BACKGROUND: The relationship and differentiation among various dendritic cells of the dermis are unclear. Recently it has hecome possible to identify different subpopulat,ions of dermal dendritic cells using anti-CD34 and anti-factor XIIIa antibodies. OBJECTIVE: To elucidate which cell types the fibrous dermal turnors consist of we compared the staining patterns of these antibodies as well as of anti-Mac 387 antibody which are labeled as inflammatory cells of the monocyte-macrophage lineage. METHODS: Tumors studied included dermatofibrosarcoma protuberans(DFSP, n=2), dermato-fibroma(n=22), neurofibroma, n=27), acrochordon(n=15), keloid, hypertrophic scar(n=10), juvenile xanthogranuloma(n=1, and malignant fibrous histiocytoma (MFH, n=1). We performed immunoperoxidase staining(AUSC technique) with polyclonal anti FXIIIa antibody, monoclonal anti-CD34 antibody, and monoclonal anti-Mac 387 antibody on the formalin-fixed-paraffin-embedded tissue specimens of these fibrous tumors. The intensity of staining was graded as negative, weakly staining, or strongly stainiring. RESULTS: FXIIIa reactivity was strongly present in dendritic and spindle-shaped cells of all dermatofibromas and some nurofibromas(11 of 27 specimens), but absent from the other fibrous tumors. Among these tumors, one of the two DFSPs was uniquely expressed CD34. Dendritic and spindle-shaped cells within tiese tumors were MAC 387 negative. In inflammatory conditions, variable numbers of MAC 38 positive cells were observed, corresponding to histiocytes and mac-rophages, but the labeling of ipithelioid cells and multinucleated foreign body giant cells were variable. CONCLUSION: The findings of significant numbers of FXIIIa positive cells in dermal fibrous tumors studied suggest that thet may be diagnostic utility associated with the use of this antit)ody. In addition, CD 34 expression by the tumor cells can be an extremely useful marker in establishing a definitive diagnosis of IFSP.
Antibodies ; Dendritic Cells ; Dermatofibrosarcoma ; Dermis ; Diagnosis ; Factor XIIIa* ; Giant Cells, Foreign-Body ; Histiocytes ; Histiocytoma, Benign Fibrous ; Histiocytoma, Malignant Fibrous ; Keloid ; Langerhans Cells ; Neurofibroma

Bowens disease is generally regarded as a premalignant dermatosis. If untreated, 3% to 5% of patients may develop squamous cell carcinoma. However, sebaciou carcinoma arising from Bowens disease is very rare. We presented a case of quarnous cell carcinoma and sebaceous circ s disease in a 68 year-old male. He had multiple bowenoid skin lesi nsties. A bean-sized nodule as developed on the bowenoid lesion of the he had a large yellow crust.ed exudative tumor on the Rt. thigh. We took a biopsy specimen of these three discrete lesions. The nu lipid stain of frozen section revealed Bowens disease, squarnous concllnoma arising from Bowen on the trunk and extremi Rt. lower abdomen. Almost of routine histology and carcinoma, and sebaceous carcinoma, respectively.
Abdomen ; Aged ; Biopsy ; Bowen's Disease ; Carcinoma, Squamous Cell* ; Frozen Sections ; Humans ; Male ; Skin ; Skin Diseases ; Thigh

Vascular leak syndrome(VLS) is characterized by endothelial damage, which causes extravasation of plasma proteins and fluid from capillaries into the extravascular space. It has been suggested that the increased vascular permeability is the result of an IL-2-induced suppression of endothelin-1 secretion by endothelial cells, an IL-2-induced activation of the complement cascade or TNF-alpha release from IL-2-activated T-cells. A 13-year-old male patient visited our hospital with abdominal pain. He was diagnosed with acute lymphoblastic leukemia(T cell type) by bone marrow study on his 2 nd day in hospital. On the 3 rd day of induction chemotherapy(prednisone, L-asparaginase, vincristine, intrathecal methotrexate), pulmonary edema and pleural effusion, ascites and generalized edema developed and lasted for 53 days without responding to supportive care. The laboratoy finding was that TNF-alpha was increased without evidence of infection and hypoalbuminemia was noted. It was suggested that the patient's clinical feature was induced by VLS.
Abdominal Pain ; Adolescent ; Ascites ; Blood Proteins ; Bone Marrow ; Capillaries ; Capillary Permeability ; Complement System Proteins ; Edema ; Endothelial Cells ; Endothelin-1 ; Humans ; Hypoalbuminemia ; Induction Chemotherapy* ; Male ; Pleural Effusion ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Pulmonary Edema ; T-Lymphocytes ; Tumor Necrosis Factor-alpha ; Vincristine

