Trichoadenoma is a rare tumor with differentiation towards the infundibular portion of the pilosebaceous canal. Clinically, it is a nodular growth, usually on the face and buttock. Histologically, it is characterized by numerous horn cysts lined with squamous epithelium in the dermis. In this report, we describe a 44-year-old man who developed trichoadenoma on his right shin. Anti-CD34 antibody stained spindle-shaped cells in the stroma just adjacent to the peripheral layers of keratinous cysts and solid masses of squamous epithelial cells. To our knowledge, this is the first description of an occurrence of trichoadenoma in the lower leg and the first to use immunohistochemical staining to know the CD34 staining pattern.
Adult ; Animals ; Buttocks ; Dermis ; Epithelial Cells ; Epithelium ; Horns ; Humans ; Leg

Primary lymphoma of the central nervous system is a rare disease, occurring spontaneously and/or in conjunction with immunosuppressive state. Its incidence is increasing according to the increment of organ transplantation and AIDS. Recently we experienced a case of primary lymphoma occurred in central nervous system after renal transplantation in a 58-year-old women who had complained of persistent headache and left hemiparesis. CT scan of the brain showed two hyperdense mass lesions in right frontal and right basal ganglia areas. Immunohistochemical stain of the excised mass lesion revealed that tumor cells were derived from B cells. The patient was treated with discontinuance of immunosuppressive drug and irradiation, but expired due to pneumonia.
B-Lymphocytes* ; Basal Ganglia ; Brain ; Central Nervous System ; Female ; Headache ; Humans ; Immunosuppression ; Incidence ; Kidney Transplantation* ; Lymphoma ; Lymphoma, B-Cell* ; Middle Aged ; Nervous System* ; Organ Transplantation ; Paresis ; Pneumonia ; Rare Diseases ; Tomography, X-Ray Computed ; Transplants

OBJECTIVES: It is well known that Acute Leukemic patients with Hyperleukocytosis (ALH, leukocyte count>or=100,000/micro L) have poor prognosis. This is indebted in fatal complications arising from cerebral and pulmonary leukostasis. To investigate the factors influence on the prognosis of these patients, we have analyzed age, sex, laboratory findings and complications and their relationship to remission rate. METHODS: Retrospective evaluation was done from January 1985 to March 1994 on fifty-four patients with ALH. We excluded secondary leukemias transformed from chronic myelogeneous leukemia, relapsed acute leukemia and myelodysplastic syndrome in this study. The prognostic factors associated with early death were also evaluated. RESULTS: 1) Hyperuricemia and incidence of central nervous system and respiratory symptoms were higher in acute myelogeneous leukemia (AML) with hyperleu-kocytosis than in acute lymphocytic leukemia (ALL), 2) Twenty-two of fifty-four patients had complete remission by remission induction chemotherapy. Remission rate was 41%, median duration of remission was 26 weeks and 1 year survival rate was 11%. 3) There were no differences in remission rate between male and female and higher WBC group (WBC>or=200,000/micro L) and lower WBC group (WBC 100,000~200,000/micro L). 4) The group with better performance status (ECOG score1-2), younger (age below 40) and higher hemoglobin level (Hb>or=10g/dL) had higher remission rate. The group of AML and with hepatomegaly had lower remission rate than the group of ALL and without hepatomegly. 5) Early death rate of AML was higher than that of All. Infection was the most common cause of early death in both AML and ALL. 6) Early death rate between the two groups managed with and without leukapheresis was not different. CONCLUSIONS: This result reveals that acute leukemia with hyperleukocytosis is grave disease, especially the patients with poor performance status (ECOG score: 3-4), older age above 40 and severe anemia (Hb<10g/dL) have poor prognosis, The group of AML and with hepatomegaly showed worse prognosis than the group of ALL and without hepatomegaly.
Anemia ; Central Nervous System ; Drug Therapy ; Female ; Hepatomegaly ; Humans ; Hyperuricemia ; Incidence ; Leukapheresis ; Leukemia* ; Leukocytes ; Leukostasis ; Male ; Mortality ; Myelodysplastic Syndromes ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Prognosis ; Remission Induction ; Retrospective Studies ; Survival Rate

