Role of the Neutrophil-to-Lymphocyte Ratio as a Predictor of Prognosis in Cellulitis / 대한피부과학회지

Background@#Cellulitis is an inflammatory disease of the skin and subcutaneous tissue caused by bacterial infection and is one of the most common reasons for admission to the Department of Dermatology. There are many biomarkers to help diagnose inflammatory diseases, and the neutrophil-to-lymphocyte ratio (NLR) has recently been raised as an option. @*Objective@#This study aimed to evaluate the efficacy of pretreatment NLR for predicting the severity and prognosis of cellulitis. @*Methods@#We reviewed the medical records of 102 patients diagnosed with cellulitis over the past 5 years. White blood cell count, erythrocyte sedimentation rate, C-reactive protein (CRP) level, procalcitonin level, and NLR were measured on the first day of admission. The associations of CRP, procalcitonin, and NLR ratio with body temperature and number of hospitalization days were assessed. @*Results@#The CRP level and NLR were positively correlated with body temperature. In addition, positive correlations were found between the number of hospitalization days and biomarkers (p＜0.05), with the NLR showing the highest coefficients. @*Conclusion@#In patients with cellulitis, the NLR is a helpful parameter for evaluating the severity and prognosis of the disease. However, further studies are required to confirm this.

Tumoral Calcinosis on the Dorsal Aspect of the Wrist Presenting as a Deep-seated Nodule / 대한피부과학회지

Tumoral calcinosis is an ectopic calcification syndrome characterized by an irregular soft tissue mass. It has been reported mainly in large joints such as the hip, shoulder, knee, and elbow, but rarely in the hands. When it occurs on the dorsal side of the wrist, there are no specific symptoms except for localized tenderness. Therefore, it is difficult to differentiate the calcification from other common hand tumors, especially ganglions. We report a case of tumoral calcinosis that occurred on the dorsal side of the wrist with magnetic resonance imaging findings.

Tumoral Calcinosis on the Dorsal Aspect of the Wrist Presenting as a Deep-seated Nodule / 대한피부과학회지

Tumoral calcinosis is an ectopic calcification syndrome characterized by an irregular soft tissue mass. It has been reported mainly in large joints such as the hip, shoulder, knee, and elbow, but rarely in the hands. When it occurs on the dorsal side of the wrist, there are no specific symptoms except for localized tenderness. Therefore, it is difficult to differentiate the calcification from other common hand tumors, especially ganglions. We report a case of tumoral calcinosis that occurred on the dorsal side of the wrist with magnetic resonance imaging findings.

Efficacy and Safety of Matrix Shave Biopsy Using a Razor Blade for the Diagnosis of Longitudinal Melanonychia / 대한피부과학회지

Background@#Longitudinal melanonychia (LM) can be caused by a variety of benign and malignant conditions. Nail matrix biopsy is necessary for the diagnosis of LM; however, physicians hesitate to perform the nail matrix biopsy due to the risk of postoperative complications like permanent matrix damage. Therefore, biopsy methods that minimize the risk of postoperative complications are necessary. @*Objective@#To investigate the efficacy and safety of the nail matrix shave biopsy using a razor blade. @*Methods@#We reviewed the medical records, clinical photographs, and histopathologic slides of patients who underwent shave biopsy for the diagnosis of LM from January 2018 to March 2020 at Wonkwang University Hospital. @*Results@#The entire pigmented lesion was removed completely by shaving only a partial thickness of the superficial matrix in all patients. The histopathologic diagnosis was melanocyte activation with no atypia in all cases. Eight patients were followed up for 7∼19 months. Resting pain after the shave biopsy improved in most cases (75%) within 1 week. One patient experienced numbness lasting for 3 months. Abnormal sensations, such as tingling and itching, were temporarily reported by two patients. One patient (12.5%) had temporary postoperative nail plate dystrophy, and three patients (37.5%) had recurrence of pigmentation. @*Conclusion@#Our protocol of shave biopsy showed a lower rate of postoperative nail dystrophy than the conventional shave biopsy. We suggest that the shave biopsy using a flexible stainless steel razor blade is a favorable alternative to the conventional shave biopsy.

