The Role of ATF3 Expression and Calcineurin Inhibition in the Putative Cancer Stem Cell Fraction of Human Cutaneous Squamous Cell Carcinoma / 대한피부과학회지

BACKGROUND: A previous study reported that calcineurin inhibition by cyclosporin A (CsA) showed tumor-enhancing effects through the induction of the ATF3 transcription factor and the associated suppression of p53. The development and aggressiveness of cutaneous squamous cell carcinoma (SCC) may be determined by cancer stem cell populations, which have self-renewing potential. OBJECTIVE: To determine the role of ATF3 and calcineurin inhibition in the proliferation of SCC and evaluate the existence of putative SCC stem cells. METHODS: We performed real-time PCR, fluorescence activated cell sorting, and clonogenicity assays in SCC13 cells under conditions of calcineurin inhibition by CsA or ATF3 and p53 overexpression. The relationships amongst calcineurin inhibition, p53, and ATF3 were demonstrated by western blot analysis and transient transfection assays in SCC13 cells. RESULTS: In putative stem cell populations of SCC13 cells enriched in self-renewal potential, p53 expression was lower than that in differentiated SCC13 cells. CsA treatment or ATF3 overexpression caused an expansion of stem cell populations. Additionally, p53 overexpression inhibited cellular proliferation and reduced clonogenicity in SCC13 cells. CsA treatment led to a decrease in p53 expression and an increase in ATF3 in SCC13 cells on western blots. SCC13 cells with CsA and small interfering RNA against ATF3 demonstrated lower cell viability than SCC13 cells with CsA only and SCC13 cells with CsA and small interfering control RNA after 14 days. CONCLUSION: Putative cancer stem cell populations and differentiated cell populations in SCCs are positively regulated by ATF3 and p53, respectively.

The Treatment Effects of Ultrasonic Surgical Aspiration for Axillary Osmidrosis / 대한피부과학회지

BACKGROUND: Axillary osmidrosis is a distressing and uncomfortable condition that can be a serious handicap in a person's personal and social life. There are many different surgical methods to treat axillary osmidrosis. However, they have caused frequently marked complications. OBJECTIVE: The purpose of this study was to evaluate the effect of ultrasonic surgical aspiration for the treatment of axillary osmidrosis. METHODS: From January 2007 to September 2008, a total of 62 patients was treated for axillary osmidrosis using ultrasonic surgical aspiration. RESULTS: Fifty-three (85.4%) patients had excellent to good results. Postoperative complications were seen in 5 (4.1%) patients out of 124 axillae. All of them were hematoma. The axillary scars are small and nearly negligible. The average recovery period was 5 days. CONCLUSION: Ultrasonic surgical aspiration displayed satisfactory therapeutic efficacy. This operation has many advantages with a high success rate, small and short scars, a low complication rate and a rapid recovery period.

A Clinical Study of 263 Patients with Childhood Vitiligo / 대한피부과학회지

BACKGROUND: Vitiligo is an acquired pigmentary disorder and half of these patients experience disease onset during childhood. The psychosocial complications of vitiligo can be substantial, and especially for children. There has been no study that has compared the clinical features according to the symmetry of the vitiligo lesions of patients with childhood vitiligo. OBJECTIVE: The purpose of this study is to evaluate the clinical aspects and distribution of the vitiligo lesions according to the symmetry in patients with childhood vitiligo. METHODS: The clinical characteristics and distribution of the vitiligo lesions according to the symmetry were investigated in the 263 childhood patients who were diagnosed with vitiligo at the Dermatology Department of our University Hospital from January 1991 to August 2008. RESULTS: Of the 263 patients, 133 (50.6%) had the asymmetric vitiligo lesions, 76 (28.9%) had the symmetric lesions and 54 (20.5%) had the multiple lesions. Of the patients with asymmetric vitiligo lesions, 91 (34.6%) had the localized lesions and 42 (16.0%) had the segmental lesions. The most common site of the vitiligo lesions was the face (54.8%). In case of the vitiligo lesions on the scalp, face and neck, the asymmetric type was predominant. The lesions on the scalp and the face showed a lesser tendency to spread to other sites. CONCLUSION: Childhood vitiligo showed the higher prevalence of asymmetric vitiligo lesions. It is expected that the asymmetric type of childhood vitiligo, and especially that on the scalp and the face, may have a favorable clinical course.

