Keratoacanthoma is important because it is frequently mistaken, both clinically and histologically, for basal-call or squamous-cell carcinoma. The usual clinical picture is that of a rapidly enlarging, nodular, umbilicated lesion occurring more often in the lower eye lid. A keratoacanthoma sometimes merges into a carcinoma and is misdiagnosed histologically, therefore cases originally diagnosed as keratoacanthoma should be closely followed. A 64-year-old Korean woman was found to have a small enlarging, umbilicated tumor in right lower lid which was recurred in 3 months after removal of tumor under the diagnosis of squamous cell carcinoma in some hospital. In our hospital, the tumor was removed under local anesthesia and found to be keratoacanthoma histopathologically.
Anesthesia, Local ; Carcinoma, Squamous Cell ; Diagnosis ; Female ; Humans ; Keratoacanthoma* ; Middle Aged

A 79-year-old man with balanitis circumscripta plasmacellularis(BCP), presenting as an erythematous constricting band of the inner surface of the prepuce encircling the penile shaft is described. The biopsy specimen of the lesion showed, in addition to the typical histologic findings of BCP, increased fibrosis and decreased amount of elastic fibers which correlate well with our clinical observations. Electron microscopic examination revelaed no viral particles or elastic fibers. Immunohistologically, IgG was found to be the major immunoglobulin class in the plasma cellular inf iltrate.
Aged ; Balanitis* ; Biopsy ; Elastic Tissue ; Fibrosis ; Humans ; Immunoglobulin G ; Immunoglobulins ; Male ; Plasma ; Virion

Mycosis fungoides palmaris et plantaris is an uncommon expression of mycosis fungoides that manifests primarily on the palms and the soles. The lesions may be quite hyperkeratotic and mimic various inflammatory palmoplantar dermatoses. A biopsy is recommended in the evaluation of recalcitrant palmoplantar dermatoses. We report a case of mycosis fungoides palmaris et plantaris in a 36-year-old woman presented with hyperkeratotic plaque on her palms and soles.
Adult ; Biopsy ; Female ; Humans ; Mycosis Fungoides* ; Skin Diseases

A 28-year old female was diagnosed preoperatively to have a pheochromocytoma producing ACTH at other hospital. However the operation was delayed due to poor general condition and abnormal liver function. She revealed severe hypercortisolism, hypokalemic metabolic alkalosis, glucose intolerance and showed rapid downhill course. She was transferred to our hospital for operation but septic complications were strarted already. She was not recovered in spite of desperate operation and died just after moribund discharge. ACTH producing pheochromocytoma is uncommon and literature review indicated high mortality rates due to improper preoperative diagnosis. Proper preoperative recognition and early surgical management is mandatory for better results.
ACTH Syndrome, Ectopic* ; Adrenocorticotropic Hormone ; Alkalosis ; Cushing Syndrome ; Diagnosis ; Female ; Glucose Intolerance ; Humans ; Liver ; Mortality ; Pheochromocytoma*

Rosacea is a disease of skin and eye that is widely underdiagnosed by ophthalmologists. Rosacea is a common chronic skin disease in Caucacian, affecting flush areas of the face that include the skin, cheeks, nose, and forehead. Ocular manifestations of rosacea mainly involve the eyelids, conjunctiva, and cornea. These include blepharitis, meibomitis, chalazia, styes, and diffusely hyperemic conjunctiva. The cornea is involved with superior punctate epithelial erosions and is most severely involved by a peripheral vascularization, usually of the lower twothirds of the cornea followed by subepithelial infiltrates. A 18 year old Korean lady was found to have hyperemic conjunctiva, chronic recurrent multiple erythematous pustular skin lesion in the face. Systemic administration of tetracycline and penglobe resulted in marked improvement in the signs and symptoms of disease. Topical corticosteroid 0.5% and chloramphenicol 0.5% also improved the manifestations of ocular rosacea.
Adolescent ; Blepharitis ; Chalazion ; Cheek ; Chloramphenicol ; Conjunctiva ; Cornea ; Eyelids ; Forehead ; Hordeolum ; Humans ; Nose ; Rosacea* ; Skin ; Skin Diseases ; Tetracycline

