Empyema Necessitatis in a Patient on Peritoneal Dialysis / 결핵및호흡기질환

Empyema necessitatis is a rare complication of an empyema. Although the incidence is thought to be decreased in the post-antibiotic era, immunocompromised patients such as patients with chronic kidney disease on dialysis are still at a higher risk. A 56-year-old woman on peritoneal dialysis presented with an enlarging mass on the right anterior chest wall. The chest computed tomography scan revealed an empyema necessitatis and the histopathologic findings revealed a granulomatous inflammation with caseation necrosis. The patient was treated with anti-tuberculous medication.

Effects of Emotional Labor, Emotional Intelligence and Social Support on Job Stress in Clinical Nurses / 기본간호학회지

PURPOSE: The purpose of this study was to investigate the effects of emotional labor, emotional intelligence and social support on job stress in clinical nurses. METHODS: Participants were 123 clinical nurses and data were collected from October to December, 2011 and analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficients and multiple regression with SPSS 18.0. RESULTS: A positive correlation was found between job stress and emotional labor. Emotional labor showed a significant negative correlation with emotional intelligence and social support, whereas a positive correlation was found between emotional intelligence and social support. The strongest predictor of job stress was emotional labor. In addition, institution satisfaction (dissatisfaction) and the reason for selecting the job (opportunities for service) accounted for 21% of variance in job stress. CONCLUSION: The results of this study suggest that it is important to manage emotional labor as well as to improve job satisfaction in order to reduce job stress in clinical nurses.

Necrotizing Sialometaplasia Accompanied by Adenoid Cystic Carcinoma on the Soft Palate

Necrotizing Sialometaplasia (NS) is a benign, self-limiting inflammatory disease of the mucus-secreting glands, and this illness mainly involves the minor salivary glands. The significance of NS resides in its clinical and histopathological resemblance to malignancy. We present here a case of necrotizing sialometaplasia on the soft palate, and this was accompanied by adenoid cystic carcinoma. We report here on this case to draw attention to the difficulty for deciding the extent of resecting a malignancy, and especially when the malignancy is simultaneously accompanied by necrotizing sialometaplasia.

A Case of Perforating Lichen Nitidus / 대한피부과학회지

Lichen nitidus is an uncommon, asymptomatic cutaneous eruption. There are many reports of variable subtype of lichen nitidus including of spinous, follicular, vesicular, hemorrhagic, actinic, purpuric, and perforating lichen nitidus. We report a 7-year-old boy who presented with multiple generalized papular eruption that was composed of discrete, flesh colored, 1-2mm sized, glistening, and round shaped papules. The histopathology of the biopsied specimen showed a well-circumscribed dermal infiltrate mainly composed of histiocytes. The overlying epidermis showed atrophy, thinning of granular layer and liquifaction degeneration of basal layer. Transepidermal perforation was observed and eosinophilic amorphous debris was in the channel of the perforation.

Expression of the c-met Gene in Invasive Ductal Carcinomas / 한국유방암학회지

PURPOSE: The c-met protein, known as the hepatocyte growth factor (HGF) receptor, is a transmembrane 190 kDa heterodimer having tyrosine kinase activity, and it is encoded by the c-met oncogene. The HGF/c-met signaling pathway has been shown to demonstrate various cellular responses including mitogenic, proliferative, morphogenic and angiogenic activities. Although HGF and c-met are known to be expressed in a variety of organs and they play important roles in signal transduction, studies on its expression and its correlation to the clinicopathological parameters of breast cancer are very rare. METHODS: In this study, we examined the c-met mRNA and the c-met protein expression by utilizing RT-PCR and immunohistochemical methods for 50 cases of invasive ductal carcinomas (IDCs) and 20 cases of normal breast tissues. RESULTS: The c-met mRNA amplification was detected in 35 cases of IDCs (70%), but not in the normal tissues. The c-met protein overexpression was detected in 27 cases of IDCs (54%) and 2 cases of normal breast tissue (10%). Both the mRNA amplification and protein overexpression rates were significantly higher in tumor than in the normal breast tissue. The c-met mRNA amplification showed a tendency to increase in an invasive cancer and nodal metastasis. The c-met protein overexpression was significantly correlated with the well differentiated grade of tumor and it showed a tendency to decrease in the metastatic tumors. The concordance between both the mRNA amplification and protein expressions were not observed. CONCLUSION: These results suggest that the HGF/c-met signal pathway may be associated with the development of breast cancer. c-met mRNA amplification may play important roles both in tumor progression and metastasis. c-met protein overexpression may contribute to the morphogenesis of well-differentiated tumor.

