Characterization of Specific IgA Response to Antigenic Determinants of Helicobacter pylori Urease Encoded by ureA and ureB in Children

Helicobacter pylori (H. pylori), a causative agent of chronic gastritis and gastric cancer, has several virulent factors for own survival and progression toward gastric diseases in human stomach. Of those, H. pylori produces mainly urease (10~15% total protein weight) that neutralize the gastric acid for survival. Here, we identified the antigenic epitope of urease and then developed an ELISA using the antigen including the epitope of urease. We identified the antigenic epitope of urease that induces IgA antibodies in human using truncated mutants. Eight kinds of serially-truncated mutant of UreA and UreB were prepared and subjected to immunoblot using pooled sera of patients with gastric disorders. UreBEnd protein containing UreB epitope was produced and investigated its diagnostic value via ELISA in children. As a result, mutants having last 24 amino acid residues of UreB carboxyl terminus deleted did not show IgA-reactive band. The clones that contained the downstream of 448(th) amino acid in UreB showed IgA-reactive band. The serodiagnostic value of the UreBEnd recombinant protein including identified epitope was confirmed via IgA ELISA and shown to have 97% sensitivity and 100% specificity. These results demonstrated that carboxyl terminal region of UreB carries an antigenic epitope for IgA response in human. It may be useful for detecting H. pylori infection with improved test accuracy and minimum use of endoscopy.

Branching Patterns of Medial and Inferior Calcaneal Nerves Around the Tarsal Tunnel

OBJECTIVE: To demonstrate the bifurcation pattern of the tibial nerve and its branches. METHODS: Eleven legs of seven fresh cadavers were dissected. The reference line for the bifurcation point of tibial nerve branches was an imaginary horizontal line passing the tip of the medial malleolus. The distances between the reference line and the bifurcation points were measured. The bifurcation branching patterns were categorized as type I, the pattern in which the medial calcaneal nerve (MCN) branched most proximally; type II, the pattern in which the three branches occurred at the same point; and type III, in which MCN branched most distally. RESULTS: There were seven cases (64%) of type I, three cases (27%) of type III, and one case (9%) of type II. The median MCN branching point was 0.2 cm (range, -1 to 3 cm). The median bifurcation points of the lateral plantar nerves and inferior calcaneal nerves was -0.6 cm (range, -1.5 to 1 cm) and -2.5 cm (range, -3.5 to -1 cm), respectively. CONCLUSION: MCN originated from the tibial nerve in most cases, and plantar nerves were bifurcated below the medial malleolus. In all cases, inferior calcaneal nerves originated from the lateral plantar nerve. These anatomical findings could be useful for performing procedures, such as nerve block or electrophysiologic studies.

Propofol Infusion Syndrome in a Patient with Epilepsia Partialis Continua / 대한간질학회지

Propofol has been used for the treatment of refractory status epilepticus, but propofol can cause propofol infusion syndrome (PRIS). PRIS is rarely developed and often fatal. The syndrome is characterized by metabolic acidosis, rhadomyolysis, and cardiac failure. Most reports were described in critically ill patients undergoing long-term propofol infusion at high doses. But many systemic confounding factors are mixed with the fatality of PRIS and there are no report on epilepsia partialis continua which has stable systemic conditions. We report PRIS in a patient with epilepsia partialis continua.

Propofol Infusion Syndrome in a Patient with Epilepsia Partialis Continua

Propofol has been used for the treatment of refractory status epilepticus, but propofol can cause propofol infusion syndrome (PRIS). PRIS is rarely developed and often fatal. The syndrome is characterized by metabolic acidosis, rhadomyolysis, and cardiac failure. Most reports were described in critically ill patients undergoing long-term propofol infusion at high doses. But many systemic confounding factors are mixed with the fatality of PRIS and there are no report on epilepsia partialis continua which has stable systemic conditions. We report PRIS in a patient with epilepsia partialis continua.

