Onychomycosis in the Elderly / 대한의진균학회지

BACKGROUND: Onychomycosis is a common disease and has a tendency to increase in its incidence. Although there have been many reports about onychomycosis, very few studies about onychomycosis in the elderly have yet been conducted. OBJECTIVE: The purpose of this study was to investigate the clinical and mycological features of onychomycosis in the elderly, and to evaluate the concept and attitude of the elder patients towards onychomycosis, which would affect the treatment and further infections of onychomycosis. METHOD: Sixty eight onychomycosis patients over 60 years old were examined clinically and surveyed by questionnaire to evaluate their concern about the onychomycosis. All the patients were confirmed by potassium hydroxide (KOH) examinations and underwent cultures on the both cornmeal potato agar with and without cycloheximide. An additional culture was done a week later when the initial culture showed contamination or no growth. RESULTS: Among 648 patients with onychomycosis, 68 patients (10.5%) were over 60 years old. Fifty (73.5%) were female and 18 (26.5%) were male. Twenty six (38.2%) had systemic illness. The average duration of onychomycosis was 13 years and the average number of onychomycosis involving nails was 4.7. Sixty three patients (92.6%) had toe nail onychomycosis. Sixty six patients (97.1%) showed distal subungal onychomycosis. Trichophyton rubrum was the main causative organism in 38 patients (55.9%). Forty one patients (60.3%) discontinued the medication in 4 weeks, and 11 (16.2%) were treated over 12 weeks. From the questionnaire, only 10 patients reported previous treatment for this problem, but with duration of treatment no longer than one month. Fifty three patients had mere understanding atypical alternation in their nails before the visit. The main reasons of the discontinuing the medication were the cost of the treatment, physical discomfort due to age, and extended duration of the therapy. CONCLUSION: From this study, we noticed that the elder onychomycosis patients could be long time carriers of fungi because of their lack of the knowledge of onychomycosis and insufficient treatment. Therefore, it is necessary to educate and support to treat the elder patients effectively.

A Case of Reactive Perforating Collagenosis Associated with Tricuspid Regurgitation / 대한피부과학회지

Reactive perforating collagenosis(RPC) is a kind of perforating disorder characterized by the transepidermal elimination of altered dermal collagen. Two types have been recognized; the childhood or inherited form and the adult or acquired form. Acquired RPC is frequently associated with diabetes, chronic renal failure with nephropathy and liver disease. We describe a case of RPC in a 41-year-old woman of about 2 months' duration. She has had a problem of tricuspid regurgitation for 3 years. Skin lesions showed scattered umbilicated papules with central keratotic plugs, 0.3-0.8cm sized, located on the proximal extremities.

Effects of Long Term Administration of Vitamin A on Lipids of Liver Tissue and Serum in Rat / 대한피부과학회지

This study was carried out to determine the effect of long term administration of vitamin A on the changes of lipids in liver tissue and serum in rat. The animals were fed with control diet(200 ug/day) and high vitimin A diet(2, 000 ug/day) for 24 weeks. Vitamin A contents of liver in high vitamin A fed rats were increased linearly accordance with duration of the vitamin A administration, but levels of serum vitamin A showed unremarkable changes during the experimental period. Contents of cholesterol and triglycerides of vitarnin A fed rats were significantly higher than those of controls. Levels of HDL-triglycerides in v:itamin A fed rats were significantly higher than those of control rats during experimental period, while levels of HDL-cholesterol and HDL-phospholipids showed unremarkable changes during experimental period. Levels of individual cholesteryl esters showed undremarkable changes during experimental period in both animal groups.

The Clinical Features and Autopsy Findings of Multiple metastatic Nodular Melanoma / 대한피부과학회지

We have experienced a 50-year-old male patient, who died of multiple metastatic nodular melanoma which had the primary lesions on the right hallux and forefoot with eventual involvement of skin and internal organs. An autopsy was performed for the evidence of metastatic features of the internal organs and their spreading routes, with concurrent histopathologic findings. The autopsy findings revealed diffuse metastases to the ipsilateral femoral and inguinal lymph nodes via ascending vascular channels and to the internal organs: 1. The heart had multiple metastatic lesions on the pericardium and right ventricular wall. And the mediastinal, periaortic and periesophageal lymph nodes were also involved. 2. The both lungs were moderately indurated and focally discolored, and showed metastatic lesions in the right lower lobe and hilar areas, Melanoma cells were diffusely invaded to the interstitia and alveoli. 3. The right 5th and 6th ribs showed the invsion of melanoma cells on their bone marrows, periostia, and Haversians canals. 4. The liver was enlarged and showed multiple various sized nodules on the surface with adesion to the parts of peritoneum, omentum and diaphragm. Melanoma cells were seen mostly on and around the sinusoidal spaces and parenchyma. 5. The stomach wall had an ulcerated metastatic lesion and the melanoma cells invaded deeply into the muscle layer. 6. The pancreas was normal in its size and shape but had multiple metastatic lesions on the head and body with melanoma celi infiltration. 7. The both kidneys were grar ular surfaced and showed two metastatic lesions on the right renal cortex and two on the left. Renal tubules and parenchyma were widely invaded by melanoma cells but the glomerular tufts were intact. 8. The adreral and thyroid glands showed four and two metastatic lesions respectively and diffuse invasion of melanoma cells into the parenchyma. 9. The brain was normal in gross appearance, but the cortex was edematous and showed settered melanoma cell infiltration.

The Singnificance of Selection of the Finger and the Great Toe in Slit - skin Smears for Mycobacterium Leprae / 대한피부과학회지

Bacteriological index(BI) was calculated by slit-skin smears taken from the earlobe and the dorsal surfaces of the proximal phalanges of the index finger and of the great toe in 110 lepromatous leprosy patients who have been treated regularly by antileprosy chemotherapy. The bacteriaI indices from the three sites were compared, and the results were as follows. 1) Sixteen patients whose BI of the earlobe smear was 4. 0 in average shawed the highest degree of positivity of M. leprae in the smears taken from the finger and the great toe. 2) ln seventy-four patients whose BI of the earlobe smear was l. 0 or higher, eight (10.8%) showed higher BI in smears taken from both the finger and the great toe, fifteen (20. 3%) and twenty-seven(36. 5%) showed approximately the same BI in smears taken from the finger and the great toe, respectively, 3) In thirty-six patients whose BI of the earlobe smear was negative, twelve (33. 3%) showed higher BI in smears taken from both the finger and the great toe. 4) The mean value of BI of the three sites was 3.7 in the earlobe, 3. 2 in the finger and 3. 0 in the great toe. Comparing the BI of the three sites, the finger and the great toe were found to have comparable BI with the earlobe, although the BI of the earlobe was highest. The authors concluded that it was quite reasonable to include the finger and the great toe in slit-skin smears for M. leprae identification, particularly when the BI of the earlobe was negative. A follow-up investigation seems mandatory.