We report a case of hidradenoma papilliferum of the left nipple in a 23-year-old female patient. Hidradenoma papilliferum occurs only in women, usually on the labia majora or in the perineal or perineal region and represents an adenoma with apocrine dif ferentiation. Histologic examination of the lesion revealed findings consistent with hidradenoma papilliferurn. She had been performed surgical excision
Acrospiroma* ; Adenoma ; Female ; Humans ; Nipples* ; Young Adult

OBJECTIVE: To examine the synergistic effects of both computer-assisted cognitive rehabilitation (CACR) and transcranial direct current stimulation (tDCS) on cognitive function in patients with stroke. METHODS: The current double-blind, sham-controlled study enrolled a total of 11 patients who were newly diagnosed with stroke. The patients of the tDCS group (n=6) completed sessions of the Korean computer-assisted cognitive rehabilitation program five times a week for 30 minutes a session during a mean period of 18.5 days concomitantly with the anodal tDCS over the bilateral prefrontal cortex combined with the CACR. The patients of the control group (n=5) also completed sessions of the sham stimulation during a mean period of 17.8 days. Anodal tDCS over bilateral prefrontal cortex (F3 and F4 in 10-20 EEG system) was delivered for 30 minutes at an intensity of 2 mA. Cathode electrodes were applied to the non-dominant arm. All the patients were evaluated using the Seoul Computerized Neuropsychological Test (SCNT) and the Korean Mini-Mental State Examination. RESULTS: Mann-Whitney U test revealed a significant difference between the two groups. The patients of the tDCS group achieved a significant improvement in the post/pre ratio of auditory continuous performance test and visual continuous performance test on the SCNT items. CONCLUSION: Our results indicate that the concomitant use of the tDCS with CACR to the prefrontal cortex may provide additional beneficial effects in improving the cognitive dysfunction for patients with stroke.
Arm ; Electrodes ; Electroencephalography ; Humans ; Neuropsychological Tests ; Pilot Projects* ; Prefrontal Cortex* ; Rehabilitation* ; Seoul ; Stroke*

Confluent and reticulated papillomatosis (CRP) was first described as a relatively rare dermatosis. CRP is characterized by slightly hyperkeratotic pigmented papules that are confluent in the center and reticulated at the periphery, located on the neck, abdomen, intermammary, and interscapular regions. Histopathologically, lesions typically reveal orthohyperkeratosis, papillomatosis, and focal acanthosis. A 20-year-old man presented with a 2-year history of slightly pruritic lesions on the chest, abdomen, back, and upper extremities. The lesions were brownish papules and plaques in a reticulated and coalescing pattern. Histologically, a basket-weave pattern of orthohyperkeratosis and mild acanthosis were seen. However, there was no significant papillomatosis, even in multiple sections. Periodic acid Schiff stain was negative for fungi. The patient was treated with doxycycline, 200 mg daily, for 4 weeks. The lesions completely resolved and did not recur during 12 months of follow-up. We report a rare case of CRP without papillomatosis.
Abdomen ; Doxycycline ; Follow-Up Studies ; Fungi ; Humans ; Neck ; Papilloma ; Periodic Acid ; Skin Diseases ; Thorax ; Upper Extremity ; Young Adult

BACKGROUND: The major limitations of the current therapeutic treatments for onychomycosis are the recurrence of the infection and the duration of the treatment. Recently, photodynamic therapy (PDT) is thought to be a novel alternative method for treatment of onychomycosis. OBJECTIVE: The aim of this study is to investigate the efficacy and safety of PDT with methyl 5-aminolevulinic acid (MAL) for the treatment of onychomycosis. METHODS: We performed MAL-PDT in eight patients with distal subungual onychomycosis on at least one great toenail. After the total three treatments, we observed the clinical and mycological courses for twelve months. RESULTS: For the twelve months of follow-up period, three patients (37.5%) showed continuous clinical improvement, two patients (25%) aggravation after transient improvement, and the rest, three patients (37.5%) resistance to treatment. All subjects complained of quite severe burning pain during irradiation of light source. CONCLUSION: In this study, we observed the highly variable clinical and mycological results of PDT in onychomycosis. We concluded that it is too difficult to consistently achieve the best fungicidal effect by PDT without strictly selected conditions.
Burns ; Follow-Up Studies ; Humans ; Light ; Nails ; Onychomycosis ; Photochemotherapy ; Recurrence ; Triazenes

