A case of soft tissue infection by Stenotrophomonas maltophilia manifesting as subcutaneous nodules in a patient with leukemia / 대한내과학회지

Stenotrophomonas maltophilia is a ubiquitous, Gram-negative organism. It is an emerging causative pathogen for severe hospital- acquired infections, particularly in debilitated or immunocompromised patients because of its resistance to various antibiotics. Soft tissue infection caused by S. maltophilia, however, is uncommon. A patient with leukemia was referred for the evaluation of subcutaneous nodules that developed after chemotherapy. With the pathological finding of neutrophilic panniculitis, S. maltophilia was confirmed in a bacteriological study of the biopsied tissue. The nodules regressed spontaneously with recovery from the neutropenia. We report a case of S. maltophilia infection that manifested as soft tissue nodules, which resolved spontaneously in a patient with leukemia.

Allergic Contact Dermatitis with Doxepin Hydrochloride Cream / 대한피부과학회지

Doxepin hydrochloride cream with potent H1 and H2 blocker activity is a tricyclic antidepressant, which is structurally similar to phenothiazines, and also known to be a contact sensitizer and photosensitizer. We report a case of allergic contact dermatitis due to doxepin hydrochloride cream in a 75-year-old-man, who developed facial edema and eczema at the application sites (face, neck and upper trunk) within several hours of application of doxepin hydrochloride cream. Clinicians should be aware of the possibility of allergic contact dermatitis to doxepin cream, if the condition worsens with use of this medication.

Clinico-pathologic Study and Detection of Human Herpesvirus 8 sequence of Kaposi's Sarcoma in Korea / 대한피부과학회지

BACKGROUND: Kaposi's sarcoma (KS) is a vascular neoplasm that was rarely seen before the AIDS and transplantation era. The isolation of human herpesvirus 8 (HHV-8) in all forms of KS strongly suggests a role of this agent in the pathogenesis. OBJECTIVE: The purpose of this study was to evaluate the clinical and histopathological features of KS and assess the presence of HHV-8 sequences in Korea. METHODS: The medical records and histopathologic slides of patients with KS, who were diagnosed at Asan Medical Center from 1989 to 2005, were reviewed. We also performed polymerase chain reaction (PCR) to find out the presence of HHV-8. RESULTS: 1.Among the 22 patients, classic KS was found in 9 and iatrogenic immunosuppressive-associated KS in 13 patients. 2.Clinical features were varied, usually limiting to the skin of the extremities, however, involvement of internal organs and mucosa was also detected. 3. The histology of cutaneous lesions associated with various clinical forms of KS was essentially identical, however, it presented different features according to their stage. 4. HHV-8 sequences were identified in all cases of KS, including the lesions of internal organs. 5.Classic KS responded well to radiation therapy, thalidomide or chemotherapy, except 2 patients. Iatrogenic immunosuppressive KS improved generally after radiation therapy, IFN-alpha, or chemotherapy, but some of the patients died due to underlying diseases. CONCLUSION: KS is a rare vascular neoplasm. We retrospectively studied twenty-two cases, and HHV-8 were detected in all cases, these supporting HHV-8 as the causative agent.

A Case of Multiple Intravascular Papillary Endothelial Hyperplasia / 대한피부과학회지

Intravascular papillary endothelial hyperplasia (IPEH), also known as Masson's pseudoangiosarcoma, is an unusual pattern of organization of a thrombus within a vein, or within one or more of the component vessels of various vascular abnormalities, such as cavernous hemangioma, pyogenic granuloma and lymphangioma. It is characterized by the development of endothelial-lined papillary projections in a vascular lumen. Lesions of IPEH usually occur on the head, neck or upper extremities as a solitary reddish or bluish nodule. Herein we report a 34-year-old female who presented with multiple bluish nodules on the left hand, which upon histopathological examination showed intravascular papillary endothelial hyperplasia.

