Characteristics of Atopic Dermatitis according to Common Phenotypes / 대한피부과학회지

Background@#The incidence of atopic dermatitis has been increasing and the condition is known to present with different phenotypes. As response to treatment varies from patient to patient, many attempts have been made to classify atopic dermatitis into different clinical phenotypes and endophenotypes to personalize treatment. @*Objective@#This is a pilot study that aims to classify atopic dermatitis into common clinical phenotypes and associate each of the phenotypes with clinical characteristics and laboratory findings. @*Methods@#A total of 186 adult atopic dermatitis patients were classified into four clinical phenotypes: lichenoid/exudative, nummular, prurigo-nodularis, and erythrodermic. We compared baseline characteristics, disease severity, laboratory test results, associated symptoms, and lesional location between the phenotypes. @*Results@#The age was lower, and proportion of very early onset group was higher in lichenoid/exudative type. Eczema Area and Severity Index score was significantly lower in nummular type patients. Total immunoglobulin E and eosinophilic cationic protein values were higher in lichenoid/exudative type patients and total immunoglobulin E and eosinophil (%) were lower in nummular type patients. In prurigo-nodularis type patients, eosinophilic cationic protein and vitamin D deficiency were frequent. Vitamin D deficiency was infrequent in erythrodermic type patients. @*Conclusion@#Lichenoid/exudative type patients showed classical characteristics of atopic dermatitis, and related to extrinsic type. In nummular type, patients tend to be more intrinsic and less severe. In prurigo-nodularis type, patients would be related to frequent vitamin D deficiency. Erythrodermic type patients showed more extensive atopic dermatitis lesions and less frequent vitamin D deficiency.

A Case of Eruptive Xanthomatosis Improved after Narrow-Band Ultraviolet B Therapy / 대한피부과학회지

Eruptive xanthomatosis is a condition of extensive yellowish papules and nodules with fat deposits which can spread systemically. Although eruptive xanthomatosis is usually related to abnormal lipid metabolism, few cases have been reported in patients with normal lipid levels. The current treatment option is treatment of dyslipidemia by lifestyle modification and lipid-lowering agents. But treatment strategies in normolipidemia patients have not been established. Herein, we report an unusual case of eruptive xanthomatosis in normolipidemia patient showing clinical improvement after narrow-band ultraviolet B therapy

A Case of Alopecia Areata in a Patient with Type I Pityriasis Rubra Pilaris / 대한피부과학회지

There have been a few cases of alopecia areata (AA) patients with pityriasis rubra pilaris (PRP), but the relationship between them is unclear. To the best of our knowledge, there have been no cases of co-occurrence reported in Korea. A 58-year-old male presented with multiple erythematous follicular papules and scaly plaques on the both legs with diffuse keratotic thickening on both palms and soles for several months. After skin biopsy, he was diagnosed with type I PRP. After treatment with oral and topical steroid, vitamin D3 analogue, oral alitretinoin, and urea cream for one week, multiple, diffuse alopecic patches appeared. He was diagnosed with AA after skin biopsy and we added topical minoxidil. Herein, we report a case of AA in a patient with type I PRP.

A Case of Eruptive Xanthomatosis Improved after Narrow-Band Ultraviolet B Therapy / 대한피부과학회지

Eruptive xanthomatosis is a condition of extensive yellowish papules and nodules with fat deposits which can spread systemically. Although eruptive xanthomatosis is usually related to abnormal lipid metabolism, few cases have been reported in patients with normal lipid levels. The current treatment option is treatment of dyslipidemia by lifestyle modification and lipid-lowering agents. But treatment strategies in normolipidemia patients have not been established. Herein, we report an unusual case of eruptive xanthomatosis in normolipidemia patient showing clinical improvement after narrow-band ultraviolet B therapy

A Case of Alopecia Areata in a Patient with Type I Pityriasis Rubra Pilaris / 대한피부과학회지

There have been a few cases of alopecia areata (AA) patients with pityriasis rubra pilaris (PRP), but the relationship between them is unclear. To the best of our knowledge, there have been no cases of co-occurrence reported in Korea. A 58-year-old male presented with multiple erythematous follicular papules and scaly plaques on the both legs with diffuse keratotic thickening on both palms and soles for several months. After skin biopsy, he was diagnosed with type I PRP. After treatment with oral and topical steroid, vitamin D3 analogue, oral alitretinoin, and urea cream for one week, multiple, diffuse alopecic patches appeared. He was diagnosed with AA after skin biopsy and we added topical minoxidil. Herein, we report a case of AA in a patient with type I PRP.

