Penile melanosis is a beniign macular hyperpigmentation of the penile shaft and/or glans. Clinically the lesions are irregular in outline and show variegated pigmentation. The main differential diagnostic problem is with acral levtiginous melanoma. A 28-year-old man was seen with slowly growing, asymptomatic, multifocal, and variegated hyperpigmented maculs on the glans penis of 28-year-duration. The post and family history were non-contributory. Hostogologic examination showed acanthosis and basal layer hyperpigrnentation but atypical melanocytes were not seen. Fontana-Masson stain showed increased melanin pigmentation with dendritic elongation of melanocytes in the basal layer of the epidermis. Little is known about the natural history and melnona risk of penile melanosis and we believe that a long-term follow-up is warranted. This patient showed no change during the follow-up period of 2 years and we will continue to monitor him long-term.
Adult ; Epidermis ; Follow-Up Studies ; Humans ; Hyperpigmentation ; Male ; Melanins ; Melanocytes ; Melanoma ; Melanosis* ; Natural History ; Penis ; Pigmentation ; Vitiligo

BACKGROUND: Lichen planus(LP) & lichenoid drug eruption(LDE) are similar in clinical manifestations and may pose difficulty in differentiation. OBJECTIVE & METHOD: We observed the clinical feature of 9 LDE patients and campared the histopathologic findings of LDE(11 specimens in 9 pateints) and LP(11 specimens in 11 patients). RESULTS: Age of onset was predominant in old age, ranging from 49 to 71 years old. Causative drugs could be proved in seven patients and were ethanb atol in two cases, and thyroigen, pentazocin, furosemide, captopril and 5 fluorouracil in each of 5 cases. In the other two cases, either of INH, RIF or EMB was suspected as a causitire agent. Blood eosinophilia was present in 5 of the 6 exmmined patients. Comparative histolgjc features of LDE and I.P were as follows. (No. of specimen LDE/LP). parakeratosis (81), focal epidermal atrophy (8/0), focal loss of granular layer (9/0), colloid bodies in the gram laor horny layer (7/2), many necrotic keratinocytes (1/0), focal vacuolar alteration in the basal layer (5/0), extravasated RBC in the epidermis or derrnis (2/0), superficial and deep pervacular infiltrate (11/2), an infiltrate around the sweat glands(2/1), an infiltrate of eosinohils(11/0), an infiltrate of plasma celis(4/1). CONCLUSION: LDE eouJd be differentiated from LP by cruhistory, cutaneous manifestations, blood eosinophilia and histopathologic findings. Histoetologic findings that were indicative of LDE were focal parakeratosis, colloid bodies in the gr nular or horney layer, focal epidermal atrophy, eosinophils and plasma cells in the cellula: ir filtrate and an infiltrate around deep vessels.
Age of Onset ; Aged ; Atrophy ; Captopril ; Colloids ; Drug Eruptions* ; Dust ; Eosinophilia ; Eosinophils ; Epidermis ; Fluorouracil ; Furosemide ; Humans ; Keratinocytes ; Lichen Planus* ; Lichens* ; Parakeratosis ; Plasma ; Plasma Cells ; Sweat ; Yeasts

