Treatment of Malignant Melanoma Using Sentinel Lymph Node Dissection / 대한피부과학회지

BACKGROUND: Sentinel lymph node dissection is a new therapeutic strategy of malignant melanoma. There was no clinical study about sentinel lymph node dissection in Korea. OBJECTIVE: Our purpose was to analyze the results of the treatment of malignant melanoma using sentinel lymph node dissection and to compare sentinel lymph node dissection with elective lymph node dissection. METHODS: History of 9 cases with malignant melanoma(1 case treated with elective lymph node dissection and 8 cases treated with sentinel lymph node dissection) at our institution over 2 years were reviewed. We evaluated the clinical & histopathologic data, status of sentinel lymph node and results of treatment. RESULTS: Sentinel lymph nodes were located within the regional lymph node basins in all 8 cases of extremity melanoma, except 1 case(trunk melanoma). Of 8 cases treated with sentinel lymph node dissection, the number of sentinel lymph node was 11, and positive lymph nodes was 3. Patients with positive sentinel lymph node were treated with therapeutic regional lymphadenectomy, chemotherapy and adjuvant therapy. No further treatment or only interferon administration was done in patients with negative sentinel lymph node. CONCLUSION: We confirmed the usefulness of lymphoscintigraphy and sentinel lymph node dissection using vital dye staining in the diagnosis and treatment of lymph node metastasis of melanoma.

A Case of Malignant Eccrine Poroma / 대한피부과학회지

Malignant eccrine poroma is a rare malignant cutaneous tumor arising from intraepithelial eccrine duct and it may develop either spontaneously or from a long standing eccrine poroma. We report a case of malignant eccrine poroma on the antihelix of the right ear in a 37-year-old female, previously diagnosed as a benign eccrine poroma with shave biopsy specimens. Histological findings are well-defined tumor cell nests disseminated in dermis. Each cell has a large, hyperchromatic atypical nuclus. The atypical mitoses, dyskeratoses, intracytoplasmic vacuolations and duct-like structures are observed. She was treated with wide surgical excision and local skin flaps.

A Case of Recurrent Pyogenic Granuloma with Multiple Satellites / 대한피부과학회지

Pyogenic granuloma is a common proliferative lesion that often occurs shortly after a minor injury or infection of the skin. Typically the lesion grows rapidly for a few weeks before stabilizing as an elevated, bright red papule, usually not more than 1 to 2 cm in size. Recurrence after surgery or cautery is not rare. The development of multiple satellite angiomatous lesions at and around the site of a previously destroyed pyogenic granuloma is a rare and alarming event. Herein we report a case of recurrent pyogenic granuloma with multiple satellites that developed after excision of a single lesion of pyogenic granuloma in an 8-year-old boy.

A Case of Polyoma Virus(PV) Infection in a Renal Allograft Recipient / 대한신장학회잡지

We report one case of renal PV infection after renal allograft transplantation leading to graft dysfunction. According to prior reports, PV induced interstitial nephritis might be a cause of graft loss. Pathologic findings show varying degrees of interstitial infiltration and tubular degenerative changes, which resemble acute cellular rejection. Therapeutic strategies have not yet been developed. Case ; A 23 years old male underwent renal transplantation from his HLA haploidentical 25 year old sister. His renal function had been good with cyclosporin, steroid and azathioprine until 9 months after transplantation, when his serum creatinine level rose to 2.2mg/dl. The renal biopsy revealed diffuse lymphocyte infiltration in the interstitium and feature of the tubulitis. Also, giant tubular epithelial cells with large, hyperchromic nuclei were present. Despite steroid pulsing and OKT3, renal function progressively de- teriorated. After 10 days of OKT3 therapy, the patient suffered from high fever, dyspnea and general aches. A chest X-ray revealed interstitial infiltration in both lung fields and the cytomegalovirus PCR (polymerase chain reaction) test of serum and blood was positive. Intravenous ganciclorvir was administered and immunosuppressants were tapered. 4 months after admission, he lost his graft function and underwent hemodialysis. The aforementioned renal biopsy was retested immunohistochemically. Nuclear inclusions in renal tubular epithelial cells were shown and these inclusions were reacted positively with PV monoclonal antibodies.