Cap-assisted Endoscopic Mucosal Resection of Rectal Perineurioma Mimicking a Neuroendocrine Tumor / 대한소화기학회지

Colorectal perineuriomas are benign mucosal-based mesenchymal tumors composed of perineurial cells and show serrated or hyperplastic crypts in epithelium on histopathological evaluation. Most perineuriomas are usually presented as sessile polyps and often as subepithelial tumors. In this case, colonoscopy revealed a rectal subepithelial tumor (measuring approximately 7 mm) with yellowish-colored normal mucosa. A rectal neuroendocrine tumor was suspected, and cap-assisted endoscopic mucosal resection was performed. Histopathological examination of the resected specimen revealed bland spindle cells showing immunopositivity for CD34.The patient was finally diagnosed with rectal perineurioma

A Case of Acroangiodermatitis with Multiple Noduloulcerative Lesions on Both Lower Legs / 대한피부과학회지

Acroangiodermatitis is a rare, self-limiting, angioproliferative disorder associated with congenital vascular malformations or acquired venous insufficiency. The clinical features of acroangiodermatitis are notably similar to those of Kaposi sarcoma, making it difficult to differentiate between the two diseases. A 57-year-old male patient presented with multiple violaceous to black, crusted, indurated plaques with ill-defined margins on both swollen lower legs. A venous Doppler study of the bilateral lower limbs was unremarkable. A histopathological examination showed a hyperplastic epidermis, a prominent proliferation of small dilated vessels lined by plump endothelial cells in the dermis, hemosiderin deposits, and lymphocytic infiltrate around vessels. Immunohistochemical analysis showed CD31＋ and podoplanin＋ staining in endothelial cells.

A Case of Acroangiodermatitis with Multiple Noduloulcerative Lesions on Both Lower Legs / 대한피부과학회지

Acroangiodermatitis is a rare, self-limiting, angioproliferative disorder associated with congenital vascular malformations or acquired venous insufficiency. The clinical features of acroangiodermatitis are notably similar to those of Kaposi sarcoma, making it difficult to differentiate between the two diseases. A 57-year-old male patient presented with multiple violaceous to black, crusted, indurated plaques with ill-defined margins on both swollen lower legs. A venous Doppler study of the bilateral lower limbs was unremarkable. A histopathological examination showed a hyperplastic epidermis, a prominent proliferation of small dilated vessels lined by plump endothelial cells in the dermis, hemosiderin deposits, and lymphocytic infiltrate around vessels. Immunohistochemical analysis showed CD31＋ and podoplanin＋ staining in endothelial cells.

Survival and Functional Outcomes after Hip Fracture among Nursing Home Residents

Following the implementation of a long-term care insurance system for the elderly in Korea, many nursing homes have been established and many more patients than ever before have been living at nursing homes. Despite the fact that this is a high-risk group vulnerable to hip fractures, no study has yet been conducted in Korea on hip fracture incidence rates and prognoses among patients residing at nursing homes. We recently studied 46 cases of hip fracture in nursing homes; more specifically, we investigated the most common conditions under which fractures occur, and examined the degree of recovery of ambulatory ability and the mortality within 1 yr. Among those who had survived after 1 yr, the number of non-functional ambulators increased from 8 hips before hip fracture to 19 hips at final post-fracture follow-up. These individuals showed poor recovery of ambulatory ability, and the number who died within one year was 11 (23.9%), a rate not significantly different from that among community-dwelling individuals. It was evident that hip-joint-fracture nursing home residents survived for similar periods of time as did those dwelling in the community, though under much more uncomfortable conditions. The main highlight of this report is that it is the first from Korea on nursing home residents' ambulatory recovery and one-year mortality after hip fracture. The authors believe that, beginning with the present study, the government should collect and evaluate the number of hips fractured at nursing facilities in order to formulate criteria that will help to enable all patients to select safer and better-quality nursing facilities for themselves or their family members.

