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.

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.

개에서 발생한 신우신염 증례

유건우,이선희,임수정,박형진,김태신,송은식,송근호 忠南大學校 獸醫科大學 附設 動物醫科學硏究所 2009 動物醫科學硏究誌 Vol.16 No.1

A 6 years old Schunauzer dog (7.2kg, intact female) with history of hematuria for two days was referred to the Veterinary Medical Teaching Hospital of Chungnam National University. Complete blood cell count showed no significant abnormalities and serum chemistry profile showed increased phosphate profile. On urinanalysis, there was evidence of bacterial infection. On ultrasonographic evaluation, irregular renal contour and increased echogenecity, pelvic and uretral dilation, and thickening of urinary bladder wall were observed. Based on these finding, the dog was diagnosed as pyelonephritis. The dog was treated with antibiotics based on antimicrobial susceptibility test results, then successfully resolved after 8 weeks of treatment.

한의진단명과 진단요건의 표준화 연구 III : 3차년도 연구결과 보고

최선미,양기상,최승훈,박경모,박종현,심범상,김성우,노석선,이인선,정진홍,이진용,김달래,임형호,김윤범,박성식,송태원,김종우,이승기,최윤정,신순식 한국한의학연구원 1997 한국한의학연구원논문집 Vol.3 No.1

The diagnostic requirements were suggested and explained regarding the systems of differentiation of symptoms and signs in the third year study of standardization and unification of the terms and conditions used for diagnosis in oriental medicine. The systems were as follows : - analyzing and differentiating of epidemic febrile disease - analyzing and differentiating in accordance with the Sasang constitution medicine based on four-type recognition - differentiation of disease according to pathological changes of Chong and Ren channels - standards for diagnosis of women's disease - standards for diagnosis of children's disease - standards for diagnosis of motor and sensor disturbance (-muscle. born, joint, etc.) - standards for diagnosis of neuropsychiatric disease - standards for diagnosis of five sense organ disease - standards for diagnosis of external disease The indivisual diagnosis pattern was arranged by the diagnostic requirements in the following order : another name, notion of diagnosis pattern, index of differentiation of symptoms and signs, the main point of diagnosis, analysis of diagnosis pattern, discrimination of diagnosis pattern, prognosis, a way of curing a disease, prescription, herbs in common use, disease appearing the diagnosis pattern, documents. The standards for diagnosis of each disease was arranged by the diagnostic requirements in the following order : another name, notion of disease, the main point of diagnosis, analyzing and differentiating of disease, analysis of disease, discrimination of disease, prognosis, a way of curing and prescription of disease, disease in western medicine appearing the disease in oriental medicine, documents.

