Atrophie blanche which was first described by Milian in 1929 is a sistinct entity and not a variation of stasis dermatitis. We reported a case of atrophie blanche which occurred in 21 year-old female. She had erythematous patches, telangiectaic purpuric areas, small 1 to 2mm ectasias suggestive of small angiomas with central ulcer, pustules and crusts on both lower legs and dorsa of feet without severe painful sensation. Histopathologic findings showed endothelial proliferation of the capillary blood vessele of dermis, presence of fibrinoid material on the superficial blood vessels and storma, and infarction of the epidermis and superficial corium. Response to treatment was not satisfactory with antibiotics and corticosteroid.
Anti-Bacterial Agents ; Blood Vessels ; Capillaries ; Dermatitis ; Dermis ; Dilatation, Pathologic ; Epidermis ; Female ; Foot ; Hemangioma ; Humans ; Infarction ; Leg ; Sensation ; Ulcer ; Young Adult

Clinicalstudies on thirty patients with lichen planus seen during the past 9 years from 1968 to 1976 at the Department of Dermatology, Busan National University Hospital were ma,de;particularly, varied clinical types of the disease and significance of histological findings were emphasized. The results obtained were as follows; 1. The incidence of lichen planus was 0.17% patients to total number of dermatologic 2. There were 19 males and 11 females in this series. The age at the first visit varied from 16 years to 71 years, and the pitients between 21 and 50 years occupied 76.7% of all. 3. The most common site of the initial lesion was extremities(66.7%), and flexor surface was rather common than extensor surface. And lesions of trunk, oral mucosa, extemal genitalia were also noticed. 4. The most common clinical type was chronic localized type(11), and hypertrophic type(4), Iichen planus of mucous membrane(4), annular type(4), acute widesprearead type(3), vesicobulIous type(2), linear type(2), follicular type(l) were also noticed. 5. Pruritus developed in 22 patints(73.3%) an@d Koebners phenomenon was noticed only in R cases(10%). 6. Histopathological examination of 25 biopsy specimens showed epidermal changes of hyperkeratosis(24), acanthosis(22), hypergranulosis(21), elongation of rete ridge(8) and liquefaction degeneration of hasal cells(25). Dermal changes include bandlike infiltration of infIammatory cells(24), melanophages in upper dermis(18), colloid or eosinophilic body(9), and dermo-epidermal separation(3).
Biopsy ; Busan ; Colloids ; Dermatology ; Eosinophils ; Female ; Genitalia ; Humans ; Incidence ; Lichen Planus* ; Lichens* ; Male ; Mouth Mucosa ; Pruritus

Intractable diarrhea associated with secondary amyloidosis in rheumatoid arthritis (RA) is a serious clinical entity with poor prognosis. We describe a 39-year-old male RA patient who presented with intractable diarrhea. Biopsy findings of terminal ileum and colon revealed amyloidosis secondary to RA. Effective treatment of rheumatoid arthritis resulted in remission of intractable diarrhea caused by amyloid protein deposition.
Adult ; Amyloid ; Amyloidosis* ; Arthritis, Rheumatoid* ; Biopsy ; Colon ; Diarrhea* ; Humans ; Ileum ; Male ; Prognosis

BACKGROUND: Recently, the commercial kits for measurement of the absolute number of CD34+ cells have been introduced as a standard method. The aims of this study was to investigated optimal timing of peripheral blood progenitor cell(PBPC) collection and optimal CD34+ cells dose transplanted by measurement of the absolute CD34+ cells. METHODS: We measured total leukocyte count, mononuclear cell count and the absolute number of CD34+ cells using ProCOUNT(Becton Dickinson, USA) in peripheral blood from 54 patients and 7 normal donors who underwent 101 leukapheresis for PBPC collection. We studied correlations among the absolute number of circulating CD34+ cells, other predictors and harvesting yields. We investigated relationships between the posttransplant hematopoietic recovery and CD34+ cells dose in 30 patients. RESULTS: The total number of CD34+ cells in harvesting products could be mostly predicted from the absolute number of circulating CD34+ cells. From 4 to 6 day after G-CSF mobilization, the absolute number of circulating CD34+ cells was peaked. A number of circulating CD34+ cells more than 20/microliter ensured 2.5x106 CD34+ cells/Kg in harvesting products. The patients received CD34+ cells dose >3.5x106/Kg led to a significantly faster recovery of platelets, compared with the patients receiving <3.5x106 CD34+ cells/Kg(P<0.05). CONCLUSIONS: These results suggest that PBPC collection should be started at day of circulating CD34+ cells more than 20/microliter or 4-6 days after G-CSF mobilization for successful leukapheresis and the CD34+ cell dose more than 3.5x106/Kg for PBPC transplantation could predicted rapid hematopoietic recovery.
Cell Count ; Granulocyte Colony-Stimulating Factor ; Humans ; Leukapheresis ; Leukocyte Count ; Stem Cells* ; Tissue Donors

