Natural Course of Swallowing Recovery and Associated Factors in Post-Ischemic Stroke Dysphagia / 대한연하장애학회지

Objective@#To identify factors associated with swallowing recovery in patients with dysphagia after ischemic stroke. @*Methods@#Patients admitted to Kangbuk Samsung Hospital from 2011 to 2019 for first acute ischemic stroke and dysphagia, as confirmed by a videofluoroscopic swallowing study (VFSS), were enrolled in this retrospective study. Patients whose Dysphagia Outcome and Severity Scale (DOSS) level was ＜6 as determined by VFSS were monitored in a dysphagia clinic and additional VFSS was performed periodically until one year after stroke. Follow-up was discontinued when the DOSS level reached 6 or 7. The main study outcomes were full recovery and tube removal rate. Cox regression analysis was used to identify prognostic factors of dysphagia. The Kaplan-Meier method was used to generate curves of the proportions of patients that achieved full recovery. @*Results@#One hundred and thirteen patients were enrolled. Multivariate analysis showed that only initial DOSS was significantly associated with swallowing recovery (13.0% for non-oral feeding vs. 35.6 % for a modified diet). @*Conclusion@#Initial swallowing status (as determined by VFSS findings) is strongly associated with swallowing recovery in post-ischemic stroke patients. Assessments of dysphagia are important for predicting dysphagia recovery and planning management strategies.

Knowledge and Behavior Regarding Cosmetics in Koreans Visiting Dermatology Clinics

BACKGROUND: Cosmetics can affect the skin condition profoundly, and yet no survey has been performed in Koreans visiting dermatology clinics. OBJECTIVE: To assess knowledge and consumer behavior regarding cosmetics in Koreans visiting dermatology clinics. METHODS: A questionnaire consisting of 43 questions concerning demographics and use/knowledge/selection/purchase of cosmetics was given to patients and accompanying persons who visited dermatologic clinics in university and private clinic settings. RESULTS: In total 1,015 subjects (73.2% females, mean age 32.5 years) completed the survey. Education level was college or higher in 72.8%. Thirty-one percent had been diagnosed with a skin disorder, atopic dermatitis and seborrheic dermatitis being the most frequent diagnoses (33.7% and 16.8%, respectively). The frequency of makeup/sunscreen/functional cosmetics use, amount of sunscreen use, recognition of functional cosmetics, and knowledge of shelf life were significantly correlated with level of education. Among “functional cosmetics,” whitening products were used most frequently (29.2%). Regardless of education level, 79.2% purchased cosmetics without checking ingredients, and 85.7% were unaware of the all-ingredient-labelling regulations, and yet subjects considered ingredient the most important factor when purchasing a product. CONCLUSION: Outpatient subjects in their twenties and thirties are the most knowledgeable about cosmetics in Korea.

A Case of Comamonas Acidovorans Corneal Ulcer

PURPOSE: To report a case of a Comamonas acidovarans corneal ulcer treated with antibiotics in Korea. Comamonas acidovarans corneal ulcer has not been previously reported to our knowledge. METHODS: A 70-year-old woman visited our clinic complaining of left ocular pain and decreased visual acuity for six days. We performed a smear and culture on the corneal lesion and treated it with topical and systemic antibiotics. RESULTS: Comamonas acidovorans was cultured from ulcer lesion. Corneal ulcer improved with the administration of ciprofloxacin and tobramycin.

Change of Dermatological Terminology and the 4th Edition of Terminolgy Book of the Korean Medical Association / 대한피부과학회지

Translation of terminology in Korean in the field of medicine has been one of the important tasks since several decades in Korea. Translation of medical terminology is deeply indebted by the Japanese scholars and direct adaptation of their work by the Korean scholars was the main trend since long time ago. It is because of we are sharing both Chinese character and the similar grammar structure. Although some modification and addition of new translation which is more suitable in the Korean language system has been tried in the different level in the past editions of English-Korean medical terminology books, extensive work has been performed in the 4th edition which was published by the Korean Medical Association in 2001. The Korean Dermatological Association has published first edition of dermatology terminology book in 1983 and the 2nd edition in 1993. Many of them adapted in the 4th edition of the terminology book of the Korean Medical Association. However, there are many changes including some new trial with innovative ideas. This special article covers the difference of two terminology books between 4th edition published by the Korean Medical Association and the 2nd edition of Korean Dermatology Association, which was summarized in the Table.

