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Purpose@#We compared the efficacy of focal laser photocoagulation and intravitreal bevacizumab injection in the treatment of chronic central serous chorioretinopathy. @*Methods@#We conducted a retrospective analysis involving 46 eyes of 46 patients with chronic central serous chorioretinopathy who received focal laser photocoagulation (22 eyes) or intravitreal bevacizumab injection (24 eyes). Changes in best-corrected visual acuity (BVCA), central macular thickness, and rates of complete subretinal fluid (SRF) resolution and recurrence were compared over a 6-month period. @*Results@#Although the focal laser photocoagulation and intravitreal bevacizumab injection groups demonstrated a significant reduction in central macular thickness at 6 months (p < 0.001), no statistically significant differences were observed between these groups at the end of the follow-up period. Notably, a gradual improvement in BVCA was observed in both groups following initial treatment, with significant improvement seen at 6 months (p = 0.049 and p = 0.048 for the laser and injection groups, respectively). However, no statistically significant difference in BVCA improvement was observed between the groups. Complete SRF resolution was achieved in 22 eyes in the laser group and 23 eyes in the injection group. Although recurrence of SRF was observed in 9 and 13 eyes in the laser and injection groups, respectively, there was no statistically significant difference between the groups (p = 0.229). @*Conclusions@#Focal laser photocoagulation and intravitreal bevacizumab injection significantly improved anatomical and visual acuity outcomes in patients with chronic central serous chorioretinopathy. Although focal laser photocoagulation was associated with more rapid visual recovery and a lower recurrence rate compared to intravitreal bevacizumab injection, further studies are needed to evaluate its potential complications.
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As the aging population increases, the number of patients with osteoporosis is gradually rising. Osteoporosis is a metabolic bone disease characterized by low bone mass and the microarchitectural deterioration of bone tissue, resulting in reduced bone strength and an increased risk of low-energy or fragility fractures. Thus, the use of anti-resorptive agents, such as bisphosphonates (BPs), to prevent osteoporotic fractures is growing annually. BPs are effective in reducing hip and other fractures. However, the longer a patient takes BPs, the higher the risk of an atypical femoral fracture (AFF). The exact mechanism by which long-term BP use affects the development of AFFs has not yet been clarified. However, several theories have been suggested to explain the pathogenesis of AFFs, such as suppressed bone remodeling, impaired bone healing, altered bone quality, and femoral morphology. The management of AFFs requires both medical and surgical approaches. BPs therapy should be discontinued immediately, and calcium and vitamin D levels should be evaluated and supplemented if insufficient. Teriparatide can be used for AFFs. Intramedullary nailing is the primary treatment for complete AFFs, and prophylactic femoral nailing is recommended if signs of an impending fracture are detected.
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Background@#Acne is a complex inflammatory disorder affecting the pilosebaceous follicles of the skin. In the search for effective acne treatments, patients frequently turn to various social media platforms, including Instagram.Notably, diverse occupational groups contribute to Instagram on acne treatment, showcasing significant variations depending on the specific group. @*Objective@#This study investigated the impact and accuracy of acne treatment posts on the Korean Instagram platform. @*Methods@#We systematically examined the “top posts” with the hashtag #acne treatment, and 107 posts were included for analysis. Posts were excluded if they were not Korean, had other medical conditions, or were duplicates. @*Results@#The distribution of posts and their respective proportions were as follows: dermatologists (n=12, 11.2%), non-dermatologists (n=17, 15.9%), skin care centers (n=54, 50.5%), influencers (n=22, 20.6%), and retailers (n=2, 1.9%). Notably, dermatologists’ posts demonstrated a significantly lower number of followers and likes compared to those of skin care centers or influencer (p＜0.001, each). The similar trend was observed for the assessment of total engagement power (calculated as likes×1＋comments×1). Additionally, we evaluated the treatment accuracy of each post using the DISCERN criteria. The average DISCERN score of dermatologists’ posts was significantly higher than that of skin care centers or influencers (p＜0.001). @*Conclusion@#Our findings underscore that, despite possessing a greater level of accuracy in their information, dermatologists exert comparatively less influence on the Korean Instagram platform. Considering the recent increase in medical content on Instagram and the growing interest among patients, the role of dermatologists in providing reliable and informed guidance has become increasingly important.