Behcet's disease is a chronic, multi systemic disorder affecting mainly young, adult males. The clinical course of Behcet's disease is characterized by exacerbation and remissons of unpredictable duration and frequency. The common underlying histopathologic lesion is a vasculitis. Loss of vision in Behcet's disease is one of the most frequent and serious of its mainfestations. It was shown as follows: 1. The sex distribution was 261 males(37.5%)and 435 females(62.5%), and this disease occured more often in women than men with a ratio of 1.7 to 1. 2. The mean age of onset was 29 year old and the age of onset reached its peak in the twenties and thirties(67.0%). 3. In topographic distribution, 599 patients(86.1%) were from Seoul, Kyonggido, Inchon, and rests of patients were from Kangwondo, Kyongsangnamdo, Pusan in order. 4. In Shimizu classification, incomplete type was the most numerous with 256 patients(36.8%), and the probable, possible and complete type were observed in order. 5. In major symptoms, oral lesion showed the highest frequency with 674 patients(96.8%), skin lesion in 416 patients(59.8%), genital lesion in 390 patients(56.0%) and ocular lesion in 93 patients(13.4%). In minor symptoms, the arthritis showed the highest frequency with 168 patients(24.1%), Oral lesion appeared in 615 patients(88.4%) and ocular lesion in 22 patients(3.2%)as the initial symptom. 6. Ocular lesions appeared in 158 eyes among 93 patients who had it. The mean age of onset of ocular lesions was 32 yeat old. Cases which the symptom was limited to right eye appeated in 16 patients(172%), the left eye in 12 patients(12.9%) and bilateral in 65 patients(69.9%). It took 43 months in average from the appearance of the initial symptom to that of the ocular lesion and in 22 patients(23.7%), the ocular lesions appeared at first. In ocular lesions, iritis and hypopyon which appeared in 127 eyes(80.4%) showed the hilithest frequency and the vitreous opacity, complicated cataract, retinal degeneration, conjunctivitis, complicated glaucoma, retinal hemorrhage and chorioretinitis were observed in order. 7. The visual acuity of 47 eyes(32.7%) belowed 0.01 and 25 eyes which were treated over 24 months showed marked loss of vision, mostly. 8. In 10 among 93 patients with ocular lesion, HLA antigen was examined, HLA-B5 detected in 6 patients, HLA-Bw51 in 4 patients and HLA-DRw8 in 5 patients.
Adult ; Age of Onset ; Arthritis ; Busan ; Cataract ; Chorioretinitis ; Classification ; Conjunctivitis ; Female ; Gangwon-do ; Glaucoma ; Gyeonggi-do ; Humans ; Incheon ; Iritis ; Male ; Retinal Degeneration ; Retinal Hemorrhage ; Seoul ; Sex Distribution ; Skin ; Vasculitis ; Visual Acuity

PURPOSE: We have done this retrospective study to know the relative incidence and clinical manifestations of organic acidopathies in Korea during 8 years(from Jul. 1997 to May 2005). This results of organic acid analysis of 1,787 patients were compared with the results of organic acid analysis that were published three years ago. METHODS: The results of quantitative organic acid analysis of samples of 1788 patients, referred from Jul. 1997 to May 2005, were analyzed retrospectively according to four age group(-2 mon, 3 mon-2 years, 3-12 years) and major clinical manifestations. Quantification of 83 organic acids was done with gas chromatography and mass spectometry. RESULTS: We diagnosed 470 patients with 27 diseases of organic acid metabolism during this study period. Diseases found more than 10 cases are cytosolic 3-ketothiolase deficiency, mitochondrial respiratory chain disorders, PDHC deficiency, mitochondrial 3-ketothiolase deficiency, glutaric aciduria type II, biotinidase deficiency, methylmalonic aciduria and propionic aciduria. Other diseases were diagnosed in less than 10 cases. CONCLUSION: Though the incidence of individual organic acidemia is low, the overall incidence of organic acidemia as a whole seems to be relatively high in Korea. Compared with the results of organic acid analysis that were reported three years ago, we couldn't find a new disease and the difference of the relative incidences of high incident diseases. We were apprehensive of the errors that was owing to the short study period(3 years), but the relative incidences of our study(8 years) were similar to the results of organic acid analysis that were reported three years ago.
Acetyl-CoA C-Acyltransferase ; Biotinidase Deficiency ; Chromatography, Gas ; Cytosol ; Electron Transport ; Humans ; Incidence ; Korea* ; Metabolism ; Multiple Acyl Coenzyme A Dehydrogenase Deficiency ; Neurologic Manifestations ; Propionic Acidemia ; Pyruvate Dehydrogenase Complex Deficiency Disease ; Retrospective Studies