Epidermal Barrier in Human Fetus and Newborn / 대한피부과학회지

BACKGROUND: The lipids of the stratum corneum, which originate from polar lipid precursors provided by the cells of the stratum granulosum via the exocytosis of lamellar bodies, with cornified cell envelope form competent epidermal barrier structurally and functionally. The ontogeny of the epidermal barrier is not clearly defined because of difficulty of sampling and methodology which defines epidermal lipids. OBJECT: From ultrastructural observation of skin samples obtained from human fetuses and newborn on serial developmental timings, we tried to clarify the sequential development of epidermal barrier. METHODS: Skin samples were obtained from 13 human fetuses from EGA(estimated gestational age) 10 to 23wks and 2 newborns. Specimens were observed by fluorescent confocal microscopy with nile red to identify the distribution of epidermal lipids, by transmission electron microscope with lanthanum to investigate the functional permeability barrier, with RuO4 to observe the intercellular lipid bilayer and morphology of lamellar bodies, with ion capture cytochemistry to investigate the formation of epidermal calcium gradient. RESULT: In nile red stain, the amount of epidermal lipid increased during fetal period. At EGA 23wks, the lipid distribution revealed linear and continuous pattern. In lanthanum tracer study, the electron dense tracer permeated all the intercellular space of the epidermis up to periderm and subepidermal space until EGA 21wks. At EGA 23wks, the tracer permeated intercellular space of epidermis weakly. It might be predicted that incomplete epidermal barrier is present at this time. In RuO4 stain, precursor of lamellar body was observed at EGA 15wks, and intercellular lipid bilayer was observed at EGA 16wks. As gestation increases, there was a steady increase in epidermal lipid bilayers. In ion capture cytochemistry, epidermal calcium gradient was first observed in follicular epidermis at EGA 20wks, and in interfollicular epidermis at EGA 23wks. From these results, it is concluded that the basic structures of epidermal barrier are formed at EGA 23wks, but it is not complete, and epidermal barrier arises first from follicular epidermis.

Two Cases of Generalized Granuloma Annulare in Early Childhood

Generalized granuloma annulare is a rare skin disease presenting generalized eruption with a distinctive histologic picture. The age of onset of generalized granuloma annulare differs from that of localized granuloma annulare. Most of the patients with generalized granuloma annulare were in the fifth to seventh decades and cases of generalized granuloma annulare in infancy or in early childhood have been rarely reported. We herein report two cases of generalized granuloma annulare in 45- and 18-month-old boys, who is the youngest patient yet reported in the Korean literature. The histopathologic findings were compatible with granuloma annulare and all lesions completely involuted in two months after administration of topical or systemic corticosteroids.

Epithelioid Hemangioma Associated with Nevus Flammeus / 대한피부과학회지

Epithelioid hemangioma, the term which was first used by Enzinger and Weiss, is synonymous with angiolymphoid hyperplasia with eosinophilia. It defines a lesion occurring usually in the dermal and subcutaneous tissue of the head and neck, characterized by localized, marginated and relatively symmetrical proliferation of the capillaries around a medium-sized vessel with an epithelioid hyperplasia of endothelial cell. There is a marked inflammatory reaction composed of lymphocytes and eosinophils. We report a case of epithelioid hemangioma associated with nevus flammeus in a 53-year-old male. Histology revealed typical feature of epithelioid hemangioma that proliferation of dilated vessels with prominent endothelial cells surrounded by dense lymphoid cell infiltrates but no eosinophils were identified.

