Differentiation of Desmoplastic Spitz Nevus from Similar Conditions

( Min-woo Kim ),( Ji Soo Lim ),( Yun Seon Choe ),( Jung Ho Kim ),( Hyun-sun Yoon ),( Soyun Cho ),( Hyun-sun Park ) 대한피부과학회 2016 대한피부과학회지 Vol.54 No.9

The diagnosis of classic Spitz nevus with characteristic histopathologic findings is often straightforward, but unusual variants can cause diagnostic difficulties. Desmoplastic Spitz nevus (DSN) is of particular importance, as its differential diagnosis from other diseases, including desmoplastic malignant melanoma (DMM), is essential but often difficult¹. A 38-year-old Caucasian woman presented with a 6-mm brownish papule of unknown onset on the dorsum of her left hand (Fig. 1A). She did not report any change in the papule size, trauma history, or related symptoms, but she wanted to have the lesion removed. Punch excision of the specimen revealed proliferation of individual spindle and epithelioid cells with scanty pigmentation within dense colla-genous dermal stroma (Fig. 1B, C). The specimen was focal positive for S-100 and HMB-45, positive for Melan-A, and 1% positive for Ki-67 (Fig. 2A∼C). The lesion did not recur after punch excision at the 1-year follow-up. Since its first report in 1975, there have been only a few case series of DSN owing to the rarity of this disease and its under-recognition, except for intermittent case reports^1-3. DSN usually presents as a small red-brown papule on the trunk and extremities. It can occur at any age, but is mostly observed in young adults, with a slight female predominance. The distinctive histopathologic features of DSN―an intradermal growth pattern of large spindle or epithelioid nevus cells embedded in a fibrotic stroma, sparse melanin pigment, no junctional activity, no Kamino bodies, no prominent nest formation―can aid its differentiation from clinical simulators. Additionally, immunohistochemistry is essential for a differential diagnosis. DSN tests positive for S-100, Melan-A, and HMB-45, whereas dermatofibroma is negative for all three³. Hypomelanotic blue nevus shows uniform positivity for HMB-45, whereas DSN shows differential expression in most spindled cells3. The distinction between DSN and DMM is the most important. DMM is more common in elderly patients and tends to occur on sun-damaged head and neck areas. It also shows cellular atypia, strong mitotic activity and Ki-67 expression, less frequent S-100 and Melan-A positivity, and almost exclusive negativity for HMB-45^2,3. Some researchers regarded DSN as an end stage of Spitz nevus that had lost continuity with the epidermis and undergone fibrosis. Paniago-Pereira et al.² also reported that DSNs occurred in patients older than 30 years. These findings suggest that desmoplasia might be an aging process of Spitz nevus. However, Barr et al.1 found no significant difference in patient age, disease duration, or trauma history between patients with DSN and common variants of Spitz nevus, and suggested that desmoplasia may be a tumor-induced reactive stromal induction rather than a regressive phenomenon. The pathogenesis of desmoplasia has not yet been clearly elucidated. Moreover, it is controversial whether DSN should be regarded as a variant of Spitz nevus or whether it belongs to a spectrum of desmoplastic nevus as a distinctive entity^3,4. Some researchers5 suggested strict diagnostic criteria for de-smoplastic nevus, including greater cellularity in the super-ficial portion, and a mixture of melanocytic nevus cells, ovoid and dendritic melanocytes, and spitzoid melanocytes. Further, they mentioned that lesions in which one particular type of melanocyte predominates over others are more likely to represent DSN. Dermoscopic findings can also aid the distinction, because DSN shows dotted vessels and reticular depigmentation whereas desmoplastic nevus demonstrates a delicate pigment network over a pinkish background⁴. Although it is regrettable that we did not acquire dermoscopic image to support the diagnosis, our case overall seems more com-patible with DSN. However, the probability of a morphologic spectrum that embraces DSN and desmoplastic nevus cannot be excluded, and requires further studies. Here, we report an unusual desmoplastic variant of Spitz nevus with a literature review, and propose keynotes for differential diagnosis from its simulators, especially DMM.

