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.

효모시스템에서 Human Transglutaminase C(TGase 2)의 발현에 관한 연구 : C-말단부위의 결손효과 An Effect of a Domain from Carboxyl Terminal Deletion of the Enzyme

우상규,정선미,이상기,안병윤,김희철 한국미생물생명공학회 ( 구 한국산업미생물학회 ) 1996 한국미생물·생명공학회지 Vol.24 No.3

Transglutaminase(TGase Ⅱ)는 펩타이드-결합 글루타민 잔기와 펩타이드-결합 라이신잔기 및 1차 아민류를 포함하는 다양한 화합물과의 교차결합에 의하여 단백질의 변형을 촉매하는 효소이다. 동물세포에는 구별가능한 5종류의 TGase가 존재한다[TGase Ⅰ(또는 K), Ⅱ(C), Ⅲ(E), Ⅳ(P)와 혈장단백 ⅩⅢa]. 그들은 아미노산 서열에서 N-말단에 약 70%의 상동성을 갖고 있으며, C-말단의 경우에는 거의 상동성이 부위(N-말단 2/3)와 비상동성 부위(C-말단 1/3 부위)의 역할을 알아보기 위해 전체효소 또는 C-말단이 결손된 형태의 효소를 Saccharmoyces cerevisiae에서 발현 하고자 하였다. Southern blot, 역전사 중합 연쇄 반응, Western blot등을 통해 전체효소 및 C-말단 결손형 효소가 형질전환된 효모에서 발현되는 것을 확인하였다. Succinylated casein에 [1,4-^14C]-putrescine이 통합되는 반응을 이용한 활성 측정에서 C-말단이 결손된 TGase Ⅱ는 같은 세포 농도에서 전체 TGase Ⅱ 효소와 비교하여 유사한 수준의 활성을 나타내었다. 이러한 결과들은 사람 TGase Ⅱ의 경우 N-말단의 높은 상동성부위가 효소의 역가결정에 중요하다는 것을 나타내 준다. 효모시스템에서 발현한 결과 효소의 역가가 나타났으나 높지 않았으며 발현된 양이 극히 낮아서 단백질의 정제나 특성연구를 위하여 발현벡터의 개량을 포함한 방법의 개선이 필요하다고 사료된다. 흥미롭게도 TGase Ⅱ의 발현이 효모의 성장을 저해하는 것으로 나타나 이러한 현상이 표피세포의 각질화에 수반된 세포의 죽음과 유관한지의 가능성에 대한 보다 자세한 연구가 필요하다. In an effort to understand the role of the conserved domain and of the heterologous one-third part of the carboxy terminal domain of transglutaminase C (TGase Ⅱ), attempts were made to express TGase Ⅱ cDNA of human origin in yeast Saccharmoyces cerevisiae as in a full-length form as well as in a form of C-terminal truncation. The 2μ-based expression plasmids which contained the TGase Ⅱ cDNA under the gal inducible promoter were introduced into yeast and the maintenance of the full-length and truncated form of the TGase Ⅱ gene plasmids were confirmed by Southern blot. The expression of e results indicate that the N-terminal homologous domain of human TGase Ⅱ retains a catalvtically active domain. The level of TGase Ⅱ expressed in yeast, however, was far lower than satisfactory and other expression system should be sought further characterization of the enzyme. The negative effect of TGase Ⅱ on the growth of yeast is interesting with respect to the physiological effect of TGase Ⅱ in the cornification f epidermal keratinocytes.

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.

