Current understanding of angiosarcoma: disease biology and evolving treatment

Angiosarcoma is a very rare soft tissue sarcoma that originates from endothelial cells and typically has a poor prognosis. It is most commonly found in elderly white men and can occur anywhere in the body, particularly in the head, neck, and scalp. Patients who have undergone previous radiation treatment or who have chronic lymphedema also face an elevated risk of this condition. Various genetic changes are suspected to contribute to the development of angiosarcoma, and these changes have been identified as potential targets for treatment. For localized disease, wide surgical resection is often the prudent course of action. A multidisciplinary approach, which may include surgery, radiotherapy, systemic chemotherapy, or immunotherapy, is typically the most effective way to achieve favorable outcomes. In this review, we discuss the general understanding of angiosarcoma and its management, with a particular focus on the current evolving treatments for the disease.

Current concepts of Kimura disease: pathophysiology and evolution of treatment

Kimura disease (KD) is a chronic inflammatory disorder that frequently involves the subcutaneous tissue of the head and neck regions. It often manifests as regional lymphadenopathy or salivary gland enlargement in the affected area. The histologic architecture of the lymph nodes in KD patients is preserved, while the affected tissues show follicular hyperplasia and eosinophilic infiltration. No single modality has been adopted as an optimal treatment for KD. This article concentrates on the fundamental features of KD and reviews current approaches to its treatment.

Analysis of subbrow upper blepharoplasty by measuring the lid-to-brow distance

BACKGROUND: Conventional upper blepharoplasty through a supratarsal incision is commonly performed for periorbital rejuvenation. However, the drawbacks of this technique include insufficient removal of lateral hooding and an unnatural postoperative appearance. Subbrow upper blepharoplasty with submuscular fascia fixation was developed to avoid these shortcomings. Herein, we report our experiences with this technique and present an objective analysis of the results. METHODS: Subbrow upper blepharoplasty was performed in 30 patients between June 2016 and October 2017. All patients had preoperative frontal view photographs, and the distance from the upper lid margin to the lower edge of the eyebrow was measured at the lateral limbus (LBD-L). RESULTS: Between preoperative and postoperative measurements, the LBD-L was shortened by an average of 0.800 and 0.833 mm on the right and left, respectively (P=0.047 and P=0.070). Most patients were satisfied with their aesthetic appearance and the improvement of their visual field. CONCLUSIONS: The lid-to-brow distance was minimally changed by the procedure, but the results were aesthetically favorable. This seemingly paradoxical finding is explained by the characteristics of the surgical procedure and the related anatomy. Among the various possible blepharoplasty techniques, subbrow upper blepharoplasty with submuscular fascia fixation has definite value for Asians.

Multiple foreign bodies causing an orocutaneous fistula of the cheek

Foreign bodies impacted in the maxillofacial region are often a diagnostic challenge. They can be a source of chronic inflammatory reactions and infections leading to the formation of an orocutaneous fistula. Such orocutaneous fistulas cause significant morbidity in most patients, eventually requiring surgery. Recently, we encountered a very rare case of an orocutaneous fistula caused by multiple foreign bodies in the cheek. Precise removal of the foreign bodies was required, and a double-sided anterolateral thigh free flap was used to reconstruct the defect. Surgeons should be aware of the complications of multiple foreign bodies and should be able to diagnose these on careful clinical examination.

Emergency Medical Centers Preparedness for a Biological Disaster in Korea

PURPOSE: To investigate different emergency medical centers' (EMCs) preparedness for a biological disaster in Korea. METHODS: A survey of 120 EMCs in Korea was done through questionnaire. We examined facilities, equipments and supplies, and emergency personnel training and drill. RESULTS: Ninety (75%) EMCs participated in the survey. Sixteen were from regional/specialized EMCs and 74 were from local EMCs. The median for the number of staffed beds were 680(range, 200~2200) and the median for patient visits were 73(range, 24~210) per day. Ten(11%) of the 90 participating EMCs had personal protective equipments (PPEs); 7(8%) had wet decontamination units; 11(12%) had independent ventilation systems; 15(17%) had mechanical ventilator; 9(10%) had life lines; 39(43%) had alternative care sites and none (0%) had triage tag with presence of contamination. At least one drill was conducted annually in 11(12%). When the availability of resources needed in a biological disaster between regional/specialized EMCs and local EMCs were compared, the regional/specialized EMCs had PPEs(38% vs. 5%, p<0.01), wet decontamination unit(44% vs. 0%, p<0.01), independent ventilation systems (31% vs. 8%, p<0.05), and drills (38% vs. 7%, p<0.01) more frequently than local EMCs. Approximately 70% of the respondents attributed the above passive preparedness results from a lack of budget and the notion that only the minimum preparedness is necessary for the possibility of a biological disaster. Also, half of the respondents agreed that new infectious diseases will occur with a possibility of more than 50% in the future. CONCLUSION: Our data indicated that preparedness of EMCs for a biological disaster in Korea was low. Therefore, we should develop comprehensive plans to remedy the identified deficiencies.