내림굿 춤 연구

임현선 한국무용연구회 2005 한국무용연구 Vol.23 No.-

This essay concerned with Naerimgut, a formalized Korea shamanism rite and its relation to health and appearance. Naerimgut must first be learned through a form of dancing moving the ones legs and arms while focused on the body as the center of one`s being. Especially this thesis attempts to analyze the contents of the dance movements in detail with a view to assessing the nature and function of each dancing movement. Naerimgut Kangsinmu is very important in that it helps the person blessed by the divine being to become a shaman to overcome isolation and suffering from society and then helps them return to society revived with new energy. In Naerimgut we have two people working together, the main dancer and the new initiate entering into the profession. The main dancer shows a series of dancing moves which have been mastered through years of experience and acts as a guardian and a guide. The initiate entering into the profession dances strangely because he or she is merely in the position of attuning the body and spirit as a new shaman. The dance movement are the in harmony with the divine being`s energy dwelling in the initiate`s body and the natural sense of the experienced dancer. At this time the initiate gradually being to imitate form figures, drawing straight and curved lines. Monotonous movements have magic power to rise the spirit through the effects of incantations and repeated movement. Jumping in the dance shows the initiate spontaneously contacting the divine being in Heaven through a sudden elevation of the heart. This can also be interpreted as self-protection fro, evil spirits. Finally, Naerimgut in Kangsinmu is elicited from ecstasy which is the essence of dancing and it expresses the spirit`s brightness because it totally expresses the original and whole self. These dancing movement in Naerimgut which arouse the bright spirit of the initiate can be found in the creative works of Korea`s traditional dance and can be explored further for refinement and development for harmonizing stage space and time.

Fe-Cr-Si과 Fe-Cr-Pt 합금의 고온 cyclic 산화거동에 관한 연구

임채선,조현준,최송천,이동복 成均館大學校 科學技術硏究所 1994 論文集 Vol.45 No.1

To investigate the cyclic oxidation behavior of Fe-Cr-Si and Fe-Cr-Pt alloys, both (82-94)wt% Fe-(5-15)wt% Cr--(1-3)wt% Si and (82-94)wt% Fe--(5-15)wt% Cr-(1--3) wt%Pt alloys were cyclically oxidized in air at 1000 and 1250℃. By the addition of Si or Pt, the oxidation resistance of Fe-Cr alloys was generally increased with the most pronouncing effects observed in Fe-15wt%Cr containing alloys. After oxidation, on the surface of Fe-Cr--Si alloys, complex oxide layers of Fe_20_3/Fe-Cr spinel/Si-rich oxide were formed, which provides the necessary oxidation resistance. Especially, Fe-15wt%Cr-3wt%Si alloys had best oxidation resistance because the inward diffusion of oxygen was considerably deterred owing to the formation of the protective inner Si0_2 layer from the initial oxidation stage. In Fe-Cr-Pt alloys, oxidation resistance was obtained by forming protective Cr_2 O_3 layers below initially formed outer Fe_2 0_3, layers. However, Fe-Cr-Pt alloys showed decreased oxidation resistance at 1250℃ compared with Fe-Cr-Si alloys.

심정지환자에서 epinephrine투여시 혈중 catecholamine의 변화

임경수,황성오,이부수,이강현,이진웅,임종천,김영식,김선만,김 현 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

Background : Cardiac arrest is a potent stimulus for the release of endogenous catecholamine and high plasma catecholamine concentration has been reported during cardiopulmonary resuscitation(CPR). Few data were present about the clinical effect of high plasma catecholamine and endogenous catecholamine response to exogenous epinephrine administration during CPR. Purpose : This study was designed to evaluate endogenous catecholamine response to cardiac arrest and exogenously administered epinephrine during CPR. Method : In 21 cardiac arrest victims, blood sample for epinephrine and norepinephrine was drawn before and 1 minute after each epinephrine administration during CPR. 1mg of epinephrine was administered immediately after intravenous access and 3 minute interval during CPR. Plasma catecholamines were quantitated by high-performance liquid chromatography. Result : Baseline plasma epinephrine concentraqtion was higher in patients with cardiac arrest than normal controls (985±1627 vs 194±173 pg/ml, p<0.05). Baseline plasma norepinephrine concentration was also elevated in patients with cardiac arrest than normal controls, although statistically insignificnat(1965±4915 vs 360±250 pg/ml). Plasma epinephrine concentration in cardiac arrest patients was significantly elevated after exogenous administration of epinephrine, but its response was blunted after the third does of epinephrine. Plasma norepinephrine concentration in cardiac arrest patients was also elevated, but its response was observed only after the first epinephrine administration. Plasma epinephrine concentration was persistently higher in patients with return of spontaneous circulation (ROSC) than patients without ROSC. there was no significant difference of plasma norepinephrine concentration whether spontaneous circulation was restored or not. Endogenous epinephrine response to exogenous epinephrine was not observed in patients having prolonged arrest time over 20 minutes. Conclusion : Results of this study suggests that significant amount of catecholamine is released by exogenous epinephrine administration in spite of high plasma catecholamine concentration, and degree of endogenous catecholamine response influences resuscitation outcome.