경기지역 일부 이주노동자들의 직무스트레스와 우울 증상의 상관성

이선웅,김규상,김태균,류향우,이미영,원용림,송윤희 大韓産業醫學會 2009 대한직업환경의학회지 Vol.21 No.1

목적 경기지역 일부 이주노동자들의 우울 증상을 파악하고 이에 영향을 미치는 요인을 평가하기 위해 직무스트레스를 중심으로 상관성을 분석하고자 하였다 방법 경기지역 9개 이주노동자 센터에 방문한 이주노동자 488명을 대상으로 12개국 언어로 번역된 구조화된 설문지를 사용하였다 조사항목은 사회 인구학적 및 작업관련 요인 건강행태 과거력 직무스트레스 우울 증상이었으며 직무스트레스는 8개 하부항목이 포함된 한국형 직무스트레스 측정도구K0SS-26을 사용하였다 우울 증상은 조맹제 등이 번역한 CES-D 번역판을 사용하였다 단변량 분석결과 유의한 관련 요인과 직무스트레스를 독립변수로 하여 우울 증상자 유무에 대한 다중 로지스틱희귀분석을 시행하여 관련 위험요인들의 상관성을 평가하였다 결과 연구대상 전체의 우울 증상율은 25.2%였지만 비중국 국적 및 불법 체류자는 각각 32.1%, 32.8%에 달하는 결과를 보였다 관련 혼란변수를 보정한 상태에서 직무스트레스 요인(OR 2.55 95% CI=1.30-4.99)이 우울 증상과 유의한 상관성을 나타내었으며 직무스트레스 하위영역 중 물리환경(OR 2.97 95% CI=1.59-5.53) 직무요구(OR 2.33 95% CI=1.26-4.32) 및 직장문화(OR 3.10 CI=1.49-6.48)가 우울 증상자 발생과 유의한 상관성을 나타냈다 결론 연구대상의 우울 증상율은 국내 일반인구집단과는 비슷한 수준이나 국내 근로자 집단에 비해서는 높았으며 특히 내부집단별로 비 중국국적 및 불법 체류자의 우울 증상율이 높았다 하지만 국적구분과 체류자격의 사회인구학적요인보다 직무스트레스요인이 이주노동자들의 우울증상과 보다 직접적인 상관이 있는 것으로 판단되어 이주노동자들의 우울 증상 발생을 예방하기 위해서는 효과적인 직무스트레스 중재방안이 조치되어야 할 것으로 판단된다. Objectives To investigate the mental health status of migrant workers We focused on the relationship between depressive symptoms and job stress Metheod A questionnaire was administered to 488 migrant workers who visited NGO migrant worker centers located in Kyung-gi province A structured self-reported questionnaire was used to assess each responder's sociodemographics work related characteristics health behaviors past medical history job stress and depression symptoms The job stress questionnaire was used according to K0SS-26 and depression symptoms were measured using CES-D which was translated into Korean We used multiple logistic regression analysis to assess the relationship between risk factors included job stress and depression symptoms Results The prevalence of depression symptoms in survey subjects was 25.2%, but the prevalence of non Chinese nationalities and illegal workers were 32.1% and 32.8% respectively Adjusting for confounding factors job stress (OR 2.55, 95% CI=1.30-4.99) had a statistical meaningful relationship with depression symptoms Among job stress domains, physical environment (OR 2.97 95% CI=1.59-5.53) job demand (OR 2.33 95% CI=1.26 4.32) and occupational climate(0R 3.10 CI=1.49-6.48) were most likely to experience depression symptoms Conclusions The prevalence of depressive symptoms among the study subjects was similar to the prevalence among the general population in Korea but higher than that among the Korean workers In particular, the prevalence among non-Chinese and illegal workers was higher However, the job stress factor appeared to have a more direct correlation with depressive symptoms than the sociodemographic factors of nationality or residential status Hence in order to prevent depressive symptoms of the migrant workers we believe that intervention on job stress is necessary

CBD으로 제작한 In:Cd_(1-x)Zn_(x)S/CdTe 태양전지의 전기적 특성에 관한 연구

심재선,송우창,방영근,김남석,임창민,장현 三陟大學校 2006 論文集 Vol.39 No.-

CdS thin films have been widely used a window material in heterojunction solar cells. In solar cell systems, where CdS thin films have been proved to be useful, partial substitution of Zn for Cd increases the optical window of the hetero-junction and also the diffusion potential. In this thesis, effects of the thickness of indium films and the annealing temperature on structural, optical and electrical properties of chemically deposited CdZnS films for the efficiency of the Cd_(1-x)Zn_(x)S/CdTe solar cells were investigated. Cd_(1-x)Zn_(x)S films were grown by chemical bath deposition (CBD), which is a very attractive method for low-cost and large-area solar cells. The open circuit voltage of Cd_(1-x)Zn_(x)S/CdTe solar cells increased due to reduced electron affinity difference between Cd_(1-x)Zn_(x)S and CdTe films. However, the conversion efficiency of Cd_(1-x)Zn_(x)S/CdTe solar cell decreased because of the higher series resistance(R_(s)) than CdS/CdTe solar cell. The series resistance and conversion efficiency of Cd_(1-x)Zn_(x)S/CdTe solar cell were improved by using indium-doped Cd_(1-x)Zn_(x)S films as window layer. Cd_(1-x)Zn_(x)S/CdTe solar cells fabricated with optimal conditions exhibited V_(oc)=630mV, J_(sc)=38.89mA/㎠ , FF=0.53, and η=13.2%

담즙정체성 간염의 임상적 양상

최선택,은종렬,임상우,김봉준,이헌주,구미진,최준혁 영남대학교 기초/임상의학연구소 2001 Yeungnam University Journal of Medicine Vol.18 No.1

