Clinical Characteristics of Mild Coronavirus Disease 2019 Inpatients / 계명의대학술지

About 30~50% COVID-19 hospital inpatients is reported to have mild clinical presentation, and the clinical course is known to be good even in the older population. In order to compare the clinical symptoms of mild patients with COVID-19 infection by age, the clinical symptoms and laboratory results were analyzed by dividing mild patients admitted to a dedicated hospital into three groups: under the age of 64, 65-84, and above 85 years of age.There was no difference in gender ratio by age among 555 mild cases. Concomitant diseases with significant differences by age were hypertension, diabetes, stroke, and coronary artery disease.Among the symptoms, cough and sore throat were different by age, and cough was significantly higher in the group under 64 years of age. Among the symptoms, cough and sore throat were different by age, and cough was significantly higher in the group under 64 years of age.The white blood cell count (WBC), neutrophil count, monocyte, blood sugar, procalcitonin, and creatinine were significantly higher in the 85 years old or older group, and the hemoglobin, albumin, and glomerular filtration rate (GFR) were significantly lower in the 85 years old or older group.

Clinical Characteristics of Mild Coronavirus Disease 2019 Inpatients / 계명의대학술지

About 30~50% COVID-19 hospital inpatients is reported to have mild clinical presentation, and the clinical course is known to be good even in the older population. In order to compare the clinical symptoms of mild patients with COVID-19 infection by age, the clinical symptoms and laboratory results were analyzed by dividing mild patients admitted to a dedicated hospital into three groups: under the age of 64, 65-84, and above 85 years of age.There was no difference in gender ratio by age among 555 mild cases. Concomitant diseases with significant differences by age were hypertension, diabetes, stroke, and coronary artery disease.Among the symptoms, cough and sore throat were different by age, and cough was significantly higher in the group under 64 years of age. Among the symptoms, cough and sore throat were different by age, and cough was significantly higher in the group under 64 years of age.The white blood cell count (WBC), neutrophil count, monocyte, blood sugar, procalcitonin, and creatinine were significantly higher in the 85 years old or older group, and the hemoglobin, albumin, and glomerular filtration rate (GFR) were significantly lower in the 85 years old or older group.

Positional Intraocular Pressure of Vitrectomized and Normal Fellow Eyes

PURPOSE: To compare posture-induced intraocular pressure (IOP) changes in vitrectomized eyes and normal eyes of patients who had vitrectomy in one eye. METHODS: A total of 31 patients older than 20 years of age who underwent vitrectomy were enrolled in the study. At least six months after vitrectomy, we measured IOP in both eyes using a rebound tonometer 10 minutes after the patient assumed sitting, supine, right lateral decubitus, and left lateral decubitus positions. Patients with a history of ocular surgery (not including vitrectomy) or recent medication use associated with IOP were excluded. IOP and ocular parameters of vitrectomized and normal fellow eyes were compared. For the decubitus position, IOP values of dependent and nondependent eyes were compared. RESULTS: No significant difference was observed in IOP between vitrectomized and normal eyes in the sitting and supine positions. The IOP for dependent eyes (on the lower side in the lateral decubitus position) was significantly higher than the IOP for nondependent eyes in both right lateral decubitus (right vitrectomized eye 19.31 ± 4.20 vs. 16.71 ± 4.02 mmHg, p < 0.001; left vitrectomized eye 18.35 ± 1.75 vs. 16.04 ± 3.02 mmHg, p = 0.003) and left lateral decubitus (right vitrectomized eye 17.32 ± 4.63 vs. 19.15 ± 3.83 mmHg, p = 0.004; left vitrectomized eye 16.19 ± 1.81 vs. 18.12 ± 2.29 mmHg, p < 0.001) positions. CONCLUSIONS: IOP was higher in the dependent than the nondependent eye in the lateral decubitus position, for both vitrectomized and nonoperated eyes.

