Evaluation of cytolytic activity and phenotypic changes of circulating blood immune cells in patients with colorectal cancer by a simple preparation of peripheral blood mononuclear cells / 대한외과학회지

PURPOSE: This study aimed to assess the cytolytic activity and the phenotype of circulating blood immune cells in cancer patients by using a simple preparation of peripheral blood mononuclear cells (PBMCs). METHODS: Peripheral blood was obtained from 94 diagnosed colorectal cancer (CRC) patients and 112 healthy donors. PBMCs were cocultured with K562 cells for 2 hours and lactate dehydrogenase released from the dead K562 cells was measured by using a spectrophotometer. Meanwhile, PBMCs were stained with fluorescence conjugated monoclonal antibodies (mAbs) and analyzed by flow cytometry. RESULTS: The cytolytic activity of PBMCs were significantly different between CRC patient and healthy groups (8.82% +/- 3.84% vs. 17.51% +/- 8.57%; P < 0.001). However, no significant difference in the cytolytic activity was observed after surgery in the CRC patient group (before surgery, 8.82% +/- 3.84% vs. after surgery, 9.95% +/- 4.94%; P = 0.326). In addition, the percentage of peripheral blood natural killer cells was significantly higher in the preoperative patient group than in the healthy group (19.97% +/- 11.51% vs. 15.60% +/- 5.77%, P = 0.041). In contrast, the percentage of peripheral blood lymphocytes was lower in the preoperative patient group than in the healthy group (28.41% +/- 8.31% vs. 36.4% +/- 8.6%, P < 0.001). CONCLUSION: These results demonstrate that circulating blood immune cells of CRC patients are functionally impaired and undergo an immunophenotypic perturbation, and show that a simple preparation of PBMCs can be useful to evaluate cellular immunity in cancer.

The Characteristics and Treatment of Bone Loss after Liver Transplant / 대한이식학회지

BACKGROUND: Bone loss after liver transplant (LT) is a long-term problem associated with an increased morbidity due to pathologic fractures. We reviewed our management of post-LT bone loss. METHODS: We collected retrospective data from 82 adult LT recipients between January 2006 and December 2009 who had preoperative and postoperative (12 to 24 months) bone mineral density (BMD) data measured by dual energy X-ray absorptiometry (DXA). BMD was decreased in 52 out of 82 patients before LT. These patients were managed with calcium plus alendronate, calcium only, or no treatment. We compared the efficacy of these three modalities and the factors influencing BMD changes and investigated the incidence of pathologic fractures. RESULTS: In decreased BMD patients (n=52), the postoperative spinal BMD was increased with all three treatment modalities. A more significant increase was found with ALN treatment (+0.103) compared to NO treatment (+0.029) (P-value: 0.016). However, femoral BMD decreased despite ALN treatment. Alendronate use was a significant factor for post-LT spinal BMD improvement in the univariate and multivariate analysis. There were significant newly-developed pathologic fractures after LT especially in osteoporotic patients (28%). CONCLUSIONS: Weekly alendronate with daily calcium may be helpful for the spinal bone mineral protection in preoperative patients with decreased BMD.

The Characteristics and Treatment of Bone Loss after Liver Transplant / 대한이식학회지

BACKGROUND: Bone loss after liver transplant (LT) is a long-term problem associated with an increased morbidity due to pathologic fractures. We reviewed our management of post-LT bone loss. METHODS: We collected retrospective data from 82 adult LT recipients between January 2006 and December 2009 who had preoperative and postoperative (12 to 24 months) bone mineral density (BMD) data measured by dual energy X-ray absorptiometry (DXA). BMD was decreased in 52 out of 82 patients before LT. These patients were managed with calcium plus alendronate, calcium only, or no treatment. We compared the efficacy of these three modalities and the factors influencing BMD changes and investigated the incidence of pathologic fractures. RESULTS: In decreased BMD patients (n=52), the postoperative spinal BMD was increased with all three treatment modalities. A more significant increase was found with ALN treatment (+0.103) compared to NO treatment (+0.029) (P-value: 0.016). However, femoral BMD decreased despite ALN treatment. Alendronate use was a significant factor for post-LT spinal BMD improvement in the univariate and multivariate analysis. There were significant newly-developed pathologic fractures after LT especially in osteoporotic patients (28%). CONCLUSIONS: Weekly alendronate with daily calcium may be helpful for the spinal bone mineral protection in preoperative patients with decreased BMD.

