Clinical and Mycological Studies on Superficial Fungal Infection / 대한의진균학회지

BACKGROUND: Superficial fungal infections are common dermatologic disorders, and causative organisms include dermatophytes, yeasts, and nondermatophyte molds. The data about incidence of fungal pathogens can be used to predict increase in antifungal resistasnce and the adequacy of our current pharmacologic repertoire, and provide insight into future developments. OBJECTIVES: This study aimed to identify epidemiologic features and the various organisms from clinically suspected cases of superficial fungal infection. METHODS: A total 11,656 specimens were collected from clinically suspected tinea corporis, tinea cruris, tinea capitis, tinea faciei, tinea manuum, tinea pedis, and finger and toe onychomycosis among patients of Dermatologic clinic of Asan Medical Center from 1998 through 2002. Clinical and culture studies on these cases were performed. However, attemps to establish the causative organism were not done. RESULTS: The incidence of clinically suspected cases was highest in the fifth to sixth decades. The ratio of male to female was 1.09:1. The incidence of toenail was highest, followed by feet, fingernail, trunk and extremeties, groin, scalp, and face. The positive rate of KOH examination was 49.2% and that of culture was 51.4%. Dermatophytes was the most commoly isolated fungal organisms except fingernail onychomycosis. Trichophyton rubrum was the most prevalent fungal pathogen among them. High incidence of Candida species and Trichosporon species was documented in hands, feet and nails. CONCLUSION: Consideration of the current epidemiologic, clinical and mycologic features in the cutaneous fungal infections is of key importance to investigational efforts, diagnosis, and treatment.

A Case of Diffuse Black Dot Tinea Capitis Caused by Trichophyton tonsurans / 대한의진균학회지

"Black dot" tinea capitis is a clinical form of tinea capitis, which is a dermatophytosis of the scalp and associated hair. It is caused by the anthropophilic endothrix organisms. We report a case of black dot tinea capitis caused by Trichophyton (T.) tonsurans in an 18-year-old woman who is a judoist in the college. She had suffered from a diffuse hair loss involving nearly entire scalp hair for 1 year. The scalp lesion showed diffuse multiple black dots with minimal inflammatory sign or scales. KOH examination revealed arthroconidia of endothrix pattern. On mycological studies, T. tonsusrans was identified. She was treated with oral itraconazole pulse therapy (2 cycles) and ketoconazole shampoo.

Management of Calculi in the Hilum of Submandibular Gland: Intraoral Removal with Marsupialization of the Duct / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The excision of submandibular gland (SMG) has been commonly used for the treatment of calculi in the hilum of SMG, since intraoral removal of the hilar stone has the potential risk of lingual nerve injury and the poor surgical field. However, it would leave loss of remained gland function and external scars after the excision. Therefore, the authors modified the intraoral retrieval techniques as the marsupialization of the Wharton's duct up to the calculi in the hilum. This study reports our clinical experience with the modified intraoral retrieval technique and the advantages of this modality for calculi in the hilum of SMG. SUBJECTS AND METHOD: SMG excision and intraoral removal with marsupialization (IRM) were used from 1994 through 2003 to treat 9 and 16 cases of calculi in the hilum of SMG, respectively. We analyzed the characteristic findings of calculi, surgical morbidities and complications by comparing two different treatment groups. RESULTS: The mean diameter of the calculi was 6.1 mm in patients with SMG excision and 7.8 mm in patients with IRM. The success rate of extraction by IRM of calculi in the hilum were 86.7%. The surgical complications were similar in both groups. The proportion of palpable calculi were significantly increased in the IRM group (92.9% vs 22.2%). We failed to remove the stone by IRM from patients, and stones were impalpable intraorally preoperatively. CONCLUSION: IRM is an excellent alternative method for the removal of palpable calculi located in the hilum of SMG. Furthermore, it would preserve the salivary gland function without external scars and with acceptable surgical complications and morbidities.

Pityriasis Rotunda Associated with Hepatocellular Carcinoma

Pityriasis rotunda is an unusual disease characterized by perfectly circular or oval-shaped dyschromic patches with a scaling surface. Histologically, the lesions resemble those of ichthyosis vulgaris. They typically involve the abdomen, the trunk and extremities. The etiology of the disease remains unknown. Pityriasis rotunda has been most commonly associated with tuberculosis, nonlymphoproliferative neoplasms such as hepatocellular carcinoma and gastric carcinoma, and malnutrition. Rarely, hepatic cirrhosis, leprosy, endometriosis, and familial G6PD deficiency can be associated with pityriasis rotunda. We describe here a patient with pityriasis rotunda associated with hepatocellular carcinoma. Pityriasis rotunda can be a presenting sign of hepatocellular carcinoma in the setting of chronic liver cirrhosis.

A Case of Hidradenoma Papilliferum / 대한피부과학회지

Hidradenoma papilliferum is a rare benign neoplasm that occurs almost exclusively on the skin of the female anogenital region. It is usually a slow-growing cystic dermal mass that can be either asymptomatic or ulcerate and bleed, and represents an adenoma with apocrine differentiation. We present a case of hidradenoma papilliferum in a 46-year old woman with a erythematous to brownish papule on the left labium majora and the typical histopathologic findings.

