There are several methods for diagnosis of leprosy, including AFB stain, the measurement of PGL-1 (phenolic glycolipid - 1) antigen titer, and DNA-PCR. In this study, we have used the DNA-PCR amplifying the RLEP repetitive sequence. Our result showed that the RLEP primer offered the more sensitive detection and identification of M. leprae DNA in clinical specimens, compared with the other primer, for example, 18-kDa antigen gene. To screen the resistant M. leprae strain of MDT (Multi-Drug Therapy), we have used the TD (Touch-Down) PCR. We arranged and amplified sequences of the genes, folP, rpoB, gyr, 23S rRNA, in M. leprae involved in MDT-resistance, and could obtain the PCR product each gene, simultaneously. This method, based on annealing temperature, was useful to the detection for diagnosis and the screen of MDT-resistant strain of M. leprae, rapidly. Thus, we suggest that the RLEP primer and TD-PCR method are effective in assessing the diagnosis of leprosy and the identification of drug-resistant M. leprae.
Diagnosis* ; DNA ; Leprosy* ; Polymerase Chain Reaction* ; Repetitive Sequences, Nucleic Acid

PURPOSE: Arteriovenous fistula at the wrist has remained the procedure of choice for long-term chronic hemod ialysis since its development by Brecia and Cimino in 1966. Thrombosis is the most common cause of early failure after arteriovenous fistula procedure, should be reconized preoperatively or intraoperatively, but no consensus exits regarding the ideal preoperative or intraoperative screening method for access surgery. We describe a simple intraoperative maneuver that can be used to detect proximal stenotic vein segments. METHODS: From September 1998 to September 1999, a total of 117 arteriovenous fistulas were performed for permanent hemodialysis in patients with chronic renal failure. Of them, a intraoperative evoked thrill test was performed in 61 patients (A group), in 56 patients (B group or control group) was not. RESULTS: Early failure rate (<30 days) was 12.5% in A group, 9.8% in B group or control group. In this study, the specificity and positive predictive value of the evoked thrill test was 100%, indicating that this maneuver is highly accurate in predicting early failure. CONCLUSION: Evoked thrill test is a simple and useful intraoperative method for improving the patency rate of autologous arteroiovenous fistula.
Arteriovenous Fistula* ; Consensus ; Fistula ; Humans ; Kidney Failure, Chronic ; Mass Screening ; Renal Dialysis ; Sensitivity and Specificity ; Thrombosis ; Veins ; Wrist

BACKGROUND: The pathogenesis of silicosis has been focused on the interaction between alveolar macrophages and silica particle. Although fibrosis in silicosis has been studied extensively, the mechanism is still not fully understood. There is increasing evidence that monokines and arachidonic acid metabolites produced by macrophage are involved in pathogenesis of silicosis. Recently, it was reported that prostaglandin E2 produced from macrophage counteracts the stimulatory effects of other monokines on fibroblast proliferation or collagen production. Until now, it was remained uncertain by which mechanism silica particle may activate alveolar macrophage to an enhanced release of prostaglandin E2. METHODS: In order to investigate the relationship between the activity of alveolar macrophage and the production of PGE2 from activated alveolar macrophage, the authors measured hydrogen peroxide and PGE2 from alveolar macrophages activated by silica in vitro and from alveolar macrophages in the silicotic nodules from rat. Experimental silicosis was induced by intratracheal infusion of silica(SiO2) suspended in saline (50 mg/ml) in Sprague-Dawley rats. RESULTS: 1) The silicotic nodules with fibrosis were seen from the sections of rat lung at 60 days after intratracheal injection with 50 mg aqueous suspension of silica. 2) In vitro, silica caused the dose dependent increase of hydrogen peroxide(p<0.05) and PGE2(p>0.05) release from alveolar macrophages. Alveolar macrophages from rats with silicotic nodules released more hydrogen peroxide and PGE2 than those of control group(p<0.05). CONCLUSION: These results suggest that silica particle could activate macrophage directly and enhanced the release of PGE2 and hydrogen peroxide from the alveolar macrophage.
Animals ; Arachidonic Acid ; Collagen ; Dinoprostone* ; Fibroblasts ; Fibrosis ; Hydrogen ; Hydrogen Peroxide ; Lung ; Macrophages ; Macrophages, Alveolar* ; Monokines ; Rats ; Rats, Sprague-Dawley ; Silicon Dioxide* ; Silicosis

