Comparison of tenofovir plus lamivudine versus tenofovir monotherapy in patients with lamivudine-resistant chronic hepatitis B

BACKGROUND/AIMS: Tenofovir disoproxil fumarate (TDF) exhibits similar antiviral efficacy against treatment-naïve and lamivudine (LAM)-resistant chronic hepatitis B (CHB). However, there are few clinical reports on the antiviral effects of TDF-LAM combination therapy compared to TDF monotherapy in patients with LAM-resistant CHB. METHODS: We investigated the antiviral efficacy of TDF monotherapy vs. TDF-LAM combination therapy in 103 patients with LAM-resistant CHB. RESULTS: The study subjects were treated with TDF alone (n=40) or TDF-LAM combination therapy (n=63) for ≥6 months. The patients had previously been treated with TDF-based rescue therapy for a median of 30.0 months (range, 8-36 months). A virologic response (VR) was achieved in 99 patients (96.1%): 95.0% (38/40) of patients in the TDF monotherapy group and 96.8% (61/63) of patients in the TDF-LAM combination therapy group. The VR rates were not significantly different between the TDF monotherapy and TDF-LAM combination therapy groups (88.9 vs. 87.3% at month 12, and 94.4 vs. 93.7% at month 24, log-rank p=0.652). Univariate and multivariate analyses revealed that none of the pretreatment factors were significantly associated with VR. CONCLUSIONS: TDF monotherapy was as effective as TDF-LAM combination therapy for maintaining viral suppression in the vast majority of patients with LAM-resistant CHB, which suggests that TDF add-on therapy with LAM is unnecessary.

Penicillamine-induced toxic epidermal necrolysis in a patient with Wilson disease

Toxic epidermal necrolysis (TEN) is rare but life-threatening severe cutaneous adverse reaction, which is mostly induced by drugs. It characterized by widespread epidermal necrosis, resulting in bullae with sloughing and frequent involvement of the mucous membrane. Due to high mortality, management of patients requires prompt withdrawal of the causative drug, appropriate supportive care, and consideration of immune-modulating agents, such as intravenous immunoglobulin or corticosteroids. Wilson disease is an inherited disorder of copper transport that results in excessive accumulation of copper in the body. Copper chelation with penicillamine is an effective first line therapy in most patients. We present a 20-year-old man with Wilson disease who developed TEN following administration of penicillamine. He was successfully treated with systemic corticosteroid, intravenous immunoglobulin, and supportive management.

Soft Tissue Augmentation with Silk Composite Graft / 대한악안면성형재건외과학회지

PURPOSE: The objective of this study was to evaluate the interaction between 4-hexylresorcinol (4HR) and antibody as that affects the performance of a silk-4HR combination graft for soft tissue augmentation in an animal model. METHODS: The silk graft materials consisted of four types: silk+10% tricalcium phosphate (TCP) (ST0), silk+10% TCP+1% 4HR (ST1), silk+10% TCP+3% 4HR (ST3), and silk+10% TCP+6% 4-HR (ST6). The antibody binding assay tested the 4HR effect and scanning electron microscopic (SEM) exam was done for silk grafts. The animal experiment used a subcutaneous pocket mouse model. The graft - SH0 or SH1 or SH3 or SH6 - was placed in a subcutaneous pocket. The animals were killed at one, two, and four weeks, postoperatively. The specimens were subjected to histological analysis and lysozyme assay. RESULTS: Groups with 4HR applied showed lower antibody binding affinity to antigen compared to groups without 4HR. In the SEM examination, there was no significant difference among groups. Histological examinations revealed many foreign body giant cells in ST0 and ST1 group at four weeks postoperatively. Both ST3 and ST6 groups developed significantly lower levels of giant cell values compared to ST0 and ST1 groups (P<0.001) at four weeks postoperatively. In the lysozyme assay, the ST1 and ST3 groups showed denser signals than the other groups. CONCLUSION: 4HR combined silk implants resulted in high levels of vascular and connective tissue regeneration.

