A 43 year-old Korean male has had multiple, grouped, asymptomatic, yellowish brown flat papules and nodules on the knees, elbows, buttocks, palms and soles for 3 years. Small yeIlowish, discrete papules first appeared on the right palm and left elbow, and gradually increased in size and number and spread to knees, buttocks and soIes. Physical examination revealed normal except for the skin lesions and no familial occurrence was noted. Gross finding of the serum was turbid, more or less creamy and paper electrophoresis revealed marked increase of prebetalipoprotein, increase of betalipoprotein and alphalipoprotein and absence of chylomicron, suggesting type III or type IV hyperlipoproteinemia. Serem choleterol was 200mg% and fasting blood sugar was 115.0mg%. with normal glucose tolerance test. Histopathology showed many aggregates of foam cells on H-E stain and many lipid droplets in the dermis on Sudan red stain. Based on the clinical and histopathological findings and lipoprotein analysis by the paper electrophoresis, the patient was diagnosed as type IV hyperlipoproteinemia with xanthoma tuberosum.
Adult ; Blood Glucose ; Buttocks ; Dermis ; Elbow ; Electrophoresis, Paper ; Fasting ; Foam Cells ; Glucose Tolerance Test ; Humans ; Hyperlipoproteinemia Type IV ; Knee ; Lipoproteins ; Male ; Physical Examination ; Skin ; Sudan ; Xanthomatosis*

We present two cases of acute febrile neutrophilic dermatosis developed in women aged 56 and 52. One of the two patients deveIoped the lesions during longterm antituberculosis chemotherapy for her advanced pulmonary tuberculosis, The other case developed the lesions, initially at the site of acupuncture done for relief of her arthralgia, followed by the involvement of the other sites. The etiology of acute febrile neutrophilic dermatosis is not clear, however, hypersensitivity and association with systemic diseases such as upper respiratory infection, malignancies, ulcerative colitis and pyoderma gangrenosum are postulated.
Acupuncture ; Arthralgia ; Colitis, Ulcerative ; Drug Therapy ; Female ; Humans ; Hypersensitivity ; Pyoderma Gangrenosum ; Sweet Syndrome* ; Tuberculosis, Pulmonary

Cystic hygroma, or cystic lymphangioma, is a true, benign, congenital rnulticystic tumor arising from sequestrations of embryonic ly mphatic iissue. Most often it occurs. At birth or early in life, and it is found most commonly in the neck, and its distribution coincides with that of the prirnitive lymph sacs. We report herein a case of huge cystic hygroma on the face and neck in a 2 month-old male infant. The swelling was softly cystic, and was partially compressible, and it was brilliantly translucent. The cystic mass contained a serous fluid. Biopsy findings showed simple endothelium-lined lymphatic vessel and loose, lace-like fibrous tissue stroma, and dilated muscle space filled with serous fluid.
Biopsy ; Humans ; Infant ; Lymphangioma, Cystic* ; Lymphatic Vessels ; Male ; Neck ; Parturition

Merkel cell carcinoma (MCC) is an unusual primary cutaneous tumor, occasionally found con-current with other malignancies. A case of MCC with coexisting squamous cell carcinoma (SCC) was studied histologically, immunohistochemically and ultrastructurally. The MCC and SCC occured at the same site, but each preserved its identity and transition between the two was not identified.
Carcinoma, Merkel Cell* ; Carcinoma, Squamous Cell

Mucormycosis refers to infections caused by the order Mucorales of the class Zygomycetes. They are acute, rapidly developing, often fatal, opportunistic infections of immunocompromised patient. We report a case of rhinocerebral mucormycosis in a 73-year-old man with a 20-year history of poorly controlled diabetes mellitus. He had black necrotic ulcers on the hard palate, left blepharoptosis, left visual loss, left facial palsy and left hemiparesis. Brain and sino-orbital MRI scan showed protrusion of left eyeball, sinusitis on the both maxillary and ethmoid sinus and left middle cerebral artery infarction. Swab of black necrotic ulcer on the hard palate yielded large fungal hyphae on KOH preparation and inoculation of necrotic tissue on Sabouraud dextrose agar revealed a rapid growth of white to gray cottony colonies that soon turned gray to dark brown. Slide culture showed globose sporangia and no rhizoid or apophysis. These morphologic characteristics were those of the Mucor species. Histopathologic examination of the palatal lesion showed large, non-septated fungal hyphae in the dermis. The patient was treated with amphotericin B 50 mg/day for 45 days but died 114 days after admission.
Agar ; Aged ; Amphotericin B ; Blepharoptosis ; Brain ; Dermis ; Diabetes Mellitus ; Ethmoid Sinus ; Facial Paralysis ; Glucose ; Humans ; Hyphae ; Immunocompromised Host ; Infarction, Middle Cerebral Artery ; Magnetic Resonance Imaging ; Mucor* ; Mucorales ; Mucormycosis* ; Opportunistic Infections ; Palate, Hard ; Paresis ; Sinusitis ; Sporangia ; Ulcer

