An 89-Year-old female patient had had a pea-sized encrusted ulcer on the vermillion border of her right upper lip for 4 years. Histopathological features of the biopsy specimen consisted of tumor islands with peripheral, palisading basaloid cells, some of which had become transformed into atypical, dyskeratotic squamous cells with ample eosinophilic cytoplasm in their centers. Total excision was advised.
Aged, 80 and over ; Biopsy ; Carcinoma, Basal Cell ; Carcinoma, Basosquamous* ; Cytoplasm ; Eosinophils ; Female ; Humans ; Islands ; Lip ; Ulcer

The Graf system has supposed advantages with its flexible nature, as compared with rigid fixation. But there have been no reports about effects in the adjacent motion segment after soft stabilization. The purpose of this study was to evaluate the radiologic changes occuring in the adjacent segments of the Graf system and to assess its ability stabilizing the lumbar spine. A retrospective review of radiographs and medical records was undertaken in 32 cases who had been treated with the Graf system in degenerative lumbar spinal disorders. The average age at operation was 52.5 years and the average follow up period was 49.6 months. The results of this study were as follows: clinical assesments based on the Kirkaldy-Willis criteria revealed excellent in 13 cases (40.6%), good in 16 cases (50%), fair in 2 cases (6.3%) and poor in 1 case (3.1%). Radiologically we analysed the adjacent segments in 25 cases except the cases which did not have the correspondence between the clinical findings and the radiological findings, and the fixated segments in 32 cases. The acceleration of degenerative changes were found in the above adjacent segments in 11 cases (44%) and in the below adjacent segments in 5 cases (27.7%). Also, those changes were found in the fixated segments with discectomy in 19 cases (50%) and in the fixated segments without discectomy in 9 cases (37.5%). In conclusion, we think that the Graf system in a lumbar region may biomechanically influence the adjacent segments. The mechanical effects of the device could be changed by the polyester bands which were followed for a longer period of time in the fixated segments. Therefore, randomized prospective studies comparing the Graf system to other treatement methods could provide clear indications for lumbar spinal disorders.
Acceleration ; Diskectomy ; Equidae ; Follow-Up Studies ; Lumbosacral Region ; Medical Records ; Polyesters ; Retrospective Studies ; Spine

PURPOSE: This study was designed to examine the effects of a solution-focused group counseling program on the family burden, active coping, expressed emotion, and family support in schizophrenic patients and their families. METHOD: The subjects consisted of 48 schizophrenic patients and 56 families. Twenty-four schizophrenic patients and 28 families were assigned to both the experimental and control groups. The solution-focused group counseling program was conducted for the families of the experimental group, but not for the control group or the patients of the experimental group. RESULT: There was a significant greater decrease in scores of family burden and expressed emotion in the experimental groups than the control groups. There was a larger increase in active coping scores in the experimental groups than the control groups, but it was not significant. There was no significant difference between the two groups in family support scores. CONCLUSION: This program may be an effective nursing intervention program for families with schizophrenic members.
Adaptation, Psychological ; Adult ; Aged ; *Counseling ; Expressed Emotion ; Family/*psychology ; Female ; Humans ; Middle Aged ; *Schizophrenia ; Social Support

CTLA-4 (=CD152), a T cell activation antigen, has been known to be homologous to CD28 in its molecular and genomic structure. Both of these two molecules are sharing their counterreceptors, B7 (CDSO) and B7-2 (CD86) and are known to play a crucial role in T cell activation. In previous our study it was reported that there are 2 forms of CTLA-4 antigen in activated human T cells, 30 kD membrane-bound form and 34 kD cytosolic-sequestered form and the former was less than 5 % of total of this antigen induced. Aims of this study are to confirm previous finding by using flow cytometry and to characterize the cytoplasmic form of human CTLA-4 by using ultrafiltration and immunoprecipitation techniques. In PHA stimulated peripheral blood lymphocyte surface expression of CTLA-4 was less than 2.1% of any of CD4+, CD8+ and CD56+ subsets. And the 34 kD form of CTLA-4 was detected in CDS+ subset only. This discrepancy confirms that 34 kD antigen is the cytoplasmic form of human CTLA-4. In ultrafiltration and subsequent Western blot analysis study this 34 kD antigen was detected in >100 kD fraction only. And in non-reducing condition this antigen formed high molecular weght complex (MW > 350 kD). In immunoprecipitation study using anti-peptide A antibody it was found that this high molecular weight complex consists of the 34 kD cytoplasmic form of CTLA-4 and previously unknown 54 kD antigen and 46 kD antigen at 1:1:8-10 ratio. And none of these 3 molecules were identified in membrane fraction of activated human T cell. The result of this study implies that CTLA-4 molecule induced upon T cell activation mainly sequestered in cytoplasrn and another signal is necessary to target this antigen on the activated T cell surface.
Antigens, CD27 ; Blotting, Western ; CTLA-4 Antigen ; Cytoplasm* ; Flow Cytometry ; Humans* ; Immunoprecipitation ; Lymphocytes ; Membranes ; Molecular Weight ; T-Lymphocytes ; Ultrafiltration

