Crohns disease is a granulomatous isease of the gastrointetin 1 tract, especially terminal ileum, but may involve the lip, mouth, anus, skin, liver and bone. The skin is a common site of extraintestinal involvement in Crohns disease, with the perianil, perineal, and peristomal areas most frequently affected. Vulvar involvement, however, is an uncommon extraintestinal manifestantion of Crohns disease. We report a case of a 16-year-old girl with Crohns disease of the vulva and perianal region. A histopathologic study of the descending colon and vulvar skin showed noncaseating granulomatous reactions composed of lymphocytes, epithelioidell and giant cells. We were able to make the diagnosis of Crohns disease of the vulvar and the patient was treated with prednisolone and metronidazole.
Adolescent ; Anal Canal ; Colon, Descending ; Crohn Disease* ; Diagnosis ; Female ; Giant Cells ; Humans ; Ileum ; Lip ; Liver ; Lymphocytes ; Metronidazole ; Mouth ; Prednisolone ; Skin ; Vulva*

Candida granuloma is a variant of chronic mucocutaneous candidasis associated with chronic infection mainly by Candida albicans in which the skin lesions are rather granulomatous and hyperkeratotic. To date a variety of defects of cell mediated immunity have been shown to be important. We describe a 2-year-old boy with cutaneous candida granuloma and immunologic dysfunction.
Candida albicans ; Candida* ; Child, Preschool ; Granuloma* ; Humans ; Immunity, Cellular ; Male ; Skin

We present a case of malignant melanoma associated wi h itiligo in the 49 year-old female patient. Skin lesions showed that centrally located dark black nodile surrounded with brownish colored plaque on the upper half and depigmented patch on the lower half on the left upper thigh and depigmented patch on the right forehead. In western countries, patients with melanoma have been obscrved to develop vitiligo or depigmented spots on the skin, while in korea, rarely observed. We reports that malignant melanoma associated with vitiligo.
Female ; Forehead ; Humans ; Korea ; Melanoma* ; Middle Aged ; Skin ; Thigh ; Vitiligo*

OBJECTIVES: The analysis of heart rate variability (HRV) is a useful non-invasive tool to investigate the autonomic nerve function. Previous studies on the relationship between HRV and depression have been reported controversial results. Similarly, the correlation between the serum lipids and depression is debatable. The purpose of this study is to examine the relationship between heart rate variability, lipid profile and depression. METHODS: A total of 42 patients with major depressive disorder (MDD) and 32 age and sex-matched normal subjects who had no previous history of major medical and mental illnesses were recruited for this study. A structured-interview was used to assess the general characteristics and psychiatric illness. HRV measures were assessed by time-domain and frequency-domain analyses. Psychological symptoms were measured using the Hamilton rating scale for anxiety (HAM-A), Hamilton rating scale for depression (HAM-D). In addition, the evaluation for lipid profile was performed by blood test. RESULTS: In serum lipid profile test, MDD group showed higher cholesterol (197.68+/-42.94 mg/dL vs. 176.85+/-34.68 mg/dL, p=0.044), TG (139.45+/-92.54 mg/dL vs. 91.4+/-65.68 mg/dL, p=0.018), LDL (130.03+/-33.18 vs. 106.62+/-27.08, p=0.004) level than normal control group. In HRV time domain analyses, the standard deviation of the NN interval (SDNN) was decreased in MDD group than normal control group, but was not significant (32.82+/-14.33 ms vs. 40.36+/-21.40ms, p=0.078). ApEn (Approximate Entrophy) was significantly increased in MDD group than normal control group (1.13+/-0.11 vs. 0.91+/-0.18, p<0.001). ApEn was correlated with LDL level (r=0.277, p=0.028), HAM-D scores (r=0.534, p<0.001) and HAM-A scores (r=0.470, p<0.001). CONCLUSION: MDD patients showed increased ApEn, one of the HRV measurement. And this ApEn was correlated with LDL, HAM-D and HAM-A scores. In this study, the analysis of ApEn would be a useful test of MDD.
Anxiety ; Autonomic Pathways ; Cholesterol ; Depression ; Depressive Disorder, Major ; Heart ; Heart Rate ; Humans

