Scar-Saving Flap during Serial Excision by Borrowing from the Opposite Side

BACKGROUND: Congenital melanocytic nevi may have various shapes according to the anatomic location. Therefore, it is desirable to apply proper surgical designs to the diverse forms considering the characteristics of the sites as well as the shape and size. OBJECTIVE: The purpose of this article is to introduce a new scar-saving flap design for semicircular defects after removing congenital melanocytic nevi without excising additional normal skin. METHODS: In most cases to excise semicircular nevi, normal skin should be excised to prevent dog ear, resulting in the long length of the scar. So we use a new scar-saving flap design by borrowing a partial length from the opposite side. RESULTS: We used this new technique for 4 cases of large semicircular skin defects. In all cases, this method had some advantages from this perspective: (1) it does not require excision of normal adjacent skin to convert a semicircular defect into a crescent shape or to remove dog-ears (2) the final suture line is not much longer than the diameter of the original defect and (3) it makes the removal of a much larger volume possible in one procedure rather than using the classic serial excision technique, which consists of a central elliptical excision within the confines of the nevus. In this way the frequency of procedures and discomfort to the patient can be reduced. CONCLUSION: We think that a scar-saving flap design by borrowing a partial length from the opposite side can be a good strategy for a semicircular skin defect.

A Case of a Symplastic Glomus Tumor / 대한피부과학회지

A glomus tumor is a benign neoplasm of neuromyo-arterial glomus, composed of vascular channels surrounded by proliferating glomus cells and nerve fibers. Occasionally it displays unusual histopathologic features such as a large size, deep location, infiltrative growth, mitotic activity, nuclear pleomorphism, or necrosis. It can be diagnosed as an "atypical" glomus tumor, including malignant glomus tumor, glomus tumor of uncertain malignant potential, symplastic glomus tumor, or glomangiomatosis. Glomangiomatosis and symplastic glomus tumors reveal benign biologic behavior. We report a typical case of a symplastic glomus tumor, showing only marked nuclear atypia, compared with a classical glomus tumor.

A Review of Mohs Micrographic Surgery and Reconstruction of Cutaneous Malignant Tumors over the Past 10 Years / 대한피부과학회지

BACKGROUND: Recent studies have shown that Mohs micrographic surgery (MMS) decreased the recurrent rate of tumors and conserved the normal, unaffected tissue. Therefore, MMS is accepted as the first choice treatment modality for cutaneous malignant tumors. OBJECTIVE: The purpose of this study was to review the use of MMS and reconstruction of cutaneous malignant tumors over the past 10 years. METHOD: We retrospectively evaluated 104 patients who had been diagnosed with cutaneous malignant tumors between January 1994 and December 2003, and had been treated with MMS and tumor reconstruction. RESULTS: There were 54 males and 50 females. The mean age was 62. Basal cell carcinoma was the most common skin tumor, and the most common anatomical site was the face. Mean number of stages of MMS were 1.91, and the mean size of the final defect after MMS was 19.46x25.4 mm. A local flap was most commonly used to repair the surgical defects (59%). Recurrent cases totalled 2 out of 104 over the 4-60 months of follow up. CONCLUSION: MMS and proper reconstruction are a reliable and effective method for the treatment of cutaneous malignant tumors and offers the lowest functional and cosmetic morbidity in skin cancer treatment.

A Review of Treatments of Keloids with Intramarginal Surgical Excision and Postoperative Irradiation to Prevent Recurrences

No abstract available.