BACKGROUND: Hydration, the water content of the stratum corneum, is an important factor in both the appearance and the barrier function of the skin. Many non-invasive methods have been developed in order to assesa the hydration state of the skin and the effect of various moisturizers. The hydrometer and carneometer are commercially available instruments which are widely used in dermatologic research. OBJECTIVE: Our purpose was to compare the measuring usefulnes of both instruments on normal subjects with a wide range of hydration states of the hornylayer. METHODS: We measured the conductance with the hydrometer and the capacitance with the corneometer in various hydrating eonditions and compared both insruments. RESULTS: Conductance had a non linear correlation with capacita ice. Capacitance measured with the corneometer had a high sensitivity to moisture in a wide range of hydration levels. On the other hand, conductance guaged with the hydrometer showed a few sensitivity to moisture at a low level. When the hydretion level was measured after a moiturizer was added, 10 % urea cream showed a sharp increase by 256% in terms of conductanae, and H-base by 97.8%. Mineral oil decreased by 41.5% and petrolatum by 62% respectively. On the other hand, when measured in terms of capacitance under the same conditions as above, 38.9 increase in 10% urea cream, 19.3% increase in H-base, 20% decrease in mineral oil, and 43.5 % decrease in petrolatum were reported. Conductance showed a higher hygroscopicity and a lower water holding capacity than capacitance did. When the measurement of the moisture level iri virious parts of the human body is performed, the corneometer provided us with more stable alies than the hydrometer. While the hydrometer can not the available and appropriate under the condition of insulation, the corneometer can measure moisture levels even down at the depth of 250mm. When measured after the oily surface of the forehead was cleansed with soft tissue, conductance and capacitance revealed higher values of moisture levels than before the eleanin. However, there is no statistical significance in these values. CONCLUSION: The hydrometer is a more appropriate tool for the measurement of moisture at a high level, and the corneometer at a low moisture level. The hydrcmeter is a more sensitive method of measuring the increase and the decrease in the moisture level.
Forehead ; Hand ; Human Body ; Ice ; Lasers, Gas ; Mineral Oil ; Petrolatum ; Skin* ; Urea ; Water ; Wettability

BACKGROUND: Hydration, the water content of the stratum corneum, is an important factor in both the appearance and the barrier function of the skin. Many non-invasive methods have been developed in order to assesa the hydration state of the skin and the effect of various moisturizers. The hydrometer and carneometer are commercially available instruments which are widely used in dermatologic research. OBJECTIVE: Our purpose was to compare the measuring usefulnes of both instruments on normal subjects with a wide range of hydration states of the hornylayer. METHODS: We measured the conductance with the hydrometer and the capacitance with the corneometer in various hydrating eonditions and compared both insruments. RESULTS: Conductance had a non linear correlation with capacita ice. Capacitance measured with the corneometer had a high sensitivity to moisture in a wide range of hydration levels. On the other hand, conductance guaged with the hydrometer showed a few sensitivity to moisture at a low level. When the hydretion level was measured after a moiturizer was added, 10 % urea cream showed a sharp increase by 256% in terms of conductanae, and H-base by 97.8%. Mineral oil decreased by 41.5% and petrolatum by 62% respectively. On the other hand, when measured in terms of capacitance under the same conditions as above, 38.9 increase in 10% urea cream, 19.3% increase in H-base, 20% decrease in mineral oil, and 43.5 % decrease in petrolatum were reported. Conductance showed a higher hygroscopicity and a lower water holding capacity than capacitance did. When the measurement of the moisture level iri virious parts of the human body is performed, the corneometer provided us with more stable alies than the hydrometer. While the hydrometer can not the available and appropriate under the condition of insulation, the corneometer can measure moisture levels even down at the depth of 250mm. When measured after the oily surface of the forehead was cleansed with soft tissue, conductance and capacitance revealed higher values of moisture levels than before the eleanin. However, there is no statistical significance in these values. CONCLUSION: The hydrometer is a more appropriate tool for the measurement of moisture at a high level, and the corneometer at a low moisture level. The hydrcmeter is a more sensitive method of measuring the increase and the decrease in the moisture level.
Forehead ; Hand ; Human Body ; Ice ; Lasers, Gas ; Mineral Oil ; Petrolatum ; Skin* ; Urea ; Water ; Wettability

