Melanoacanthoma is an extremely rare pigmented benign mixed epithelial tumor of both melanocytes and keratinocytes. A 52-year-old female presented an asymptomatic, slightly elevated, 1. 2 cm x 0. 8 cm, dark black-colored plaque on her right buttock of 2 years' duration. Histopathologic finding of the plaque shows hyperkeratosis, focal parakeratosis, follicular plugging, acanthosih, papillomatosis and pseudo-horn cyst in the epidermis. The tumor is composed of basaloid and squarnous cells with many foci of clusters and whorls of melanin pigment-laden cells. Electron microscopic finding reveals many scattered melanocytes in the entire epidermis. Melanin granules are found mostly in the melanocytes but can also be found in a few keratinocytes.
Buttocks ; Epidermis ; Female ; Humans ; Keratinocytes ; Melanins ; Melanocytes ; Middle Aged ; Papilloma ; Parakeratosis

Meningioma is the second most common primary intraspinal tumor. Most spinal meningiomas are located in the intradural extramedullary space and extradural meningiomas are less common. It is quite rare for this tumor to be found in the spinal epidural space of a child. These tumors may be easily confused as a malignant neoplasm because a metastatic lesion commonly located in the epidural space. We report a case of spinal epidural meningioma in a 12-year-old girl. Magnetic resonance findings led to the preoperative diagnosis of a metastatic lesion. The patient underwent total resection of the mass lesion and laminoplasty. She showed an excellent neurological recovery.
Child* ; Diagnosis ; Epidural Neoplasms ; Epidural Space ; Female ; Humans ; Meningioma* ; Spine*

BACKGROUND AND OBJECTIVES: The transplantation of human umbilical cord blood cells (hUCBCs) has been shown to attenuate the unregulated activation of microglia in a rat model of cerebral palsy (CP). To investigate whether hUCBCs transplantation is also anti-inflammatory in humans, we performed a clinical trial in patients with CP. METHODS AND RESULTS: Allogeneic or autologous hUCBCs and erythropoietin (EPO) were intravenously injected into human patients with CP (mean age of approximately 38 weeks), and patients were analyzed for their motor function and social behavior. Blood samples were tested for cytokine levels. The most surprising finding in the study was that the cytokine levels were dependent on the donor cell source (allogeneic or autologous). Interestingly, the allogeneic treatment group demonstrated significantly decreased levels of pro-inflammatory factors, such as IL-1alpha, IL-6, TNF-beta, and RANTES, and showed a statistically significant improvement in motor and social behavior compared to the autologous treatment group. CONCLUSIONS: Given that inflammation plays a pivotal role in CP, our results suggest that allogeneic hUCBCs therapy may be an appropriate strategy for CP treatment. In addition, prior to transplantation, a detailed analysis of the amount of proinflammatory cytokines in cord blood may be needed to avoid exacerbating inflammatory responses.
Animals ; Cerebral Palsy ; Chemokine CCL5 ; Cytokines ; Erythropoietin ; Fetal Blood ; Humans ; Inflammation ; Interleukin-6 ; Lymphotoxin-alpha ; Microglia ; Rats ; Social Behavior ; Tissue Donors ; Transplants ; Umbilical Cord

