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.

Effect of Inclusion of Lacquer (Rhus verniciflua Stokes) Meal on Carcass Traits and Meat Quality in Growing-finishing Pigs

Song, Chang-Hyun,Kim, Jin-Soo,Shinde, Prashant,Kim, Young-Woo,Kim, Kwang-Hyun,Kwon, Ill-Kyung,Kang, Sun-Moon,Lee, Sung-Ki,Chae, Byung-Jo Korean Society for Food Science of Animal Resource 2010 한국축산식품학회지 Vol.30 No.4

In this study, pigs [n=117; (Landrace ${\times}$ Yorkshire) ${\times}$ Duroc; $64{\pm}0.5$ Kg initial body weight] were used to investigate the effect of feeding different levels of lacquer (Rhus verniciflua Stokes) meal on performance, carcass traits and quality of meat kept under refrigeration at $3{\pm}1^{\circ}C$. The pigs were randomly allotted to 3 treatments on the basis of body weight and sex and each treatment was replicated 3 times (13 pigs in each replicate). Lacquer meal in sawdust form obtained from the stem bark and heartwood of sun-dried lacquer trees was added to the grower and finisher diets at 0, 20 and 40 g/kg diet. The experimental diets were fed for 8 wk. Inclusion of lacquer meal had no influence (p>0.05) on growth performance of pigs. Improvement in carcass traits and decreased back fat thickness were noticed in pigs fed diets added with 20 and 40 g/kg lacquer meal. Longissimus muscle obtained from pigs fed lacquer meal had higher moisture and lower fat content, thiobarbituric acid reactive substances and water holding capacity. Meat from lacquer fed pigs was also darker and redder. The data indicates that lacquer meal can be incorporated up to 40 g/kg in the diet of fattening pigs without affecting growth performance. Also, lacquer meal increases carcass lean content and improves the oxidative stability of the meat.

한의진단명과 진단요건의 표준화 연구 II (표준화 실례) : 2차년도 연구결과 중간 보고

양기상,최선미,최승훈,안규석,박경모,박종현,김성우,신승호,정우열,전병훈,고현,김정범,신상우,김성훈,김동희,권영규,엄현섭,장혜옥 한국한의학연구원 1996 한국한의학연구원논문집 Vol.2 No.1

The diagnostic requirements were suggested and explained regarding the systems of differentiation of symptoms and signs in the second year study of standardization and unification of the terms and conditions used for diagnosis in oriental medicine. The systems were as follows; - differential diagnosis according to condition of body fluid, differentiation of syndromes according to the state of qi and blood, differential diagnosis according to relative excessiveness or deficiency of yin and yang(氣血陰陽津液辨證) - differentiation of diseases according to pathological changes of the viscera and their interrelation - analyzing and differentiating of febrile diseases in accordance with the theory of the six channels(傷寒辨證) The individual diagnosis pattern was arranged by the diagnostic requirements in the following order : another name(異名), notion of diagnosis pattern, index of differentiation of symptoms and signs(辨證指標), the main point of diagnosis, analysis of diagnosis pattern(證候分析), discrimination of diagnosis pattern(證候鑑別), a way of curing a diseases(治法), prescription(處方), herb in common use(常用藥物), diseases appearing the diagnosis pattern(常見疾病), documents(文獻調査). This study was carried out on the basis of the Chinese documents and references.

2003년 국내 중증급성호흡기증후군 진료 현황 및 문제점 분석

이진수,김은실,정문현,백제중,정선화,안주희,최영화,이선희,고철우,김성범,김민자,박승철,기현균,송재훈,최상호,김양수,이상오,조용균,박영훈,정숙인,김연숙,이흥범,손창희,장성희,정희진,김우주 대한감염학회 2004 감염과 화학요법 Vol.36 No.3