Metabolic acidosis (MA) is associated with increased proteolysis, increased osteoclast activity and blunted cardiac muscle response, but the effect of MA on various clinic al parameters in CAPD patients is not well known. To evaluate the effects of MA on serum albumin level and other nutritional parameters in CAPD patients, we studied 106 CAPD patients retrospectively who have had monthly biochemical measurement and urea kinetic studies every 6 months for more than 2 years. The patients were divided into three groups according to their mean total CO2 (tCO2) level of the 2-year follow-up (Group l; mean tCO2 < 22mM/L, Group ll; 22mM/L < or = mean tCO2 < 26mM/L, and Group lll; mean tCO2 > or = 26mM/L), and the clinical, biochemical, and urea kinetic data were compared among the three groups. 1)The mean age of the subjects was 46.9+/-12.2 years with a sex ratio of 1.2:1, the mean CAPD duration 28.3+/-21.8 months, mean body weight (Bwt) 59.0+/-8.9kg, %Bwt/IBW 104.1+/-11.5%, %LBM/Bwt 75.5+/-11.1% and well-nourished patients by subjective global assessment (SGA) were 65%. 2)The mean BUN, creatinine, total protein and albumin of all patients were 55.6+/-13.6mg/dL, 12.3+/-3.5mg/dL, 6.6+/-0.7g/dL and 4.0+/-0.4g/dL, respectively. In urea kinetic study, the mean NPCR, weekly Kt/ Vurea, SCCr and RRF were 0.96+/-0.16g/kg/day, 2.02+/-0.37, 63.7+/-18.4L/week/1.73m2, and 0.99+/-1.32ml/ min, respectively. 3)The mean age was significantly higher in group l (51.0+/-10.8) than those of group ll (47.0+/-12.4) and lll (42.6+/-11.4) (P<0.05). %Bwt/IBW of group l (114.4+/-15.8%) was also significantly higher than those of group ll (104.6+/-12.6%) and lll (103.5+/-13.7 %) (P<0.05), but there were no significant differences in sex ratio, CAPD duration, %LBM/Bwt, and SGA among the three groups. 4)The mean tCO2 in group l, group ll, and group lll were 20.6+/-1.2mM/L, 23.9+/-1.1mM/L, and 27.3+/-0.8mM/L, respectively. Compared to group lll, group l had significantly higher BUN (61.1+/-14.3 vs. 46.1+/-7.2mg/dL, P<0.05) and serum albumin (4.04+/-0.31 vs. 3.75+/-0.39g/dL, P<0.05), in spite of comparable dialysis dose and albumin loss into dialysate. 5)NPCR (1.02+/-0.21g/kg/day vs. 0.88+/-0.14g/kg/ day, P<0.05) and ultrafiltration volume (1.4+/-0.4 vs. 1.0+/-0.3, P<0.05) were significantly higher in group l than those of group lll. But there were no significant differences in Kt/Vurea, SCCr, RRF, and 24-hour dialysate loss of protein/albumin among the three groups. 6)No differences were observed among the three groups in the changes of body weight, %Bwt/IBW, %LBM/Bwt, BUN, albumin, NPCR, and RRF from the baseline values after the 2-year follow-up. 7)There were significant inverse correlations between the mean tCO2 level and NPCR (r=-0.33, P<0.001), %Bwt/IBW (r=-0.32, P<0.001), RRF (r=-0.29, P<0.005), and serum albumin level (r=-0.24, P<0.05). But, creatinine, %LBM/Bwt, and Kt/Vurea did not show any correlation with the mean tCO2 level. 8)Using stepwise multiple regression analysis, NPCR (beta=-0.3491, P<0.001), %Bwt/IBW (beta=-0.046, P<0.001), and ultrafiltration volume (beta=-0.0012, P< 0.005) were independent factors affecting the mean tCO2 level. In conclusion, low total CO2 level in long-term CAPD patients may reflect increased protein intake and mild to moderate degree of metabolic acidosis may not affect the nutritional status of well-dialyzed CAPD patients.
Acidosis* ; Body Weight ; Creatinine ; Dialysis ; Follow-Up Studies ; Humans ; Myocardium ; Nutritional Status ; Osteoclasts ; Peritoneal Dialysis, Continuous Ambulatory* ; Proteolysis ; Retrospective Studies ; Serum Albumin* ; Sex Ratio ; Ultrafiltration ; Urea

