A Comparison of Stent-Assisted Mechanical Thrombectomy and Conventional Intra-Arterial Thrombolysis for Acute Cerebral Infarction

BACKGROUND AND PURPOSE: We evaluated whether stent-assisted thrombectomy (SAT) is safer or more clinically beneficial than aggressive mechanical clot disruption (AMCD) for patients with acute intracranial artery occlusion. METHODS: We retrospectively analyzed the clinical data of 72 patients (33 with SAT and 39 with AMCD) who underwent intra-arterial thrombolysis for acute intracranial artery occlusions. Procedure parameters, clinical outcomes, and incidence of complications were compared between the SAT and AMCD groups. RESULTS: The time interval to recanalization was shorter in SAT patients (69.2+/-39.6 minutes, mean+/-standard deviation) than in AMCD patients (94.4+/-48.0 minutes, p<0.05). Recanalization was achieved in more SAT patients (91%) than AMCD patients (80%), but with no statistically significance. Urokinase was used less frequently in SAT patients (21%) than in AMCD patients (92%, p<0.05), and the incidence of symptomatic hemorrhages was lower in SAT patients (3%) than in AMCD patients (18%, p<0.05). Device-related complications in SAT patients comprised two cases of stent fracture and one case of distal migration of a captured thrombus. The proportion of patients with good outcomes, defined as scores from 0 to 3 on the modified Rankin Scale, was similar in the two groups at discharge (SAT, 46%; AMCD, 39%), but significantly higher in the SAT group than in the AMCD group at 3 months (64% vs. 40%, p<0.05) and 6 months (67% vs. 42%, p<0.05) after discharge. CONCLUSIONS: The outcomes and clinical parameters were better for SAT during thrombolytic procedures for acute intracranial artery occlusions than for AMCD for up to 6 months. However, some device-related complications occurred during stent interventions.

Expression of Toll-Like Receptors in Verruca and Molluscum Contagiosum

Recent studies indicate that several Toll-like receptors (TLRs) are implicated in recognizing viral structures and instigating immune responses against viral infections. The aim of this study is to examine the expression of TLRs and proinflammatory cytokines in viral skin diseases such as verruca vulgaris (VV) and molluscum contagiosum (MC). Reverse transcription-polymerase chain reaction and immunostaining of skin samples were performed to determine the expression of specific antiviral and proinflammatory cytokines as well as 5 TLRs (TLR2, 3, 4, 7, and 9). In normal human skin, TLR2, 4, and 7 mRNA was constitutively expressed, whereas little TLR3 and 9 mRNA was detected. Compared to normal skin (NS), TLR3 and 9 mRNA was clearly expressed in VV and MC specimens. Likewise, immunohistochemistry indicated that keratinocytes in NS constitutively expressed TLR2, 4, and 7; however, TLR3 was rarely detected and TLR9 was only weakly expressed, whereas 5 TLRs were all strongly expressed on the epidermal keratinocytes of VV and MC lesions. In addition, the mRNA expression of IFN-beta and TNF-alpha was upregulated in the VV and MC samples. Immunohistochemistry indicated that IFN-beta and TNF-alpha were predominately localized in the granular layer in the VV lesions and adjacent to the MC bodies. Our results indicated that VV and MC skin lesions expressed TLR3 and 9 in addition to IFN-beta and TNF-alpha. These viral-induced proinflammatory cytokines may play a pivotal role in cutaneous innate immune responses.

A Study on Clinical and Etiological Aspects of Chronic Urticaria by Questionnaire / 대한피부과학회지

BACKGROUND: Although urticaria is a common disorder that affects as many as 20% of all people at some time during their lifetime, the etiology of urticaria is still unknown in most cases. OBJECTIVE: We attempted to analyze the clinical characteristics of chronic urticaria according to etiological aspects. METHODS: The study was carried out on 230 patients with chronic urticaria, who visited our clinic with urticaria between March 2003 and February 2006. The diagnosis was made by detailed questionnaire and limited laboratory and provocation tests. RESULTS: Of the 230 patients with chronic urticaria, 138 (60.0%) presented with idiopathic urticaria, 53 (23.1%) autoimmune urticaria, 33 (14.4%) physical urticaria and 6 (2.5%) another type. Chronic idiopathic urticaria was combined with physical components in 97 cases (42.2%), and cholinergic component was the most common form. Chronic idiopathic urticaria and autoimmune urticaria showed a higher score than physical urticaria in the severity of disease, but there was no significant difference in the duration of urticaria. CONCLUSION: Our data shows the clinical-etiological aspects and classification of chronic urticaria. Although the symptom severity of chronic idiopathic urticaria and autoimmune urticaria is higher than that of physical urticaria, our data is limited to predict the treatment response rate or the prognostic variables of chronic urticaria owing to the short follow-up period. Further studies will be needed to identify the natural course of chronic urticaria.

Hinged Turnover Flap for Reconstruction of Nasal Ala Defect / 대한피부과학회지

Surgical remedy of nasal ala present a challenge to the reconstructive surgeon. As ala have anatomic complexity and a paired structure, reconstruction must be precise and aesthetically acceptable. The reconstruction of full-thickness ala defects often require staged surgical procedures, and they can introduce operational risks and consume extraordinary time and cost. However, a hinged turnover flap can offer a one-stage repair of full-thickness ala defects. With this procedure, satisfactory ala reconstruction was achieved in one step, and good aesthetic and functional results were obtained.

