Below-Knee Prosthetic Bypass Is a Viable Option for Limb Salvage in Patients with Extensive Femoropopliteal Occlusive Disease

Purpose@#This study aimed to (1) evaluate the outcomes of below-knee prosthetic bypass (BKPB) in the absence of the great saphenous vein, and (2) identify risk factors associated with these outcomes. @*Materials and Methods@#This study included 37 consecutive patients who underwent BKPB with or without distal modification between 2010 and 2022. We further assessed the following treatment outcomes: primary patency (PP), secondary patency (SP), limb salvage (LS), and amputation-free survival (AFS) rates. The risk factors for PP were also examined. @*Results@#Most patients (n=31) were male. In 32 (86.5%) patients, BKPBs were performed for chronic limb-threatening ischemia. At the time of initial admission, two (5.4%) early deaths and three (8.1%) major amputations were noted. At 1 year after BKPB, the overall PP, SP, LS, and AFS rates were 78%, 85%, 85%, and 70%, respectively; at 3 years, they were 58%, 70%, 80%, and 52%, respectively; and at 5 years, they were 35%, 58%, 62%, and 29%, respectively. Notably, PP was significantly lower in limbs with ≤1 patent tibial arteries than in limbs with ≥2 patent artery (hazard ratio [HR], 3.80; 95% confidence interval [CI], 1.14-12.69 for overall; and HR, 12.97; 95% CI, 2.15-78.08 for distal anastomosis to below-knee popliteal artery). However, the PP was unaffected by the distal modification. @*Conclusion@#BKPB is a viable option for LS in patients with extensive femoropopliteal disease. Tibial runoff was significantly correlated with patency; therefore, decision-making for BKPB and follow-up must involve careful evaluation of the outflow arteries.

Histopathological Examination of the Nail Plate and Comparison between Periodic Acid-Schiff and Gomori’s Methenamine Silver Stains for the Diagnosis of Onychomycosis / 대한피부과학회지

Background@#A direct potassium hydroxide (KOH) smear is used to diagnose onychomycosis despite its broad sensitivity range. For a more accurate diagnosis, histopathologic examination can be used and consistently show high sensitivity. @*Objective@#We investigated the value of histopathologic examination of the nail plate as a diagnostic tool for onychomycosis. We proposed effective routine diagnostic staining to compare sensitivity between periodic acid-Schiff (PAS) and Gomori’s methenamine silver (GMS) staining. @*Methods@#This retrospective study was conducted from January 1, 2019 to May 31, 2020, and included 97 patients who showed negative results on direct KOH smear but had clinical manifestations that implied onychomycosis. We performed nail plate biopsy and PAS or GMS staining to identify fungal hyphae missed in the direct KOH smear. Sensitivity comparison between PAS and GMS was performed in co-stained samples. @*Results@#Among 97 patients with 102 cases, 55 cases (53.9%) of onychomycosis were confirmed by histopathologic examination. A total of 68 patients (70.1%) had a previous medical history of antifungal agents within previous six months. PAS and GMS staining were concurrently performed in 73 cases, and onychomycosis was confirmed in 41 cases. The sensitivity of PAS was 100% (41/41), while that of GMS was 87.8% (36/41); this difference was not significant. @*Conclusion@#This study suggests that histologic examination of the nail plate is an effective tool to diagnose onychomycosis and can be performed with a direct KOH smear. Two staining methods, PAS and GMS, are recommended for concurrent performance to enhance the identification of fungal hyphae.

