Surgical Outcomes of Sphenoid Wing Meningioma with Periorbital Invasion

Objective@#: The aim of this study was to evaluate the clinical outcome of sphenoid wing meningioma with periorbital invasion (PI) after operation. @*Methods@#: Sixty one patients with sphenoid wing meningioma were enrolled in this study. Their clinical conditions were monitored after the operation and followed up more than 5 years at the outpatient clinic of a single institution. Clinical and radiologic information of the patients were all recorded including the following parameters : presence of PI, presence of peri-tumor structure invasion, pathologic grade, extents of resection, presence of hyperostosis, exophthalmos index (EI), and surgical complications. We compared the above clinical parameters of the patients with sphenoid wing meningioma in the presence or absence of PI (non-PI), then linked the analyzed data with the clinical outcome of the patients. @*Results@#: Of 61 cases, there were 14 PI and 47 non-PI patients. PI group showed a significantly higher score of EI (1.37±0.24 vs. 1.00±0.01, p<0.001), more frequent presence of hyperostosis (85.7% vs. 14.3%, p<0.001), and lower rate of gross total resection (GTR) (35.7% vs. 68.1%, p=0.032). The lower score of pre-operative EI, the absence of both PI and hyperostosis, smaller tumor size, and the performance of GTR were associated with lower recurrence rates in the univariate analysis. However, in the multivariate analysis, the performance of GTR was the only significant factor to determine the recurrence rate (p=0.043). The incidences of surgical complications were not statistically different between the subtotal resection (STR) and GTR groups, but it was strongly associated tumor size (p=0.017). @*Conclusion@#: The GTR group showed lower recurrence rate than the STR group without differences in the surgical complications. Therefore, the GTR is strongly recommended to treat sphenoid wing meningioma with PI for the better clinical outcome.

Corrigendum to: Dual mechanisms for the regulation of brain-derived neurotrophic factor by valproic acid in neural progenitor cells

The authors note that on page 685, the acknowledgement of “This study was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MEST) (No. 2017R1D1A1B03031920),” should instead appear as “This study was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MEST) (No. 2017R1D1A1B03031920) and Chung-Ang University Research Grants in 2017.”

Dual mechanisms for the regulation of brain-derived neurotrophic factor by valproic acid in neural progenitor cells

Autism spectrum disorders (ASDs) are neurodevelopmental disorders that share behavioral features, the results of numerous studies have suggested that the underlying causes of ASDs are multifactorial. Behavioral and/or neurobiological analyses of ASDs have been performed extensively using a valid model of prenatal exposure to valproic acid (VPA). Abnormal synapse formation resulting from altered neurite outgrowth in neural progenitor cells (NPCs) during embryonic brain development has been observed in both the VPA model and ASD subjects. Although several mechanisms have been suggested, the actual mechanism underlying enhanced neurite outgrowth remains unclear. In this study, we found that VPA enhanced the expression of brain-derived neurotrophic factor (BDNF), particularly mature BDNF (mBDNF), through dual mechanisms. VPA increased the mRNA and protein expression of BDNF by suppressing the nuclear expression of methyl-CpG-binding protein 2 (MeCP2), which is a transcriptional repressor of BDNF. In addition, VPA promoted the expression and activity of the tissue plasminogen activator (tPA), which induces BDNF maturation through proteolytic cleavage. Trichostatin A and sodium butyrate also enhanced tPA activity, but tPA activity was not induced by valpromide, which is a VPA analog that does not induce histone acetylation, indicating that histone acetylation activity was required for tPA regulation. VPA-mediated regulation of BDNF, MeCP2, and tPA was not observed in astrocytes or neurons. Therefore, these results suggested that VPA-induced mBDNF upregulation was associated with the dysregulation of MeCP2 and tPA in developing cortical NPCs.

A Novel Mediastinal Drainage Tube for Mediastinitis

Mediastinitis is a life-threatening disease, and effective drainage is needed to treat mediastinitis with abscess formation. We recommend an alternative drainage method using chest tube binding with a Silastic Penrose drainage tube. The use of a Silastic Penrose drainage tube may help to manage mediastinitis with abscess formation. This method facilitates effective draining and prevents tissue adhesion.