호흡구조 분석을 통한 태평무 호흡표기법 연구 : 한성준류 강선영의 태평무를 중심으로

임현선 한국무용연구회 2006 한국무용연구 Vol.24 No.1

본 연구에서는 먼저 한국춤 호흡을 표기할 수 있도록 고안된 호흡표기법을 이용하여 태평무의 호흡을 문석하고, 그 결과에 대한 과학적 타당성을 확보함으로써 태평무의 호흡을 체계적으로 정형화하는 방법론 모색에 역점을 두었다. 특히 한국춤의 실기 현장에서 중요하게 요구되는 호흡에 대한 분석은 그 호흡의 기본원리를 이해하는 기초가 되기 때문에 이를 이용한 춤 호흡의 객관적 근거를 찾아보고자 하였다. 따라서 본 연구의 목적은 태평무의 무용동작 특성과 호흡표기의 과학적 검증을 위해 태평무의 동작과 각 동작에 따른 호흡의 유형을 실험적으로 분석함으로써 무보나 동작표기 만으로 설명될 수 없는 호흡의 형태와 흐름을 총체적으로 파악하여 정형화하고 이를 통해 호흡표기의 과학적 타당성을 확보하고자 하는데 있다. 본 연구는 연구의 목적을 달성하기 위하여 다음과 같은 연구가설을 설정하였다. 1. 태평무의 호흡유형은 들숨, 날숨, 멈춤의 형태로 나타날 것이다. 2. 태평무의 호흡유형은 호흡의 크기에 따라 세분화된 형태로 나타날 것이다. 3. 들숨, 날숨, 멈춤의 태평무 호흡유형과 호흡곡선의 일치도는 매우 높게 니티날 것이다. 태평무의 충동작에 따른 호흡표기의 과학적 검증을 위해 태평무의 동작과 각 동작에 따른 호흡유형을 실험적으로 분석하여 호흡표기와 비교한 결과 다음과 같은 결론에 도달했다. 1. 호흡을 유형별로 분류하고 이를 세부적으로 분석해본 결과, 호흡표기와 호흡곡선은 매우 높은 일치도를 나타냈다. 2. 호흡을 들숨, 날숨, 멈춤으로 분류한 세 유형 중에서는, 멈춤의 유형에서 그 일치도가 100%로 가장 완벽한 수준으로 높게 나타났으며 들숨의 유형 또한 93.4%의 중앙값을 보임으로서 높게 나타났다. 그리고 날숨의 유형에서는 65.6%의 중앙값을 보임으로서, 멈 춤이나 들숨에 비해서 다소 떨어졌으나 평균 이상의 일치를 이루었다. 3. 들숨의 크기로 분류한 큰들숨, 중간들숨, 작은들숨의 세 유형에서 각각의 중앙값은 92.5%, 97.1%, 93.8%로 나타나 매우 높은 일치도를 보였다, 그리고 날숨의 크기로 분류한 큰날숨, 중간날숨, 작은날숨의 세 유형에서 각각의 중앙값은 12.1%, 61.9%, 62.5%로 나타나 들숨이나 멈춤보다는 다소 낮았다. 또한 멈춤의 분류에 따른 각각의 중앙값은 큰멈춤, 중간멈춤, 작은멈춤 모두에서 100%의 완벽한 수준의 일치를 이루었다. In this study I analyze the breathing in Taepyeongmu, using the system designed to transcribe the breathing method of Korean traditional dance, and aim to develop a methodology that systematically standardizes the breathing in Taepyeongmu, by scientifically analyzing the result. In particular, I seek an objective ground for breathing in dance, for an analysis of breathing enables an understanding the fundamental principles of breathing, which is of absolute importance in performing Korean dance. This study, therefore, analyzes through experiments each movement and the breathing thereof in Taepyeongmu, then comprehensively theorizes and systemizes such modes and flows of breathing that cannot be explained through dance steps or movement directions, so that the characteristics of movements may be clarified and the system of transcribing breathing may secure its scientific validity. After analyzing each movement and the breathing thereof in Taepyeongnut and comparing them with the system of transcribing breathing, 1 arrive at the following conclusion: 1. A classification of breathing modes and its subsequent analysis shows that the transcribed breathing coincides with the breathing curve. 2. Among the three categories of inhaling, exhaling, and pausing, the coincidence rate is perfect and the highest in pausing. In inhaling, the coincidence rate is very high—93-4%. The coincidence rate in exhaling is 65.6% — somewhat lower than in pausing and inhaling but relatively high. 3. In the further classified analysis, the coincidence rates in long inhaling, medium inhaling, and short inhaling are respectively 92.5%, 97.1%, and 93.8% — all very high. In long exhaling, medium exhaling, and short exhaling, the coincidence rates are respectively 73-7%, 61.9%, and 62.5% — all lower than in inhaling and pausing. In case of pausing, long pausing, medium pausing, and short pausing all showed the perfect coincidence rate of 100%.