Change of alpha-SM Actin Expression Induced by the Antibody for TGF-beta in Fibroblast NIH3T3 Culture: The basic research for the inhibition of wound contracture

PURPOSE: The purpose of this experiment is to measure the expression of TGF-beta and alpha-SM actin (smooth muscle actin) from fibroblast culture by the duration of culture days and to analyze the inhibition of alpha-SM actin expression in fibroblast by the antibodies for TGF-beta. METHODS: The levels of alpha-SM actin from the paired NIH3T3 cell cultures with TGF-beta 1 containing medium (10 ng/ml) and with the antibody (for TGF-beta) medium (1 or 2 ug/ml) were determined by SDS PAGE for cell lysate protein, Western blot with ECL autoradiography and immuno - slot blot. RESULTS: In NIH3T3 culture, the expression of alpha-SM actin increased at culture days 4, 5, 6. TGF-beta was expressed from 2nd day of culture and increased by day 7. The addition of TGF beta (10 ng/ml) did not increased the expression of alpha-SM actin. But alpha-SM actin expression decreased in the presence of anti-TGF beta antibody. The decrease of expression was proportional to the concentration of antibody and duration of exposure to the antibody. CONCLUSIONS: Endogenous TGF-beta produced by fibroblast cultures is sufficient to express the alpha-SM actin from the myofiboblast. There was no additive expression of alpha-SM actin with exogenous TGF-beta 1. The antibody for TGF- beta inhibits the production of the alpha-SM actin during wound healing and may prevent the wound contracture.

The Nerve-dependency of Merkel Cell Proliferation in Cultured Human Fetal Glabrous Skin

Merkel cells are thought to function as slowly adapting mechanoreceptors and are known as targets for sensory nerves. However, the nerve-dependency of Merkel cells remains controversial. In this respect, some investigators have found interregional differences between hairy and glabrous skin and others have shown intraregional differences within denervated rat touch domes. Differences between species have also been reported. This study was performed to determine whether Merkel cells proliferate in vitro in the absence of the systemic factors, blood vessels and the intact nerves in human skin. Suspension organ culture was performed using fetal digits to investigate their in vitro proliferation. Merkel cells and cutaneous nerves were identified using antibodies to cytokeratin 20 and protein gene product 9.5 (PGP 9.5), respectively. Fetal digits of 56-82 day gestational age were cultured in serum free medium in a high O2 (45%) environment. Tissues were harvested before starting culture (D0) and 1,4,7,14, 28d after culture. Merkel cells were observed in the volar pads and dorsal nail matrices at D0. After 28d of suspension organ culture, digits looked healthy structurally and the number of Merkel cells had increased. However, PGP 9.5-immunoreactive nerves were markedly diminished after 1 day of culture and almost disappeared after 4 days. Merkel cell proliferation in vitro suggested that Merkel cell development is probably nerve-independent in human fetal glabrous skin.

A Clinical Differences between Asymptomatic Varicose Vein and Symptomatic Varicose Vein

PURPOSE: This study was designed to describe clinical differences between symptomatic and asymptomatic group in varicose vein. METHOD: We reviewed 59 cases of varicose vein managed in our hospital. The retrospective review of clinical records was done from March, 1999 to October, 1999. All patients were put into two groups:those were symptomatic and asymptomatic. RESULT: Analysis showed that varicose vein was more frequent in women than in men. 27.1% were asymptomatic and 72.9% were symptomatic. The mean age was 39.1 years in asymptomatic group and 52.1 years in symptomatic group. In asymptomatic group, the mean age of the male patients was 45.2 years and that of the female patients was 35.4 years. In symptomatic group, the mean age of the male patients was 49.6 years, that of the female patients was 54.2 years. The age difference between the two groups were 5.4 years in male in comparison with 19.8 years in female. In the symptomatic group, the frequency of association with deep vein thrombosis (DVT) was 21% (male:28% vs female:8.3%). CONCLUSION: The varicose vein appears to be a gradually progressive disease. In female patients, aging factor may be more important for the development of symptom. DVT is one of major causes of development of symptom.