유치원에서의 영어지도를 위한 Storytelling 활용 방안

선우윤미 The English Linguistic Science Association of Kore 2000 English Linguistic Science Vol.4 No.-

하수도용 PVC관의 역학적 특성에 관한 연구

金宣祐,崔訓,南廷勳,尹順鍾 弘益大學校 科學技術硏究所 2005 科學技術硏究論文集 Vol.16 No.-

In this paper, we present the results of an experimental investigation pertaining to the mechanical properties of polyvinyl chloride pipe (PVC pipe) which is widely utilized in the sewage and waste water drainage system. PVC pipe has superior characteristics such as high corrosion resistance against various chemicals, no electrical conductivity and electrical corrosion, high strength and stiffness per unit weight, etc. Due to the above mentioned characteristics, in recent years, many developed countries (including Japan, USA, Europe, etc.) are adopting as a major material for the sewage and waste water drainage system. In order to promote wide variety of utilization in the Korean market, appropriate quality of PVC pipe must be maintained and provided to the design and construction engineers. Several PVC pipe samples were taken and relevant tests were conducted to investigate the quality, i.e., mechanical properties, according to the associated test specifications. The results of experimental investigations are presented and discussed.

승모판대치술후 도플러 심초음피를 이용한 인공 판막의 종류에 따른 최대혈류속도와 평균혈류속도에 관한 연구

박선우,김권배,김윤년,김기식 啓明大學校 醫科大學 1988 계명의대학술지 Vol.7 No.2

The conventional non-invasive and invasive technique have limitations in evaluating cardiac prosthetic valves and artificial valves. We have used continuous wave Doppler echocardiography to evaluate 48 patients with tissue and mechanical mitral valves implanted within 4 months prior to examination. The results are as follows. 1) Of these patients, male are 28. The mean ages of male are 35.60 (yr) and female are 41.82. 2) The differences of peak and mean velocities of prosthetic acardiac valves between male and female are not significant, but the differences of valvular size between male and female are significant(male:31.00±1.30(mm), female:29.36±2.11, p<0.01). 3) The difference of size and flow velocities between mechanical (Edwards-Duromedics) and tissue(Ionescue-Shiley) valves are not significant, but the ages of patients with mechanical valves are significantly lower than tissue valves(mechanical valve; 34.05±11.28, tissue valve; 43.62±11.26, p<0.01). 4) The differences of flow velocities between mechanical and tissue valves, sizes of which are 31mm, are significant statistically (peak velocity; 130.15±24.59 vs 110.00±19.41, mean velocity; 74.49±23.14 vs 51.38±12.71, p<0.01). 5) The sizes of valves are larger, the peak and mean velocities are lower, but it is not significant statistically. The results indicated that Doppler echocardiography is a useful method for evaluating function of prosthetic valves.

고분자 재료의 계장화 충격실험에 관한 연구

최선웅,우창기,윤종희 한국공작기계학회 2004 한국생산제조학회지 Vol.13 No.6

Impact behavior of polycarbonate in various defect state was investigated using an instrumented impact tester. A method of analyzing raw impact data was developed and successfully demonstrated the impact behavior in terms of load-displacement and energy-displacement curves. This technique was shown to be capable of separating defect, no-defect initiated fractures as well as their propagation behaviors.

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

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.

GC-ECD를 이용한 유기염소계 및 Pyrethroid계 농약 동시 분석법

김우성,이선화,김재이,정지윤,이명자,박영채,이영자,정성욱,이봉헌,박흥재 한국환경과학회 2003 한국환경과학회지 Vol.12 No.4

Pesticides were extracted from samples with 70% acetone and methylene chloride in order, and then cleaned up via open-column chromatography apparatus packed with florisil, and finally analyzed simultaneously the organochlorine and pyrethroid pesticides using GC(ECD). An ultra-2 fused silica capillary column was used to separate and identify the products. The resolution between the last isomeric peak of cypermethrin(59.987min) and the first isomeric peak of flucythrinate(60.043min) was not satisfactory. The last isomeric peak of fenvalerate(62.344min) and the first isomeric peak of fluvalinate(62.397min) were overlapped. Recoveries of soybean sample for the most pesticides were 73.3% to 102.4%. Detection limits were between 0.004 and 0.063 ㎍/㎎ when this method was used.