Pemphigus is a rare, blistering autoimmune disease in which the action of antibodies is now well established. The most effective therapy is the administration of cortioseroids. Prior to the use of steroids, it was commonly fatal. Since the availability of corticosteroidsnortality has been markedly reduced. However prolonged administration of steroids may be difficult to sustain because of severe side effects. For these, other sdjuvant therapies were considered. Such as immunosuppresive drugs, gold, dapsone, plasmapheresis and intralesional injection of corticosteroid. Of these, immunosuppressive therapies are most commonly used. Recently cyclosporine which was for human organ transplantation is used in dermatology. Cyclosporine is a potent immunosupprc save agent with no appreciable effect on bone marrow and a selective inhibition to helper T cells. In our case, cyclosporine was administrated to the patient who had suffered from severe pemphigis vulgaris for 3 years without responding to treatment. We gave cyclosporine 400mg and prednisolon, 90mg per day. But we found a sudden increase of the RUN/Cr level and a shut down of the renal funtion. Therefore we discontinued cyclosporine and treated acute renal failure. However the renal damag e was irreversible and two days later the patient died.
Acute Kidney Injury* ; Antibodies ; Autoimmune Diseases ; Blister ; Bone Marrow ; Cyclosporine ; Dapsone ; Dermatology ; Humans ; Injections, Intralesional ; Organ Transplantation ; Pemphigus* ; Plasmapheresis ; Steroids ; T-Lymphocytes, Helper-Inducer ; Transplants

Syndromal acanthosis nigricans is associated with cellular resistance to the action of insulin and other endocrinopathies. In the insulin resistant state, increased insulin binds to the receptors of insulin-like growth factors (IGFs). IGFs are growth prompting peptides, which act as direct mitogens on cells containing the receptors. Through these actions, increased cellular growth and metabolism cause the skin lesions of acanthosis nigricans. Hyperandrogenism is also found in syndromal acanthosis nigricans patients. When associated with insulin resistance, these states are proportionally related. Increased insulin prompts the synthesis of androgen and conversely, increased androgen elevates the insulin resistance. We present three cases of syndromal acanthosis nigricans with hyperpigmented skin lesions and obesity. Laboratory findings demonstrated normal fasting blood suga levels with increased insulin and C-peptide levels and decreased insulin receptors. The oral glucose tolerance test was normal. We suggest that these patients were in an insulin resistant state. Skin biopsies from the axilla in all three cases showed hyperkeratosis, irregular acanthosis and upward projection of dermal papillae as finger like fashion. Thus all three cases represent syndromal acanthosis nigricans associated with an insulin resistant state based on clinical, histopathological, and laboratory findings. The three patients were treated with dietary control.
Acanthosis Nigricans* ; Axilla ; Biopsy ; C-Peptide ; Fasting ; Fingers ; Glucose Tolerance Test ; Humans ; Hyperandrogenism ; Insulin Resistance* ; Insulin* ; Metabolism ; Mitogens ; Obesity ; Peptides ; Receptor, Insulin ; Skin ; Somatomedins

Authors experienced a 13-day-old boy who had suffered from walnut sized hard erythematous nodules on left axilla, anterior and posterior aspect of the neck which began to develop 9 days after birth. Histopathologic findings revealed subcutaneous fat necrosis and needle-shaped cleft in several fat cells. The skin lesions spontaneously resolved at 2 months of age. The clinical pattern, the skin manifestations, and the histologic appearance of the lesions were diagnostic of subcutaneous fat necrosis of newborn.
Adipocytes ; Axilla ; Humans ; Infant, Newborn* ; Juglans ; Male ; Neck ; Necrosis* ; Parturition ; Skin ; Skin Manifestations ; Subcutaneous Fat*

Bowenoid papulosis is manifested by clinically the benign-appearing papules of anogenital region and histopathologically similar features of squamous cellurar inoma in situ in human. A cause is thought to be Human Papillomavirus infection, type 16. The treatment is mainly through conservative management but others are topical application of podophyllin, shave excision, local excision, cryotherapy, electrodessication, topical applcation of 5-FU ointment and subcutaneous injection of recombinant interferon gamma. We present a case of Howenoid papulosis treated with DNCB imriunotherapy. The patient, had multiple papules on the penis with mild pruitus. Histopatnologic findings showed crowding and irregular arrangement of the nucleic many of which are large, hyperchromatic, and pleomorphic. Dyskeratotic and multinucleated keratinocytes wire also present, as were atypical mitoses, scattered in epidermal layer. We treated him with DNCB immunotherapy. Initially he was sensitized with 2,000 ug/0.1ml and two weeks later he received 50 ug/0.1ml per every week. After 3 weeks, he had showed no improvement and we elevated the dose to 100 ug/0.1ml. He was improved after 6th trial and his skir. lesions were almostly disappeared at present.
Crowding ; Cryotherapy ; Dinitrochlorobenzene* ; Fluorouracil ; Humans ; Immunotherapy* ; Injections, Subcutaneous ; Interferons ; Keratinocytes ; Male ; Mitosis ; Papillomavirus Infections ; Penis ; Podophyllin