A Case of Treatment of Traumatic Recurrent Frontal Sinusitis with T-tube / 대한이비인후과학회지

The most common disease process involving the frontal sinus is infection secondary to inadequate drainage through the frontal recess. Obstruction of the frontal recess may result from rhinosinusitis, allergic rhinitis, nasal polyposis, tumor and traumatic injury. The principle treatments are not only ventilation and drainage but also removal of predisposing factors. If there is no response to conservative treatment, surgical treatment is considered. To prevent closure of the frontal recess, external approach, endoscopic approach, grafts, indwelling tubes and mucoperiosteal flaps have been used. Insertion of silicone tube in frontal recess is a simple and easy method of drainage through frontal recess. We report a case of traumatic recurrent frontal sinusitis which was treated by endoscopic sinus surgery with silicone T-tube insertion.

Comparison of the Effect of High-Dose Steroid with That of Super-High-Dose Steroid Therapy in Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Corticosteroids have been used for therapeutic management of sudden sensorineural hearing loss (SSNHL). Because the levels of steroid within inner ear after systemic administration is very low, high-dose steroid regimens have been used. The purpose of this study is to compare the effect of high-dose (HD) steroid therapy with that of super-highdose (SHD) steroid therapy in SSNHL. SUBJECTS AND METHOD: The study group consisted of 97 patients diagnosed as SSNHL. They were divided into two groups : those who were administered 60 mg prednisolone as the initial high dose (HD group) and those who were administered 1,200 mg hydrocortisone (about 300 mg prednisone) as the super high dose (SHD group). RESULTS: Hearing improvement was observed in 76.8% of HD group and in 67.9% of SHD group and there was no statistically significant difference in the rate of hearing improvement between HD group and SHD group. CONCLUSION: Super-high-dose steroid regimen is not superior to high-dose steroid regimen in the treatment of SSNHL.

Is Helicobacter Pylori the Pathogen of Chronic Tonsillitis? / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tonsillar tissue is a component of mucosa-associated lymphoid tissue (MALT), which has evolved to protect vulnerable mucosal surfaces. Helicobacter pylori, implicated as an etiological factor in duodenal ulcer and gastritis, induces the appearance of lymphoid aggregates in the stomach. Therefore, we investigate the possibility that tonsils can be extragastric reservoir and target tissue for H. pylori. SUBJECTS AND METHOD: Campylobacter-Like Organism (CLO) test and immunohistochemical (IHC) analysis for H. pylori was performed on 98 patients undergoing tonsillectomy. Chronic tonsillitis group (62 patients) and controlled group (36 patients) were enrolled in this study. Tissue samples were collected from excised palatine tonsils. Two millimeter diameter tissue piece that had been obtained from palatine tonsil specimens were placed in the CLO test kit. Remnant tonsils were sent to the Department of Pathology for IHC analysis. RESULTS: Using the CLO test, H. pylori was detected in 60 (61.2%) of the 98 patients, 39 (62.9%) of 62 in chronic tonsillitis group and 21 (58.3%) of 36 in control group. Using the IHC analysis, it was detected in 54 (55.1%) of the 98 patients, 35 (56.5%) of 62 in chronic tonsillitis group and 19 (52.8%) of 36 in control group. There are no significant differences between chronic tonsillitis group and control group with regard to both CLO & IHC analysis. CONCLUSION: This result suggests that palatine tonsil represents an extragastric reservoir for H. pylori infection, but not a target tissue.

A Case of Contact Dermatitis from Henna Tattooing / 대한피부과학회지

The art of body adornment by body piercing and tattooing has become increasingly popular in our modern culture. Temporary henna tattoos are readily available worldwide, last several weeks on the skin, and offer a self-limited, convenient alternative to a permanent tattoo. The addition of para-phenylenediamine (PPD), which is widely recognized as a sensitizer, increases the risk of allergic contact dermatitis from these henna tattoo mixtures, and a number of cases have been reported. We report a case of contact dermatitis from a henna tattoo mixture, which was diagnosed by the patch test and identification and quantification of PPD and nickel in a temporary henna tattoo.