Pulmonary embolism is not a frequent cause of morbidity and mortality in patients with or without malignancies. Pulmonary embolism should be ruled out when sudden tachypnea and pulmonary hypertension develop in leukemic children, and chest radiograph shows no or minimal abnormalities. A 14-year-old girl with acute lymphoblastic leukemia was admitted due to neutropenic fever and dyspnea. Chest computed tomography and ventilation/perfusion scan showed pulmonary embolism, and embolectomy revealed aspergillosis. Invasive aspergillosis is the major opportunistic fungal pathogen in neutropenic patient and an important cause of death. The critical elements of successful management of invasive aspergillosis complicating neutropenia and pulmonary embolism are early diagnosis, initiation of aggressive doses of amphotericin B, reversal of immune suppression and feasible surgical resection of the lesions. To the best of our knowledge, this is the first report of pulmonary embolism caused by Aspergillus in an immunocompromised setting in Korea and we present a case report with a brief review.
Adolescent ; Amphotericin B ; Aspergillosis ; Aspergillus* ; Cause of Death ; Child* ; Dyspnea ; Early Diagnosis ; Embolectomy ; Female ; Fever ; Humans ; Hypertension, Pulmonary ; Korea ; Mortality ; Neutropenia ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Pulmonary Embolism* ; Radiography, Thoracic ; Tachypnea ; Thorax

BACKGROUND: Cough is a frequent side effect of angiotensin converting enzyme(ACE) inhibitors and the mechanism of cough is postulated to be associated with accumulation of bronchial irritants which are substrates of ACE. Based on this pathophysiologic mechanism, baseline ACE activity could potentially play the key role in the development of ACE inhibitor-induced cough and ACE gene polymorphism, which account for part of the ACE activity, and to compare the clinical characteristics between subjects who developed cough and those who did not with ACE inhibitor use. METHOD: The cough group(N=84) consisted of subjects who developed troublesome cough with ACE inhibiors and who ceased coughing in 4 weeks after cessation of ACE inhibitor treatment. Patients with evidence of acute respiratioy illness were excluded. The non-cough group(N=116) consisted of subjects who did not develop cough with over 12 months of ACE inhibitor treatment. Clinical characteristics were collected by personal contact and chart review. ACE genotyping was done by PCR amplification of DNA from peripheral blood using previously published primers and agarose gel electrophoresis. RESULTS: Underlying diseases of the cough group were hypertension(47), valvular heart disease(23), ischemic heart disease(4), dilated cardiomyopathy(7) and others (3), whereas Underlying diseases of the non-cough group were hypertension(48), valvular heart disease(33), ischemic heart disease(12), dilated cardiomyopathy(20) and others(3). There was no significant difference in the distribution of underlying diseases between the two groups. Cough induced by ACE inhibitors occurred in an average of 8 weeks after treatment initiation and subsided in an average of 3.8 weeks after discontinuation of ACE inhibitors. There was a preponderance of females in the cough group(F : M=73 : 27) compared to the non-cough group(F : M=40 : 60, p<0.01). There was no significant difference in mean age, total cholesterol, and the frequency of hypertension and diabetes between the two groups. Genotypic frequencies of ACE gene were I/I : I/D : D/D=38 : 42 : 30 for the cough group and 45 : 36 : 19 for the non-cough group which showed no significant difference between the two groups. Allelic frequencies were I : D=54 : 46 and 62 : 38 in the cough and non-cough group respectively and the difference was not statistically significant. CONCLUSION: Women are more susceptible to ACE inhibitor-induced cough, and ACE inhibitor induced cough is not associated with ACE gene polymorphism.
Angiotensin-Converting Enzyme Inhibitors ; Angiotensins* ; Cholesterol ; Cough* ; DNA ; Electrophoresis, Agar Gel ; Female ; Heart ; Humans ; Hypertension ; Irritants ; Peptidyl-Dipeptidase A* ; Polymerase Chain Reaction

BACKGROUND: Cough is a frequent side effect of angiotensin converting enzyme(ACE) inhibitors and the mechanism of cough is postulated to be associated with accumulation of bronchial irritants which are substrates of ACE. Based on this pathophysiologic mechanism, baseline ACE activity could potentially play the key role in the development of ACE inhibitor-induced cough and ACE gene polymorphism, which account for part of the ACE activity, and to compare the clinical characteristics between subjects who developed cough and those who did not with ACE inhibitor use. METHOD: The cough group(N=84) consisted of subjects who developed troublesome cough with ACE inhibiors and who ceased coughing in 4 weeks after cessation of ACE inhibitor treatment. Patients with evidence of acute respiratioy illness were excluded. The non-cough group(N=116) consisted of subjects who did not develop cough with over 12 months of ACE inhibitor treatment. Clinical characteristics were collected by personal contact and chart review. ACE genotyping was done by PCR amplification of DNA from peripheral blood using previously published primers and agarose gel electrophoresis. RESULTS: Underlying diseases of the cough group were hypertension(47), valvular heart disease(23), ischemic heart disease(4), dilated cardiomyopathy(7) and others (3), whereas Underlying diseases of the non-cough group were hypertension(48), valvular heart disease(33), ischemic heart disease(12), dilated cardiomyopathy(20) and others(3). There was no significant difference in the distribution of underlying diseases between the two groups. Cough induced by ACE inhibitors occurred in an average of 8 weeks after treatment initiation and subsided in an average of 3.8 weeks after discontinuation of ACE inhibitors. There was a preponderance of females in the cough group(F : M=73 : 27) compared to the non-cough group(F : M=40 : 60, p<0.01). There was no significant difference in mean age, total cholesterol, and the frequency of hypertension and diabetes between the two groups. Genotypic frequencies of ACE gene were I/I : I/D : D/D=38 : 42 : 30 for the cough group and 45 : 36 : 19 for the non-cough group which showed no significant difference between the two groups. Allelic frequencies were I : D=54 : 46 and 62 : 38 in the cough and non-cough group respectively and the difference was not statistically significant. CONCLUSION: Women are more susceptible to ACE inhibitor-induced cough, and ACE inhibitor induced cough is not associated with ACE gene polymorphism.
Angiotensin-Converting Enzyme Inhibitors ; Angiotensins* ; Cholesterol ; Cough* ; DNA ; Electrophoresis, Agar Gel ; Female ; Heart ; Humans ; Hypertension ; Irritants ; Peptidyl-Dipeptidase A* ; Polymerase Chain Reaction

