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단순 봉합이 불가능하였던 횡격막 결손 부위를 Silastic sheet로 대치하여 교정함으로써 수술 후 좋은 경과를 취하였다. Diaphragmatic defect usually may be repaired by direct primary sutures, but sometimes which may be required incorporation of foreign substance as a replacement. Such defects are seen in congenital absence of diaphragm, huge diaphragmatic hernias and on bloc excision for tumor. The success of vascular prosthesis in recent years has stimulated the investigation and development of new synthetic materials for the repair of tissue defects in various parts of the body including chest wall and diaphragm. Recently we experienced a patient who had a huge diaphragmatic defect in left side (10cm×10cm) with severe dyspnea and chest pain due to massive diaphragmatic hernia of intraabdominal viscus. The defect was impossible to direct suture ligation for long standing surrounding fibrotic conditions, and therefore it was replaced by Silastic sheet (Silicone rubber prosthetic material). With the good postoperative result, now we report this case with literature considerartions.
We report a case of fibroma of tendon sheath developed in a 22-year-old woman. The tumor of about 5 years duration was protruding on the volar surface of her 4th finger tip. It was well-demarcated rubbery-hard, and immovable on palpation. The surface on the tumor was smooth and had some telangiectasias. It was asymptomatic and non-tender. The histopathologic findings of excised specimen revealed well-demarcated lobulated mass with widely-spacd: fibroblasts in a hyalinized collagenous matrix. The characteristic slit-like spaces were found in hypoellular and fasciitis-like region. After excision, local recurrence has not been observed for about one and a half years of follow-up period. (Kor J Dermatol 1993; 31(1): 131-133)
We performed a clinicopathological study of nineteen patients with chronic inflammatory nodose lesions of the legs which responded to the treatment with isolniazid. The results were summarized as follows: 1. Seven patients had a personal or family history of tuberculcsis and all patients showed a high tuberculin sensitivity. But, no one showed the evidence of active pulmonary tuberculosis. 2. The inflammatory nodules and swelling of the legs were resolved within 12 months in all cases. Resolution of the nodules was more rapid than that of leg swelling. 3. The clinical characteristics of the patients with chronic inflanimatory nodules were the same as those of the cases with erythema nodosum or erytiema induratum reported previously in Korea. The basic histopathologic process of inflarr matory nodules seemed to be vasculitis. (Kor J Dermatol 1992;30(5):644-650)
We reviewed the 43 medical records of patients with cellulitis or erysipelas who had been admitted at the depar1ment of dermatology of Seoul National University Hospital and followed them up for mean 21.6 months. The results were as follows. 1. The sex ratio of patients with cellulitis was 1:1.4 and the average age was 49 years. 2. The lower extremity as the most frequently invloved site of cellulitis with the frequency of 58.1% (25 cases), with the head and neck being involved in 16 cases(37.2%) and trunk and upper extremity in 1 case each(2.3% ). 3. The portals of infecticin were suspected in 33 cases(76% ), where tinea pedis was detect,ed in 18 cases(41.9%), previous skin infeection 10 cases(23.3%) and trauma in 9 cases(20.9%). 4. Initial systemic symptoms were fever(76.7%), chill(65.1%) and headache(37.2%). Erythema(100%), local heating(90,7%), tenderness(88.4%), swelling(86.0%), ulcer(16.3%), bulla(14.0%), lymphangitis(9.2%) and lymphadenit,is(9.2%) were found in the skin lesions. 5. The laboratory findings revealed leukocytosis in 35.7%, elevaed ESR in 86.8% positive 6. ASO titer in 63.0% and positive CRP in 80%, Microorganism. were detected in only 1 of 15 blood cultures, in 2 of 4 bulla fluid cultures and in 7 of 9 bus cultures. There was no growth of causative microorganisms in 3 tissue cultures and 9 saline needle aspiration cultures. Penicillin was used as primary antibiotics in 19 cases, which changed to another antibiotics due to lack of improvement in 3 cases and cefazolin was used in 21 cases, which changed in 2 cases due to the same reason. 7. Average admission priod was 11 days(range from 3 to 20 days) and 30.2% of patients wit.h cellulitis experienced recurrence, but 48% on low extrernity in contrast with 6.7% on head and neck. (Kor J Dermatol 1992;30(5):618-624)