Histopathological Examination of the Nail Plate and Comparison between Periodic Acid-Schiff and Gomori’s Methenamine Silver Stains for the Diagnosis of Onychomycosis / 대한피부과학회지

Background@#A direct potassium hydroxide (KOH) smear is used to diagnose onychomycosis despite its broad sensitivity range. For a more accurate diagnosis, histopathologic examination can be used and consistently show high sensitivity. @*Objective@#We investigated the value of histopathologic examination of the nail plate as a diagnostic tool for onychomycosis. We proposed effective routine diagnostic staining to compare sensitivity between periodic acid-Schiff (PAS) and Gomori’s methenamine silver (GMS) staining. @*Methods@#This retrospective study was conducted from January 1, 2019 to May 31, 2020, and included 97 patients who showed negative results on direct KOH smear but had clinical manifestations that implied onychomycosis. We performed nail plate biopsy and PAS or GMS staining to identify fungal hyphae missed in the direct KOH smear. Sensitivity comparison between PAS and GMS was performed in co-stained samples. @*Results@#Among 97 patients with 102 cases, 55 cases (53.9%) of onychomycosis were confirmed by histopathologic examination. A total of 68 patients (70.1%) had a previous medical history of antifungal agents within previous six months. PAS and GMS staining were concurrently performed in 73 cases, and onychomycosis was confirmed in 41 cases. The sensitivity of PAS was 100% (41/41), while that of GMS was 87.8% (36/41); this difference was not significant. @*Conclusion@#This study suggests that histologic examination of the nail plate is an effective tool to diagnose onychomycosis and can be performed with a direct KOH smear. Two staining methods, PAS and GMS, are recommended for concurrent performance to enhance the identification of fungal hyphae.

Goblet Cell Carcinoid of the Rectum in a Patient with Neurofibromatosis Type 1

No abstract available.

Human Herpesvirus 8-Negative and Epstein-Barr Virus-Positive Effusion-Based Lymphoma in a Patient with Human Immunodeficiency Virus

A 39-year-old man infected with human immunodeficiency virus (HIV) was admitted to our hospital because of sudden onset of chest pain. Chest radiography revealed pneumothorax of the right lung. Computed tomographic scans disclosed a 5.8-cm-sized emphysematous bulla in the right middle lobe of the lung. Histologically, the wedge-resected lung showed medium to large atypical cells within the bullous cavity of the Pneumocystis jirovecii pneumonia, without solid mass formation. These atypical cells were confirmed to be large B-cell lymphoma, Epstein-Barr virus-positive and human herpesvirus 8-negative. Therefore, this case was not diagnosed as primary effusion lymphoma, but effusion-based lymphoma arising in an emphysematous cavity of an HIV-infected patient. This type of effusion-based lymphoma has never been reported, and, although rare, it should be noted in order to clinically diagnose this lymphoma.

Composite Pheochromocytoma or Paraganglioma of Adrenal Gland: A Case Report with Immunohistochemical Studies and Electron Microscopic Examination

Composite pheochromocytoma or paraganglioma of the adrenal gland is a well-recognized, yet extremely rare tumor with only one case reported in Korea. We report a case of incidentally found composite pheochromocytoma and ganglioneuroma of the adrenal gland in a 44-year-old female composed of intermingled components of pheochromocytom, ganglioneuroma, and cells with intermediate features. On immunohistochemical staining, the pheochromocytoma component was positive for synaptophysin and chromogranin, but negative for S-100 protein. Staining for the S-100 protein revealed sustentacular cells which formed a peripheral coat around the "Zellballen" and Schwann cells. The Fontana-Masson stain defined neuromelanin granules of ganglion cells and the ganglion cells expressed neural markers such as neurofilament proteins. Ultrastructural findings revealed pheochromocytes with a round or ovoid nucleus and occasionally prominent nucleolus containing numerous adrenaline and noradrenaline granules.

Fatal Water Intoxication in a Schizophrenic Patient / 대한법의학회지

We report a case of fatal water intoxication in a schizophrenic patient. A 41-year-old schizophrenic male, who was admitted to a psychiatric hospital, was found dead in the restroom of the hospital. He had drunk many bowls of tap water before. On the postmortem examination, the brain was diffusely edematous, but no apparent herniation was noted. The lung was mildly expanded with edema. The stomach and intestine were diffusely expanded, and the intestine and mesentery were extensively edematous. Bilateral hydronephrosis was observed. A subcapsular hematoma with focal cortical rupture was observed in the right kidney. The vitreous sodium was 102 mEq/l and potassium was 10.5 mEq/l.