A 35-year-old housewife was diagnosed with onychomycosis and treated by oral terbinafine, 250mg/day, for 4 months. Clinically all infected nails improved gradually. However, her left great toe-nail was not improved thereafter. At that time the proximal end of the onychomycotic lesion was marked with surgical blade, and terbinafine therapy was continued for four weeks. However, the onychomycotic nail was not improved, and the scratch mark passed by the proximal end of the infected nail. Therefore, we detected the resistance to the therapy and switched the medication to itraconazole 100 mg/day and then another scratch mark was done at the proximal end of the onychomycotic lesion. After another 2 weeks the infected nail went along with the scratch mark distally, and showed clinical improvement. After 8 weeks therapy of itraconazole, she was cured clinically and mycologically. The fungal culture was identified as Aspergillus sydowii.
Adult ; Aspergillus* ; Humans ; Itraconazole ; Onychomycosis*

Non-muscle invasive bladder cancer (NMIBC) patients frequently fail to respond to treatment and experience disease progression because of their clinical and biological diversity. In this study, we identify a prognostic molecular signature for predicting the heterogeneity of NMIBC by using an integrative analysis of copy number and gene expression data. We analyzed the copy number and gene expression profiles of 404 patients with bladder cancer obtained from The Cancer Genome Atlas (TCGA) consortium. Of the 14 molecules with significant copy number alterations that were previously reported, 13 were significantly correlated with copy number and expression changes. Prognostic gene sets based on the 13 genes were developed, and their prognostic values were verified in three independent patient cohorts (n=501). Among them, a signature of CCNE1 and its coexpressed genes was significantly associated with disease progression and validated in the independent cohorts. The CCNE1 signature was an independent risk factor based on the result of a multivariate analysis (hazard ratio=6.849, 95% confidence interval=1.613–29.092, P=0.009). Finally, gene network and upstream regulator analyses revealed that NMIBC progression is potentially mediated by CCND1-CCNE1-SP1 pathways. The prognostic molecular signature defined by copy number and expression changes of CCNE1 suggests a novel diagnostic tool for predicting the likelihood of NMIBC progression.
Biodiversity ; Cohort Studies ; Computational Biology* ; Disease Progression ; Gene Expression ; Gene Regulatory Networks ; Genome ; Humans ; Multivariate Analysis ; Population Characteristics ; Risk Factors ; Transcriptome ; Urinary Bladder Neoplasms* ; Urinary Bladder*

Mycoplasma pneumoniae is a common cause of community-acquired pneumonia in children, with a peak incidence at 5-14 years. Extrapulmonary manifestations occur in 20-25% of patients with M. pneumoniae infection. Most auto-antibodies that cause immune hemolytic anemia in humans are cold agglutinins. The formation of cold agglutinins is frequently observed during M. pneumoniae infections, and cold agglutinin disease usually occurs during M. pneumoniae infections. Nevertheless, severe hemolysis is exceptional. If a patient has any underlying disease related to hemolysis, it is possible to accelerate hemolysis. Hereditary spherocytosis is a common cause of hereditary hemolytic anemia resulting from red blood cell membrane defects. Hemolysis of red cells may result from corpuscular abnormalities or extracorpuscular abnormalities, such as immune or non-immune mechanisms. We report a case of hereditary spherocytosis associated with severe hemolytic anemia due to Mycoplasma pneumonia.
Agglutinins ; Anemia, Hemolytic ; Anemia, Hemolytic, Autoimmune ; Anemia, Hemolytic, Congenital ; Child ; Cold Temperature ; Cryoglobulins ; Erythrocytes ; Hemolysis ; Humans ; Incidence ; Membranes ; Mycoplasma ; Mycoplasma pneumoniae ; Pneumonia ; Pneumonia, Mycoplasma ; Spherocytosis, Hereditary