A Case of Acute Posterior Multifocal Placoid Pigment Epitheliopathy Following Human Papilloma Virus Vaccination

PURPOSE: To report a case of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) that developed after human papilloma virus (HPV) vaccination. CASE SUMMARY: A 31-year-old woman experienced sudden bilateral blurred vision and paracentral scotomas four days before visiting the hospital. The symptoms occurred two weeks after the second vaccination with quadrivalent HPV vaccine (Gardasil®, MSD Korea, Seoul, Korea), and she had no pain or cold symptoms. At initial visit, the anterior chamber cells were observed, and the anterior vitreous was found to be clear. On fundus examination, multiple placoid yellow-whitish lesions were observed at the posterior pole, and fluorescein angiography showed early hypofluorescence and late hyperfluorescence with staining. Under a diagnosis of bilateral APMPPE, oral corticosteroid was used as treatment for two weeks, after which symptoms were resolved, anterior chamber cells disappeared, and lesions at the posterior pole markedly decreased. After five weeks, multiple hyperreflective areas on the outer retinal layers as well as missing photoreceptor and retinal pigment epithelial layers were almost recovered upon optical coherence tomography. CONCLUSIONS: Non-infectious uveitis such as APMPPE can rarely present after HPV vaccination. Further studies are necessary to understand whether HPV vaccine is a direct cause of uveitis.

Current Challenges in Diabetic Retinopathy: Are We Really Doing Better?

Management of diabetic complications has been a worldwide major global health issue for decades. Recent studies from many parts of the world indicate improvement in this area. However, it is unknown if such an improvement is being realized in Koreans. Although there is limited information regarding diabetic retinopathy management among Koreans, recent epidemiologic studies have indicated improved screening rates and less frequent visual impairment among type 2 diabetics. Moreover, results achieved with new diagnostic and treatment modalities aimed to improve diabetic retinopathy management are encouraging for both physicians and patients.

Beneficial Effect of Diet Intervention on School Children with Atopic Dermatitis

BACKGROUND: Atopic dermatitis (AD) is one of the most common skin disorders affecting infants and children. Food allergy is a strong risk factor for the development of AD. This study was designed to evaluate the improvement of symptoms among AD patients in the late childhood while they take the customized (organic, balanced, non-allergic, diverse vegetable, little saturated fat and trans fat free) diet. METHODS: Nineteen children with AD who agreed to the written consent were enrolled in the study from October to December, 2014. We supplied them with the customized diet for 8 weeks. Clinical evaluations, blood tests and nutritional status were conducted at baseline, at 4th and at 8th week. Eczema area and severity index (EASI) and Scoring atopic dermatitis (SCORAD) were used to determine the severity of AD. RESULTS: The mean age of 19 patients was 8.5±1.54 years. EASI and SCORD index were decreased after diet intervention (2.6±3.06 [standard deviation] vs. 2.0±2.93 P=0.026, 24.9±10.76 vs. 20.0±12.65 P=0.009). Pruritus scores using visual analogue scale, rated by patients and hemoglobin revealed statistically significant improvement after diet intervention. CONCLUSIONS: The customized diet helps to improve the symptoms of atopic dermatitis and the nutritional indicators. Additional long-term and large-scale studies are required as well as the development of various diets.

A Clinical and Radiological Study on 31 Palmoplantar Epidermal Cysts / 대한피부과학회지

BACKGROUND: Epidermal cysts seldom arise on the palm or sole because of the absence of pilosebaceous apparatus in palmoplantar skin. Palmoplantar epidermal cysts (PPECs) are not included in this location's tumor category, because they appear as slightly elevated, hardly movable dermal or subcutaneous nodules without a central punctum, unlike other epidermal cysts. As a result, PPECs often mimic corns, calluses, or verruca. OBJECTIVE: The purpose of this study was to review the clinical features of PPECs and to explore the usefulness of ultrasonography as a diagnostic tool. METHODS: We retrospectively reviewed the medical records and ultrasonographic findings of 31 patients with PPECs among 341 patients with a confirmed epidermal cyst. Among them, 12 patients were evaluated preoperatively by ultrasonography. The data were compared between the ultrasonographic diagnosis and the final diagnosis. RESULTS: Unlike previous reports, PPECs were relatively common, and comprised 9.1% (31/341) of all epidermal cysts. They also appeared more on the sole than on the palm. In addition, PPECs were confused with corns, calluses, and other benign tumors at the first visit, because of their different clinical features from ordinary epidermal cysts. However, preoperative ultrasonography of 12 cases enabled us to make a correct diagnosis. After the operation, no recurrence was found at the last follow-up in any of the patients. CONCLUSION: PPECs have some different clinical features compared to typical epidermal cysts with a non- palmoplantar location. Therefore, it is often difficult to distinguish PPECs from other benign tumorous conditions. However, ultrasonography was useful for the preoperative diagnosis of PPECs because of its safety, low cost, non-invasiveness and, most importantly, its accuracy.

