Two-signal models are useful in explaining various types of immune responses. In particular, secondary, so-called costimulatory, signals are critically required for the process of T-cell activation, survival, differentiation, and memory formation. Early studies in rodent models showed that targeting T-cell costimulatory pathways elicits immunological tolerance, providing a basis for development of costimulatory therapeutics in allograft rejection. However, as the classic definition of T-cell costimulation continues to evolve, simple blockade of costimulatory pathways has limitations in prevention of allograft rejection. Furthermore, functions of costimulatory molecules are much more diverse than initially anticipated and beyond T cells. In this mini-review, we will discuss CD137-CD137L bidirectional signals as examples showing that two-signals can be applicable to multiple phases of immune responses.
Adaptive Immunity* ; Allografts* ; Memory ; Rodentia ; T-Lymphocytes

BACKGROUND: Recently, tattooing of the body has become popular, and its associated psychological, sociological, and cultural implications have changed compared to past years. However, little is known about the current clinical features, including motive and satisfaction for having a tattoo, because of societal repulsions toward the practice. OBJECTIVE: To evaluate the clinical manifestations of tattooed young Korean males and to compare the findings with previous studies. METHODS: Between September 2010 and July 2011, 223 patients with tattoos who visited the Eulji Medical Center and Armed Forces Yangju Hospital were selected. The patients were evaluated through a self-administrated questionnaire and physical examinations. RESULTS: The majority of patients were classified into the "did not complete university" education group (56.1%). Most tattooed males had two living parents (83.4%) and were raised in households whose income statuses were not marked by poverty. The average age at which their first tattoo was received was 19.0 years. Most tattooed males had a negative attitude towards their tattoos (67.3%). The most common motivation for getting a tattoo was curiosity, but cosmetic purposes were also important (19.4%). A majority of the tattooing was conducted by a tattoo artist (73.3%). The most common tattoo content was letters. Black-colored tattoos were most frequently observed. The complication rate was 13.9%. The most common motivation for tattoo removal was negative comments that were made at work, in public, and in school (38.2%). CONCLUSION: Recent patterns of tattooing have changed significantly since previous reports. The satisfaction rate in getting a tattoo was not favorable. Understanding the current clinical features related to tattooing is important and it is necessary for dermatologists to provide professional advice regarding tattooing among young males.
Arm ; Cosmetics ; Exploratory Behavior ; Family Characteristics ; Humans ; Male ; Motivation ; Parents ; Poverty ; Tattooing ; Surveys and Questionnaires

Papular xanthoma is one of the clinicopathologic variants of normolipemic cutaneous non-Langerhans cell histiocytosis. It is a very rare condition that is characterized by non-confluent, yellowish papules located on the face, trunk and mucous membranes with no internal involvement. It has been predominantly reported in adults but childhood cases were also recently seen. We report a typical case of papular xanthoma in a 14-month-old boy who presented numerous yellow-brown papules on the face, arm and buttock. On histologic findings, it showed typical features of papular xanthoma.
Adult ; Arm ; Buttocks ; Histiocytosis ; Humans ; Infant ; Mucous Membrane ; Xanthomatosis

BACKGROUND: The current modality of choice for the treatment of Port-wine stains (PWS) is laser photocoagulation. Laser therapy for the treatment of PWS, especially with a pulsed dye laser (PDL), has been proven safe and effective; however, because penetration of the PDL is too shallow for an effective ablation of the blebs, treatment of blebbed PWS, using PDL, may be insufficient. OBJECTIVE: We demonstrated the clinical efficacy of a 1,064 nm long pulsed Nd:YAG laser with contact cooling device for blebbed PWS. METHODS: Twenty one patients with blebbed PWS (Fitzpatrick skin types II-V) underwent a treatment, using a 1,064 nm long pulsed Nd:YAG laser with a contact cooling device at 8-week intervals. Treatments were done using 5~6 mm spot sizes at 20~30 ms and 95~170 J/cm2. Laser parameters were adjusted in order to meet the needs of each individual patient's lesions. RESULTS: All subjects tolerated the treatments well, and showed clinical improvement from blebs. Of the 21 patients, 18 of them experienced either moderate or excellent response. CONCLUSION: Use of a 1,064 nm long pulsed Nd:YAG laser results in a greater depth of vascular coagulation. A 1,064 nm long pulsed Nd:YAG laser with contact cooling device may be regarded as a promising therapeutic option for the treatment of blebbed PWS.
Blister ; Humans ; Laser Therapy ; Lasers, Dye ; Light Coagulation ; Port-Wine Stain ; Skin