Clinical and Histologic Features of Pityriasis Rosea and Pityriasis Lichenoides in Children / 대한피부과학회지

BACKGROUND: Pityriasis rosea is an acute inflammatory dermatosis with an unproven etiology. The typical clinical feature consists of an initial, single herald patch followed by development of smaller, disseminated, papulosquamous, ovoid macules. However, an unusual papular type of pityriasis rosea is relatively common in children and it shows similar clinical characteristics to pityriasis lichenoides. OBJECTIVES: Our purpose was to observe the clinical and histologic features of pityriasis rosea and pityriasis lichenoides, and differentiate two diseases in children. METHODS: Sixteen children with pityriasis rosea and nineteen children with pityriasis lichenoides were investigated clinically and histologically. RESULTS: 1. Clinically, pityriasis rosea may be differentiated from pityriasis lichenoides by the existence of herald patch, short duration, the uniformity of size and shape, and residual pigmentation. 2. Focal parakeratosis, intraepidermal vesicle and papillary derma edema are more common in pityriasis rosea. In contrast, deep dermal infiltration, dyskeratosis, epidermal necrosis and confluent parakeratosis are more common in pityriasis lichenoides. 3. Comparing to the plaque type, a papular type of pityriasis rosea shows more involvement in the extremities with longer duration. Histologically, parakeratosis and papillary dermal edema are less and spongiosis is more commonly observed in papular type. CONCLUSIONS: Pityriasis rosea in children often shows papules especially on the extremities, similar to that of pityriasis lichenoides. However, from the results in this study, we believe that two diseases can be differentiated if both clinical and histologic findings are carefully studied.

Identification of Pseudomonas Aeruginosa Isolated from Burn Patients by Nested Polymerase Chain Reaction: Special reference to comparison with conventional blood culture

PURPOSE: Pseudomonas aeruginosa has emerged as one of the most problematic bacteria in modern hospital settings, and this organism is increasingly isolated as a nosocomial pathogen. Burn patients are particularly susceptible to Pseudomonas infection. Therefore, the accurate and sensitive microbiologic tests are needed for strict management of this prevalent microorganism. METHODS: A nested polymerase chain reaction test based on consecutive amplification of the lipoprotein genes, oprL and oprI, was designed and evaluated, in comparison with the conventional blood culture, for its ability to detect Pseudomonas aeruginosa in clinical materials of burn patients. RESULTS: Positive results of PCR based on oprL gene were observed only for Pseudomonas aeruginosa. All other bacteria (n=4) tested by this amplification method were negative. Also the lowest detection level was 1X101 bacteria per ml of blood samples. In addition, PCR afforded a significantly higher detection rate for Pseudomonas aeruginosa than the conventional blood culture technique in clinical materials of burn patients (25.9% vs. 8.6%). CONCLUSION: This study suggests that the nested PCR technique is highly specific and sensitive test for detectionof Pseudomonas aeruginosa, and therefore it may be a useful adjunct tool, in combination with other conventional techniques, for detection of Pseudomonas aeruginosa infection.

The life of Dr. John William Heron, the second superintendent of Chejungwon / 의사학

The purpose of this paper is to overview the life of John W. Heron, M. D. who was the first appointed medical missionary to Korea by the Presbyterian Church USA. Although he was a competent doctor as well as a devoted missionary, he is not well-known yet, because he died early after 5 years' service in Korea. Dr. Heron was born in Derbyshire, England on June 15, 1856. His father, Rev. E. S. Heron, was a Scotch Minister of Congregational Church. His family emigrated to America in 1870 when he was fourteen years old and settled in Knoxville, Tennessee. In 1881, he was admitted to the University of Tennessee Medical School and graduated with highest honors in 1883. After training in New York University Hospital, he refused the offer of professorship from the University of Tennessee to become a medical missionary to Korea. He arrived in Seoul on June 21, 1885 and began to work in Royal Government Hospital, Chejungwon, the predecessor of Severance Hospital. In 1887, he became the superintendent of the Hospital following Dr. Horace N. Allen. He also worked for the Royal family and sometimes traveled to the rural areas to care for the patients. He started Chejungwon Church which later became Namdaemoon Presbyterian Church. In 1887, Dr. Heron worked as a member of the Bible translation committee and in 1889, he was elected as the chairman of the Public Committee of the Presbyterian Churches. In 1890, he established 'The Korean Religious Tract Society (Chosunsyungkyoseohoi) with Underwood and Ohlinger. The society published and replenished Christian books, periodical magazines and booklets. In the Summer of 1890, Dr. Heron did his best to take care of the sick suffering from an epidemic dysentery and himself got infected because of the terrible overwork. He passed away on July 26th, 1890. On his deathbed, he told his soldier and native friends around him as follow: "Jesus loves you. He gave His life for you. Stand by Him!" The martyrdom of Dr. Heron should be remembered in the Korean history of mission, because he was the first victim among the foreign missionaries who had lived and worked in Seoul for Korean mission. Dr. Heron's mind of love, service and devotion should be remembered by the medical doctors working today in caring for the patients suffering from physical and spiritual illnesses.