The Clinical Significance of Symmetry in the Distribution of Vitiligo Lesions / 대한피부과학회지

BACKGROUND: Vitiligo is an acquired disease that causes depigmented patches of various sizes. The most widely used method of classification is by the distribution, which is categorized into four types: localized, segmental, universal, and generalized vitiligo. In addition, vitiligo can be divided into segmental and non-segmental, according to its relation to dermatomes. However, few studies have compared the clinical features and prognosis with the symmetry of the vitiligo lesions. OBJECTIVE: We examined 690 vitiligo patients to investigate the clinical significance of symmetry in the distribution of vitiligo lesions. METHODS: The clinical characteristics, distribution, and lesion sizes were investigated in 690 patients who were diagnosed with vitilgo at the Dermatology Department of Chungnam National University Hospital from January 1991 to August 2006. RESULTS: Of the 690 vitiligo patients, 369 (53.3%) had symmetric vitiligo lesions and 321 (46.5%) had asymmetric lesions. Patients with symmetric lesions had an older age of onset, longer duration of disease, wider distribution area, and greater tendency of the lesions to enlarge with time. CONCLUSION: Our clinical classification method, based on the the symmetry of the vitiligo lesions, may help physicians to predict the course and prognosis of the disease. Therefore, the dissemination of new vitiligo lesions in symmetric vitiligo patients should be observed closely.

Accessibility of Peritoneal Organs according to the Routes of Approach in NOTES / 대한소화기학회지

BACKGROUND/AIMS: Natural orifice transluminal endoscopic surgery (NOTES) is a new era of minimally invasive surgery which has the potential to offer scarless surgery. So far, numerous reports on various routes to peritoneal organs in NOTES have been published. In case of transgastric approach, it is more inconvenient than transcolonic approach to access upper abdominal organs because of retroflexion. However, most data were subjective and there was no report examining the best access route for the exploration of peritoneal organs. The aim of this study was to evaluate the best access route according to the abdominal organs objectively. METHODS: Six female pigs weighing 30 to 35 kg were placed under general anesthesia. Incisions were made on both anterior wall of stomach body and rectosigmoid colon 15 to 20 cm above anal verge, respectively. Then, via each incision site, we evaluated the endoscopic visibility and checked the elapsed time to access abdominal organs in sequence (gallbladder (GB), spleen, bladder, uterus, and ovary). RESULTS: On comparison of the mean time to approach each organs, GB and ovary showed statistical difference in the mean time to approach between transgastric and transcolonic approaches. It took relatively shorter time to access GB via transcolonic route than transgastric route (352.3+/-80.1 sec vs. 222.2+/-82.0 sec, p=0.021). Next, we evaluated the time to access upper organs (GB and spleen) and lower organs (bladder, uterus and ovary). In case of lower organs, it showed no difference in time between transgastric and transcolonic approaches. However, to explore upper organs, transcolonic route was more favorable than transgastric route (351.8+/-80.7 sec vs. 273.3+/-110.3 sec, p=0.002). CONCLUSIONS: For exploration of lower organs, there is statistically no significant difference in time between transgastric and transcolonic approaches. But, in case of upper organs, transcolonic approach is superior to transgastric approach.

A Case of Angioleiomyoma on the Posterior Surface of Ear Helix / 대한피부과학회지

Angioleiomyoma is a benign tumor of smooth muscle origin arising from the muscular layer of blood vessel walls. The tumor usually occurs in the lower extremities as a slow-growing, firm, mobile, and occasionally painful nodule. We report a case of angioleiomyoma which occurred on an unusual site, the posterior surface of ear helix.