PURPOSE: 99mTc-sestamibi (MIBI) and 99mTc-tetrofosmin have been used as substrates for P-glycoprotein (Pgp) and multidrug resistance associated protein (MRP), which are closely associated with multidrug resistance of the tumors. To understand different handling of radiotracers in cancer cell lines expressing Pgp and MRP, we compared cellular uptakes of 99mTc-MIBI and 99mTc-tetrofosmin. The effects of cyclosporin A (CsA), well-known multidrug resistant reversing agent, on the uptake of both tracers were also compared. MATERIALS AND METHODS: HCT15/CL02 human colorectal cancer cells for Pgp expressing cells, and human non-small cell lung cancer A549 cells for MRP expressing cells, were used for in vitro and in vivo studies. RT-PCR, western blot analysis and immunohistochemistry were used for detection of Pgp and MRP. MDR-reversal effect with CsA was evaluated at different drug concentrations after incubation with MIBI or tetrofosmin. Radioactivities of supernatant and pellet were measured with gamma well counter. Tumoral uptake of the tracers were measured from tumor bearing nude mice treated with or without CsA. RESULTS: RT-PCR, western blot analysis of the cells and immunochemical staining revealed selective expression of Pgp and MRP for HCT15/CL02 and A549 cells, respectively. There were no significant difference in cellular uptakes of both tracers in HCT15/CL02 cells, but MIBI uptake was slightly higher than that of tetrofosmin in A549 cells. Co-incubation with CsA resulted in a increase in cellular uptakes of MIBI and tetrofosmin. Uptake of MIBI or tetrofosmin in HCT15/CL02 cells was increased by 10- and 2.4-fold, and by 7.5 and 6.3-fold in A549 cells, respectively. Percentage increase of MIBI was higher than that of tetrofosmin with CsA for both cells (p< 0.05). In vivo biodistribution study showed that MIBI (114% at 10 min, 257% at 60 min, 396% at 240 min) and tetrofosmin uptake (110% at 10 min, 205% at 60 min, 410% at 240 min) were progressively increased by the time, up to 240 min with CsA. But increases in tumoral uptake were not significantly different between MIBI and tetrofosmin for both tumors. CONCLUSION: MIBI seems to be a better tracer than tetrofosmin for evaluating MDR reversal effect of the modulators in vitro, but these differences were not evident in vivo tumoral uptake. Both MIBI and tetrofosmin seem to be suitable tracers for imaging Pgp- and MRP-mediated drug resistance in tumors.
Animals ; Blotting, Western ; Carcinoma, Non-Small-Cell Lung ; Cell Line ; Colorectal Neoplasms ; Cyclosporine ; Drug Resistance ; Drug Resistance, Multiple* ; Humans ; Immunohistochemistry ; Mice ; Mice, Nude ; Multidrug Resistance-Associated Proteins* ; P-Glycoprotein* ; Radioactivity ; Technetium Tc 99m Sestamibi

