Transfollicular extrusion of sebaceous gland lobules was observed in a case of actinic keratosis and 2 cases of sebaceous hyperplasia. The patient of act.inic keratosis was a 44-year-old white man and the patients of sebaceous hvperplasia were a i3-year-old Korean girl and a 28-year-old Korean man. The sebaceous gland lobules located within the dilated infundibular area and partly between separated granular layers were intact and partly surrounded by keratin materjal. No histopathologic overlapping of sebaceous gland lobules was observed. We suppose that transfollicular ext,rusion of sebaceous gland lobules may not be artifact. but one of natural phenomena. But further study will be necessary to evaluate the significance of this peculiar histopathologic findings.
Adult ; Artifacts ; Female ; Humans ; Hyperplasia ; Keratosis ; Keratosis, Actinic ; Sebaceous Glands*

We present two very interesting cases of acute graft-versus-host disease (GVHD), whose skin rashes initially appeared on the localized area of total nodal irradiation (TNI) performed previously to prevent graft rejection and/or GVHD. The histopathologic findings showed some dyskeratotic cells in the epidermis and perivascular mononuclear cell infiltration in the upper dermis. The immunohistochemical studies revealed that HLA-DR was diffusely strongly positive in a number of keratinocytes, whereas both CD4 and CD8 were focally weakly positive in the perivascular lymphocytes in the upper dermis. Later on, liver dysfunction and diarrhea developed and skin rashes began to spread over the other parts of the body in those two patients.
Dermis ; Diarrhea ; Epidermis ; Exanthema ; Graft Rejection ; Graft vs Host Disease* ; HLA-DR Antigens ; Humans ; Keratinocytes ; Liver Diseases ; Lymphocytes ; Skin*

Malignant peripheral nerve sheath tumor is a neoplasm that most often arises in anatomically discernible peripheral nerves or neurofibroma. A 37-year-old woman presented with a rapid growing pedunculated, huge mass on the left breast for 1 month. She has suffered from neurofibromatosis type 1 with multiple cafe au lait spots and neurofibromas. The huge mass has developed from a subcutaneous nodule on the left breast. The clinical and histopathological data showed a malignant peripheral nerve sheath tumor. Since no sign of the metastasis was observed, local excision was performed. We, herein, report a case of malignant peripheral nerve sheath tumor developed in the patient of nurofibromatosis type 1.
Adult ; Breast ; Cafe-au-Lait Spots ; Female ; Humans ; Neoplasm Metastasis ; Neurofibroma ; Neurofibromatoses* ; Neurofibromatosis 1 ; Peripheral Nerves*

Hepatitis A virus (HAV) infection is common in developing countries, including Korea. It can be accompanied by extrahepatic complications such as renal failure, arthritis, and vasculitis. Pleural effusion is a very rare complication of HAV infection, which has been reported usually in children, and has benign clinical courses. Here we report a case of pleural effusion with ascites which occurred in an adult hepatitis A patient. A 26-year-old-woman presented generalized myalgia and fever and was diagnosed as acute hepatitis A. Despite of the improvement of laboratory findings, fever and cough persisted. Pleural effusion newly appeared on the serial chest radiologic images. After the fever settled down, the pleural effusion resolved spontaneously at 13th day of admission.
Acute Disease ; Adult ; Female ; Hepatitis A/complications/*diagnosis ; Humans ; Pleural Effusion/complications/*diagnosis/radiography ; Tomography, X-Ray Computed

OBJECTIVES: The purpose of this study is to evaluate and compare the maternal and neonatal complications of the overt diabetes with that of gestational diabetes. METHOD : The medical records of 65 pregnant patients complicated by diabetes mellitus at Eulji medical center from January, 2001 to December, 2002 were reviewed retrospectively. Thirteen patients of them were diagnosed as a overt diabetes and the others were diagnosed as a gestational diabetes. RESULTS: Maternal complications were that preeclampsia in 15.4% and preterm labor in 15.4% in overt diabetes patients and preeclampsia in 9.6%, fourth degree laceration in 1.9%, preterm labor in 3.8%, placenta abruption in 1.9%, cardiomyopathy in 1.9% and polyhydroamnios in 1.9% in gestational diabetes patients. Neonatal complications were that hypoglycemia in 38.5% and respiratory distress syndrome in 15.4% in overt diabetes patients and hypoglycemia in 25%, hyperbilirubinemia in 9.6% and shoulder dystocia in 1.9% in gestational diabetes patients. There were no statistic differences in maternal and neonatal complications in two groups when management had done. And in gestational diabetes group, maternal and neonatal complications were significantly higher in no management group than management group regardless of management types. CONCLUSION: If early detection and management were done in overt and gestational diabetes, there were no difference in maternal and neonatal complications. Regardless of types of diabetes, early detection and management were important.
Cardiomyopathies ; Diabetes Mellitus ; Diabetes, Gestational* ; Dystocia ; Female ; Humans ; Hyperbilirubinemia ; Hypoglycemia ; Lacerations ; Medical Records ; Obstetric Labor, Premature ; Placenta ; Pre-Eclampsia ; Pregnancy ; Retrospective Studies ; Shoulder

