Clinical impact of symptom-to-door time on 1-year mortality in patients with non-ST segment elevation acute myocardial infarction / 대한내과학회지

BACKGROUND/AIMS: Symptom-to-door time is associated with the prognosis for ST-segment elevation myocardial infarction. However, this value has not been a concern in patients with non-ST segment elevation myocardial infarction (NSTEMI). The aim of this study was to assess the relationship between symptom-to-door time and clinical outcomes in patients with NSTEMI. METHODS: In total, 1,971 patients with NSTEMI (64.8+/-12.1 years, 23.6% women) were enrolled between Nov. 2005 and Jan. 2008. The patients were divided into two groups according to the time difference between the presentation of symptoms and first medical contact: group I (12 hours, n=538). One-year mortality rates were compared between the groups. Thrombolysis In Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk scores were calculated in all study patients. RESULTS: The mean age was 64.4+/-12.2 years in group I and 65.6+/-12.0 years in group II (p=0.046). No significant differences existed between the two groups, except for the prevalence of hypertension, diabetes mellitus, initial systolic blood pressure, and initial serum creatinine levels. One-year mortality rates decreased significantly in group I patients [hazard ratio (HR)=1.35, 95% CI (confidential interval): 1.03~1.75, p=0.028] based on a multivariate Cox proportional analysis, which was adjusted by GRACE score, baseline characteristic variables, and predictors of a 1-year mortality in a univariate analysis. In intermediate-to high-risk patients (n=1,184, defined as having a TIMI risk score above 3 points), significant differences were observed in mortality rates between the two groups (HR=1.35, 95% CI: 1.02~1.80, p=0.037); the low-risk patients (n=787, HR=1.57, 95% CI: 0.80~3.05, p=0.188), however, showed no such differences. CONCLUSIONS: Symptom-to-door time was an independent long-term clinical predictor in patients with NSTEMI, especially in intermediate-to high-risk groups.

Infection Control Activities in Korea University Medical Center / 병원감염관리

No Abstract available.

A Case of Ehlers - Danlos Syndrome / 대한피부과학회지

No abstract available.

Juvenile Generalized Pustular Psorasis Treated with Etretinate and Methotrexate / 대한피부과학회지

A case of generalized pustular psoriasis in a 12 year-old girl is described. She had generalized pustular eruptions on erythematous base, presenting lake of pus, yellowish brown crusts and denudation associated with high fever and chills. With the administration of oral etretinate at a dose of 0.8mg/kg/day for 1 week, rapid and dramatic remission was achieved. About 3 months after her discharge, there developed another wave of new pustules with fever. She was again placed on etretinate therapy. However, there was no expected response as before with developing new pustules continuously. At that time, we tried combination therapy with etretinate and methotrexate. the pustules and erythema began to remit, with eventual clearing of the skin in 6 weeks.

A Case of Histiocytic Cytophagic Panniculitis / 대한피부과학회지

We report a case of histiocytic cytophagic panniculitis in a 5-year-old male. The patient has complained of multiple erythematous indurated palques with tenderness on the lower abdomen, periocular areas, left forearm and both thighs associated with high fever for 45 days. Hepatosplenomegaly and enlarged lymph nodes were found. Laboratory data revealed pancytopenia, elevation of liver enzymes and prolon gation of PT and PTT. Histopathologic findings of subcutaneous plaque taken from the left forenrm showed lobular panniculitis with fat necrosis and some phagocytic histiocytes containing erythrocytes, leukocytes, lymphocytes and nuclear debris, that had the appearance of bean bag. There found no atypical histiocytic infiltrations or cellular pleomorphism.