Epidermolysis bullosa simplex (Dowling-Meara type) associated with pyloric atresia and congenital urologic abnormalities

We report a case of epidermolysis bullosa simplex, Dowling-Meara type (EBS-DM), which was associated with congenital pyloric atresia (PA) and various urologic abnormalities, a diagnosis confirmed by immunofluorescence mapping and electron microscopic findings. Immunofluorescent mapping showed the serum from a patient with bullous pemphigoid faintly binding to the floor of the blister, and monoclonal antibodies against type IV and VII collagens were also stained on the floor of the blister. Electron microscopy showed epidermolytic cleavage and prominent clumping of tonofilaments in the basal and suprabasal keratinocytes. An abdominal radiograph and barium swallow showed a complete obstruction at the pyloric channel level. The widespread bullae healed without any scar formation and the bullae formation was localized on the extremities after 3 months of age without any specific treatment. Multiple urologic abnormalities such as bilateral hydronephrosis, hydroureter and a distended bladder with trabeculation were observed at 12 months of age. Currently, with the patient at 4 years of age, bullae still appear on the hands and feet and nail shedding can be observed. The patient's father, a paternal uncle and a paternal aunt had had similar bullous eruptions in infancy, all of which had improved spontaneously by the age of one.

Langerhans Cell Histiocytosis in Children: Report of six cases with clinicopathological observation / 대한피부과학회지

BACKGROUND: Langerhans cell histiocytosis (LCH) is a broad spectrum of clinical diseases having proliferation of Langerhans cells in common. LCH may be manifested in a variety of ways, ranging from a spontaneously regressing skin lesion to a multisystemic life-threatening disorder. Congenital self-healing reticulohistiocytosis is widely regarded as a limited form of LCH. It is present at birth or shortly thereafter and involute spontaneously. OBJECTIVE: Our purpose was to investigate the relationship between clinicopathologic characteristics and prognosis of LCH in children. METHODS: Six children with LCH were investigated clinically and histopathologically. Immunostains were performed with CD1a and S100 antibodies in 5 cases using paraffin-embedded sections and an electron microscopic examination was done in 1 case. RESULTS: Among the 6 cases of LCH, 4 cases were confined to the skin, and 2 cases showed internal organ involvement. All LCH confined to the skin showed resolution of the skin lesion in 1 year, and 2 cases involving internal organ showed bad prognosis. Histopathological findings showed large histiocytes with eosinophilic cytoplasm in common. Immunohistochemical stains (5 cases) showed positive reactions with CD1a and S-100, and electron- microscopical observation in one case demonstrated laminated dense bodies. There was no significant histopathological or immunohistochemical difference between LCH confined to the skin which showed resolution of lesions and LCH involving internal organs with grave prognosis. CONCLUSIONS: Clinical types of Langerhans cell histiocytosis could not be differentiated only from the histopathological findings of the skin. The distinction between Langerhans cell histiocytosis confined to the skin showing spontaneous resolution and congenital self-healing reticulohistiocytosis remains to be clarified.