A Case of Kikuchi-Fujimoto Disease, Subsequently Evolving to Systemic Lupus Eyrthematosus / 소아과

Kikuchi-Fujimoto disease(KFD), also known as histiocytic necrotizing lymphadenitis, is a self-limited systemic illness and it has the pathognomonic histological appearance of lymph nodes. KFD is rarely associated with systemic lupus erythematosus (SLE). The diagnosis of KFD can precede, postdate or coincide with the diagnosis of SLE. Our case describes a young woman, originally diagnosed as having Kikuchi's disease by lymph node histology, who subsequently developed SLE with constitutional symptoms, skin rash, hematologic and immunologic disorder and high titer of antinuclear antibody. This raises consideration for the proposal that KFD may reflect a SLE-like auto-immune condition. Patients with KFD should be kept under observation for several years for the development of SLE. And KFD should be ruled out in SLE flare-up accompanied by lymphadenopathy.

Development and Expression of Recombinant Ara h 1 Fragment Proteins

No abstract available.

A Case of Gastrocolic Fistula by Primary Colon Cancer

A gastrocolic fistula is a fistulous communication between a segment of colon and the stomach. It is a rare complication and is caused most commonly by a carcinoma of the colon or the stomach. Among the less common causes of a gastrocolic fistula are a benign gastric ulcer, chronic ulcerative colitis, Crohn's disease, a carcinoid tumor, syphillis, an intraabdominal abscess, a lymphoma, trauma, intestinal tuberculosis, and iatrogenic factors. Recently, the incidence of gastrocolic fistulas has decreased due to earlier diagnosis and treatment of stomach and colon cancer. The classic triad of symptoms are lienteric diarrhea, feculent vomiting, and foul eructations, but all patients do not necessarily present with these symptoms. A gastrocolic fistula is usually diagnosed by using a barium enema, but occasionally can be detected by using an upper gastrointestinal series or endoscopy. Here, we report experience with a fistula between a cancerous transverse colon and the stomach and give a review of the literature.

Expression of the c-Met, p53 and Ki-67 Proteins in Astrocytic Tumors

OBJECTIVE: The pathologic diagnosis of the astrocytoma has been primarily based on the histologic grading, however, there are some discrepancies among the pathologists on the tumor grading. Met protein, known as the hepatocyte growth factor receptor, is a transmembrane 190 kDa heterodimer with tyrosine kinase activity, encoded by c-met gene. Although c-Met protein is known to be expressed in a variety of tissues and plays important roles in signal transduction, the study on its expression related to clinicopathological prognostic parameters in brain tumor is rare. METHODS: We have evaluated c-Met protein expression in association with p53 and Ki-67 expression in 35 astrocytic tumors (15 diffuse astrocytomas: LGA, 11 anaplastic astrocytomas: AA, 9 Glioblastoma multiforme: GBM) using immunohistochemical method. RESULTS: c-Met immunoreactivity was observed in 2 LGA(13.3%), 5AA(45.5%), 4GBM cases (44.4%), respectively. p53 immunoreactivity was observed in 2 LGA(13.3%), 4AA(36.4%), 4GBM cases (44.4%), respectively. Ki-67 labelling index was 1.7+/-1.0% (LGA), 13.3+/-.2% (AA) and 18.0+/-.1% (GBM), respectively. Each c-Met expression and the Ki-67 labelling index were statistically correlated between low grade and anaplastic astrocytomas. The c-Met and p53 expression rate were not associated with increased Ki-67 labelling index. But, c-Met, p53, Ki-67 expression tended to increase with higher grade of malignancy. CONCLUSION: We conclude that c-Met expression may contribute to the invasiveness and tumor progression of the astrocytoma and c-Met expression is useful in discrimination between low grade astrocytoma and anaplastic astrocytoma.