Graft-Versus-Host Disease after Liver Transplantation

PURPOSE: Graft-Versus-Host Disease (GVHD) is a rare (0.1~2%) but severe complication after liver transplantation (LT). It is the most lethal complication after LT and there are currently no effective preventive or therapeutic measures available. Approximately 90 such cases have been reported in the literature, but only one case has been reported in Korea. METHODS: We performed a retrospective analysis of 767 patients who underwent LT (living donor:deceased donor=554:213) at Seoul National University Hospital, Korea from 1998 to 2009. Four patients (4/767, 0.52%) with histologically proven GVHD were found. The diagnosis of GVHD was made according to observing macrochimerism in the peripheral blood and the affected tissue biopsy. RESULTS: Four patients underwent LT due to Hepatitis B virus-related liver cirrhosis and two of these patients had coexisting hepatocellular carcinoma. Three patients received livers from deceased donors and one received a liver from a live donor. All their blood matching were identical. The first diagnosed case underwent human leukocyte antigen (HLA) typing only after LT and it showed complete one-way donor-recipient HLA matching. The onset of GVHD occurred between 10 days and 55 days after LT. All the patients developed high-grade fever, skin rash, neutropenia, diarrhea and the main signs and symptoms related to GVHD. All the patients died because of sepsis despite intensive treatment. CONCLUSION: GVHD after LT is an extremely rare and fatal complication and it is difficult to diagnose. Therefore, we should perform pre-transplant HLA matching and try to establish an early diagnosis for patients who are clinical suspicious of having GVHD. Further study in this area is needed and physicians need to be alert to detect this malady.

Could patients who underwent hepatic resection due to hepatocellular carcinoma with high alpha-fetoprotein be monitored for recurrence by alpha-fetoprotein level? / 대한간학회지

BACKGROUND/AIMS: The follow-up strategy after hepatectomy for hepatocellular carcinoma (HCC) usually depends on the experience of physician, resulting in frequent imaging studies, which leads to increased cost. Hence, we investigated the role of monitoring alpha-fetoprotein (AFP) levels after hepatectomy in patients with preoperative high AFP. METHODS: From January 2000 to December 2004, 66 patients who underwent curative hepatectomy due to HCC with preoperative AFP level >400 ng/mL were reviewed. Changes in AFP level after the operation were investigated. The recurrence was suspected in case of two consecutive increase of AFP over cut-off value. Cut-off value was determined by ROC curve. All patients were divided into 2 groups: patients who met the definition (Group S) and those who didn't (Group D). RESULTS: AFP level of 20 ng/ml was proposed as the cut-off value for diagnosis of recurrence by ROC curve. Thirty two patients who didn't have the AFP level decreased below 20 ng/ml after the resection had HCC recurred, whereas 16 out of 34 patients who had AFP decreased had tumor recurrence. The AFP level of patients without recurrence was kept below 20 ng/ml during the follow-up. The AFP level of 44 out of 48 recurred patients increased over 20 ng/ml upon recurrence. By definition, group D were 5 patients. In 4 patients of group D, the AFP level didn't increase above 20 ng/ml upon recurrence. These patients had HCC and they recurred 1 year after the surgery. CONCLUSIONS: In patients with preoperative AFP level >400 ng/ml, the AFP level tended to increase above 20 ng/ml at recurrence mostly within 1 year. Hence, we proposed that these patients could be monitored by only AFP until 1 year after surgery.