섬유낭종성 유방질환(Fibrocystic Breast Disease) 치료에 있어서 Danazol 효과의 임상적 연구

임현묵,장선택 중앙대부설한국의과학연구소 1986 한국의과학 Vol.18 No.4

염화수소(Hydrogen Chloride)와 관련성이 추정되는 직업성 천식 1례

임현술,유선희,김두희,이영현 동국대학교 경주대학 1996 東國論集 Vol.15 No.-

염화수소(hydrogen chloride)는 분자식은 HCl이며 염산가스라고 불리기도 하며 강한 자극성 냄새가 나는 무색의 기체이다. 물에 녹아서 염산이 되며 공기 중에서 물에 녹기 쉬운 성질 때문에 연무 형태로 존재한다. 본 증례로 34세 남자로 타이어에 사용되는 철사를 제조하는 공장에 다니는 근로자로 간헐적으로 고농도의 염화수소에 폭로된 후 1년 8개월의 잠복기를 거친 후 기관지 천식이 발생한 예로 총 호산구수는 증가되어 있었으나 혈청 IgE는 정상 범위였다. 55가지 알레르기항원을 사용한 피부 단자검사에서 House dust, Hay dust, Mixed grain, Dermatophagoides farinae와 Dermatophagoides pterynyssinus에 양성 반응을 보였고, 유발검사에서는 양성 반응을 보였다. 직업성 여부를 파악하기 위해 작업장 내에서 8시간 동안 근무하면서 30분 내지 한시간 간격으로 폐기능검사를 시행한 결과 1초간 노력성 호기량(FEV1) 이 20%이상 감소하여 2시간 동안 지속되는 양성 반응을 관찰할 수 있었다. 본 증례는 외인성 천식 소질이 있으면서 작업장 내에서 고농도의 염산증기에 폭로되어 기관지 천식 발작이 되었는데, 작업장의 고농도의 염화수소가 기관지 천식의 기여요인 또는 악화요인으로 작용하였다고 생각한다. Occupational asthma is an importent occupation-related disease. We exprienced a case of asthma induced by high concentration of hydrogen chloride vapour. The prevalence rate of this asthma is unknown. The patient of the case complained of cough, sputum and dyspnea after exposure to hydrogen chloride. Serum IgE(IgE-PRIST) was normal range but total eosinophil count was elevated. FEV₁ was 73% of predicted value and expiratory wheezing sound was observed on whole lung field. FEV₂was decreased to 48.9% of baseline on 5 hours 30 minutes, respectively, after exposure of hydrogen chloride at workplace. On follow up examination, the patient complained of an intermittent dyspnea and cough.

한국판 섬망 평가 척도-98(K-DRS-98)의 표준화 연구

임경옥,김수영,이양현,이선우,김정란 大韓神經精神醫學會 2006 신경정신의학 Vol.45 No.6

Objective : This study was conducted to develop and to validate the Korean version of Delirium Rating Scale-Revised-98(K-DRS-98), which is a scale for diagnosing delirium and evaluating its severity. Method : After developing the K-DRS-98, 102 patients were rated by it among 4 diagnostic groups, such as delirium (N=25), dementia (N=27), schizophrenia (N=25) and others (N=25). To test for reliability, K-DRS-98 was independently administered by two psychiatrist. To test for validity, Korean version of Mini-Mental State Examination (MMSE-K) and Clinical Global Impression (CGI) were administered simultaneously. Statistical analysis was done with SPSS window version 12 package and statistical significance was p<0.05. Result : Intemal consistencies (Cronbach α) of two raters were 0.867 and 0.858, respectively. Inter-rater reliability (κ) was 0.893 for severity items of K-DRS-98 and κ value of diagnosis items was 0.969. In Delirium group, Pearson correlation Coefficients (r) of K-DRS-98 were -0.682 for MMSE-K and 0.667 for CGI. In comparison Delirium group with Others, ANOVA post hoc multiple comparison LSD was statistically significant (p<0.001). The cutoff score to diagnosis of delirium can be recommended 16 for seventy items and 21.5 for total score, respectively. Conclusion : The K-DRS-98 was showed good reliability and validity for the assessment of delirium. The K-DRS-98 is an easy and useful tool for diagnosing delirium and assessing its severity.