BACKGROUND: Melanin pigmentation plays a major role in normal skin color. The rates of melanin synthesis by melanocytes appear to be regulated by ultraviolet-B(UVB) radiation and chemicals, though the precise mechanisms modulating human epidermal pigmentation are unknown. Several chemicals including arbutin kojic acid(KA), pentadecenoic acid (PDA) and glycolic acid (GA) have been suggested as a meanogenesis inhibitory compounds because of their chemical or biological similarties with hydroquinone or their tyrosinase inhibitory effect. OBJECTIVE: The purpose of this study was to evaluate the inhibitory effect of arbutin, GA, KA and PDA on UV-induced melanogenesis in the vitro and in vivo pigmentary system. METHODS: Cultured normal melanocytes and B-16 melanoma cells, and C57BL mice and human volunteers were used for in vitro and in vivo studies respectively. They were administered to UVB irradiated or nonirradiated cultured normal human melanocytes, and B-16 melanoma cells. For the in vivo study, these chemicals were topically applied to C57BL mice and human volunteer skin after UVB irradiation, Numeric and morphologic changes and melanin content were measured in cultured normal human melanocytes and B-16 melanoma cells. In the C57BL mice, numeric and morphologic changes of split-COPA stained melanocytes were assessed. In the human volunteers, gross pigementary changes were evaluated. RESULTS: 1. The number and melanin content of cultured melanocytes initially decreased after UVB-irradiation, but the melanin content increased 5 days after irradiation. 2. Cell numbers of irradiated or nonirradiated cultured human melanocytes decreased in arbutin(10-3M), KA(10-3M, 10-5M), PDA(10-3M) groups. Those of the cultured B-16 melanoma cells decreased only in the arbutin(10-3M) group after UVB irradiation. 3. Melanin contents of cultured human melanocytes decreased in arbutin(10-3M, 10-5M), KA(10-3M, 10-5M) and PDA(10-3M) groups. Those of cultured B-16 melanoma cells decreased in arbutin(10-3M, 10-5M) groups after UVB-irradiation or nonirradiation. 4. The number of split-DOPA(+) melanocytes decreased in the groups treated with KA 1% for 3, 5 and 7 weeks, KA 0.1%, arbutin 3%, arbutin 5% for 5 and 7 weeks and PDA 5.0% for 7 weeks in the C57BL mice. 5. The number of split-DOPA(+) melanocytes decreased in the groups treated with KA 1.0%, PDA 5.0%, arbutin 3% and arbutin 5% for 5 and 7 weeks and KA 0.1% for 7 weeks in UVB irradiated C57BL mice. 6. Visible inhibition of UVB-induced yperpigmentation was observed in arbutin applied sites in 4 of the 6 volunteers 3 weeks after the application. GA did not show an inhibitory effect on UVB-induced hyperpigmentation in all subjects. CONCLUSION: Arbutn, KA, PDA had a suppressive effect on melanization of nonirradiated melanocytes and melanoma cells as well as UVB-induced hyperpigmentation. It is suggested that these drugs might be candidates as compounds that may control hyperpigmentary disorders.
Animals ; Arbutin* ; Cell Count ; Healthy Volunteers ; Humans ; Hyperpigmentation ; Melanins ; Melanocytes ; Melanoma ; Mice ; Mice, Inbred C57BL ; Monophenol Monooxygenase ; Pigmentation ; Skin ; Volunteers

Woringer-Kolopp(W-K) disease is a rare, localized, histologically malignant, but clinically indolent lymphoproliferative disorder. It usually shows only a single slowly enlarging skin lesion mainly on the extremities. Some authors have regarded W-K disease as a variant of mycosis fungoides. However, recent studies suggest that W-K disease may represent a spectrum of T cell lymphoproliferative disoreers that may not be related to mycosis fungoides. We report a case of Woringer-Kolopp disease in a 60-year-old male who presented with a solitary slowly growing tumor on his left palm for 3 years. Histopathologic examination showed marked acanthosis and pagetoid infiltration confined to the epidermis. He was treated with 4,000 red electron beam irradiation to the area with complete resolution of the lesion. Three years later, a similar lesion appeared on his left foot dorsum. He was treated as previously with a good response and there has been no new lesion during the last 1 year follow up period.
Epidermis ; Extremities ; Follow-Up Studies ; Foot ; Humans ; Lymphoproliferative Disorders ; Male ; Middle Aged ; Mycosis Fungoides ; Pagetoid Reticulosis* ; Skin