PURPOSE: Facial paralysis is an uncommon but significant complication of chronic otitis media (COM). Surgical eradication of the disease is the most viable way to overcome facial paralysis therefrom. In an effort to guide treatment of this rare complication, we analyzed the prognosis of facial function after surgical treatment. MATERIALS AND METHODS: A total of 3435 patients with COM, who underwent various otologic surgeries throughout a period of 20 years, were analyzed retrospectively. Forty six patients (1.33%) had facial nerve paralysis caused by COM. We analyzed prognostic factors including delay of surgery, the extent of disease, presence or absence of cholesteatoma and the type of surgery affecting surgical outcomes. RESULTS: Surgical intervention had a good effect on the restoration of facial function in cases of shorter duration of onset of facial paralysis to surgery and cases of sudden onset, without cholesteatoma. No previous ear surgery and healthy bony labyrinth indicated a good postoperative prognosis. CONCLUSION: COM causing facial paralysis is most frequently due to cholesteatoma and the presence of cholesteatoma decreased the effectiveness of surgical treatment and indicated a poor prognosis after surgery. In our experience, early surgical intervention can be crucial to recovery of facial function. To prevent recurrent cholesteatoma, which leads to local destruction of the facial nerve, complete eradication of the disease in one procedure cannot be overemphasized for the treatment of patients with COM.
Adult ; Aged ; Chronic Disease ; Facial Nerve/surgery ; Facial Nerve Diseases/*etiology/*surgery ; Facial Paralysis/*etiology/*surgery ; Female ; Humans ; Male ; Middle Aged ; Otitis Media/*complications ; Retrospective Studies ; Young Adult

Fibroepithelioma of Pinkus is generally accepted as a low-risk variant of basal cell carcinoma. A 66-year-old man was presented with a solitary dark red nodule with superficial erosion on his right groin. It tended to bleed, but was otherwise asymptomatic. Histopathologically, the tumor was composed of long, thin, branching and anastomosing strands of basaloid cells, which extends from the epidermis into the fibromucinous stroma. Basaloid tumor cells were palisaded at the periphery of the strands, and small buds were seen projecting from the epithelial strands. Significant amounts of melanin pigment were deposited in the papillary and reticular dermis, and the stroma between the tumor cords and also inside the tumor cells. The lesion was completely excised with clear margin. We report a case of pigmented fibroepithelioma of Pinkus with review of the literature in this communication.
Aged ; Carcinoma, Basal Cell ; Dermis ; Epidermis ; Groin ; Humans ; Melanins

Abrupt reoxygenation (or reperfusion) after anoxia (or ischemia)-induced injury resulted in the loss of contractile property, destruction of cell organelles, and ultimately, cell death in cardiac myocytes. This phenomenon has been called 'oxygen paradox' or 'reperfusion injury'. The purpose of this study was to investigate the changes of fine structures and enzyme activities associated with oxygen paradox during 60 min. of anoxia, followed by a 30 min. of reoxygenation. Cardiac myocytes were dissociated from neonatal rat ventricles and cultured for three days. While they were exposed to anoxia and reoxygenation, the cardiac myocytes were investigated through beating counts, enzyme cytochemistry, immunofluorescence, electron microscopy for morphological study. Activity staining and Western blot for Cu, Zn-SOD, NADPH-diaphorase stain and nitrite concentration mesurement for nitric oxide synthase, and catalase activity measurement were performed. After 60 min. of anoxia, the beating rate increased remarkably. Swollen mitochondria with amorphous dense clumps, mild contracture of myofibrils and retraction of cytoplasmic processes were observed in cardiac myocytes. Under confocal microscope, weak reaction of Mn-SOD and myosin were observed, whereas reaction of Cu, Zn-SOD was enhanced in perinuclear region. Cu, Zn-SOD and catalase activity in cardiac myocytes increased markedly. Nitric oxide synthase activity increased gradually with time. After 30 min. of reoxygenation following 60 min anoxia, structural changes of myocardial cells was more pronounced than in the cells of anoxic group. Beating rate was variable but decreased gradually. Myocardial cells showed evidence of severe structural alterations, including marginal clumping of chromatids, varying-sized bleb formation, many vacuoles, mitochondrial matrix exposed to cytoplasm and fragmen-tation of cristae, myofibrillar hypercontracture. Decline of immunocytochemical reaction of Mn-SOD, myosin and Cu, Zn-SOD were observed under confocal microscope. The declines of activity and quantity of Cu, Zn-SOD were severe compared to control. In contrast, nitric oxide synthase activity significantly increased. Catalase activity was lower than in anoxic group, but still higher than in control activity. These results suggested that there were two possible mechanisms for the drastic morphological changes induced by anoxia-reoxygenation; 1) direct effect of oxygen free radicals, and 2) reaction of nitric oxide with superoxide radicals, which resulted in generation of toxic metabolites of nitric oxide, exacerbated myocardial cellular damages.
Animals ; Anoxia ; Blister ; Blotting, Western ; Catalase ; Cell Death ; Chromatids ; Contracture ; Cytoplasm ; Fluorescent Antibody Technique ; Free Radicals ; Histocytochemistry ; Microscopy, Electron ; Mitochondria ; Myocytes, Cardiac* ; Myofibrils ; Myosins ; Nitric Oxide ; Nitric Oxide Synthase ; Organelles ; Oxygen ; Rats ; Superoxide Dismutase ; Superoxides ; Vacuoles