Delayed Cutaneous Hypersensitivity Reactions in a General Adult Population of Korea / 대한피부과학회지

We messured delayed cutaneous hypersensitivity reactions by Multitest CMI Kit. Total 209 normal adults ranging in age from 17 to 55 year(male 106, female 103) were tested. The results were obtained as follows ; 1. Sum of average diameter of positive antigens wss 20.7mm in male and 15.6mm in female. 2. Number of positive antigens was 3.9 in male and 3.4 in female. 3. Rate of anergy was 1.4%(0.9% in male, 1.9% in female). 4. The rate of subjects below warning score(below 10mm in male, below 5mm in female) was 2.8% in male and 5.8% in female. 5. Antigen with the highest response was tuberculin in both sex(male 95.3%, female 89.3%) and antigen with the lowest response was trichophyton(22.5%). 6. Aversge score of positive response of every antigens was highest in tuberculin at both sex(male 2.8mm, female 2,6mm) 7. Average score of total antigens with positive response was 5.5mm in male and 4.6mm in female. 8. The rate of false positive reaction to 70% W/V glycerine was 1.4% totally.

A Case of Mycosis Fungoides / 대한피부과학회지

We report a case of 68-year-old male patient who was confirmed as d'emblee type of mycosis fungoides. The skin lesions showed sharply rnargined multiple reddish brown coIarcd papules, ndules, and tumors on the groin, thign, abdomen, and neck. The microscopic findings showed the epidermotropism and pautrier's micruabscess in the epidermis, and the infiltration of atypical cells in the dermis. The electron micrascopic findings showed irregular contour of the nuclear mernbrane within atypical lymphocytes. Thc lesions were gradually diminished by superficial radiation therapy.

A Case of Elastosis Perforans Serpiginosa Associated with Pseudoxanthoma Elasticum / 대한피부과학회지

we report a case of elastosis perforans serpiginosa associated with pseudoxanthoma e1asticurn on t:he neck of 27-year-old male patient. The lesions showecl erythematous scaly hyperkeratotic papules forming serpiginous pattern on yellowish elevated plaques. A skin biopsy specimen from the neck lesion revealed dense accurmulations of coarse elastic fibers partly cngulfed by epithelium in the papillary dcrrnis and increase cif short, irregulary clumped and degenerated clastic fibers in the middermis. On funduscopic exarnination, angioid streak is noted around the optic disk.

A Clinical Study of Recombinant Interferon - alpha Ointment in the Treatment of Several Viral Skin Diseases: Multicenter Trials / 대한피부과학회지

A study evaluating the therapeutic effect of recombinant interferon-a ointment on several viral skin diseases was done. A total of 204 patients, 92 of herpes simplex, 90 of herpes zoster and 22 of varicella, were included in this study. Two different concentration of recombinant interferon-a ointment(l*10IU/g; group A, 1*10IU/g; group B) and placebo vehicle(control group) were applied topically on the early lesion of the disease. The evaluation of therapeutic effect was done by the measurement of time interval from the day of vesicle formation to the day of crust formation, The results were as follows; 1. Herpes sirnplex: Crust formation observed within 6 days in 70. 1% of group A. 63.9% of group B and 26.7%, of control group. The time of crust formation of group A and B was shorter than that of control group (p<0.01, P<0.05). 2. Herpes zoster: Crust formation observed within 10 days in 64. 3% of group A. 46.7% of group B and 33. 3% of control group. The time of crust formation of group A was shorter than that of control group (p<0.05). 3. Varicella: Crust formation observed within 6 days in 87. 5% of group A, 72.7% of group B and 66.7% of control group. Therefore we have been impressed that recombinant interferon-a ointment is an effective topical therapeutic agent and 1*10IU/g recombinant interferon-a clintment is more effective than 1*10IU/g recombioant interferon-a ointment for above viral skin diseases.