Disseminated superficial actinic porokeratosis (DSAP) consists of multiple annular, hyperkeratotic lesions that have a bilateral distribution on sun-exposed areas, particularly the extremities. DSAPs have a wider distribution than porokeratosis of Mibelli and usually develop during the 3rd or 4th decade of life. Squamous cell carcinoma that arises in the classical type of porokeratosis of Mibelli is well-documented, but there are only a few reports of squamous cell carcinoma in DSAP. Here, we describe a 62-year-old man with DSAP who developed squamous cell carcinoma on his right forearm.
Carcinoma, Squamous Cell ; Extremities ; Forearm ; Humans ; Middle Aged ; Porokeratosis

Castleman's disease (CD) is an uncommon lymphoproliferative disorder of unknown origin. There are two histological types: hyaline-vascular type and plasma cell type. CD is usually located in the mediastinum, but may be seen in any site including the neck, axilla, mesentery, and retroperitoneum. A 52-year-old male complained of vague lower abdominal pain. There was no palpable mass and all laboratory data showed nonspecific findings. Abdominal computed tomography scan showed a solitary homogenous, well-defined mass in the mesentery. The laparoscopic complete resection was performed without complications. Histologic examination of resected lesion revealed the hyaline-vascular type of CD. In the hyaline-vascular type of CD, laparoscopic approach constitutes a complete treatment. We present here the case of laparoscopic treatment of isolated mesenteric CD.
Abdominal Pain ; Axilla ; Giant Lymph Node Hyperplasia ; Humans ; Lymphoproliferative Disorders ; Male ; Mediastinum ; Mesentery ; Middle Aged ; Neck ; Plasma Cells

BACKGROUND/AIMS: Bacterial infection of biliary tract may cause severe inflammatory response or sepsis. An immediate bile culture and appropriate antibiotic administration are important to control the biliary tract infection. The objective of the study was to identify organisms in bile and the features of antibiotic susceptibility in patients with biliary tract infection. METHODS: We retrospectively reviewed the clinical records of 212 patients whose bile had been cultured for variable biliary tract diseases at Inje University Ilsan Paik Hospital from Jan. 2000 to Feb. 2007. Bile samples were obtained from percutaneous transhepatic biliary drainage (PTBD, n=89), percutaneous transhepatic gallbladder drainage (PTGBD, n=14) or endoscopic naso-biliary drainage (ENBD, n=49). RESULTS: The overall positive rate of bile culture was 71.7% (152 cases). The organisms cultured were Escherichia coli (25.0%), Enterococcus spp. (13.4%), Klebsiella spp. (11.1%), Pseudomonas spp. (11.1%), and coagulase-negative Staphylococcus (9.7%) in decreasing order. Effective antibiotics for Gram-negative organisms were amoxicillin/clavulanic acid, amikacin, imipenem, and piperacillin/tazobactam in order of effectiveness. Of the cultured blood samples from 160 patients, fifty (31.2%) showed positive bacterial growth. The organisms isolated from blood were similar to those found in the bile. CONCLUSIONS: A broad spectrum penicillin/beta-lactamase inhibitor is a recommendable antimicrobial for empirical treatment for biliary tract infection. However, Gram-positive bacteria such as Enterococcus spp. or methicillin-resistant Staphylococcus aureus are emerging as causative microorganisms. If these organisms are isolated, antimicrobial drugs should be replaced by narrower-spectrum antimicrobials.
Aged ; Aged, 80 and over ; Anti-Bacterial Agents/*pharmacology ; Bacteremia/epidemiology/microbiology ; Bacterial Infections/*microbiology ; Bile/*microbiology ; Bile Duct Diseases/*microbiology ; Cholangiopancreatography, Endoscopic Retrograde ; Female ; Humans ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Retrospective Studies