The epidermal cell-derived thymocyte activating factor (ETAF) produced by keratinocytes and endowed with IL-1 like activities, can potentiate or stimulate a variety of immune reactionsl. In addition to stimulating thymocyte proliferation, it enhanced IL-2 production by mitogen-stimulated lymphocytes. In this study, IL-2 activity stimulated by ETAF was investigated by using peripheral lymphocytes (PBL)and LBRM33 1A5 cell lines. The expression of HLA-DR antigen and the effect of r-IFN-gamma on IL-1 production by keratinocytes were also evaluated : 1. The HLA-DR positive cultured keratinocytes were obser ved in interferon (IFN), interferon-phorbol myristic acid (IFN-PMA) and interferon-lipopolysaccharide (IFN-LPS) groups. There was no HLA-DR expression in the control. PMA. and LPS group. 2. Il-1alpha from supernatants of cultured keratinocytes were produced by all groups including control group. The amounts of IL-1alpha produced by IFN, IFN-PMA and IFN-LPS groups were higher than the other groups. 3. There were no statistical differences between total IL-1alpha from cultured keratinocytes and control or other experimental groups. 4. In experiment for positivie control, the anrounts of IL-2 production by PBL and LBRM33 1A5 cell line were increased proportional to the concentration of added rIL-1. But there was no difference between groups above 1.0 U/ml and 0.5 fmol in LBRM33 1A5 cell line. 5. the production of IL-2 by PBL were increased by phytohemagglutinin (PHA), PHAPMA and PHA-LPS groups. There were no production of IL-2 in control, IFN, LPS, only LPS added group, and IL-1alpha. The IL-2 induced by PHA-PMA group was much higher than the other groups. The production of IL-2 was stimulated by IL-1 of supernatarnts and cell lysates from the cultured keratinocytes, but here was no correlation between IL-2 production and added IL-1. 6. The production of IL-2 by LBRM33 IA5 were increased by PHA, PHA-PMA and PHA-LPS groups. There were no production of IL-2 in the other groups. In summary, the results suggest that supernatants and cell lysates from cultured keratinocytes can stimulate the IL-2 production by human PBL and LBRM33 1A5 cell line. Therefore the ETAF can potentiate or stimulate the immune reactions and enhance IL-2 production by mitogen-stimulated lymphocytes.
Cell Line ; HLA-DR Antigens ; Humans ; Interferons ; Interleukin-1* ; Interleukin-2* ; Keratinocytes* ; Lymphocytes* ; Myristic Acid ; Thymocytes

Ramsay Hunt syndrome (RHS) might cause serious complications, such as facial paralysis and hearing loss if diagnosis and treatments are delayed. Early diagnosis is therefore very important to avoid such serious complications. We report a case of RHS that was occurred during the treatment of postherpetic neuralgia resulted from zoster sine herpete. The patient showed severe segmental intercostal neuralgia at the right 11 and 12th thoracic level. There were no history of the trauma, operation and skin rash and vesicle on the lesion site. Varicellar-zoster virus (VZV) IgG Antibody was positive but VZV IgM antibody was negative. Pain nature was severe sharp, electrical shock like pain, but no paresthesia and dysesthesia was not existed. About two month later, small painful vesicular eruptions were occurred around the ipsilateral auricle. At this time, VZV IgM antibody was positive. Acyclovir, prednisolone, fexofenadine were immediately prescribed. The patient relieved from RHS without any complications. Clinician should be suspect the possibility of zoster sine herpete if the patient showed severe atypical chest wall pain.
Acyclovir ; Diagnosis ; Early Diagnosis ; Exanthema ; Facial Paralysis ; Hearing Loss ; Herpes Zoster Oticus* ; Herpes Zoster* ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Neuralgia ; Neuralgia, Postherpetic ; Paresthesia ; Prednisolone ; Shock ; Thoracic Wall ; Zoster Sine Herpete*