Malignant syphilis (also known as lues maligna) is a rare dermatologic manifestation of syphilis and this is more commonly seen in patients with human immunodeficiency virus (HIV) infection. A 40-year-old man presented with general malaise and widespread cutaneous noduloulcerative lesions covered with lamellar crusts for 15 days. He had been diagnosed with HIV infection 6 years earlier, but had not regularly taken antiretroviral drugs. The syphilis serology showed a VDRL (venereal disease research laboratory) titer of 1 : 256 and a positive TPPA (treponema pallidum particle agglutination test) at presentation. Histologic exam showed the dense perivascular inflammatory infiltrates composed of lymphocytes, histiocysts and neurophils with some plasma cells in the underlying upper and reticular dermis. Obliterated blood vessels with eosinophilic materials were observed as an unusual histologic feature of syphilis. Based on the clinical, histological and serological findings, a diagnosis of malignant syphilis accompanied by acquired immune deficiency syndrome (AIDS) was made. The patient was treated with intramuscular benzathine penicillin G at 2.4 million units per week for 3 weeks, and the skin lesions completely healed with post-inflammatory hyperpigmentation. It is necessary to take into account this entity among the possible diagnoses in HIV-infected patients with cutaneous noduloulcerative lesions.
Acquired Immunodeficiency Syndrome ; Adult ; Agglutination ; Blood Vessels ; Dermis ; Eosinophils ; Ethylenediamines ; HIV ; HIV Infections ; Humans ; Hyperpigmentation ; Lymphocytes ; Penicillin G Benzathine ; Plasma Cells ; Skin ; Syphilis

Metastatic tumors to the heart are far more frequent than primary tumors of the heart. Cardiac metastasis may be detected up to 30 percent of patients with fatal lung cancers. Metastatic cancer to the heart is difficult to suspect. Where cardiac metastasis is diagnosed ante-mortem, signs and symptoms of the primary cancer are usually the presenting features and the presence of cardiac involvement is often incidentally detected. We experienced a case of 35-year-old woman with metastatic lung cancer invading the left atrium via pulmonary vein, which was not proved pathologically. She presented with hemoptysis and chest pain. Transthoracic echocardiography demonstrated massive cardiac infiltration with tumor and decreased cardiac wall motion, correlating with the chest CT findings, which were also remarkable for the presence of intracardiac mass and direct invasion to adherent pericardium, pulmonary vein and left atrium. We suggest that careful examination of 2D echocardiography can be noninvasive and valuable tool for diagnosis of metastatic cancer to the heart.
Adult ; Carcinoma, Large Cell* ; Chest Pain ; Diagnosis ; Echocardiography ; Female ; Heart ; Heart Atria* ; Hemoptysis ; Humans ; Lung Neoplasms ; Lung* ; Neoplasm Metastasis* ; Pericardium ; Pulmonary Veins ; Tomography, X-Ray Computed

We present a case of accessory tragus (AT) which developed at an unusual site, the nasal vestibule, of a 1-day-old girl. To our knowledge, this is the first report of an accessory tragus that appears on the nasal vestibule.