Evaluation of the Accuracy in Maximum Intensity Projection Images of Cerebral Computed Tomographic Angiography for the Diagnosis of Cerebral Vasospasm Following Subarachnoid Hemorrhage, in Comparison to Digital Subtraction Angiography

OBJECTIVE: The purpose of this retrospective study is to determine the accuracy of maximum intensity projection (MIP) images of computed tomographic angiography (CTA) for diagnosis of cerebral vasospasm (CV) following subarachnoid hemorrhage (SAH) compared with that of digital subtraction angiography (DSA). MATERIALS AND METHODS: For patients admitted to our hospital for SAH, MIP images of CTA and DSA were checked at admission, and images were taken again 1 week later. This protocol was used in 39 cases. MIP images of CTA and DSA examinations were reviewed by two independent readers. RESULTS: Accuracy of MIP images of CTA in various arterial segments, using DSA as the gold standard: the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for different segments varied from 84 to 97, 33–100, 84–100%, 25–85, and 79–97%, respectively, for readers. Accuracy of CTA in various vasospasm severity, using DSA as the gold standard: the sensitivity, specificity, PPV, NPV, and accuracy for different vasospasm severity varied from 44 to 100, 69–100, 36–100%, 61–100, and 88–100%, respectively, for readers. Accuracy of CTA in central segments versus peripheral segments, using DSA as the gold standard: the sensitivity, specificity, PPV, NPV, and accuracy for central segments and peripheral segments varied from 90 to 94, 68–83, 93–97%, 56–69, and 87–93%, respectively, for readers. CONCLUSION: MIP imaging of CTA is a useful modality when diagnosing CV after SAH.

The Role of Psychological Factors in Tinnitus / 한양의대학술지

Based on the limitation of biomedical model of tinnitus, more attention has been paid to personalities or psychological aspects. Depressive disorder, anxiety disorder, and sleep disturbance were comorbid illnesses of tinnitus and research showed that neurobiological mechanisms such as dysfunction of limbic system or HPA axis were common in tinnitus and affective disorders and that comorbid psychiatric disorders enhanced the negative outcome of tinnitus. Recently, more attention is being paid to the relation of tinnitus with personality and the role of stress. Although the causal relation of personality and tinnitus is unclear, stress in itself showed that it can be a trigger in the development of tinnitus, and stress of tinnitus can cause adverse effects. Since the effect of fear-related cognition such as catastrophic thought about tinnitus was revealed more recently, its therapeutic implication should be explored. This review will describe the product of previous research and discuss future direction about psychological factors related to tinnitus.

Genetic Variations of ABCC2 Gene Associated with Adverse Drug Reactions to Valproic Acid in Korean Epileptic Patients

The multidrug resistance protein 2 (MRP2, ABCC2) gene may determine individual susceptibility to adverse drug reactions (ADRs) in the central nervous system (CNS) by limiting brain access of antiepileptic drugs, especially valproic acid (VPA). Our objective was to investigate the effect of ABCC2 polymorphisms on ADRs caused by VPA in Korean epileptic patients. We examined the association of ABCC2 single-nucleotide polymorphisms and haplotype frequencies with VPA related to adverse reactions. In addition, the association of the polymorphisms with the risk of VPA related to adverse reactions was estimated by logistic regression analysis. A total of 41 (24.4%) patients had shown VPA-related adverse reactions in CNS, and the most frequent symptom was tremor (78.0%). The patients with CNS ADRs were more likely to have the G allele (79.3% vs. 62.7%, p = 0.0057) and the GG genotype (61.0% vs. 39.7%, p = 0.019) at the g.-1774delG locus. The frequency of the haplotype containing g.-1774Gdel was significantly lower in the patients with CNS ADRs than without CNS ADRs (15.8% vs. 32.3%, p = 0.0039). Lastly, in the multivariate logistic regression analysis, the presence of the GG genotype at the g.-1774delG locus was identified as a stronger risk factor for VPA related to ADRs (odds ratio, 8.53; 95% confidence interval, 1.04 to 70.17). We demonstrated that ABCC2 polymorphisms may influence VPA-related ADRs. The results above suggest the possible usefulness of ABCC2 gene polymorphisms as a marker for predicting response to VPA-related ADRs.

