PURPOSE: The number of resected lymph nodes can influence the current N staging. This study examined the significance of the metastatic lymph node ratio on the survival of patients with pT2 gastric cancer. METHODS: The records of 176 patients who had undergone curative gastrectomy and diagnosed with pT2 gastric cancer by pathology, between February 1990 and October 2002 were retrospectively reviewed. Those patients with other organ metastases or those who had undergone a dissection of less than 15 lymph nodes were excluded. The clinicopathologic prognostic variables were evaluated using the SPSS statistical program. RESULTS: There were 115 men and 61 women with a mean age of 59 years. The median survival period was 93 months (2~184 months). Metastatic lymph nodes were found in 100 cases (56.8%), a mean of 34.6 lymph nodes were dissected, a mean of 3.2 lymph nodes metastasized, and a mean metastatic lymph node ratio of 0.09 was found. According to the UICC TNM classification, the number of stage IB (N0) cases was 76 (43.2%), stage II (N1) was 74 (42.0%), stage IIIA (N2) was 18 (10.2%), and stage IV (N3) was 8 (4.5%). The overall 5-year survival rate was 75.2%. According to the UICC TNM classification, the 5-year survival rate was stage IB, II, IIIA, and IV was 88.6%, 74.3%, 39.5%, and 33.3%, respectively. The metastatic lymph node ratio (nR) was divided into 4 categories; nR0 (76) = 0, 0 Classification ; Female ; Gastrectomy ; Humans ; Lymph Nodes* ; Male ; Neoplasm Metastasis ; Pathology ; Prognosis ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate*

Primary or secondary cicatrical alopecia is devided by depending on the pattern of follicular destruction. Secondary cicatrical alopecia by significant hairdressing related burns are rare. A 24-year-old man, college student developed round 4x2.5cm sized erythematous bald patch with crust on the top of the occipital scalp. He was injured after being overheated by the steam cap at the hair salon 46 days ago. He received burn dressing and triamcinolone intralesional injection treatment in the private clinic, but no symptom was improved. In our hospital, initially he was treated by wet dressing with KMNO4 and topical anitibiotics for prevention of secondary infection and then treated by topical minoxidil solution for 7months. After 7months, his symptom was not observed any improvement and then performed biopsy. Histologic exam showed an perifollicular fibrosis and complete absence of follicles. After 13 months, he received excision and closure of scar by the plastic surgeon.
Alopecia* ; Bandages ; Biopsy ; Burns* ; Cicatrix ; Coinfection ; Fibrosis ; Hair Color* ; Hair* ; Humans ; Injections, Intralesional ; Minoxidil ; Scalp ; Steam ; Triamcinolone ; Young Adult

We report a case of synchronous multiple colon adenocarcinomas in a patient with neurofibromatosis type 1 (NF1). NF1 is an autosomal dominant inherited disorder and patients with NF1 have high risk for both benign and malignant tumors. However, adenocarcinomas involving the colon have rarely been reported in patients with NF1. A 61-year-old man was referred for generalized peritonitis due to descending colon perforation. Left hemicolectomy was performed and pathologic examination showed four adenocarcinomas. Peritoneal nodules were confirmed as metastatic adenocarcinoma (pT4N1M1). The patient also had clinical features compatible with NF1 such as cafe au lait macules, axillary freckles, neurofibromas across the body, and Lisch nodules. Upon review of the literature, colon adenocarcinoma in patients with NF1 tends to occur in males and relatively young age groups, and is associated with advanced tumor stages and multiple colon cancers. To improve treatment outcome, early colonoscopic surveillance should be considered in patients with NF1.
Adenocarcinoma* ; Colon* ; Colon, Descending ; Colonic Neoplasms ; Humans ; Male ; Melanosis ; Middle Aged ; Neurofibroma ; Neurofibromatoses ; Neurofibromatosis 1* ; Peritonitis ; Treatment Outcome