목적 : 2002년 말 중국에서 SARS가 발생한 이후 국내에서도 2003년 10월까지 총 3명의 추정환자, 17명의 의심환자가 보고되었다. 향후 추가적인 SARS의 유행이 우려되는 상황에서, 그간의 SARS 환자 진료에 있어서의 실질적인 준비사항, 진료 현황 등에 대한 조사를 통해 문제점을 파악하여, 향후 더 나은 대비가 될 수 있도록 개선점을 제시하고자 하였다. 재료 및 방법 : SARS로 의심되는 환자를 진료 경험이 있는 병원의료진을 대상으로 2003년 10월에 설문조사를 실시하였다. 설문에는 SARS 환자 진료 시의 실질적인 조치, 진료 현황, 병실, 응급실 및 외래에서의 격리 시설과 준비사항, 보건당국의 관리와 지원에 관한 사항을 포함하였다. 결과 : 대상이 되는 22개 병원 중 17개(17/22, 77.2%) 병원이 설문에 응하였다. SARS 환자를 위한 격리실은 응급실, 외래, 일반병실 및 중환자실에서 각각 9개(9/17, 52.9%), 5개(5/17, 29.4%), 15개(15/16, 93.7%), 4개(4/16, 25%) 병원에서 음압처리가 되어있지 않은 일인실 혹은 다인실이 사용되었고, 1개(1/16, 6.3%) 병원에서만 일반병실에서 음압격리실이 운영되었다. 입원환자의 진찰 시 개인보호구의 착용은 거의 모든 의료기관에서 이루어졌다. 보건당국에서 SARS지정병원의 시설 등을 사전에 확인한 곳은 1곳(1/12, 8.3%)이였고, 14개 병원(14/15, 93.3%)에서는 보건당국에 의뢰한 검사결과를 통하 받지 못하였다. 결론 : 의료기관에서 SARS 환자용 격리실뿐만 아니라 기존의 격리실 설비 등이 미흡하였으며, 특히 중환자실 및 외래의 준비가 더욱 부족하였다. 보건당국의 의료기관에 대한 종합적인 지원이 부족하였고, 병원과의 원활한 연계가 잘 이루어지지 않았다. SARS 만이 아닌 격리를 필요로 하는 질환의 적절한 진료를 위해 향후 병원 시설의 정비와 정부차원에서의 보다 구체적이고 실질적인 대책마련이 필요하다. Background : There was an worldwide outbreak of the Severe Acute Respiratory Syndrome (SARS) originated from China in late 2002. During that period three cases of suspected SARS and 17 cases of probable SARS were reported in Korea. With the concerns about the reemergence of SARS-coV transmission, it is important to be prepared for any possibility. So, this study is aimed to analysis the past measures in managing SARS and propose the amendatory plans to improve the preparedness. Materials & Methods : Questionnaires were collected among clinicians with any experience in managing the probable or suspected SARS cases in Oct. 2003. 17 out of 22 hospitals responded to the questionnaire. The contents in the questionnaire were practical activities, personal equipments, response plans, isolation facilities in emergency centers, outpatient clinics, general wards and intensive care units, and relationship with the public health department. Results : The dedicated isolation rooms in emergency centers, outpatient clinics, general wards, and intensive care units were prepared in 9 (9/17, 52.9%), 5 (5/17, 29.4%), 15 (15/16, 93.7%), and 4 (4/16, 25.0%) hospitals, respectively. Except for one hospital that newly made negative pressure room for SARS, single or multi-bed rooms without airborne infection control were used in all the other hospitals. The personal precaution principles were kept quite well in general wards. Before the designation of SARS hospital by the public health department prior evalution to see if the hospital was suitable for managing SARS was conducted in only 1 (1/12, 8.3%) hospital. The results of laboratory diagnosis were reported back in 1 (1/15, 6.6%) hospital. Conclusions : The isolation facilities which can control airborne infection were almost deficient not only for SARS but also for other respiratory transmissible diseases. For the infection control of transmissible diseases including SARS, more investment is needed on medical facilities and comprehensive support from the public health department required.