BACKGROUND: Gastric cancer remains the main cause of cancer-related death in Korea. Accurate preoperative staging of gastric cancer is essential to predict prognosis and to plan optimal treatment. Although there are many reports dealing with the diagnostic values of conventional methods, controversies are still present especially in the field of preoperative staging. In this study, we evaluated the accuracy of gastroscopy and upper gastrointestinal series(UGI) for diagnosis of gastric cancer, and determined the usefulness of ultrasonography and computed tomography for preoperative staging. METHODS: One hundred twenty-three patients, who underwent operation from Aug. 1991 to Mar. 1995 under the diagnosis of gastric cancer were analyzed. We excluded 15 patients because their postoperative definitive stagings were undetemined. RESULTS: 1) Among 123 patients, the proportion of early gastric cancer was 26.0%(32/123) and that of the advanced gastric cancer was 74.0%(91/123). 2) The sensitivity of endoscopic diagnosis of gastric cancer was 96.7%(119/123), and the accuracy to determine the depth of invasion was 82.9% (102/123). 3) The sensitivity of UGI study for gastric cancer was 89.9%(98/109), and the accuracy to determine the depth of invasion was 61.5%(61/109). 4) The sensitivity of abdominal ultrasonography to detect the tumor was 11.3%(8/71), the accuracy to determine the T stage was 29.2%(28/96), and the sensitivity and specificity to detect lymph node metastasis was 13.6%(8/59), 100%(37/37), respectively. 5) The sensitivity of abdominal CT to detect the tumor was 74.3%(26/35), the accuracy to determine the T stage was 32.5%(13/40), and the sensitivity and specificity to detect lymph node metastasis were 34.5%(9/29), 72.7%(8/11), respectively. 6) The accuracy of preoperative staging was 45.5%(56/123). The 49.6%(62/123) of gastric cancer was downstaged, whereas only 4.1%(5/123) was overstaged. CONCLUSION: Our results show that high accuracy for diagnosis of gastrie cancer with the gastroscopy and UGI. However preoperative staging with ultrasonography and computed tomograpy was often underestimated, which could be concluded that the usefulness of the radiologic methods was limited.
Diagnosis* ; Gastroscopy ; Humans ; Korea ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Sensitivity and Specificity ; Stomach Neoplasms* ; Tomography, X-Ray Computed ; Ultrasonography

BACKGROUND: There have been few clinical studies of halo nevi. OBJECTIVE: The purpose of this study was aimed at evaluating the clinical and histopathologic features of halo nevi and correlation between halo nevi and vitiligo. METHODS: The medical records of 40 patients with halo nevi and biopsy specimens of 30 patients with halo nevi were reviewed. RESULTS AND CONCLUSION: 1.The ratio of male to female patients was 1:1.5. 2.The mean age of the onset was 20.1 years (male : 11.5, female : 25.9). 3.Multiple halo nevi were present in 32.5%(male : 25%, female : 37.5%). 4.The areas in which the lesions developed were head and neck(39.1%), back(32.8%), anterior chest(12.5%), abdomen(10.9%), groin(3.1%), and lower extremity(1.6%) in descending order. 5.The mean duration of each color in central nevus was as follows: black(2.7 years), pink(3.5 years), gray(4.9 years) 6.The most common pathology of the central nevus was intradermal(80%). 7.The halo nevi associated with vitiligo were 21 cases(52.5%) out of 40 patients. Among them, the cases with non-segmental vitiligo were 13(61.9%), the cases with segmental vitiligo were 8(38.1%). 8.Out of the 21 cases with halo nevi associated with vitiligo, the cases with halo nevi prior to vitiligo were 4(19.1%), concurrent onset 12(57.1%) and the cases with halo nevi after vitiligo were 5(23.8%).
Biopsy ; Female ; Head ; Humans ; Male ; Medical Records ; Nevus ; Nevus, Halo* ; Pathology ; Vitiligo

We report a case of subcutaneous phaeohyphomycosis caused by Exophiala(E,) jeanselmei in a 66-year-old female, who showed a mild tender, 4.5x3.5cm sized, erythematous cystic mass with satellite lesions on the left forearm for 4 months. Histopathologically, suppurative granulomatous inflammation, brownish conidia in a chain and hyphae were observed. Fungal culture grew out the typical black-gray velvety colonies of E. jeanselmei after 2 weeks. The isolate grow well at 25 C, but very poorly at 37 C. No growth could be observed at 40 C. Sporulation adequate for evaluation was present on the malt extract agar. We confirmed E. jeanselmei by colony and microscopic morphology, temperature tolerance and sugar assimilation tests. The patient had been treated with itraconazole for 6 momths. Complete remission was observed.
Agar ; Aged ; Exophiala* ; Female ; Forearm ; Humans ; Hyphae ; Inflammation ; Itraconazole ; Phaeohyphomycosis* ; Spores, Fungal