Reconstruction with Sutureless Burow's Graft Using Adhesive Skin Tape (Steri-strip(R)) for Cutaneous Defect after Skin Surgery / 대한피부과학회지

BACKGROUND: There are various methods of reconstruction of cutaneous surgical defect after removal of skin tumor, and skin graft is frequently used. Classically, in full-thickness skin graft (FTSG), nylon basting sutures with a tie-over bolster dressing are used in securing skin graft to the recipient wound bed, but this method is complicated, time-consuming, and may cause complications. OBJECTIVE: The aim of this study was to evaluate the usefulness of an adhesive skin tape (Steri-strip(R)) for securing a graft without suture when performing a Burow's skin graft, one of the types of FTSG. METHODS: We conducted a case-controlled retrospective study. A total of 45 patients (total 46 cases) treated with Burow's skin graft after removal of skin tumor between May 2006 and August 2010 were enrolled in this study, and grafts were secured with Steri-strip(R) (case, n=26) or conventional tie-over bolster dressings (control, n=20). The cosmetic results were scored at 1, 3, and 6 months after the operation. Also, the size and depth of the defect were measured and the run-time of the operation for the skin graft was checked. RESULTS: The operation time for the Steri-strip(R) group was significantly less than for the conventional tie-over bolster dressing group (p0.05). CONCLUSION: Sutureless Burow's graft with skin tape required less time than the conventional method with a similar cosmetic result. Thus we suggest that sutureless Burow's graft with skin tape may be an easy and useful method to reconstruct the defect after skin surgery.

Vancomycin Induced Linear IgA Bullous Dermatosis / 대한내과학회지

No abstract available.

Clinicohistopathological Study of Recurrent Basal Cell Carcinomas after Surgical Excision / 대한피부과학회지

BACKGROUND: Basal cell carcinoma in Korea is the most common skin cancer and its incidence is increasing at a steady rate. It is not unusual for dermatologists to experience the recurrence of tumor after surgery but there is no data on recurrent basal cell carcinoma in Korea. OBJECTIVE: The aim of this retrospective survey was to determine the clinical and histopathological characteristics of recurrent basal cell carcinoma after surgical excision in Korean patients. METHODS: We analyzed clinical findings and histopathologic subtypes of 21 cases of recurrent basal cell carcinoma after surgical excision among 480 cases diagnosed between January of 1980 and December of 2006 at the Department of Dermatology, Chonbuk National University Hospital. RESULTS: Overall recurrence rate was 4.38%. The average interval between the surgical excision of the primary tumor and recurrence was 40.8 months. The mean age of the patients was 65.1 years old and the ratio of men to women was 1 : 2. The most frequent location of the tumor recurrence was the nose and the mean size was 1.2 cm. There were no immunocompromised patients with underlying disorders, but two patients had taken corticosteroid for an extended period of time. The most common histological subtype of the primary and the recurrent basal cell carcinoma was nodular type. Six cases of primary basal cell carcinomas of nodular type transformed to aggressive subtype when they recurred. Perineural involvement of the primary basal cell carcinoma was found in 5 cases. CONCLUSION: This study demonstrates the clinicopathological features of recurrent basal cell carcinoma in the Korean population and we hope this data would be of help to dermatologists when treating Korean patients with basal cell carcinoma.

A Case of Borderline Lepromatous Leprosy Presenting in a Immigrant Woman / 나학회지

A 36 year-old woman immigrated from Nepal showed erythematous plaques on her face, buttock and legs one month after the immigration. Before the correct diagnosis was made, the patient had been erroneously treated as anallergic dermatitis for three months. Clinico-pathologically, her skin lesion was borderline lepromatous type leprosy with bacilli positive. We report the case to keep the high index of suspicion for leprosy when we meet with patients from the countries where leprosy is still epidemic.

A Case of Nicolau Syndrome / 대한피부과학회지

Nicolau syndrome is a rare adverse reaction of the skin at the site of intramuscular drug injection, and has largely unidentified pathogenesis. It consists of the development of an acute, severe pain and a localized erythematous rash during intramuscular injection leading to cutaneous, subcutaneous and even muscular necrosis. We report a case of a 55-year-old woman who presented with a painful skin necrosis in her buttocks following an intramuscular diclofenac-beta-dimethyl-aminoethanol injection.