A Case of Streptococcal Toxic Shock Syndrome Clinically Presenting with Purpura Fulminans / 대한피부과학회지

Purpura fulminans is a term that describes an acute, often lethal, syndrome of hemorrhagic necrosis of the skin, due to dermal vascular thrombosis associated with vascular collapse and disseminated intravascular coagulation. Although it is seen in several clinical settings, it occurs most commonly in patients with acute, current infection. The causative organisms include meningococci, Gram-negative bacilli, staphylococci, streptococci and rickettsia. We report a case of streptococcal toxic shock syndrome in a 63-year-old female. She presented with irregular-shaped, massive ecchymoses and hemorrhagic bullae with progressive skin necrosis on her left thigh. Streptococcus pyogenes was found from blood culture and bulla, and multiple organ dysfunction occurred.

Expression of Toll-like Receptor 4 on Human Keratinocytes by Lipoteichoic Acid / 대한피부과학회지

BACKGROUND: We have recently shown that lipopolysaccharide (LPS), a major biologically active component of Gram-negative bacteria, mediate the activation of human keratinocytes by CD14 and Toll-like receptor (TLR 4). However, the mechanism of activation of keratinocytes by Gram-positive bacterial toxins remains unclear. OBJECTIVE: We investigated the mechanism of activation of human keratinocytes by lipoteichoic acid (LTA), a main stimulatory component of Gram-positive bacteria. METHODS: The effects of LTA on CD14, TLR2 and TLR4 mRNA expression were measured by quantitative RT-PCR in cultured human keratinocytes. To determine whether the effects of LTA on CD14, TLR2 and TLR4 expressions of the human keratinocytes were biologically functional, NF-kappaB nuclear translocation and IL-1alpha secretion were measured by immunofluorescence staining and ELISA, respectively. Furthermore, to determine whether these effects by LTA were specific for CD14, TLR2 and TLR4, some cells were pretreated with anti-CD14, anti-TLR2, or anti-TLR2 monoclonal antibodies prior to the addition of LTA. RESULTS: TLR4 mRNA expression on keratinocytes was augmented by exposure to LTA. LTA binding to keratinocytes resulted in NF-kappaB nuclear translocation and secretion of interleukin-1alpha. These responses by LTA were effectively abrogated by preincubating cells with anti-TLR4 monoclonal antibody, but not with anti-CD14 or anti- TLR2 monoclonal antibodies. CONCLUSION: These results indicate that, similar to LPS, LTA induces activation of human keratinocytes mainly through TLR4, however, in contrast to LPS signaling, LTA-induced keratinocyte activation is CD14-independent.

Two Cases of Fournier's Gangrene / 대한피부과학회지

Fournier's gangrene is a form of necrotizing fasciitis of the perineal, genital or perianal region due to perianal infection, urinary tract infection or local trauma. Even though many patients may present with minor skin lesions in the early stages of the disease, the natural course of this necrotizing disease is rapid progression of gangrene, eventually resulting in sepsis and death. Therefore, rapid and accurate diagnosis is the most important factor for a successful outcome. We report two cases of Fournier's gangrene in a 21-year-old and 24-year-old male, both of whom commonly presented with painful swelling and tenderness of the scrotum. Although one man showed a rapidly-spreading erythema and induration to the flank and lateral chest, they were both successfully treated with early antibiotic therapy and surgical drainage.

Study of Atopic Dermatitis Information on the Internet in Korea / 대한피부과학회지

BACKGROUND: The internet is an important and rapidly-evolving source of health-related information, and many patients with atopic dermatitis attempt to find information from the internet. OBJECTIVE: This study was performed to investigate the current information available on atopic dermatitis on the internet in Korea. METHODS: We chose two search engines and three community portal sites to analyze the information in which the topic of 'atopy' could be found. RESULTS: Among the 595 web sites and 1,485 communities, 97% of the web sites and 73.7% of the communities were related products or service advertisements, and some of them provided incorrect or exaggerated information. There were only 10 web sites and 20 available communities with genuine information, and most of these also presented unattested treatment methods, including alternative therapies. CONCLUSION: It is quite understandable that patients with atopic dermatitis want to seek information related to their disease, and the internet has the potential to be a useful source of information. However, there are no regulations to control the accuracy and quality of information on the internet. We should take an active role in identifying the accuracy and evaluating the quality.

A Case of Primary Perianal Actinomycosis / 대한피부과학회지

Actinomycosis is a chronic infection, which mainly affects of the cervicofacial area, thorax or abdomen, and is caused by anaerobic Actinomyces. The predilection site of abdominal involvement is the appendix and cecum. Although perianal actinomycosis as a secondary site of abdominal actinomycotic disease is a well known presentation, primary perianal actinomycosis without involvement of the internal organs is rare. We report a case of primary perianal actinomycosis. A 65-year-old male presented with a recurrent perianal abscess. Histopathologic findings showed acute and chronic inflammation with characteristic sulfur granules, composed of many basophilic, rod-like, Gram-positive bacilli, indicative of actinomycosis.

Classical Type Ehlers-Danlos Syndrome: Report of a Case and Review of Literature

No abstract available.