Background & Objective: Sex differences in cerebral atherosclerosis and subsequent stroke have not been thoroughly investigated and conflicting data exist. The aim of this study was to investigate sex differences in the risk factors and distribution of large artery atherosclerotic stroke in a Korean population. Methods: We included consecutive acute ischemic stroke patients with symptomatic extracranial atherosclerosis (ECAS) or intracranial atherosclerosis (ICAS) based on brain and vascular imaging who presented at our hospital between January 2011 and December 2015. We then compared risk factor profiles and the proportion of symptomatic ECAS and ICAS between men and women. Results: Eight hundred and forty four patients were enrolled during the study period. The proportion of ECAS in men was notably higher than in women (19.4% in men vs. 9.3% in women; p < 0.001). A multiple regression analysis showed that male gender was a factor favoring ECAS (vs. ICAS, odds ratio [OR], 3.554; 95% confidence interval [CI], 2.175-5.808; p < 0.001). Age (OR, 1.051; 95% CI, 1.031-1.072; p = 0.001) and hyperlipidemia (OR, 2.330; 95% CI, 1.538-3.529; p < 0.001) were also factors favoring ECAS. However, after stratification by sex, the association was only significant in men. Conclusions: There is a sex difference in the distribution of atherosclerotic stroke. Sex may be an effect modifier of the association between atherosclerotic risk factors and atherosclerotic distribution.
Stroke

Leiomyoma is commonly found in the female genital tract, but occurrence in the urinary bladder is very rare with only 235 cases reported in the literature. These tumors have been classified as intravesical (63%), intramural (7%) and extravesical (30%) depending on the direction of the growth. We report a case of intravesical leiomyoma of the urinary bladder in a 36 year-old woman who exhibited dysuria and urinary retention. The gross and microscopical findings of leiomyoma of the bladder are similar to those of the uterus. Immunohistochemical stains for estrogen receptor (ER) and progesterone receptor (PR) revealed diffuse nuclear staining in smooth muscle cells, supporting the hypothesis of hormonal influence in tumorigenesis.
Adult ; Carcinogenesis ; Coloring Agents ; Dysuria ; Estrogens ; Female ; Humans ; Leiomyoma* ; Myocytes, Smooth Muscle ; Receptors, Progesterone ; Urinary Bladder* ; Urinary Retention ; Uterus

No abstract available.

Reiters syndrome is an unusual disease characterized a triad of nongonococcal urethritis, conjunctivitis, and arthritis in association with the mircoutaneous lesions of keratoderma blenorrhagica and balarintis circinata. We present herein a case of Reiters syndome combined yiti lung cancer. A 39-year-old man has experienced naigrating polyarthralgia and high fever ilitermittently for about 20 years, Hyperkeratotic erythemnous patches and plaques, which dyeliped about 1 year ago, have aggravated and expanded to the whole body. Histopathologic sections from the plaque on the right forc ari showed characteristic findings including thickened parakeratotic horny layer and spongiform micropustules of Kogoji He was associated with HLA-B27. On the chest X-ray, a thumbtip size mass was incidently found. Chest CT and bone scan findings supported lung cancer and multiele metastases.
Adult ; Arthralgia ; Arthritis ; Conjunctivitis ; Fever ; HLA-B27 Antigen ; Humans ; Lung Neoplasms* ; Lung* ; Neoplasm Metastasis ; Thorax ; Tomography, X-Ray Computed ; Urethritis

Progressive zosteriform macular pigmented lesion(PZMPL) is a chronic pigmentary dermatosis similar to progressive cribriform and zosteriform hyperpigmentation(PCZH). This dermatosis described by Simoes in 1980 is characterized by a uniformly tanned macular pigmented lesion in a zosteriform distribution preceded by multiple pruritic macular pigmentation in a part of the dermatome for a period. PZMPL is not a fully understood disease entity but it is thought to be a variant of PCZH. It is differentiated from PCZH by accompanying pruritus as a prodromal symptom, a characteristic clinical course, and histological findings such as pigmentary incontinence. We report herein a case of PZMPL in a 17 year-old girl with the pigmentary skin lesion extending from the left forearm to the left chest along the Blaschkos line. The histological findings revealed increased melanin pigments in the basal layer and focal pigmentary incontinence in the upper dermis. To our knowledge, this case is the first report of PZMPL in korea thought to be the same case reported by Simoes.
Adolescent ; Dermis ; Female ; Forearm ; Humans ; Korea ; Melanins ; Pigmentation ; Prodromal Symptoms ; Pruritus ; Skin ; Skin Diseases ; Thorax ; Triacetoneamine-N-Oxyl