The peneicillin binding protein gene(mecA gene) is present in the methicillin-resistant Staphylococcus strains but not in the susceptible ones. The goal of the present study was to establish experimental evidences which might use polymerase chain reaction(PCR) for culture confirmation and eventually clinical diagnosis of methicillin resistant Staphylococcui. Two primers (5'-AAAATCGATGGTAAAGGTTGGC-3', 5'-AGTTCTGCAGTACCGGATTTGC-3') based on the known DNA sequence of the mecA gene from methicillin-resistant Staphylococcus aureus were used in PCRs to screen for the presence of this gene in Staphylococcal isolates from various clinical settings. When the primers were used to copy the DNA of the mecA gene, only 533 base-pair DNA fragment was appeared. The product indicates a positive PCR result for methicillin-resistant Staphylococcal isolates. In contrast, from the DNA of the methicillin-sensitive Staphylococcal isolates the 533bp was not amplified. Results obtained with PCR were generally consistent with those of standard microbiological assays. The mecA gene in methicillin-high resistant Staphylococci was located on the approximately 5.56kb Hind III restriction fragment. The 533bp probe was hybridized to the 5.56kb Hind III restriction fragment of mecA-positive S. aureus. No hybridization was occured in the mecA-negative strain. The mecA gene was cloned, named pHL-1201 and verified by colony hyhridization. The 533bp probe was hybridized to the approximately 5.56kb Hind III restriction fragment of the DNA obtained from pHL-1201. PCRs with the primers successfully distinguished methicillin-resistants from methicillin-susceptible strains of S. aureus and S. epidermidis.
Base Sequence ; Carrier Proteins ; Clone Cells* ; Cloning, Organism* ; Diagnosis ; DNA ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus ; Polymerase Chain Reaction* ; Staphylococcus aureus ; Staphylococcus*

Ankylosing spondylitis is a disease that shows a young age of onset (less than 40 years old), inflammatory back pain, sacroiliitis and a strong association with HLA-B27. Yet some recently reported cases have presented with a late age of onset (more than 55 years old), atypical clinical presentations and a low response to NSAIDs, and this has also been named late onset spondyloarthropathy (LOSPA). As compared with early onset spondyloarthropathy (EOSPA), the LOSPA patients more frequently suffer with combined peripheral arthritis and inflammatory systemic symptoms and a high ESR and CRP level, but they lack the typical axial symptoms. Yet there have been few reports about late onset ankylosing spondylitis (LOAS). The previous cases of LOSPA and LOAS were managed with NSAIDs, steroids, methotrexate and sulfasalazine, but none were managed with TNF antagonists. LOAS is rare and difficult for management because of the patients' older age and the lack of experiences with this malady, so we report here on the four cases of LOAS that were successfully treated by TNF antagonists.
Age of Onset ; Anti-Inflammatory Agents, Non-Steroidal ; Arthritis ; Back Pain ; HLA-B27 Antigen ; Humans ; Loa ; Methotrexate ; Sacroiliitis ; Spondylarthropathies ; Spondylitis, Ankylosing ; Steroids ; Sulfasalazine

OBJECTIVE: The purpose of this study was to analyze the inclination, pertinence and influential factor in emergent cesarean section according to the assortment and analysis of the indication of emergent cesarean section. METHODS: The retrospective study was performed with the review of 360 emergent cesarean section cases from January 2003 to December 2003. RESULTS: The indication of cesarean section was followed by the order of progress failure (47.5%), previous cesarean section (19.2%), and fetal distress (15.8%). The improper operation of emergent cesarean section was done in fetal distress (28.1%), progress failure (8.6%), and induction failure (16.7%). The absence of acceleration with prolonged bradycardia was the most common (50.0%) type of fetal distress. The emergent cesarean section were done more commonly on Tuesday and Friday during weekdays and it was the peak time in a whole day of cesarean section from 11 o'clock to 12 o'clock and 16 o'clock to 17 o'clock. CONCLUSION: It was proved that twenty six (7.2%) cases of emergent cesarean section were done improperly. Now, work through the non-medical factors are considered more important to reduce improper section rate.
Acceleration ; Bradycardia ; Cesarean Section* ; Female ; Fetal Distress ; Pregnancy ; Retrospective Studies