프랜차이즈 시스템의 규범에 관한 연구

임재석,김선현 부천대학 2001 論文集 Vol.22 No.-

본 논문은 빠르게 성장하고 있는 조직형태의 하나인 프랜차이즈 시스템에 대한 분석이다. 기업의 확장 수단으로 직영점이 아니고 가맹점으로 확장방법을 선택하느냐 하는 요인들에 대해서 분석한다. 프랜차이즈를 이용하는 이유를 설명하는 전통적인 견해는 단순히 사업 확장을 위한 자본조달에 어려움이 있는 기업이 자본을 조달하기 위한 방법으로 이용한다는 것이 있으나 비교적 최근에는 위험을 회피하기 위한 방법으로 프랜차이즈를 활용한다는 견해, 대리 문제를 해결하기 위한 수단이라는 주장, 최적자본구조를 구성하기 위하여 이용한다는 견해, 그리고 시장 영향력을 증대시키기 위한 방법으로 프랜차이즈를 활용한다는 주장이 있다. 자원할당이론은 기업의 재무적 필요성에 의해 성립되는 것에 비해 대리이론은 다분히 조직 관리적 측면이 강조된 설명이라는 특징이 있으며, 거래비용이론과 탐색비용이론은 프랜차이즈 형성 근거를 설명하면서도 조직 관리적 측면의 시사점을 일부분 가지고 있음을 알 수 있다. This paper is about the analysis of the franchise system, an organization that is growing fast. I analyze the factors such as whether to choose the method of expanding into a member store rather than the one of direct management, as a way of expanding an enterprise. The traditional view of explaining the reason for using a franchise lies in the fact that enterprises having difficulty in raising money for simply expanding the business is using it as a way to raise its capital. On relatively recent days risk-avoiding franchises are utilized to avoid the risk accompanying the expansion or the estabilishment of enterprises. There are an assertion that a franchise is a means of solving the problem of agency, a view that it's used to organize the optimal capital structure, and an assertion that it's utilized as a way of increasing the impact on the market. Agency theory is, characteristically, mostly an explanation that stresses the aspect of organizational management, while the material allotment theory is formed by the financial need of an enterprise. We can see that the transaction expense theory and the exploration expense theory have the part of current events in the aspect of organizational management, while they explain the reason for the formation of franchises.

갈근(葛根)으로부터 분리된 puerarin의 항당뇨 효과

임현애,임지선,김정상 경북대학교 농업과학기술연구소 2006 慶北大農學誌 Vol.24 No.-

본 연구에서는 갈근 및 그의 주 이소플라본인 puerarin의 활성을 세포수준에서 분석하였다. 먼저 갈근에 함유된 이소플라본의 양을 분석한 결과, puerarin이 총 이소플라본의 90 % 차지하였다. 다음으로는 puerarin의 항당뇨 활성을 검정한 결과 먼저 탄수화물 및 지방소화효소저해활성에 대해서는 거의 미비한 것으로 나타났으나 인슐린 감수성 및 지방세포의 분화의 유도에 대해서는 농도의존적으로 작용하는 것으로 관찰되었다. 따라서 puerarin은 지방조직내로 포도당의흡수를 촉진함으로서 항당뇨 효능을 발휘하는 것으로 추정된다. In this study we evaluated the anti-diabetic potential of Puerariae Radix and its isoflavone (puerarin) by investigating their inhibitory activities against digestive enzymes, α-amylase, α-glucosidase and lipase and effect on glucose uptake and PPAR γ expression. The activities of carbohydrate digestive enzymes were not inhibited by puerarin. Glucose uptake in differentiated adipocytes was stimulated by puerarin. Furthermore, puerarin enhanced the differentiation of preadipocytes as evaluated by triacylglycerol (TG) accumulation, which is specific for differentiated adipocytes. The effect of puerarin on expression of peroxisome proliferator-activated receptor γ (PPAR-γ) gene, which is associated with obesity and dyslipidemia, was examined by both real-time PCR and reverse transcriptase PCR. The study demonstrated that puerarin increased the expression of PPAR-γ. In conclusion, puerarin showed potential to exert anti-diabetic action by enhancing cellular glucose uptake and thereby TG accumulation in adipocyte tissue.