BACKGROUND: Tinea pedis is the most common dermatophytosis which is usually treated by antifungal agent. Recently, there has been a resurgence of interest in potential phototherapy for the local treatment of bacterial and fungal infection. OBJECTIVE: The aim of this study is to evaluate the therapeutic effect of full spectrum light (F.S.L) phototherapy for patients with tinea pedis. METHODS: Lesions were irradiated for 20 minutes, 2 times a week for 4 consecutive weeks with F.S.L. emitting wavelengths from 320 nm to 5000 nm. Clinical symptoms were observed and KOH direct smear and fungal culture were done. RESULTS: Global assessment score was improved after the application of eight sessions of F.S.L phototherapy. 18% of total patient were cleared, 45.4% a marked improvement, 27.3% a mild improvement and 9.1% of patients had no effect. And the fungal exams, KOH direct smear and culture, were conversion to negative in 7 out of 11 patients. Significant adverse effects were not observed. CONCLUSION: F.S.L phototherapy might be another treatment option for the tinea pedis patients.
Enzyme Multiplied Immunoassay Technique ; Humans ; Light ; Phototherapy ; Tinea ; Tinea Pedis

Merkel cell carcinoma is a rare, aggressive skin cancer that occurs most frequently in the elderly on sun-exposed areas. However, any possible cutaneous or mucosal sites may also be involved. It usually presents as a rapidly- growing, painless, single red or purple colored cutaneous papule, nodule or indurated plaque that may elude diagnosis until histopathologic examination. We report a case of an 83-year old female patient who presented with a 3 x 3.5 cm sized, skin-colored, painful nodule on the left mandibular angle area. A new red nodule had combined on the original lesion after 6 months, and showed unusual clinical manifestation. Microscopically, the tumor cells were uniform with round to oval-shaped nuclei and scanty cytoplasm, and they showed a trabecular arrangement. In immunohistochemical studies, the patient was reactive to cytokeratin-20, and focally reactive to NSE and synaptophysin.
Aged ; Aged, 80 and over ; Carcinoma, Merkel Cell* ; Cytoplasm ; Diagnosis ; Female ; Humans ; Keratin-20 ; Skin Neoplasms ; Synaptophysin

BACKGROUND: Alopecia areata (AA) is an autoimmune condition of the hair follicle, resulting in bald patches. The details of the pathogenesis of AA still remain unclear. However, several recent studies have indicated that AA is an organ-specific autoimmune disease in which T cells (especially CD8+T cells), as well as certain cytokines (especially Th1 cytokines, IL-1, IFN-gamma, and TNF-alpha) may play an important role in its development. OBJECTIVE: The purpose of this study was to characterize the cytokine response in the peripheral blood of patients with AA, before and after treatment. METHODS: Twenty one active AA patients and 10 healthy people were evaluated in this study. The levels of 3 cytokines, including IFN-gamma, IL-10, and IL-16, in all subjects were measured at the first visit and 3 months after treatment. RESULTS: The levels of IFN-gamma, IL-10, and IL-16 in the AA group were significantly elevated (p<0.05) compared to the normal control group. The level of IFN-gamma showed an excellent response to treatment (hair regrowth>75%), and was decreased in comparision to the level before treatment (p=0.003). There was no difference in the cytokine levels after PUVA, DPCP, or a combination therapy of PUVA and DPCP (p>0.05). CONCLUSION: The results suggest the involvement of IFN-gamma in the AA process. Also, IFN-gamma could be a potential marker for treatment. Even though different treatments have different mechanisms, IFN-gamma is considered to be a common pathway for alopecia areata treatment.
Alopecia Areata* ; Alopecia* ; Autoimmune Diseases ; Cytokines ; Hair Follicle ; Humans ; Interleukin-1 ; Interleukin-10* ; Interleukin-16* ; T-Lymphocytes

BACKGROUND: There are many therapeutic methods for treating vitiligo including PUVA, narrow-band UVB, topical corticosteroids, tacrolimus, calcipotriol, intralesional injection of steroids or oral corticosteroids, but there is no reliable treatment. Autologous epidermal grafting has been used by several authors, and is reported to be a surgical method which has minimal adverse effect, little risk of scarring, and is easily performed in the clinic. OBJECTIVE: The purpose of this study was to evaluate the effectiveness of autologous epidermal grafting in the treatment of vitiligo, and investigate both patient satisfaction, and any adverse effects. METHODS: The evaluation was conducted using 44 patients (48 cases) with intractable vitiligo who had been treated by autologous epidermal grafting using suction blistered epidermis. We investigated both patient satisfaction, and any problems or adverse effects during the procedure. The efficacy was rated as excellent (repigmentation >75%), good (repigmentation 75-50%), fair (repigmentation 50-25%), or poor (repigmentation <25%). Efficacies according to clinical type, recipient sites, the preparation method for recipient sites, the disease duration at operation and the duration after operation were also investigated. RESULTS: Eexcellent repigmentation was shown in 77.1% of the patients. The epidermal graft was more effective in treating segmental vitiligo, and when the disease duration was more than 36 months. Patient satisfaction was more than 75%. CONCLUSION: The autologous epidermal graft is an effective treatment modality. However, for more effective results and a high level of patient satisfaction we think doctors should only treat stable vitiligo. They should explain the operation procedure, side effects, and postoperative PUVA therapy in detail to the patient.
Adrenal Cortex Hormones ; Blister ; Cicatrix ; Epidermis ; Humans ; Injections, Intralesional ; Patient Satisfaction ; PUVA Therapy ; Steroids ; Suction ; Tacrolimus ; Transplants* ; Vitiligo*

