The pseudolymphoma syndrome that may mimic malignant lymphoma clinically and histopathologically has been described as a hypersensitivity reaction to anticonvulsant drugs. It consists of the triad of a fever, generalized rash and lyrnphadenopathy. In some cases, varying degrees of malaise, hepatosplenornegaly, abnormal liver function tests, arthralgias, eosinophilia and blood dyscriasias may also be present. We report a case of pseudolymphoma syndrome due to carbamazepine in a 47-year-old man. He had a diffuse edematous and erythematous patches, papules and vesicles associated with high fever, hepatosplenomegaly and lymphadenopathy. The histopathologic finding slowed a dense atypical mononuclear cell infiltrate of the upper dermis associated with Pautriers microabscess like structures and severe dermal edema. Laboratory findings revealed leukocytosis and an abnormal liver function test. Three weeks after the withdrawal of carbamazepine and treatment with oral prednisolone, his skin lesion and general condition markedly improved.
Anticonvulsants ; Arthralgia ; Carbamazepine* ; Dermis ; Edema ; Eosinophilia ; Exanthema ; Fever ; Humans ; Hypersensitivity ; Leukocytosis ; Liver Function Tests ; Lymphatic Diseases ; Lymphoma ; Middle Aged ; Prednisolone ; Pseudolymphoma* ; Skin

BACKGROUND: Melanin pigment plays a major role in the expression of normal human skin color as well as in the photoprotection against ultraviolet damage. Melanin produced in melanocytes is transferred via dendrites to surrounding keratinocytes, and this anatomical relationship is termed as epidermal melanin unit. The rates of pigment synthesis and transfer by melanocytes appear to be influenced by ultraviolet light, though the precise factors regulating human epidermal pigmentation remain unelucidated. It has been reported that keratinocytes in vitro release factors that could modulate melanocyte behavior. Ultraviolet irradiation was also been known to enhance the release of various kinds of cytokine from keratinocytes in vivo and in vitro. OBJECTIVE: We postulated that keratinocytes rather than melanocytes could play a primary role in UVB-induced pigmentation, and keratinocytes, when irradiated with UVB, release substances that could modulate or stimulate melanin synthesis from melanocytes. The fact that keratinocytes are located efficiently for direct sunlight irradiation at the top of melanocytes, that they release various biological factors known to simulate melanin synthesis from melanocytes and that they constitute the majority of epidermal cells supported this possibility. To investigate this possibility, we evaluated the effect of supernatant from UVB-irradiated cultured keratinocytes on the growth, melanin content, and tyrosinase activity of human melanocytes. METHODS: Human cultured keratinocytes were irradiated with UVB(30, 60, or 120mj/cm2)once, and after 24 hours, supernatant of the keratinocytes were collected and added to a growth medium of melanocytes for 5 days in concentration of 15, 25 or 35%, We observed numeric and morphologic changes as well as melanin content and tyrosinase activity in situ of cultured human melanocytes. RESULTS: 1. When cultured melanocytes were incubated with supernatant of non-irradiated keratinocytes, the number of melanocytes, amount of melanin and tyrosinase activity increased in groups added with 25% or35% concentration of supernatant. 2. The number of melanocytes incubated with 15% or 25% concentrations of supernatant from cultured keratinocytes irradiated with UVB increased in both 30 and 60mj/cm2 of UVB irradiated groups and decreased in 120mJ/cm2of UVB irradiated groups. 3. The melanin content of melanocytes incubated with 15% concentration of supernatant from UVB-irradiated cultured keratinocytes increased in 120mJ/cm2 of UVG irradiated groups. 4. The tyrosinase activity of melanocytes incubated with 15% concentration of supernatant from UVB-irradiated cultured keratinocytes increased in 120mJ/cm2 of UVB irradiated groups and the tyrosinase activity of melanocytes incubated with 25% concentration of supernatant from UVB-irradiated cultured keratinocytes increased with 35% supernatant concentration of supernatant from UVB-irradiated keratinocytes, the tyrosinase activity increased in 30mJ/cm2of UVB irradiated groups. CONCLUSION: The above results suggest that UVB-irradiated kerationcytes release soluble or photoactivated factors which could modulate the growth and melanization of melanocytes, and that keratinocytes play an important or primary role in the regulation of UVB induced pigmentation.
Biological Factors ; Dendrites ; Humans* ; Keratinocytes* ; Melanins* ; Melanocytes* ; Monophenol Monooxygenase* ; Pigmentation ; Skin ; Sunlight ; Ultraviolet Rays

