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

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

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

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

PURPOSE: To observe sequential changes of acute and subacute hypersensitivity pneumonitis in high resolution CT and to correlate the findings with pulmonary function test and bronchoalveolar lavage. MATERIALS AND METHODS: This study includes 11 patients with pathologically (n=10) and clinically(n=1) proved acute and subacute hypersensitivity pneumonitis. The extent of ground glass attenuation and nodules on high resolution CT scan was correlated with pulmonary function test and bronchoalveolar lavage. We also evaluated serial changes of the lesion in high resolution CT scans. RESULTS: The extent of parenchymal abnormalities on high-resolution CT scans were significantly correlated with diffusing capacity (GGA & DLco:r=0.95, p<0.003, Nodule & DLco:r=-0.94, P<.005) and FEV1 (GGA & FEV1: r=-0.57, p<.05, Nodule & FEV1: r=-0.56, P<.05) on pulmonary function test and relatively correlated with total count of cells (GGA & total count of cells: r=0.86, P<.03, Nodule & total count of cells: r=0.71, p<0. 11) on bronchoalveolar lavage. The order in disappearance of abnormal findings were poorly defined centrilobular nodule, ground glass attenuation, and well defined small centrilobular nodule on sequential CT scans. CONCLUSION: The authors conclude that HRCT is useful for diagnosis and follow up evaluation of the acute and subacute hypersensitivity pneumonitis. Quantitative analysis of extent of disease on HRCT is useful for evaluation of clinical status.
Alveolitis, Extrinsic Allergic* ; Bronchoalveolar Lavage* ; Diagnosis ; Follow-Up Studies ; Glass ; Humans ; Hypersensitivity* ; Respiratory Function Tests* ; Tomography, X-Ray Computed

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

Superficial fungal infections of the face, especially at the beard region, are frequently misdiagnosed. Application of corticosteroids modifies these original clinical manifestations and induces other dermatoses, which may lead to misdiagnosis. We report the case of a patient with fungal folliculitis on the face. The patient had multiple papules and pustules on the perioral area, cheek and periorbital area. Clinically, these lesions looked like lupus miliaris disseminatus faciei or rosacea. At first, we treated the patient with systemic roxithromycin and topical clindamycin, but there was no response to the therapy. Histopathological and mycological examinations revealed that the diagnosis was folliculitis due to Trichophyton mentagrophytes. The lesion was cured by administration of itraconazole for 6 weeks.
Adrenal Cortex Hormones ; Cheek ; Clindamycin ; Diagnosis ; Diagnostic Errors ; Folliculitis* ; Humans ; Itraconazole ; Rosacea ; Roxithromycin ; Skin Diseases ; Trichophyton*