Effect of amaranth seed extracts on glycemic control in HepG2 cells / 한국영양학회지

Purpose@#This study was carried out to investigate the effect of amaranth seed extracts on glycemic regulation in HepG2 cells. The 80% ethanol extracts of amaranth seeds were used to evaluate α-amylase and α-glucosidase activities, cell viability, glucose uptake and messenger RNA (mRNA) expression levels of acetyl-CoA carboxylase (ACC), glucose transporter (GLUT)-2, GLUT-4, insulin receptor substrate (IRS)-1 and IRS-2. @*Methods@#The samples were prepared and divided into 4 groups, including germinated black amaranth (GBA), black amaranth (BA), germinated yellow amaranth (GYA) and yellow amaranth (YA). Glucose hydrolytic enzyme, α-amylase and α-glucosidase activities were examined using a proper protocol. In addition, cell viability was measured by MTT assay. Glucose uptake in cells was measured using an assay kit. The mRNA expression levels of ACC, GLUT-2, GLUT-4, IRS-1 and IRS-2 were measured by reverse transcription polymerase chain reaction. @*Results@#The inhibitory activities of α-amylase and α-glucosidase were highly observed in GBA, followed by BA, GYA and YA. Similar results were observed for glucose. The GBA effect was similar compared to the positive control group. The mRNA expression levels of ACC, GLUT-2, GLUT-4, IRS-1, and IRS-2 were significantly increased. The potential hypoglycemic effects of amaranth seed extracts were observed due to the increase in glucose metabolic enzyme activity, and glucose uptake was mediated through the upregulation of ACC, GLUT-2, GLUT-4, IRS-1, and IRS-2 expression levels. @*Conclusion@#Our findings suggest that the amaranth seed is a potential candidate to prevent a diabetes. The present study demonstrated the possibility of using amaranth seeds, especially GBA and BA for glycemic control.

Baumann Skin Type in the Korean Male Population

BACKGROUND: Research into the Baumann skin type (BST) has recently expanded, with growing interest in the development of an efficient and effective skin type classification system for better understanding of this skin condition. OBJECTIVE: We aimed to identify male-specific skin type characteristics with investigation into the distribution of BST by age and region in the Korean male population and to determine the intrinsic and extrinsic factors related to skin type. METHODS: A questionnaire was administered to collect information about age, region, working behavior, drinking behavior, smoking behavior, usual habit of sun protection, medical history, and the BST which consisted of four parameters; oily (O) or dry (D), sensitive (S) or resistant (R), pigmented (P) or non-pigmented (N), and wrinkled (W) or tight (T). RESULTS: We surveyed 1,000 Korean males aged between 20 and 60 years who were divided equally by age and region. Of the total respondents, OSNW type accounted for the largest percentage and ORPW type the lowest. In terms of Baumann parameters, O type was 53.5%, S type was 56.1%, N type was 84.4% and W type was 57.5%. Several behavioral factors were found to have various relationships with the skin type. CONCLUSION: The predominant skin type in the Korean male respondents was OSNW type, and the distribution of skin types with regards to age and region was reported to be distinct. Therefore, skin care should be customized based on detailed skin types considering the various environmental factors.

A Case of Peritoneal Sarcomatoid Mesothelioma with Absence of Occupationl Exposure to Asbestos / 고신대학교의과대학학술지

Sarcomatoid mesothelioma is not very common, mesothelioma is directly attributable to occupational asbestos exposure, with 90% of cases showing a history of exposure. A 66-year-old male was admitted with an abdominal pain that persisted for 3 weeks. He had no abdominal mass. Computed tomography showed soft tissue thickening in perihepatic space and nodularities in omentum and peritoneum with ascites. There was no absolute diagnosis evidence in ascites analysis. Although the pathology of ascites was free for malignancy, the patient underwent omentum biopsy for definitive diagnosis. In laproscopic exploration, there was omental cake, peritoneal nodular seeding. It was suspected cancer carcinomatosis. Immunohistochemical findings suggested that it was sarcomatoid masothelioma. This is the rare case of a peritoneal sarcomatoid mesothelioma, without any exposure to asbestos.

Percutaneous Stenoscopic Lumbar Decompression with Paramedian Approach for Foraminal/Extraforaminal Lesions

The lumbar foramen is affected by different degenerative diseases, including extraforaminal disc herniation, foraminal stenosis (FS), and degenerative or spondylolytic spondylolisthesis. The purpose of this study was to describe percutaneous stenoscopic lumbar decompression with a paramedian approach (para-PSLD) for foraminal/extraforaminal lesions. All operative procedures were performed using a complete uniportal endoscopic instrument system. The para-PSLD can be easily applied to patients with FS and narrow disc space or facet joint hypertrophy. The anatomical view of a para-PSLD is similar to that of a conventional open surgery and allows for good visualization of the foraminal/extraforaminal areas. We suggest that para-PSLD is an alternative and minimally invasive procedure to treat degenerative lumbar foraminal/extraforaminal stenoses.