Comparison of Long-term Outcome According to Preoperative Clinical Course in Patients Undergone Liver Transplantation for Hepatocellular Carcinoma within Milan Criteria

PURPOSE: We wanted to evaluate the influence of preoperative non-surgical treatment and its duration for hepatocellular carcinoma (HCC) patients who underwent liver transplantation (LT). METHODS: We analyzed 75 patients with HCC who underwent living donor liver transplantation from January 1999 to December 2005. The median follow-up was 40.2 months. The patients were divided into the not treated group (26 patients) and non-surgically treated group (49 patients). We compared the overall survival (OS) and disease-free survival (DFS) rates of the 24 not treated patients with that of the 33 treated patients within the Milan criteria. The treated group was divided to 39 short-term ( or =3 years) treated patients by the preoperative treatment duration. The OS and DFS rates were analyzed. RESULTS: For 57 patients within the Milan criteria, the 1-, 3- and 5-year OS rates and the 1-, 3- and 5-year DFS rates were 80.0%, 68.5%, 64.8%, 82.0%, 77.2% and 75.1%, respectively. There were no different characteristic between the not treated group and the treated group, except for the mean age and the Child-Turcotte-Pugh score. Compared to the treated group, the OS and DFS rates were slightly better in the not treated group (p=0.053). There were more patients who underwent transcatheter arterial chemoembolization only in the short-term treated group and there were more patients who had microvascular invasion in the long-term treated group. The OS and DFS rates showed no significant difference between the two groups. CONCLUSION: It is possible that LT is a first treatment for HCC patients. If the patients' response to preoperative treatment was good, then their prognosis may be same regardless of the treatment duration.

Comparison of Long-term Outcome According to Preoperative Clinical Course in Patients Undergone Liver Transplantation for Hepatocellular Carcinoma within Milan Criteria

PURPOSE: We wanted to evaluate the influence of preoperative non-surgical treatment and its duration for hepatocellular carcinoma (HCC) patients who underwent liver transplantation (LT). METHODS: We analyzed 75 patients with HCC who underwent living donor liver transplantation from January 1999 to December 2005. The median follow-up was 40.2 months. The patients were divided into the not treated group (26 patients) and non-surgically treated group (49 patients). We compared the overall survival (OS) and disease-free survival (DFS) rates of the 24 not treated patients with that of the 33 treated patients within the Milan criteria. The treated group was divided to 39 short-term ( or =3 years) treated patients by the preoperative treatment duration. The OS and DFS rates were analyzed. RESULTS: For 57 patients within the Milan criteria, the 1-, 3- and 5-year OS rates and the 1-, 3- and 5-year DFS rates were 80.0%, 68.5%, 64.8%, 82.0%, 77.2% and 75.1%, respectively. There were no different characteristic between the not treated group and the treated group, except for the mean age and the Child-Turcotte-Pugh score. Compared to the treated group, the OS and DFS rates were slightly better in the not treated group (p=0.053). There were more patients who underwent transcatheter arterial chemoembolization only in the short-term treated group and there were more patients who had microvascular invasion in the long-term treated group. The OS and DFS rates showed no significant difference between the two groups. CONCLUSION: It is possible that LT is a first treatment for HCC patients. If the patients' response to preoperative treatment was good, then their prognosis may be same regardless of the treatment duration.

