ABSTRACT
Background/Aims@#The use of a self-expandable metal stent (SEMS) is recommended for unresectable malignant biliary obstruction (MBO). Stent-related adverse events might differ according to the position of the stent through the ampulla of Vater (AOV). We retrospectively evaluated SEMS patency and adverse events according to the position of the SEMS. @*Methods@#In total, 280 patients who underwent endoscopic SEMS placement due to malignant distal biliary obstruction were analyzed retrospectively. Suprapapillary and transpapillary SEMS insertions were performed on 51 patients and 229 patients, respectively. @*Results@#Between the suprapapillary group (SPG) and transpapillary group (TPG), the stent patency period was not significantly different (median [95% confidence interval]: 107 days [82.3 to 131.7] vs 120 days [99.3 to 140.7], p=0.559). There was also no significant difference in the rate of adverse events. In subgroup analysis, the stent patency for an MBO located within 2 cm from the AOV was found to be significantly shorter than that for an MBO located more than 2 cm from the AOV in the SPG (64 days [0 to 160.4] vs 127 days [82.0 to 171.9], p<0.001) and TPG (87 days [52.5 to 121.5] vs 130 [97.0 to 162.9], p<0.001). Patients with an MBO located within 2 cm from the AOV in both groups had a higher percentage of duodenal invasion (SPG: 40.0% vs 4.9%, p=0.002; TPG: 28.6% vs 2.9%, p<0.001) than patients with an MBO located more than 2 cm from the AOV. @*Conclusions@#The SPG and TPG showed similar results in terms of stent patency and rate of adverse events. However, patients with an MBO located within 2 cm from the AOV had a higher percentage of duodenal invasion with shorter stent patency than those with an MBO located more than 2 cm from the AOV, regardless of stent position.
ABSTRACT
Purpose@#There are no effective treatment methods with which to control complications of radiation proctitis with fistula or recurrent bleeding following radiation treatment for prostate, cervical, or rectal cancer. Mesenchymal stem cells (MSCs) can induce immune modification, resulting in tissue repair and regeneration. Therefore, we used a rat model of radiation-induced proctitis and observed the effects of using human placenta-derived (PD) and adipose tissue-derived (AD) MSCs. @*Materials and Methods@#Female Sprague Dawley rats were irradiated at the pelvic area with 25 Gy. We injected 1×10 6 cells of human PD-MSCs, human AD-MSCs, human foreskin fibroblasts, and control media into the rectal submucosa following irradiation. We sacrificed rats for pathologic evaluation. @*Results@#Fibrosis on the rectum was reduced in both MSC groups, compared to the control group. Mucosal Ki-67 indices of both MSC injected groups were higher than those in the control group. Although caspase-3 positive cells in the mucosa gradually increased and decreased in the control group, those in both MSC injected groups increased rapidly and decreased thereafter. @*Conclusion@#We demonstrated the effects of regional MSC injection treatment for radiation-induced proctitis in rats. MSC injection reduced fibrosis and increased proliferation in rat mucosa. Human AD-MSCs and PD-MSCs had similar effectiveness.
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Purpose@#The current drain tubes for preventing surgically biliary anastomotic stricture are not naturally and easily removed. If a drain tube using biodegradable material is easily available and the degradation time of the tube is well controlled, surgical anastomotic stricture and fibrosis could be prevented. The aim of this animal study was to evaluate the preventive effect of novel biodegradable stents (BS) on biliary stricture and fibrosis after duct-to-duct (DD) biliary anastomosis. @*Methods@#Ten mini-pigs were allocated to the control group (n = 5) and or the stent group (n = 5). The common bile duct was exposed through surgical laparotomy and then resected transversely. In the stent group, a 4-mm or 6-mm polydioxanone/ magnesium sheath-core BS was inserted according to the width of the bile duct, followed by DD biliary anastomosis. In the control group, DD biliary anastomosis was performed without BS insertion. @*Results@#In the stent group, stents were observed without deformity for up to 4 weeks in all animals. Eight weeks later, histopathologic examination revealed that the common bile duct of the anastomosis site was relatively narrower in circumference in the control group compared to the stent group. The degree of fibrosis in the control group was more marked than in the stent group (3.84 mm vs. 0.68 mm, respectively; P < 0.05). @*Conclusion@#Our study showed that novel BS maintained their original shape and radial force for an adequate time and then disappeared without adverse events. The BS could prevent postoperative complications and strictures after DD biliary anastomosis.
