A 42-year-old woman presented with ichthyosiform eruptions on her trunk and buttock which developed 20 days prior to consulatation. She had taken the cholesterol-lowering drug(lovastatin, a 3-hydroxy-3-methylglutaryl-coenzyme A (HMG CoA) reductase inhibitor) for 4 months. After stopping the drug, the skin lesions gradually improved and after two months most of the lesions had disappeared. After 3 months of follow up the skin lesions could not be seen any more. Acquired ichthyosis in our patient could be an untoward effect of HMG CoA reductase inhibitor by disturbing the skin lipid metabolism.
Adult ; Buttocks ; Female ; Follow-Up Studies ; Humans ; Hydroxymethylglutaryl CoA Reductases ; Ichthyosis* ; Lipid Metabolism ; Lovastatin ; Oxidoreductases ; Skin

BACKGROUND: Immunolcgical assays are required for the accurate diagnosis of autoimmune bullous dermatoses including pemphigus vulgaris(PV) and pemphigus foliaceus(PF). In the detection of circulating autoantibodies to pemphigus antigens(desmosomal components), the priority remains controversial between indirect immunofluorescence(IF) and immunoblot(IB) assay. OBJECTIVE: In the present study we compared the sensitivity of indirect IF and that of IB using amplified alkaline phosphatase staining system in the detection of pemphigus autoantibodies. PATIENTS: We selected eight patients with serum endpoint titer of 1:80 in preliminary study. Among these patients three were PV and five were PF. METHODS/RESULTS: The titers of IgG autoantibodies found on indirect IF were confirmed as 1: 80 in all patients, whereas the titers examined by IB assay were much higher, 1: 640 to 1: 2560. In the 3 sera of PV patients, the titers of two cases were 1: 1280 and the third case was 1: 2560. In 5 cases of PF, one was 1:640, two were 1: 1280, and two were 1:2560. CONCLUSION: This result suggests that the immunoblot examination using amplified alkaline phosphatase staining system demonstrates higher sensitivity compared with indirect IF(p=0.0003 by Mann-Whitney U test) in the detection of pemphigus autoantibodies.
Alkaline Phosphatase ; Autoantibodies* ; Diagnosis ; Fluorescent Antibody Technique, Indirect* ; Humans ; Immunoglobulin G ; Pemphigus* ; Skin Diseases, Vesiculobullous

BACKGROUND: Immunolcgical assays are required for the accurate diagnosis of autoimmune bullous dermatoses including pemphigus vulgaris(PV) and pemphigus foliaceus(PF). In the detection of circulating autoantibodies to pemphigus antigens(desmosomal components), the priority remains controversial between indirect immunofluorescence(IF) and immunoblot(IB) assay. OBJECTIVE: In the present study we compared the sensitivity of indirect IF and that of IB using amplified alkaline phosphatase staining system in the detection of pemphigus autoantibodies. PATIENTS: We selected eight patients with serum endpoint titer of 1:80 in preliminary study. Among these patients three were PV and five were PF. METHODS/RESULTS: The titers of IgG autoantibodies found on indirect IF were confirmed as 1: 80 in all patients, whereas the titers examined by IB assay were much higher, 1: 640 to 1: 2560. In the 3 sera of PV patients, the titers of two cases were 1: 1280 and the third case was 1: 2560. In 5 cases of PF, one was 1:640, two were 1: 1280, and two were 1:2560. CONCLUSION: This result suggests that the immunoblot examination using amplified alkaline phosphatase staining system demonstrates higher sensitivity compared with indirect IF(p=0.0003 by Mann-Whitney U test) in the detection of pemphigus autoantibodies.
Alkaline Phosphatase ; Autoantibodies* ; Diagnosis ; Fluorescent Antibody Technique, Indirect* ; Humans ; Immunoglobulin G ; Pemphigus* ; Skin Diseases, Vesiculobullous