용접 근로자의 혈액 및 요중 망간 농도

현대우,안선희,김강윤,최호춘 大韓産業醫學會 1998 대한직업환경의학회지 Vol.10 No.4

Blood and urine samples were taken from 447 welders exposed to manganese containing welding fumes and 127 office workers not exposed to welding fumes as a control. The air samples were analyzed by flame atomic absorption spectrophotometer(Varian 30A, Australia), and blood and urine samples were analyzed by flameless atomic absorption spectrophotometer(Z-8100, Hitachi, Japan). Data were evaluated in accordance with type of industry, smoking habits, and work duration. The results obtained were as follows: 1. The limit of detection(LOD) levels of manganese in blood and urine were 0.11㎍/100㎖ and 0.14㎍/ι, respectively. Our results of manganese concentration were shown within ±2 standard deviation which was the upper and lower warning limit(UWL or LWL) on quality control chart. 2. The airborne concentrations of manganese in welding workplaces were 0.067㎎/㎥ showing differences by type of industry; 0.017㎎/㎥ in automobile assembly and manufacturing industries, 0.084㎎/㎥ in steel heavy industries and 0.180㎎/㎥ in shipyards. 3. The blood manganese concentrations showed differences by type of industry showing the highest values of 1.70㎍/100㎖ in shipyards, 1.24㎍/100㎖ in automobile assembly and manufacturing industries and 1.111㎍/100㎖ in steel heavy industries. Urinary manganese concentration corrected by urinary creatinine concentrations was 0.34㎍/g creatinine in automobile assembly and manufacturing industries, 0.43㎍/g creatinine in steel heavy industries and 0.48㎍/g creatinine in shipyards. There were no difference urinary manganese concentrations by type of industry. 4. The overall blood manganese concentration was 1.26㎍/100㎖, and urinary manganese concentration was 0.35㎍/g creatinine in welders. In contrast to these values, blood and urinary manganese concentrations were lower in control group showing 0.73㎍/100㎖,, and 0.28㎍/g creatinine, respectively. 5. Smoking habits did not seem to affect on blood and urinary manganese concentrations both in welders and office workers. 6. Blood manganese concentrations were significantly higher in welder who had worked longer than 10 years than in welder who had worked less than 10 years. 7. The blood manganese concentrations were significantly correlated to airborne manganese concentrations(r=0.318, n=64), work duration(r=0.425, n=538), and cumulative exposure indices(CEI) (r=0.354, n=64).

제한효소 DNA 분석법에 의한 국내분리 렙토스피라균의 동정

장우현, 김석용, 서정선 忠北大學校 遺傳工學硏究所 1988 遺傳工學硏究 Vol.2 No.1

본문참고

도심 가로변 공개공지의 중간영역적 특성 분석과 활성화 계획방향 제안

김선태,양우현 중앙대학교 건설환경연구소 2001 環境科學硏究 Vol.12 No.1

The purpose of this study is examine the characteristics of public open space in the office buildings located in urban commercial strip, in terms of its relationships to street, to building, and to other surrounding facilities. Theoretical basis of this research is that public outdoor space are to be the intermediate territory set between streets and a building. 14 commercial buildings in Seoul were selected as sample cases and they were closely surveyed and analyzed in a comparative manner. Some results from the case study are the facts that the most decisive factor affecting the vitality of public open space is the relationship to fronting street and the building, rather than its size, and that continuity of pedestrian path from street to building entries, strong pedestrian flow, visual contact, and other surrounding attractive facilities are important factors to be the successful public outdoor space. Also pertinent layout of street furnitures and landscape elements matching the characteristics of the space, setting and users are also considered to be a critical factor. Based on these findings, several planning guidelines are suggested for the vitalization of the space, mainly in terms of the location of public open space in relation to street, the design techniques and devices reflecting the purpose of the space, and territorial arrangement and furniture layout, and the patterns of relationship to surrounding space and facilities.