Effect of 4-hexylresorcinol on Blood Coagulation and Healing of Injured Vessel in a Rat Model

Correction of post-traumatic anterior open bite by injection of botulinum toxin type A into the anterior belly of the digastric muscle: case report

Post-traumatic anterior open bite can occur as a result of broken balance among the masticatory muscles. The superior hyoid muscle group retracts the mandible downward and contributes to the anterior open bite. Denervation of the digastric muscle by injection of botulinum toxin type A (BTX-A) can reduce the power of the digastric muscle and help to resolve the post-traumatic anterior open bite. A patient with a bilateral angle fracture had an anterior open bite even after undergoing three operations under general anesthesia and rubber traction. Although the open bite showed some improvement by the repeated operation, the occlusion was still unstable six weeks after the initial treatment. To eliminate the residual anterior open bite, BTX-A was injected into the anterior belly of the digastric muscle. Following injection of BTX-A, the anterior open bite showed immediate improvement. Complication and relapse were not observed during follow-up. Long-standing post-traumatic open bite could be successfully corrected by injection of BTX-A into the anterior belly of the digastric muscle without complication.

The Effect of a Hydroxyapatite and 4-hexylresorcinol Combination Graft on Bone Regeneration in the Rabbit Calvarial Defect Model

0.05) at 8 weeks after grafting. The BMD and BV in the experimental group at 4 weeks after surgery was significantly higher than those in the control group (P<0.05).CONCLUSION: 4-hexylresorcinol and hydroxyapatite combination graft material showed higher initial bone formation than the control, however, there was no difference at 8weeks after operation.

The Effects of Tetracycline-loaded Silk Fibroin Membrane on Guided Bone Regeneration in a Rabbit Calvarial Defect Model

0.05). Regenerated bone volume (mm3) of 1% TC-loaded SFM, SFM, and control were 36.56+/-8.50, 25.86+/-8.17, and 19.09+/-5.07 at 8 weeks postoperatively, respectively (P<0.05).CONCLUSION: The 1% TC-loaded SFM showed more bone regeneration than the SFM and the uncovered control, in guided bone regeneration.

The Effect of Silk Fibroin/Nano-hydroxyapatite/Corn Starch Composite Porous Scaffold on Bone Regeneration in the Rabbit Calvarial Defect Model

0.05).CONCLUSION: The rabbit calvarial defect was not successfully repaired by silk fibroin/nano-hydroxyapatite/corn starch composite scaffold and may have been due to an inflammatory reaction caused by silk powder. In the future, the development of composite bone graft material based on various components should be performed with caution.

Primary Correction of Unilateral Cleft Lip by the Tennison-Randall Method: Cases Report and Literatures Review

Relapsed extranodal NK/T-cell lymphoma in the mandible, Nasal Type: a case report and review of the literatures

Extranodal NK/T-cell lymphoma (NTCL), nasal type is rare and highly fatal malignant neoplasm. Early diagnosis and establishing treatment plan are very difficult. Furthermore, NTCL in the mandible is an extremely rare condition. The clinical significance of presented case is the very rare location of NTCL. To the best of author's knowledge, this is the first reported case of NTCL of the mandible in the literature.

Tessier No. 2 Oblique Facial Cleft Not Associated with Cleft Lip or Palate: a Case Report

A Case of Sea Anemone Dermatitis / 대한피부과학회지

Sea anemone dermatitis, caused by the toxin of sea anemones (member of phylum Cnidaria), is characterized by erythematous papules, wheals, or vesicles, accompanied by pain and itching. A 25-year old woman presented with multiple erythematous papules on her right forearm, after contact with a sea anemone while scuba diving. She took both courses of an acute toxic reaction and a delayed allergic reaction.

A Case of Intravascular Large B Cell Lymphoma / 대한피부과학회지

Intravascular large cell lymphoma (angiotropic large cell lymphoma) is a rare, multifocal, intravascular neoplasm of lymphoid cells that preferentially involves the vasculature of the skin and central nervous system. We report a 33-year-old man who had asymptomatic purpuric patches on both thighs, left arm, and left flank. A biopsy specimen showed intravascular collections of tumor cells with irregular nuclear contour and prominent nucleoli. These cells were positive for CD45, CD20, but negative for CD3, and CD56. The clinicopathologic features and immunohistochemical profiles were diagnostic of intravasculr large B cell lymphoma.

