A Case of Type 2 Leprosy Reaction in Borderline Lepromatous Leprosy Masquerading as Orbital Cellulitis in an Immigrant Worker / 나학회지

Hansen's disease(HD) is a chronic infectious disorder acquired by inoculation of Mycobacterium leprae. With the establishment of complex multidrug therapy, the incidence rate of leprosy patients has continually shown to decline by 90% compared to the incidence rate in the 1990s. However, the prevalence of the disease still remains high in southeast asian countries. Due to the rarity and diverse nature of cutaneous presentation, HD is often misdiagnosed with other dermatoses or infectious conditions. Especially, when a patient presents with unusual presentation with leprosy reaction with no classical feature such as sensory disorders and skin lesion, the diagnosis is further delayed with misguided treatments. Herein we present a 27-year-old Indonesian immigrant who displayed clinical features mimicking that of orbital cellulitis who was later diagnosed with borderline lepromatous leprosy through histologic and PCR confirmation, in light of alerting the probability of leprosy in immigrants with intractable skin presentations.

A Case of Borderline Lepromatous Leprosy Masquerading as Chronic Eczema / 나학회지

Leprosy is a chronic granulomatous disease affecting the skin and peripheral nervous system. Because of its variable manifestations, leprosy can be misdiagnosed as syphilis, sarcoidosis, psoriasis and eczema. A 73 year-old man showed erythematous papules on his arms and legs. He had been erroneously treated as eczema before the correct clinicopathological diagnosis of borderline lepromatous leprosy was made. We report this case to suggest that dermatologists should pay careful attention while diagnosing new cases of leprosy.

Empirical Treatment of Highly Suspected Nontuberculous Mycobacteria Infections Following Aesthetic Procedures

BACKGROUND: Infection caused by nontuberculous mycobacteria (NTM) has been increasing. Awareness of this infection is crucial yet problematic. Delayed management may lead to destructive results. We empirically treated a series of patients with clinical suspicion of NTM infection prior to the identification of the pathogen. METHODS: A total of 12 patients who developed surgical site infections between January 2011 and February 2014 were reviewed. Patients with a skin and subcutaneous infection resistant to standard management over two weeks, and previous history of aesthetic procedures within three months were regarded as highly suspected of having an NTM infection. A variety of diagnostic modalities were examined simultaneously, along with starting empirical treatment including a combination of clarithromycin and moxifloxacin, and surgical debridement. RESULTS: All wounds healed completely within 4 weeks. The mean follow-up duration was 7.2 months, and none of the patients developed relapse. Specific NTM pathogens were identified in six patients. Eight patients showed caseating granuloma implying an NTM infection. One patient showed an uncommon Stenotrophomonas infection, which was successfully treated. Three patients had no evidence of a pathogen despite repeated microbial tests. Complications such as scarring, pigmentation, and disfigurement were common in all the patients. CONCLUSIONS: NTM should be considered in the differential diagnosis of an unusual skin and soft-tissue infection. We propose an empirical regimen of clarithromycin and moxifloxacin as an efficient treatment option for an NTM infection.

Analysis of the Prognostic Factors for Abdominal Trauma

PURPOSE: Recently, trauma is more frequent due to the increases in the population, the number of traffic accident, and the incidence of violence. Especially, abdominal trauma is a leading cause of morbidity and mortality. We analyzed the clinical features and the factors associated with morbidity and mortality. METHODS: We analyzed 136 patients of abdominal trauma who were admitted at the Department of Surgery, Chonnam National University Hospital, from January 2003 to June 2005. We analyzed the cause of trauma, the injured organ, combined injuries, mental status, blood pressure, laboratory findings, morbidity, and mortality. The relationships between by variable were assesed by using the independent samples test and the Kruskal?Wallis test. RESULTS: The causes of trauma were traffic accidents (98 cases, 72%), falling accidents (9 cases, 6.6%), violence (6 cases, 4.4%), and stab injuries (6 cases, 4.4%). The injured organs were the small intestines (47 cases, 34.6%), the liver (35 cases, 25.7%), the spleen (26 cases, 19.1%), the mesentery (17 cases, 12.5%), the large intestines (15 cases, 11.0%), the pancreas (14 cases, 10.3%), etc. The most common combined injury was chest injury (53 cases, 39%). Comatose or semicomatose mental status and shock on admission (1.6 mg/dL) were significant prognostic factors. The incidence of postoperative complications was 40.4%, and frequent complications were wound infection (8.1%) and re-bleeding (8.1%). The overall mortality rate was 18.4%, and most common cause was hypovolemic shock (18 cases, 13.2%), however, there was no statistical difference according to injurd organ. CONCLUSION: In the multivariate analysis, mental status, hemoglobin, and serum creatinine level were the most significant prognostic factors. When an abdominal trauma patient arrives at the emergency room, a rapid and accurate evaluation of the patient's status and risk factors, and resuscitation, if necessary, have to be performed to lower the morbidity and mortality.