Therapeutic Feasibility of Full Endoscopic Decompression in One- to Three-Level Lumbar Canal Stenosis via a Single Skin Port Using a New Endoscopic System, Percutaneous Stenoscopic Lumbar Decompression

STUDY DESIGN: This retrospective study involved 450 consecutive cases of degenerative lumbar stenosis treated with percutaneous stenoscopic lumbar decompression (PSLD). PURPOSE: We determined the feasibility of PSLD for lumbar stenosis at single and multiple levels (minimum 1-year follow-up) by image analysis to observe postoperative widening of the vertebral canal in the area. OVERVIEW OF LITERATURE: The decision not to perform an endoscopic decompression might be due to the surgeon being uncomfortable with conventional microscopic decompression or unfamiliar with endoscopic techniques or the unavailability of relevant surgical tools to completely decompress the spinal stenosis. METHODS: The decompressed canal was compared between preoperative controls and postoperative treated cases. Data on operative results, including length of stay, operative time, and surgical complications, were analyzed. Patients were assessed clinically on the basis of the Visual Analog Scale (VAS) score for the back and legs and using the Oswestry Disability Index (ODI). RESULTS: Postoperative magnetic resonance imaging revealed that PSLD increased the canal cross-sectional area by 52.0% compared with the preoperative area at the index segment (p<0.001) and demonstrated minimal damage to the normal soft tissues including muscles and the extent of removed normal bony tissues. Mean improvements in VAS score and ODI were 4.0 (p<0.001) and 40% (p<0.001), respectively. CONCLUSIONS: PSLD could be an alternative to microscopic or microendoscopic decompression with various advantages in the surgical management of lumbar stenosis.

A Study of Clinical Aspects of Scabies in the Jeonbuk Province / 대한피부과학회지

BACKGROUND: Scabies is a contagious skin infestation primarily observed in poor or overcrowded environments. However, an individual may be affected regardless of hygiene and/or socioeconomic status, and/or age. OBJECTIVE: To investigate the characteristics and epidemiology of scabies in patients visiting a single tertiary hospital in Jeonbuk province. METHODS: We retrospectively reviewed the medical records of 194 patients with scabies who visited the Dermatology clinic at Wonkwang University Hospital between June 2015 and May 2018. RESULTS: Of the 194 patients investigated, 82 (42.3%) were men and 112 (57.7%) were women. The mean age of men was 46.3 years and that of women was 60.1 years. Scabies was diagnosed in patients most commonly in autumn. The most common symptom of scabies was the occurrence of papules (83.5%) followed by the presence of burrows (23.2%). The most common route of infection was a nursing hospital (26.3%), except unknown (29.4%). Medications used to treat scabies included 5% permethrin cream, 10% crotamiton ointment, and 1% gamma benzene hexachloride lotion. The mean duration of treatment was 33.9 days using 5% permethrin cream, 34.8 days using 10% crotamiton ointment, and 34.6 days using 1% gamma benzene hexachloride lotion. CONCLUSION: This study could help in the prevention and management of scabies, by guiding clinicians in choosing optimal therapeutic agents based on patients' condition.

The Incidence of Pruritus and Biochemical Marker Associated with Pruritus in Hemodialysis Patients

No abstract available.

Recent advances of basal cell carcinoma, squamous cell carcinoma, and carcinoma in situ

Incidence of basal and squamous cell carcinoma is increasing among Korean. With increasing this incidence we need to attend the management and prevention of these cutaneous malignancies. Basal cell carcinoma (BCC) is the most common skin malignancy. Sun exposure is the most important environmental cause of BCC. Daily sun protection especially avoiding sun exposure between 10 a.m. and 4 p.m. provides most effective prevention against chronic ultraviolet-induced skin damage. Hedgehog pathway inhibitors are used locally advanced and metastatic BCC lesions in Korea. Until recently, there are no reports whether it developed resistance of Hedgehog pathway inhibitors with advanced BCC in Korean patients. Among malignant skin tumors, 19.1% were squamous cell carcinoma (SCC). The incidence of SCC was rapidly increased over the past years. However, the incidence rate of SCC in Japan has not been changed from the period 1976–1980 to 1986–1990. Sentinel lymph node biopsy for SCC did not provide diagnostic value. Bowen's disease and Erythroplasia of Queyrat are considered as carcinoma in situ of the skin. Erythroplasia of Queyrat have worse prognosis with a higher rate of malignant degeneration. Dermoscopy may helpful tool in assisting the noninvasive diagnosis of carcinoma in situ of the skin.