Apert syndrome : 증례보고

박광선,박호원,이주현,서현우 大韓小兒齒科學會 2008 大韓小兒齒科學會誌 Vol.35 No.3

Apert syndrome은 관상봉합의 조기유합에 의한 첨두증(acrocephaly)과 합지증(syndactyly)이 함께 나타나는 선천성 유전 질환으로서, 1906년 Apert에 의해 보고된 증후군이다. 약 65,000∼160,000당 1명꼴로 발생되며, FGFR2(fibroblast growth factor receptor 2)의 돌연변이로 생겨난다고 알려져 있고, 상염색체 우성 유전을 한다. 임상적으로 첨단두증(acrobrachycephaly)을 보이고, 특징적으로 손과 발의 합지증을 보이며, 높은 이마와 평평한 뒤통수, 후퇴된 중안면부, 안구돌출, 시력이상, 양안격리증, 밑으로 쳐진 안검열, 상악골 형성부전, 상대적인 하악 전돌의 양상 등을 보인다. 감소된 비강인두와 좁아진 후비공으로 인한 구호흡과 전방부 개교를 보이며, 이완시에 입술의 모양은 사다리꼴 형태를 보인다. 중이염이 흔하고, 청각장애를 유발하기도 하며, 정신지체가 높은 비율로 나타난다. 특징적인 구내소견으로 연구개열 또는 구개수열과 가성 경구개열, V자 모양의 악궁과 치열의 총생 등이 관찰되며, 전치부 개방교합과 구치부 교차교합을 동반한 Class III부정교합을 보인다. 본 증례는 강릉대학교 치과병원 소아치과에 내원한 6세 3개월의 남아로 충치 치료를 받고 싶다는 것을 주소로 내원하였다. 이 환자에서 보이는 Apert syndrome의 특징적인 치과적 소견에 대해 보고하는 바이다. Apert syndrome is an autosomal dominant condition characterized by craniosynostosis, midface hypoplasia, and syndactyly of the hands and feet. It occurs in about 1 of every 65,000 to 160,000 births and is caused by a mutation in the fibroblast growth factor receptor 2(FGFR2) gene. Apert syndrome typically produces acrobrachycephaly(tower skull). The occiput is flattened, and there is a tall appearance to the fore head. Ocular proptosis is a characteristic finding, along with hypertelorism and downward slanting lateral palpebral fissures. The middle third of the face is markedly retruded and hypoplastic, resulting in a relative mandibular prognathism. The reduced size of the nasopharynx and narrowing of the posterior choana can lead to mouth breathing, contributing to an open-mouth apprance. Three fourths of all patients exhibit either a cleft of the soft palate or a bifid uvula. The maxillary hypoplasia leads to a V-shaped arch and crowding of the teeth. A 6-year-old male patient visited to the Department of Pediatric dentistry, Kangnung National University of Dental Hospital. He visited the hospital to get treatment of carious teeth. The purpose of this report is to present a specific dental manifestations about the apert syndrome.

동공 크기 분포의 새로운 결정법

조현우,안운선 성균관대학교 기초과학연구소 1986 論文集 Vol.37 No.1

An improvement over the conventional method of pore size distribution analysis has been made in this work. This improved method utilizes the t-plot of nitrogen adsorption in combination with the conventional method which utilizes the full range nitrogen adsorption isotherms. The proposed method is very convenient in that only lower pressure range adsorption isotherms are used and thereby obtaining the small transition pore distribution. The results of the analysis obtained by this method for a few adsorbents agree very well with those obtained by the conventional method. The possibility has also been considered for any relation between the porosity of adsorbents and its successive small range of the t-plot curve.

의원성 사고로 발생한 타액선염 : 증례보고

김현우,허경회,이원진,허민석,이삼선,최순철 대한구강악안면방사선학회 2004 Imaging Science in Dentistry Vol.34 No.2

A case of sialadenitis is presented in a patient with painful swelling of the right mouth floor. The condition was caused by trauma on the right mouth floor during dental treatment, which had happened 15 days before admission. On aspiration, mucous secretion was found and ultrasonography showed obstruction of duct. Histopathological studies and surgical investigation established a definite diagnosis of obstructive sialadenitis caused by ductal laceration. As surgical treatment sialodochoplasty was selected. The case and relevant considerations are discussed.