Management of an Intra-abdominal Fluid Collection after Gastric Cancer Surgery

PURPOSE: Intra-abdominal fluid collection is one of the risk factors associated with postoperative morbidity or mortality for patients who undergo gastric cancer surgery. The aim of this study was to analyze the clinicopathological characteristics of the patients with postoperative intra-abdominal fluid collection and to identify the indications for inserting a percutaneous drain (PCD) in patients with intra-abdominal fluid collection. MATERIALS AND METHODS: Among the 1,277 patients who underwent operations for gastric cancer at Seoul National University Hospital between April 2005 and July 2006, the data of 117 patients with an intra-abdominal fluid collection were reviewed. RESULTS: The number of patients' with pathologic stage I, II, III and IV disease was 42 (36.8%), 23 (20.2%), 16 (14%) and 33 (28.9%), respectively. Forty-three patients (36.3%) underwent PCD insertion and the other 43 patients received conservative management. A univariate analysis of multiple clinical variables revealed that age, gender, diabetes, liver disease, lymph node dissection, the pathologic stage and the body mass index (BMI, kg/m2) were not significantly associated with PCD insertion (P>0.05). However, the univariate analysis showed that two characteristics were associated with a significantly high incidence of PCD insertion: a diameter of an intra-abdominal fluid collection greater than 4 cm and infectious signs such as leukocytosis, fever and bacteremia. CONCLUSION: About two thirds of the intra-abdominal fluid collections after surgery for gastric cancer were managed with only conservative method without other morbidities of mortality. Surgeons should consider performing PCD insertion if the largest diameter of an intra-abdominal fluid collection is over 4 cm or if infectious signs are seen.

A Case of Angiosarcoma on the Scalp in a Teenage Girl / 대한피부과학회지

Angiosarcoma is a rare and highly malignant vascular tumor of endothelial cell origin. Cutaneous angiosarcoma usually occurs on the scalp and face of the elderly person, frequently in the sixth and seventh decade. Unusually, we experienced a case of angiosarcoma of the scalp in a 12-year-old girl. The patient had a solitary, well-demarcated 0.7X0.7cm sized, non-tender, blue-violaceous to gray-black colored, crusted papule on the vertex for 2 months. She was treated by wide surgical excision only but no recurrence in the last eight years after excision.

A Clinical and Histopathologic Study of Rubella / 대한피부과학회지

BACKGROUND: Although rubella is a mild exanthematous viral infection and its incidence has been greatly decreased after effective vaccination, epidemics of rubella has been noted at 5- to 7-year intervals. But there has been few report about the clinical and histopathologic study of rubella in Korean literatures. OBJECTIVE: The purpose of this study was to review the clinical and histopathologic characteristics of rubella of 1996 outbreak. METHODS: We reviewed the clinical features and histopathologic findings in 50 patients diagnosed as rubella in Department of Dermatology, Presbyterian Medical Center from January 1996 through to May 1996. RESULTS: 1. The male-female ratio was 1: .17. The age distribution was 13-32 years and 72% of patients were aged 16-25 years. 2. Erythematous maculopapular rash on whole body was developed in all patients. Eighty two percent of the patients had fever and lymphadenopathy, and 36% of the patients had petechiae of soft palate. The main prodromal symptoms were sore throat(50%), headache(34%), and upper respiratory symptoms(22%), as order of frequency. 3. Positive serologic test for rubella IgM antibody was 79.5%. 4. The most common abnormal laboratory finding was leukopenia(58%), and followed by positive ASO(34%), the presence of atypical lymphocytes(21%), and thrombocytopenia(8%). 5. Histologically, epidermal changes were mild to moderate vacuolopathy(92.3%), the presence of dyskeratotic cells(30.8%), spongiosis(23.1%), and exocytosis(15.4%). Dermal findings were mild superficial perivascular lymphohistiocytic infiltration(100%), upper dermal edema(53.8%), perivascular edema(38.4%), pigmentary incontinence(30.8%), and the presence of extravasated RBC(23.1%). Eosinophil infiltration(15.4%) and the presence of large nucleated lymphocytes(92.3%) were also observed. Conclusions: According to the results of our study about rubella outbreak in 1996, clinical signs and symptoms were similar to those of previously described. Histologically, superficial perivascular dermatitis with mild to mederate vacuolar interface change was a main feature and large nucleated lymphocytes were frequently noted.

A Case of Toxic Epidermal Necrolysis Due to Contact of Paraquat(Gramoxone(R)) / 대한피부과학회지

Occasionally, erythema multiforme has been reported to occur in association with allergic contact dermatitis to various substances including paraquat(Gramoxone(R)). In these cases the erythema multiforme has ranged from mild localized exanthem to life-threatening toxic epidermal necrolysis. We report a case of toxic epidermal necrolysis developed from erythema multiform due to contact of paraquat.