STUDY DESIGN: A retrospective study. OBJECTIVES: We assessed the intraobserver and interobserver reliability of TLICS classification in the thoracolumbar injuries, which had been evaluated in our hospital. It was compared with that of the older, McAfee classification and discussed for clinical validation. SUMMARY OF LITERATURE REVIEW: Among the numerous literatures regarding the thoracolumbar injury, there is no consensus on the most useful classification, and there is nothing comparing the McAfee classification with the TLICS classification. MATERIALS AND METHODS: Among the 230 patients that were treated with conservative care or operation from January 1, 2005 to January 1, 2010 in our hospital, 185 patients with initial CT and MRI images were assessed. Five orthopedic surgeons reviewed histories, plain film, CT and MRI of the 185 thoracolumbar injury cases, respectively. Each case was classified and scored according to the McAfee classification and the TLICS classification. The case assessment was recorded and the orthopedic surgeons repeated the assessment 1 month later. Intraobserver and interobserver reliability were assessed by statistical analysis. The actual management of each case was compared with the treatment recommended by TLICS classification to calculate the validity of the indexes. RESULTS: Intraobserver and interobserver reliability in TLICS were higher than those in the McAfee classification. Agreement of the TLICS classification for treatment recommendation was 81.7%, comparing with the actual management of previous McAfee classification. Validity indexes were satisfactory in therapeutic decision making, especially specificity. CONCLUSIONS: TLICS classification has a relative high K-value, when compared with that of the McAfee classification for intraobserver and interobserver reliability. Through clinical studies, including prospective observational analysis, TLICS classification can be applied and adjusted more adequately.
Consensus ; Decision Making ; Humans ; Orthopedics ; Retrospective Studies ; Spinal Injuries

STUDY DESIGN: A case report. OBJECTIVES: To document that Gelfoam(R) (Pharmacia & Upjohn, Kalamazoo, MI) contributes to granuloma formation and spinal cord irritation by immune response. SUMMARY OF LITERATURE REVIEW: The Gelfoam(R) or microfibrillar collagen applied during various operation for hemostasis. Some complications of Gelfoam(R), such as mechanical cord compression, postoperative swelling and mass effect in closed cavity have been reported. MATERIALS AND METHODS: The patient was underwent posterior decompression and instrumented posterolateral fusion under the diagnosis of the ossification of ligamentum flavum at T10-11 and T11-12. In operation, Gelfoam(R) was used at epidural space. She complained of sensory deterioration and muscle weakness around lower extremities after 10days postoperatively. A second operation was performed. RESULTS: Postoperatively, the patient immediately improved motor grade except spasticity. She is under observation. CONCLUSIONS: Gelfoam(R) at epidural space after posterior decompression can result hyperactive immune reaction and irritate spinal cord.
Collagen ; Decompression ; Epidural Space ; Gelatin Sponge, Absorbable ; Granuloma ; Hemostasis ; Humans ; Ligamentum Flavum ; Lower Extremity ; Muscle Spasticity ; Muscle Weakness ; Spinal Cord ; Spinal Cord Diseases ; Spinal Fusion