Olfactory neuroblastoma: CT and MR Findings

PURPOSE: The purpose of our study was to determine the CT and MR imaging features of olfactory neuroblastomas in 15 patients. MATERIALS AND METHODS: Fifteen patients with pathologically proven sinonasal olfactory neuroblastomas were included in this study. MRI was performed in 12 cases, and CT in 11, while eight patients underwent both MRI and CT. Features analyzed included the extent of the tumor at the time of presentation, its size and enhancement pattern, erosion or destruction of bony structures adjacent to the tumor, and intratumoral cystic areas. Metastasis to regional lymph nodes of head and neck area was also evaluated. RESULTS: In all patients, the epicenter of primary tumor was the superior nasal cavity or ethmoid sinuses. In 14 patients, the wall of the nasal cavity including the lamina papyracea was involved, while in 13 there was invo l vement of the cribriform plate. Intracranial tumor extension was demonstrated in nine patients, and intracranial frank mass formation in four. On MR, eight of 12 masses showed low signal intensity on T1-weighted images, while in 11 cases, T2-weighted images revealed iso- or high intensity. In 11 patients, the tumor showed a prominent enhancement pattern on post-contrast enhanced images, while CT scans showed tumor enhancement in all 12 patients. CONCLUSION: Olfactory neuroblastomas generally invade the paranasal sinuses and or-bit,and are at Kadish stage B or C at the time at which symptoms suggest the need for a hospital visit. Intracranial tumor extension of the tumor is frequent, but mass formation large enough to be detected radiologically is seen in less than half of all cases.

Extensive Peritoneal Calcifications Associated with Continuous Ambulatory Peritoneal Dialysis

Peritoneal calcification, which can lead to intestinal obstruction and potentially lethal hemoperitoneum, is a rare complication of continuous ambulatory peritoneal dialysis. We describe a case in which extensive peritoneal calcification had arisen for this reason. Although the patient was asymptomatic, extensive calcification was present on the parietal and visceral peritoneum, including the hepatic and splenic surface.

Computed Radiogra p hy in Skeletal Imaging: Visual Assessment of Compressed Image Quality

PURPOSE: To evaluate the effect of lossy image compression on skeletal images and to determine the compression ratio which does not lead to difficulties when images are interpreted for diagnostic purposes. MATERIALS AND METHODS: Thirty-two computed radiographs (CR) of osteolytic bone tumors were obtained from Picture Archiving and Communication System. They were compressed to three different levels (Q factor 30, 70, 120) using the JPEG (Joint Photographic Expert Group) technique. Ninety-six pairs of uncompressed and compressed images were randomly ordered and then serially displayed on two high-resolution monitors. During a side-by-side review, three radiologists independently compared each pair of uncompressed and compressed images, and these were rated once using a five-category ordinal scale for tumor-related findings, linear structures, and soft tissues. The reviewers were then obliged to decide which image in each pair was of better quality, and finally, they were asked to evaluate the influence of image compression on diagnostic accuracy. RESULTS: The reviewers found no significant difference in image quality between uncompressed and compressed images with a Q factor 30. Compressed images with a Q factor of 70 or 120, however, revealed clinically relevant degradation. Among 96 observations of compressed images, 15 with a Q factor of 70 and 35 with a Q factor of 120 were considered inadequate for clinical purposes. CONCLUSION: If the JPEG technique is used, compressed CR skeletal images with a Q factor of 30 are acceptable for clinical application. Compressed images with a Q factor of 70 or 120 may, however, cause diagnostic difficulty and thus cannot be used for clinical purposes.

Complications of Median Sternotomy: CT Findings

In heart surgery or surgery for mediastinal mass, median sternotomy is the most common surgical approach. Thefrequency of complications after sternotomy is very low (0.5%-5%), but once a complication develops, the high riskinvolved results in high mortality; early detection and treatment are thus essential. In determining the presenceand extent of complications after sternotomy, chest radiography and clinical findings are of limited usefulness,though for detecting the existence of complications and evaluating the extent of lesions, CT is very useful. Weillustrate the clinical characteristics and CT findings of complications after median sternotomy.

Hard Palate Masses: Differential Diagnosis with CT and MR

PURPOSE: To determine the differential points of hard palate masses, using CT and MR. MATERIALS AND METHODS: MR (N=18) and CT (N=15) findings in 30 patients with pathologically-proven hard palate masses were reviewed. Masses originating in minor salivary glands were the most common (66.7%, N=20), and the remainder were accounted for by squamous cell carcinoma (N=5), lymphoma (N=2), malignant schwannoma (N=1), neurofibroma (N=1), and cholesterol granuloma (N=1). Location and demarcation of the lesions, MR signal intensity, degree of enhancement, internal architecture, and the patterns of adjacent tissue plane invasion were analyzed. RESULTS: The location of lesions originating in minor salivary glauds was as follows: paramedial, 73.7% (14/19); midline, 85.7% (6/7); and marginal,0% (0/4). On MR imaging, signal intensity and degree of enhancement showed no significant differential point except lower T2 signal intensity (3/5) and less enhancement (4/5) in squamous cell carcinoma than in other masses. Necrosiswas seen in 10/21 malignant masses (47.6%), poor demarcation in 10/21 (47.6%), bone invasion in 19/21 (90.5%), and tissue plane invasion in 15/21 (71.4%); in benign masses, the corresponding figures were 4/9 (44.4%), 1/9 (11.1%), 2/9 (22.2%), and 3/9 (33.3%). Two of 21 malignant masses (9.5%) showed none of the above charachteristics. CONCLUSION: Centrally located lesions most probably originate in minor salivary glands. In the hard palate, benign masses can show features which are generally thought to be those of malignant tumors, whereas malignant tumors can be free of such features; in differential diagnosis, caution is therefore required.