Pseudo-Bartter syndrome is a rare medical disease of the kidney characterized by normal blood pressure, hypokalemic metabolic alkalosis, hyperreninemia and hyperaldosteronism with drug history of diuretics. We report US, CT and MRI findings of a patient with clinically proved pseudo-Bartter syndrome. The patient was a 37-year-old woman with a history of long term ingestion of the diuretics(furosemide) for 20 years. Renal US revealed hyperechoic renal medulla at both kidneys. The resistive index(RI), calculated from the duplex doppler waveform is 0.61. Unenhanced CT revealed faint high attenuation along the medulla. Tl-weighted MRI revealed indistinct corticomedullary differentiation.
Adult ; Alkalosis ; Blood Pressure ; Diuretics ; Eating ; Female ; Humans ; Hyperaldosteronism ; Kidney ; Magnetic Resonance Imaging

Primary varicella infection usuelly runs a benign clinical course in the helthy population. However, hemorrhagic chicken pox presents with a very extensive eruption of hemorrhagic vesicles in patients with decreaed platelets or impaired immunity and is accompanied by severe constitutional symptoms. A 7-year-old male was admi due to abdompal pain for 1 day and peneralized vesicular eruption for 5 days. The eruption first appeared on the trunk and then spread to involved face, scalp and extrsmities. The skin rash was compatable with varicella but despite the administration of acclovir intravenously, the vesicular eruption became hemorrhagic. Ten days after admission, having experienced cardisc arrest twice and with his mental state in coms, he was diseharged as his situation was hopelesa. We have experienced a giatient diagnosed as having hemorrhagie, chicken pox complicated by encephalopathy.
Chickenpox* ; Chickens* ; Child ; Exanthema ; Humans ; Male ; Scalp

No abstract available.
Spinal Fractures*

"Dual LAD" was defined as the early bifurcation of the proximal LAD into two vessels : a short LAD which remained in the anterior interventricular sulcus and does not reach the apex, and a long LAD which leaves the anterior interventricular sulcus only to return to the distal sulcus and continue to the apex. Recognition of "Dual LAD" is essential to prevent errors of interpretation of the coronary arteriogram and for planning of optimal surgical therapy. We report 2 cases of "Dual LAD" with the review of the literatures.
Coronary Vessels*

BACKGROUND: The emergency physician(EP)'s interpretation of the electrocardiogram(ECG) is important in determining the disposition of patients evaluated in an emergency department(ED) for chest pain o other cardiac complaints. This particularly important in life-threatening ECG findings. When the cardiologist's final interpretation was defined as the correct one, the concordance compared with the EP was reported to be 50-60%, while the missed diagnosis of acute myocardial infarction(AMI) was reported as 0.6-8.0%, which could be deleterious to the patient. METHOD AND MATERIAL : One hundred and twenty eight ECGs were interpreted by two residents from each year residency. ED records of the study patients were reviewed, and the EP's and cardiologist's ECG interpretations were compared. The ECGs were classified by severity according to the following system: class I, normal or minor abnormalities only; class II, abnormalities with potential to alter case management; and class III, potentially life-threatening abnormalities. RESULTS: The overall concordance between EP's and cardiologist's ECG interpretations was 59.3% and the concordance comparing each year residency showed no statistical significant difference (p value less than 0.05). The underdiagnosed rate was 48.4%, 32.0%, 23.4%, 22.7% for first, second, third and fourth year residency respectively, and 2.3%, 5.5%, 10.9%, 5.5% respectively for the overdiagnosed rate. CONCLUSION: Although the overall concordance showed a relatively high result in our study, the concordance of class III ECG resulted a much lower rate. Therefore, additional studies are needed to identify variables that contribute to ED ECG misinterpretation and to develop methods to resolve these difficulties. Assessment of department ECG misinterpretation would be useful in focusing on resident and staff education.
Case Management ; Chest Pain ; Diagnosis ; Education ; Electrocardiography* ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Internship and Residency

PURPOSE: To evaluate MR imaging findings of degenerating parenchymal neurocysticercosis and to determine the characteristics which distinguish it from other brain diseases. METHODS: MR imagings of 19 patients (56 lesions)of degenerating parenchymal neurocysticercosis were retrospectively evaluated, focusing on the size and locationof lesions, signal intensity patterns of cyst fluid and wall, the extent of the surrounding edema and features of contrast enhancement. RESULTS: Degenerating parenchymal neurocysticercosis was located in gray or subcortical white matter in 89.3% of 56 lesions(50/56); most of these (98.2%) were smaller than 2cm in diameter. Cyst fluidsignal was hyperintense relative to CSF on T1 and proton density weighted images (92.9%). A hypointense signal rimof the cyst wall was noted in the lesions on proton density (92.9%) and T2 weighted (98.2%) images. Surrounding edema was mostly mild. Peripheral rim enhancement was noted in all lesions, and this was frequently irregular and lobulated (67.9%) with a focal defect in the enhancing rim (41.1%). CONCLUSION: Findings which could be helpfulin distinguishing degenerating parencymal neurocysticerosis from other brain diseases are as follows : small, superficial lesions ; hyperintense signal of the cyst fluid on T1 and proton density weighted images ; hypointense signal of the cyst wall on proton density and T2 weighted images ; relatively mild extent of surrounding edema,and peripheral rim enhancement which is frequently irregular and lobulated with a focal defect in the enhancingrim.
Brain Diseases ; Cyst Fluid ; Cysticercosis ; Edema ; Humans ; Magnetic Resonance Imaging ; Neurocysticercosis* ; Parasites ; Protons ; Retrospective Studies