A Case of Lentigo Maligna Melanoma / 대한피부과학회지

Lentigo maligna melanoma(LMM) is the least common type of melanoma and most commonly affects the sun-exposed skin of the elderly. We herein report a case of LMM evolved from lentigo maligna(LM). A 71-year-old female presented with a longstanding irregular brown patch containing two black papules on the left cheek which developed 8 months ago. Histopathologic findings were consistent with LM and LMM. We performed a wide excision and dufourmental flap for reconstruction with no recurrence for 30 months. Sun exposure has been known as the most important etiologic factor for the development of malignant melanoma including LMM and the incidence has an increasing tendency. Thus, skin biopsy is recommended in the evaluation of a longstanding irregular brown patch on the face to prevent LMM.

Repair of Defect Caused by Surgical Removal of Skin Cancers by Secondary Intention / 대한피부과학회지

BACKGROUND: There are a few methods, including primary intention, deleyed primary closure and secondary intention, to irpair several types of defects. But commonly-used primary intentional repair of a defect after surgical removal of a skin cancer by graft, flap or simple closure has several limitations such as the need of a skillful technique and various complications. OBJECTIVE: We undertook a secondary intention using occlusive dressing with a polyurethane film after skin cancer surgery instead of a primary repair and evaluated its efficacy, particularly in points of simplicity and safety, and cosmetic results. METHODS: We randomly chose 14 cases of skin cancers in 13 patients who had undergone simple surgical excision or Mohs micrographic surgery and then undertook secondary intention with polyurethane film after informed consent. Postsurgical wound care included cleansing with normal saline or boric acid, then covering the defect with antibiotic ointment, gauze and film a at regular intervals.

A Clinical and Histologic Study of Pigmented Basal Cell Carcinoma / 대한피부과학회지

BACKGROUND: Pigmented basal cell carcinoma(PBCC) is a clinical and histological variant of BCC, which is known to show better prognosis than non-PBCC. There has been no report about the PBCC among Korean patients. OBJECTIVE: Our purpose was to identify the clinical and histologic characteristics of PBCC and to determine whether this correlated with prognosis. METHODS: A clinical and histological survey was done with 62 lesions of 56 cases of PBCC that visited the Department of Dermatology, Presbyterian Medical Center during the last 10 years(1988 - 1998). Some results were then compared with results of non-PBCC. RESULTS: 1. The frequency of BCC in the total number of new outpatients was 0.34%, and 83.6% of BCC contained pigment histologically. 2. The male-female ratio was 1.24:1, and 92.9% of the patients with PBCC were older than the age of 40 years with the mean age of 62.9 years. 3. 88.7% of the PBCC occurred on the face, especially on the nose(38.7%), cheek(19.4%), and eyelid(17.7%). Clinically, most of the tumors were noduloulcerative(77.4%) and diffuse pigmentation was more common than dotted. 4. The most frequent histologic types were nodulocystic(43.6%) and mixed(43.6%) type followed by superficial(6.4%), micronodular(1.6%), adenoid (1.6%), infiltrative(1.6%), basosquamous(1.6%) types. Histologically 51.6% of the tumors were associated with ulceration, and 71% of the tumors were associated with infiltration of inflammatory cells. 5. Fontana-Masson stains showed pigment is melanin and it was found in both tumor nests and surrounding dermis in most cases(95.0%). Hypertrophic melanocytes with prominent dendrites were seen in the tumor nodule(77.8%) and in the normal epidermis overlying tumor(22.2%). 6. Margins were examined for evidence of residual tumor in 48 lesions that were excised. In 4 lesions(8.3%) were the margin positive for tumor. This was statistically not significant (p>0.05) compared with 10 excisions of non-PBCC in which 2(20%) showed positive margins. CONCLUSION: High incidence of PBCC is a characteristic feature in Korean patients, and PBCC showed better prognosis than non-PBCC because it is more frequently excised with adequate margins.