Localized Intrahepatic Bile Duct Dilatation without a Visible Mass or Stone as depicted on CT Images: Findings of Malignancy Prediction

PURPOSE: This study was performed to evaluate factors that can predict the presence of a malignancy for localized intrahepatic bile duct dilatation without a visible mass or stone as depicted on CT images. MATERIALS AND METHODS: A total of 29 patients (male: 16, female: 13) who had localized intrahepatic bile duct dilatation without a visible mass, stone or injury as depicted on CT images were included in the study. A history of extrahepatic malignancy and biliary stone disease, tumor marker levels, CT findings of the intrahepatic bile duct and associated findings were reviewed. The findings were analyzed between two groups (patients with a malignancy and patients with benign disease) on follow-up. RESULTS: In 29 patients, 11 patients had malignant lesions (four metastases and seven cholangiocarcinomas). The history of an extrahepatic malignancy and the shape of an intrahepatic duct obstruction or stenosis as seen on CT were significantly correlated with the results between the benign and malignant group of patients. The follow-up results of the malignant group of patients indicated that for six patients who had developed a new mass, one patient each showed aggravation of ductal dilatation and thickening of the ductal wall. CONCLUSION: When a patient with localized intrahepatic bile duct dilatation without a definite cause has a history of an extrahepatic malignancy or shows abrupt tapering or irregular narrowing on CT images, short-term follow-up should be performed. The patient should be investigated carefully for mass formation or a change of the dilated bile duct due to a possibility of malignant ductal dilatation.

Effect of the surface modifications and the use of washer on the reverse torque of the implant prosthetic gold retaining screw / 대한치과보철학회지

The screw loosening is one of the complications that happen frequently in dental implant prostheses. The purpose of this study was to evaluate the changes of reverse/loosening (opening) torque of the screw according to the surface modifications by sandblasting and 24K gold electroplating as well as to determine the possibility of the clinical use of a washer in dental implant. The reverse torque of 4 experimental conditions(control, sandblasted, use of washers, electroplasted) was measured by digital torque gauge (Model MGT50Z, Mark-10 Corp., 458 West John Street Hicksville, NY 11801 USA). Electronic torque controller (Nobel Biocare DEA 020) was used in fastening the gold screws into abutment replicas. Mixed Linear Model Analysis method was used for statistical analysis. To examine the changes of screw thread surface, microphotographs were taken by Olympus PME-3 metallurgic microscope (Olympus Optical Co. Ltd., Tokyo, Japan). Within the limitations of this study, the following results were drawn: 1. The surface modifications of the gold screws and the use of a washer have significantly affected the reverse torque value compared to the control group (p<0.01). 2. Sandblasting and electroplating treatments demonstrated significantly higher reverse torque val-ue than that of control group. 3. The use of a washer may be one of the useful clinical methods that prevent the screw loosening. However, further studies are necessary for the material selection and design of the washer.

Comparison of CT Angiography and Conventional Angiography in Detection of Intracranial Aneursyms

PURPOSE: To evaluate the usefulness of CT angiography (CTA) for the detection and assessment of intracranial aneurysms, compared with the findings of conventional angiography (CA) and surgery. MATERIALS AND METHODS: Among 243 patients who underwent CTA because of suspected intracranial a-neurysm, 116 who underwent surgery were studied. The patients were divided into two groups. Group 1 consisted of 77 patients (94 aneurysms) who underwent both preoperative CTA and CA, while group 2 comprised 39 patients (47 aneurysms) who underwent preoperative CTA only. The detection rate, size, shape and direction of the neck and its relationship to the adjacent vessel of the intracranial aneurysm seen during CTA were retrospectively compared with those seen during CA and surgery. Two radiologists worked in a blinded fashion without access to clinical information. RESULTS: In group 1, the detection rate of aneurysms seen during CTA was 89 % (84 of 94 cases), and for CA was 95 % (89 of 94 cases). Among ten undetected aneurysms, four cases were less than 3mm in size and six were out of the scanning area. In group 2, the detection rate of aneurysms seen during CTA was 94 %(44 of 47cases). Among three undetected aneurysms, one case was less than 3mm in size and two were out of the scanning area. For delineation of an aneurysm (the direction and shape of the neck, for example), CTA was equal or superior to CA in 75 of 82cases(91 % ). CONCLUSION: CTA is a useful technique for the evaluation of intracranial aneurysms in the circle of Willis, but cannot depict all vessels in the brain. CTA performed in conjunction with CA is useful for the detection of intracranial aneurysms.

