Pigmented(melanotic) schwannoma is a very rare variant of schwannoma that characteristically has massive cytoplasmic melanin. Since it was described in 1946 by Bjorneboe, about 44 cases have been reported in the English literature. It has a relatively benign clinical course, but the cases arising in the cranial nerve and sympathetic chain show aggressive behavior with malignant potential. We herein report a typical case of pigmented schwannoma with light microscopic findings. The results of immunohistochemical and electronmicroscopic study are also presented. The patient was a 30 year-old Korean male who had a mass in his posterior neck for 10 years that recently.began to induce neurologic manifestations. The tumor, which was mainly in the extramedullary intradural space of the cervical canal extending to the extradural space and soft tissues of the neck, was relatively well defined and composed of black solid tissue. Microscopic, densely pigmented spindle cells forming fascicles, nuclear palisading, whorling and polygonal cells with vacuolated or clear cytoplasm were characteristic. Immunohistochemically, the tumor cells were positive for vimentin, S-100 protein, and HMB-45. Electron microscopic study revealed that the tumor cells have interdigitating cytoplasmic processes containing varying stages of melanosomes with a very focal basal lamina and Luse body like collagen bundles.
Male ; Humans

OBJECTIVE: Spontaneous intracerebral hemorrhage (ICH) in young adults is rare. The purpose of this study was to investigate causes, sites and other factors affecting the prognosis of ICH in young adults aged < or = 40 years. METHODS: We reviewed 39 consecutive patients diagnosed with spontaneous ICH between January 2001 and June 2012. Patients with primary subarachnoid hemorrhage, previously diagnosed brain tumor bleeding, or vascular malformation were excluded. We analyzed the differences in prognostic factors such as hemorrhage location and vascular structural etiology. The outcome was measured using the Glasgow outcome scale (GOS), and a good outcome was defined as a score of 4 or more. RESULTS: We retrospectively evaluated 39 patients (mean age, 33 years; SD = 6.4, range 17 to 40 years). The most common structural etiology was arteriovenous malformation. A statistically significantly higher proportion of patients with good outcomes had a lower initial systolic blood pressure (SBP < or = 160 mmHg, p = 0.036), a higher initial Glasgow coma scale (GCS) (9 or more, p = 0.034), lower cholesterol levels (< 200 mg/dl, p = 0.036), and smoking history (at discharge, p = 0.008; 6 months after discharge, p = 0.019). CONCLUSION: In this study, cryptogenic ICH was the leading cause of spontaneous ICH. A GCS score of 9 or more on admission, a lower serum cholesterol level (< 200 mg/dl), and a lower SBP (< 160 mmHg) predicted a good outcome.
Aged ; Arteriovenous Malformations ; Blood Pressure ; Brain Neoplasms ; Cerebral Hemorrhage ; Cholesterol ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Hemorrhage ; Humans ; Prognosis ; Retrospective Studies ; Smoke ; Smoking ; Subarachnoid Hemorrhage ; Vascular Malformations ; Young Adult

OBJECTIVE: Spontaneous intracerebral hemorrhage (ICH) in young adults is rare. The purpose of this study was to investigate causes, sites and other factors affecting the prognosis of ICH in young adults aged < or = 40 years. METHODS: We reviewed 39 consecutive patients diagnosed with spontaneous ICH between January 2001 and June 2012. Patients with primary subarachnoid hemorrhage, previously diagnosed brain tumor bleeding, or vascular malformation were excluded. We analyzed the differences in prognostic factors such as hemorrhage location and vascular structural etiology. The outcome was measured using the Glasgow outcome scale (GOS), and a good outcome was defined as a score of 4 or more. RESULTS: We retrospectively evaluated 39 patients (mean age, 33 years; SD = 6.4, range 17 to 40 years). The most common structural etiology was arteriovenous malformation. A statistically significantly higher proportion of patients with good outcomes had a lower initial systolic blood pressure (SBP < or = 160 mmHg, p = 0.036), a higher initial Glasgow coma scale (GCS) (9 or more, p = 0.034), lower cholesterol levels (< 200 mg/dl, p = 0.036), and smoking history (at discharge, p = 0.008; 6 months after discharge, p = 0.019). CONCLUSION: In this study, cryptogenic ICH was the leading cause of spontaneous ICH. A GCS score of 9 or more on admission, a lower serum cholesterol level (< 200 mg/dl), and a lower SBP (< 160 mmHg) predicted a good outcome.
Aged ; Arteriovenous Malformations ; Blood Pressure ; Brain Neoplasms ; Cerebral Hemorrhage ; Cholesterol ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Hemorrhage ; Humans ; Prognosis ; Retrospective Studies ; Smoke ; Smoking ; Subarachnoid Hemorrhage ; Vascular Malformations ; Young Adult