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Background@#Atopic dermatitis (AD) is a common skin disease which, depending on its severity, can have a significant impact on the quality of life of affected individuals. In cases of severe AD, systemic immunomodulatory agents can be considered for treatment. However, the available treatment options for moderate AD are limited. According to previous reports, however, 308-nm excimer light is a potential treatment for localized, moderate AD. @*Objective@#This study aimed to assess the clinical efficacy and safety of 308-nm excimer light in Korean adults with AD. @*Methods@#This study included Korean patients aged over 19 years, who were diagnosed with AD by a dermatologist, with bilateral, symmetric, and eczematous lesions. The symmetrical lesions in each patient were treated as control-test pairs. Treatment with 308-nm excimer light was applied to the test lesion twice a week for 4 weeks. The severity of the eczema, trans-epidermal water loss, and epidermal capacitance were measured. @*Results@#A total of 25 participants were enrolled in the study. After the first visit, two participants withdrew, whereas the remaining 23 completed the study. There was a statistically significant improvement in AD severity in the test group than in the control group (p<0.001). Skin barrier function also improved in the test than in the control group (p<0.01). @*Conclusion@#This study provides preliminary evidence for the use of 308-nm excimer light as a treatment option to improve symptoms and skin barrier function in moderately localized AD.
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Laparoscopic sleeve gastrectomy (LSG) has become a standalone primary procedure as a bariatric metabolic surgery since the early 2000s. The overall complication rate of LSG is reported to range from 2% to 15%. Staple line leakage (SLL) remains a major adverse event and occurs in approximately 1%–6% of patients. Choosing the optimal treatment modality is a complex process. Clinicians must understand that nutritional support and drainage of fluid collection are essential for initial management. Conservative endoscopic management and sufficient drainage can resolve approximately 70% of SLLs. Endoscopic management of bariatric complications has been rapidly evolving in recent years and can be considered in all patients who are hemodynamically stable. We will review the available endoscopic management techniques, including stent placement (self-expanding stents and bariatric-specific stents), clipping, tissue sealant application, and internal drainage (double-pigtail stents [DPS] placement, endoscopic vacuum therapy, and septotomy). Stent placement remains the mainstream treatment for SLLs. However, healing with stents requires multiple sessions/stents and a long course of recovery. Endoscopic internal drainage is gaining popularity and has the potential to be a superior method. The importance of early intervention and combined endoscopic methods should be recognized.
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Purpose@#As coronavirus disease 2019 pandemic has been prolonged, it became crucial to analyze the long-term impact of the pandemic on emergency department (ED) utilization for efficient use of emergency medicine resources. @*Methods@#We reviewed the data of children (≤ 18 years) who visited the ED in Daejeon, Korea, from February 2019 through January 2021. This period was dichotomized by February 2020 into the reference and pandemic periods. The latter period was further divided into the early (February-August 2020) and late pandemic periods. Between the reference and pandemic periods, and between the early and late pandemic periods, we respectively compared proportions of children in all patients (including adults), age groups, high acuity (the Korean Triage and Acuity Scale 1-2), diagnostic codes, visits via ambulances, ED length of stay, and ED disposition. @*Results@#Compared to the reference and early pandemic periods, the pandemic and late pandemic periods respectively showed changes as follows: proportion of children in all patients (from 29.8% to 19.0% and from 19.8% to 18.1%; all Ps < 0.001), children younger than 5 years (from 56.7% to 49.9% and from 52.1% to 47.4%; all Ps < 0.001), high acuity (from 12.0% to 7.8% [P < 0.001] and from 8.8% to 6.7% [P = 0.004]), “Injury, poisoning and certain other consequences of external causes (S00-T98; from 30.0% to 49.0% and from 48.3% to 49.8%),” and “Diseases of the respiratory system (J00-J99; from 29.6% to 10.3% and from 12.8% to 7.5%).” Increases in the visits via ambulances, ED length of stay, children undergoing intensive care unit hospitalization or death were noted only in comparison between the reference and pandemic periods. @*Conclusion@#A long-term impact of the pandemic on ED use may be a decrease in the proportion of young or ill children.