BACKGROUND AND OBJECTIVES: The coronary vasospasm has been shown to play an important role in the pathogenesis of not only variant angina but also ischemic heart disease in general, including other forms of angina pectoris, acute myocardial infarct, and sudden death. The angiographic features of coronary vasospasm are focal and diffuse patterns in clinical setting. We attempted to clarify the differences in vessel wall morphologic appearance between the sites of focal and diffuse vasospasm by intravascular ultrasound(IVUS). MATERIAL AND METHODS: We studied 23 patients(32 segments) with variant angina in whom coronary angiograms were normal and coronary spasm was documented by intracoronary injection of acetylcholine. Coronary spasm was defined as luminal diameter reduction > or = 90% compared with baseline coronary artery diameter. Focal spasm was defined if the length of spastic narrowing was less than 10mm. By IVUS, we observed atheromatous plaques in 32 spasm segments with either focal or diffuse vasospasm. We measured maximal intimal thickness, luminal cross-sectional area(CSA), and external elastic membrane-CSA in spasm sites. RESULT: When comparing maximal intimal thickness between focal (n=15) and diffuse vasospasm segments(n=17), there was significantly greater thickness at focal spasm segments(1.21+/-0.36mm vs. 0.70+/-0.23mm, P<0.001). The maximal plaque area was similar between two groups but tended to be greater in focal spasm segments(6.03+/-2.06mm2 vs. 4.92+/-2.59mm2, P=NS). When circular shaped factor(CSF : standardized index of eccentricity) was compared, focal spasm segments were greater than diffuse spasm segments(0.89+/-0.06 vs. 0.97+/-0.02, P<0.001). At the segments of focal spasm, remodeling index was greater compared to the segments of diffuse spasm(1.02+/-0.16 vs. 0.86+/-0.13, P<0.001). CONCLUSION: Focal spasm segments were more eccentric and had greater atheromatous plaque than diffuse spasm segments. Positive remodeling pattern was observed at the segments of focal spasm and negative remodeling pattern at the segments of diffuse spasm. There were morphologic differences of vessel wall appearance between focal and diffuse spasm sites.
Acetylcholine ; Angina Pectoris ; Coronary Vasospasm* ; Coronary Vessels ; Death, Sudden ; Muscle Spasticity ; Myocardial Infarction ; Myocardial Ischemia ; Phenobarbital ; Plaque, Atherosclerotic ; Spasm

BACKGROUND AND OBJECTIVES: This study was designed to investigate whether the serum concentration of the carboxy-terminal propeptide of procollagen type I PIP, a marker of myocardial fibrosis, was related to the change of the ventricular filling dynamics in patients with early type 2 diabetes mellitus (DM). SUBJECTS AND METHODS: Echocardiography was performed in 28 patients with type 2 DM and 32 age-matched healthy controls, ranging from 31-69 years of age, with normal left ventricular (LV) systolic function and ECG at rest. Subjects with diabetic complications, including microalbuminuria, nephropathy (Cr>1.3 mg/dL), severe obesity (BMI> or =30 kg/m2), LV hypertrophy (LV septal thickness and/or posterior wall thickness 12 mm on M-mode) and hypertension, were excluded. The serum concentrations of PIP and Transforming growth factor TGF-beta1 were measured by enzyme immunoassay methods. RESULTS: The type 2 DM group had lower mitral (Type 2 DM vs. Control: 0.88+/-0.28 vs. 1.17+/-0.34, p<0.01) and tricuspid E/A ratios (1.15+/-0.25 vs. 1.30+/-0.25, p=0.01) than the control group. The level of serum PIP was higher (p<0.05) in patients with type 2 DM than in the control group (131.1+/-45.6 vs. 109.3+/-32.5). The difference in the duration between transmitral forward (A) and pulmonary venous retrograde (Ar) waves (A-Ar) was considered an estimate of a passive diastolic function. A-Ar was inversely related with the serum PIP level in type 2 diabetes (r=-0.43, p=0.03). CONCLUSION: These results show a relationship between the LV diastolic function and the serum concentration of PIP in early type 2 DM. These findings suggest that the determination of the serum level of PIP is a useful method for the screening and early diagnosis of myocardial fibrosis associated with DM.
Collagen Type I ; Diabetes Complications ; Diabetes Mellitus ; Diabetes Mellitus, Type 2* ; Diastole ; Early Diagnosis ; Echocardiography ; Electrocardiography ; Fibrosis* ; Humans ; Hypertension ; Hypertrophy ; Immunoenzyme Techniques ; Mass Screening ; Obesity, Morbid ; Procollagen ; Transforming Growth Factor beta1 ; Transforming Growth Factors