Protein-calorie malnutrition is common in CAPD patients and is associated with increase in morbidity and mortality in CAPD patients. There are many causes of malnutrition in CAPD patients, and it is well known that a large amount of protein losses through peritoneal membrane is one of them. To investigate the effect of the peritoneal membrane transport characteristics on the nutritional status in long-term CAPD patients, we conducted a cross- sectional study on clinically stable 115 patients (63 males and 52 females) who have been on CAPD for more than 2 years, and assessed nutritional status by subjective global assessment (SGA), biochemical, anthropometric and urea kinetic parameters. Patients were divided into 4 groups according to the results of standard peritoneal equilibration test (PET). The results were as follows: 1) The patients were divided into 4 groups according to the PET results: high transporter (n=16, 14%), high average transporter (n=38, 33%), low average transporter (n=50, 43%), and low transporter (n=11, 10%). 2) The mean age of the patients was 50.1+/-11.6 years (range, 19-75) with sex ratio (M:F) 1.2:1 and mean duration of dialysis was 57.5+/-27.8 months (range, 24-135). The mean body weight (Bwt) was 59.2+/-8.9kg, percent ideal body weight (%IBW) was 104.7+/-15.6%, %lean body mass (LBM)/Bwt was 82.1+/-11.1%, and malnourished patients by subjective global assessment (SGA) were 32.2% (38/115). 3) The mean BUN, creatinine, total protein, and albumin level of the patients were 54.5+/-13.1mg/dL, 12.3+/-3.0mg/dL, 6.7+/-0.8g/dL, and 3.8+/-0.6g/dL, respectively. 4) There were no significant differences in age, sex ratio, CAPD duration, peritonitis rate, %LBM/ Bwt, and SGA among the 4 groups. 5) Total protein (g/dL) and albumin (g/dL) levels in high transporters were 6.4+/-0.5, 3.5+/-0.4, respectively, and they were significantly lower than those of low transporters (7.2+/-0.6, 4.2+/-0.5) (P<0.05). 6) 24 hour dialysate protein (g/day) and albumin (g/day) losses were significantly higher in high transporters (8.10+/-1.85, 4.19+/-1.23) compared to those of low transporters (5.07+/-1.85, 2.78+/-0.99) (P<0.05). 7) The level of IGF-1 (ng/mL) was significantly lower in high transporters (150.5+/-86.2) compared to that of low transporters (310.3+/-162.1) (P<0.05). 8) The level of BUN (mg/dL), Cr (mg/dL) were also lower in high transporters (45.4+/-13.1, 10.1+/-2.0) than those of low transporters (61.6+/-18, 14.7+/-2.7), but there were no significant differences in Hct, total cholesterol, prealbumin, and transferrin among the 4 groups. 9) There were no statistically significant differences in Kt/Vurea, RRF, NPCR, dietary calorie and protein intakes among the 4 groups. 10) Anthrometric parameters such as TSF, BSF, MAC and LBM measured by three different methods (LBMCr, LBMimp, LBManthro) didn't show any significant differences among the 4 groups. In conclusion, increased peritoneal permeability may not adversely affect SGA and anthropometric status of long-term CAPD patients, although it is associated with lower serum albumin, creatinine, and IGF-1 level. Clinical significance of these findings remains to be elucidated.
Body Weight ; Cholesterol ; Creatinine ; Dialysis ; Humans ; Ideal Body Weight ; Insulin-Like Growth Factor I ; Male ; Malnutrition ; Membranes ; Mortality ; Nutritional Status* ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Permeability ; Prealbumin ; Protein-Energy Malnutrition ; Serum Albumin ; Sex Ratio ; Transferrin ; Urea

Hypercalcemia is a common complication in CAPD patients treated with calcium-containing phosphate binders and using the standard dialysate (SCD) calcium concentration of 3.5mEq/L. We performed a retrospective study in 25 CAPD patients to determine whether a low calcium dialysate (LCD) containing 2.5mEq/L calcium would reduce the incidence of hypercalemia with adequate control of serum inorganic phosphate levels and diminish the need to use aluminum-containing phosphate binders. All patients had previously used SCD before converting to LCD. The incidence of hypercalcemia (more than 2 episodes of corrected serum calcium > or = 10.5mg/dL) tended to be lower after converting to LCDl 0.27 (0-2.76) vs. 0 (0-1.97) episodes/patient-yearl. Intact PTH level increased from 38.8 (0.1-1599.3)pg/mL to 70.6 (9.5-1540.0)pg/mL after conversion, but there was no statistical sifnificance. Serum calcium, inorganic phosphate, alkaline phosphatase and bicarbonate levels did not change after converting to LCD. We were able to reduce aluminum hydroxide dosagel 1.09 (0-10.88) vs. 0 (0-3.26)g/day/patientl and increase calcium carbonate dosage (1.95 0.92 vs. 2.98 2.14g/day/ patient) after conversion significantly (P<0.05). The frequency of peritonitis was similar in LCD and SCD period. In conclusion, low calcium dialysate is useful in diminishing aluminum-containing phosphate binder dosage and increasing calcium carbonate dosage to maintain a similar phosphate value. Its effects on renal osteodystrophy remain to be assessed.
Alkaline Phosphatase ; Aluminum Hydroxide ; Calcium Carbonate ; Calcium* ; Humans ; Hypercalcemia ; Incidence ; Kidney Failure, Chronic ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Renal Osteodystrophy ; Retrospective Studies