A Case of Basal Cell Carcinoma and Verruca Vulgaris Arising from Nevus Sebaceus / 대한피부과학회지

No abstract available.

Short-term Effects of 308-nm Xenon-chloride Excimer Laser and Narrow-band Ultraviolet B in the Treatment of Vitiligo: A Comparative Study

We compared the clinical efficacy of a short-term intervention of 308-nm excimer laser with that of narrow-band UVB (NBUVB) phototherapy for vitiligo patients to see the early response. Twenty-three symmetrically patterned patches of vitiligo on 8 patients were selected. Vitiligo patches on one side of the body were treated 2 times per week for a maximum of 20 treatments with the excimer laser, and NBUVB phototherapy was used on patches on the other side. Improvement (repigmentation) was assessed on a visual scale via serial photographs taken every five treatments and scored as follows: 0, or=75% improvement. At five treatments, the excimer laser-treated patches had an average score of 0.26, compared with 0.04 for patches treated with NBUVB phototherapy. A slightly higher repigmentation (p>0.05) in the excimer treated area was thus observed. At 10, 15, or 20 treatments, the differences between the average scores were significant: 0.83, 1.17, and 1.39 for the excimer-treated patches, and 0.17, 0.30, and 0.74 for the NBUVB pho-totherapy-treated areas (p<0.05). In conclusion, the 308-nm excimer laser appears to be more effective than NBUVB phototherapy, as it produces more rapid and profound repigmentation.

Concurrent Reactivation of Varicella Zoster Virus and Herpes Simplex Virus in an Immunocompetent Child

Latency within the nervous system is a characteristic feature of herpesviridae infection. It is reactivated by triggering factors such as UV exposure, stress, and trauma. Simultaneous reactivation of herpes simplex and herpes zoster is uncommon, however, an observation provably explained by differences in the trigerring mechanism. Concurrent reactivation of herpes simplex virus (HSV) and varicella zoster virus (VZV) is occasionally encountered in immunosuppressed patients; on the other hand, it is rarely reported in immunocompetent individuals. We present the case of an immunocompetent 8-yr-old female patient with concurrent reactivation of HSV on the face and VZV on the right L2 dermatome.

Quality of Life in Psoriasis Patients / 대한피부과학회지

BACKGROUND: Psoriasis is a chronic inflammatory skin disease and it has been shown to impact the quality of life (QOL) of the patients to which was known to be almost the same degree as other more life threatening disorders. Until now little is known about the impact of psoriasis on QOL in Korean psoriasis patients. OBJECTIVE: To investigate psoriasis related to the quality of life on the physical, social, psychologic aspects. METHOD: We applied forty one questionnaires to 100 psoriasis patients. And all the patient's condition was evaluated by the Psoriasis Area and Severity Index (PASI). RESULTS: 1. Disability score of PDI on the physical, social, and psychological aspects were 2.20, 1.65, and 1.78, respectively. 2. Physical disability showed no differences according to age(between below 39 years old group and above 40 years old group), marriage, and sex. However, the group with higher PASI score (>15) showed more disability than the group with lower PASI score in the physical aspect (p15) group showed more disability than the lower PASI score group in the social aspect (p15) group showed more disability than the lower PASI score group in the psychologic aspect (p<0.01). CONCLUSION: Most of psoriasis patients had moderate to severe disadvantage in their QOL. Therefore, it is important for the dermatologist to recognize patient's physical, social, and psychologic distress on counseling and management. And further research is needed to determine appropriate parameter to measure the degree of disability of psoriasis patients on quality of life aspect.

Identification of UVB Effects on Gene Expressed by Normal Human Melanocytes / 대한피부과학회지

BACKGROUND: Irradiation of the skin with ultraviolet rays result in alterations of immune response as well as melanogenesis and melanocarcinogenensis. These effects are largely mediated by soluble mediators released from epidermal cells in response to ultraviolet rays. OBJECTIVE: To evaluate the effect of ultraviolet B (UVB) irradiation on the normal human melanocyte gene expression. METHODS: We demonstrated genes modulated by UVB irradiation among over 300 genes coding CDs, cytokins, growth factors, and growth factor receptors in normal human melanocytes by cDNA microarray technique. RESULTS: Two genes out of 384 genes in cultured normal human melanocytes were found up-regulated following UVB irradiation. They are the genes coding lactotransferrin and CD160. Forty one genes out of 384 genes were found down-regulated by UVB irradiation. They included the genes coding IL-9, IL-5, TNF-alpha, TNF-beta, IL-6 receptor and CD20. CONCLUSION: These results provide the basis for future studies on the immunologic role in modulated genes by UV-stressed human melanocytes.