A Case of Febrile Ulceronecrotic Mucha-Habermann's Disease in an Infant / 대한피부과학회지

Febrile ulceronecrotic Mucha-Habermann's disease (FUMHD) is an unusual severe form of pityriasis lichenoides et varioliformis acuta (PLEVA) characterized by abrupt onset of widespread ulceronecrotic cutaneous eruption associated with high fever and systemic symptoms. In most cases, a mild typical form of PLEVA was usually present prior to the acute fulminating course. We report a case of FUMHD in a 6-month-old infant, who presented widespread hemorrhagic papules and coalescent thickly crusted ulcerations, high fever, liver dysfunction, and diarrhea with histopathologic findings suggestive of PLEVA.

A Case of Interdigital Dermatophytosis / 대한의진균학회지

The dermatophytosis of the hands is dry, scaly, erythematous macules with well demarcation on the palms and dorsa of hands. However, involvement of fingerwebs without any other affected area of the hands is rare. We report a case of interdigital dermatophytosis caused by Trichophyton (T.) rubrum in a 38-year-old man, who showed fine scaly erythematous macules on the left third fingerweb. Fungal culture from scales of the lesions showed typical white to deep red, cottony colonies of T. rubrum.

Identification of Candida Species Using CHROMagar Candida in Superficial Cutaneous Candidiasis / 대한피부과학회지

BACKGOUND: CHROMagar Candida is a new differential culture medium that allows selective isolation and identification of clinically important Candida species. However, no study of CHROMagar Candida in superficial cutaneous candidiasis has been reported in Korea. OBJECTIVE: The purpose of this study was to evaluate the use of CHROMagar Candida to identify Candida species isolated from patients with cutaneous candidiasis. METHOD: A total of 95 strains isolated from 92 patients with candidiasis (70 Candida albicans, 9 Candida parapsilosis, 7 Candida guilliermondii, 1 Candida krusei, 1 Candida glabrata, 1 Candida tropicalis, 2 C. albicans plus C. parapsilosis, 1 C. albicans plus C. krusei) were subcultured to CHROMagar Candida (KOMED, Korea) and incubated for 48 hours. Colony appearance on CHROMagar Candida was assessed by two observers. RESULTS: Expected colony appearance on CHROMagar Candida was 100% for C. albicans, C. krusei, C. glabrata and C. tropicalis, respectively but 85.7% for C. guilliermondii and 77.8% for C. parapsilosis. Three mixed cultures of Candida species, not detected by conventional methods, were detected by CHROMagar Candida. CONCLUSION: CHROMagar Candida is a useful isolation medium capable of a rapid presumptive identification of Candida species and more reliable detection of mixed cultures in clinical specimens.

A Case of Subcutaneous Phaeohyphomycosis Caused by Exophiala jeanselmei / 대한피부과학회지

We report a case of subcutaneous phaeohyphomycosis caused by Exophiala (E.) jeanselmei in a 75-year-old female, who showed subcutaneous abscesses on the both forearms for 8 months. Histopathologically, suppurative granulomatous inflammation and short hyphae & spores were observed. Fungal culture grew out the typical black-gray velvety colonies of E. jeanselmei after 3 weeks. The isolate grew well at 25degrees C, but very poorly at 37degrees C. No growth could be observed at 40degrees C. We confirmed E. jeanselmei by colony & microscopic morphology and temperature tolerance test. The patient had been treated with fluconazole for 3 months.

A Case of Nodular Hidradenoma with Apocrine Differentiation / 대한피부과학회지

Nodular hidradenoma is a relatively infrequent benign tumor that shows differentiation from or toward the structure of the eccrine sweat gland. We report a case of nodular hidradenoma with apocrine differentiation in a 74-year old female who had an asymptomatic, 3.5x2.7x1.0cm-sized, smooth-surfaced, round, erythematous to bluish tumor mass with cystic grape-like nature on the right thigh for 3 years. Histological findings showed a well-circumscribed tumor composed of solid portions with fusiform basophilic cells and clear round cells, cystic spaces, tubular lumina, squamoid feature and decapitation secretion.

A Case of Acquired Digital Fibrokeratoma Resembling Cutaneous Horn / 대한피부과학회지

Acquired digital fibrokeratoma is a relatively unusual benign fibrous tumor that is usually found on the distal extremities. It is characterized by a solitary, flesh-colored, firm and hyperkeratotic projection with a surrounding collarette of raised skin at the base. We report a case of acquired digital fibrokeratoma resembling cutaneous horn in a 31-year-old male who showed a 0.5x0.5x2 cm, firm, hyperkeratotic protruded mass with secondary changes including crust and bleeding on the left 4th finger.