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Background@#Fibroblasts produce collagen molecules that support the structure of the skin.The decrease and hypersynthesis of collagen causes skin problems such as skin atrophy, wrinkles and scars. @*Objective@#The purpose of this study is to investigate the mechanism of mitoxantrone on collagen synthesis in fibroblasts. @*Methods@#Cultured fibroblasts were treated with mitoxantrone, and then collagen synthesis was confirmed by reverse transcription-polymerase chain reaction and Western blot. @*Results@#Mitoxantrone inhibited the expression of type I collagen in fibroblasts at both the mRNA and protein levels. In the collagen gel contraction assay, mitoxantrone significantly inhibited gel contraction compared to the control group. Mitoxantrone inhibited transforming growth factor (TGF)-β-induced phosphorylation of SMAD3. Finally, mitoxantrone inhibited the expression of LARP6, an RNA-binding protein that regulates collagen mRNA stability. @*Conclusion@#These results suggest that mitoxantrone reduces collagen synthesis by inhibiting TGF-β/SMAD signaling and LARP6 expression in fibroblasts, which can be developed as a therapeutic agent for diseases caused by collagen hypersynthesis.
ABSTRACT
Unlike classic pyoderma gangrenosum (PG), the bullous variant of PG is typically represented by a painful erythematous papule, plaque, and superficial bulla that progress into the ulceration with bullous margin. Generally, bullous PG is most commonly associated with myeloproliferative disorders, such as acute myeloid leukemia (AML). Bullous PG in AML patients rarely occurs, but once it does, it suggests a poor clinical prognosis. Although many cases of classic PG in AML patients have been reported, bullous PG is relatively rare. Therefore, we present a case of bullous PG that developed in a patient with AML and was successfully treated with high-dose systemic steroids.
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Trichophyton tonsurans is an anthropophilic endothrix dermatophyte that has been the main causative organism of tinea capitis in the United States, Canada, Mexico, and other Latin American countries. In Korea, tinea capitis caused by T. tonsurans has been reported since 1995, but kerion celsi caused by T. tonsurans is rare. Kerion celsi is an inflammatory suppurative dermatophytosis of the scalp associated with hair loss. In this study, we report a case of kerion celsi occurring on the parietal scalp of a 6-year-old child diagnosed in a mycological study. T. tonsurans was identified and treated with oral itraconazole and topical epiconazole.
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Primary cutaneous anaplastic large cell lymphoma is primary cutaneous lymphoma that is composed of large lymphoid cells with anaplastic and pleomorphic morphology and expresses the CD30 antigen. Generally, primary cutaneous anaplastic large cell lymphoma is represented by a single, erosive plaque located on the trunk or extremities, but rarely on the dorsum of the hand. A 36-year-old man visited our hospital with a plaque on the dorsum of his left hand for 2 months. The plaque was 6×5 cm in size and violet-colored, with erosion. Histopathological findings showed infiltration of large anaplastic cells in the dermis and subcutaneous fat tissue. Immunohistochemically, it showed positive results for CD3, CD4, and CD30 and negativity anaplastic lymphoma kinase. Imaging examination showed no additional lesions, and the diagnosis was confirmed as primary cutaneous anaplastic large cell lymphoma. The patient was treated with radiation therapy four times and the lesion completely disappeared.
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Sweet syndrome is characterized by fever, tender, erythematous skin lesions, neutrophilia, high levels of serum inflammatory markers, and diffuse mature neutrophil infiltration typically localized to the upper dermis. Various drugs have been shown to be associated with Sweet syndrome. Bortezomib, a proteasome inhibitor approved for the treatment of multiple myeloma, has been reported to be associated with erythema, pruritus, eczemas, and, rarely, erythema multiforme-like skin changes or vasculitis. We describe a case involving a 65-year-old male who received bortezomib for the treatment of multiple myeloma. Over three cycles, multiple nodular lesions recurred through periods of aggravation and relief from symptoms. On the basis of the signs, symptoms, and biopsy results, the patient was diagnosed as showing Sweet syndrome. Skin lesions that occur during treatment of underlying disease can affect the patients’ treatment compliance. This case report indicates that a bortezomib rechallenge is an option for patients who develop sweet syndrome
ABSTRACT
Prurigo nodularis (PN) is a chronic cutaneous condition characterized by a papulonodular pruriginous eruption accompanied by pruritus. PN lesions are typically firm and itchy hyperkeratotic nodules and papules, which provoke a scratch response. PN may often represent an initial cutaneous manifestation of human immunodeficiency virus (HIV) infection. The association between PN and HIV is attributable to various etiopathogenetic mechanisms including cutaneous immunological abnormalities. Diagnosis of HIV infection in a patient with PN is challenging.We report a case of confirmed HIV infection in a patient with treatment-resistant PN, who was successfully treated using combination treatment that included HIV antiretroviral therapy and narrow-band ultraviolet-B radiation.