Clinicopathological Study on Metastatic Skin Cancer / 대한피부과학회지

BACKGROUND: Metastatic skin cancers are relatively uncommon, however, may forcast the diagnosis of internal malignancy. Therefore, early recognition can contribute to proper management. OBJECTIVE: We studied patients with metastatic skin cancer to find out average age, gender distribution, frequency of primary tumor, time interval between manifestation and primary cancer, and their clinical appearance, location, other metastatic sites and survival time. METHODS: We reviewed the medical records, clinical photographs and histopathologic records of 80 patients who had been diagnosed with metastatic skin cancer at the department of dermatology and pathology in Chonbuk National University Hospital during the last 19 years from January 1986 to December 2004. RESULTS: The mean age at the time of diagnosis was 58.8 years. The ratio of men to women was 1.05:1. The most frequent primary tumors were breast cancer (20.0%), lung cancer (15.0%), colorectal cancer (8.8%), head and neck cancer (8.8%), and gastric cancer (8.8%). Lung cancer in men and breast cancer in women were the most common primary cancers. The sites of metastatic skin cancer were widespread over the whole body. However, the abdomen and chest were the most common sites for metastases, because most cutaneous metastases occur at body regions near the primary tumor. Metastatic skin cancers usually presented as discrete, painless, hard nodules, with sudden onset. However, we also found ulcers, inflammatory patches, plaques and cystic masses as clinical manifestations of metastatic skin cancer. The mean interval time between manifestation and primary tumor was 23.5 months. Histopathological findings indicated that adenocarcinoma was the most common pathologic type, followed by squamous carcinoma, melanoma and small cell carcinoma. Metastatic skin cancers revealed grave prognosis. The mean survival time after diagnosis of metastatic skin cancer was 9.9 months. CONCLUSION: The incidence of metastatic skin cancer was much lower than in western countries, maybe because of genetic and racial differences. Overall incidence of common metastatic skin cancer was similar to that found in the literature, but our results showed a periodic difference according to primary cancer type, other organs metastasized, plus mean survival rate was 9.9 months, thereby confirming a poor prognosis of metastatic skin cancer.

Four Cases of Burow's Graft for Periorbital Defect Reconstruction after Skin Cancer Surgery / 대한피부과학회지

The skin defects made from excision of malignant skin tumors can usually be reconstructed by secondary intention, primary closure, a local flap or skin graft. When reconstructing any skin defect, we must consider the defect site and size, reconstruction method, blood supply, wrinkling, relaxed skin tension line, donor site, patient's age, general health status, maintenance of function and cosmetic aspect. Reconstruction of the periorbital area is challenging to the dermatologist owing to the complex function of the eye, relative lack of adjacent loose tissue, free anatomic margin, and the need to maintain symmetry with the contralateral eye. The Burow's graft is a useful technique for periorbital wound reconstruction, using a full-thickness skin graft where the donor site is the skin adjacent to the wound. The use of adjacent skin as a graft gives a better color, texture, and thickness match than traditional donor sites. It also provides a simple method for reconstruction of wounds, compared to those repaired by a tight primary closure or local flap which may have excessive tension on sutures and distortion of nearby structures.

A Case of Reiter's Syndrome / 대한피부과학회지

Reiter's syndrome is a multisystemic disease characterized by a triad of urethritis, conjunctivitis and arthritis in association with skin lesions such as keratoderma blenorrhagica and balanitis circinata. Most cases of Reiter's syndrome are closely related to HLA-B27. We present a case of Reiter's syndrome that has typical clinicopathologic characteristics. A 37-year-old man had experienced weight loss and polyarthralgia for 7 months. He had painful swelling on the shoulders, elbows and knee joints, and hyperkeratotic plaques all over his body. He had no history of dysentry or sexual exposure, but was associated with the HLA-B27 antigen. Histopathology of the skin lesions on the back showed hyperkeratosis, rete ridge elongation and Munro microabscess. He was treated with corticosteroids, sulfasalazine, methotrexate, topical steroids and intra-articular corticosteroid injections. His skin lesions and urethritis were improved after 1 week, and his arthritis was improved after 6 months of therapy.

A Case of Actinomycosis of the Inguinal Area / 대한피부과학회지

Actinomycosis is a chronic bacterial infection characterized by suppurative, fibrosing inflammation, and sinus tracts draining sulfur granules. It usually involves the head, neck, thorax and abdomen. Actinomycosis involving the inguinal area is extremely rare. A 55-year-old man presented with an asymptomatic, erythematous, hard, nontender nodule in his left inguinal area. A biopsy taken from the nodule showed an abscess and sulfur granules in the dermis. Gram staining and methenamine silver staining demonstrated a mesh of branching rods. Cultures of the pus and tissue specimens failed to grow any organisms. Based on the histopathologic findings, we diagnosed this case as actinomycosis of the inguinal area and treated it with a surgical method.