A Case of Cutaneous Cholesterol Embolism / 대한피부과학회지

Cutaneous cholesterol embolism is a disease due to the embolism of cholesterol crystals from ulcerated atheromatous plaques to peripheral vessels of the skin. It has been associated with major vessel surgery, angiography, angioplasty, intra-aortic balloon pump placement, anticoagulation, thrombolytic therapy and cardiopulmonary resuscitation. In addition, it may occur spontaneously. In paraffin-fixed sections, the cholesterol crystals are dissolved and leave needle-like clefts within the lumina of arterioles. We report a case of cutaneous cholesterol embolism in a 72-year-old woman who had purplish gangrenous lesions on both her feet after coronary angiography and percutaneous transluminal coronary angioplasty.

Clinical and Epidemiologic Study of Adult Measles / 대한피부과학회지

BACKGROUND: Clinical manifestations and complications of measles are more severe in adults than children. But, there has been few clinical and epidemiologic data about adult measles in Korea. OBJECTIVE: We investigated clinical features, laboratory findings, disease courses and complications and discussed the reason why measles incidence has been increasing recently in young adults to find out the solutions to prevent measles. METHOD: From April 1999 to February 2001, we examined prodromal symptoms, skin rash, complications, routine CBC, and blood chemistry of 42 adults who were admitted in KangBuk SamSung Hospital for measles and performed qualitative serum measles specific IgM and IgG antibody test using ELISA method. RESULTS: Age distribution of most adult measle patients was between 15 and 25 years old(78.6%). Fever was found in all patients and cough, coryza, headache, myalgia, conjunctivitis, sore throat, nausea, diarrhea, and vomit were found in decreasing order of frequency. Skin rashes were started from the face and spread to trunk, arms and then legs in 37 patients out of 42. Five patients had skin rash in the face and trunk at the same time, and one had hemorrhagic rash. Koplik's spots were found in 26 patients (62%). Among them, 2 had Koplik's spots before the rash and 24 had Koplik's spots with the rash simultaneously or thereafter. Koplik's spots were disappeared as skin rash disappeared. Exfoliative dermatitis was found following the skin rash in one patient. Among 26 patients who performed qualitiative serum measles specific IgM and IgG antibody test using ELISA, the seropositivity of measles specific IgM was 70%, of measles specific IgG was 27%, and of both measles specific IgM and IgG was 12%. Complications were like this; hepatitis in 23, cervical lympadenitis in 20, laryngitis and bronchitis in 7, otitis media in 4, pneumonia on chest X-ray in 3, hepatosplenomegaly on upper abdomen ultrasonography in 5. Two patients were in pregnancy of 12 and 16 weeks, and the former had spontaneous abortion. Pnemonia and otitis media were recovered within average 5 days after administrating antibiotics and antipyretics.