Expression of nucleoside diphosphate(NDP) kinase, which is homologous to the nm23 gene product in a variety of species, has been found to be inversely associated with metastatic potential. However, the relationship remains controversial according to the tumor cell types and experimental system, with conflicting results from different research groups. In order to determine whether NDP kinase expression serves as a marker for metastatic potential in human skin cancer, we assessed the levels of NDP kinase expression in 9 keratoacanthomas (KAs), 26 squamous cell carcinomas (SCCs), and 25 basal cell carcinomas (BCCs) using immunohistochemistry. The expression of NDP kinase was intense in KA and SCC compared with BCC. However, the difference of NDP kinase expression between KA and SCC was not statistically significant. And there was no statistically significant difference in NDP kinase expression between SCC with metastasis and SCC without metastasis. Our results contradict the hypothesis concerning the possible role of nm23 gene as a metastatic suppressor gene in human skin cancer. The mechanism of overexpression in various tumor cell types and its biological significance in cutaneous carcinogenesis remain to be determined.
Antibodies, Monoclonal ; Carcinoma, Basal Cell/enzymology/secondary ; Carcinoma, Squamous Cell/enzymology/secondary ; Comparative Study ; Erythrocytes/enzymology ; Human ; Immunohistochemistry ; Keratoacanthoma/enzymology ; Nucleoside-Diphosphate Kinase/*analysis/blood ; Skin Diseases/enzymology ; Skin Neoplasms/*enzymology/secondary ; Transcription Factors/analysis

Anastomosing hemangioma (AH), a rare benign vascular tumor, is a newly recognized variant of capillary hemangioma. In the microscopic examination, this tumor has characteristic feature of the unique anastomosing sinusoidal capillary sized vessels. It can be misdiagnosed as a malignancy such as renal cell carcinoma or angiosarcoma. Herein, we report a case of AH originating in the right kidney of a 43-year-old man, which was initially considered as cystic renal cell carcinoma on computed tomography (CT). The patient underwent laparoscopic radical nephrectomy, but pathologic result was AH of the kidney. There was no evidence of recurrence or metastasis 5 months after the surgery.
Adult ; Capillaries ; Carcinoma, Renal Cell* ; Hemangioma* ; Hemangioma, Capillary ; Hemangiosarcoma ; Humans ; Kidney ; Neoplasm Metastasis ; Nephrectomy ; Recurrence

This is a case report of complete mouth rehabilitation in a patient with generalized attrition and loss of posterior support. After analyzing the condition of the temporomandibular joint, multiple implants were placed to restore collapsed occlusion. Fixture/abutment level intraoral scanning was done instead of using conventional impression materials which entail multiple bite registration for cross-mounting. A ‘jaw motion tracking’device, ‘digital face-bow transfer’, and ‘double scan technique’ which enables duplicating temporary restoration to definitive restoration were used to fabricate definitive prostheses. By using various digital techniques, complete mouth rehabilitation was done with minimal chair time in a patient with unstable occlusion.

BACKGROUND: Nitrous oxide (N2O) and remifentanil both have anesthetic-reducing and antinociceptive effects. We aimed to determine the anesthetic requirements and stress hormone responses in spinal cord-injured (SCI) patients undergoing surgery under sevoflurane anesthesia with or without pharmacodynamically equivalent doses of N2O or remifentanil. METHODS: Forty-five chronic, complete SCI patients undergoing surgery below the level of injury were randomly allocated to receive sevoflurane alone (control, n = 15), or in combination with 67% N2O (n = 15) or target-controlled infusion of 1.37 ng/ml remifentanil (n = 15). Sevoflurane concentrations were titrated to maintain a Bispectral Index (BIS) value between 40 and 50. Measurements included end-tidal sevoflurane concentrations, mean arterial blood pressure (MAP), heart rate (HR), and plasma catecholamine and cortisol concentrations. RESULTS: During surgery, MAP, HR, and BIS did not differ among the groups. Sevoflurane concentrations were lower in the N2O group (0.94 +/- 0.30%) and the remifentanil group (1.06 +/- 0.29%) than in the control group (1.55 +/- 0.34%) (P < 0.001, both). Plasma concentrations of norepinephrine remained unchanged compared to baseline values in each group, with no significant differences among groups throughout the study. Cortisol levels decreased during surgery as compared to baseline values, and returned to levels higher than baseline at 1 h after surgery (P < 0.05) without inter-group differences. CONCLUSIONS: Remifentanil (1.37 ng/ml) and N2O (67%) reduced the sevoflurane requirements similarly by 31-39%, with no significant differences in hemodynamic and neuroendocrine responses. Either remifentanil or N2O can be used as an anesthetic adjuvant during sevoflurane anesthesia in SCI patients undergoing surgery below the level of injury.
Anesthesia ; Arterial Pressure ; Catecholamines ; Heart Rate ; Hemodynamics ; Humans ; Hydrocortisone ; Nitrous Oxide* ; Norepinephrine ; Plasma ; Spinal Cord Injuries