Background: Cholestatic hepatitis is failure of bile to reach the duodenum with hepatocellular damage and no demonstrable obstruction of the major bile ducts. The prognosis is usually good with recovery in less than 4 weeks after withdrawal of the offending drug. However, a prolonged course lasting over 3 months is possible and, in rare cases, progression to ductopenia with development of a vanishing bile duct syndrome occurs. A differential diagnosis with other causes of Chronic liver disease is needed. Materials and Methods: From January 1991 through Jaunary 2000, 14 patients diagnosed as cholestatic hepatitis by liver biopsy were inclouded. The possible causative drug, clinical features, laboatory findings, and progression of cholestatic hepatitis were evaluated. The semiquantitative study of liver lesions was performed by two independent observers. Results: Causes of cholestatic hepatitis are 5 cases of oriental medicine, 3 cases of anti-tuberculosis medication, 1 case of ticlopidine and antibiotics and 4 cases of unknown causes. The clinical features of cholestatic hepatitis were jaundice, itching, urine color change, and general weakness. During 6 to 30 months, LFT of 5 patients showed prolonged elevation. Elevated total cholesterol ≥250 mg/dL in 6 patients, pheripheral blood eosinophilia in 5 patients, auto-antibody positive in 6 patients were observed respectively. The biopsies showed intralobular bilirubinostasis with a mixed portal inflammatory infiltration. Conclusion: In cholestatic hepatitis. durations of abnormal LFT are variable regardless of causative drugs. If cholestatic hepatitis progresses toward chronic course, viral hepatitis, primary biliary cirrhosis, and autoimmune hepatitis should be differentially diagnosed and sequential liver biopsies are needed.

Paraquat 중독환자의 초기검사로서 sodium dithionite를 이용한 소변내 paraquat검출의 임상적 의의

윤갑준,임경수,이진웅,김영식,이부수,박덕우,김선만,이강현,황성오,안무업 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

Background : Mortality from paraquat intoxication depends upon plasma paraquat concentration. To know the severity of paraquat intoxication is important for directing therapeutic modality and predicting prognosis. Sodium dithionite test for urinary paraquat provides an easy and simple method to determine the severity of paraquat intoxication in emergency department. purpose : To determine whether the result urinary paraquat test by sodium dithionite can predict outcome in patients with paraquat intoxication in emergency department. Subjects : 48 patients(male 31, female 17, mean age 37 years) who had exposure to paraquat and presented within 24 hours after exposure. Result : Thirty five patients were positive in paraquat urine test and thirteen patients were negative. Clinical manifestations were more severe in positive patients than in negatives. Complication was much more in positives than in negatives. 28 of 35 patients(80%) in positives and 2 of 13 patients(15%) in negatives died. Conclusion : Positive test for urinary paraquat is associated with high mortality and morbidity from paraquat intoxication, and qualitative test for urinary paraquat by sodium dithionite is an useful method to determine the severity of paraquat intoxication in emergency department.

발전기 고정자 권선용 마이카/에폭시 수지의 표면 및 구조분석

이상교,심재선,정의남,송우창,박하용,심상흥,임윤희,박종국,심낙순 三陟大學校 1998 論文集 Vol.31 No.1

The purpose of this study is to determine the ageing mechanism of Mica/Epoxy composite material for large generator stator windings in order to estimate remaining life of generator. X-ray analysis is performed to investigate the position and structure of mica crystal in insulation materials. The phase change of aged and sound specimen under each atmosphere isn't observed. Surface analysis of insulation materials by optical microscope also show that the sound and aged specimen, sliding phenomenon by shear and thermal stress is observed both interface between mica and epoxy.

세라믹 섬유필터를 이용한 디젤 입자상물질 배출저감에 관한 기초연구

주용남,홍민선,문수호,이동섭,임우택 한국대기환경학회 2003 한국대기환경학회지 Vol.19 No.3

Works were focused on back pressure characteristics of ceramic fiber filter on DPF(Diesel Particulate Filter) system and experiments were performed to select appropriate filter which can filter particulates. Filters were installed on metal-support tube which has openings for exhaust as flow. Ceramic fiber filters with high specific surface area and adequate high temperature strength are commercially available for filtration of diesel particulates and in-situ hot regeneration. Thus, ceramic blanket and ceramic board which are used as insulating media were applied to filter and filteration apparatus was installed on exhaust as line connected to 2.0L diesel engine. Alternating filter structure to adapt DPF system, collection efficiency test of diesel particulates was measured. In case of ceramic blanket, pressure drop was low, caused by the destruction of soft structures. Also, particulate collection efficiency was decreased depending on loading time. In case of ceramic board, structure design was altered to reduce back pressure on DPF system. Structure design was altered to induce Z-flow by making 10mm and 5mm holes on the surface of media. Alteration of 5mm hole showed that media have low back pressure but particulate collection efficiency was 77%, while 10mm hole showed that of 90%.