Acromelanosis progressiva is a peculiar progressive pigmentary disorder characterized by intensely dark and sharply demarcated hyperpigmentation over the dorsa of fingers and toes, and the pigmentation rapidly spread proximally. A 19-year-old female had sharply demarcated symmetric dark aroarn macules on the dorsa of her hands and feet, forearms, lower legs, face and neck. These pigmentations at first appeared at the age of 5 on the dorsa of her fingers and toes, thereafter these pigmertatons spread progressively to the proximal portion of her body. Histologically, a proliferation of mela biocyte at the epidermal-dermal junction was seen, associated with mild hyperkeratosis. She was othervise normal on physical examination and had no family historv of consanguinity.
Consanguinity ; Female ; Fingers ; Foot ; Forearm ; Hand ; Humans ; Hyperpigmentation ; Leg ; Neck ; Physical Examination ; Pigmentation ; Toes ; Young Adult

No abstract available.
Constriction, Pathologic* ; Diagnosis*

Bilateral nonfunctioning adrenal cortical carcinoma is an extremely rare disease with poor prognosis. We report a case of asynchronous bilateral nonfunctioning adrenal cotical carcinoma. The patient was a 55 year-old man who had complained of discomfort in the right upper quadrant and flank area. There was no endocrinological abnomaliries. Abdominal CT revealed about 9.5 x 7.0 cm sized right adrenal mass. Under the impression of nonfunctioning adrenal cortical carcinorna, right radical adrenalectomy was performed. After 1 year from operation, 5.0 x 7.0 x 6.0 cm sized new mass was detected in the left adrenal gland with metastasis to the peritoneum.
Adrenal Glands ; Adrenalectomy ; Adrenocortical Carcinoma* ; Humans ; Middle Aged ; Neoplasm Metastasis ; Peritoneum ; Prognosis ; Rare Diseases ; Tomography, X-Ray Computed

The courses of the progression in the fibrous dysplasia are characterized by asymptomatic progression or spontaneous regression in some cases after the growth has ceased and the aims of treatment for a fibrous dysplasia are prevention of the pathologic fractures and correction of the deformities. The osteogenic potentiality of the cambium layer in the periosteum and the beneficial effect on the osteogenesis of the impregnating bone graft with autologous red marrow are well documented. We experienced an extensive fibrous dysplasia with cortical thinning and pathologic fracture and it was managed with subperiosteal combined xenograft of Kiel bone with autologous red marrow for the induction of cortical thickening and prevention of the pathologic fractures because of the inoperability of curettage due to extensive lesion over the entire femur, limitations in obtaining large amount of autogenous cancellous bone for the graft and lack of the facilities of the bone bank. This subperiosteal composite xenograft with autologous red marrow for a fibrous dysplasia gave an excellent result of a remarkable cortical thickening and we think this can be a type of management for a entensive fibrous dysplasia. So we are reporting this case with bibliographic reviews.
Bone Banks ; Bone Marrow ; Cambium ; Congenital Abnormalities ; Curettage ; Femur ; Fractures, Spontaneous ; Heterografts ; Osteogenesis ; Periosteum ; Transplants

Background: The reverse sural artery (RSA) flap is widely used for lower extremity reconstruction. However, patients sometimes suffer from donor site complications such as scar contracture and paresthesia, resulting in dissatisfaction with the aesthetic outcomes. This study investigated the characteristics of donor site morbidity associated with RSA flaps and described our experiences of dealing with complications by performing resurfacing surgery using thoracodorsal artery perforator (TDAP) flaps. Methods: From April 2008 to August 2018, a total of 11 patients underwent contracture release and resurfacing surgery using TDAP flaps due to donor morbidity associated with RSA flaps. All affected donor sites were covered with a skin graft, the most common of which was a meshed split-thickness skin graft (six cases). Results: Eight of the 11 patients (72.7%) suffered from pain and discomfort due to scar contracture, and seven (63.6%) complained of a depression scar. The donor sites were located 6.3±4.1 cm below the knee joint, and their average size was 140.1 cm². After resurfacing using TDAP flaps, significant improvements were found in the Lower Extremity Functional Scale (LEFS) scores and the active and passive ranges of motion (AROM and PROM) of the knee joint. The LEFS scores increased from 45.1 to 56.7 postoperatively (P=0.003), AROM increased from 108.2° to 118.6° (P=0.003), and PROM from 121.4° to 126.4° (P=0.021). Conclusions Planning of RSA flaps should take into account donor site morbidity. If complications occur at the donor site, resurfacing surgery using TDAP flaps achieves aesthetic and functional improvements.