A Case of Aspirin Intolerance in Chronic Urticaria / 대한피부과학회지

Aspirin intolerance is defined as acute urticaria-angioedema, bronchospasm, severe rhinitis, or shock occuring within three hours of aspirin ingestion. Aspirin intolerance occurs most frequently in individuals with chronic urticaria, asthma, chronic rhinitis, and normal individual in order of decreasing frequency. NSAIDs frequently cross-react with aspirin in intolerant individuals. We report a case of aspirin intolerance, which cross-reacts with naproxen, in a 42-year-old male with chronic urticaria. He experienced angioedema within 20 minutes after ingesting aspirin (700mg) and within 2 hours after ingesting naproxen (125mg). He has also experienced itching, wheal, chest tightness, and nausea during oral challenge test with aspirin.

A Case of Tuberous Xanthoma in Early Childhood / 대한피부과학회지

We report a 6-year-old male with primary hypercholesterolemia who had tuberous xanthoma. Yellowish nodules first appeared on the knees 3 years ago and gradually increased in size and number and also occurred on the left elbow. The laboratory findings showed markedly increased serum cholesterol and slightly increased triglyceride. Serum lipoprotein electrophoresis showed a marked increase in beta-fraction, suggesting type II hyperlipoproteinemia. Histopathology showed many aggregates of foam cells in the dermis and subcutaneous fat.

An Evaluation of Cockroach Allergies in Atopic Dermatitis

BACKGROUND: Atopic dermatitis (AD) is primarily influenced by environmental factors including exposure to pollutants and indoor allergens (particularly, house dust mites). Al-though house dust mite antigens are the most prevalent components of indoor allergens in Korea, cockroaches also can be considered to act as an important allergen. OBJECT: This study was done to evaluate the differences in three different atopic patch test (APT) techniques, and the relationship between APT and skin prick test, total IgE, and specific serum IgE level using cockroach allergen. Methods: We performed patch test in 57 patients with AD and 30 normal controls on clinically lesional and normal appearing skin with German cockroach (GC) allergens (extract, as is) in three different techniques (standard, scratch, DMSO). Reactions were evaluated after 48hours, and compared with the results of skin prick test, total and specific IgE levels. Detailed atopy history and severity scoring were taken. RESULTS: In the GC (whole body) prick test positive group, there was 1263.02 IU/ml of total IgE, and this amount was significantly higher than GC (whole body) prick test negative group who had 549.46 IU/ml (P0.05). There was no significant relationship between the positive reactions to patch test and prick test to Ext and As is antigen. The APT results showed no significant concordances with skin prick test and RAST for cockroach antigens. CONCLUSIONS: APT seems to be a different dimension of atopic skin inflammation and may pro-vide further diagnostic information in addition to a patient's history, skin prick test, and RAST results.

Prognostic Significance of Prostate-specific Antigen Level Two Months after Maximal Androgen Blockade in Metastatic Prostate Cancer / 대한비뇨기과학회지

PURPOSE: The aim of this study was to analyze the prognostic significance of pre- and post-treatment serum prostate-specific antigen (PSA) level, together with a variety of other clinicopathological parameters, in patients with metastatic prostate cancer receiving maximal androgen blockade (MAB). MATERIALS AND METHODS: The PSA levels before and during MAB, together with various clinicopathological parameters, were measured in 65 patients with newly diagnosed metastatic prostate cancer. The prognostic significance of these parameters, including the PSA level two and six months after MAB (PSA2MO and PSA6MO), a 50% reduction in the pretreatment PSA level after MAB (PSA50), the extent of disease (EOD), performance state, Gleason score and pretreatment hemoglobin, were analyzed by both univariate and multivariate tests. RESULTS: Of the forty-nine patients with a pretreatment PSA level of > or =50ng/ml, twenty-four (24/49, 48.9%) showed normalized ( or =50ng/ml, patients with a normalized PSA2MO showed a higher survival rate than those with a non-normalized PSA2MO from the univariate analysis using the Log-Rank test (p=0.0001), and PSA2MO was revealed as the most useful prognostic factor (p=0.022) from the multivariate analysis using the Cox proportional hazards regression model. CONCLUSIONS: A normalized ( or =50ng/ml.