Bone marrow-derived mesenchymal stromal cells (MSCs) have been reported to be beneficial for the treatment of liver fibrosis. Here, we investigated the use of genetically engineered MSCs that overexpress hepatocyte growth factor (HGF) as a means to improve their therapeutic effect in liver fibrosis. Liver fibrosis was induced by intraperitoneal injection of dimethylnitrosamine. HGF-secreting MSCs (MSCs/HGF) were prepared by transducing MSCs with an adenovirus carrying HGF-encoding cDNA. MSCs or MSCs/HGF were injected directly into the spleen of fibrotic rats. Tissue fibrosis was assessed by histological analysis 12 days after stem cell injection. Although treatment with MSCs reduced fibrosis, treatment with MSCs/HGF produced a more significant reduction and was associated with elevated HGF levels in the portal vein. Collagen levels in the liver extract were decreased after MSC/HGF therapy, suggesting recovery from fibrosis. Furthermore, liver function was improved in animals receiving MSCs/HGF, indicating that MSC/HGF therapy resulted not only in reduction of liver fibrosis but also in improvement of hepatocyte function. Assessment of cell and biochemical parameters revealed that mRNA levels of the fibrogenic cytokines PDGF-bb and TGF-beta1 were significantly decreased after MSC/HGF therapy. Subsequent to the decrease in collagen, expression of matrix metalloprotease-9 (MMP-9), MMP-13, MMP-14 and urokinase-type plasminogen activator was augmented following MSC/HGF, whereas tissue inhibitor of metalloprotease-1 (TIMP-1) expression was reduced. In conclusion, therapy with MSCs/HGF resulted in an improved therapeutic effect compared with MSCs alone, probably because of the anti-fibrotic activity of HGF. Thus, MSC/HGF represents a promising approach toward a cell therapy for liver fibrosis.
Animals ; Cell Engineering ; Cells, Cultured ; *Genetic Engineering ; Hepatocyte Growth Factor/analysis/*genetics ; Humans ; Liver/metabolism/pathology ; Liver Cirrhosis/pathology/*therapy ; Male ; *Mesenchymal Stem Cell Transplantation ; Mesenchymal Stromal Cells/*metabolism ; Rats ; Rats, Sprague-Dawley ; *Up-Regulation

Manganese-enhanced magnetic resonance imaging (MEMRI) offers a novel neuroimaging method in visualizing the activity patterns of neural circuits. MEMRI is using the divalent manganese ion, which has been used as a cellular contrast agent. The present study was conducted to determine the contrast-enhancing effects of manganese ion administered into the spinal cord of rats. Manganese ion was administered into the spinal cord by lumbar puncture. Ex vivo magnetic resonance images were obtained at 6, 12, 24, and 48 hours after manganese ion injection. Although the highly contrasted images were not observed 6 or 12 hr after manganese injection, the distinctive manganese-enhanced images began to appear at 24 hours after manganese ion injection. These results suggest that the gray matter is the foci of intense paramagnetic signals and MEMRI may provide an effective technique to visualize the activity-dependent patterns in the spinal cord.
Animals ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Manganese ; Neuroimaging ; Rats ; Spinal Cord ; Spinal Puncture

PURPOSE: To determine the quantitative parameters of breast MRI that predict tumor invasion in biopsy-proven DCIS. MATERIALS AND METHODS: From January 2009 to March 2010, 42 MRI examinations of 41 patients with biopsy-proven DCIS were included. The quantitative parameters, which include the initial percentage enhancement (E1), peak percentage enhancement (E(peak)), time to peak enhancement (TTP), signal enhancement ratio (SER), arterial enhancement fraction (AEF), apparent diffusion coefficient (ADC) value, long diameter and the volume of the lesion, were calculated as parameters that might predict invasion. Univariate and multivariate analyses were used to identify the parameters associated with invasion. RESULTS: Out of 42 lesions, 23 lesions were confirmed to be invasive ductal carcinoma (IDC) and 19 lesions were confirmed to be pure DCIS. Tumor size (p = 0.003; 6.5 +/- 3.2 cm vs. 3.6 +/- 2.6 cm, respectively) and SER (p = 0.036; 1.1 +/- 0.3 vs. 0.9 +/- 0.3, respectively) showed statistically significant high in IDC. In contrast, E1, Epeak, TTP, ADC, AEF and volume of the lesion were not statistically significant. Tumor size and SER had statistically significant associations with invasion, with an odds ratio of 1.04 and 22.93, respectively. CONCLUSION: Of quantitative parameters analyzed, SER and the long diameter of the lesion could be specific parameter for predicting invasion in the biopsy-proven DCIS.
Breast ; Carcinoma in Situ ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Diffusion ; Humans ; Lymphokines ; Magnetic Resonance Imaging ; Multivariate Analysis ; Odds Ratio ; Thymine Nucleotides