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Acantholytic acanthoma is a rare benign neoplasm of epidermal keratinocytes that clinically presents as a solitary, asymptomatic keratotic papule or nodule on the trunk. A 40-year-old female visited our hospital with a 20-year history of a single papule on her right thigh. On physical examination, the lesion measured 0.5×0.4 cm in size and appeared brown in color with central hyperkeratosis. Histopathological evaluation showed hyperkeratosis, acanthosis, papillomatosis, dyskeratosis, and acantholysis. Only six cases of acantholytic acanthoma have been reported in Korea. We report a rare case of acantholytic acanthoma that occurred in a 40-year-old female who presented with a keratotic papule on her right thigh.
ABSTRACT
Primary cutaneous anaplastic large cell lymphoma is primary cutaneous lymphoma that is composed of large lymphoid cells with anaplastic and pleomorphic morphology and expresses the CD30 antigen. Generally, primary cutaneous anaplastic large cell lymphoma is represented by a single, erosive plaque located on the trunk or extremities, but rarely on the dorsum of the hand. A 36-year-old man visited our hospital with a plaque on the dorsum of his left hand for 2 months. The plaque was 6×5 cm in size and violet-colored, with erosion. Histopathological findings showed infiltration of large anaplastic cells in the dermis and subcutaneous fat tissue. Immunohistochemically, it showed positive results for CD3, CD4, and CD30 and negativity anaplastic lymphoma kinase. Imaging examination showed no additional lesions, and the diagnosis was confirmed as primary cutaneous anaplastic large cell lymphoma. The patient was treated with radiation therapy four times and the lesion completely disappeared.
ABSTRACT
Sweet syndrome is characterized by fever, tender, erythematous skin lesions, neutrophilia, high levels of serum inflammatory markers, and diffuse mature neutrophil infiltration typically localized to the upper dermis. Various drugs have been shown to be associated with Sweet syndrome. Bortezomib, a proteasome inhibitor approved for the treatment of multiple myeloma, has been reported to be associated with erythema, pruritus, eczemas, and, rarely, erythema multiforme-like skin changes or vasculitis. We describe a case involving a 65-year-old male who received bortezomib for the treatment of multiple myeloma. Over three cycles, multiple nodular lesions recurred through periods of aggravation and relief from symptoms. On the basis of the signs, symptoms, and biopsy results, the patient was diagnosed as showing Sweet syndrome. Skin lesions that occur during treatment of underlying disease can affect the patients’ treatment compliance. This case report indicates that a bortezomib rechallenge is an option for patients who develop sweet syndrome
ABSTRACT
Prurigo nodularis (PN) is a chronic cutaneous condition characterized by a papulonodular pruriginous eruption accompanied by pruritus. PN lesions are typically firm and itchy hyperkeratotic nodules and papules, which provoke a scratch response. PN may often represent an initial cutaneous manifestation of human immunodeficiency virus (HIV) infection. The association between PN and HIV is attributable to various etiopathogenetic mechanisms including cutaneous immunological abnormalities. Diagnosis of HIV infection in a patient with PN is challenging.We report a case of confirmed HIV infection in a patient with treatment-resistant PN, who was successfully treated using combination treatment that included HIV antiretroviral therapy and narrow-band ultraviolet-B radiation.
ABSTRACT
Acantholytic acanthoma is a rare benign neoplasm of epidermal keratinocytes that clinically presents as a solitary, asymptomatic keratotic papule or nodule on the trunk. A 40-year-old female visited our hospital with a 20-year history of a single papule on her right thigh. On physical examination, the lesion measured 0.5×0.4 cm in size and appeared brown in color with central hyperkeratosis. Histopathological evaluation showed hyperkeratosis, acanthosis, papillomatosis, dyskeratosis, and acantholysis. Only six cases of acantholytic acanthoma have been reported in Korea. We report a rare case of acantholytic acanthoma that occurred in a 40-year-old female who presented with a keratotic papule on her right thigh.