Anesthetic experience using extracorporeal membrane oxygenation for cesarean section in the patient with peripartum cardiomyopathy: a case report / 대한마취과학회지

Peripartum cardiomyopathy is a rare form of cardiomyopathy that is associated with significant mortality. It can cause a cardiac arrest during cesarean section even though the patient does not have any previous symptom and sign. The most important thing of anesthesia in this patient is an optimization of hemodynamic and respiratory status. We report the successful general anesthesia using of extracorporeal membrane oxygenation for cesarean section in a 34-year-old woman with fulminant peripartum cardiomyopathy.

Simple Renal Cyst / 대한신장학회지

No abstract available.

Upregulation of Heat Shock Proteins in the Kidney in Hypertension

The present study was undertaken to determine the regulation of heat shock proteins (HSP) in the kidney in hypertension. Two-kidney, one clip (2K1C) or deoxycorticosterone acetate (DOCA) -salt hypertension was induced in male Sprague-Dawley rats. At weeks 1 and 4 after inducing the hypertension, the expression of HSP70, HSP32 and HSP25 was determined in the kidney by Western blot analysis. In 2K1C hypertension, the expression of HSP70, HSP32 and HSP25 was increased in the clipped kidney at both weeks 1 and 4. However, in the contralateral kidney, their expression was not significantly altered at week 1, but increased at week 4. In DOCA-salt hypertension, the expression of HSP remained unaltered in the remnant kidney at week 1, but significantly increased at week 4. These results indicate that HSP are differentially regulated in the kidney according to the duration and the model of hypertension.

A Study Concerning the Psychopathology and Psychiatric Consultaion of Medical Outpatients: Focused on Medical Outpatients Compared with Health Control Group / 신경정신의학

OBJECTIVES: This study was carried out to investigate the characteristics of psychopathology of medical outpatients and to consider the necessity of psychiatric intervention. METHODS: Total 840 subjects were selected for this study. They were divided into two groups; patient group included 482 medical outpatients of our hospital, and the control groups included 190 ordinary people who have not been ill and 168 people who visited health care center. SCL-90-R (Symptom Checklist-90-Revision), BDI (Beck Depression Inventory), and STAI (State-Trait Anxiety Inventory) were used to measure psychopathology. A self-reported questionnaires were conpreted by the subjects and the hospital records were reviewed to find out the clinical characteristics and psychiatric consultation if any. RESULTS: 1) In the results of SCL-90-R, the patient group showed higher levels of somatization, depression, anxiety and psychosis in compared to the control group. 2) In the results of BDI, more people answered that they had serions difficulty in the patient group than in the control group. 3) In the results of STAI, the patient group showed higher score in the trait-anxiety as well as state-anxiety than the control group. 4) Many medical outpatients thought of psychological factor as the cause of their illnesses. 5) Despite medical outpatients were likely to suffer from physical symtoms of psychological causations, psychiatric consultation was no more than 3.1%. CONCLUSION: While medical outpatients showed overt depression, anxiety, somatization, psychosis, there was few psychiatric intervention. In considering that the depression and anxiety have a negative effect on medical outpatients, psychiatric consultation and treatment is needed to expand in the clinical field.

Cytokine Profile in the Aspirated Cystic Fluids in Autosomal Dominant Polycystic Kidney Disease (ADPKD) Patients / 대한신장학회잡지

BACKGROUND: The pathogenesis of ADPKD is still unknown but the proliferation of cystic epithelia and the fluid secretion to cystic lumen are thought to be important. Cytokines play a pivotal role in growth, differentiation, and apoptosis in general, but there were few reports about the cytokine profile in ADPKD cysts. METHODS: In this study, we measured cytokine content in aerobic culture-negative cystic fluids from 23 patients with symptomatic normal to end-stage (n=3) ADPKD in order to elucidate the possibility that cytokines are related to the development and progression of disease. Enzyme-linked immunosorbent assays (ELISAs) were used to detect IL-1beta, IL-2, IL-4, IL-6, IL-10, and IFN-gamma with commercial kits. RESULTS: Male to female ratio was 6 : 17 and the median age at examination was 52 years (range 36 to 78). IL-1beta was present in 18 of 23[78%] (11 to 173 pg/mL), IL-2 in 18 of 23[78%] (5 to 159 pg/ mL), IL-4 in 9 0f 23[39%] (8 to 156 pg/mL) and IL-6 in 10 of 23[43%] (16 to 1498 pg/mL). IL-10, and IFN-gamma were not detected. IL-1beta concentrations correlated directly with those of IL-2 (r=0.7671). IL- 6 levels in patients with azotemia (n=7) [288.4+/-26.2 (mean+/-S.D.)] were significantly higher than those of normal renal function group (98.3+/-413.9)(p<0.01). Such difference was not found in other cytokines. Cytokine concentrations did not correlate with sodium concentrations, nor with cystic fluid osmolality, indicating that differences in concentrations among fluids could not be explained by differences in water content. And, there was no significant correlation between the intracystic concentrations of these cytokines and the corresponding cyst diameters. CONCLUSION: These data identify proinflammatory cytokines as possible mediators to the morbidity of ADPKD. Especially, IL-6 levels of cystic fluid were elevated in the azotemic ADPKD patients.