A Case of Intestinal Type Mucinous Adenocarcinoma and Strumal Carcinoid Tumor arising in One of Bilateral Mature Cystic Teratoma of the Ovary / 대한산부인과학회잡지

Malignant transformation of mature cystic teratoma (MCT) is an uncommon complication occuring in approximately 1-3%. Any of the constituent tissues of a teratoma has the potential to undergo malignant transformation; squamous cell carcinoma is the most commonly associated cancer, however, adenocarcinomas or carcinoid tumors arising in mature cystic teratoma are uncommon, especially simultaneously. We present an unusual case of postmenopausal women having mucinous adenocarcinoma and strumal carcinoid tumor simultaneously arising in one of bilateral mature cystic teratoma of the ovary. We suggest malignant transformation of MCT should be treated according to the management of the worst histologic diagnosis of the transformations if there are 2 or more malignancies are arised in MCT of the ovary.

Double High-dose Chemotherapy with Autologous Stem Cell Transplantation in Patients with High-risk Neuroblastoma: A Pilot Study in a Single Center

Double high-dose chemotherapy (HDCT) was applied to 18 patients with highrisk neuroblastoma including 14 patients who could not achieve complete response (CR) even after the first HDCT. In 12 patients, successive double HDCT was rescued with peripheral blood stem cells collected during a single round of leukaphereses and in 6 patients, second or more rounds of leukaphereses were necessary after the first HDCT to rescue the second HDCT. The median interval between the first and second HDCT (76 days; range, 47-112) in the single harvest group was shorter than that (274.5 days; range, 83-329) in the double harvest group (p<0.01). Hematologic recovery was slow in the second HDCT. Six (33.3%) treatment-related mortalities (TRM) occurred during the second HDCT but were not related to the shorter interval. Disease-free survival rates at 2 years with a median follow-up of 24 months (range, 6-46) in the single and double harvest group were 57.1% and 33.3%, respectively. These results suggest that successive double HDCT using the single harvest approach may improve the survival of high-risk patients, especially who could not achieve CR after the first HDCT despite delayed hematologic recovery and high rate of TRM during the second HDCT.

Risk-based Grouping of Patients and Risk-directed Treatment in Neuroblastoma / 대한소아혈액종양학회지

PURPOSE: This study was done to evaluate whether risk-directed treatment can improve survival of patients with high risk neuroblastoma (NBL). METHODS: Forty two patients with NBL were newly diagnosed and treated at Samsung Seoul Hospital from June 1997 to December 2000. Patients were divided into high risk or low risk group according to 3 important prognostic factors. Poor prognostic factors were defined as follows; amplification of N-myc oncogene, age at diagnosis higher than 1 years, and INSS stage 4. Patients with 2 or more poor prognostic factors were defined as high risk patients. While conventional treatment including surgery, radiotherapy, and pre and post-operative chemotherapy was applied to low risk patients, intensive multimodality treatment including single or double high dose chemotherapy (HDCT) and autologous peripheral blood stem cell transplantation (PBSCT) followed by immunotherapy using interleukin-2 (IL-2) and differentiating therapy using 13-cis-retinoic acid (CRA) was applied to high risk patients. RESULTS: Among 42 patients, 30 patients were high risk, 10 patients were low risk, and 2 patients were impossible to classify. Forty five HDCTs and PBSCTs were applied to 28 high risk patients and 2 low risk patients. All of the low risk patients are alive without relapse. Three year event free survival (EFS) after diagnosis in high risk patients was 54.8%. EFS after diagnosis in patients with 2 or 3 risk factors were 81.3%, 39.3% (P=0.0292) respectively. EFS after HDCT was 65.1%. EFS after HDCT in patients with 2 or 3 risk factors were 85.7%, 47.1% (P=0.0527) respectively. CONCLUSION: Risk-based grouping of patients and risk-directed treatment are necessary for better outcome. Multimodality treatment including HDCT and autologous PBSCT followed by immunotherapy using IL-2 and differentiatin therapy using CRA can improve survival in high risk patients.