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Angiolipoma is a benign fatty neoplasm that has components of proliferating blood vessels. These types of lesions commonly occur in the subcutaneous tissue of the limbs and trunk. Angiolipoma in the gastrointestinal tract is extremely rare, and the final diagnosis generally depends on histological examination of the excised biopsy. In most previously reported cases, the lesions were diagnosed and treated with surgical management. In this study, we report a case of gastric angiolipoma of approximately 4 cm in size that was diagnosed and treated with endoscopic submucosal dissection.
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Basal cell carcinoma (BCC) is the most common malignant tumor of the skin, with a nearly 2-fold increase in incidence rates over the last two decades. A punch biopsy is considered the primary diagnostic tool for BCC; however, recent studies have reported favorable sensitivity and specificity of dermoscopy as a diagnostic tool for this malignancy. Diagnosis of BCC using the “Menzies criteria” was associated with high sensitivity, and surgery performed immediately after clinico-dermoscopic diagnosis was associated with a high positive predictive value.Therefore, in view of the high diagnostic accuracy, positive predictive value, and cost-effectiveness, direct surgical treatment without preoperative biopsy may serve as a primary therapeutic strategy for BCCs that present with typical clinico-dermoscopic features. We report two cases of BCC in patients who underwent successful Mohs microsurgery without preoperative biopsy, using dermoscopy as a primary diagnostic tool.
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Background@#Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by recurrent abscesses, nodules, and fistulous tracts. Recently, novel staging systems, including sonographic scoring system of hidradenitis suppurativa (SOS-HS), have been widely introduced in HS. @*Objective@#To assess the efficacy of SOS-HS compared with Hurley staging and modified sartorius scoring (MSS) system and determine the necessity of ultrasound evaluation. @*Methods@#A radiologist performed an ultrasound evaluation, and three dermatologists reviewed the images and videos. Clinical characteristics, including staging and demographic data, were recorded by three dermatologists. The correlation of each staging system and the significance of vascularity (Doppler mode) and lesion depth on sonography were statistically analyzed. @*Results@#Among the 46 patients, 34.8% were classified as stage 1 and 3, and 30.4% were classified as stage 2 in the SOS-HS system, which was statistically higher than the Hurley staging (p＜0.0005). MSS score increased according to the SOS-HS stages (p＜0.0005, p=0.001). Vascularity and depth of involvement also increased with SOS-HS and Hurley staging. @*Conclusion@#Sonographic examination can be applied in HS severity assessment and documentation of the clinical characteristics of each lesion in detail. Special tools, such as Doppler mode and depth assessment, can also be useful in HS evaluation.
ABSTRACT
Angiolipoma is a benign fatty neoplasm that has components of proliferating blood vessels. These types of lesions commonly occur in the subcutaneous tissue of the limbs and trunk. Angiolipoma in the gastrointestinal tract is extremely rare, and the final diagnosis generally depends on histological examination of the excised biopsy. In most previously reported cases, the lesions were diagnosed and treated with surgical management. In this study, we report a case of gastric angiolipoma of approximately 4 cm in size that was diagnosed and treated with endoscopic submucosal dissection.
ABSTRACT
Basal cell carcinoma (BCC) is the most common malignant tumor of the skin, with a nearly 2-fold increase in incidence rates over the last two decades. A punch biopsy is considered the primary diagnostic tool for BCC; however, recent studies have reported favorable sensitivity and specificity of dermoscopy as a diagnostic tool for this malignancy. Diagnosis of BCC using the “Menzies criteria” was associated with high sensitivity, and surgery performed immediately after clinico-dermoscopic diagnosis was associated with a high positive predictive value.Therefore, in view of the high diagnostic accuracy, positive predictive value, and cost-effectiveness, direct surgical treatment without preoperative biopsy may serve as a primary therapeutic strategy for BCCs that present with typical clinico-dermoscopic features. We report two cases of BCC in patients who underwent successful Mohs microsurgery without preoperative biopsy, using dermoscopy as a primary diagnostic tool.