Syringoid eccrine carcinoma (SEC) is a rare cutaneous malignant tumor thought to be derived from eccrine sweat apparatus. It is usually present in the head, neck and trunk region, and often occurs in the fourth to seventh decades of life. A 94-year-old male patient visited our department with an 80-year history of a lesion showing a 2×2 cm sized well-demarcated round shaped erythematous to pinkish colored nodule with ulcer on his left thigh. Histological findings revealed a tumor consisted mainly of numerous small cords and nests forming luminal or tubular structures and tumor cells showing variable atypia. Some ductal structures showed tadpole appearance. On immunohistochemical staining, epithelial membrane antigen, S-100, cytokeratin 7 and carcinoembryonic antigen were reactive and Ki-67 showed less than 10% positivity. Based on these findings, the final diagnosis was made as SEC. The patient was treated with local wide excision and didn't show any recurrence during the follow-up period of 12 months. Herein, we report a very rare case of SEC which occurred on the left thigh and discuss 10 cases of SEC presented on the extremities, including our case.
Carcinoembryonic Antigen ; Diagnosis ; Extremities ; Follow-Up Studies ; Head ; Humans ; Keratin-7 ; Larva ; Male ; Mucin-1 ; Neck ; Phenobarbital ; Recurrence ; Sweat ; Sweat Gland Neoplasms ; Thigh* ; Ulcer

PURPOSE: Autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD) are neurodevelopmental disorders. previous report have examined the neurologic problems both in ASD and ADHD. METHODS: We studied 49 children with ASD and 51 with ADHD who had visited our hospital's neuropsychiatric clinic from January 1999 to December 2008. We examined age, EEG abnormalities, developmental delays, and seizures in both groups. RESULTS: 1) The mean age of children diagnosed with ASD was 4 years while that for ADHD was 9 years (P=0.000). 2) The percentage of abnormal EEG in children with ASD was 54.5% and that for those with ADHD was 25.4% (P=0.027). 3) The percentage of developmental delays in children with ASD was 89.8% and that for those with ADHD was 39.2% (P=0.000). 4) The mean age of first seizure in children with ASD was 13 years and that for those with ADHD was 6 years (P=0.005). CONCLUSION: The percentage of abnormal EEG and developmental delay in children with ASD was more than in those with ADHD. The mean age of diagnosis in children with ASD was younger than in those with ADHD and the mean age of first seizure in children with ASD was older than in those with ADHD. The percentage children with ASD who exhibited normalized EEGs upon follow-up was greater than that for children with ADHD.
Attention Deficit Disorder with Hyperactivity ; Autistic Disorder ; Child ; Autism Spectrum Disorder ; Developmental Disabilities ; Electroencephalography ; Epilepsy ; Follow-Up Studies ; Humans ; Seizures

Numerous treatment modalities for acute or subacute herpes zoster and postherpetic neuralgia have been introduced. Therefore, we updated the treatment modalities by conducting a wide review of the medical literature and we created a new treatment algorithm for herpes zoster and postherpetic neuralgia.
Herpes Zoster ; Neuralgia, Postherpetic

"Hemobilia" upper gastrointestinal bleeding that originates from within the biliary tract, is a rare complication of the laparoscopic cholecystectomy. Only a few cases have been reported in the literature. It is more common in accidential or iatrogenic injury of the liver and bile ducts, even occurring spontaneously in cholelithiasis, several inflamatory processes, and vascular and neoplastic changes. The laparoscopic cholecystectomy is a recently developed and advanced surgical procedure that has rapidly gained acceptance. Its complications remain to be clinically analyzed. The authors experienced a case of massive hemobilia after a laparoscopic cholecystectomy. A 54-years-old man with hemobila resulting from right hepatic artery pseudoaneurysm communicating with the intra-hepatic bile duct was treated with angiographic tanscatheter embolization on the of 24th postoperative day. We report this case with a brief review of the literature.
Aneurysm, False ; Bile Ducts ; Biliary Tract ; Cholecystectomy, Laparoscopic* ; Cholelithiasis ; Hemobilia* ; Hemorrhage ; Hepatic Artery ; Liver