Mobilization and Collection of the Peripheral Blood Stem Cell from Normal Bone Marrow by G-CSF Alone / 대한소아혈액종양학회지

PURPOSE: Peripheral blood stem cells (PBSC) can be mobilized by use of G-CSF alone from normal bone marrow. In this study, feasibility of mobilization, collection, and hematologic recovery after transplantion were evaluated. METHPDS: From normal undamaged bone marrow of normal PBSC donors and patients with high risk brain tumor who had no experience of chemotherapy or radiotherapy, PBSC was mobilized by use of G-CSF alone. Ten ug/kg/day of G-CSF was injected subcutaneously and leukaphereses were done on the fourth and fifth day of G-CSF injection. Nucleated cells (NC), mononuclear cells (MNC), CD34+ cells and colony forming cells (CFC) were counted. Hematologic recovery was evaluated in 4 autologous transplantations and 6 allogeneic transplantations, 4 of which were done after T cell depletion. RESULTS: Twenty four leukaphereses were done in 6 normal donors and 6 patients with high risk brain tumor. Median 603.3 (342.6~834.5) mL/kg of blood was processed for median 447 (392~549) minutes. Collected cells were as follows; NC: 11.88 (3.11~25.89)x108/kg of donor, MNC: 8.66 (2.61~12.84)x10(8)/kg of donor, CD34+ cells: 7.05 (2.95~11.73)x10(6)/kg of donor, CFC: 25.38 (3.62~35.27)x10(5)/kg of donor, respectively. In allogeneic transplantation, time to reach absolute neutrophil count (ANC)> 500/uL, 1,000/ uL and platelet count> 20,000/uL, 50,000/uL were 10 (9~15) days, 11 (9~16) days, 11 (8~30) days, and 32 (19~156) days, respectively. In autologous transplantation, time to reach ANC> 500/uL, 1,000/uL and platelet count> 20,000/uL, 50,000/uL were 9.5 (9~11) days, 10.0 (9~11) days, 10.5 (9~13) days, and 14.5 (13~17) days, respectively. CONCLUSION: Sufficient number of undamaged PBSC was collected from normal bone marrow by use of G-CSF alone. Hematologic recovery after transplantaion was more rapid than allogeneic bone marrow transplantation or autologous PBSCT which was done with cells collected after chemotherapy and/or radiotherapy.

A Case of Allogeneic BMT in a Patient with Severe Combined Immune Deficiency / 대한소아혈액종양학회지

A 11-month-old male with severe combined immune deficiency (SCID) received allogeneic bone marrow transplantation (BMT). He had suffered from recurrent infection and chronic diarrhea. Two older brother died of pneumonia 2 months after birth, but his HLA identical sister was healthy. He had very low number of T lymphocyte and NK cell. Although number of B lymphocyte was normal, level of immunoglobulin was extremely low. First BMT was done when he was 11 months old. Eighteen milliliter of bone marrow was simply infused without conditioning or GVHD prophylaxis. T lymphocyte appeared and fever which persisted despite use of antibiotics disappeared at day 7. Grade II GVHD developed, but was well controlled with corticosteroid. T lymphocyte subpopulation became normal at day 42. But pancytopenia developed and persisted despite use of G-CSF. Second BMT was done 4 months after 1st BMT. The conditioning regimen included busulfan (8 mg/kg) and cyclophosphamide (200 mg/kg), and ATG, cyclosporine and short-course MTX were used for GVHD prophylaxis. He achieved ANC> 500/uL at day 20 and platelet> 20,000/uL at day 29. BM examination on day 45 showed that 100% of marrow cells were donor origin. Acute and chronic GVHD did not develop. Since T lymphocyte was observed on day 21, various immunological parameters were normalized sooner or later. Immunological reconstitution was complete on day 280. Vaccination was given after 1 year of BMT and he is healthy now.

Correlation between Progenitor Cell Dose and the Rate of Engraftment in Autologous Peripheral Blood Stem Cell Transplantation and Allogeneic Bone Marrow Transplantation / 대한수혈학회지