The Effects of the Heparin-Coated Maximum Arterial Re-Creation (MAC) Stent on Porcine Coronary Stent Restenosis

BACKGROUND: Stent thrombosis and late restenosis are still major limitations in the clinical use of coronary stenting. Heparin-coated stent may reduce the incidences of stent thrombosis and restenosis. Heparin-coated stents were compared with control stents in a porcine coronary stent restenosis model in order to evaluate the effects of heparin-coated stent on stent restenosis. METHODS: Heparin was coated on a stent by deposition of an ultra-thin polymeric film containing amine groups by means of plasma polymerization. And then stent was immersed in heparin solution. Stent overdilation injury (stent:artery=1.3:1.0) was performed with bare (Group I, n=4) and heparin-coated (Group II, n=5) MAC stents in porcine coronary arteries. Follow-up quantitative coronary angiography (QCA) was performed at 4 weeks after stenting. The histopathologic assessments (KERN=*)of stented porcine coronary arteries were compared in between 2 groups. RESULTS: 1)Luminal area of stented artery was 7.05+/-1.25 mm2 in Group I and 7.67+/-2.85 mm2 in Group II, which were not different between two Groups. 2)Histopathologic stenosis of Group I was 35.7+/-13.2%, which was higher than 28.6+/-14.7% of Group II (p<0.05). Ratio of neointima/media was 1.16+/-0.52 in Group I and 0.87+/-0.31 in Group II and neointimal area was higher in Group I than in Group II (3.81+/-1.78 mm2 vs. 2.82+/-1.11 mm2, p<0.05 respectively). 3)PCNA (Proliferating cell nuclear antigen) index of GroupI was 10.0+/-2.2%, which was higher than in Group II (6.8+/-4.0%). CONCLUSIONS: Heparin-coated MAC stent may be effective in the inhibition of neointimal proliferation in a porcine stent restenosis model.

Immunohistochemical and Ultrastructural Cellular Differentiation in Papillary and Solid Epithelial Neoplasm of the Pancreas

Papillary and solid epithelial neoplasm of the pancreas from five patients were studied using immunohistochemistry and electron microscopy to define the cellular origin of this type of tumor. The tumors ranged in diameter form 5.5 to 15 cm Grossly, these were well circumscribed by a firm, gray-white, fibrous capsule and their cut-surface showed mainly area containing mucinous substance with necrotic and hemorrhagic material, with some solid portion. Microscopically, there was a solid and papillary pattern, with uniform cells typically having round to ovoid nuclei containing indistinct nucleoli and eosinophilic, granular cytoplasm. Within the cytoplasm of the tumor cells, numerous PAS-positive granules were found. Immunostaining was positive for neuron-specific enolase(three of five cases), alpha1-antitrypsin and alpha1-antichymotrypsin(three of five cases) in the solid and papillary portion of the tumor. But no polypeptide hormone immunoreactive cells were present in all cases except for gastrin which showed focally weak positivity in the papillary area. Ultrastructurally, the papillary and solid epithelial neopasm of the pancreas showed evidence of acinar cell differentiation, because in the cell of one observed some zymogen-like granules and presence of annulate lamellae. But also, abundant typical neurosecretory granules were detected in the tumor cells ultrastructurally. Both facts suggested acinar and islet cell differentiation of the tumor. From the these findings, it concluded that papillary and solid epithelial neoplasm of the pancreas may be originated from a primordial cell which will be able to render both endocrine and exocine component.

Evaluation of DNA Ploidy of Bronchogenic Carcinomas by Image Analysis

In order to extract useful tumor cell-specific information. DNA contents and other morphological parameters were measured by image analysis. Single cell preparation was made from archived paraffin blocks of 14 cases of bronchogenic squamous cell carcinoma, poorly differentiated, by protease treatment. The cells were Feulgen stained, and DNA content, area, perimeter, and major axis of the tumor cell nuclei were measured. Inflammatory lymphocytes concurrent with the tumor cells were used as an internal standard. DNA ploidies of the lymphocytes and 2C tumor cells showed simple peaks with Gaussian distribution and mean coefficients of variation of 10% and 14% respectively. By the location and proportion of the tumor cells other than 2C cells, DNA ploidies could be classified into diploidy(1 case), polyploidy(2 cases), and aneuploidy(11 cases). The mean proportion of DNA aneuploidal tumor cells relative to the total tumor cells was 82.8%. In 8 cases, nuclear areas showed more or less overlapped distribution, whereas DNA contents showed discrete peaks. THes results suggest that many bronchogenic squamous cell carcinomas, poorly differentiated, have DNA aneuploidy and high proportion of aneuploidal cells, and that nuclear size and DNA content are more or less independent parameters.