We report two cases of kerion celsi caused by Trichophyton tonsurans, One is a 16-year-old male Judo-player in athletic high school and the other is a 7-year-old boy. Kerion celsi is a highly inflammatory, suppurative fungal infection of the scalp caused mainly by zoophilic dermatophytes transmitted from animals to man. The first case presented with a 4cm sized, markedly inflammatory, boggy mass on the occipital scalp. The second one showed several 2-3cm sized, erythematous, follicular pustules and plaques with partial hair loss on the frontal and parietal scalp. The diagnosis was established by histopathologic and mycologic studies that are KOH, fungus culture, slide culture and histopthologic exams of the lesional specimen. All the lesions of the patients were cleared with itraconazole for several weeks and short-term systemic steroid.
Adolescent ; Animals ; Arthrodermataceae ; Child ; Diagnosis ; Fungi ; Hair ; Humans ; Itraconazole ; Male ; Rabeprazole ; Scalp ; Sports ; Tinea Capitis* ; Trichophyton*

Sebaceous carcinoma is a rare, aggressive, malignant tumor derived from the adnexal epithelium of sebaceous glands. This tumor occurs most frequently on the eyelids, but may occur on the extraoccular sites. Clinically, it is presented as a solitary tumor in most cases and very rarely as multiple ones. We report a case of multiple. sebaceous carcinomas on the frontal region in a 73 year-old man. He had well-demarcated, reddish, asymptomatical, protruding masses on the frontal region for 2 months. The histopathologic findings showed irregular, variable sized, lobular tumor nests of the entire dermis, and each lobule was composed of foamy cytoplasmic atypical cells and undifferentiated cells containing, eosinophilic cytoplasm. He was treated with surgical excision and no recurrence was observed during 6 months.
Aged ; Cytoplasm ; Dermis ; Eosinophils ; Epithelium ; Eyelids ; Humans ; Recurrence ; Sebaceous Glands

BACKGROUND: Generalized sterile pustular eruption with fever which occurs in generalized pustular psoriasis (GPP) and acute generalized exanthematous pustulosis(AGEP) present a diagnostic and therapeutic problems. In Korea, there are a few studies of clinical and histopathologic reviews of these diseases, but long term follow-up and comparative clinicopathologic studies of these two diseases are not available. OBJECTIVE: This study attempts to identify the differences of these two diseases in the aspects of clinical, laboratory, and histopathologic findings. METHODS: We evaluated the clinical features, laboratory and histopathologic findings in 41 patients with generalized pustular eruption who had visited Pusan National University hospital during the past 20 years and reviewed the literature. RESULTS: 1. The ratio of patients with GPP(n=32) to ones with AGEP(n=9) was 3.6:1. 2. The mean age at diagnosis was 32.9(male) and 28.9(female) years in GPP, and 10.3 years(male) and 62.8 years(female) in AGEP. 3. The number of patients of GPP with previous personal history of psoriasis vulgaris were 15/32(46.9%) and the number of ones with previous family history of psoriasis vulgaris were 2/32(6.3%). 4. There was no patient of AGEP with personal or familial history of psoriasis. 5. The number of patients with recent drug intake history were 4/32(12.9%) in GPP and 9/9(100%) in AGEP. And common drugs suspected to cause AGEP were antibiotics(4 cases) and analgesics(3 cases). 6. Associated systemic symptoms were fever(37.5%), arthralgia(18.8%), and itching(62.5%) in GPP, whereas 66.7%, 33.3%, and 55.6%, respectively in AGEP. 7. The mean duration of pustules was 32.9 days in GPP and 7.2 days in AGEP. 8. Reccurences of generalized pustular eruption were 46.9% in GPP and 0% in AGEP. 9. Laboratory findings revealed leukocytosis(34.4%), elevated erythrocyte sedimentation rate(28.1%), hypoalbuminamia(25.0%), and eosinophilia(6.3%) in GPP, whereas 77.8%, 55.6%, 33.3%, and 71.4%, respectively in AGEP. 10. GPP and AGEP are diseases sharing similar clinical features, but these two diseases show distinctive clinical, laboratory, and histologic features. We suggest that it is important to be aware of these distinctions for avoidance of unnecessary aggressive therapy indicated for GPP.
Acute Generalized Exanthematous Pustulosis* ; Blood Sedimentation ; Busan ; Diagnosis ; Fever ; Follow-Up Studies ; Humans ; Korea ; Psoriasis*