Three Cases of Trichophyton rubrum Syndrome / 대한피부과학회지

Dermatophytoses are often observed coexisting fungal infections. Trichophyton (T.) rubrum syndrome is defined as the following obligatory criteria. (A) Skin lesions at the following four sites: (1) feet; (2) hands; (3) nails; and (4) at least one lesion in another location than (1) (2) or (3), except for groins. (B) Positive microscopic findings of KOH preparations of skin scrapings in all four locations. (C) Identification of T. rubrum by culture at three of the four locations at least. Three cases of T. rubrum syndrome is reported in a 50-year-old woman, in a 73-year-old man, and in a 55-year-old man.

A Case of Trichilemmal Carcinoma / 대한피부과학회지

Trichilemmal carcinoma is a rare malignant neoplasm of hair follicle which is derived from or differentiates towards the outer root sheath. Despite the frequent presence of histologically malignant features, it has a relatively benign clinical behavior. We report a case of trichilemmal carcinoma in an 87-year-old woman who showed a solitary slightly tender, 1.5X2cm-sized, verrucous, erythematous nodule with crust on the vertex of scalp. In her past medical history, it had been excised at a private clinic without a histopathological evaluation and recurred 1 year later. Histopathologically, tumor cells showed PAS-positive cytoplasms and cytologic atypia with a few mitotic figures. The patient was treated with a wide surgical excision. She has had no evidence of recurrence or metastasis.

A Case of Psoriasis vulgaris Associated with Vitiligo / 대한피부과학회지

Psoriasis vulgaris, a disorder of partially genetic origin, affects 1-3% of the general population. Vitiligo, generally considered an autoimmune disease, affects 0.5% of the general population. Despite the relatively common occurrence of each disease, the concurrence of each disease in a patient has been considered unusual. It is difficult to discern any particular relationship between vitiligo and psoriasis. Assuming that vitiligo and psoriasis are pathogenetically distinct and are grouped independently of each other. We report a case of psoriasis vulgaris associated with vitiligo in a 19-year-old man. Diagnosis was confirmed by clinical and histopathological findings. He is being treated with narrow band UVB phototherapy.

Ribosomal DNA Gene Analysis of Dematiaceous Fungi Using Polymerase Chain Reaction-Restriction Fragment Length Polymorphism / 대한피부과학회지

BACKGROUND: There are three kinds of diseases caused by dematiaceous fungi: chromoblastomycosis, phaeohyphomycosis, and eumycotic mycetoma. The dematiaceous fungi have been identified and classified by morphological, biochemical and physiological tests. Recently molecular analysis has been introduced to the field of medical mycology. OBJECTIVE: Ribosomal DNA gene analysis of dematiaceous fungi using polymerase chain reaction(PCR)-restriction fragment length polymorphism(RFLP) is investigated. METHODS: The dematiaceous fungal strains studied were eight clinical isolates of chromoblastomycosis and phaeohyphomycosis agents(3 strains of Fonsecaea pedrosoi, 2 strains of Exophiala dermatitidis, 1 strain of Exophiala jeanselmei, 1 strain of Phialophora verrucosa, 1 strain of Rhinocladiella aquaspersa) and 4 standard strains(F. pedrosoi IFM 4889, E. dermatitidis IFM 4828, P. verrucosa IFM 4928, R. aquaspersa IFM 4930). Total twelve strains of dematiaceous fungi were cultured on Sabouraud dextrose broth and their DNA was extracted by bead-beating method. PCR-RFLP of ribosomal gene small subunit(SSU rDNA) and internal transcribed spacer(ITS)1-ITS2 ribosomal regions using the primer pairs NS1-NS2 and ITS1-ITS4, respectively were done. RESULTS: The PCR product obtained from the SSU rDNA amplification was of approximately 603 bp and restriction profile was clustered into two genetically heterogenous groups, the first one formed by F. pedrosoi and the second one formed by other dematiaceous fungi. In contrast, the amplified PCR products of ITS regions ranged in sized from 580 to 620 bp and restriction profile was clustered into five genetically heterogenous groups and it can be possible to differentiate dematiaceous fungi. But one clinical isolate of F. pedrosoi showed intra-specific variability. CONCLUSION: The PCR-RFLP analysis of SSU rDNA and ITS regions provided useful information for identification and classification of dematiaceous fungi.