A Case of Gastric Mucinous Adenocarcinoma Presenting as a Characteristic Mucin Pool / 대한소화기내시경학회지

Mucinous adenocarcinoma is a rare histologic type of gastric carcinoma. Most mucinous gastric carcinoma is diagnosed by histology after surgical resection. However, in this report, we preoperatively predicted the type of a tumor (mucinous type) from its characteristic endoscopic finding. An endoscopic examination showed a cauliflower-like mass on the upper body of the posterior wall. At first we could not find the mass because it was covered with a thick mucin-like substance. After gastric lavage and mucin aspiration we found a tumor mass which was surrounded with a characteristic mucin pool. Abdominal CT showed a 6 cm sized-mass connected with the gastric fundus. Total gastrectomy with esophagojejunostomy was performed. The pathology of the tumor proved to be a mucinous adenocarcinoma.

A Clinical Analysis of Thyroglossal Duct Cyst and Sinus

PURPOSE: Anomalies in the thyroglossal duct are the most common midline, or paramedian cervical lesions of congenital origin. Presenting as a thyroglossal duct cyst (TGDC) or a thyroglossal duct sinus (TGDS), they are found in all age groups. This clinical study was intended to elucidate the clinical characteristics, and the outcomes, of surgical treatment of these anomalies. METHODS: Between January 1992 and May 2002, 91 patients underwent surgery for a TGDC or a TGDS at 4 hospitals affiliated to Hallym University. The demographics of the patients, the clinical characteristics of the lesions, and the outcomes of the treatments were retrospectively evaluated. These characteristics were evaluated according to age groups; younger than 15 (38 patients) and older than 15 (53 patients) years. RESULTS: The male to female ratio was 1.67: 1 (It is better to give the actual figures.), with the first decade showing the highest incidence in the age distribution (33%). Painless masses (83.6%) were the most common presenting symptom, with most symptoms having been manifest for less than 1 year (67%). TGDCs were 90% and TGDSs were 10%. There were 62 cases of infrahyoid and 18 of suprahyoid lesions, with 80 cases on the midline and 11 on the paramedian within 2 cm from the midline. Of the paramedian lesions, 2 cases were in the younger group and 9 were in the older group. This tendency of laterality in the location by age group showed no statistical significance (p=0.172). All the patients underwent a Sistrunk operation, and one experienced a recurrence. CONCLUSION: This study justified the Sistrunk operation as the treatment of choice for anomalies of the thyroglossal duct. The lateral lesions occurred in the old age groups more frequently. A careful approach is needed with paramedian cervial lesions in adults to avoid the loss of the proper treatment of possible hidden congenital lesions.

Localized Pneumoconiosis Manifested by Solitary Pulmonary Nodule Mimicking Lung Cancer: One case report / 대한흉부외과학회지

Pneumoconiosis is fibrogenic disease, caused by inhalation of mineral dust. It is defined as the accumulation of dust in the lung and tissue reaction to its presence and the dust is considered to be an aerosal of solid and inanimate particles. It is among the most common and the most important occupational lung disease, especially in developing countries. It is required three prerequisites for making a clinical diagnosis of pneumoconiosis: 1) a full clinical and occupational history together with the result of physical examination; 2) previous X-ray for comparison; and 3) a clear understanding of the time scale involved in the progression of the diseases. Most pneumoconiosises are slow to evolve and changes in the appearances take many months -usually years- to occur. Pneumoconiosis is represented on a plain X-ray of the chest as multiple small round opacities, usually smaller than 1cm diameter. In 58 years old female patient, pneumoconiosis is manifested as 5 X 4 X 3cm sized solitary pulmonary nodule without any occupational history and past histoty of exposure of dust. so we treated this case with right upper lobectomy. Therefore we report this case with a brief review of literatures.

Pneumatosis Cystoides Intestinalis of Adult Ileum: A Case Report

Pneumatosis cystoides intestinalis is an uncommon condition characterized by the presence of multiple gas-filled cysts within the gastrointestinal wall. This lesion occurs in association with a large variety of gastrointestinal and non-gastrointestinal conditions. Herein, we describe a case of pneumatosis cystoides intestinalis of the small intestine that developed in a 31-year-old man with a history of duodenal ulcer and pyloric stenosis. Emergency exploro-laparotomy was done due to a suspicion of ulcer perforation. Primary closure for duodenal ulcer perforation and segmental resection of ileum were done. Resected ileum showed diffuse sponge-like changes in the wall. Microscopically, variable-sized cystic lesions, lined by flat or multinucleated giant cells, were noted throughout the intestinal wall.