Comparison of Urea Kinetic Modeling and Indices of Nutrition in Hemodialysis Patients / 대한신장학회잡지

OBJECTIVES: Protein-calorie malnutrition has been shown to be prevalent among patients on long-term hemodialysis(HD) patients. And assessment of nutritional status of HD patients has assumed greater importance because of the association of protein- calorie malnutrition with increasing morbidity and mortality. So we observed the incidence and clinical effect of protein-calorie malnutrition, and we compared the indices of nutrition with dialysis adequacy utilizing urea kinetic modeling in HD patients. METHODS: We performed a cross-sectional study in which eight parameters, based on anthropometry, blood chemistry and subjective symptoms, were scored according to the degree of abnormalities in 48 HD patients. A malnutrition index was derived from these scores. We also performed comparative analysis to identify significant correlations of the indices of urea kinetic modeling with the other parameters of nutritional status. RESULTS: The malnutrition index classified 12(25 %) patients as normal, 28(58%) intermediately malnourished, and 8(17%) as severely malnourished. Malnutrition index showed a significant correlation with the body mass index(BMI), mid-arm circumference(MAC), mid-arm muscle area(MAMA), duration of HD, total lymphocyte count,trnsferrin. The malnutrition index also showed a significant correlation with renal creatinine clearance(Ccr), alkaline phosphatase. However, malnutrition index showed no meaningful correlation with TWR-Kt/V, TW-Kt/V, BUN, cholesterol,calcium, triglyceride. The value of Ccr was significantly lower in the severely malnourished and intermediately group than in the normal group. CONCLUSION: In assessing the nutritional status of HD patients, body weight, MAC, MAMA, duration of HD, total lymphocyte count, transferrin, alkaline phosphatase and Ccr were considered useful parameters. No meaningful relationships between TW-Kt/V and malnutrition index or between NPCR (normalized protein catabolic rate) and malnutrition index were found in this cross-sectional study. As the number of patients with longer duration of HD or negligible Ccr has increased in the malnourished patients, regular monitoring of these parameters, especially TWR-Kt/V and residual renal function may be helpful to assess dialysis adequacy to keep good nutritional status of each HD patient.

A Case of SIADH Related to Drug-indeced Generalized Maculopapular Rash / 대한내분비학회지

Syndrome of inappropriate antidiutetic hormone(SIADH) secretion is the most common cause of hyponatremia in clinical medicine. Before diagnosis of the SIADH is made, other causes for a decreased diluting capacity and nonosmotic stimuli for AVP release need to be rule out. Disorders associated with SIADH can be divided into 4 major etiologic groups: malignancies, pulmonary diseases, central nervous disorders, and drugs. A 45-year-old woman was admitted due to maculopapular skin eruption and fever after taking medications for fever and myalgia. Generalized tonic clonic seizure was developed nine days later, and laboratory results showed marked hyponatremia. During the evaluation, treatment, and subsequent follow-up, the diagnosis of SIADH was confirmed, but the definitive cause was obscure. With fluid restriction, sodium replacement and demeclocycline therapy, she recovered completely 6 months later. We suggest that the SIADH might be related to drug-induced generalized maculopapular rash via menmgitis-like reaction in CSF as one of systemic adverse side effects to drugs rather than direct effect of related drugs.

The Prediction of Postoperative Pulmonary Complications in the Elderly Patients / 결핵

BACKGROUND: we have evaluated the association of age, smoking, type of anesthesia, type of operation, duration of surgery, previous history of chronic pulmonary diseases with postoperative pulmonary complications and identified which parameter of preoperative spirometry was a predictor of postoperative pulmonary complications. METHOD: In 270 patients older than 60 years, the postoperative pulmonary complications were evaluated according to age, smoking, type of anesthesia, type of operation, duration of surgery, previous history of chronic pulmonary diseases and the parameters of preoperative spirometry were analyzed. RESULTS: The postoperative pulmonary complications rates were significant higher among patients older than 70 years, and among those with previous chronic pulmonary diseases or their smoking history. The pulmonary complications were increased among patients with general anesthesia or duration of surgery more than 2 hours. The pulmonary complications rates did not differ according to sex, type of operation. The patients with hypercarbia(PaCO2> 45mmHg) have more increased postoperative complications. The preoperative FEVl less than 1 liter, FVC, MMEFR & MVV less than 50% of predicted respectively were predictive of complications. CONCLUSION: Age 70, history of smoking,duration of operation more than 2 hours, general anesthesia, previous chronic pulmonary disease and hypercarbia (> or=45mmHg) on preoperative arterial blood gas analysis were predictivd of pulmonary complications. Among the parameters of spirometry, FEV1, FVC, MMEFR and MVV were indicator of predicting postoperative pulmonary complications.

Two Cases of Nocardial Infection in the Renal Transplant Recipient / 대한이식학회지

Nocardia is a kind of aerobic Actinomycetes, gram positive organism that was acid-fast when stained with the modified Ziehl-Neelsen method. Nocardia is a soil saprophyte widely distributed throughout the world which usually introduced through the respiratory tract and may develop a disseminated infection, especially subcutaneous abscess and or central nervous system infection. Nocardiosis is an important opportunistic infection in immunosuppressed patients, lymphoma, sarcoidosis, and organ transplant patient. Sulfonamide therapy is known as a treatment of choice in nocardiosis. We report the two cases of nocardiosis in renal transplant recipient. Nocardia asteroides was isolated in our two cases. We treated sucessfully with Trimethoprim/Sulfamethoxazole(Bactrim).