A Case of Onychomycosis Caused by Fusarium solani / 대한의진균학회지

Although dermatophytes are still the main etiologic agents of onychomycosis, some species of nondermatophytic molds and yeasts are also capable of invading the nails. Fusarium (F.) solani is a nondermatophytic mold which is saprophytic fungus in soil. Onychomycosis due to Fusarium species almost always involve the great toenails, particularly in the presence of traumatic or dystrophic abnormalities. We report a case of toenail onychomycosis caused by F. solani in a 42-year-old female. The patient presented with typical distal subungual onychomycosis. Direct microscopic examination of scrapings on the potassium hydroxide preparation revealed fungal elements and repeated cultures on Sabouraud's dextrose agar showed the same whitish to cream-colored, cottony colonies. Multiple, sickle-shaped, multiseptate macroconidia and long, slender monophialides were observed in the slide culture. We confirmed F. solani by gross and light microscopic morphology of the colony. The patient was treated with 250 mg of terbinafine daily for 3 months.

A Case of Angioleiomyoma on The Upper Lip / 대한피부과학회지

Angioleiomyoma is a benign solitary tumor that arises from muscle layer of the vein walls and mainly develops on the lower extremities of middle-aged women. But it is rarely found on the lip. We report an unusual case of angioleiomyoma in a 27-year-old male who showed an asymptomatic, 0.3 X 0.5 cm sized mass on the upper lip for 3 years. Histopathologically, various sized, numerous vessels and bundles of smooth muscle fibers were observed in the dermis.

A Case of Subcutaneous Panniculitis-like T-Cell Lymphoma / 대한피부과학회지

Subcutaneous panniculitis-like T-cell lymphoma(SPTL) is a rare cytotoxic T-cell lymphoma of the skin, which preferentially infiltrates subcutaneous tissue. In the World Health Organization(WHO) classification of T-cell and natural killer cell lymphoma it is listed as an example of extranodal lymphoma. We report a case of SPTL in a 31-year-old man, who presented with fever, night sweats, fatigue and three, tender, erythematous, indurated, subcutaneous plaques on the trunk. Typical histologic features of panniculitic infiltration with rimming of fat cells and sparing of the dermis and epidermis were seen. The immunophenotypic studies showed a cytotoxic T-cell phenotype by CD3+, CD8+, TIA-1+, CD20- and CD56-. In situ hybridization for Epstein-Barr virus-encoded RNA was negative.

A Case of Segmental Neurofibromatosis / 대한피부과학회지

Segmental neurofibromatosis(neurofibromatosis type V) is rare disorder characterized by limitation of cafe-au-lait spots and neurofibroma or only neurofibroma on a given unilateral segment of the body. We report a case of segmental neurofibromatosis that developed in a 58-year-old male. The skin lesion was situated on the right antecubital area and wrist in the distribution of dermatomes C5 and C6. Histopathologic examination showed well-demarcated, non-encapsulated tumor of the dermis was composed of thin wavy collagenous fibers and loosely spaced spindle cells with elongated wavy nuclei. The patient was treated with surgical excision and carbon dioxide laser.

A Case of Psoriasiform Syphilid / 대한피부과학회지

Psoriasiform lesion is rare in secondary syphilis. We report a case of psoriasiform syphilid in a 36-year-old man, who showed condyloma lata on the perianal area and multiple erythematous scaly plaques on the face, glans penis, scrotum, and both palms and soles. He had sexual contact with prostitute about 3 months ago. The differential diagnosis included papulosquamous diseases, especially psoriasis but a psoriasiform syphilid was confirmed through skin biopsies and serologic tests. The patient was treated with benzathine penicillin G 2.4 million units intramuscularly weekly for 3 weeks. After the treatment with benzathine penicillin G, the skin lesions disappeared completely.

A case of primary of the follopian tube / 대한산부인과학회잡지

No abstract available.