Lymphoepithelioma-like Carcinomas of the Stomach Report of 4 cases associated with Epstein-Barr virus

Lymphoepithelioma-like carcinoma (LELC) that histologically resembles nasopharyngeal lymphoepithelioma has been reported in various sites including the stomach, salivary gland, lung, skin, thymus, tonsil and uterine cervix. LELC of the stomach was rarely reported after the first report by Burke et al. in 1990. More than 60% of them were associated with Epstein-Barr virus (EBV). Most commonly affecting elderly Asians with slight male predominance (M/F ; 1.2/1), it usually is located in the proximal portion of the stomach and distinguished from lymphoid-rich adenocarcinoma by the absence of definitive glandular differentiation in the LELC. We recently experienced 4 cases of LELC of the stomach associated with EBV. Patients consisted of two Korean females and two Korean males with one in 3rd decade, one in 5th decade and two in 6th decade. The tumors of all cases were located in the proximal portion of the stomach. Gross types were 1 Borrman type I, 2 Borrman type II and 1 early gastric carcinoma type IIc. The size of the tumors varied from 0.8 cm to 7 cm. Microscopic findings were similar in all 4 tumors.; The tumors were composed of syncytial nests of undifferentiated cells having vesicular nuclei with prominent nucleoli, admixed with abundant lymphoplasma cell infiltration in the stroma. Immunohistochemical staining revealed that the tumor cells were reactive for cytokeratin and the stromal lymphocytes were mostly T cells. There were dark hybridization signals in the nuclei of most of the tumor cells but no signals in the stromal lymphocytes in three cases on in situ PCR hybridization and on all cases PCR amplification for EBNA-1. It is concluded that LELCs of the stomach have distinctive histologic characteristics and the usual association with EBV. Further accumulation of these cases will define the prognosis.

The Expression of TGF-beta1 and TGF-beta Receptor I in Human Lung Cancer

A majority of human lung cancer cell lines have developed resistance to growth inhibition via the activation of transforming growth facter-beta (TGF-beta). Previous studies have reported that growth inhibition of TGF-beta is linked to the expression of transforming growth factor-beta receptor type I (TGF-betaRI). Immunohistochemical studies of TGF-beta1 and TGF-betaRI have been carried out in 43 cases of lung neoplasm; including 25 cases of squamous cell carcinoma, 13 cases of adenocarcinoma, 2 cases of adenosquamous cell carcinoma, and 1 case each of undifferentiated carcinoma, small cell carcinoma and neuroendocrine carcinoma. Reverse transcriptase polymerase chain reaction (RT-PCR) for TGF-beta1 mRNA was also performed in 40 cases of tumors and 14 control cases of normal parenchyme. Immunohistochemically, TGF-beta1 and TGF-betaRI expression were noted in the cytoplasm of all type of tumor cells. The staining intensity and areas were examined and scored from 0 to 5. As a whole, TGF-beta1 staining scores in the neoplastic lesions were higher than that of the adjacent normal parenchyme, bronchial epithelium or alveolar epithelium. However, TGF-betaRI staining scores were generally lower than that of the adjacent normal components. The TGF-beta1 mRNA showed a higher percentage of expression in tumors than in normal control. Tumor size, lymph node metastasis, histological differentiation and histological type of tumors did not correlated with the staining score of TGF-beta1 and TGF-betaRI. These results indicate that although various types of human lung carcinoma cells produce TGF-beta1, they show a reduction in TGF-betaRI, resulting in an escape from growth inhibition by TGF-beta1.

A Case of Paraneoplastic Membranous Nephropathy Associated with Adenocarcinoma of the Lung / 대한암학회지

The paraneoplastic nephrotic syndrome can be diagnosed by clinical and immunologic features. We have had a case of paraneoplastic nephrotic syndrome in the patients with aadeno-carcinoma of the lung, whose diagnosis was made by excluding other causes of nephrotic syndrome. The type of renal lesion was membranous glomerulopathy which commonly occurs in carcinoma. The quantity of proteinuria in this patient had decreased according to the improvement of lung cancer with combination chemotherapy. After fourth chemotherapy he was refractory to treatment, and unfortunately he had passed away with cardiac tamponade.