A Comparison Study of the Staphylococcal Exotoxins and Staphylococcal Enterotoxin A-specific IgE Antibody between Childhood and Adulthood Atopic Dermatitis

BACKGROUND: The skin of patients with atopic dermatitis (AD) exhibits a striking susceptibility to colonization with Staphylococcus aureus (S. aureus). Superantigens produced by S. aureus and their specific IgE antibodies are thought to be important precipitating factors of AD, but there are few reports evaluating these 2 factors at the same time, particularly in adult AD patients. OBJECTS: Our purpose was to investigate the differences in the culture degree of S. aureus from the lesion, non-lesion, and control group of child and adult AD patients, to research the correlation between the exotoxin production, total IgE, anti-SEA IgE and the disease severity by SCORAD index, to ascertain the differences between child and adult AD patients. METHODS: The clinical severity of 30 child (2 to 15 years of age) and 30 adult patients (16 to 40 years of age) with AD was evaluated by using SCORAD index. S. aureus was isolated from lesional and non-lesional skin of AD patients, and from healthy controls. Staphylococcal exotoxins were detected by using reversed passive latex agglutination toxin detection kits. Anti-SEA IgE antibody was determined by using AlaSTATt assay RESULTS: S. aureus colonizations were found in 11 (36.7%) of the lesional skin, in 5 (16.7%) of the non-lesional skin of 30 child AD patients, and in 26 (86.7%), in 20 (66.7%) of 30 adult AD patients, respectively. The colonization rates of S. aureus in child patients were much lower than those in adult patients, both form lesional skin and non-lesional skin. Staphylococcal exotoxins were detected in 5 (45.5%) of the 11 colonizations from lesional skin, in 2 (40%) of the 5 colonizations from non-lesional skin of children, and in 10 (38.5%) of the 26 colonizations, in 9 (45%) of the 20 colonizations of adults, respectively. Staphylococcal enterotoxin A (SEA) was most frequently detected in both groups. S. aureus colonization was correlated with the severity of AD in childhood, but not in adulthood. However, there were no statistical significances between severity of AD and others such as exotoxin production, and the level of total IgE and anti-SEA IgE in both groups. CONCLUSION: The colonization of S. aureus was more common in adult AD patients than child AD patients. Anti-SEA IgE level was much higher in adult AD patients than in child AD patients. It is tempting to speculate that the colonization of S. aureus and exotoxin production might be related to the disease. duration rather than clinical severity of AD.

Prevalence & Diversity of Extended-spectrum beta -Lactamase-Producing Escherichia coli and Klebsiella pneumoniae Isolates in Korea / 대한임상미생물학회지

BACKGROUND: Increase in extended-spectrum -lactamase(ESBL)-producing Escherichia coli and Klebsiella pneumoniae have been reported in Korea. The aim of this study was to determine the nationwide prevalence of ESBL-producing E. coli and K. pneumoniae, and to investigate the types of ESBLs. METHODS: A total of 2,221 E. coli and 1,128 K. pneumoniae consecutive isolates were yearly collected from 12 hospitals in 1999 and 2000. ESBL production was performed by National Committee for Clinical Laboratory Standards methods and double synergy tests. The type of ESBL was determined by polymerase chain reaction (PCR), isoelectric focusing, and nucleotide sequence analysis. RESULTS: ESBL-producing E. coli and K. pneumoniae isolates were detected from all 12 hospitals participated. The proportion of ESBL-producers was 9.1%(2.0-19.6%) of the E. coli and 29.2% (10.0-60.8%) of the K. pneumoniae isolates. Among the 22 isolates sequenced, SHV-12 was found in six isolates, SHV-2a in three isolates, TEM-52 in five isolates, TEM-106 in three isolates, and each of TEM-15, TEM-20, TEM-43, and TEM-107 in one isolate. CTX-M-14 was also found in one isolate. CONCLUSION: ESBL-producing E. coli and K. pneumoniae are widespred to all levels of Korean hospitals. The most common types of ESBLs in Korea are SHV-12, SHV-2a, and TEM-52. In addition, we also identified new TEM-derived ESBLs.