Are Controversial Issues in Cervical Total Disc Replacement Resolved or Unresolved?: A Review of Literature and Recent Updates

Since the launch of cervical total disc replacement (CTDR) in the early 2000s, many clinical studies have reported better outcomes of CTDR compared to those of anterior cervical discectomy and fusion. However, CTDR is still a new and innovative procedure with limited indications for clinical application in spinal surgery, particularly, for young patients presenting with soft disc herniation with radiculopathy and/or myelopathy. In addition, some controversial issues related to the assessment of clinical outcomes of CTDR remain unresolved. These issues, including surgical outcomes, adjacent segment degeneration (ASD), heterotopic ossification (HO), wear debris and tissue reaction, and multilevel total disc replacement (TDR) and hybrid surgeries are a common concern of spine surgeons and need to be resolved. Among them, the effect of CTDR on patient outcomes and ASD is theoretically and clinically important; however, this issue remains disputable. Additionally, HO, wear debris, multilevel TDR, and hybrid surgery tend to favor CTDR in terms of their effects on outcomes, but the potential of these factors for jeopardizing patients' safety postoperatively and/or to exert harmful effects on surgical outcomes in longer-term follow-up cannot be ignored. Consequently, it is too early to determine the therapeutic efficacy and cost-effectiveness of CTDR and will require considerable time and studies to provide appropriate answers regarding the same. For these reasons, CTDR requires longer-term follow-up data.

Recent advances of basal cell carcinoma, squamous cell carcinoma, and carcinoma in situ

Incidence of basal and squamous cell carcinoma is increasing among Korean. With increasing this incidence we need to attend the management and prevention of these cutaneous malignancies. Basal cell carcinoma (BCC) is the most common skin malignancy. Sun exposure is the most important environmental cause of BCC. Daily sun protection especially avoiding sun exposure between 10 a.m. and 4 p.m. provides most effective prevention against chronic ultraviolet-induced skin damage. Hedgehog pathway inhibitors are used locally advanced and metastatic BCC lesions in Korea. Until recently, there are no reports whether it developed resistance of Hedgehog pathway inhibitors with advanced BCC in Korean patients. Among malignant skin tumors, 19.1% were squamous cell carcinoma (SCC). The incidence of SCC was rapidly increased over the past years. However, the incidence rate of SCC in Japan has not been changed from the period 1976–1980 to 1986–1990. Sentinel lymph node biopsy for SCC did not provide diagnostic value. Bowen's disease and Erythroplasia of Queyrat are considered as carcinoma in situ of the skin. Erythroplasia of Queyrat have worse prognosis with a higher rate of malignant degeneration. Dermoscopy may helpful tool in assisting the noninvasive diagnosis of carcinoma in situ of the skin.

Baumann Skin Type in the Korean Female Population

BACKGROUND: To meet the need for a subspecialized skin type system, the Baumann skin type (BST) system was proposed. OBJECTIVE: To evaluate the distribution of BST types and influencing factors among Korean women. METHODS: BST questionnaires were administered to 1,000 Korean women. The possible responses were as follows: oily (O) or dry (D), sensitive (S) or resistant (R), pigmented (P) or non-pigmented (N), and wrinkled (W) or tight (T). The correlations of the BST with the subjects' age, location, ultraviolet (UV) ray exposure, drinking and smoking habits, and blood type were assessed. RESULTS: The OSNT, DSNT, DRNT, and OSNW skin types were the most common skin types (55.3%). The O, S, P, and W types accounted for 46.6%, 68.8%, 23.2%, and 31.9%, respectively. The proportion of the O and S type was the highest in Gyeongsangbuk-do (55.0%) and Seoul (77.2%). The proportion of the P and W type was the highest in Gyeongsangbuk-do (33.0%) and Chungcheong-do (39.0%). The O type decreased in the higher age group, whereas the P and W type showed a reversed tendency. In smokers, the proportion of W type was significantly higher than in the non-smokers (66.3% vs. 24.1%, p<0.05). CONCLUSION: The 4 most common BST types were OSNT, DSNT, DRNT, and OSNW. In the comparison across the 4 BST parameters according to the age, region, smoking and drinking habits, occupation, blood type, and UV exposure, significant differences were observed. Individualized and customized skin care is required according to the personal skin type.

A Case of Localized Cutaneous Infection Caused by Scedosporium apiospermum Presenting as Cellulitis

No abstract available.