BACKGROUNDS/AIMS: The objective of this study was to evaluate the relationship between initial personal experiences with distal pancreatectomy and perioperative risk factors, outcomes, and management of pancreatic fistulas. METHODS: Between May, 2007 and May, 2010, a total of 28 patients who had undergone elective distal pancreatectomy were evaluated for this study. Perioperative factors and the occurrence of pancreatic fistula were analyzed on the basis of International Study Group of Pancreatic Fistula (ISGPF) criteria. RESULTS: There were sixteen cases of benign neoplasms and twelve cases of malignant tumors. The remnant pancreas was manually sutured with ligation of the pancreatic duct (n=14), auto-suture stapling along with manual sutures (n=12), or stapling alone (n=2). According to the ISGPF classification, morbidity and mortality associated with pancreatic fistulas was 42.9% (n=12) and 0%, respectively. These pancreatic fistulae were classified as grade A in 8 cases (28.6%), grade B in 3 cases (10.7%), and grade C in one case (3.6%). All patients with pancreatic fistula were treated conservatively. CONCLUSIONS: Perioperative factors do not affect the risk of pancreatic fistula. Adequate drainage is the most effective method for management of a pancreatic fistula after distal pancreatectomy.
Drainage ; Humans ; Ligation ; Pancreas ; Pancreatectomy ; Pancreatic Ducts ; Pancreatic Fistula ; Risk Factors ; Sutures

PURPOSE: The purpose of this study was to evaluate the effects of a mentoring program to improve the exercise and dietary habits of adolescents. METHODS: A non-equivalent control group, pretest-posttest design was used. The independent variable was a mentoring program for improvement of exercise and dietary habits of adolescents, in which the mentors were nursing students and the mentees were female middle school students. The dependent variables were weekly exercise frequency, weekly exercise time, perception of exercise benefit, frequency of vegetable intake, and dietary habits. The intervention was conducted by various methods such as group education, individual approach through the mentor-mentee relationship, and multimedia approaches. RESULTS: At follow-up, the perception of the exercise benefit was significantly greater in the intervention group than in the control group. The weekly exercise frequency and frequency of vegetable intake in the intervention group were significantly greater after the intervention than those before the intervention. CONCLUSION: This mentoring program is potentially of an effective health promotion program for adolescents and will enable nursing students who participate in the program as mentors to gain confidence in their professional capability.
Adolescent ; *Adolescent Psychology ; Data Interpretation, Statistical ; *Exercise ; Female ; *Food Habits ; Health Promotion ; Humans ; *Mentors ; Program Development ; Students/psychology

Pembrolizumab is an immune checkpoint inhibitor that selectively blocks the programmed cell death (PD)-1 receptor. Although it has a dramatic effect on the treatment of advanced malignancies, instability of immune tolerance may cause immune-related adverse events in the skin. A 62-year-old male with a history of metastatic urothelial carcinoma was referred to the dermatology department and presented with a widespread mucocutaneous rash. Itching appeared 7 days after the first administration of pembrolizumab, and on the third day after the second administration, an erythematous maculopapular rash that coalesced into large flaccid bullae on the whole body with a positive Nikolsky’s sign developed. A biopsy revealed a subepidermal bulla with basal keratinocyte necrosis. Pembrolizumab was discontinued due to the diagnosis of toxic epidermal necrolysis (TEN), and intravenous methylprednisolone was started. Herein, we report a case of TEN induced by pembrolizumab to highlight immune-related cutaneous adverse events in patients receiving anti-PD-1 therapy.