BACKGROUND: The bcl-2 is a newly known oncogene involved in tumorigenisis by blocking apoptosis or programmed cell death. Overexpression of bcl-2 protein has been detected in a variety of human malignancies. However, recent studies of the expression of bcl-2 protein in human melanoma and melanocytic nevus have been controversial. OBJECTIVE: The purpose of this study was to examine whether there are any differences in the expression of bcl-2 protein between melanocytic nevus and rnalignant melanoma. METHODS: Immunohistochemical analysis of bcl-2 protein expression was performed on the formalin-fixed, paraffin-embedded tissue sections of 22 melanocytic nevus and 29 malignant melanomas (20 primary and 9 metastatic) using anti bcl-2 monoclonal antibody with an avidin-biotin peroxidase complex procedure. RESULTS: The results were as follows. 1. The positive rate for bcl-2 protein was observed in 95.4% (21/22) of melanocytic nevus and 95.0% (19/20) of primary malignant melanomas. Therefore, there was no significant difference between the two groups in the positive rate for bcl-2 prtoein. 2. The percentage of stained cells and the staining intensity of bcl-2 protein were significantly increased in melanocytic nevus compared to malignant melanoma (p<0.05). 3. The positive rate for bcl-2 expression of metastatic malignant melanoma [44.4% (4/9)] was significantly decreased compared to that of primary malignant melanoma [95.0%(19/20) ] (p<0. 05). But, there was no significant difference betweeen tumor thickness and histological type of malignant, melanoma in the expression of bcl-2 protein. 4. In melanocytic nevus, immunoreactivity of bcl-2 protein gradually diminished or even disappeared towards the deep dermis. CONCLUSION: the bcl-2 expression was decreased in malignant melanoma compared to melanocytic nevus. It. suggests that the loss of bcl-2 expression may play a significant role in the progression and metastasis of malignant melanoma.
Apoptosis ; Cell Death ; Dermis ; Humans ; Melanoma* ; Neoplasm Metastasis ; Nevus, Pigmented* ; Oncogenes ; Peroxidase

Atrial fibrillation(AF) diagnosed by fibrillatory waves of atrial activity and an irregular ventricular response on ECG is a common arrhythmia associated with increased cardiovascular morbidity and mor- tality. The incidence of AF increases markedly with advancing age and the presence of congestive heart failure. Most patients with AF can be attributed to organic heart disease such as rheumatic, atherosclerotic and hypertensive heart disease. But there is an increasing awareness of so-called lone AF which has no underlying cardiac or metabolic abnormality. We report a case of paroxysmal AF developed just before the induction of anesthesia in a 73-year-old patient who had no history of cardiovascular disease.
Aged* ; Anesthesia ; Anesthesia, General* ; Arrhythmias, Cardiac ; Atrial Fibrillation* ; Cardiovascular Diseases ; Electrocardiography ; Heart Diseases ; Heart Failure ; Humans ; Incidence

This study aims to evaluate the status of Korean healthcare among Organization for Economic Cooperation and Development countries and to monitor the trend of health care status since 2000. The position value for relative comparison (PARC) index was selected to gauge the level of healthcare status in demand, supply, accessibility, quality, and cost as per healthcare policy aspects. The Mann-Kendall test was conducted to allocate healthcare status of Korea since 2000. The PARC values indicate strength and weakness of Korean healthcare system by the mathematical comparisons. Korea positioned higher in demand, supply, accessibility, and quality. Yet, there are shortages in human resources and primary care. In conclusion, we suggest utilizing this study provides evidence to prioritize health care problems that can lead to establishing healthcare policy.
Decision Making ; Delivery of Health Care ; Health Policy ; Health Priorities ; Humans ; Korea ; Organisation for Economic Co-Operation and Development ; Primary Health Care

Chemotherapy offers palliative treatment to patient with advanced nonresectable hepatoma. The usefulness of systemic chemotherapy is limited becaused of serious side reaction and low concentration of drug at tumor. Butthis problem may be overcome by intraarterial infusion. Nonsurgical percutaneous hepatic arteiral catheterizationwas done in 21 patients with primary hepatoma, and infusion chemotherapy was done in 19 patients who were successful in catherization. The results were as follows; 1. Selective catheterization of hepatic artery proper,common hepatic artery, and celiac artery were seccessful in 4, 9 and 4 patients, respectively. The success rate ofselective catheterization is 80.9% including celiac artery among 21 patients with hepatoma. 2. Simple catherization method was applied in 14 patients, and catheter exchange and Loop methods were applied in 2 and 1patient respectively. 3. Complications related to catheterization, such as infection and bleeding on punctured site, intimal injury and dislodgement of catheter were not serious. 4. Drugs were well tolerated without serioustoxicity or complication. 5. 3 patients showed objective response and median survival time of treated patients is 2.5 months.
Carcinoma, Hepatocellular ; Catheterization ; Catheters ; Celiac Artery ; Drug Therapy ; Hemorrhage ; Hepatic Artery ; Humans ; Infusions, Intra-Arterial ; Methods ; Palliative Care