Purpose: Completion total gastrectomy (CTG) for remnant gastric cancer (RGC) is a technically demanding procedure and associated with increased morbidity. The present study aimed to evaluate postoperative complications and their risk factors following surgery for RGC after initial partial gastrectomy due to gastric cancer excluding peptic ulcer. Materials and Methods: We retrospectively reviewed the data of 107 patients who had previously undergone an initial gastric cancer surgery and subsequently underwent CTG for RGC between March 2002 and December 2020. The postoperative complications were graded using the Clavien-Dindo classification. Logistic regression analyses were used to determine the risk factors for complications. Results: Postoperative complications occurred in 34.6% (37/107) of the patients. Intraabdominal abscess was the most common complication. The significant risk factors for overall complications were multi-visceral resections, longer operation time, and high estimated blood loss in the univariate analysis. The independent risk factors were multivisceral resection (odds ratio [OR], 2.832; 95% confidence interval [CI], 1.094–7.333;P=0.032) and longer operation time (OR, 1.005; 95% CI, 1.001–1.011; P=0.036) in the multivariate analysis. Previous reconstruction type, minimally invasive approach, and current stage were not associated with the overall complications. Conclusions Multi-visceral resection and long operation time were significant risk factors for the occurrence of complications following CTG rather than the RGC stage or surgical approach. When multi-visceral resection is required, a more meticulous surgical procedure is warranted to improve the postoperative complications during CTG for RGC after an initial gastric cancer surgery.

Purpose: This study evaluated real-world compliance with surgical treatment according to Korea's gastric cancer treatment guidelines. Materials and Methods: The 2018 Korean Gastric Cancer Treatment Guidelines were evaluated using the 2019 national survey data for surgically treated gastric cancer based on postoperative pathological results in Korea. In addition, the changes in surgical treatments in 2019 were compared with those in the 2014 national survey data implemented before the publication of the guidelines in 2018. The compliance rate was evaluated according to the algorithm recommended in the 2018 Korean guidelines. Results: The overall compliance rates in 2019 were 83% for gastric resection extent, 87% for lymph node dissection, 100% for surgical approach, and 83% for adjuvant chemotherapy, similar to 2014. Among patients with pathologic stages IB, II, and III disease who underwent total gastrectomy, the incidence of splenectomy was 8.08%, a practice not recommended by the guidelines. The survey findings revealed that 48.66% of the patients who underwent gastrectomy had pathological stage IV disease, which was not recommended by the 2019 guidelines. Compared to that in 2014, the rate of gastrectomy in stage IV patients was 54.53% in 2014. Compliance rates were similar across all regions of Korea, except for gastrectomy in patients with stage IV disease. Conclusions Real-world compliance with gastric cancer treatment guidelines was relatively high in Korea.

BACKGROUND: Cardiac patients undergoing open heart surgery usually require ventilatory support that involves ICU admission in the postoperative period. We tried to find out determinants of postoperative ventilatory support time. METHODS: We reviewed the medical records of 56 open heart surgery patients retrospectively in terms of their disease, preoperative physical status, age, post-bypass arterial oxygen tension/inspired oxygen fraction (PaO2/FIO2) ratio, number of inotropics used and searched the relationship between each factor and postoperative intubation time. RESULTS: None of the factors except the number of inotropics used had an significant influence on the postoperative intubation time. CONCLUSION: In open heart surgical patients their disease, preoperative physical status, age, postbypass PaO2/FIO2 ratio do not affect postoperative intubation time rather than number of inotropics used does.
Heart* ; Humans ; Intubation* ; Medical Records ; Oxygen ; Postoperative Period ; Retrospective Studies ; Thoracic Surgery*