Background: Patients with stable psoriasis showing clearear-clear response can consider extending the dosing interval of biologics. However, few studies have reported the treatment outcomes following irregular dosing intervals of biologics in patients with psoriasis. Objective: We compared treatment outcomes after regular and irregular dosing intervals of biologics in patients with psoriasis. Methods: This single-center, retrospective observational study included patients who received biologics for treatment of plaque psoriasis between January 1, 2014 and December 31, 2019. We compared patient demographics, clinical characteristics, biologics administered, and treatment outcomes based on the regularity of the dosing interval. Results: Among 95 patients investigated, 63 (66.3%) received biologics at regular dosing intervals. We observed no significant intergroup differences in the final Psoriasis Area Severity Index (PASI) scores (1.2 vs. 1.8, p=0.16) and in the percentage improvement in PASI scores from baseline levels (−89.8% vs. −90.8%, p=0.68). The rate at which biologics were switched was higher in the irregular-dosing group than in the regular-dosing group; however, the difference was statistically nonsignificant (28.1% vs. 12.7%, p=0.06). We observed a significant intergroup difference in patients who were administered guselkumab at baseline (12 [21.8%] vs. 0 [0.0%], p=0.01). Conclusion This study showed that compared with regular dosing intervals, irregular dosing intervals of biologics were associated with high rates of switching of these agents, although we observed no statistically significant differences with regard to PASI scores. Therefore, it is important to adhere to the standard dosing schedule prescribed for biologics, and guselkumab may improve patient compliance.

BACKGROUND: Ferroptosis is an iron-dependent, non-apoptotic programmed cell death. Cellular senescence contributes to aging and various age-related diseases through the expression of a senescence-associated secretory phenotype (SASP). Senescent cells are often resistant to ferroptosis via increased ferritin and impaired ferritinophagy. In this study, we investigated whether treatment with JQ1 could remove senescent cells by inducing ferroptosis. METHODS: Senescence of human dermal fibroblasts was induced in vitro by treating the cells with bleomycin. The senolytic effects of JQ1 were evaluated using a SA-β gal assay, annexin V analysis, cell counting kit-8 assay, and qRT-PCR. Ferroptosis following JQ1 treatment was evaluated with qRT-PCR and BODIPY staining. RESULTS: At a certain range of JQ1 concentrations, JQ1 treatment reduced the viability of bleomycin-treated cells (senescent cells) but did not reduce that of untreated cells (non-senescent cells), indicating that JQ1 treatment can selectively eliminate senescent cells. JQ1 treatment also decreased SASP expression only in senescent cells. Subsequently, JQ1 treatment reduced the expression of ferroptosis-resistance genes in senescent cells. JQ1 treatment induced lipid peroxidation in senescent cells but not in non-senescent cells. CONCLUSION The data indicate that JQ1 can eliminate senescent cells via ferroptosis. This study suggests ferroptosis as a new mechanism of senolytic therapy.

Background: Patients with stable psoriasis showing clearear-clear response can consider extending the dosing interval of biologics. However, few studies have reported the treatment outcomes following irregular dosing intervals of biologics in patients with psoriasis. Objective: We compared treatment outcomes after regular and irregular dosing intervals of biologics in patients with psoriasis. Methods: This single-center, retrospective observational study included patients who received biologics for treatment of plaque psoriasis between January 1, 2014 and December 31, 2019. We compared patient demographics, clinical characteristics, biologics administered, and treatment outcomes based on the regularity of the dosing interval. Results: Among 95 patients investigated, 63 (66.3%) received biologics at regular dosing intervals. We observed no significant intergroup differences in the final Psoriasis Area Severity Index (PASI) scores (1.2 vs. 1.8, p=0.16) and in the percentage improvement in PASI scores from baseline levels (−89.8% vs. −90.8%, p=0.68). The rate at which biologics were switched was higher in the irregular-dosing group than in the regular-dosing group; however, the difference was statistically nonsignificant (28.1% vs. 12.7%, p=0.06). We observed a significant intergroup difference in patients who were administered guselkumab at baseline (12 [21.8%] vs. 0 [0.0%], p=0.01). Conclusion This study showed that compared with regular dosing intervals, irregular dosing intervals of biologics were associated with high rates of switching of these agents, although we observed no statistically significant differences with regard to PASI scores. Therefore, it is important to adhere to the standard dosing schedule prescribed for biologics, and guselkumab may improve patient compliance.