A Case of Subcutaneous Sweet's Syndrome in MYelodysplastic Syndrome Showing Nuelear Segmentation Anomalies of Neutrophils / 대한피부과학회지

We encountered a case of Sweet's syndrome associated with myelodysplastic syndrome in a 60-year-old woman. The clinical presentation strongly suggested Sweet's syndrome. A skin biopsy specimen taken from her skin lesion on the leg showed an infiltration of numerous neutrophils in the subcutis instead of the dermis which is the main area of neutrophilic infiltration in Sweet's syndrome. Among infiltrating cells, many neutrophils(8%) showed nuclear segmentation anomalies, that is, hyposegmentation(pseudo-Pelger-Huet anomaly) or hypersegmentation. Peripheral blood neutrophils had similar anomalies. This subcutaneous variant of Sweet's syndrome, Sweet's panniculitis, is rare and nuclear segmentation anomalies of neutrophils are probably a good clue to underlying myelodysplastic syndrome.

A Case of Transient Acrodermatitis Enteropathica in a Full-Term Breast-Fed Infant / 대한피부과학회지

We herein report a case of transient acrodermatitis enteropathica in a 3-month-old, breast-fed, full-term infant. The patient was presented with a 2-month history of diarrhea and crusted erythema- tous patches on the periorificial area. Similar lesions were seen in his siblings. His serum zinc level and the zinc level in his mother's breast milk were markedly reduced. Diarrhea and skin lesions disappeared promptly with oral zinc supplementation and did not recur when zinc was discontinued after three weeks. Our case indicates that even full-term infants, who feed excl-usively on mothers milk, run a risk of developing zinc deficiency, if the concentration of zinc in the breast milk is very low.

A Case of Cutaneous Mycobacterium marinum Infection / 대한피부과학회지

Mycobacterium marinum is a photochromogenic and slowly growing acid-fast organism classified in Runyon's group I of atypical mycobacteria. Infection with M. marinum occurs when the organism is inoculated usually in association with exposure to contaminated water and the disease is characteristically limited to the skin but deep soft tissue may be involved. We report a case of M. marinum infection in a 43-year-old man with erythematous verrucous plaque on his right knee, which was caused by a shell wound on a beach 3 months ago. The skin biopsy specimen showed pseudoepitheliomatous hyperplasia and several small epithelioid granulomas in the dermis. Culture of the tissue specimen revealed slowly growing whitish colonies in the dark, which changed yellowish after exposure to light. The microorganism was identified as M. marinum by biochemical tests, and was confirmed by the DNA-DNA hybridization method. The skin lesion disappeared after 3 moaths of treatment with minocycline, 200mg daily.

A Case of Livedo Reticularis Associated with Decompression Sickness / 대한피부과학회지

Livedo reticularis is a mottled bluish discoloration of the skin which occurs in a netlike pattern and is not a diagnosis in itself, but is a nonspecific reaction pattern. It may be classified as idiopathic and secondary livedo reticularis. Decompression sickness can occur during decompression after diving into deep sea water or during a rapiid ascent from sea level, and is one of the many causes of the secondary livedo reticularis. We report a case of livedo reticulris which developed in a patient with decompression sickness. A biopsy from the purpuric patch revealed an unusual histopathologic finding that resembles those of bullae and sweat gland necrosis in drug induced coma.

Cutaneous Infection Caused by Fusarium verticillioides in a Patient with Diabetes Mellitus and Liver Cirrhosis / 대한의진균학회지

Fusarium species, which are common soil saprophytes, have been implicated as a pathogen causing a variety of opportunistic infections such as keratitis, onychomycosis, burn wound infection or disseminated systemic infections in immunocompromised hosts. We report a case of cutaneous infection caused by F. verticillioides in a 59-year-old man, with a long history of diabetes mellitus and alcoholic liver cirrhosis. He presented with a few papules and fluctuant cutaneous nodules on both forearms traumatized by woodstick 4 months ago. The diagnosis of F. verticillioides infection was established by histopathologic examination and finding of tissue cultures.