The Effect of Long-term Tamoxifen Therapy on Endometrium Evaluated by Transvaginal Sonography in Postmenopausal Women Undergone Breast Cancer Surgery / 대한암학회지

PURPOSE: Tamoxifen is a non-steroidal antiestrogenic drug used mainly in the adjuvant therapy of breast cancer and it also has estrogenic effect to the endometrium. We investigated the effects of tamoxifen on endometrial thickening in postmenopausal women taking adjuvant tamoxifen therapy for breast cancer, and analyzed the correlation between sonographic findings, pathologic findings and duration of tamoxifen therapy. MATERIALS AND METHODS: Forty three patients previously operated and being treated by tamoxifen since July 1995 to August 1999 were involved in this study. Control group was selected from patients of postmenopausal syndrome visiting postmenopausal clinic more than 2 years after menopause since January 1994 to August 1997. Endometrial thicknesses of breast cancer patients taking tamoxifen were measured twice a year for 2 years and then once a year by transvaginal ultrasonography. They were considered abnormal when those thicknesses were greater than 6 mm. Sonographic mearsurements of control patients were done once at the first visit and which were compared with those of breast cancer patients. RESULTS: The mean endometrial thicknesses of breast cancer patients receiving tamoxifen therapy were 5.06 mm (4.86~5.21 mm) at 6th month, 5.1 mm (4.92~6.00 mm) at 12th month, 5.13 mm (4.89~5.32 mm) at 18th month, 5.15 mm (4.97~5.28 mm) at 24th month and 5.14 mm (4.96~5.21 mm) at 36th month. The mean thickness of control patients was 4.87 mm. The mean endometrial thickness of breast cancer patients and that of control patients were 5.07 mm and 4.87 mm respectively. Only one patient with stage I breast cancer showed endometrial thicknessof 6 mm during follow-up and endometrial biopsy showed atypical endometrial hyperplasia. Endometrial thickness significantly increased after 18 months of tamoxifen therapy, but the rate of increase was slow. CONCLUSION: The endometrial thickness increased with duration of tamoxifen therapy, but the rate of increase was slow and seldom exceeded 6 mm. So we concluded the risk of endometrial cancer is low.

Vascular Trauma Secondary to Orthopedic Procedure

Liability to vascular trauma in orthopedic procedures results from the close relation between bones and vessels and complicated use of sharp instruments and retractors. Prompt diagnosis and management are mandatory to avoid high mortality and morbidity. We report 6 vascular injuries secondary to orthopedic procedures performed between 1994 and 1998. Two injuries occurred as a consequence of intramedullary nailing and Ilizarov external fixation of a femur fracture, one injury from lumbar laminectomy, one injury as a result of total hip replacement, one from hip flexion contracture release and the other one secondary to knee flexion contracture release. Injury occurred to three femoral arteries, one femoral artery and vein, one popliteal artery, and one iliac artery and IVC. Four vascular injuries required bypass grafts, division was done in AV fistula following disc operation. Conservative treatment was given to one vascular injury. There was no significant complication and death in our series except one case of graft infection that was revised with extra-anatomic bypass. The goal of management of vascular trauma that occurs during the orthopedic procedure is to save the limb and even the life. Urgent management based on knowledge of vascular structure and skillful surgical technique are needed.

Prognostic Significance of Tumor Angiogenesis in Breast Cancer / 한국유방암학회지

The well-known prognostic factors for breast cancer, such as axillary lymph node status, do not always account for the exact outcome. The development of other accurate prognostic factors would help in assessing high risk for recurrence and death. Recently, much experimental evidence has accumulated showing that tumor growth and metastasis are dependent on tumor angiogenesis. To investigate the status of angiogenesis in breast cancer, we counted the microvessel density (MVD) of brest cancer tissues, which were stained with anti-CD34 antibody, as a measure of tumor angiogenesis. We classified 43 breast-cancer patients into 22 with low MVD ( or =47/200xPF). We estimated the correlations between the MVD and other established prognostic factors. We also calculated survivals based on MVD. The MVD was in the range between 10 and 93 (mean+/-SD=46.9+/-21.7). The positive rate of lymph-node metastasis in high MVD patients was 32.6%, which was higher than the 23.3% for low-MVD patients. We found a significant correlation between MVD and histologic grade (p=0.037), but could not fine any significant correlation between MVD and menopausal status, tumor size, nuclear grade, estrogen receptor, or progesterone receptor. Retrospectively, the receptor status of estrogen and of progesterone had significant impacts on survival (ER: p=0.0001, PR: p=0.0001). The 4-year disease-free survival rate of high-MVD patients was 56.6+/-12.5%, and that of low-MVD patients was 69.0+/-10.8% (p=0.449). The 4-years overall survival rate of high-MVD patients was 71.1+/-11.1%, and that of low-MVD patients was 74.1+/-12.2 (p=0.449). In conclusion, the determination of MVD in breast cancer tissue may be useful as a prognostic factor, but it is necessary to investigate the MVD in a large number of patients before this conclusion can be stated with certainty.