PURPOSE: Schwannoma, a benign peripheral nerve tumor, is slow-growing, encapsulated neoplasm that originates from the Schwann cell of the nerve sheath. Schwannoma most frequently involves the major nerve. Schwannoma occurring in the superficial radial nerve rare. This is a report of our experience with schwannoma arising from the superficial radial nerve with neurologic symptom. METHODS: A 55-year-old woman presented with eight-month history of progressive numbness and paresthesia in dorsum of the thumb and index finger. Physical examination revealed a localized mass on the midforearm. Sonographic examination showed an ovoid, heterogenous, hypoechoic lesion, located eccentrically in related to the superficial radial nerve. The lesion was mobile in the transverse but not in the longitudinal axis of the nerve, which was thought to favour schwannoma rather than neurofibroma. At operation, a 20 x 15 mm ovoid, yellowish grey mass was seen arising from the superficial radial nerve. The tumor present as eccentric masses over which the nerve fibers are splayed. Using operating microscope, the tumor was removed, preserving the surrounding nerve. RESULTS: Histology confirmed that the mass was a benign schwannoma. There were no postoperative complications. After two months the patient had no clinically demonstrable sensory deficit. CONCLUSION: An unsusual case of a schwannoma of the superficial radial nerve is presented. In case with neurologic symptom, prompt surgical decompression must be made to prevent further nerve damage and to restore nerve function early.
Axis, Cervical Vertebra ; Decompression, Surgical ; Female ; Fingers ; Humans ; Hypesthesia ; Middle Aged ; Nerve Fibers ; Neurilemmoma ; Neurofibroma ; Neurologic Manifestations ; Paresthesia ; Peripheral Nervous System Neoplasms ; Physical Examination ; Postoperative Complications ; Radial Nerve ; Thumb

No abstract available.

PURPOSE: Pincer nail is a relatively rare deformity characterized by an increase in transverse curvature along the longitudinal axis of the nail. This curvature commonly increases from proximal to distal end of nail, leading to pinching, curling, and distortion of the underlying soft tissue and resulting frequently in severe pain. Numerous surgical procedures have been reported. Preserving the width of the nail in the correction of the pincer nail is very important for functional and aesthetic reasons. We report the results of the correction of the pincer nail using autogenous dermofat graft with a good result. METHODS: From May 2006 to September 2008, dermofat graft was performed in 6 patients with pincer nail. Patients were four women and two men, and the average age was 51. The affected digits were the unilateral great toes in four patients and the unilateral thumbs in two patients. Average follow-up period was 13 months. Surgical procedure was removal of nail using an elevator to avoid damage to the nail bed. An incision was created in distal portion of hyponychium. Paronychium was dissected from distal phalanx by periosteal elevator through incision of hyponychium and tunnel was made. Then dermofat grafts harvested from inguinal area were inserted into the tunnel. Finally, a silicone sheet was inserted eponychial fold for prevention of synechia. Objective assessment was evaluated by use of the width index and height index. RESULTS: All patients reported resolution of the pain and soft tissue pinching sensation that they had before the operation. There was good adherence between the nail plate and the underlying nail bed. The nails have regrown and were corrected in a normal and flattened appearance. The width index and height index were improved. CONCLUSION: The autogenous dermofat graft seems to provide an effective treatment of the pincer nail with preservation of the nail matrix.
Axis, Cervical Vertebra ; Congenital Abnormalities ; Elevators and Escalators ; Female ; Follow-Up Studies ; Humans ; Male ; Nails ; Sensation ; Silicones ; Thumb ; Toes ; Transplants

PURPOSE: Panendothelial markers such as factor VIII, CD34, CD31, CD105 (endoglin) and D2-40 are useful to identify proliferating endothelium that is related to tumor invasion. This study was designed to identify the correlation between the expressions of panendothelial and lymphatic vessel markers in preoperative biopsy specimens and the clinicopathologic factors. METHODS: Preoperative biopsy specimens from 72 patients were immunostained for CD105, CD34, CD31, Factor VIII and D2-40. The microvessel and lympathic vessel densities (MVD and LVD) were counted in dense vascular foci (hot spots) on a x200 field in each specimen. The correlation between these factors and the clinicopathologic parameters were analyzed. RESULTS: The MVD by CD105 showed statistically significant correlation with tumor emboli, the T-stage, nodal metastasis and the stage, and the MVD by CD34 had statistically significant correlation with tumor emboli, nodal metastasis and the stage. The lympathic vessel density (LVD) by D2-40 showed a statistically significant correlation with tumor emboli, the T-stage and nodal metastasis. CONCLUSION: The MVD by CD105 and the LVD by D2-40 in preoperative biopsy specimens of colorectal cancers may be useful markers for the prediction of invasiveness.
Biopsy* ; Colorectal Neoplasms* ; Endothelium ; Factor VIII ; Humans ; Lymphatic Vessels* ; Microvessels ; Neoplasm Metastasis