PURPOSE: Airway pathology in children with atopic asthma can be reflected by the concave shape of the maximal expiratory flow-volume (MEFV) curve and high fractional exhaled nitric oxide (FeNO) values. We evaluated the capacity of the curvilinearity of the MEFV curve, FeNO, and their combination to distinguish subjects with atopic asthma from healthy individuals. METHODS: FeNO and angle β, which characterizes the general configuration of the MEFV curve, were determined in 119 steroid-naïve individuals with atopic asthma aged 8 to 16 years, and in 92 age-matched healthy controls. Receiver operating characteristic (ROC) curve analyses were performed to determine the cutoff points of FeNO and angle β that provided the best combination of sensitivity and specificity for asthma detection. RESULTS: Asthmatic patients had a significantly smaller angle β and higher FeNO compared with healthy controls (both, P<0.001). For asthma detection, the best cutoff values of angle β and FeNO were observed at 189.3° and 22 parts per billion, respectively. The area under the ROC curve for the combination of angle β and FeNO improved to 0.91 (95% confidence interval [CI], 0.87–0.95) from 0.80 (95% CI, 0.75–0.86; P<0.001) for angle β alone and 0.86 (95% CI, 0.82–0.91; P=0.002) for FeNO alone. In addition, the combination enhanced sensitivity with no significant decrease in specificity. CONCLUSION: These data suggest that the combined use of the curvilinearity of the MEFV curve and FeNO is a useful tool to differentiate between children with and without atopic asthma.
Asthma* ; Child* ; Humans ; Nitric Oxide* ; Pathology ; ROC Curve ; Sensitivity and Specificity

To investigate the underlying mechanisms of C18 fatty acids (stearic acid, oleic acid, linoleic acid and alpha-linolenic acid) on mast cells, we measured the effect of C18 fatty acids on intracellular Ca2+ mobilization and histamine release in RBL-2H3 mast cells. Stearic acid rapidly increased initial peak of intracellular Ca2+ mobilization, whereas linoleic acid and alpha-linolenic acid gradually increased this mobilization. In the absence of extracellular Ca2+, stearic acid (100 microM) did not cause any increase of intracellular Ca2+ mobilization. Both linoleic acid and alpha-linolenic acid increased intracellular Ca2+ mobilization, but the increase was smaller than that in the presence of extracellular Ca2+. These results suggest that C18 fatty acid-induced intracellular Ca2+ mobilization is mainly dependent on extracellular Ca2+ influx. Verapamil dose-dependently inhibited stearic acid-induced intracellular Ca2+ mobilization, but did not affect both linoleic acid and alpha-linolenic acid-induced intracellular Ca2+ mobilization. These data suggest that the underlying mechanism of stearic acid, linoleic acid and alpha-linolenic acid on intracellular Ca2+ mobilization may differ. Linoleic acid and alpha-linolenic acid significantly increased histamine release. Linoleic acid (C18:2: omega-6)-induced intracellular Ca2+ mobilization and histamine release were more prominent than alpha-linolenic acid (C18:3: omega-3). These data support the view that the intake of more alpha-linolenic acid than linoleic acid is useful in preventing inflammation.
alpha-Linolenic Acid ; Fatty Acids* ; Histamine Release* ; Inflammation ; Linoleic Acid ; Mast Cells ; Oleic Acid ; Verapamil

BACKGROUND: As the elderly population increases, elderly patients visiting emergency departments (ED) with acute abdominal pain will also likely increase. The underlying causative diseases in these older patients are different from younger patients, usually more serious. Thus, correct diagnosis is very important, but difficult. There needs to be a better understanding of the characteristics of the elderly patient with acute abdominal pain seen in the ED. METHODS: We retrospectively reviewed the medical records of 98 elderly patients (>or=65 years) and 109 adult controls (<65 years) visiting an ED at one general hospital looking at the final diagnoses, characteristics of abdominal pain, admissions, and surgeries. RESULTS: Hepatobiliary tract diseases and bowel obstruction were more common in the elderly patients. The elderly had more admissions and surgeries than younger patients. In addition, they were more likely to have a fatal disease such as myocardial infarction. CONCLUSION: There is a difference in the underlying diseases causing acute abdominal pain in the elderly patients versus younger patients. In terms of frequency of admission and surgery, the elderly present with more serious and fatal diseases. We must consider these features when seeing an elderly patient with acute abdominal pain in an ED.
Abdominal Pain ; Adult ; Aged ; Emergencies ; Hospitals, General ; Humans ; Medical Records ; Myocardial Infarction ; Retrospective Studies