The histogenesis and differentiation of sweat gland tumors are controversial. Twenty-two cases of sweat gland tumors were stained by immunoperoxidase technique (ABC method) for the presence of S-100 protein, CEA, and two kinds of keratin. Four syringomas, 4 eccrine poromas, 2 eccrine porocarcinomas, 2 eccrine spiradenomas, 1 papillary eccrine adenoma, 3 clear cell hidradenomas, 3 mixed tumors of skin, 2 papillary syringocystadenomas, and 1 cylindroma were included. All samples were formalin-fixed and paraffin-erribedded. Two monoclonal cytokeratin ant.ibodies, MA-902 (specific for cytokeratin No. 8) and MA-903 (specific for cytokeratins No.1,5,10,11) were used. In normal eccrine and apocrine glands, MA-902 stains cells of the intradermal duct and secretory portion. While MA-903 stains cells of the intraepidermal and intradermal duct and myoepithelial cells of eccine and apocrine glands, S-100 protein is found in the secretory cells of the intradermalduct and secretory portion, while CEA stains the secretory and ductal cells of eccrine and apocrine glands. All sweat gland tumors we studied stained by 4 antibodies in variable positive rates, Based on these findings, we discuss the histogenesis of various sweat gland tumors. (Kor J Dermatol 1992; 30(3): 303-316)
Thirty two cases of nevus sebaceus were studied by immunohistochemical staining employing three anticytokeratin antibodies(34bE, 34bB, CAM 5.2) and anti-involucrin antibody in order to clarify the biochemical characteristics of the covering epidermis of nevus sebaceus. An attempt was made to compare the expression pattern of these proteins in the epidermis of nevus sebaceus with that in normal skin and in epidermal nevus. Serial sections in all cases were also stained with PAS in attempt to correlate these protein expression with the amount of glycogen in the epidermis of nevus sebaceus. The following results are obtained. 1. The expression of cytokeratin and involucrin in the epidermis of nevus sebaceus was changed as the age of the lesions increased, but we could not identify a uniform pattern according to the age of lesions. 2. Several CAM 5.2 positive cells were found in the basal layer of the epidermis of nevus sebaceus lesion obtained from patients over 10 years of age. 3. The expression of cytokeratin and involucrin did not show any correlation with glycogen content. These results suggest that the covering epidermis of the lesion of nevus sebaceus may not be nevoid proliferation of epidermal nevus. (Kor J Dermatol 1992; 30(3): 279-290)
We report a case of pigmented spindle cell nevus occurred in a 4-year-old girl. The lesion was well-demarcated, 2.5 x 3mm sized black macule on the left thenar area. The histopathologic findings of excisional biopsy specimen revealed the prociferation of uniform spindle-shaped pigmented melanocytes at the dermoepidermal junction and sharply definded lateral margins. (Kor J Dermetol 1992; 30(l): 119-121)
H^+-ATPase의 활성을 조절할 수 있는 물질을 찾기 위하여 토마토 뿌리조직으로부터 마이크로솜을 분리하고, La^3+의 효과를 조사하였다. 원형질막 및 액포막에 위치하는 H^+-ATPase의 활성은 각각의 선택적 저해제인 vanadate와 NO_3^-의 처리시 감소하여, La^3+이 원형질막 및 액포막 H^+-ATPase 활성을 50% 저해하는 La^3+농도인 Ki 값은 각각 57, 78μM이었다. La^3+에 의한 저해요소는 Triton X-100을 처리한 leaky 마이크로솜에서도 얻어져, La^3+이 이온채널의 존재와 관계없이 H^+-ATPase의 활성을 직접적으로 저해함을 확인하였다. 한편, La^3+의 활성저해 효과는 ATP농도 증가로 감소하였고, ATP의 효과는 농도 의존적으로 나타났으며, 7mM ATP에 의해 La^3+에 의한 H^+-ATPase 활성 저해가 완전히 억제되었다. 