The cystic neoplasms of the pancreas in Korea / 대한내과학회지

BACKGROUND: Cystic neoplasms of the pancreas are being recognized with increased frequency. In 1993, a report on 123 cases of cystic neoplasms of the pancreas diagnosed over a period of 32 years was published in Korea. Many changes on the concept of cystic neoplasms of the pancreas have been made, including classification and diagnostic criteria. The present study was conducted wherein a new survey on cystic neoplasms of the pancreas in Korea. METHODS: Cystic neoplasms of the pancreas diagnosed over a period of 12 years, from 1993 to 2004 in 25 university hospitals throughout Korea were collected. They were classified according to the World Health Organization classification of cystic neoplasms of the pancreas. RESULTS: A total of 1264 cases of cystic neoplasms of the pancreas were diagnosed. The diagnoses and frequencies are as follows: intraductal papillary mucinous neoplasm, 499 (39.5%); mucinous cystic neoplasm, 318 (25.2%); serous cystic neoplasm, 232 (18.4%); solid pseudopapillary neoplasm, 192 (15.2%); cystic endocrine neoplasm, 11 (0.8%); lymphoepithelial cyst, 8 (0.6%); acinar cell neoplasm, 3 (0.2%); mature teratoma, 1 (0.1%). Increase in the annual number of diagnoses was evident. In intraductal papillary mucinous neoplasm and mucinous cystic neoplasm, a significant increase in mean age was seen in patients with malignant neoplasms. CONCLUSIONS: Cystic neoplasms of the pancreas are diagnosed with increasing frequency in Korea, the most common being intraductal papillary mucinous neoplasm of the pancreas. In intraductal papillary mucinous neoplasm and mucinous cystic neoplasm, the grade of dysplasia increased with mean age, suggesting an adenoma-carcinoma sequence.

A Case of Nevus Sebaceous on the Forearm / 대한피부과학회지

Nevus sebaceous, a cutaneous harmatoma histopathologically presenting epidermal and adnexal hyperplasia, is a congenital lesion that occurs primarily on the face, scalp, and neck area. It is rarely found on the trunk or extremities. We report a case of 34-year-old female with nevus sebaceous on the left forearm, which is considered to be a rare predilection.

Combination Therapy with Pulsed Dye Laser and Intralesional Bleomycin for the Treatment of Recalcitrant Warts / 대한피부과학회지

BACKGROUND: Some warts prove resistant to multiple therapies, particularly on an immunosuppressed patient. A previous study revealed that combination therapy with pulsed dye laser and intralesional bleomycin was effective on recalcitrant warts. OBJECTIVE: The aim of this study was to confirm whether the combination therapy with pulsed dye laser and intralesional bleomycin was effective for the treatment of recalcitrant warts. METHOD: Fifteen patients, all with recalcitrant warts, were recruited. Two patients were on long-term immunosuppressant drugs. Twenty warts were treated in total. The warts were anaesthetized with local anesthetic cream (EMLA(R) 5% cream) then treated with a pulsed dye laser (5mm spot, fluence 9.5-10J/cm2). Immediately following this, bleomycin (1mg/ml) was injected into the base of the warts. At 3-4 weeks after the last treatment, the warts were evaluated to assess clearance rate, total treatment numbers and side effects. RESULT: 1. Complete clearance was achieved for 17 out of 20 warts (85%). 2. Partial clearance was achieved for 3 out of 20 warts (15%). 3. Recalcitrant warts were cleared with an average of 1.95 treatments. 4. Recalcitrant warts on the immunosuppressed patients were cleared with an average of 2.0 treatments. 5. No significant side effects were observed. CONCLUSION: Combination therapy with the pulsed dye laser and intralesional bleomycin appears to be a safe, rapid, well tolerated and successful treatment for recalcitrant warts. It also appears to be effective for recalcitrant warts on immunosuppressed patients.