Objectives : 201Tl - chloride, 99mTc - MIBI, 99mTc(V) - DMSA SPECT has been used in distinguishing lung cancer from benign lesion. To compare the diagnostic efficacy of SPECT with these tumor - seeking agents, we performed three consecutive SPECT using 201Tl, 99mTc - MIBI, 99mTc(V) - DMSA in same subjects with a solitary pulmonary lesion. Methods : SPECT was carried out at 10min and 3hr for 201Tl after injection of 2 mCi, and 2hr for 99mTc - MIBI and 99mTc(V) - DMSA after injection of 20mCi, respectively, in 37 patients with a solitary pulmonary lesion(27 lung cancer and 10 benign diseases). In patients showing visual uptake on lesion site, we obtained the lesion - to - bakground(target lesion/contralateral normal lung) uptake ratio from transverse slice for each radionuclide and also calculated the retention index for 201Tl. Results : The diagnostic sensitivity of 201Tl, 99mTc - MIBI and 99mTc(V) - DMSA SPECT to lung cancer was 100%, 96% and 73%, and the specificity was 40%, 70% and 70%, respectively. The low specificities for these agents were mainly due to high positive uptake in patients with active pulmonary tuberculosis. There were no significant differences in uptake ratios and retention index between malignant and benign lesions, and among the histologic types of lung cancer Conclusion : 201Tl and 99mTc - MIBI showed higher sensitivity than 99mTc(V) - DMSA for detecting lung cancer, but was of limited usefulness in distinguishing lung cancer from benign lesion due to low specificity, especially in area with a high prevalence of active pulmonary tuberculosis.
Humans ; Lung Neoplasms* ; Lung* ; Prevalence ; Sensitivity and Specificity ; Succimer* ; Tomography, Emission-Computed, Single-Photon* ; Tuberculosis, Pulmonary

Objectives : 201Tl - chloride, 99mTc - MIBI, 99mTc(V) - DMSA SPECT has been used in distinguishing lung cancer from benign lesion. To compare the diagnostic efficacy of SPECT with these tumor - seeking agents, we performed three consecutive SPECT using 201Tl, 99mTc - MIBI, 99mTc(V) - DMSA in same subjects with a solitary pulmonary lesion. Methods : SPECT was carried out at 10min and 3hr for 201Tl after injection of 2 mCi, and 2hr for 99mTc - MIBI and 99mTc(V) - DMSA after injection of 20mCi, respectively, in 37 patients with a solitary pulmonary lesion(27 lung cancer and 10 benign diseases). In patients showing visual uptake on lesion site, we obtained the lesion - to - bakground(target lesion/contralateral normal lung) uptake ratio from transverse slice for each radionuclide and also calculated the retention index for 201Tl. Results : The diagnostic sensitivity of 201Tl, 99mTc - MIBI and 99mTc(V) - DMSA SPECT to lung cancer was 100%, 96% and 73%, and the specificity was 40%, 70% and 70%, respectively. The low specificities for these agents were mainly due to high positive uptake in patients with active pulmonary tuberculosis. There were no significant differences in uptake ratios and retention index between malignant and benign lesions, and among the histologic types of lung cancer Conclusion : 201Tl and 99mTc - MIBI showed higher sensitivity than 99mTc(V) - DMSA for detecting lung cancer, but was of limited usefulness in distinguishing lung cancer from benign lesion due to low specificity, especially in area with a high prevalence of active pulmonary tuberculosis.
Humans ; Lung Neoplasms* ; Lung* ; Prevalence ; Sensitivity and Specificity ; Succimer* ; Tomography, Emission-Computed, Single-Photon* ; Tuberculosis, Pulmonary