BACKGROUND: Anaplastic thyroid carcinoma is one of the most aggressive human cancers with a median survival of only 6 months. Local surgical tumor debulking combined with radio-chemotherapy is generally used to treat this malady, but the low success rate has prompted the search for new therapeutic targets. We used 5-aminoimidazole-4-carboxamide-1-beta-D-ribofuranoside (AICAR) as an AMP-activated protein kinase (AMPK) activator to induce growth suppression and apoptosis in the anaplastic thyroid carcinoma cells. METHODS: We investigated the effect of AICAR on the proliferation of thyroid cancer cell lines (ARO, WRO and FRO) by performing methyl-thiazoletetrazolium bromide assay. We wanted to see the effect of AICAR on the apoptosis and cell cycle of the thyroid cancer cells, and we wanted to determine the mechanism of these changes. RESULTS: The proliferation of all thyroid cancer cell lines was significantly inhibited by administration of AICAR. FRO was the most susceptible cell line to AICAR treatment and so further studies were then performed with this cell line. The suppressive effect of AICAR on cell proliferation was related with phosphorylation of AMPK and the increased apoptosis. Also, cell cycle analysis revealed that progression to the G2-M phase was arrested (S-phase arrest) by AICAR treatment. S-phase arrest was associated with the increased protein expression of p21. CONCLUSION: In the anaplastic thyroid cancer cell lines, AICAR inhibited proliferation due to the arrest in the S-phase; this was accompanied with the increased expression of p21. Overall, AMPK activation by AICAR or any other pharmacological agent could be a tempting potential target for thyroid cancer therapy.
Aminoimidazole Carboxamide ; AMP-Activated Protein Kinases ; Apoptosis ; Cell Cycle ; Cell Line ; Cell Proliferation ; Humans ; Phosphorylation ; Thyroid Gland* ; Thyroid Neoplasms*

PURPOSE: The jejunal free flap has the shorter ischemic time than other flap and requires a laparotomy to harvest it. As the evaluation of the perfusion the buried flap is very important, the perfusion of the buried jejunal free flap requires monitoring for its salvage. We tried to improve the monitoring flap method in the jejunal free flap and examined its usefulness. METHODS: From March 2002 to March 2006, the monitoring flap method was applied to 4 cases in 8 jejunal free flaps for the pharyngeal and cervical esophageal reconstructions. The distal part of the jejunal flap was exposed without suture fixation through cervical wound for monitoring its perfusion. The status of perfusion was judged by the color change of jejunal mucosa and mesentery. If necessary, pin prick test was performed. Doppler sonography was applied to mesenteric pedicle of the monitoring flap in case of suspicious abnormal circulation. RESULTS: The monitoring flap shows no change in 3 cases, but the congestion happened in one case at the 12 hours after the operation. This congestion was caused by the twisting or kinking of the mesenteric pedicle of the monitoring flap. So, we fixed up the monitoring flap close to adjacent cervical skin for prevention of rotation. Finally, the main part of transferred jejunal flap was intact. CONCLUSION: The success of a jejunal free flap depends on close postoperative monitoring and early detection of vascular compromise. So, various monitoring methods have been tried, for instance, direct visualization using a fiberoptic pharyngoscope, through a Silastic window placed in the neck flap, or external surface monitoring with an Doppler sonography, use of a buried monitoring probe. But, all of the above have their own shortcomings of simplicity, non-invasiveness, reliability and etc. In our experience, monitoring flap can be a accurate and reliable method.
Estrogens, Conjugated (USP) ; Free Tissue Flaps* ; Laparotomy ; Mesentery ; Mucous Membrane ; Neck ; Perfusion ; Skin ; Sutures ; Wounds and Injuries

PURPOSE: To compare single-shot echo-planar MR imaging(EPI) with breath-hold fast T2-weighted imaging(HASTEor Turbo spin-echo T2WI) for evaluation of the role of EPI in distinguishing small hepatocellular carcinoma fromcavernous hemangioma. MATERIALS AND METHODS: We retrospectively evaluated MR images of 35 patients (21 cases ofsmall HCC and 14 cases of cavernous hemangioma). EPI and breath-hold fast T2WI images were obtained and comparedon the basis of lesion detection sensitivity, lesion-to-liver signal intensity ratio(SIR), contrast ratio(CT), andlesion-to-liver contrast to noise ratio(CNR). RESULTS: For the detection of small HCC, the sensitivity of EPI andbreath-hold fast T2WI were equal in 14 of 21 cases(71.4%). The detection sensitivity of cavernous hemangioma withEPI and breath-hold fast T2WI was 100%(14/14). Mean SIR on breath-hold fast T2WI was 2.02+/-0.45 for small HCC and3.65+/-0.97 for cavernous hemangioma; on EPI, the corresponding figures wer 2.91+/-0.57 and 6.98+/-1.37. Mean CR onbreath-hold fast T2WI was 1.16+/-0.58 for small HCC and 2.65+/-0.57 for cavernous hemangioma; On EPI, the figuresobtained were 2.27+/-0.52 and 6.26+/-2.19, respectively. Mean CNR on breath-hold fast T2WI was 14.24+/- 4.098 forsmall HCC and 50.28+/-10.96 for cavernous hemangioma, while on EPI, the corresponding figures were 13.84+/-3.02 and45.44+/-11.21. CONCLUSION: In detecting focal hepatic mass, the sensitivity of EPI and breath-hold fast T2WI arecomparable; for the diagnosis of small HCC and cavernous hemangioma, EPI can provide additional information.
Carcinoma, Hepatocellular ; Diagnosis ; Hemangioma ; Hemangioma, Cavernous* ; Humans ; Magnetic Resonance Imaging* ; Noise ; Retrospective Studies