BACKGROUND: Bone marrow transplantation (BMT) or peripheral blood stem cell transplantation (PBSCT) following high dose chemotherapy has been an important therapeutic option for patients with hematologic malignancies or some solid tumors. The number of progenitor cells in the collection products has been used to determine the optimum time to stop the collections and to predict the hematopoietic engraftment after transplantation. In this study, we investigated the relationship between end-product cell counts measured by different methods and the influence of the infused cell dose on the engraftment rate. METHODS: Twenty five patients receiving autologous PBSCT and 25 patients receiving allogeneic BMT were studied. The number of total nucleated cells (TNC), of mononuclear cells (MNC), of CD34+ cells, and of CFU-GM (colony-forming unit-granulocyte monocyte) colonies were measured in each collection product. The number of days required to achieve an absolute neutrophil count (ANC) of 0.5x109/L with TNC count of 1.0x109/L and platelet count of 20x109/L without transfusions was taken as an arbitrary measure of the engraftment rate. RESLUTS: A close correlation between CD34+ cells/kg and CFU-GM/kg was observed in both collection products (p<0.05). However, MNC/kg also showed significant correlations with CD34+ cells/kg and CFU-GM/kg in allogeneic bone marrow collection products (p<0.05). The CFU-GM amount in the PBSC products was greater than that in the bone marrow collection products (p<0.05). Time to engraftment was a median of 14 (range 9-50) days in autologous PBSCT group, but 29 (range 17-57) days in allogeneic BMT group. In autologous PBSCT, infused CD34+ cells/kg and CFU-GM/kg correlated significantly with ANC recovery (p<0.05). CONCLUSIONS: The number of CD34+ cells was correlated with that of CFU-GM in the collection products, and the infused cell doses showed positive relation to the engraftment rate in autologous PBSCT. These findings suggest that measurement of CD34+ cell counts alone would be a sufficient parameter to predict the engraftment rate in autologous PBSCT.

Pattern of Recurrence after Curative Resection of Gastric Cancer / 대한암학회지

PURPOSE: Despite radical lymph node dissection and combined resection, the operative result of progressive gastric cancer remains unsatisfactory. The prognosis of gastric cancer has not been improved. In case of recurred gastric cancer, the problem is low curative resection rate. We tried to study the pattem of recurrence after curative resection for gastric cancer. MATERIALS AND METHODS: We had retrospectively analyzed the recurrence pattern of 191 patients who recurred after curative resection of gastric cancer. We analyzed the interval between operation and recurrence, primary tumor location, tumor histologic type, Borrmann's type, pathologic stage, DNA ploidy pattem and lymph node metastasis. RESULT: The number of recurred gastric cancer patients was 191. The M: F ratio was 2.03: 1. Seven cases were early gastric cancer. The interval between operation and recurrence was from 1 month to 130 months. The early recurrence within 24 months was found in 147 patients (77.0%), the intermediate recurrence from 25 months to 60 months was found in 38 patients (19.9%), the late reeurrence after 60 months was found in 6 patients (3.1%). The pattems of recurrence were as follows: loco-regional recurience, including lymph node and site of anastomosis, was found in 51 cases, liver metastasis in 37 cases, peritoneal metastasis in 74 cases, extraperitoneal metastasis in 29 cases including Virchows node. In undifferentiated cancer, peritoneal metastasis was higher than in other histologic types (p<0.05). 59 cases was found in stage IV, 47 cases in stage IIIb, 43 cases in stage IIIa, 31 cases in stage II, 8 cases in stage Ib, and 3 cases in stage Ia. We found peritoneal metastasis was very high in stage IIIb. The 5-year survival was better in loco-regional group than that of other patterns of recurrence. CONCLUSION: Recurrence after operation was found within 24 months, that in most of patients, so the follow up is very important in this period and the recurred pattem after curative resection for gastric cancer was related with cell differentiation of primary tumor and stage. In local recurrence, the survival rate was higher than the other pattern of recurrence.

Clinicopathologic Comparison of the Young and the Old in the Patients with Gastric Cancer / 대한암학회지

PURPOSE: Gastric cancer is considered to be a disease of the middle aged and elderly, but there was increased interest in clinicopathologic features of both the young aged and the old aged gastric cancer. MATERIALS AND METHODS: In an attempt to compare the young below 35 years old with the old over 70 years old about the clinicopathologic characteristics, we reviewed 110 young patients and 146 old patients who were experienced at the Department of Surgery, Chonnam University Hospital from July 1982 to June 1997. We have analyzed the age, sex ratio, location, size, number of the cancer, Borrmanns classification, histologic classification, stage of the cancer, DNA ploidy, curative resectibility, 5 year survival rate in both groups. Comparisons of outcomes between groups were done using z(2) analysis. P value of <.05 was considered significant. A statistical test of the survival rates was made with the Z test and Kaplan-Meier method. Other statistics were analyzed by the log-rank method. RESULT: In the old, the incidence af the gastric cancer was higher in man than in woman(2.24: 1). In the young, the male to female sex ratio was 1: 1.16. The antrum was the most common site of gastric cancer in both groups. The cardia was more frequently involved in the young than the old(17.3%:7.5%). In the histologic classification, tubular adenocarcinoma was the most common in both groups. The young had 17.3% of incidence of signet ring cell carcinoma, but 2.7% in the old. The incidence of the early gastric cancer was 20.0% in the young and 17.8% in the old, which was not significantly different. The incidence of Borrmann type III was predominant in both groups. In Borrmann type IV, the young was revealed 18.0%, the old was revealed 8.2%, but there was no significant difference statistically. There were no significant differences in the stage and 5-years survival rate of the gastric cancer in both groups. CONCLUSION: This study showed the differences between the young and the old in the sex ratio, location, histological types of the gastric cancer. It meaned that there were some differences between the both groups in the etiology of gastric cancer, development and progression patterns.