The frequencies of multiple synchronous carcinomas of the colon and the rectum have been reported to range from 2.1 to 6.3%. Currently, the frequency is higher in colorectal cancer patients, and the diagnosis is better due to the many diagnostic tools that have been developed. There are a few reported cases of five cancers in a patient at the same time. We report here on the case of five synchronous cancers arising from the colon and the rectum in a patient without a familial history of colon cancer or of genetic predisposing factor. The patient was a 62-yr-old woman who presented with frequently loose stool for six months and intermittent abdominal pain for two months. Colonoscopic examination revealed two adenocarcinomas, one each at the sigmoid colon and the rectum; the cancer in the sigmoid colon was obstructed at nearly 40 cm above the anal verge. Computed tomographic colonoscopy revealed many other polyps and masses in the colon and a metastatic mass at segment 8 in the liver. A total proctocolectomy and ileostomy were performed. Histologic evaluation revealed the five lesions to be adenocarcinomas invading the pericolic fat; 1 out of 30 lymph nodes was invaded by the cancer cells.
Abdominal Pain ; Adenocarcinoma ; Colon ; Colon, Sigmoid ; Colonic Neoplasms ; Colonoscopy ; Colorectal Neoplasms ; Female ; Humans ; Ileostomy ; Liver ; Lymph Nodes ; Polyps ; Rectum

PURPOSE: In treatment of facial bone fracture, occurred in children, we generally use wires, miniplate, absorbable plate or their combination. These foreign bodies can be palpable, and sometimes may cause infections, and need reoperation for removing. When bone fragments are multiple, small or thin, they are hard to handle and make accurate reduction of all fragments. In these cases, a biodegradable tissue adhesive, Histoacryl(R) (n-butyl-2-cyanoacrylate), can be used as fixation technique for small, multiple, and thin fracture fragments. METHODS: 3 years old and 6 years old children, who has comminuted fracture on frontal sinus, we used Histoacryl(R) for fixation of multiple bone fragments. After approaching by coronal incision, we pulled out all bone fragments and reconstructed bone fragments by Histoacryl(R) and fixed those on frontal sinus by absorbable plates. RESULTS: Photographs and 3-dimensional CT obtained preoperatively and postoperatively. And we compared them each other in terms of accuracy of reconstructed bony contour. We could reconstruct almost all bone fragments easily along 3-dimensional structure and get excellent aesthetic results. There was no complication such as infection. CONCLUSION: In treatment of comminuted facial bone fracture, occurred in children, Histoacryl(R) is an excellent method for accurate reconstruction in small and thin bone fragments which cannot be fixed by wire, miniplate or absorbable plate without complication.
Child ; Enbucrilate ; Facial Bones ; Foreign Bodies ; Fractures, Comminuted ; Frontal Sinus ; Humans ; Reoperation ; Tissue Adhesives

PURPOSE: Schwannoma is a slow-growing, encapsulated benign peripheral nerve tumor that originates from the Schwann cell of the nerve sheath. Schwannoma most frequently involves the major nerve. Schwannoma of the foot is rare. This is a report of our experience with a small, deep-seated, and non-palpable schwannoma occurring in the foot. METHODS: A 42-year-old woman presented with the plantar pain of the right foot during 2 years. Physical examination did not identified a palpable mass. She made a clinical diagnosis of plantar fasciitis and was conservatively treated 2 years ago. Since her plantar foot pain was aggravated, she was recently visited again. For the evaluation of her plantar foot pain, sonographic examination of the whole right foot was performed, and it revealed a small hypoechoic hetergenous, deep-seated mass beneath the plantar aponeurosis. At operation, a 0.7x0.6x0.4cm sized, ovoid, yellowish grey mass was removed. RESULTS: Histology was confirmed that the mass was a benign schwannoma. There were no postoperative complications. CONCLUSION: Unsusual case of a schwannoma with the plantar foot pain during 2 years is presented. It should be recognized a small, deep-seated, non-palpable schwannoma as a possible cause of plantar foot pain.
Adult ; Fasciitis, Plantar ; Female ; Foot ; Humans ; Neurilemmoma ; Peripheral Nervous System Neoplasms ; Physical Examination