OBJECTIVE: The objective of this study is to assess the health-related quality of life (HRQOL), to examine the correlation among each measurement, and to identify the predictor for HRQOL in Korean patients with rheumatoid arthritis (RA). METHODS: The HRQOL and clinical and laboratory parameters were assessed by Short Form Health Survey-36 (SF-36), EuroQol5 Dimensions (EQ-5D), time trade off (TTO) and standard gamble (SG) using computer software, Centers for Epidemiologic StudiesDepression (CES-D), social support, self-efficacy scale, Korean Health Assessment Questionnaire (KHAQ), functional class, radiologic classification, morning stiffness, Ritchie index, erythrocyte sedimentation rate (ESR), and c-reactive protein (CRP) respectively from 100 outpatients with RA. And the data of the SF-36 and EQ-5D in RA patients were compared with those in 228 healthy controls. RESULTS: Of the 100 subjects with RA, 93 (93 %) were women with mean age of 51.7+/-9.8 years. The mean years of disease onset were 11.16+/-9.23. The mean scores of SF-36 global health (GH), mental component summary (MCS) and physical component summary (PCS) were 51.5+/-20.6, 61.6+/-26.6, and 47.1+/-24.1, respectively. The mean EQ-5D utility and visual analog scale (VAS) score were 0.58+/-0.3 and 61.7+/-20.5, respectively. The mean scores of the TTO and SG were 0.56+/-0.58 and 0.51+/-0.39. The SF-36 and EQ-5D scores in RA patients were significantly lower than those in healthy controls. The mean scores of 8 KHAQ disability index and visual analog pain scale were 0.83+/-0.65 and 50.0+/-23.7, respectively. The mean scores of CES-D, self-efficacy scale, social support, and social network were 9.67+/-6.76, 68.2+/-15.2, 2.37+/-0.19, and 2.19+/-0.55, respectively. The KHAQ mean score was negatively correlated with the scores of SF-36 GH, MCS, PCS, EQ-5D utility, EQ-5D VAS score, social support, social network (r=-0.62, r=-0.47, r=-0.64, r=-0.60, r=-0.39, r=-0.26, r=-0.36, respectively, all p's<0.001), and self-efficacy scale (r=-0.24, p=0.02), and positively correlated with the CES-D (r=0.61, p<0.001). In multivariate models, the predicting variables of SF-36 GH were KHAQ and self-efficacy scale. The predicting variables of SF-36 MCS were age, KHAQ, and self-efficacy scale and the predicting variables of SF-36 PCS were age, income, KHAQ, and self-efficacy scale. CONCLUSION: These results suggest that HRQOL in Korean patients with rheumatoid arthritis is significantly lower than healthy control. The age, HAQ, CES-D, self-efficacy scale were meaningful variables that was significantly correlated with HRQOL. Therefore, the efforts to improve HRQOL may be designed to improve the self-efficacy and the depression in addition to conventional treatment.
Arthritis, Rheumatoid* ; C-Reactive Protein ; Classification ; Depression ; Erythrocyte Indices ; Female ; Humans ; Outpatients ; Pain Measurement ; Quality of Life* ; Surveys and Questionnaires ; Visual Analog Scale

BACKGROUND AND PURPOSE: Exercise is recommended for every patient with Parkinson's disease (PD). The effectiveness of two different forms of exercise for PD, Tai Chi and combined stretching-strengthening exercise, was compared. METHODS: Patients with mild-to-moderate PD were recruited to join either the combined stretching-strengthening exercise group (n=7), the Tai Chi group (n=9), or the control (nonintervention) group (n=7). Exercise was performed three times a week over a period of 8 weeks. The Tai Chi exercise was led by certified instructors based on a Tai-Chi-for-arthritis program. The combined stretching-strengthening exercise comprised folk dancing, stepping, and elastic-band exercises. The subjects' functional fitness, parkinsonian symptoms, quality of life (QoL), and depression were evaluated. RESULTS: Both exercise groups yielded better results in their overall functional fitness after the intervention. However, no improvement with exercise was found for parkinsonian symptoms, as evaluated using the Unified Parkinson's Disease Rating Scale. With respect to the domains of QoL, the combined stretching-strengthening exercise group fared better in the social domain of QoL, and the Tai Chi group fared better in the emotional domain, while QoL and depression worsened in the control group. The postintervention QoL was improved relative to the control condition only for the Tai Chi group. Although the exercise interventions did not have any effect on depression, the control group was associated with a significant deterioration. CONCLUSIONS: Exercise improved the functional fitness and QoL of PD patients, with Tai Chi yielding better results in QoL and favorable results in functional fitness. These findings suggest that Tai Chi could be a good exercise strategy for patients with PD.
Dancing ; Depression ; Exercise ; Humans ; Parkinson Disease* ; Quality of Life ; Tai Ji*