Dermatophagoides Farinae-specific IgE and IgG4 Antibodies in Atopic Dermatitis Patients / 대한피부과학회지

BACKGROUND: The pathogenesis of atopic dermatitis is still unknown. Many reports have suggested that the house dust mite antigen may play a role in the pathogenesis of atopic dermatitis. The IgG4 allergen-specific subclass has been considered to be involved both in allergic reactions and associated with the appropriate response to allergen-specific immunotherapy. OBJECT: The purpose of this study was to evaluate the positive rate of the allergic prick test to D. farinae and the levels of D. farinae-specific IgE and Ig64. METHODS: We performed the allergy prick test, RAST for D. farinae-specific IgE and ELISA for D. farinae-specific IgG subclasses and compared the values between atopic dermatitis patients and normal controls. RESULTS: 1. D. farinae was the most common allergen in patients with atopic dermatitis and the positive rate of the allergic prick test was 61.0%. The positive rate of the allergic prick test and the positive rate to D. farinae increased as c]inical grading increased. 2. The Positive reaction rate of D. farinae-specific IgE(RAST) in those with atopic dermatitis was 68.8% and increased as the positive reactions of the allergic prick test to D. farinae and chnical grading increased. 3. Among the IgG subclasses, only the level of D. farinae-specific IgG4 was significantly higher in atopic dermatitis than normal controls. 4. The level of D. farinae-specific IgG4 showed a tendency to decrease in accordance with the clinical severity grades. CONCLUSION: These results suggested that D. farinae might play an important role in the development of atopic dermatitis and well-designed studies should continue to be performed in order to delineate the biological significance of IgG4.

Prognostic Significance of Tumor Angiogenesis in Breast Cancer

The well-known prognostic factors for breast cancer, such as axillary lymph node status, do not always account for the exact outcome. The development of other accurate prognostic factors would help in assessing high risk for recurrence and death. Recently, much experimental evidence has accumulated showing that tumor growth and metastasis are dependent on tumor angiogenesis. To investigate the status of angiogenesis in breast cancer, we counted the microvessel density(MVD) of breast cancer tissues, which were stained with anti-CD34 antibody, as a measure of tumor angiogenesis. We classified 43 breast-cancer patients into 22 with low MVD ( or =47/200 PF). We estimated the correlations between the MVD and other established prognostic factors. We also calculated survivals based on MVD. The MVD was in the range between 10 and 93(mean SD=46.9 21.7). The positive rate of lymph-node metastasis in high-MVD patients was 32.6%, which was higher than the 23.3% for low- MVD patients. We found a significant correlation between MVD and histologic grade (p=0.037), but could not find any significant correlation between MVD and menopausal status, tumor size, nuclear grade, estrogen receptor, or progesterone receptor. Retrospectively, the receptor status of estrogen and of progesterone had significant impacts on survival (ER : p=0.0001, PR : p=0.0001). The 4-year disease-free survival rate of high-MVD patients was 56.6 12.5%, and that of low-MVD patients was 69.0 10.8% (p=0.449). The 4-year overall survival rate of high-MVD patients was 71.1 11.1%, and that of low-MVD patients was 74.1 12.2 (p=0.449). In conclusion, the determination of MVD in breast cancer tissue may be useful as a prognostic factor, but it is necessary to investigate the MVD in a large number of patients before this conclusion can be stated with certainty.