Catastrophic antiphospholipid syndrome is a highly fatal condition characterized by widespread thromboembolism subsequent to a triggering factor (e.g., infection, trauma, and neoplasia) in antiphospholipid antibody-positive patients. This paper reports a case of a 29-year-old male without the underlying disease who developed extensive mesenteric thromboembolism and jejunal necrosis during the treatment for acute enteritis. The patient’s condition was improved with low-molecular-weight heparin and an intravenous Ig treatment with emergency surgery. The serum antiphospholipid (anticardiolipin IgM) and lupus anticoagulant antibody tests showed positive results. Acute infectious enterocolitis is generally considered a mild disease. On the other hand, aggressive evaluation and treatment should be considered if the clinical conditions do not improve and deteriorate rapidly despite appropriate antibiotic treatment because of the possibility of acute immunological complications, such as catastrophic antiphospholipid syndrome.

Catastrophic antiphospholipid syndrome is a highly fatal condition characterized by widespread thromboembolism subsequent to a triggering factor (e.g., infection, trauma, and neoplasia) in antiphospholipid antibody-positive patients. This paper reports a case of a 29-year-old male without the underlying disease who developed extensive mesenteric thromboembolism and jejunal necrosis during the treatment for acute enteritis. The patient’s condition was improved with low-molecular-weight heparin and an intravenous Ig treatment with emergency surgery. The serum antiphospholipid (anticardiolipin IgM) and lupus anticoagulant antibody tests showed positive results. Acute infectious enterocolitis is generally considered a mild disease. On the other hand, aggressive evaluation and treatment should be considered if the clinical conditions do not improve and deteriorate rapidly despite appropriate antibiotic treatment because of the possibility of acute immunological complications, such as catastrophic antiphospholipid syndrome.

BACKGROUND: We reviewed the guidelines for the transfusion of red cells, platelets, and fresh frozen plasma (FFP) of the Korean Society of Blood Transfusion and modified the previous guidelines for transfusions at our hospital. We evaluated the appropriateness of the current hospital transfusions with these algorithms based on these guidelines. METHODS: The medical records of 266 transfusion episodes of patients receiving transfusions of red cells (144), platelets (61), and FFP (61), were reviewed retrospectively at Ewha Womans University Mokdong Hospital during 2002. RESULTS: Inappropriateness rates for transfusion episodes were 2.8% for red cells, 4.9% for platelets, and 44.3% for FFP. 144 red cell transfusions comprised 73 episodes (50.7%) in acute blood loss and 71 (49.3%) in chronic anemia. Among them, 2 episodes in each condition were assessed as inappropriate, respectively. 61 platelet transfusions comprised 32 episodes (52.5%) for a prophylaxis in marrow failure and 13 (21.3%) for active bleeding and 6 (9.8%) for acute disseminated intravascular coagulation (DIC) and 10 (16.4%) for others. Among them, 3 episodes for clinical bleeding were assessed as inappropriate. Out of 61 FFP transfusions, 34 episodes (56%) (16 liver disease with complications, 11 acute DIC, and 7 others) were assessed as appropriate and 27 episodes (44%) (8 liver diseases without complications, 10 surgical procedures and 9 others) were assessed as inappropriate. CONCLUSIONS: We modified our previous guidelines for transfusions according to the transfusion guidelines proposed by the Korean Society of Blood Transfusions. These guidelines could be easily applied to evaluate the appropriateness of transfusions performed at our hospital and to specify the cases of inappropriate transfusions.
Anemia ; Blood Transfusion ; Bone Marrow ; Dacarbazine ; Disseminated Intravascular Coagulation ; Female ; Hemorrhage ; Humans ; Liver Diseases ; Medical Records ; Plasma* ; Platelet Transfusion ; Retrospective Studies