IgE and In Vivo Delayed Hypersensitivity to the Recall Antigens in Atopic Dermatitis and Their Relationship / 대한피부과학회지

We measured serum 1gE by using IgE 'Eiken' radioirnrnunoassay Kit and delayed cutaneous hypersensitivity responsiveness by the Multitest CMI Kit (Institut Merieux) that simultaneously administrates 7 standardized recall antigens(tetanus, diphtheria, streptococcus, tuberculin, candida, trichophyton, proteus) and 70% W/V glycerin diluent control by multiple prick puncture. We studied 40 cases comprising 20 patients with atopic dermatitis (AD) and 20 healthy children as control. The results were obtained as follows; 1) The mean serum level of IgE in AD(63.3+/-395.2 1U/ml) was higher than in control(155.6+/-67.1IU/ml) (p<0.0l), but the intensity of reaction (IR) & rate of reaction (RR) in AD (l.34+/-1.06, 0.38+/-0.23) was not significantly decreased than in control (1.70+/-0.87,0.44+/-0.16). 2) 1n both AD & control group, tuberculin showed highest IR R RR. 3) Anergic state was found in only one patient with disseminated cutaneous lesions Sc 4) serum IgE, but rate of hypoergy was significantly increased in AD(65%) than in control (30%) (p<0.05). 4) Serum IgE was not statistically correlated with IR and RR, but IR was statistically correlated with RR (p<0.001, r=0.9504). 5) IgE level in severe AD (generalized skin lesion) was significantly increased than in both mild AD 8c control group (p<0. 001). but IR & RR were not statistically correlated with disease severity.

A Case of Epidermolytic Hyperkeratosis / 대한피부과학회지

Epidermolytic hyperkeratosis, previously called bullous congenital ichthyosiform erythroderma is a dominantly inherited disorcler and usually manifested by blisters at or shortly after birth. We report a case of epidermolytic hyperkeratosis in 9 year old girl vrho developed generalized erythema &: easily eroded vesicles at birth. Later the skin lesions progresed to characteristic thick, grayish-dark brown verruform cais, affecting predominantly flexural and intertriginous areas. Fiistologic findings show typical granular degeneration.

A Case of Acrodermatitis Enteropathica / 대한피부과학회지

Diiodohydroxyquin introduced by Dillaha et al in 1953, had been the mainstay for the treatment of acrodermatitis enteropathica (A.E.). However, following the report by Moynahan and Barnes in 1973 of successful treatment with the oral administration of zinc sulfate, the clinical response to this treatment has been confirmed by different investigators in many countries. In Korean literature, Rhim et al reported two cases of A,E. in siblings successfully treated with oral zinc sulfate in 1980. In our case of cow's milk-fed, 7 month-old male infant, typical claasical features of total alopecia, diarrhea and periorificial dermatitis developed at about 3 months. of age and the zinc level in serum was 101 ug/dl at the first visit. Treatment first with diiodohydroxyquin was initiated at a dose of 315 mg/day by mouth for the first week and 630 mg/day for the second week, but this therapeutic regimen brought about little or no effect. Because of no definite improvement even with increasing dose of 1260 mg/day for another week, treatment was. changed to oral zinc sulfate. The patient began to receive zinc sulfate 50mg at first day by mouth and the dosage was immediately increased to l00mg daily from the next day. Within 72 hrs there found dramatic improvement in the skin lesions and diharrhea stopped. Twenty days after the start of zinc therapy, nearly all the skin lesions disappeared and the patient was discharged in satisfactory condition with only mild residual erythema. (countinued..)

A Case of the Sign of Leser-Trelat / 대한피부과학회지

The sign of Leser-Trelat refers to the sudden appearance and rapid increase in size and number of freckles and seborrheic keratoses, It is considered to be a sign of internal malignant tumors, most probable of the gastrointestinal tract. We report a case of adenocarcinoma of the stomach associated with the sign of Leser-Trelat and the literatures were reviewed. This 62-year-old man, over a period of 5 months, developed multiple seborrheic keratoses over his trunk and extremities. He came to our department in August 1981, because of sudden increse in their number and size during the several preceding months. He had never complained of the symptoms of gastrointestinal tract such as gastric pain, vomiting, indigestion, and weight loss. On examination of the skin, hundreds of brown or brown-black, more or less greasy verrucous papules were found almoat exclusively on the extensor aspects of forearms and lower legs. These lesions were variable in size and were consistent clinically with seborrheic keratoses. The findings of both fiberoptic biopsy and upper gastrointestinal tract series of roentgenographic studies were compatible with ulcer and adenocarcinoma of the stomach. Based on our experience, it is again suggested that though seborrheic keratoses are very common in the elderly, the rapid increase in size and number should arouse suspicion of an internal malignancy.