A Case of Chronic Gastrointestinal Bleeding from a Meckel's Diverticulum Detected by Wireless Capsule Endoscopy / 대한소화기학회지

Meckel's diverticulum is an embryonic derivative of the omphalomesenteric duct and the most commonly encountered congenital anomaly of the gastrointestinal tract. Its incidence records about 2%. Among them, only 5% are symptomatic with complications-bleeding, intestinal obstruction, inflammation, and perforation. In particular, bleeding is a common complication and has always been caused by an ulceration of the ileal mucosa adjacent to the acid-producing ectopic mucosa in a Meckel's diverticulum. Wireless capsule endoscopy is a new method enabling non-invasive diagnostic endoscopy of the entire small intestine. We experienced a case of Meckel's diverticulum detected by wireless capsule endoscopy in a 34 year-old man who presented with chronic obscure gastrointestinal bleeding.

Alterations of p16INK4A Gene in Korean Squamous Cell Carcinoma and Basal Cell carcinoma of the Skin / 대한피부과학회지

BACKGROUND: The inactivation of the cyclin dependent kinase 4 inhibitor p16INK4A may be caused by deletion, mutations or promoter hyper-methylation. Recently, DNA methylation of p16INK4A promoter has been shown to suppress of p16INK4A gene transcription in various tumors. OBJECTIVE: We analyzed the gene status of p16INK4A in squamous cell carcinoma (SCC) and basal call carcinoma (BCC) of the Korean skin to investigate whether the inactivation of the gene participated in carcinogenesis. METHODS: We examined 12 SCC and 3 BCC cell lines using PCR to detect homozygous deletion of chromosome 9p21 region and methylation-specific PCR. RESULTS: Deletion of the p16INK4A gene were not, but methylation of the p16INK4A promoter region was common in SCC of the skin. CONCLUSION: These results suggest that de novo methylation of the p16INK4A promoter region seems to play an important role in the pathogenesis of SCC.

A Clinical Study on Herpes Zoster During the Last 10-Year-Period (1994-2003) / 대한피부과학회지

BACKGROUND: Herpes zoster is a common dermatologic disease characterized by unilateral pain and vesicular eruptions. The incidence of herpes zoster seems to be increasing recently. OBJECTIVE: The aim of this study was to elucidate the epidemiology and the clinical characteristics of herpes zoster. METHOD: During the 10-Year-Period from Jan. 1994 to Dec. 2003, 1089 patients with herpes zoster were evaluated in regard to annual incidence, age, sex, and monthly, seasonal, and dermatomic distributions. Patients with herpes zoster were further assessed concerning associated diseases and complications. RESULT: 1. The annual incidence averaged over the 10 years was 2.98% (1089 cases of total 36, 531 outpatients) which is increasing recently. 2. Herpes zoster was seen most frequently in the 7th decade of life, and the ratio of male to female was 1: 1.43. 3. There was no marked monthly or seasonal variation in the incidence of herpes zoster. 4. The most common dermatomic distribution was thoracic dermatome (49.6%), followed by trigeminal (19.5%), cervical (14.9%), lumbar (7.9%), sacral (5.3%) and multiple dermatomic involvement (2.8%). 5. Associated diseases of herpes zoster were observed in 398 patients (36.5%), which included hypertension (12.6%), diabetus mellitus(7.9%), gastric ulcer (2.8%), chronic renal failure (1.7%), asthma(1.7%), angina pectoris (1.6%), malignancy (0.6%) and so on. 6. The most common complication of herpes zoster was postherpetic neuralgia (7.4%), followed by eye complication (3.2%), secondary bacterial infection (1.8%), scar formation (0.8%), neurogenic bladder (0.4%), and Ramsay-Hunt syndrome (0.2%). CONCLUSION: Most of the results described in this study are similar to those previously reported, except for a higher incidence in female. The recent annual incidence of herpes zoster shows a tendency to increase.