Comparison of Root Images between Post-Myelographic Computed Tomography and Magnetic Resonance Imaging in Patients with Lumbar Radiculopathy

OBJECTIVE: To evaluate the diagnostic value of computed tomography-myelography (CTM) compared to that of magnetic resonance imaging (MRI) in patients with lumbar radiculopathy. METHODS: The study included 91 patients presenting with radicular leg pain caused by herniated nucleus pulposus or lateral recess stenosis in the lumbar spine. The degree of nerve root compression on MRI and CTM was classified into four grades. The results of each imaging modality as assessed by two different observers were compared. Visual analog scale score for pain and electromyography result were the clinical parameters used to evaluate the relationships between clinical features and nerve root compression grades on both MRI and CTM. These relationships were quantified by calculating the receiver-operating characteristic curves, and the degree of relationship was compared between MRI and CTM. RESULTS: McNemar's test revealed that the two diagnostic modalities did not show diagnostic concurrence (p<0.0001). Electromyography results did not correlate with grades on either MRI or CTM. The visual analog pain scale score results were correlated better with changes of the grades on CTM than those on MRI (p=0.0007). CONCLUSION: The present study demonstrates that CTM could better define the pathology of degenerative lumbar spine diseases with radiculopathy than MRI. CTM can be considered as a useful confirmative diagnostic tool when the exact cause of radicular pain in a patient with lumbar radiculopathy cannot be identified by using MRI. However, the invasiveness and potential complications of CTM are still considered to be pending questions to settle.

A Comparative Study between Cellulitis and Necrotizing Fasciitis / 대한피부과학회지

BACKGROUND: Necrotizing fasciitis is a life-threatening soft tissue infection involving the fascia and subcutaneous tissues. Diagnosis of necrotizing fasciitis is often delayed because of an underestimation or an overlap between it and cellulitis. OBJECTIVE: We aimed to evaluate and compare the clinical, laboratory, and microbiological characteristics of cellulitis and necrotizing fasciitis. METHODS: We retrospectively reviewed medical records of patients diagnosed as having cellulitis or necrotizing fasciitis and hospitalized at our hospital between January 2011 and December 2016. RESULTS: The study included data from 185 patients having cellulitis and 33 patients having necrotizing fasciitis. There were significant differences between cellulitis and necrotizing fasciitis regarding clinical and laboratory factors. Necrotizing fasciitis was primarily associated with the following features at the time of admission: A thigh/buttock location [odds ratio (OR) 9.04, 95% confidence interval (CI) 1.72∼47.64, p=0.009], pain not controlled with use of non-opioid analgesics (OR 6.26, 95% CI 2.21∼17.71, p0.32 ng/mL (OR 9.41, 95% CI 4.18∼21.93, p 0.32 ng/mL, it would be appropriate to evaluate for the possibility of necrotizing fasciitis and use broad-spectrum antibiotics to cover for Gram-negative organisms.

A Case of Infantile Tinea Capitis Treated with Oral Fluconazole / 대한피부과학회지

No abstract available.

A Nationwide Retrospective Study of Opioid Management Patterns in 2,468 Patients with Spinal Pain in Korea

STUDY DESIGN: Retrospective patient data collection and investigator survey. PURPOSE: To investigate patterns of opioid treatment for pain caused by spinal disorders in Korea. OVERVIEW OF LITERATURE: Opioid analgesic prescription and adequacy of consumption measures in Korea have markedly increased in the past decade, suggesting changing patterns in pain management practice; however, there is lack of integrated data specific to Korean population. METHODS: Patient data were collected from medical records at 34 university hospitals in Korea. Outpatients receiving opioids for pain caused by spinal disorders were included in the study. Treatment patterns, including opioid types, doses, treatment duration, outcomes, and adverse drug reactions (ADRs), were evaluated. Investigators were interviewed on their perceptions of opioid use for spinal disorders. RESULTS: Among 2,468 analyzed cases, spinal stenosis (42.8%) was the most common presentation, followed by disc herniation (24.2%) and vertebral fracture (17.5%). In addition, a greater proportion of patients experienced severe pain (73.9%) rather than moderate (19.9%) or mild (0.7%) pain. Oxycodone (51.9%) and fentanyl (50.8%) were the most frequently prescribed opioids; most patients were prescribed relatively low doses. The median duration of opioid treatment was 84 days. Pain relief was superior in patients with longer treatment duration (≥2 months) or with nociceptive pain than in those with shorter treatment duration or with neuropathic or mixed-type pain. ADRs were observed in 8.6% of cases. According to the investigators' survey, "excellent analgesic effect" was a perceived advantage of opioids, while safety concerns were a disadvantage. CONCLUSIONS: Opioid usage patterns in patients with spinal disorders are in alignment with international guidelines for spinal pain management. Future prospective studies may address the suitability of opioids for spinal pain treatment by using appropriate objective measurement tools.