BACKGROUND: Idiopathic left ventricular tachycardia (ILVT), one of common idiopathic ventricular tachycardias which develop without structural abnormality of the heart. It has been reported that ILVT has a typical QRS morphology of right bundle branch block and left axis and unique clinical and electrophysiological characteristics. Intravenous verapamil is shown to be very effective in acute termination. However, radio-frequency catheter ablation is now recommended as the treatment of choice for long-term managemnt. This study was performed to determine the clinical and electrophysiological characteristics of ILVT and to evaluate the effects of radiofrequency catheter ablation (RFCA) of ILVT. METHODS: Seventeen patients (12 men, 5 women:mean age : 39+/-15 years) with ILVT were included in this study. ILVT was diagnosed based on the results of electrocardiogram, echocardiogram, cardiac catheterization, and electrophysiology study (EPS). EPS was performed with the standard technique in fasting state for more than 6 hours. In patients with their clinical VTs reproducibly induced during EPS, RFCA was attempted using endocardial activation mapping and pace-mapping. The mode of induction and termination, response to verapamil, and site of origin of the ILVT were evaluated. The local electrogram chacteristics at the sites of successful catheter ablation were also evaluated in patients undergoing RFCA. RESULTS: All 17 patients presented with recurrent palpitation but none with syncope or sudden cardiac death. None had a significant heart disease. The spontaneous ventricular tachycardias were of right bundle branch block morphology with left superior axis in 11 cases, right inferior axis in 1, and northwest axis in 5. The VTs were terminated with intravenous verapamil in all of 14 patients receiving IV verapamil. VT of same morphology as the clinical VT was induced with programmed electrical stimulation in 13 cases (76.4%), of whom 2 cases required isoproterenol infusion. The most frequent mode of induction was single ventricular extrastimulation (7 cases). Mean cycle length of the induced VTs was 320+/-59 ms. RFCA was attempted in 11 cases and successful in 9 (82%). The successful ablation sites were and central mid septum (3 cases), posterior mid septum (3 cases), posterior apical septum (3 patients) of the left ventricle (3 patients). At the successful ablation sites, the local ventricular activation preceded the onset of QRS complex by 34+/-15 ms (range : 10-58) and the paced QRS complexes during pace-mapping were identical to those of the induced or spontaneous VTs in 11.7+/-0.4 leads (range : 11-12). However, Purkinje potential was recorded only in 2 cases. There were no complications associated with EPS and RFCA. CONCLUSIONS: The present study suggests that ILVT is mild in symptoms, highly sensitive to verapamil, mostly caused by reentry, and can be cured by radiofrequency catheter ablation guided by pace-mapping and activation mapping.
Axis, Cervical Vertebra ; Bundle-Branch Block ; Cardiac Catheterization ; Cardiac Catheters ; Catheter Ablation* ; Catheters* ; Death, Sudden, Cardiac ; Electric Stimulation ; Electrocardiography ; Electrophysiology ; Fasting ; Heart ; Heart Diseases ; Heart Ventricles ; Humans ; Isoproterenol ; Male ; Syncope ; Tachycardia, Ventricular* ; Verapamil