Prognostic Factor in Early Gastric Cancer / 대한암학회지

PURPOSE: In advanced gastric cancer, the important prognostic factors are depth of invasion and status of lymph node metastasis, etc. In early gastric cancer, it remains controversial that depth of invasion or lymph node metastasis is corelated to the prognosis. A retrospective analysis of early gastric cancer was performed to evaluate the clinicopathologic features and to know the factors affecting the prognosis. MATERIALS AND METHODS: From January 1981 to May 1997, we experienced 1850 cases of gastric cancer who performed gastric resections. Among them, 371 cases were early gastric cancer (20.1% of all resected gastric cancer cases). We defined 12 variable factors such as sex, age, tumor location, gross type, histologic type, depth of invasion, status of lymph node metastasis, tumor size, DNA ploidy pattem, stage, operation type, and resection type for prognostic factor and analyzed them. RESULTS: Overall five year survival rate was 89.6% and ten year survival rate was 82.0%. The trend of annual incidence in recent nine years showed steady increase from 13.1% in 1988 to 25.7% in 1996. Survival showed no significant correlation with sex, age, tumor location, gross type, histologic type, tumor size, DNA ploidy, resection type. According to univariate analysis, depth of invasion, lymph node metastasis, stage had statistically significant association with prognosis. Among them, lymph node metastasis had an inde- pendent and predominant impact on survival according to multivariate analysis. CONCLUSION: Early gastric cancer appears to show steady increase of annual incidence, and lymph node metastasis appears to be closely related to the prognosis.

Human Papillomavirus Infection in Anal Carcinoma, Anal Condylomata and Rectal

In order to examine the association of human papilloma virus(HPV) infection with anal carcinoma, the authors used polymerase chain reaction(PCR) and in situ hybridization technique to detect HPV DNA in formalin fixed, paraffin-embedded tissues from 46 anal carcinoma patients. At the same time, 28 condyloma accuminata specimens and 25 rectal adecarcinomas were examined for HPV DNA with in situ hybridization(ISH). By PCR analysis, using type specific primers and probes for HPV 6, 11, 16, 18 and 33, HPV type 16 DNA was demonstrated in 30(65.2%) of 46 anal carcinoma specimens, but HPV type 6, 11, 18 or HPV type 33 was not identified. HPV DNA Positivity was different according to the site of the anal carcinoma. In anal marginal squamous celt carcinoma, 3(27.3%) of 11 contained HPV DNA but 27(77.1%) of 35 anal canal carcinoma contained HPV DNA. Among the anal canal carcinomas, the cloacogenic carcinoma contained HPV DNA in 11(84.6%) of 13 and squamous cell carcinoma contained in 16(72.7%) of 22 specimens. Two of six local recurrences and three of nine lymph node metastases had HPV-16 DNA. When the anal carcinomas were analysed using ISH technique for HPV type 6, 11, 16, 18, the frequency of Positivity decreased to 4(11.4%) of 35 and stained only for HPV type 16/18. Among the 28 condyloma accuminata specimens, 24(85.7%) contained HPV DNA type 6/11 and only 2(7.1%) contained type 16/18 by ISH technique. In contrast to anal carcinoma, male was predominent in condyloma accuminata patient(82.1% of 28) and 6 patients were homosexual man. HPV DNA was not demonstrated in all the cases of rectal adenocarcinoma by ISH. We conclude that HPV infections are associated with the development of anal canal carcinoma but are not associated with adenocarcinoma of the rectum. In anal carcinomas, anal canal carcinoma is more closely associated with HPV infection than anal marginal carcinoma. Among the HPV types studied, type 16, 18 are more closely linked with malignant transformation.

Fasciotomy following arterial surgery

No abstract available.