BACKGROUND: Bone marrow scintigraphy using Tc-99m labeled antigranulocyte antibody has been reported to be able to evaluate bone marrow status. We have performed antigranulocyte antibody scan and hematopoietic activity in order to identify bone marrow status in patients with hematologic diseases. METHODS: Sixty-nine patients were enrolled in this study from October 1995 to May 1997. Images were acquired at four and twenty-four hour after injecion of 20mCi 99mTc labeled antigranulocyte antibody (BW 250/183). Patients were divided into four groups according to scintigraphic findings, those with increased marrow uptake (marrow expansion), decreased uptake, focal defect and normal findings. RESULTS: Leukemias and myelodysplastic syndromes frequently showed bone marrow expansion. Seventeen of 21 patients (81%) with AML, and all of ALL and biphenotypic leukemias showed bone marrow expansion. Five of 6 with CML, all Hodgkin's diseases and 3 of 4 MDS also showed marrow expansion. In contrast, all aplastic anemia patients showed decreased marrow uptake, and extra-axial noted in 2 patients with aplastic anemia. All of ten patients with multiple myeloma and 2 of 4 (50%) with Hodgkin disease showed focal marrow defects. Three of 11 with non-Hodgkin lymphoma and 4 of 21 with AML also showed focal marrow defects. CONCLUSION: Bone marrow scintigraphy using antigranulocyte antibody has clearly demonstrated the distribution of bone marrow in various hematologic diseases. Thus, it seems to be a useful method in the assessment of bone marrow status in patients with hematologic disease.
Anemia, Aplastic ; Bone Marrow ; Hematologic Diseases* ; Hodgkin Disease ; Humans ; Leukemia ; Lymphoma, Non-Hodgkin ; Multiple Myeloma ; Myelodysplastic Syndromes ; Radionuclide Imaging

OBJECTIVE: The purpose of this study is to evaluate the efficacy and safety of mirtazapine treatment in multicenter population consisting of Korean patients suffering from moderate-to-severe depression. METHODS: Total 163 of in and outpatients with a diagnosis of major depressive disorder (DSM-IV) and 18 or over scores of 17-items Hamilton Rating Scale for Depression (HAMD) received treatment with mirtazapine (15-45 mg/day) for 6 weeks. Efficacy was assessed by HAMD, Montgomery and Asberg Depression Rating Scale (MADRS), Beck's Depression Inventory (BDI), and Clinical Global Impression (CGI) scales and statistical analyses were performed on the intent-to-treat sample (143 patients) using the last-observation-carried-forward method. In addition, reported adverse events, routine laboratory parameters, and vital signs were investigated to evaluate the safety of mirtazapine. RESULTS: Mean daily dose of mirtazapine was 28.4 mg. At the end of the study, the response rate (50% or more reduction from baseline in HAMD scores) was 75.5% and the remission rate (7 or less in HAMD score) was 42.7%. Mirtazapine treatment induced significant reduction in depressive symptoms at the 4(th) day and substantial reduction along the treatment period, as assessed by changes in HAMD, MADRS, BDI, and CGI scales. At the 4(th) day and first week of mirtazapine treatment, the mean HAMD-17 total score was significantly reduced compared that of the baseline and the response rates were 11.9% and 28.7%, respectively. Mirtazapine was well tolerated in general, and somnolence and sedation were the most common adverse events reported. In addition, there were no clinically relevant changes in laboratory parameters and vital signs, although body weight was increased. CONCLUSION: Although this trial had many limitations of open non-comparative study, mirtazapine was demonstrated to an effective treatment for moderate to severe major depressive disorder and was well tolerated. A potentially rapid onset of overall therapeutic efficacy of mirtazapine was suggested by significant changes in all major variables of efficacy after 4(th) day of treatment.
Body Weight ; Depression ; Depressive Disorder, Major ; Diagnosis ; Humans ; Outpatients ; Vital Signs ; Weights and Measures

PURPOSE: To investigate the care patterns for radiation therapy and to determine inter-hospital differences for patients with laryngeal carcinoma in Korea. MATERIALS AND METHODS: A total of 237 cases of laryngeal carcinoma (glottis, 144; supraglottis, 93) assembled from 23 hospitals, who underwent irradiation in the year of 1998 and 1999, were retrospectively analyzed to investigate inter-hospital differences with respect to radiotherapy treatment. We grouped the 23 hospitals based on the number of new patients annually irradiated in 1998; and designated them as group A (> or =900 patients), group B (> or =400 patients and <900 patients), and group C (<400 patients). RESULTS: The median age of the 237 patients was 62 years (range, 25 to 88 years), of which 216 were male and 21 were female. The clinical stages were distributed as follows: for glottis cancer, I; 61.8%, II; 21.5%, III; 4.2%, IVa; 11.1%, IVb; 1.4%, and in supraglottic cancer, I; 4.3%, II; 19.4%, III; 28.0%, IVa; 43.0%, IVb; 5.4%, respectively. Some differences were observed among the 3 groups with respect to the dose calculation method, radiation energy, field arrangement, and use of an immobilization device. No significant difference among 3 hospital groups was observed with respect to treatment modality, irradiation volume, and median total dose delivered to the primary site. CONCLUSION: This study revealed that radiotherapy process and patterns of care are relatively uniform in laryngeal cancer patients in Korean hospitals, and we hope this nationwide data can be used as a basis for the standardization of radiotherapy for the treatment of laryngeal cancer.
Female ; Glottis ; Humans ; Immobilization ; Korea ; Laryngeal Neoplasms ; Male ; Retrospective Studies