BACKGROUND: Idiopathic left ventricular tachycardia (ILVT), one of common idiopathic ventricular tachycardias which develop without structural abnormality of the heart. It has been reported that ILVT has a typical QRS morphology of right bundle branch block and left axis and unique clinical and electrophysiological characteristics. Intravenous verapamil is shown to be very effective in acute termination. However, radio-frequency catheter ablation is now recommended as the treatment of choice for long-term managemnt. This study was performed to determine the clinical and electrophysiological characteristics of ILVT and to evaluate the effects of radiofrequency catheter ablation (RFCA) of ILVT. METHODS: Seventeen patients (12 men, 5 women:mean age : 39+/-15 years) with ILVT were included in this study. ILVT was diagnosed based on the results of electrocardiogram, echocardiogram, cardiac catheterization, and electrophysiology study (EPS). EPS was performed with the standard technique in fasting state for more than 6 hours. In patients with their clinical VTs reproducibly induced during EPS, RFCA was attempted using endocardial activation mapping and pace-mapping. The mode of induction and termination, response to verapamil, and site of origin of the ILVT were evaluated. The local electrogram chacteristics at the sites of successful catheter ablation were also evaluated in patients undergoing RFCA. RESULTS: All 17 patients presented with recurrent palpitation but none with syncope or sudden cardiac death. None had a significant heart disease. The spontaneous ventricular tachycardias were of right bundle branch block morphology with left superior axis in 11 cases, right inferior axis in 1, and northwest axis in 5. The VTs were terminated with intravenous verapamil in all of 14 patients receiving IV verapamil. VT of same morphology as the clinical VT was induced with programmed electrical stimulation in 13 cases (76.4%), of whom 2 cases required isoproterenol infusion. The most frequent mode of induction was single ventricular extrastimulation (7 cases). Mean cycle length of the induced VTs was 320+/-59 ms. RFCA was attempted in 11 cases and successful in 9 (82%). The successful ablation sites were and central mid septum (3 cases), posterior mid septum (3 cases), posterior apical septum (3 patients) of the left ventricle (3 patients). At the successful ablation sites, the local ventricular activation preceded the onset of QRS complex by 34+/-15 ms (range : 10-58) and the paced QRS complexes during pace-mapping were identical to those of the induced or spontaneous VTs in 11.7+/-0.4 leads (range : 11-12). However, Purkinje potential was recorded only in 2 cases. There were no complications associated with EPS and RFCA. CONCLUSIONS: The present study suggests that ILVT is mild in symptoms, highly sensitive to verapamil, mostly caused by reentry, and can be cured by radiofrequency catheter ablation guided by pace-mapping and activation mapping.
Axis, Cervical Vertebra ; Bundle-Branch Block ; Cardiac Catheterization ; Cardiac Catheters ; Catheter Ablation* ; Catheters* ; Death, Sudden, Cardiac ; Electric Stimulation ; Electrocardiography ; Electrophysiology ; Fasting ; Heart ; Heart Diseases ; Heart Ventricles ; Humans ; Isoproterenol ; Male ; Syncope ; Tachycardia, Ventricular* ; Verapamil

The preparation for video capsule endoscopy (VCE) of the bowel suggested by manufacturers of capsule endoscopy systems consists only of a clear liquid diet and an 8-hour fast. While there is evidence for a benefit from bowel preparation for VCE, so far there is no domestic consensus on the preparation regimen in Korea. Therefore, we performed this study to recommend guidelines for bowel preparation before VCE. The guidelines on VCE were developed by the Korean Gut Image Study Group, part of the Korean Society of Gastrointestinal Endoscopy. Four key questions were selected. According to our guidelines, bowel preparation with polyethylene glycol (PEG) solution enhances small bowel visualization quality (SBVQ) and diagnostic yield (DY), but it has no effect on cecal completion rate (CR). Bowel preparation with 2 L of PEG solution is similar to that with 4 L of PEG in terms of the SBVQ, DY, and CR of VCE. Bowel preparation with fasting or PEG solution combined with simethicone enhances the SBVQ, but it does not affect the CR of VCE. Bowel preparation with prokinetics does not enhance the SBVQ, DY, or CR of VCE.
Capsule Endoscopy ; Consensus ; Diet ; Endoscopy, Gastrointestinal ; Fasting ; Korea ; Polyethylene Glycols ; Simethicone

Percutaneous endoscopic gastrostomy (PEG) is an effective method for delivering enteral nutrition to patients with dysphagia, cerebrovascular accidents, Parkinsonnism, dementia, and head and neck cancer. PEG is generally regarded as safe and it is associated with low risks of morbidity and mortality. The complications of the PEG are known to be mostly minor and they include wound infection, gastric leakage, bleeding, ileus, pneumoperitoneum and aspiration pneumonia. We recently experienced a ruptured pseudoaneurysm of the left gastric artery, which was occurred as a complication during PEG insertion in a 73-year-old female. To the best of our knowledge, this is the first case report in Korea about successful angiographic embolization for a ruptured pseudoaneurysm of the left gastric artery and this was associated with a PEG procedure.
Aged ; Aneurysm, False ; Arteries ; Deglutition Disorders ; Dementia ; Enteral Nutrition ; Female ; Gastrostomy ; Head and Neck Neoplasms ; Hemorrhage ; Humans ; Ileus ; Korea ; Pneumonia, Aspiration ; Pneumoperitoneum ; Stroke ; Wound Infection