No Association of TGF-beta Gene Polymorphism with the Progression of Autosomal Dominant Polycystic Kidney Disease(ADPKD) in Korean Patients / 대한신장학회잡지

BACKGROUND: Two genetic loci, PKD1 and PKD2, have been identified as being responsible for ADPKD, and PKD1 is known to be associated with poor prognosis. However, the presence of intrafamilial clinical diversity suggests the presence of disease-modifying loci. Because the mechanism of renal failure in ADPKD includes cystic growth and tubulointerstitial atrophy and fibrosis, we studied the associations between two cytokine gene polymorphisms in the TGF-beta gene, which are known to be related with chronic tubulointerstitial inflammation, and ADPKD progression in Korean patients. METHODS: 47 normal controls and 114 individuals with ADPKD were genotyped by PCR-RFLP, and the TGF-beta gene leader sequence of T869C(Leu10Pro) variant was compared with MspA1I and G915C (Arg25Pro) with BglI. Statistic significances were determined using the Chi-square test. RESULTS: The distribution of alleles for the TGF-beta Leu10Pro polymorphism in ADPKD was : T 52%, C 48%, which was similar to the Korean(56 : 44, p= 0.670) and Western controls(65 : 35), and in addition, no differences were found between the CRF and the non-CRF groups(p=0.571) or the early hypertension and the normotension groups(p=0.252). The distribution of alleles for the TGF-beta Arg25Pro polymorphism was all GG type, which was different from Western controls(90 : 10, p=0.000). CONCLUSION: Our results suggest that the polymorphism at Arg25Pro of TGF-beta in Korean population has different allele distribution from Western, and the polymorphism at Leu10Pro of TGF-beta has no association with the renal progression of Korean ADPKD patients.

Pharmacokinetics of Antimycobacterial Drugs in Peritoneal Dialysis / 대한신장학회잡지

BACKGROUND: Tuberculosis is more prevalent in dialysis patients than in the general population, and more difficult to make a diagnosis, and often leads to death, Moreover, extra-caution is needed in prescribing anti-tuberculosis medications as dose modification is frequently needed in patients with renal insufficiency. Several pharmacokinetic studies have been performed for antimycobacterial regimens in patients with renal insufficiency, including under hemodialysis. However, the anti-mycobacterial regimens of patients on peritoneal dialysis have been made based on empirical methods because of few pharmacokinetic studies. METHODS: To elucidate the pharmacokinetic profiles of anti-mycobacterial regimens for peritoneal dialysis, we measured both plasma and peritosol concentrations of anti- tuberculous drugs including isoniazide, rifampin and pyrazinamide in 9 patients maintained on chronic ambulatory peritoneal dialysis(CAPD). RESULTS: After a conventional oral dose of anti-tuberculosis medication, their plasma concentrations were in the therapeutic range, but the peritosol concentration of rifampin was below the therapeutic range. CONCLUSION: No dose adjustments are required for isoniazid, rifampin and pyrazinamide for the treatment of systemic or peritoneal tuberculosis in CAPD patients. On the contrary, oral rifampin is not expected to be effective in the treatment of tuberculous peritonitis, because of its low peritosol concentration.