Calciphylaxis has been described as a rare condition in patients with end-stage renal disease and secondary hyperparathyroidism. Selye et al. first coined the term calciphylaxis to describe soft-tissue calcification and cutaneous necrosis. The common manifestation include painful digital necrosis and medial calcification of small and medium sized vessels. Calciphylaxis is a clinical diagnosis and is characterized by painful, violaceous, mottled skin lesions. Radiographic studies reveal calcification of median and small vessels under the knee but vascular calcification is not specific for calciphylaxis. Histolopathologic findings show a markedly reduced lumen, secondary to the fibrin deposition and inflammation in and around the outer media with an outer ring of calcification which leads to progressive ischemic tissue necrosis. Kidney transplantation and parathyroidectomy is recommened but it is controversial. We present the case of a 64-years-old man with chronic renal failure as well as painful ischemic necrosis on the lower extremity. The pertinets literature is reviewed.
Calciphylaxis ; Diagnosis ; Fibrin ; Humans ; Hyperparathyroidism, Secondary ; Inflammation ; Kidney Failure, Chronic* ; Kidney Transplantation ; Knee ; Lower Extremity ; Necrosis ; Numismatics ; Parathyroidectomy ; Skin ; Vascular Calcification

BACKGROUND: Ultraviolet(UV) light is one of the injurious environmental agents which is known to lead to apoptosis of cells. However, studies on UVB-induced apoptosis of melanocytes are still lacking and there are some discrepancies between researchers. OBJECTIVE: Our purpose was to evaluate the characteristics of UVB-induced apoptosis of melanocytes and G361 cells. METHODS: Cultured normal human melanocytes and malignant melanoma cell lines (G361 cells) were analyzed by several detection methods including morphological examination of propidium iodide(PI) stained cells under fluorescence microscopy, quantitation of fragmented DNA, and flow cytometric analysis. RESULTS: Both melanocytes and G361 cells showed similar rate of apoptosis with gradual increment of UVB doses by the quantitation of fragmented DNA. However, flow cytometric analysis using scatter properties and PI stainability revealed that the melanocytes were more resistant to UVB than G361 cells. CONCLUSION: We suggest that melanocytes seem to be more resistant to UVB-induced injury than G361 cells. In addition, various methods for the detection of apoptosis might be necessary for its study. (Ann Dermatol 10:(3) 147152, 1998).
Apoptosis* ; Cell Line ; DNA ; Humans* ; Melanocytes* ; Melanoma ; Microscopy, Fluorescence ; Propidium

PURPOSE: Increasing evidence suggests that Randalls plaque contributes to the pathogenesis of urinary stone formation. The purpose of our study is to compare the incidence of the abnormal metabolic stone risk factors between the calcium stone former with papillary calcification and the calcium stone former without papillary calcification on unenhanced spiral computed tomography (CT). MATERIALS AND METHODS: A series of patients with calcium stones (n=49) underwent unenhanced spiral CT and complete metabolic evaluation after they consumed a random diet for 1 month after stone removal. Of the 49 patients, 38 patients showed papillary calcification on unenhanced spiral CT and 11 patients did not. Their blood was evaluated by using a multichannel analysis sequential multichannel autoanalyzer (SMA)-20 and PTH tests. The 24-hour urinary constituents were assayed for calcium, oxalate, citrate, total volume, phosphorus and sodium. We compared the incidence of abnormal metabolic risk factors between the two groups. Statistical analysis was performed by chi-square tests. RESULTS: The incidences of hyperuricemia were 27.3% in the patients without papillary calcification and 31.6% in the patients with papillary calcification. The incidences of hypernatriuria were 18.2% versus 42.1%, the incidences of hypercalciuria were 36.4% versus 26.3%, the incidences of hyperuricosuria were 18.2% versus 18.4%, the incidences of hyperoxaluria were zero versus 28.9%, and the incidences of hypocitraturia were 45.5% versus 44.7%, respectively. The difference between the two groups was statistically significant only for hyperoxaluria (p=0.043). CONCLUSIONS: Hyperoxaluria is the only metabolic risk factor that more frequently occurred in the patients with papillary calcification. Our date suggest that hyperoxaluria may be an important factor in the pathogenesis of papillary calcification.
Calcium ; Citric Acid ; Diet ; Humans ; Hypercalciuria ; Hyperoxaluria ; Hyperuricemia ; Incidence ; Phosphorus ; Risk Factors* ; Sodium ; Tomography, Spiral Computed* ; Urinary Calculi