CD44 is a hyaluronic acid receptor that exists as a standard 90-kd form (CD44H) as well as several CD44 variants isoforms are produced through alternative splicing. Alternatively spliced variants of the CD44 molecule have been found to be associated with invasive and metastatic potential of cancer cells and poor prognosis in several types of carcinoma. The purpose of the present study is to define the expression of CD44H and CD44v6 in ovarian tumors and to investigate whether the expression of these molecules is associated with adverse prognosis. We evaluated the expression of CD44 isoforms in 58 ovarian tumors by means of immunohistochemistry, and correlated between CD44 expression and the histologic types, tumor grade, peritoneal implants, pseudomyxoma peritonei and FIGO stage. While the CD44H was commonly expressed in ovarian tumors, the CD44v6 was expressed in a minor proportion of serous tumors in comparison with frequent expression of v6 isoform in mucinous tumors. The CD44H expression was significantly higher in stage I/II than in stage III. However, there was no correlation between the expression of CD44 and the presence of peritoneal implants or pseudomyxoma peritonei. These results suggest that CD44H could play an important role in the adhesive function in the lower stage of the ovarian tumor and reduced expression in the higher stage might be related to the metastasis and widespread invasion of ovarian carcinoma cells.
Adhesives ; Alternative Splicing ; Female ; Hyaluronic Acid ; Immunohistochemistry ; Mucins ; Neoplasm Metastasis ; Ovary ; Prognosis ; Protein Isoforms ; Pseudomyxoma Peritonei

Pyoderma gangrenosum is a rare, recurrent, painful and ulcerative skin disorder of unknown etiology, but is commonly associated with a variety of underlying systemic diseases of ulcerative colitis, rheumatoid arthritis, monoclonal gammopathies, Crohns disease, chronic active hepatitis and some hematologic diseases such as leukemia, thrombocythemia, dysglobulinemia and myeloma. We describe a 50 year-old woman who had pyoderma gangrenosum associated with idiopathic myelofibrosis. The findings of a bone marrow biopsy revealed proliferation of fibroblasts and a dense reticulin network, which were consistent with myelofibrosis. Steroid therapy resulted in a good response temporarily but, she died within a year after diagnosis. To our knowledge, our present case associated with idiopathic myelofibrosis is the first reported case in the Korean literature.
Arthritis, Rheumatoid ; Biopsy ; Bone Marrow ; Colitis, Ulcerative ; Crohn Disease ; Diagnosis ; Female ; Fibroblasts ; Hematologic Diseases ; Hepatitis, Chronic ; Humans ; Leukemia ; Middle Aged ; Paraproteinemias ; Primary Myelofibrosis* ; Pyoderma Gangrenosum* ; Pyoderma* ; Reticulin ; Skin ; Thrombocytosis ; Ulcer

Familial benign chronic pemphigua is a rare disease characterized by a localized recurrent eruption of grouped vesicles and exudative lesions involving the neck, groin, axillae and intertriginous areas. There are no systemic manifestations but chronicity and pruritic lesions creates a significant social and psychological handicap to those afflicted. We presented a case of familial benign chronic pemphigus in a 39 years old man He has had recurrent vesicles, fissures and crust formation in inguinal area for 10 years. Light microscopic findings showed suprabasal vesiculation with acantholysis and villi formation. And electron-microscopic findings showed as follows: Bizzare microvilli changes with widened intercellular spaces, followed by loss of desmosome and complete acantholysis. Tonofilament-desmosome complex is disrupted. Many of acantholytic cells are associated with abnormal keratinization which is repreaented by perinuclear thickened bundles of tonofilament arranged in whorls or lumps. Authors diagnosed with clinical symptoms, light and electron-microscopic findings as Hailey-Hailey disease. The lesions were improved by systemic antibiotics and steroid with cold soaking.
Acantholysis ; Adult ; Anti-Bacterial Agents ; Axilla ; Desmosomes ; Extracellular Space ; Groin ; Humans ; Intermediate Filaments ; Microvilli ; Neck ; Pemphigus, Benign Familial* ; Rare Diseases