Antimicrobial Resistance of Clinically Important Bacteria Isolated from Hospitals Located in Representative Provinces of Korea / 대한임상미생물학회지

BACKGROUND: A rapid increase of antimicrobial-resistant bacteria has become a serious problem in many countries. The aim of this study was to determine the prevalence of resistance among frequently isolated gram-positive and -negative bacteria in Korea. METHODS: Data of routine antimicrobial susceptibility test for medically important bacteria, isolated during 3 months of 2002, were collected from 12 university and 1 commercial laboratories in Korea. RESULTS: The proportions of methicillin-resistant Staphylococcus aureus (MRSA) were 60-88%, but vancomycin-resistant S. aureus was not detected. Among the Enterococcus faecium isolates, the resistance rate to vancomycin was 29%. The resistance rates of Escherichia coli and Klebsiella pneumoniae: 11% and 24% to cefotaxime, respectively, and 12% and 21% to cefoxitin, respectively. The resistance rates of Citrobacter freundii, Enterobacter cloacae, and Serratia marcescens: 28%, 34% and 21% to cefotaxime, respectively, <1%, 8% and 14% to cefepime, respectively. The resistance rates of Acinetobacter baumannii and Pseudomonas aeruginosa were: 65% and 37% to piperacillin, 64% and 19% to ceftazidime, 13% and 20% to imipenem, respectively. The resistant rates varied according to the hospital size. The resistance rates were generally higher among the isolates in the hospitals with more than 1,000 beds. The rates of penicillin-nonsusceptible Streptococcus pneumoniae were 58-90%. Among the Haemophilus influenzae isolates, 55-68% were resistant to ampicillin. CONCLUSIONS: Antimicrobial resistant strains were prevalent among the medically important clinical isolates, especially, MRSA, vancomycin-resistant enterococci, extended-spectrum -lactamase- or AmpC -lactamase-producing E. coli and K. pneumoniae, third generation cephalosporin-resistant C. freundii, E. cloacae and S. marcescens, imipenem-resistant A. baumannii and P. aeruginosa, penicillin-nonsusceptible S. pneumoniae and ampicillin-resistant H. influenzae. The antimicrobial resistance has become a serious problem in Korea.

A Study on the Evaluation of the Staphylococcal Exotoxins and Staphylococcal Enterotoxin A-specific IgE Antibody in Childhood Atopic Dermatitis / 대한피부과학회지

BACKGROUND: The skin of patients with atopic dermatitis (AD) exhibits a striking susceptibility to colonization with Staphylococcus aureus (S. aureus). Superantigenic exotoxins produced by S. aureus and their specific IgE antibodies are thought to be important precipitating factors of AD, but there are few reports evaluating these 2 factors at the same time. OBJECT: Our purpose was to examine whether the isolation of S. aureus colonies and the presence of the exotoxins from the skin of childhood AD patients and the level of anti-staphylococcal enterotoxin A(SEA) IgE antibody in their sera correlated with their severity of AD. METHODS: Thirty patients with mild-to-severe AD, 2 to 15 years of age, were evaluated by using SCORAD index. S. aureus was isolated from lesional and non-lesional skin of AD patients, and from healthy controls. By using reversed passive latex agglutination toxin detection kits, we examined whether staphylococcal exotoxins could be detected. Anti-SEA IgE antibody was determined by using AlaSTAT(R)assay. RESULTS: S. aureus colonizations were found in 11(36.7%) of the lesional skin and in 5(16.7%) of the non-lesional skin of 30 AD patients. Staphylococcal exotoxins were detected in 5(45.5%) of the 11 colonizations from lesional skin and in 2(40%) of the 5 colonizations from non-lesional skin. SEA was most frequently detected. S. aureus colonization was correlated with the severity of AD. However, there were no statistical significances between severity of AD and others such as exotoxin production, and the level of total IgE and anti-SEA IgE. Total IgE level was significantly higher in the group of exotoxin production, and correlated with the level of anti-SEA IgE. CONCLUSION: The correlation between S. aureus colonization and severity of AD in our study might support the role of S. aureus in patients with AD. On the other hand, it could be considered that exacerbation of AD trigger more colonization of S. aureus by way of disruption of skin barrier function from scratching or reduced immune responses needed for defense against bacteria. Although there was no correlation between AD severity and exotoxin production and the level of anti-SEA IgE in this study, staphylococcal exotoxins and their specific IgE antibodies might play a role at least in a subset of AD patients.