Clinical and Epidemiologic Study of Adult Measles / 대한피부과학회지

BACKGROUND: Clinical manifestations and complications of measles are more severe in adults than children. But, there has been few clinical and epidemiologic data about adult measles in Korea. OBJECTIVE: We investigated clinical features, laboratory findings, disease courses and complications and discussed the reason why measles incidence has been increasing recently in young adults to find out the solutions to prevent measles. METHOD: From April 1999 to February 2001, we examined prodromal symptoms, skin rash, complications, routine CBC, and blood chemistry of 42 adults who were admitted in KangBuk SamSung Hospital for measles and performed qualitative serum measles specific IgM and IgG antibody test using ELISA method. RESULTS: Age distribution of most adult measle patients was between 15 and 25 years old(78.6%). Fever was found in all patients and cough, coryza, headache, myalgia, conjunctivitis, sore throat, nausea, diarrhea, and vomit were found in decreasing order of frequency. Skin rashes were started from the face and spread to trunk, arms and then legs in 37 patients out of 42. Five patients had skin rash in the face and trunk at the same time, and one had hemorrhagic rash. Koplik's spots were found in 26 patients (62%). Among them, 2 had Koplik's spots before the rash and 24 had Koplik's spots with the rash simultaneously or thereafter. Koplik's spots were disappeared as skin rash disappeared. Exfoliative dermatitis was found following the skin rash in one patient. Among 26 patients who performed qualitiative serum measles specific IgM and IgG antibody test using ELISA, the seropositivity of measles specific IgM was 70%, of measles specific IgG was 27%, and of both measles specific IgM and IgG was 12%. Complications were like this; hepatitis in 23, cervical lympadenitis in 20, laryngitis and bronchitis in 7, otitis media in 4, pneumonia on chest X-ray in 3, hepatosplenomegaly on upper abdomen ultrasonography in 5. Two patients were in pregnancy of 12 and 16 weeks, and the former had spontaneous abortion. Pnemonia and otitis media were recovered within average 5 days after administrating antibiotics and antipyretics.

Cyclosporine Combination Therapy in Alopecia Areata / 대한피부과학회지

BACKGROUND: Alopecia areata is a common dermatologic disorder and the course is so variable that some patients undergo spontaneous remission and others undergo total hair loss. There is no clearly superior therapy in the treatment of alopecia areata. The theory of autoimmune pathogenesis of alopecia areata suggests a potential therapeutic effect of cyclosporine. OBJECTIVE: We evaluated the therapeutic effect of oral cyclosporine combined with other modalities in severe and refractory alopecia areata. METHOD: 28 patients(M:16, F:12) with severe or refractory alopecia areata were treated with oral cyclosporine 3-4 mg/kg/day, oral prednisolone 5 mg/day, topical steroid and minoxidil for at least 3 months. Subjects were composed of 12 multifocal alopecia areata patients, 10 alopecia totalis patients, and 6 alopecia universalis patients. Blood pressure, CBC/DC, liver function test, BUN/Cr, Na/K/Cl, lipid series, and urinalysis were checked to avoid any side effects. RESULTS: 1. Of the 28 patients, 20 patients(71%) showed new hair growth, 5 patients(18%) did not respond to therapy and 3 patients(11%) were not available for follow up exams. 2. Mean time until new hair growth was 2.5 months. 3. Side effects occurred in 13 patients(47%), and they were as follows: 4 patients with hypertrichosis, 4 patients with gastrointestinal disturbances, 2 patients with abnormal urinalysis, and 3 patients with lipid series abnormality. 4. Three patients discontinued therapy due to side effects of 2 beause hypertrichosis and 1 because of abnormal urinalysis. CONCLUSION: Cyclosporine combination therapy is recommended in severe and refractory alopecia areata. Side effects were observed in 13 patients, but most of them were mild and transient. Severe side effects can be prevented by careful monitoring.

A Case of Sporotrichosis Treated with Oral Fluconazole / 대한의진균학회지

59-year-old man visited our clinic due to painful ulcer and crust on the left upper arm 12 months ago. On past history, he had been injured by steel pipe on the left forearm 18 months before. We diagnosed him lymphocutaneous sporotrichosis and treated him with fluconazole 200 mg/day for 11 weeks. He was cured without side effect and had no sign of recurrence during 10 months follow up. We noticed that fluconazole is one of the effective and safe drug in the treatment of sporotrichosis. However, it is necessary to clarify the appropriate dose and duration for treatment of sporotrichosis with fluconazole.

A Case of Sporotrichosis Treated with Oral Fluconazole / 대한의진균학회지

59-year-old man visited our clinic due to painful ulcer and crust on the left upper arm 12 months ago. On past history, he had been injured by steel pipe on the left forearm 18 months before. We diagnosed him lymphocutaneous sporotrichosis and treated him with fluconazole 200 mg/day for 11 weeks. He was cured without side effect and had no sign of recurrence during 10 months follow up. We noticed that fluconazole is one of the effective and safe drug in the treatment of sporotrichosis. However, it is necessary to clarify the appropriate dose and duration for treatment of sporotrichosis with fluconazole.