A Case of Cutaneous Polyarteritis Nodosa

Cutaneous polyarteritis nodosa(CPAN) is a benign form of rare vasculitis of small and medium-size arteries with a recurrent but benign course without systemic involvement. We experienced a 61-year-old male who had two months history of multiple deep-purpurish livedo reticularis on both lower legs. Noncutaneous manifestations including malaise, fever, myalgia, and arthritis were absent. A skin biopsy specimen from the livedo reticularis on the leg showed perivascular and trans-mural neutrophilic and lymphocytic infiltration of medium-sized arteries in the dermal-subcutaneous junction and fibrinoid necrosis of the vessel walls. The patient was treated with colchicine for 2months and showed markded improvement.

A Statistical Survey on 1448 Skin Tumors for the Recent 10 Years / 대한피부과학회지

BACKGROUND: Many studies focused on the distribution of skin tumors in Korea, but none of them included whole data refered from deparments other than dermatology and primary physicians. OBJECTIVE: This study was to investigate the incidence and distribution of skin tumors among Korean people. METHODS: A study was made on 1448 cases of skin tumors which were obtained mainly from surgical pathology specimen during the period of 10 years from 1992 to 2001 at Department of Dermatology in Keimyung University Dongsan Medical center. RESULTS: 1. Of the 1448 cases of skin tumors, 1171 cases(80.9%) were benign tumor, 277 cases (19.1%) were malignant tumor and male to female ratio was 1: 1.1. 2. Among the 1171 cases of benign tumors, 174 cases of melanocytic nevi, 173 cases of epidermal cyst, 109 cases of seborrheic keratosis, 62 cases of granuloma pyogenicum were noted. 3. Among 277 cases of malignant tumors, 107 cases of basal cell carcinoma, 58 cases of squamous cell carcinoma, 27 cases of metastatic cutaneous carcinoma, 24 cases of Bowen disease were noted. 4. The predilection sites of Intradermal nevi were face(38.4%), trunk(17.4%), scalp(16.3%), and those of epidermal cyst were face(41.0%), trunk(29.5%), neck(8.1%). The predilection site of basal cell carcinoma, squamous cell carcinoma was face(80.4%, 58.6%). CONCLUSION: The 1448 cases of skin tumors, which were confirmed histologically from surgical pathology specimen at Department of Dermatology in the Keimyung University Dongsan Medical Center during the period of 10 years from 1992 to 2001, were reviewed.

A Case of Subcutaneous Fat Necrosis of the Newborn / 대한피부과학회지

Subcutaneous fat necrosis of the newborn is an uncommon transient panniculitis which is characterized by asymptomatic, firm to rubbery, purple-red, erythematous subcutaneous nodules and plaques occurring during the first 4 weeks of life. Characteristic histologic findings are areas of fat necrosis associated with inflammation in the subcutaneous tissue and needle-shaped clefts with radial arrangement in fat cells as well as foreign body giant cells. We report a case of subcutaneous fat necrosis in a 9 day-old male who had suffered from hard erythematous nodules on both upper arms.

A Case of Sporadic Adenomatous Polyposis Coli Combined with Rectal Cancer / 대한소화기내시경학회지

Adenomatous polyposis coli (APC) is a rare autosomal dominant disorder in which about 20~30% of affected individuals do not have a family history. It is characterized by hundreds to thousands of adenomas in the colon. APC usually develops during the second or third decade of life. If the polyposis is not treated surgically, colorectal cancer can develop in almost all patients before age 40. We experienced a case of adenomatous polyposis coli combined with rectal cancer in a 26-year-old male patient complaining of low abdominal pain without a family history of APC.