A Biomechanical Comparison of Carbonate Apatite Collagen Composite and Hydroxyapatite Implanted in Bone Defects of Rabbit Tibiae / 대한정형외과학회잡지

Autograft is frequently used to restore anatomic morphology and functional properties in bone defects. Disadvantages of the autograft are related to donor site morbidity and include the risk of wound infection, increased blood loss and additional postoperative discomfort. Allograft and xenograft, which are currently employed as the most common alternative to autografts, encounter the complications such as fracture, resorption and nonunion secondary to immunologic rejection. These volumetric and immunologic concerns with biologic implants have stimulated interest in the potential for synthetic, bioinert materials as bone graft substitutes. Hydroxyapatite (HA), a calcium phosphate ceramic, is a well known biocompatible artificial bone substitite without induction of systemic toxic and foreign body reactions. Bone conduction usually occurrs by the implanted HA but biodegradation of HA is poor and the bone formation around HA is slow. Carbonate apatite has been known as that the physicochemical properties are similar of the natural bony apatite and demonstrates no toxic reactions with better biodegradation. Carbonate apatite collagen composite was reported to show more bone formation and biodegradation than hydroxyap atite. In this study, the composite (CA-C) consisted of carbonate apatite and type I collagen was implanted in rabbit tibiae to evaluate the possibility as an artificial bone substitute. Forty HA (HA group) and forty CA-C (CA-C group) were applied in 80 dissected rabbit tibiae and fixed by external fixators. For biomechanical study, the rabbits were sacrificed and the specimens were obtained in 2, 4, 6 and 8 weeks after implantation. Tensile load was applied to the prepared tibiae in Instron and biomechanical properties were investigated. The fracture at the callus occurred as transverse or short oblique fracture in the vertical direction to the axis of applied tensile load. In each group, the tensile strength at breaking point increased significantly with time and at 4 weeks more prominent increase in break strength was observed (p<0.05). HA group showed higher mean strength before 6 weeks and at 8 weeks CA-C group higher mean strength but statistical significance could not be found. There was no significant difference in extension length at breaking point between both groups and time intervals. In summary, carbonate apatite collagen composite revealed similar biomechanical properties as hydroxyapatite, suggesting its clinical usefulness as a bone substitute, but it will be necessary to improve biodegradational property, stiffness of carbonate apatite collagen composite.

A Radiological and Histological Study of Carbonate Apatite Collagen composite and Hydroxyapatite Implanted in Bone Defects of the Rabbit Tibiae / 대한정형외과학회잡지

Autograft is frequently used to restore anatomic morphology and functional properties in bone defects. Disadvantages of the autograft are related to donor site morbidity and include the risk of wound infection, increased blood loss, and additional postoperative discomfort. Allograft and xenograft, which are currently employed as the most common alternative to autografts, encounter the complications. such as fracture, resorption, and nonunion secondary to immunologic rejection. Hydroxyapatite(HAp), a calcium phosphate ceramic, is a well known biocompatible artificial bone substitute without induction of systemic toxic and foreign body reactions. Bone conduction is usually occurred by the implanted HAp. Biodegradation of HAp is poor and the bone formation around HAp is slow and about more than 70% of the natural apatite in bone is composed of carbonate apatite that has carbonic radical(CO3) instead of hydroxyl radical(OH-) or Phosphate radical(PO4 ) of HAp. Carbonate apatite ahs been known as that the physicochemical properties are similar of the natural bony apatite. In vivo experiment, carbonate apatite demonstrates non-toxic reactions. In this study, the compostite consisted of carbonate apatite and type I collagen, which is the bony structural protein, was implanted in rabbit tibiae to evaluate possibility as an artificial bone substitute. Biodegradation rate of the composite, the rate and qiantity of the regenerative cortical and cancellous bone formation were investigated radiologically and histopathologically. HAp and the carbonate apatite coilagen composite(Ap-C) were applied in the dissected rabbit tibiae(7-8mm), and fixed by external fixators. Postoperative roentgenograms were taken 2, 4, 6, and 8 weeks after implantations. For histological ohservations, the rabbits were sacrificed and the specimens were obtained 2, 4, 6, and 8 weeks after operation. Radiological Lane scores of Ap-C were 1.16±0.92, 2.16±0.98, 3.33± 0.82, and 3.67±0.51 in 2. 4, 6 and weeks after operation, while the Lane score of HAp were 0.53±0.84, 0.83±0.75, 1.67±0.81, and 2.83±0.98 respectively. Ap-C demonstrated the faster degradation and more bone formation then HAp. Though physicochemical properties of carbonate apatite is similar to those of HAp, the carbonate apatite and type I collagen composite(Ap-C) revealed rather faster degradation and bone formation than HAp in both radiological and histological investigations.