A Case of Herpes Zoster Duplex Unilateralis with Herpes Zoster Generalisatus / 대한피부과학회지

Herpes zoster, involving noncontiguous dermatomes, is a rare disease. This unique presentation has been referred to as zoster duplex unilateralis or bilateralis, depending on whether one or both sides of the body are involved. A 76-year-old man, who had been treated for chronic obstructive pulmonary disease, presented with painful grouped vesicles on the right forehead and the right flank accompanied with generalized crusted papulovesicles. Tzanck smear showed multinucleated giant cells, and the histopathologic findings were consistent with herpes viral infection. We report a rare case of herpes zoster duplex unilateralis with herpes zoster generalisatus.

Two Cases of Venous Lakes / 대한피부과학회지

Venous lakes are small, bluish-purple, slightly-raised, soft papules or nodules occurring on the exposed skin of elderly people. The lips and ears are the most common sites. Histopathologically, large, dilated and irregular thin-walled venules are located on the upper and mid-dermis. Venous lake is not a rare disease, however, there has been no report of this condition in Korean literature. We report two cases of venous lake together with a review of the pertinent papers.

A Case of Fungal Eosinophilic Folliculitis / 대한피부과학회지

Recently, a new classification of eosinophilic folliculitis (EF) was made as follows: classic eosinophilic pustular folliculitis (EPF; Ofuji's disease), HIV associated EF, pediatric EF, fungal EF and miscellaneous group. A 10-year-old boy presented with a 2-week history of pruritic, erythematous papules with a plaque on his left cheek. A biopsy specimen revealed folliculitis with predominant eosinophilic infiltrates. Clinicohistopathologically, the most compatible diagnosis was eosinophilic pustular folliculitis and subsequently, dapsone was administered for 2 weeks but the lesion showed insufficient improvement, and the original confluent papules changed to a KOH-positive, arciform scaly lesion. A serial section from the paraffin block of the first biopsy, which had been histopathologically negative for fungal hyphae in the first, revealed hyphae in a single follicular canal in only one section out of 100 sections examined. This is believed to be the first reported case of fungal eosinophilic folliculitis in Korea.

A Case of Merkel Cell Carcinoma in Association with Bowen's Disease / 대한피부과학회지

Merkel cell carcinoma is an uncommon malignancy of the skin that was first described by Toker in 1972 and occasionally found concurrent with other malignancies such as squamous cell carcinoma, basal cell carcinoma or, as in the present study, with Bowen's disease. We report a unique case of Merkel cell carcinoma coexisting with Bowen's disease on the left forearm of a 42-year-old man who had a past history of multiple Bowen's disease. The tumor was excised and the specimen was examined histopathologically. The tumor cells exhibit trabecular, cord-like arrangement in the dermis, partly extending into subcutaneous tissue without involvement overlying epidermis, where Bowen's disease lesion was absent but the peripheral patch area exhibit Bowen's disease. The tumor cells in the dermis were positive for neuron-specific enolase and chromogranin. This is the first report of a case of Merkel cell carcinoma associated with Bowen's disease in Korea.

A Case of Papillary Eccrine Adenoma / 대한피부과학회지

Papillary eccrine adenoma is a rare benign sweat gland neoplasm. It occurs most often as a solitary nodule in women and is located predominantly on the distal portion of the extremities. This tumor is similar to tubular apocrine adenoma in histological and clinical aspects, so distinction of these tumors is still controversial. We report a case of two papillary eccrine adenomas developed on the left popliteal and calf area of a 58-year-old-man, this is the first report of the multiple papillary eccrine adenomas in Korea.

A Case of Recurrent Erythema Nodosum Leprosum for 3 Years / 나학회지

Erythema nodosum leprsum(ENL) is a painful, erythematous subcutaneous and dermal nodules which occurs mainly in lepromatous leprosy. Usually, it starts about 1 year after onset of treatment and lasts from a few days to weeks or months. Rarely it lasts for years. Although the lesions of ENL develop any part of the body, the favorite sites are extensor sites of the extremities, medial thigh, and face. We report a case of ENL which showed about 20 times recurrences for 3 years from 15months after initial treatment because of its widespread inflammatory lesions and duration of the disease. The ENL lesions recurred repeatedly with 2 weeks to 3months interval for 3 years and the tender reddish nodules developed not only in extremities but also on the trunk. During treatment course, he developed diabetes mellitus, Cushings syndrome as complications of long term use of corticosteroid and also developed xanthoma, hyperpigmentation, and ichthyosis.