Toxoplamosis is a common parasitic infection that is widely distributed throughout the world, including the United States. However, the incidence in Korea is unknown. This report concerns a case of toxoplasmosis that manifested as intraparotid lymphadenitis in a 37-year-old woman. The etiology, clinical, microscopic, and laboratory findings, and treatment are reviewed.
Adult ; Female ; Humans ; Incidence ; Korea ; Lymphadenitis* ; Parotid Gland* ; Toxoplasmosis* ; United States

BACKGROUND AND OBJECTIVES: The epithelial rupture theory for the polyp formation has been well approved. According to Norlander et al., the polyp formation initiated by multifactorial pathophysiological events (infection/inflammation) appears to be a series of the consecutive events involving the rupture of epithelium, prolapse of lamina propria, epithelial ingrowth, microcavity formation, and finally the polyp formation. The purpose of this study is to determine the effects of steroid and steroid receptor blocker at the early stage of the polyp formation in a rabbit model. MATERIALS AND METHODS: In 20 New Zealand white rabbits, polyps were induced by epithelial damage with ostial occlusion. The mometasone and RU 486, given by the biodegradable film (polylactic acid), were used to investigate the possible effects of steroid and steroid receptor blockers. After one and three weeks, macroscopic polyps were counted postmortem and on histological slides after serial sectioning. RESULT: The polyp formation was significantly increased in the RU 486-treated group, whereas it was reduced in the mometasone-treated group. According to the alpha-actin immunohistochemistry, neovascularization at the margin of the initial polyp in the RU 486-treated group markedly increased compared with the mometasone-treated group. CONCLUSION: Steroid is thought to inhibit the initial polyp formation by reducing neovascularization particularly at the margin of initial polyp.
Actins ; Epithelium ; Immunohistochemistry ; Mifepristone ; Mucous Membrane ; Nasal Polyps ; Polyps* ; Prolapse ; Rabbits ; Receptors, Steroid* ; Rupture ; Steroids ; Mometasone Furoate

En bloc defects, which can also be defined as extensive composite defects, present as one of the most complex reconstructive challenges in the head and neck area. Although most head and neck defects can be reconstructed using a single free tissue transfer, the use of two free flap is indicated for massive tissue defects or for composite tissue requirement that cannot be met with a single free flap. In this paper, we report two patients with composite defects. They underwent single-stage, double free flap reconstruction utilizing a fibular osteoseptocutaneous flap to reconstruct the mandible and floor of the mouth, as well as an innervated radial forearm fasciocutaneous composite flap with the palmaris longus tendon and the latissimus dorsi free flap for the total tongue reconstruction. Both patients had acceptable functional and aesthetic outcomes.
Forearm ; Free Tissue Flaps* ; Head ; Humans ; Mandible ; Mouth ; Neck ; Superficial Back Muscles ; Surgical Flaps ; Tendons ; Tongue ; Tongue Neoplasms

PURPOSE: The purpose of this study is to evaluate the factors affecting the endoleaks of endovascular aneurysm repairs in infrarenal abdominal aortic aneurysms. METHODS: On a retrospective basis, we analyzed 122 patients, who underwent endovascular aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysm between March, 2006 and June, 2011. According to the endoleak, the patients were divided into 2 groups: endoleak group and non-endoleak group. We compared the following variables between the 2 groups: patient clinical characteristics (age, gender, body mass index, history of smoking, hypertension, diabetes mellitus, and coronary artery disease) and anatomical features of the aneurysms. RESULTS: A total of 111 male and 11 female patients were included. Fifty-two patients showed endoleak (42.6%) during follow-up periods (median: 4.6 years). There was no significant difference between endoleak and non-endoleak group according to patient's clinical characteristics and used devices. However, there were significant differences between two groups according to the anatomical features of the aneurysm, such as the morphology, size of the aneurysm, and the size and angle of the neck of the aneurysm. CONCLUSION: Endoleak indicated high frequency when the aneurysm size is large, and when the neck aneurysm is large, with the neck angle being more than 60 degrees. Thus, patients with more than one of the above three characteristics may need more attentive and cautious procedures as well as a closer follow-up.
Aneurysm ; Aortic Aneurysm, Abdominal ; Body Mass Index ; Coronary Vessels ; Diabetes Mellitus ; Endoleak ; Female ; Follow-Up Studies ; Humans ; Hypertension ; Male ; Neck ; Retrospective Studies ; Smoke ; Smoking