PURPOSE: The aim of this study was to analyze the relationship between central lymph node metastasis and the associated factors in patients with papillary thyroid carcinoma (PTC) according to the tumor size, and we wanted to determine an appropriate treatment for PTC. METHODS: From June 2005 to May 2007, 218 patients with PTC underwent total thyroidectomy or lobectomy, and they also received central lymph node dissection at our institution. The patients were divided into three groups: group 1 (tumor < or =5 mm), group 2 (5 mm10 mm). We retrospectively reviewed these patients to analyze the relationship between tumor size and the clinicopathological characteristics, including age, gender, lymph node metastasis, extrathyroidal extension, capsular invasion and lymphovascular invasion. RESULTS: There were 47 (21.6%) patients in group 1, 101 (46.3%) patients in group 2 and 70 (32.1%) patients in group 3. The tumor size was closely correlated with the presence of extrathyroidal extension, capsular invasion and lymph node metastasis (P<0.001). Lymph node metastasis was not only closely correlated with tumor size, but it was also significantly associated with extrathyroidal extension, capsular invasion and lymphovascular invasion (P<0.05). CONCLUSION: Our study confirmed that some factors, including central lymph node metastasis, capsular invasion and extrathyroidal extension, were frequently observed in patients with papillary thyroid microcarcinoma (PTMC), and central lymph node metastasis was related to tumor size, extrathyroidal extension, capsular invasion and lymphovascular invasion. Therefore, routine central lymph node dissection is recommended during the initial surgery for patients with PTMC.
Carcinoma ; Carcinoma, Papillary ; Factor IX ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

Gallbladder (GB) injuries after blunt abdominal trauma are uncommon. An isolated blunt GB injury is extremely rare, due to the anatomic location of the GB that is protected by the liver, intestines, omentum and ribs. A GB injury follows a vague and insidious clinical course, and therefore GB injuries are commonly undiagnosed until an exploratory laparotomy is performed. Early diagnosis is important, as trauma to the GB should be treated surgically and a delay in treatment can result in considerable mortality and morbidity. We encountered a patient who was diagnosed with a GB rupture based on computed tomography that showed a hemoperitoneum, high-density material in the GB lumen and a leakage of contrast material. The patient underwent an exploratory laparotomy. We report a case of isolated GB rupture after blunt abdominal trauma.
Early Diagnosis ; Gallbladder ; Hemoperitoneum ; Humans ; Intestines ; Laparotomy ; Liver ; Omentum ; Ribs ; Rupture

Simple liver cysts are common and benign lesions, and most of them are detected by ultrasonography (US) or computed tomography (CT) during a medical checkup. Because simple liver cysts are generally asymptomatic, they do not require treatment, although hemorrhage, infection or rupture may occur in rare cases and these cases must receive proper treatment. The diagnosis of simple liver cysts is usually easy because of their typical morphological findings on US or CT. However, when a liver cyst contains hemorrhage or it is inflamed on imaging studies, it is sometimes difficult to differentiate simple hepatic cysts from such conditions as cystadenoma and cystadenocarcinoma. In this report, we describe a case of simple liver cyst that was complicated by intracystic hemorrhage, and this malady was initially diagnosed as biliary cystadenocarcinoma. We successfully treated this lesion by left lateral segmentectomy.
Cystadenocarcinoma ; Cystadenoma ; Diagnosis ; Hemorrhage* ; Liver ; Mastectomy, Segmental ; Rupture ; Ultrasonography