To evaluate the role of digital rectal examination(DRE), prostate specific antigen(PSA), transrectal ultrasound(TRUS) and prostate specific antigen density(PSAD) and the effectiveness of TRUS-guided perineal prostatic biopsy in the diagnosis of prostate cancer, the clinical data were reviewed from the 78 patients who were suggested to have prostate cancer with DRE, PSA or TRUS, and pathologically confirmed by TRUS-guided six systematic biopsy between May 1993 and February 1995. Of 78 patients, 15 patients(19.2%) had prostate cancer, 60 patients(76.9%) BPH, 2 patients (2.6%) chronic prostatitis and 1 patient(1.3%) prostatic metastasis from transitional cell carcinoma of the bladder. Only 2 of 15 cancers (13.3%) were localized cancer, while 10 of 15 cancers(66.7%) had distant metastasis. Although 35 patients received TURP among 60 patients with BPH, and their specimens were investigated pathologically whether prostate cancer was present, there was no prostate cancer. Of 34 patients whose PSA levels were below 10ng/ml, none had prostate cancer regardless of the results of DRE and TRUS. PSA had the highest sensitivity(100%) and DRE the highest specificity (79.4%) among the modalities. The positive predictive value of DRE, PSA and TRUS was 48.0%, 22.1% and 36.1% respectively. DRE and TRUS had 54.5% and 44.8% Positive predictive value in patients with elevated PSA level in contrast to 0% positive predictive value in patients with normal PSA level. Because 3 patients of prostate cancer with negative DRE and positive TRUS had elevated PSA level(>20ng/ml), the addition of TRUS to PSA and DRE was not helpful in early detection of prostate cancer. Although PSAD of prostate cancer group and non-prostate cancer group was 1.312+/-0.155(S.E.) and 0.279+/-0.036 respectively(p<0.05), we could not found any superiority of PSAD to PSA in early diagnosis of prostate cancer. In conclusion, these results suggest that PSA and DRE should be used as the first line modality in early diagnosis of prostate cancer, TRUS-guided prostatic biopsy may be considered as a confirmative modality in patients with elevated PSA level or abnormal DRE and the clinical.trials for standardization of the upper normal limit of PSA should be followed.
Biopsy* ; Carcinoma, Transitional Cell ; Diagnosis ; Early Diagnosis ; Humans ; Neoplasm Metastasis ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Prostatitis ; Sensitivity and Specificity ; Transurethral Resection of Prostate ; Ultrasonography* ; Urinary Bladder

Bullous pemphigoid is an autoimmune, subepidermal blistering disease commonly seen in the elderly. It is known as autoimmune bullous dermatoses with an estimated prevalence of 1 in 40,000 and shows no gender or racial predilection. It has an autoimmune nature with immunoglobulin (Ig) G and/or C3 complement targeting hemidesmosomal antigens located in the epidermal basement membrane zone. Drug-induced pemphigoid, although rare, can occur in patients taking penicillamine, furosemide, captopril, penicillin, or sulfasalazine, but infliximab-induced pemphigoid has not been reported. We experienced a case of infliximab-induced pemphigoid in 54-year-old woman with a 17-year history of rheumatoid arthritis.
Aged ; Antibodies, Monoclonal ; Arthritis, Rheumatoid ; Basement Membrane ; Blister ; Captopril ; Complement C3 ; Female ; Furosemide ; Humans ; Infliximab ; Immunoglobulins ; Middle Aged ; Pemphigoid, Bullous ; Penicillamine ; Penicillins ; Prevalence ; Skin Diseases, Vesiculobullous ; Sulfasalazine

Transesophageal echocardiography(TEE) was performed during pharmacologic stress with dobutamine for evaluation of coronary artery disease in 15 patients (12 men, 3 women ; mean age, 70 years) with inadequate transthoracic echocardiographic images. In five patients, additional indications for TEE were present. Dobutamine was administered according to a standard protocol with a maximum dose of 40microg/kg per minute. Angina and an increase in simple ventricular ectopy were noted in one patient each, but no other complication or side effect was noted. Images (midesophageal four-and two-chamber views ad transgastric short-and long-axis views) were satisfactory for interpretation in 14 patients. In one patient, the apex could not be optimally visualized. Five patients (33%) had resting wall motion abnormalities. Wall motion abnormality developed in three patients(20%) and worsened in two(13%). Dobutamine stress TEE findings were normal in eight patients. Coronary angiography in two patients revealed significant stenosis corresponding to stress-induced wall motion abnormalities. Dobutamine stress TEE is a safe, feasible, well-toerated alternative to conventional stress echocardiography for detecting myocardial ischemia.
Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Dobutamine* ; Echocardiography ; Echocardiography, Stress ; Echocardiography, Transesophageal* ; Feasibility Studies* ; Female ; Humans ; Male ; Myocardial Ischemia

Idiopathic thrombocytupenic purpura is known as an autommune t,hrombocytopenic purpura. It is characterized by either an acute or gradual onset of petechiae or ecchymoses in the skin and mucous membranes, especially in the mouth. Epistaxis, conjunct.ival hemorrhage, hemorrhagic bullae in the mouth, gingival bleeding, melena, and hematemesis may occur. We report a case of idiopathic thrombocytopenic purpura in a 10-year-old male, who showed multiple petechiie and ecchymoses on both lower extremities, and hemorchagic bullae in the mouth. Periheral blood smear showed decreased platlet count, and in the bone marrow megakeyocytes were incraesed. Bleeding time was increased, but coagulation time was normal.
Bleeding Time ; Bone Marrow ; Child ; Ecchymosis ; Epistaxis ; Hematemesis ; Hemorrhage ; Humans ; Lower Extremity ; Male ; Melena ; Mouth ; Mucous Membrane ; Purpura ; Purpura, Thrombocytopenic, Idiopathic* ; Skin

No abstract available.
Animals ; Interleukin-2 ; Mice*