BACKGROUND: Pringle maneuver and nitroglycerin (NTG) administration to reduce hemorrhage during hepatectomy may affect renal blood flow (RBF) and renal cortical perfusion (RCP) by reducing blood pressure (BP), perload and others. However, so far there have been no studies on RBF and RCP changes during and after hepatic vascular maneuver in hepatectomy. The purpose of this study was to evaluate the changes in RBF and RCP along with low dose (2 microgram/kg/min) NTG with or without low dose (3 microgram/kg/min) dopamine after the occlusion and reperfusion of hepatic blood flow. METHODS: Eighteen mongrel dogs were divided into three groups according to drug administration after hepatic reperfusion; control group (group C, n = 6), NTG group (group N, n = 6), and NTG with dopamine group (group N-D, n = 6). After femoral arterial and central venous catheterization, a midline abdominal incision was made, and the hepatic artery (HA) and the portal vein (PV) were exposed for clamping and declamping. Thereafter, the right renal artery was exposed, and a doppler probe for measuring RBF was placed around the right renal artery, and a thermal diffusion microprobe was inserted in the renal outer cortex to measure RCP. Hemodynamics, RBF and RCP, were repeatedly measured before and after HA and PV reperfusion. RESULTS: No significant change in heart rate was observed in any group. The BP decreased in all the groups after HA and PV occlusion. In group C, the BP recovered to the baseline level after hepatic reperfusion but not in groups N and N-D. The RBF and RCP decreased in all groups after HA andPV occlusion. The RBF increased compared to baseline in N-D after hepatic reperfusion, and the RCP increased versus baseline in N-D, 10 minutes after hepatic reperfusion. CONCLUSIONS: In conclusion, it was observed that the RBF and RCP increased compared to baseline by administering dopamine during HA and PV reperfusion. Therefore, the prophylactic administration of low dose dopamine during hepatectomy offers an effective method of protecting renal function.
Animals ; Blood Pressure ; Catheterization, Central Venous ; Central Venous Catheters ; Constriction ; Dogs* ; Dopamine* ; Heart Rate ; Hemodynamics ; Hemorrhage ; Hepatectomy ; Hepatic Artery ; Liver* ; Nitroglycerin* ; Perfusion* ; Portal Vein ; Renal Artery ; Renal Circulation* ; Reperfusion* ; Thermal Diffusion

BACKGROUND/AIMS: Borrmann type 4 advanced gastric cancer (AGC) is difficult to diagnose. There are no typical endoscopic findings. Endoscopic biopsies have a high false negative rate because Borrmann type 4 AGC frequently resides below the submucosal cells from which it develops. The aim of this study was to investigate the endoscopic findings of Borrmann type 4 AGC in order to improve diagnosis rates. MATERIALS AND METHODS: A total of 24 patients with pathologically proven Borrmann type 4 AGC at the Ewha Womans University Medical Center between January 2008 and May 2013 were included. We divided the cases according to their distinguishing endoscopic findings. The diagnostic yield for endoscopic biopsies was evaluated. RESULTS: The most common endoscopic findings were cases with Bormann type 4 AGC like lesions (diffuse infiltrative, n=10), followed by Bormann type 3 AGC like lesions (ulceroinfiltrative, n=9), Borrmann type 2 AGC like lesions (ulcerofungating, n=4) and early gastric cancer like lesion (n=1). Among the 23 cases in which endoscopic biopsies was performed, the diagnostic yield for the first endoscopic biopsy was 87.0% (n=20). All of the second endoscopic biopsies failed to diagnose the malignancy. CONCLUSIONS: The endoscopic findings of Borrmann type 4 AGC are atypical and diverse. In cases where negative results are accompanied by a malignant impression, further meticulous evaluation should be performed with careful targeting.
Academic Medical Centers ; Biopsy ; Diagnosis ; Endoscopy, Gastrointestinal ; Female ; Humans ; Stomach Neoplasms*

PURPOSE: Endocrine abnormalities are common feature of chronic renal failure. The purpose of this study is to understand women's hormonal changes in connection with renal transplantation and to verify improved quality of life of recipient by comparing level of sexual hormone between renal transplant recipients and dialyzed patients. METHODS: To evaluate the level of hormones before and after female renal transplantation, we measured FSH, LH, estradiol, progesterone and prolactin (PRL) in 10 renal transplant recipients (RTR), 10 chronic renal failure patients (CRF) undergoing dialysis (hemodialysis or peritoneal dialysis) and 10 healthy, regularly menstruating women (controls). RESULTS: All 30 females' mean age was 37.83 years. All 10 RTR were menstruating and mean age was 38.6 years and mean serum creatinine (sCr) level was 1.09 mg/dL. Of ten dialyzed patients (6 hemodialysis and 4 peritoneal dialysis), nine of ten dialyzed patients had menstrual disturbance and their mean age was 37.5 years and mean sCr level was 9.8 mg/dL. In RTR, serum PRL and LH level were reduced compared with CRF patients, but these hormones were increased compared with controls. In RTR, progesterone level was significantly lower compared with controls, whereas slightly decreased compared with CRF patients. Estradiol level in dialyzed patients was significantly higher compared with RTR or controls and in RTR was increased compared with controls. CONCLUSION: Following successful renal transplantation, uremic hormonal abnormalities were ameliorated. However, these hormonal changes are not always fully restored which can be attributed to renal insufficiency grade or result from the administered immunosuppressive treatment.
Creatinine ; Dialysis ; Estradiol ; Female* ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation* ; Progesterone ; Prolactin ; Quality of Life ; Renal Dialysis ; Renal Insufficiency ; Transplantation