Basal cell carcinoma (BCC) in the skin is the most common malignancy worldwide. Surgery is still the golden standard treatment for BCCs, but it may be intensive and sometimes excessively destructive. Imiquimod is a member of novel class of immune response modifiers which stimulate or enhance both the innate immune system and cell-mediated immune response and approved by FDA for treating anogenital wart. A 73-year-old male patient was presented with 8x10cm sized erythematous scaly, peripheral ridging patch with central black colored crust on the back. Histopathological finding showed masses of various shapes and sizes composed of basalioma cells. He refused surgery treatment, so we tried 5% imiquimod cream (AldaraTM, 3M) topically three times weekly for the duration of 7 months. Although lesions had incompletely resolved, clinically and histopathologically improvement was observed. Herein we report a case of basal cell carcinoma which responded to imiquimod.
Aged ; Carcinoma, Basal Cell* ; Humans ; Immune System ; Male ; Skin ; Warts

Allopurinol (4-hydroxypyrazolo[3, 4-d]pyrimidine) is a xanthine oxidase inhibitor and is widely used in the treatment of hyperuricemia. Allopurinol hypersensitivity syndrome (AHS) includes a prolonged illness initially manifested by fever, a prominent cutaneous reaction, eosinophilia, hepatic abnormalities, and decreased renal function. Two patients in our study had a decreased renal function; one due to bilateral polycystic kidneys and the other due to bilateral ureteral stones. Both had received allopurinol for asymptomatic hyperuricemia. Whilst taking this medication, they showed a generalized erythematous, maculopapular eruption with fever, leukocytosis, eosinophilia, a further decrease of renal function and prolonged severe hepatic abnormalities. One patient showed an improvement after they stopped taking allopurinol and were treated with steroids, however, died, due to combined giant cell pneumonia. However, the other patient did improve when they stopped taking allopurinol.
Allopurinol* ; Eosinophilia ; Fever ; Giant Cells ; Humans ; Hypersensitivity* ; Hyperuricemia* ; Leukocytosis ; Pneumonia ; Polycystic Kidney Diseases ; Steroids ; Ureter ; Xanthine Oxidase

OBJECTIVE: To evaluate the frequency of complex regional pain syndrome (CRPS) and to determine the risk of CRPS after stroke according to the degree of shoulder subluxation by quantitative radiographic analysis. METHOD: Sixty-four stroke patients (40 male; 24 female, mean age: 59.2 10.4) were included in the study. All subjects underwent a clinical examination that included spasticity and Brunnstrom stage; and a radiologic examination. The diagnosis of CRPS was based on clinical criteria and three-phase scintigraphies. The degree of shoulder subluxation was assessed by the distance between inferomedial point of acromion and the center of humeral head and glenoid fossa. RESULTS: CRPS after stroke occurred in 34 patients (53%). There were significant differences in Brunnstrom stage and shoulder subluxation between the CRPS groups and the non CRPS groups. Among radiographic measurements, vertical distance ratio (involved/uninvolved) and oblique distance ratio indicated a strong correlation with CRPS (p<0.01). Among clinical variables and radiographic measurements, oblique ratio was the most valuable determinant of the risk for CRPS. CONCLUSION: Shoulder subluxation shows a significant correlation with CRPS after stroke. We suggest oblique ratio as a useful measurement of shoulder subluxation to estimate the risk of CRPS.
Acromion ; Diagnosis ; Female ; Humans ; Humeral Head ; Male ; Muscle Spasticity ; Shoulder* ; Stroke*