BACKGROUND: It has been reported that KONCPA(KOH+Nail clipping+PAS reaction) test might be a useful complementary method with a high positive rate and an exellent view for making the diagnosis of onychomycosis. OBJECTIVE: KONCPA test, Onyehomycosis This study was aimed to know whether KONCPA test would increase the diagnostic sensitivity of onychomycosis, and agree with the findings of fungus culture and whether KONCPA finding would be of help in diagnosing the causative fungi even in case that KOH smear and fungus culture fail to identify the causative fungi. METHODS: Using 95 onychomycotic nail samples obtained from 87 patients, the KONCPA findings were compared with those of KOH smear and fungus culture. RESULTS: The results were as follows ; 1. The positive rates for dtecting the causative fungi from KOH srnear, fungus culture and KONCPA test were 779%, 45.3% and 95.8% respectively. The time required for KONCPA test, showing the highest positive rate, was only about 2 to 3 hours. 2. The fungus culture identified the causative fungi from 43 samples, of which dermatophytes were found in 31 samples(72.1%), Candida spp. in 5 samples(11.6%) and molds in 7 samples(16. 3%). KOH smear revealed the causative fungi in 63 samples : dermatophytes 56(88.9%), Candida spp. 4(6.3%) and molds 3(4.8%). KONCPA yielded the highest positivity by detecting the pathogenic fungi in 86 samples(95.8%): dermatophytes 60(69.8%), Candida spp. 8(9.3%), molds 10 (11.6%) and mixed infections 8(9.3%). 3. Compared with the results of fungus culture, 3 groups of fungi showed morphologic differences on KONCPA test: dermatophyte showing septated long and thin hyphae and a few arthrospores, Candida sp. showing blastospores and/or grape-like clusters of regular spores and pseudohyphae, and mold showing irregular hyphae with variable width and aggregates of irregular spores. 4. Of the 52 samples which were negative in fungus culture, 33(63.5%) showed findings of dermatophyte, 2(3.8% ) of Candida sp., 2(3.8% ) of mold and the remaining 11 samples(21.2% ) were negative on KOH smear, Of these 52 samples, KONCPA diagnosed 34(65.4%) to be dermatophytes, 6(11.5%) Candida syp., 6(11.5%) molds, 1(1.9%) mixed infection and 2 samples(3.8%) to be negative. CONCLUSION: KONCPA test is useful in the diagnosis of onychomycosis because of its higher positive rate in detecting the causative fungi compared with fungus culture or KOH smear. It is also a timesaving and simple procedure Furthermore, in case that KOH smear and fungus culture fail to identify the causative fungi, it is possible to make a presumptive diagnosis by the findings of KONCPA test.
Arthrodermataceae ; Candida ; Coinfection ; Diagnosis ; Fungi ; Humans ; Hyphae ; Onychomycosis* ; Spores

The effect of induced hypotension with sodium nitroprusside(SNP) on alveolar-arterial oxygen tension difference and pulmonary shunting in 10 surgical patients with normal pulmonary function was studied under general anesthesia. Heart rate, mean arterial pressure, central venous pressure, blood gases and hemoglobin were measured before, during and after SNP infusion. Using the above data, alveolar-arterial oxygen tension difference and pulmonary shunting were calculated. The results were as follows. 1) Mean arterial pressure decreased significantly from 98+/-9.1mmHg before SNP infusion to 61+/-3.0 mmHg during SNP infusion(p<0.001), and increased to 96+/-6.7mmHg again after SNP infusion. 2) Heart rate increased significantly from 78+/-10.5 beats/min. to 101+/-11.9 beats/min.(p<0.001), and decreased to 84+/-11.5 beats/min. again. 3) Arterial oxygen tension decreased from 489+/-32.5mmHg to 480+/-25.0mmHg, but was not statistically significant. (p>0.05). 4) Alveolar-arterial oxygen tension difference increased from 188+/-29.0mmHg to 196+/-25.0mmHg, but was not statistically significant(p>0.05). 5) Pulmonary shunting increased from 9.0+/-1.83% to 9.2+/-1.50%, but was not statistically significant.(p>0.05). The above findings suggest that pulmonary shunting in patients with normal lung function will not affected during induced hypotension with SNP.
Anesthesia, General ; Arterial Pressure ; Central Venous Pressure ; Gases ; Heart Rate ; Humans ; Hypotension* ; Lung ; Nitroprusside* ; Oxygen* ; Sodium*