Two Cases of Acute Febrile Neutrophilic Dermatosis (Sweet's Syndrome) / 대한피부과학회지

We present two cases of acute febrile neutrophilic dermatosis developed in women aged 56 and 52. One of the two patients deveIoped the lesions during longterm antituberculosis chemotherapy for her advanced pulmonary tuberculosis, The other case developed the lesions, initially at the site of acupuncture done for relief of her arthralgia, followed by the involvement of the other sites. The etiology of acute febrile neutrophilic dermatosis is not clear, however, hypersensitivity and association with systemic diseases such as upper respiratory infection, malignancies, ulcerative colitis and pyoderma gangrenosum are postulated.

A Case of Xanthoma Tuberosum / 대한피부과학회지

A 43 year-old Korean male has had multiple, grouped, asymptomatic, yellowish brown flat papules and nodules on the knees, elbows, buttocks, palms and soles for 3 years. Small yeIlowish, discrete papules first appeared on the right palm and left elbow, and gradually increased in size and number and spread to knees, buttocks and soIes. Physical examination revealed normal except for the skin lesions and no familial occurrence was noted. Gross finding of the serum was turbid, more or less creamy and paper electrophoresis revealed marked increase of prebetalipoprotein, increase of betalipoprotein and alphalipoprotein and absence of chylomicron, suggesting type III or type IV hyperlipoproteinemia. Serem choleterol was 200mg% and fasting blood sugar was 115.0mg%. with normal glucose tolerance test. Histopathology showed many aggregates of foam cells on H-E stain and many lipid droplets in the dermis on Sudan red stain. Based on the clinical and histopathological findings and lipoprotein analysis by the paper electrophoresis, the patient was diagnosed as type IV hyperlipoproteinemia with xanthoma tuberosum.

Three Cases of Familial Benign Chronic Pemphigus / 대한피부과학회지

Familial Renign Chronic Femphigus(FRCP) is rare, persistent and vesicobullous genodermatoai. Three casee of FRCP with typical clinical and histapathological findings are reported. The first case of FBCP was 27-year-oId man who had recurrent episodes of grou vesicles and rust with miId pruritue at the posterior neck, in both axillae and in inguinal area for 10 years. The second case was 49-year-old woman with skin lesions of recurrent persistent. vesicles, pustules on the erythematous skin, crust and lichenification on the flexural area of extrimeties, axillae, ingumal and neck area for 10 yeara. The third case was 49-year-old male patient who had recurrent pruritic grouped vesicles with crust on the neck and axillary area. In all three patients, skin eruptions usually began and or aggravated in the spring or summer and tend to heal spontaneously in the autumn and winter and showed positive Nikolsky sign. The only one case of the reported three casea had familiaI history of skin lesions similar to FRCP. Histopat,holag;ic finding of biopsy specimens from the vesicular eruption showed auprabasal vesiculation with acantholysis, lacunae and villi formation in all 3 cases.

A Case of Malignagr Lymphoma / 대한피부과학회지

A 28-year-old male patient is described who developed multiple erythematous nodules and papules on the face, upper chest, back, upper and lower extrimities, leading to extensive ia.filtration of the skin and lymph nodes. Histology from the involved lymph node and skin nodule revealed widely scattered patchy infiltration of abnormal. hyperchromatic polymorphous histiocytes in the dermis. The patient died at about 8 months after onset of the disease, in spite of antineoplastic treatment.