A Case of Congenital Self-Healing Reticulohistocytosis with Skull Involvement / 대한피부과학회지

Congenital self-healing reticulohistiocytosis(CSHRH) consists of multiple disseminated papulonodular skin lesions of varying sizes and regress spontaneously in several weeks to months with little or no scarring, and until recently it has been regarded as a benign cutaneous disease without systemic involvement. However, involvement of organ systems other than the skin has been described occasionally and recurrence of disease at sites distant from the skin has been documented. We present a case of CSHRH in a full termed, normal spontaneous vaginal delivered male neonate. He had reddish colored nodules on the whole body without systemic symptoms. Four weeks later, the skin lesions cleared concurrently with bony involvement of the skull. Because multiple organ systems can be involved and recurrences are possible, long-term follow-up of these patients is indicated.

A Case of Congenital Esophageal Stenosis Due to Tracheobronchial Remnants in Adult / 대한소화기내시경학회지

Congenital stenosis of the esophagus is a rare form of esophageal stenosis in adults. The main causes of congenital esophageal stenosis are the esophageal web, esophageal stricture due to tracheobronchial remnants, and idiopathic esophageal muscular hypertrophy. Recently we have experienced a 32-year-old male with dysphagia, indigestion, postprandial chest discomfort who was diagnosed as congenital esophageal stenosis due to tracheobronchial remnant. The esophagogram showed stricture of the distal esophagus with secondary proximal dilatation and endoscopic finding revealed marked stenosis on the distal esophagus with normal surrounding mucosa. The esophageal manometric finding showed decreased body peristalsis and incomplete relaxation of the lower esophageal sphincter. The patient was treated by surgical resection of the stenotic segment with end to end anastomosis. We report this rare case of adult type tracheobronchial remnant with analysis of various worldwide report and with brief review of literature.

Chronic Hydroxyurea-induced Dermatomyositis-like Eruption Showing Epidermal Dysmaturation

Hydroxyurea is an effective treatment for a variety of myeloproliferative disodrers. A distinct cutaneous reaction to long-term administration of hydroxyurea has been characterized and designated hydroxyurea dermopathy. Epidermal dysmaturation refers to histologic changes that may be observed in the epidermis after any significant cytoreductive therapy. We report a patient with hydroxyurea-induced dermatomyositis-like eruption showing epidermal dysmaturation who developed an erythematous scaly patches on the dorsal aspects of the hands while on long-term administration of hydroxyurea for chronic myelogenous leukemia.

The Effect of Dehydroepiandrosterone on Expression of Elastin in Cultured Skin Fibroblasts / 대한피부과학회지

BACKGROUND: Dehydroepiandrosterone(DHEA) and its sulfate ester dehydro- epiandrosterone sulfate(DHEA-S) are the steroids secreted most abdundantly by the human adrenal gland, but the physiologic role remains uncertain. Elastin is one of the major extracellular matrix components of the dermis and plays an important role in providing elasticity and resilience of the skin. Expression of elastin genes at transcriptional level is regulated and modulated by cytokines, vitamin D3, insulin-like growth factor-1, and steroids. But only little is known about the molecular and cellular mechanism underlying the effect of DHEA on the expression of elastin in cultured skin fibroblasts. OBJECTIVE: The purpose of this study was to examine the effect of DHEA on elastin gene expression in cultured skin fibroblasts. METHODS: In this study, the effects of DHEA were examined by Northern blot hybridization, chloramphenicol acetyltransferase assay(CAT), and laser scanning microscopy in cultured human fibroblasts. RESULTS: In Northern blot hybridization, levels of elastin mRNA were increased 1.5-fold at 1 nmol of DHEA, 4.2-fold at 0.1 mol and 6.5-fold at 10 mol, compared to untreated control. DHEA caused a alteration in the elastin mRNA expression in a dose-related fashion. In CAT assay, the relative mRNA CAT activity was 0.9 at a concentration of 1 nmol, 2.4 at 0.1 mol, and 2.7 at a 10 mol. DHEA caused a marked increase on elastin promotor activity. In confocal laser scanning microscopy, the immunosignal for elastin in DHEA-treated fibroblasts is more intense compared to the control. CONCLUSION: These results indicate that DHEA may be a powerful up-regulator of elastin production, suggesting transcriptional activation of gene expression in cultured skin fibroblasts.