Comparative Evaluation of Hair Density and Grouped Hair Unit Pattern between Androgenetic Alopecia and Normal Scalp

BACKGROUND: Human hair usually emerges from the scalp in groups of 2 or 3-hair units. Hair densities and grouping patterns in androgenetic alopecia (AGA) patients are known to be different from those in normal adults, but no comparative study has ever before been made in Korea. Therefore we have developed some technical improvements on phototrichogram methodology to evaluate the differences between these two groups. BACKGROUND: Objectives: This study was performed to quantify Koreans' hair characteristics at each site (vertex, occipital, temporal) of the scalp according to the age and to compare the differences of hair characteristics of AGA and normal adults using phototrichogram. METHODS: Hairs in the precisely defined circle at each (vertex, temporal, occipital) site of the scalp in 37 AGA male patients and 15 healthy male volunteers were evaluated according to age. Each circumscribed area of the scalp, centered with a dot tattoo to ensure reproducibility, was photographed just after shaving, and named 'primary image'. Two days later, the same area was again photographed, and named 'secondary image', from which the hair density and the grouping pattern of hair follicular units were determined by the image analyzer program. RESULTS: The results can be summarized as follows: 1. In normal adult males, the range of hair density was 117~13/cm2~140~16/cm2, with the hair density of the occiput being significantly higher than that of the temple. No significant differences in hair density were shown between vertex and occiput. 2. In AGA male patients, the range of hair density was 102~23/cm2-137~17/cm2, and the differences of the hair density between vertex and occiput were statistically significant. 3. The numbers of grouped hair units per square centimeter in the non-bald adult male group ranged from 59~11/cm2 to 73~14/cm2. The most common grouped hair unit was a 2-hair unit, followed by a 1-hair unit and a 3-hair unit group. 4. In the AGA group, the numbers of grouped hair units per square centimeter ranged from 57~6/cm2 to 72~12/cm2, showing no significance with the control group. The most common grouped hair unit was a 1-hair unit, followed by a 2-hair unit and a 3-hair unit group. CONCLUSIONS: The AGA group compared remarkably with the normal adult male group, showing a lower hair density with a larger proportion of 1-grouped hair units. Based on the data about hair density and hair grouping patterns in AGA patients, surgeons can estimate the area of donor scalp with the most probable number of follicular units in hair trans-plantation procedures.

Extraocular Sebaceous Carcinoma

Sebaceous carcinoma is an uncommon neoplasm usually associated with ocular adnexa. This malignancy may occur at any anatomic site that contains sebaceous glands. Despite the widespread anatomic distribution of sebaceous glands, extraocular sebaceous carcinoma occurs with far less frequency. We report a case of an 87-year-old Korean woman with extraocular sebaceous carcinoma treated with total excision.

A Case of Allergic Contact Dermatitis to Dermovate(R) and Eumovate(R) Ointment / 대한피부과학회지

Allergic contact dermatitis to topical corticosteroids seems to occur more frequently than previously supposed. But it is not easily recognized because the allergic condition for which the steroid is mostly prescribed masks the sensitization. Moreover, corticosteroids evoke some anti-inflammatory effect, even in case of steroid hypersensitivity. A 40-year-old man visited our department for the evaluation of aggravated skin lesion of trunk. Previously he was treated with Dermovate(R) and Eumovate(R) ointment for chronic dermatitis. He was patch tested to the Korean standard series, with Dermovate(R) and Eumovate(R) ointment as is. Patch test showed positive reactions to both ointments.

A Case of Bednar Tumor / 대한피부과학회지

Bednar tumor is an uncommon pigmented subtype of dermatofibrosarcoma protuberans(DFSP). The histopathological finding is characterized by a typical storiform pattern composed of spindle-shaped cells resembling DFSP except for the presence of melanin-containing cells scattered within the lesion. The origin of the spindle-shaped cells and melanin-containing cells within the tumor remains unknown. We report a case of Bednar tumor in a 26-year-old woman on the right shoulder which was presented as asymptomatic, firm, black-colored, 1x1.5 cm nodule over 2 years. Histologically, the proliferated spindle-shaped cells showed a cartwheel pattern and stained positively with CD34, similar to those of a common DFSP. The tumor was widely excised and there is no evidence of recurrence from follow-up of 6 months.