A Surveillance on Nosocomial Acquisition of Clostridium difficile and Comparative Analysis of 3 Molecular Typing Methods including Pulsed-Field Gel Electrophoresis, Arbitrarily Primed Polymerase Chain Reaction, and Ribotyping / 감염

BACKGROUND: Clostridium difficile is a major cause of nosocomial infectious diarrhea. Nosocomial clusters of C. difficile disease have been ascribed to the transfer of the organism form patient to patient. The aim of this study was to survey the nosocomial acquisition of C. difficile infection and to evaluate the efficacy and efficiency of epidemiologic typing systems by molecular analysis of the isolates. METHODS: A surveillance study for C. difficile acquisition was performed in patients admitted to neurology ward (NW) and medical intensive care unit (MICU) in an 800-bed tertiary-care hospital from August 1998 to October 1998. Stool specimens were taken weekly for culture of C. difficile. All isolates were examined for toxin B gene by PCR assay. Three molecular typing methods, including pulsed-field gel electrophoresis (PFGE), ribotyping, and arbitrarily primed polymerase chain reaction (AP-PCR) were used to differentiate individual strains of C. difficile isolates. Their performance characteristics were compared according to the consensus guidelines by the European Society for Clinical Microbiology and Infectious Disease. RESULTS: A total of 38 C. difficile strains were isolated from 308 stool cultures. The period prevalence was 7.4/1000 patient-days and 21.2/1000 patient-days in the NW and MICU, respectively (P=0.034). The acquisition incidence of C. difficile infection was 1.85/ 1,000 patient-days and 5.33/1,000 patient-days in NW and MICU, respectively. The toxin B gene was detected in 38% (8/21) of C. difficile isolates; 62.5% from diarrheal patients and 23% from asymptomatic patients. In a comparison of the three typing systems, the typeability was 0.444 by PFGE, 0.972 by AP-PCR and 1 by ribotyping, and the discrimination index was 0.975 by PFGE, 0.810 by AP-PCR and 0.777 by ribotyping. All three typing systems were highly reproducible. AP-PCR was the least costly and most rapid method. CONCLUSION: The relatively high prevalence of C. difficile infection in the hospital might indicate a potential nosocomial spread, even though the acquisition incidence was low. AP-PCR appears to be an efficacious and efficient method for the epidemiologic study of C. difficile infection, and its suboptimal discriminative power may be enhanced by complementary PFGE.

A Surveillance on Nosocomial Acquisition of Clostridium difficile and Comparative Analysis of 3 Molecular Typing Methods including Pulsed-Field Gel Electrophoresis, Arbitrarily Primed Polymerase Chain Reaction, and Ribotyping / 감염

BACKGROUND: Clostridium difficile is a major cause of nosocomial infectious diarrhea. Nosocomial clusters of C. difficile disease have been ascribed to the transfer of the organism form patient to patient. The aim of this study was to survey the nosocomial acquisition of C. difficile infection and to evaluate the efficacy and efficiency of epidemiologic typing systems by molecular analysis of the isolates. METHODS: A surveillance study for C. difficile acquisition was performed in patients admitted to neurology ward (NW) and medical intensive care unit (MICU) in an 800-bed tertiary-care hospital from August 1998 to October 1998. Stool specimens were taken weekly for culture of C. difficile. All isolates were examined for toxin B gene by PCR assay. Three molecular typing methods, including pulsed-field gel electrophoresis (PFGE), ribotyping, and arbitrarily primed polymerase chain reaction (AP-PCR) were used to differentiate individual strains of C. difficile isolates. Their performance characteristics were compared according to the consensus guidelines by the European Society for Clinical Microbiology and Infectious Disease. RESULTS: A total of 38 C. difficile strains were isolated from 308 stool cultures. The period prevalence was 7.4/1000 patient-days and 21.2/1000 patient-days in the NW and MICU, respectively (P=0.034). The acquisition incidence of C. difficile infection was 1.85/ 1,000 patient-days and 5.33/1,000 patient-days in NW and MICU, respectively. The toxin B gene was detected in 38% (8/21) of C. difficile isolates; 62.5% from diarrheal patients and 23% from asymptomatic patients. In a comparison of the three typing systems, the typeability was 0.444 by PFGE, 0.972 by AP-PCR and 1 by ribotyping, and the discrimination index was 0.975 by PFGE, 0.810 by AP-PCR and 0.777 by ribotyping. All three typing systems were highly reproducible. AP-PCR was the least costly and most rapid method. CONCLUSION: The relatively high prevalence of C. difficile infection in the hospital might indicate a potential nosocomial spread, even though the acquisition incidence was low. AP-PCR appears to be an efficacious and efficient method for the epidemiologic study of C. difficile infection, and its suboptimal discriminative power may be enhanced by complementary PFGE.

Identification of Serotypes of Orientia Tsutsugamushi Using Nested PCR / 감염

BACKGROUND: For the early diagnosis of tsutsugamushi disease, polymerase chain reaction (PCR) using skin specimen might be a precise and useful diagnostic tool. The purpose of this study is to detect and identify the serotype of the Orientia tsutsugamushi from the skin lesions of the patients with tsutsugamushi disease by nested PCR. METHODS: Nested PCR was used to diagnose tsutsugamushi disease and identify the serotype of the O. tsutsugamushi; Karp, Kato, Gilliam or Boryong/Kuroki. The primer sets were derived from serotype-specific DNA sequences encoding the 56kDa antigen of O. tsutsugamushi. The PCR products were analyzed by using direct cyclic sequencing. RESULTS: The serotype-specific DNA bands with 1% agarose gel electrophoresis of amplified DNAs by nested PCR were observed in all 11 skin biopsy specimens from 8 patients with tsutsugamushi disease. Among 8 patients, 7 were proved to be infected with Boryong/Kuroki strains and one with Karp. One Karp strain showed one base mutation with amino acid sequence variation, but all the Boryong/ Kuroki strains showed no mutation. CONCLUSION: We suggest that serotype-specific nested PCR is a simple, rapid and precise diagnostic method, and useful for early diagnosis of tsutsugamushi disease. Furthermore, we might detect the sequence variations of serotype-specific DNA sequences encoding 56-kDa antigen among strains.