Sequential Analysis of Hepatitis Be Antigen Status in Infants Born to Hepatitis Be Antigen-Positive Mothers

PURPOSE: The objectives of this study are to evaluate the significance of HBeAg positivity in infants born to HBeAg and HBsAg positive mothers. METHODS: The HBeAg status of 22 HBeAg positive, HBsAg negative infants born to HBeAg and HBsAg positive mothers from December 1996 to March 1999 were evaluated by enzyme immunoassay. RESULTS: The number of HBsAg positive carrier mothers was 213(4.9%) out of 4,338 pregnant women. HBeAg was positive in 76(41.5%) out of 183 HBsAg positive mothers. Only 49 infants born to 76 HBeAg positive mothers could be evaluated; 36 infants were HBeAg positive and HBsAg negative. Laboratory follow up was possible in 22 infants. HBeAg disappeared in 7 cases within two months and in 20 cases within 12 months(over 90%). Ultimately, twenty-two babies who were HBsAg-negative and HBeAg-positive became negative for HBeAg, however, one showed HBsAg in follow up of 6 months of age. CONCLUSION: HBeAg positivity in infants born to HBeAg positive mothers may result from the maternofetal transmission and this HBeAg eventually disappeared without clinical significance.

Single Clone of Toxic Shock Syndrome Toxin 1-Producing Methicillin-Resistant Staphylococcus Aureus Isolated from a Neonatal Intensive Care Unit Patients / 대한임상미생물학회지

BACKGROUND: Six babies infected with Staphylococcus aureus occurred in a neonatal intensive care unit (NICU) over a period of 2 months, which was successfully controlled with the aid of moleculartyping of the isolates. METHODS: We examined the staphylococcal toxins, mecA and tst gene PCR, and repetitive-element PCR (rep-PCR) typing in S. aureus isolated from the clinical specimens of infected babies, nasal swabs of the patients and medical personnels in a NICU, and environmental equipments. RESULTS: Among all S. aureus isolates tested, they were toxic shock syndrome toxin 1 (TSST-1)- producing methicillin-resistant S. aureus (MRSA) who have mecA and tst gene, and one identical rep- PCR pattern all, except 3 MRSA isolated from the nasal swabs of 2 non-infected patients and 1 medical personnel. CONCLUSIONS: It was demonstrated that TSST-1 producing MRSA became epidemic in the NICU as a result of the spread of a single clone.

Nitroblue Tetrazolium(NBT) Test as a Screening Test of Urinary Tract Infection in Children

PURPOSE: It has been reported that the Nitroblue Tetrazolium(NBT) test is more accurate than the urine pH, leukocyte esterase and nitrite test as a screening test of urinary tract infection (UTI). The purpose of this study is to compare the NBT test with other screening tests and evaluate the clinical usefulness of the NBT test as a screening test. METHODS: We selected 298 results out of the 304 urine cultures which were performed from March, 1999 to July, 1999 and compared them with screening tests such as NBT, urine pH, leukocyte esterase and nitrite tests. We interpreted those results as the urinary tract infection when the screening results were urine NBT(+), pH(>6.5), leukocyte esterase(>or=++) and nitrite(+). RESULTS: Urine NBT, pH and leukocyte esterase tests showed the statistical significance in comparison with the urine culture results(chi-square tests; P<0.001, <0.05, <0.001), while urine nitrite tests did not show statistical significance. As time passing, the sensitivity of 10 min, 30 min, 60 min NBT test was increased to 35%, 72%, 80% respectively but the sensitivity of urine pH and leukocyte esterase was as low as 33%, 16% respectively. But, the specificity of NBT test was reduced from 93% to 53% as the time went by, while the specificity of urine pH and leukocyte esterase tests were as high as each 79%, 96% respectively. Urine NBT tests at 10 min and 30 min showed a higher positive and negative predictive value than those of the other screening tests. CONCLUSION: Urine NBT test as a screening test for UTI was more accurate than the urine pH, nitrite and leukocyte esterase tests. But we think that we should develop a more quick and precise screening test in the future, because of the long time it requires to perform it.