A Case of Sweet's Syndrome associated with Rheumatoid Arthritis / 대한피부과학회지

Sweet's syndrome, also referred to as acute febrile neutrophilic dermatosis(AFND), is an unusual entity characterized by painful erythematous plaques. Histologically a dense perivascular infiltrate composed predominantly of neutrophils without discernable vascular wall change. Sweet's syndrome can be associated with several disorders, such as inflammatory bowel diseases, various malignant tumors, and autoimmune diseases including rheumatoid arthritis, but the association of Sweet's syndrome with rheumatoid arthritis seems to be uncommon and no case has ever been reported in Korea. Herein we describe a patient who had Sweet's syndrome associated with rheumatoid arthritis.

Bile Carcinoembryonic Antigen in Colorectal Cancer

PURPOSE: Serum level of carcinoembryonic antigen (CEA) is clinically one of the prognostic factors in the follow-up evaluation of the colorectal cancer (CRC) patient. It has been recently suggested that the bile CEA level is also useful in early detection of the liver metastasis of colrectal cancer. If the bile CEA is also correlated with the cancer progression or prognosis like as serum CEA, it will be another useful clinical parameter in the evaluation and treatment of CRC patients. Therefore this study is aimed to reveal the correlation of the bile CEA with the progression of tumor and to estimate the possibility of bile CEA as a useful clinical parameter. METHODS: Preoperative serum levels of CEA were measured in 58 patients of CRC who were operated in Pundang CHA hospital. The levels of bile CEA were also checked with the aspiration of bile in gall bladder at laparotomy. The positive value of CEA was settled as more than 5ng/ml. RESULTS: The 58 patients were classified into 29 cases of Dukes'AB group, 23 cases of Dukes'C group & 6 cases of Dukes'D group. The positive rates of serum CEA were 24.1% in AB group, 30.4% in C group & 66.7% in D group, and those of bile CEA were 44.8%, 56.5% & 83.3% individually. When group C was also divided into N1(13 cases) & N2 (10 cases) groups according to the number of the metastatic lymph nodes, serum & bile CEA positive rates were 15.4% & 46.1% in N1 group, and 50% & 70% in N2 group. Both of serum & bile CEA levels were all positive and markedly elevated in 4 hepatic metastasis cases of group D. CONCLUSIONS: Positive rate of bile CEA was increased according to the progression of tumor stage. Marked elevation of bile CEA was especially noted in liver metastatic cases. Therefore bile CEA can be considered as a clinical parameter in evaluation of cancer progression & prognosis like as serum CEA, and also as a useful indicator of hepatic metastasis.

Solid and papillary neoplasms of the pancreas

Solid and papillary neoplasms of the pancreas, a rare tumor usually found in young female patients, seldom presents with metastasis since it is a tumor with low potential for malignancy. The prognosis for this lesion is much more favorable than that for other pancreatic neoplasms. In an attempt to understand the characteristics and prognosis of this lesion, we reviewed twenty cases treated at the Department of Surgery, Severance Hospital, Yonsei University from 1985 to 1994. The mean age of the patients was 25.6 years (range: 13 to 39 years), and 19 (95%) were women. Chief complaints were palpable mass (50%), pain (45%), and indigestion(5%). In laboratory studies, tumor markers, including CEA, CA125, CA19-9, and aFP were studied in eight patients, and found negative. Other laboratory findings were also nonspecific. These tumors may occur anywhere in the pancreas. In our studies, the tumor was most often located in the tail (45%), and the head (40%) of the pancreas. These were treated by distal pancreatectomy and splenectomy (55%), Whipple's operation (20%), pylorus preserving pancreatoduodenectomy (10%), enucleation (10%) or excision (5%). Significant morbidity or mortality was not observed during hospitalization, and no recurrence or malignant degeneration occurred during the mean follow-up period of 4 years (range: 1 month to 9 years). In conclusion, this study has suggested that the patients with a solid and papillary neoplasm of the pancreas have a good prognosis for successful treatment, if the disease is diagnosed early and the tumor is completely resected. A higher index of suspicion, and more aggressive diagnostic workups are needed in dealing with this disease entity.