ABSTRACT
Background@#Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by recurrent abscesses, nodules, and fistulous tracts. Recently, novel staging systems, including sonographic scoring system of hidradenitis suppurativa (SOS-HS), have been widely introduced in HS. @*Objective@#To assess the efficacy of SOS-HS compared with Hurley staging and modified sartorius scoring (MSS) system and determine the necessity of ultrasound evaluation. @*Methods@#A radiologist performed an ultrasound evaluation, and three dermatologists reviewed the images and videos. Clinical characteristics, including staging and demographic data, were recorded by three dermatologists. The correlation of each staging system and the significance of vascularity (Doppler mode) and lesion depth on sonography were statistically analyzed. @*Results@#Among the 46 patients, 34.8% were classified as stage 1 and 3, and 30.4% were classified as stage 2 in the SOS-HS system, which was statistically higher than the Hurley staging (p＜0.0005). MSS score increased according to the SOS-HS stages (p＜0.0005, p=0.001). Vascularity and depth of involvement also increased with SOS-HS and Hurley staging. @*Conclusion@#Sonographic examination can be applied in HS severity assessment and documentation of the clinical characteristics of each lesion in detail. Special tools, such as Doppler mode and depth assessment, can also be useful in HS evaluation.
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This study investigated how physical and cognitive function and psychological factors affected the health-related quality of life (HRQoL, hereafter HQ) of stroke patients in South Korea. The study enrolled 32 right-handed subjects with chronic cerebral infarction with disability and preserved cognitive function (Mini-Mental State Examination ≥ 20). Physical disability was assessed using the modified Rankin Scale (mRS) and Korean modified Barthel Index (KMBI). Quality of life was measured using the World Health Organization Quality of Life-Abbreviated form (WHOQOL-BREF, hereafter WB) and the 36-Item Short-form Health Survey (SF-36) in face-to-face interviews. Psychological distress was investigated using the Beck Depression Inventory Scale-II. The associations of each domain of WB and SF-36 were investigated using Pearson correlation analyses. Physical disability was negatively correlated with HQ in the SF-36. The physical function and bodily pain scales of the SF-36 were negatively correlated with physical disability. The general health domain of the SF-36 was negatively correlated with psychological scores. Emotional status was associated with physical health, social relationships, and general health in HQ. In summary, the severity of physical disability was associated with the patient's general and physical health and body pain. These findings suggest the importance of psychological, cognitive, and physiological interventions for improving the quality of life of patients after cerebral infarction.
Subject(s)
Humans , Cerebral Infarction , Cognition , Depression , Health Surveys , Korea , Psychology , Quality of Life , Stroke , Weights and Measures , World Health OrganizationABSTRACT
This study investigated how physical and cognitive function and psychological factors affected the health-related quality of life (HRQoL, hereafter HQ) of stroke patients in South Korea. The study enrolled 32 right-handed subjects with chronic cerebral infarction with disability and preserved cognitive function (Mini-Mental State Examination ≥ 20). Physical disability was assessed using the modified Rankin Scale (mRS) and Korean modified Barthel Index (KMBI). Quality of life was measured using the World Health Organization Quality of Life-Abbreviated form (WHOQOL-BREF, hereafter WB) and the 36-Item Short-form Health Survey (SF-36) in face-to-face interviews. Psychological distress was investigated using the Beck Depression Inventory Scale-II. The associations of each domain of WB and SF-36 were investigated using Pearson correlation analyses. Physical disability was negatively correlated with HQ in the SF-36. The physical function and bodily pain scales of the SF-36 were negatively correlated with physical disability. The general health domain of the SF-36 was negatively correlated with psychological scores. Emotional status was associated with physical health, social relationships, and general health in HQ. In summary, the severity of physical disability was associated with the patient's general and physical health and body pain. These findings suggest the importance of psychological, cognitive, and physiological interventions for improving the quality of life of patients after cerebral infarction.