Antimicrobial Resistance Surveillance of Bacteria in 1999 in Korea with a Special Reference to Resistance of Enterococci to Vancomycin and Gram-Negative Bacilli to Third Generation Cephalosporin, Imipenem, and Fluoroquinolone

The trend of antimicrobial resistance of bacteria isolated from patients in 30 Korean hospitals in 1999 was analyzed with a particular attention to cefotaxime- or fluoroquinolone-resistant gram-negative bacilli, imipenem-resistant Pseudomonas aeruginosa, and vancomycin-resistant enterococci. Adequacy of susceptibility testing, and any change in the frequencies of isolated species were also analyzed. The results showed that only 20% and 30% of hospitals tested the piperacillin-tazobactam and cefoxitin susceptibility of Enterobacteriaceae, respectively, only 24% of hospitals the piperacillin-tazobactam susceptibility of P. aeruginosa, and 17% of hospitals the fusidic acid susceptibility of staphylococci. Among the isolates 26.3% were glucose-nonfermenting gram-negative bacilli, and 34.7% of Enterococcus were Enterococcus faecium. Slight decline of cefotaxime-resistance rate to 20% was noted in Klebsiella pneumoniae, while fluoroquinolone-resistantce rate was 68% in Acinetobacter baumannii. The ceftazidime- and imipenem-resistance rates were 17% and 18%, respectively in P. aeruginosa. The vancomycin-resistance rate of E. faecium rose significantly to 15.1%, but the rates varied significantly depending on hospitals suggesting presence of different degree of selective pressure or nosocomial spread. In conclusion, the prevalence of imipenem-resistant P. aeruginosa and the increase of vancomycin-resistant E. faecium were the particularly worrisome phenomena observed in this study.

A Case of Facial Nerve Palsy Associated with Epstein-Barr Virus Infection in a Child / 대한소아신경학회지

Facial palsy is a rare complication of infectious mononucleosis of Epstein-Barr virus infection, which can be easily overlooked by clinicians if one is unnoticed about it. We report a 2 year and 11 month old boy who was diagnosed by facial nerve palsy caused by Epstein-Barr virus infection. Pseudothrombocytopenia was also associated with him. Steroid (prednisolone 2mg/kg) was administered daily for 2 weeks and then maintained with alternative tapering schedule (2mg/kg at once QOD) in order to decompress facial nerve. He was completely recovered at 2 months of follow-up.

Primary Cutaneous Mucormycosis Associated with Trauma / 대한피부과학회지

We report a case of primary cutaneous mucormycosis, one of five clinical forms of mucormycosis, in a 68-year-old immunocompetent woman, which developed after trauma. We treated her successfully with amphotericin B for 23 days.

The Antimicrobial effects of Lidocaine and Epinephrine / 대한피부과학회지

No Abstract Available.

A Case of Cutaneous Endometriosis / 대한피부과학회지

Endometriosis is defined as the growth of endometrial tissue outside the uterine cavity and its occurrence is usually related anatomically to the uterus and its attachments. Cutaneous endometriosis occurs most commonly as a secondary process in scars after abdominal or pelvic procedures including hysterotomy, hysterectomy, cesarean section, episiotomy, and laparoscopy. Because of the rarity of cutaneous endometriosis, and the failure of the recognition of the correlation between the intensity of the pain and the menstrual cycle, the diagnosis can be easily missed. We present a case of cutaneous endometriosis occurred in the scar of a previous cesarean section in a 27-year-old woman.