A Case of Hydronephrosis as a Complication of Pelvic Actinomycotic Abscess / 대한신장학회잡지

Pelvic actinomycosis is a chronic granulomatous suppurative disease caused by an anaerobic gram- positive organism Actinomyces israelii. It is commonly associated with an intrauterine device(IUD) and can mimick pelvic or intra-abdominal malignant neoplasm. Ureteral obstruction leading to hydronephrosis is a rare complication of tubo-ovarian abscess. We experienced a case of hydronephrosis as a complication of pelvic actinomycotic abscess. The patient was a 46-year-old women presenting with fever and right flank pain. Leukocytosis and pyuria were present and a hydronephrosis was diagnosed by intravenous pyelography. Ultrasonography and a computerised tomography revealed a mass in right adnexum compressing the right ureter. Removal of retroperitoneal abscess and salphingo-oophorectomy were done and the diagnosis of actinomycosis was made by pathologic finding of resected mass. Postoperatively, the patient was treated with second-generation cephalosporin successfully.

Development of a Dose Calibration Program for Various Dosimetry Protocols in High Energy Photon Beams / 대한방사선종양학회지

PURPOSE: To develop a dose calibration program for the IAEA TRS-277 and AAPM TG-21, based on the air kerma calibration factor (or the cavity-gas calibration factor), as well as for the IAEA TRS-398 and the AAPM TG-51, based on the absorbed dose to water calibration factor, so as to avoid the unwanted error associated with these calculation procedures. MATERIALS AND METHODS: Currently, the most widely used dosimetry protocols of high energy photon beams are the air kerma calibration factor based on the IAEA TRS-277 and the AAPM TG-21. However, this has somewhat complex formalism and limitations for the improvement of the accuracy due to uncertainties of the physical quantities. Recently, the IAEA and the AAPM published the absorbed dose to water calibration factor based, on the IAEA TRS-398 and the AAPM TG-51. The formalism and physical parameters were strictly applied to these four dose calibration programs. The tables and graphs of physical data and the information for ion chambers were numericalized for their incorporation into a database. These programs were developed user to be friendly, with the Visual C++ language for their ease of use in a Windows environment according to the recommendation of each protocols. RESULTS: The dose calibration programs for the high energy photon beams, developed for the four protocols, allow the input of informations about a dosimetry system, the characteristics of the beam quality, the measurement conditions and dosimetry results, to enable the minimization of any inter-user variations and errors, during the calculation procedure. Also, it was possible to compare the absorbed dose to water data of the four different protocols at a single reference points. CONCLUSION: Since this program expressed information in numerical and data-based forms for the physical parameter tables, graphs and of the ion chambers, the error associated with the procedures and different user could be solved. It was possible to analyze and compare the major difference for each dosimetry protocol, since the program was designed to be user friendly and to accurately calculate the correction factors and absorbed dose. It is expected that accurate dose calculations in high energy photon beams can be made by the users for selecting and performing the appropriate dosimetry protocol.

Sclerotherapy of Renal Cysts in Korean ADPKD Patients / 대한신장학회잡지

BACKGROUND: Autosomal dominant polycystic kidney disease(ADPKD) is the most common hereditary renal disease in adults, and its major complaints include pain and abdominal fullness due to cyst expansion. So far, for the control of these symptoms, cyst ablation with ethanol or tetracycline, laparoscopic manipulations and surgical marsupialization have been used. METHODS: We used conventional ethanol(n=9) or n-butyl cyanoacrylate(NBCA) plus lipiodol solution (n=18) or both(n=3) for separate cysts as the sclerosing agent in 24 adult Korean ADPKD patients. And their clinical courses after treatment were evaluated. RESULTS: The male to female ratio was 8 : 16 and the mean age at the treatment was 50 yrs(S.D. 13.1). Causes for aspiration were pain in 14 and abdominal fullness in 7 patients and the range for the cyst diameters aspirated were 5-16 cm. Flank pain or discomfort were decreased subjectively in most cases except two. Mean arterial pressures(S.D.) (mmHg) before and after procedure were as follows 112(11.1)(basal), 96(9.6)(1 month) and 98(9.7)(6 month)(p < 0.05, paired-t test). Blood urea nitrogen levels(mg/dL) were not changed 6 month later[24 (12.1) vs. 22(14.6)]. There was no major complication such as bleeding or infection and no death and associated with procedure. There was no difference of therapeutic effect according to sclerosing agent. CONCLUSION: NBCA was as effective as conventional ethanol for sclerotherapy in ADPKD and cyst ablation therapy showed a BP-lowering effect in short-term period.