statistically significant. In regard to postsurgical hyperamylasemia, although a statistically significant difference could not be detected, this malady developed in 3 of 12 cases in whom endoscopic nasobiliary drainage (ENBD) tubes were inserted. This showed a trend to be higher than that for 13 cases of 113 patients for whom endoscopic nasobiliary drainage tubes were not inserted. Concerning the postsurgical hospitalization period, it was significantly longer in the cases who developed complications (p=0.018), and there was a tendency for a prolonged hospitalization period for the patients who were older than 60 years, for women, recurrent cases and the cases with a history of the bile duct surgery. Yet these had no statistical significance CONCLUSION: It appears that the primary closure of bile duct is a technique that could be performed safely for all choledocolithotomy patients , and this is regardless of the size of bile duct diameter, history of surgery on the bile duct system, gender, emergency operation, age, recurrent biliary stones, the presence of presurgical nasobiliary drainage tube and the presence of concomitant diseases.
Bile Ducts* ; Bile* ; Choledocholithiasis ; Drainage ; Emergencies ; Female ; Hospitalization ; Humans ; Hyperamylasemia ; Length of Stay ; Retrospective Studies ; Wound Infection

OBJECTIVE: The abacus, first used in Asian countries more than 800 years ago, enables efficient arithmetic calculation via visuo-spatial configuration. We investigated whether abacus-trained children performed better on cognitive tasks and demonstrated higher levels of arithmetic abilities compared to those without such training. METHODS: We recruited 75 elementary school children (43 abacus-trained and 32 not so trained). Attention, memory, and arithmetic abilities were measured, and we compared the abacus with the control group. RESULTS: Children who had learned to use an abacus committed fewer commission errors and showed better arithmetic ability than did controls. We found no significant differences between children with and without abacus training in other areas of attention. CONCLUSION: We speculate that abacus training improves response inhibition via neuroanatomical alterations of the areas that regulate such functions. Further studies are needed to confirm the association between abacus training and better response inhibition.
Asian Continental Ancestry Group ; Case-Control Studies* ; Child ; Cognitive Science ; Humans ; Mathematics ; Memory