이러한 결과로부터 La^3+은 원형질막과 액포막의 H^+-ATPase들에 결합하여 ATP 결합친화력을 감소시킴으로써 활성을 저해하며, 뿌리조직 H^+-ATPase의 활성조절제로 이용이 가능함을 확인하였다. In order to find a chemical agent which is able to modulate the activity of H^+-ATPase, microsomal preparation was obtained from the root tissue of tomato plant and the effect of La^3+ was measured. The activities of plasma and vacuolar membrane H^+-ATPase were analyzed by the inhibited activities using their specific inhibitors, vanadate and NO_3^-, respectively. La^3+ inhibited microsomal ATPases in a dose-dependent manner and the inhibitory effect of La^3+ was suppressed by both vanadate and NO_3^-, implying that La^3+ inhibits both plasma and vacuolar membrane H^+-ATPase. The Ki values of La^3+ which inhibit 50% of the activities of plasma and vacuolar membrane H^+-ATPase were 57 and 78μM, respectively. The H^+-ATPase of the leaky microsomes made by the treatment of Triton X-100 were also inhibited by La^3+, suggesting that La^3+ directly inhibits both enzymes. Meanwhile, the inhibitory effect of La^3+ was decreased by increasing the concentration of ATP. The effect of ATP was also concentration-dependent and 7 mM ATP completely removed the inhibitory effect of La^3+. These results imply that La^3+ inhibits both plasma and vacuolar membrane H^+-ATPase by decreasing the binding affinity of ATP and La^3+ can be used to control the activity of root H^+-ATPase.
A Clinicopathologic study was made on lymphomas of the skin including 7 cases of mycosis fungoides (MF) and 13 cases of non-Hodgkin's lymphoma(NHL). The results are summarized as follows. 1. Patients with MF had a longer clinical course(average 9.1 years) and presented with widespread patches and plaques. They had no evidence of extracutaneous involvement at the time of diagnosis. Histologically, MF showed a dense cellular infiltrate in the upper dermis with epidermal involvement. Pautrier's microabscesses were present in 4 of 7 cases. 2. Patients with NHL had a shorter clinical course(average 2.7 months) and all but one presented with a single nodule or multiple nodules. More than half of the patients with NHL showed evidence of extracutaneous involvement at the time of diagnosis. Histologically, NHL showed diffuse, patchy, or perivascuiar and periappendageal infiltration of atypical lymphoid cells in the dermis and subcutaneous tissue. Some cases showed epidermal involvement of tumor cells but pautrier's microabscesses were not present. 3. Most tumor cells reacted with UCHL-1 in 6 of 7 MF cases. On the basis of immunohistochemical staining results with 12 NHL cases, 6 B cell lymphomas and 6 T cell lymphomas were identified.
■ Background 3,175 cardiac surgeries were performed in the Pusan Paik Hospital from Sep. 1985 to April 2002, and recently several kinds of current techniques for open heart surgery were adopted with good results. ■ Method Retrospective analysis of the cases and review of the results of operation and usefulness of current techniques such as OFF-Pump CABG. ARCH-FIRST TECHNIQUE. MICRO-WAVE ABLATION, TRANSPLANTATION and MINIMAL INCISION were done. ■ Results ① Among the total cases (3,179), open heart and non-open heart surgery cases were 1,988 and 218, respectively. ② 188 cases of CABG were done. Among them, 20 cases underwent OFF-PUMP coronary artery bypass surgery. 21 cases underwent complete arterial revascularization, and 14 cases underwent both. ③ 75 cases of aortic aneurysm (ascending or arch aneurysm) were operated undercardiopulmonary bypass. The causes of these aneurysm were dissecting aneurysm (45), annuloaortic ectasia(24), non-dissecting chronic aneurysm(5). In the surgery of arch aneurysm. 7 cases underwent ARCH-FIRST TECHNIQUE with good results. ④ In the treatment of atrial fibrillation coupled with valvular heart disease. MICRO-WAVE ABLATION were performed in 18 cases with 83.3 % sinus rhythm recovery. ⑤ Four cases of heart transplantation were performed, using Shumway method, with 3 survivals and one death. ⑥ Minimally invasive incision (using lower sternal incision) was performed successfully in the cases of tricuspid valve diseases(10) and congenital septal defects (50). ■ Conclusion The over all postoperative hospital mortality with open heart surgery was not so high as 3.5 %, whereas more proper management of the all patients with current techniques must be continued.