ABSTRACT
Background@#Our purpose in this study was to evaluate any deficiency of protein intake for different types of sarcopenia, including osteosarcopenia and sarcopenic obesity and to establish a cut-off value for the relationship between malnutrition, sarcopenia, and osteosarcopenia. @*Methods@#The cross-sectional study was performed using data from the Korea National Health and Nutrition Examination Survey. A total of 4,020 participants (men, 1,698 and women, 2,322) were analyzed in the present study. Sarcopenia is defined according to the criteria for the Asia Working Group for Sarcopenia. To evaluate the adequacy of protein intake, the value obtained by dividing the amount of protein consumed through food by the daily recommended protein amount (50 g/day) of Korean males was defined as the nutrient intake ratio. @*Results@#Total protein (P<0.001 in men, P<0.001 in women) and low dietary intake protein (P<0.001 in men, P=0.046 in women) were significantly lower in the sarcopenia group than in the normal group, and were significantly lower in the osteosarcopenia group than in the normal group for both men and women. The cut-off value of the adjusted weight of protein intake for sarcopenia was 0.58 g/kg/day in men and 0.98 g/kg/day in women. The cut-off value for adjusted weight of protein intake for osteo-sarcopenia was 0.8 g/kg/day in men and 0.5 g/kg/day in women. @*Conclusions@#A comprehensive dietary assessment to detect nutritional deficits that predispose one to or aggravate muscle atrophy is important for establishing a treatment plan for patients with malnutrition.
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A mucocele is a cystic dilatation of the vermiform appendix that contains mucous material. The symptoms associated with it are not specific and the diagnosis is seldom made prior to surgery. The reported prevalence in appendectomy specimens procured during surgery is 0.2-0.3%. Recently, we experienced a case of patient with appendiceal mucocele detected by colonoscopic examination. This case did not show typical colonoscopic features of a mucocele, demonstrating protrusion of mucin, in the absence of a smooth mound with normal overlying mucosa surrounding the appendiceal orifice. The case involved a 64-year-old woman who underwent a colonoscopy. An abdominopelvic computed tomography scan suggested a normal appendix. Subsequently, we performed an appendectomy. The pathologic finding was a low-grade appendiceal mucinous neoplasm.
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Purpose@#The aim of this study was to report our experiences of sleeve gastrectomy (SG) in obese patients with type 1 diabetes mellitus (T1DM) and to assess its metabolic outcomes through a review of the literature and a meta-analysis. @*Materials and Methods@#We conducted a retrospective review of the electronic medical records of all patients who underwent bariatric surgery between January 2008 and February 2019 at a single institution. A literature search was performed using PubMed, Cochrane library, and Embase, and a meta-analysis for each direct comparison between pre- and postoperative groups was performed using the random effects DerSimonian–Laird method. Results: We identified three obese patients with T1DM who underwent SG. The baseline body mass index (BMI), HbA1c, and total daily insulin dose was 40.8 (37-47.4) kg/m2 , 7.1% (6%-7.7%), and 92.3 (54-113) units, respectively. After surgery, the BMI and total daily insulin dose reduced to 32.2 (30.2-37.6) kg/m2 and 22.3 (12-40) units, respectively. However, the HbA1c increased to 7.8% (5.4%-10.8%). In the meta-analysis, the weighted mean reduction in BMI, HbA1c, and total daily insulin dose were 10.69 kg/m2 (95% CI 7.01-14.37, P＜0.00001, I2 =0%), 0.3% (95% CI −0.10-0.71, P=0.1447, I2 =0%), and 58.52 units (95% CI 15.96-101.08, P=0.07, I2 =0%), respectively. @*Conclusion@#SG showed excellent weight-reducing effects during a short follow-up period in obese patients with T1DM and improved the glycemic control by reducing insulin requirement.