A Case of Frey's Syndrome / 대한피부과학회지

Freys syndrome is a type of pathologic gustatory hyperhidrosis occurring as a result of injury to the nerves in the region of the parotid gland. The syndrome usually manifests as unilateral flushing, sweating, and rarely pain in response to gustatory stimuli. The most likely mechanism is aberrant reinnervation of the sweat glands of the face by the severed parotid parasympathetic nerve fibers. We report a case of Freys syndrome in a 58-year-old woman who had been treated with incision and drainage at age 10 due to an abscess occurred in the parotid area. Thereafter she complained local flushing and sweating on the left infraauricular area during mastication. She was treated with 0.5% atropine cream once a day for two weeks, resulting in marked reduction of flushing and sweating proved by Minors starch-iodine test.

Diagnostic Utility of a Rapid ICT Tuberculosis Assay for the Diagnosis of Pulmonary Tuberculosis / 대한임상미생물학회지

BACKGROUND: Diagnosis of tuberculosis is more complicated because of low sensitivity and time consuming procedures of the conventional diagnostic methods as well as nonspecific clinical features. Recently the serologic diagnosis of tuberculosis has been reported as one of rapid sensitive and specific methods. We evaluated the ability of a rapid ICT Tuberculosis assay(AMRAD/ICT Diagnostics, Syndey, Australia) to detect pulmonary tuberculosis. METHODS: ICT Tuberculosis assay was performed to the sera from 50 patients with pulmonary tuberculosis (24 patients with smear positive, 26 patients with smear negative) and 105 controls (48 patients without tuberculosis, 57 healthy controls). RESULTS: Antibodies were detected in 22 of 24 (92%) smear positive patients and 22 of 26 (85%) smear negative patients who had been clinically diagnosed as having active pulmonary tuberculosis. Two (4.2%) out of 48 patients without tuberculosis and 1 (1.8%) out of 57 healthy controls had a positive antibody response. The overall sensitivity, specificity, and positive and negative predictive value of the ICT Tuberculosis assay were 88%, 97%, 94%, and 94%, respectively. CONCLUSIONS: The ICT Tuberculosis assay was not only sensitive and specific but also rapid and simple. This assay will be useful as a diagnostic method of pulmonary tuberculosis in combination with sputum smear and X-ray.

A Comparison of UVB-induced Minimal Erythema Dose ( MED ) s to the Skin of the Back and Extremities in Young Adult Koreans / 대한피부과학회지

BACKGROUND: The erythemal response of the skin to UVB radiation is used as a diagnostic phototest and guideline to phototherapy. OBJECTIVE: The purpose of this study was to compare the UVB-induced MEDs to the back, arm, and thigh skin METHODS: A sunlight fluorescenct lamp(Waldmann UV 7001K) was used as a UVB radiation source. The back, arm, and thigh skin were irradiated with the dose, from 40mJ/cm2 to 180mJ/cm2. The minimal doses for erythema responses to the skin were assessed visually at 24 hours after irradiation. RESULTS: MEDs of the back, arm and thigh skin were 92.6 +/- 17.3mJ/cm2(mean +/- S.D.), 123.0 +/- 24.2mJ/cm2, and 126.6+/- 28.3mJ/cm2, respectively. The most frequent MED was 100mJ/cm2 for the back skin and 120mJ/cm' for the arm skin and thigh skin. CONCLUSION: In this study, UVB-induced MEDs to the back, arm, and thigh skin in young adult Koreans were assessed. A significant difference in the MED was found between the back and extremities skin, with a lower value for the back skin(92.6 +/- 17.3mJ/cm2) than for the arm skin(123.0 +/- 24.2mJ/cm2) or for the thigh skin(126.6 +/- 28.3mJ/cm2).

A Case of Congenital Acute Megakaryoblastic Leukemia with Down Syndrome

We experienced a case of congenital acute megakaryoblastic leukemia with Down syndrome. The patient was admitted due to characteristic facial figure of Down syndrome and abdominal distension. Acute megakaryoblastic leukemia was diagnosed with abundant megakaryoblast in peripheral blood smear, severe myelofibrosis in bone marrow biopsy and positive platelet glycoprotein III a receptor. On third hospital day, the patient expired due to DIC and pulmonary hemorrhage. Authors report the case with review of literature.