BACKGROUND/AIMS: During partial liver resection, intermittent hepatic pedicle clamping results in less hepatocyte damage than continuous clamping. However, the optimal duration of ischemia and reperfusion during the intermittent hepatic vascular clamping has not been determined. So, this study aimed to determine the optimal duration of ischemia and reperfusion. METHODS: Using partial ischemia(70%) rat model, the maximum limit of ischemic time and minimum limit of reperfusion time were evaluated. To assess the maximum limit of ischemic time, rats were divided into three groups for 15, 20, and 30 minutes of ischemia followed by 60 minutes reperfusion. To assess the minimum limit of reperfusion time, reperfusion following 15-minute ischemia was repeated 10 times in three groups for 5, 10, and 15 minutes of reperfusion. In the ischemic experiments, hepatic blood flow and ATP levels were serially measured. In the reperfusion experiments, serum liver enzyme, 1-month survival rates, as well as, hepatic blood flow and ATP level were serially measured and then, the 1-month survival rate was compared between the continuous ischemic group and intermittent ischemic groups. RESULTS: (1) In the 15- minute ischemic group, the hepatic blood flow and ATP levels returned to preischemic values after 1 hour of reperfusion. But in the 20- or 30-minute ischemic groups, the hepatic blood flow and ATP levels did not return to preischemic values. (2) In the 15-minute reperfusion group, the survival rate and hepatic function, such as hepatic blood flow and ATP levels, were better than the 5- or 10-minute reperfusion groups. CONCLUSION: In 70% partial ischemic rat model, the maximum limit of ischemic time was 15 minutes. In cases of intermittent ischemia and reperfusion, there was less liver damage in the 15-minute reperfusion group compared to the 5- or 10-minute reperfusion groups.
Adenosine Triphosphate ; Animals ; Constriction* ; Hepatocytes ; Ischemia ; Liver ; Models, Animal ; Rats ; Reperfusion ; Survival Rate

OBJECTIVE: This study was conducted to evaluate the clinical efficacy of simple total laparoscopic hysterectomy in the aspect of operation indication, operation time, hospitalization day, blood loss, and postoperative complications. METHODS: A retrospective evaluation for 312 women who undergone simplified total laparoscopic hysterectomy from January, 2002 to June, 2003 was done. RESULTS: The mean age of patients was 45.2 years, mean parity was 2.2, and mean uterine weight was 272.3 gm. The most common surgical indication was uterine myoma in 136 cases (43.5%), followed by adenomyosis in 90 cases (28.8%), myoma combined with adenomyosis in 52 cases (16.6%), uterine prolapse in 15 cases (4.8%), and HSIL 19 cases (6%) respectively. The most common concomitant operation was salpingooophorectomy in 53 cases (16.9%), followed by adhesiolysis in 40 cases (12.8%), colporraphy in 14 cases (4.4%), electrocauterization (ovary) in 4 cases (1.3%), pelvic floor suspension in 4 cases (1.3%), and TVT in 1 case (0.3%). The mean operation time was 107 minutes, and the average hospital day was 5.2 days. The preoperative and postoperative hemoglobin difference was 1.2 gm/dL. The complications of STLH were ureteral injury in 2 cases, intestinal injury in 1 case, and stump bleeding in 1 case. CONCLUSION: The most important factors for successful STLH were sufficiently trained laparoscopic team and the degree of pelvic adhesion. The most potential advantages of STLH are shorter duration of operation time, hospitalization, and less postoperative complications and more cost effectiveness. Therefore, STLH can be a new alternative option for hysterectomy and may replace the other methods of hysterectomy such as abdominal, vaginal and laparoscopic assisted vaginal hysterectomy (LAVH).
Adenomyosis ; Cost-Benefit Analysis ; Female ; Hemorrhage ; Hospitalization ; Humans ; Hysterectomy* ; Hysterectomy, Vaginal ; Leiomyoma ; Myoma ; Parity ; Pelvic Floor ; Postoperative Complications ; Retrospective Studies ; Ureter ; Uterine Prolapse