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Purpose@#The purpose of this study is to evaluate the usefulness of individualized metabolic surgery score for Korean patients in determining bariatric surgical procedures. @*Materials and Methods@#A total of 135 patients with type 2 diabetes mellitus who underwent sleeve gastrectomy (n=19) or Roux-en-Y gastric bypass (n=116) at our institute with a 1-year follow up were analyzed for the predictive power of diabetes remission using the individualized metabolic surgery scoring system. @*Results@#At the postoperative follow-up of 1 year, the remission of type 2 diabetes mellitus (HbA1C＜6.5%, off medications) was achieved in 88 (65.2%) patients. The remission rates showed no significant differences between patients who underwent sleeve gastrectomy and Roux-en-Y gastric bypass (63.2% versus 65.5%; P=0.84), regardless of the severity of type 2 diabetes mellitus. Although there was no statistically significant difference in the remission rate according to the bariatric surgery procedures (P＞0.99 in mild, P=0.11 in moderate, P＞0.99 in severe IMS score), remission rates were higher in moderate severity patients who underwent Roux-en-Y gastric bypass than in those who underwent sleeve gastrectomy (69.7% versus 37.5%). @*Conclusion@#The remission rates after bariatric surgery procedures were similar to that of the previously reported study. Despite the limitations of our data, the individualized metabolic surgery score can be used as a complement to other scoring systems in Korean patients.
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Background@#Our purpose in this study was to evaluate any deficiency of protein intake for different types of sarcopenia, including osteosarcopenia and sarcopenic obesity and to establish a cut-off value for the relationship between malnutrition, sarcopenia, and osteosarcopenia. @*Methods@#The cross-sectional study was performed using data from the Korea National Health and Nutrition Examination Survey. A total of 4,020 participants (men, 1,698 and women, 2,322) were analyzed in the present study. Sarcopenia is defined according to the criteria for the Asia Working Group for Sarcopenia. To evaluate the adequacy of protein intake, the value obtained by dividing the amount of protein consumed through food by the daily recommended protein amount (50 g/day) of Korean males was defined as the nutrient intake ratio. @*Results@#Total protein (P<0.001 in men, P<0.001 in women) and low dietary intake protein (P<0.001 in men, P=0.046 in women) were significantly lower in the sarcopenia group than in the normal group, and were significantly lower in the osteosarcopenia group than in the normal group for both men and women. The cut-off value of the adjusted weight of protein intake for sarcopenia was 0.58 g/kg/day in men and 0.98 g/kg/day in women. The cut-off value for adjusted weight of protein intake for osteo-sarcopenia was 0.8 g/kg/day in men and 0.5 g/kg/day in women. @*Conclusions@#A comprehensive dietary assessment to detect nutritional deficits that predispose one to or aggravate muscle atrophy is important for establishing a treatment plan for patients with malnutrition.
ABSTRACT
Purpose@#The aim of this study was to report our experiences of sleeve gastrectomy (SG) in obese patients with type 1 diabetes mellitus (T1DM) and to assess its metabolic outcomes through a review of the literature and a meta-analysis. @*Materials and Methods@#We conducted a retrospective review of the electronic medical records of all patients who underwent bariatric surgery between January 2008 and February 2019 at a single institution. A literature search was performed using PubMed, Cochrane library, and Embase, and a meta-analysis for each direct comparison between pre- and postoperative groups was performed using the random effects DerSimonian–Laird method. Results: We identified three obese patients with T1DM who underwent SG. The baseline body mass index (BMI), HbA1c, and total daily insulin dose was 40.8 (37-47.4) kg/m2 , 7.1% (6%-7.7%), and 92.3 (54-113) units, respectively. After surgery, the BMI and total daily insulin dose reduced to 32.2 (30.2-37.6) kg/m2 and 22.3 (12-40) units, respectively. However, the HbA1c increased to 7.8% (5.4%-10.8%). In the meta-analysis, the weighted mean reduction in BMI, HbA1c, and total daily insulin dose were 10.69 kg/m2 (95% CI 7.01-14.37, P＜0.00001, I2 =0%), 0.3% (95% CI −0.10-0.71, P=0.1447, I2 =0%), and 58.52 units (95% CI 15.96-101.08, P=0.07, I2 =0%), respectively. @*Conclusion@#SG showed excellent weight-reducing effects during a short follow-up period in obese patients with T1DM and improved the glycemic control by reducing insulin requirement.