OBJECTIVE: The purpose of this study was to elucidate the anatomical development of physiologic suture closure processes in infants using three dimensional reconstructed computed tomography (CT). METHODS: A consecutive series of 243 infants under 12 months of age who underwent three dimensional CT were included in this study. Four major cranial sutures (sagittal, coronal, lambdoidal and metopic suture) were classified into four suture closure grades (grade 0=no closure along the whole length, grade 1=partial or intermittent closure, grade 2=complete closure with visible suture line, grade 3=complete fusion (ossification) without visible suture line), and measured for its closure degree (suture closure rates; defined as percentage of the length of closed suture line divided by the total length of suture line). RESULTS: Suture closure grade under 12 months of age comprised of grade 0 (n=195, 80.2%), grade 1 (n=24, 9.9%) and grade 2 (n=24, 9.9%) in sagittal sutures, whereas in metopic sutures they were grade 0 (n=61, 25.1%), grade 1 (n=167, 68.7%), grade 2 (n=6, 24%) and grade 3 (n=9, 3.7%). Mean suture closure rates under 12 months of age was 58.8% in metopic sutures, followed by coronal (right : 43.8%, left : 41.1%), lambdoidal (right : 27.2%, left : 25.6%) and sagittal sutures (15.6%), respectively. CONCLUSION: These quantitative descriptions of cranial suture closure may help understand the process involved in the cranial development of Korean infants.
Cranial Sutures ; Growth and Development ; Humans ; Infant ; Sutures

Recently we experienced 10 cases of posterior urethral injury associated with pelvic fracture. Of these patients 5 underwent primary realignment with perineal traction on the prostate (Selikowitz method), and the other 5 underwent immediate cystostomy and delayed urethroplasty (Johanson method). Comparison of the post-operative complications didn`t appear to show significant differences in the 2 groups, although the numbers were small. But patients who performed immediate cystostomy and delayed urethroplasty showed some disadvantages of the long period of treatment, high charges, often multiple hard procedures and the long time of operation. Therefore in the initial management of posterior urethral injury, we think it better to take primary realignment in Korean socioeconomic circumstances, if the patient is not in the high risk.
Cystostomy ; Humans ; Prostate ; Traction

The epidermis, which is composed mainly of keratinocyt;es, undergoes continual proliferation and differentiation, To study keratinocyte differentiation, it is necessary to separate the keratinocytes at their sucessive stages of maturation. We separate the keratinocytes by layers by using Percoll and obtain the relatively pure fractions of basal cells, spinous cells, and granular cells, 76. 8%, 67. 2%, 30%. respectively.
Epidermis ; Humans* ; Keratinocytes

No abstract available.
Adolescent* ; Humans

We report a case of ureteral migration of a surgical clip after partial nephrectomy in which the clip was misdiagnosed as a ureteral stone. A 37-year-old woman had undergone laparoscopic partial nephrectomy of right renal cell carcinoma at another hospital 2 years previously. Postoperatively, she had gradually acquired lower urinary tract symptoms. Then, she complained of sudden right flank pain for a week. A plain X-ray and enhanced abdominopelvic computed tomography scan were performed. A 0.5 cmx1.0 cm right upper ureteral opacity with borderline hydronephrosis was seen but could not be found on the X-ray. Ureteroscopy revealed a medium-sized Hem-o-Lok clip on the right upper ureter that was removed with a stone basket. We concluded that a Hem-o-Lok clip used for collecting system sealing had migrated to the ureter and had been misdiagnosed as a ureteral stone on a computed tomography scan.
Carcinoma, Renal Cell ; Female ; Flank Pain ; Humans ; Hydronephrosis ; Lower Urinary Tract Symptoms ; Nephrectomy ; Surgical Instruments ; Ureter ; Ureteral Calculi ; Ureteroscopy

Paraganglioma is a benign tumor arising in the paraganglion system scattered throughout the body, but its cytopathologic findings arenot well known. We experienced a case of paraganglioma of carotid body diagnosed by fine needle aspiration. The patient was a 30 year-old female who suffered from the left neck mass for 3 years. The mass was 3x3crn in size without pulsation or bruit. Cytologically, the smear revealed aggregated and singly scattered tumor cells having abundant pale cytoplasm and indistinct cell borders. Their nuclei were round to oval, but enlarged nuclei were occasionally observed. The nuclear membrane was smooth with fine clumping of chromatin. Differentiation from metastatic follicular carcinoma of the thyroid gland was difficult.
Adult ; Biopsy, Fine-Needle ; Carotid Body ; Chromatin ; Cytoplasm ; Female ; Glomerulosclerosis, Focal Segmental* ; Humans ; Neck ; Nephrotic Syndrome* ; Nuclear Envelope ; Paraganglioma ; Thyroid Gland