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Rosacea fulminans is an extreme form of rosacea characterized by a rapid onset and fulminating course with prominent erythema, pustules,and cysts on the face. It can have an impact on obstetrical outcomes, and its treatments may have limitations during pregnancy. A 33-year-old woman and a 22-year-old woman presented with rosacea fulminans during the first pregnancy andwere treated with erythromycin and prednisone, respectively. After delivery, there was a significant improvement in the lesion. Rosacea fulminans recurred during the second pregnancy, but the skin lesions showed better progression. Rosacea fulminans can causesevere distress and different outcomes of pregnancy. It is recommended to consult about the risk of recurrence in future pregnancies.
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Biodegradable stents have the highly attractive advantage that they do not need to be removed after insertion into human organs. For this reason, biodegradable stents using various biodegradable materials have been developed and applied to the several human organs for a long time with the possibility of success. In the gastrointestinal tract, benign esophageal stricture was the first indication of biodegradable stents, and several biodegradable stents are currently attempting to overcome several technical limitations and to be inserted benign bile duct and pancreatic strictures by endoscopic procedure. However, in order to maintain a high radial expansion force while properly controlling the degradation time, there are many problems to be solved because the thickness of the raw material must be adequately maintained at a constant thickness. In this review, the issues or previous clinical results related to biodegradable stents were reviewed, and the concepts of the basics and the problems related to the development of biodegradable stents were discussed.
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Background/Aims@#Using an appropriate guidewire can increase the success rate of selective cannulation in endoscopic retrograde cholangiopancreatography. The purpose of this technical study was to investigate the characteristics of each guidewire type and to evaluate its efficiency and rapidity of insertion. @*Methods@#We conducted a three-point bending test using a universal testing machine to investigate the flexibility and bending features of each guidewire. 3D-printed silicone tubes with various types of stricture and a hand-made biliary tree silicone model with six-stranded intrahepatic ducts were used to evaluate the success rate and insertion time of each guidewire. @*Results@#In the three-point bending test, the characteristics of each guidewire were classified. We found that the bending strengths and times were independent of shaft thickness. Using two in vitro biliary duct models, we determined that the success rate and total insertion time were better for guidewires with a resilient shaft and angled tip than for other types of guidewires (p<0.001). Although thickness of the guidewire affected the success rate (p<0.05), it did not affect the total insertion time (p≥0.05). @*Conclusions@#Among several types of guidewire, some factors (resilient shaft, highly flexible, and angled tip) appeared to be associated with the efficiency and rapidity of the guidewire insertion.
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Purpose@#Repeating endoscopic retrograde cholangiopancreatography (ERCP) in patients with recurrent common bile duct (CBD) stones is problematic in many ways. Choledochoduodenostomy (CDS) and choledochojejunostomy (CJS) are 2 surgical treatment options for recurrent CBD stones, and each has different advantages and disadvantages. The aim of this study was to compare the 2 surgical options in terms of the recurrence rate of CBD stones after surgical treatment. @*Methods@#This retrospective multicenter study included all patients who underwent surgical treatment due to recurrent CBD stones that were not effectively controlled by medical treatment and repeated ERCP between January 2006 and March 2015. We collected data from chart reviews and medical records. A recurrent CBD stone was defined as a stone found 6 months after the complete removal of a CBD stone by ERCP. Patients who underwent surgery for other reasons were excluded. @*Results@#A total of 27 patients were enrolled in this study. Six patients underwent CDS, and 21 patients underwent CJS for the rescue treatment of recurrent CBD stones. The median follow-up duration was 290 (180–1,975) days in the CDS group and 1,474 (180–6,560) days in the CJS group (P = 0.065). The postoperative complications were similar and tolerable in both groups (intestinal obstruction; 2 of 27, 7.4%; 1 in each group). CBD stones recurred in 4 patients after CDS (4 of 6, 66.7%), and 3 patients after CJS (3 of 21, 14.3%) (P = 0.010). @*Conclusion@#CJS may be a better surgical option than CDS for preventing further stone recurrence in patients with recurrent CBD stones.
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Background@#Lichen sclerosus et atrophicus is an uncommon, benign, chronic lymphocyte-mediated inflammatory dermatosis that occurs mainly in the genital area. It causes substantial discomfort and morbidity, mostly in adult women. @*Objective@#To investigate the clinicopathological characteristics of patients with vulvar lichen sclerosus et atrophicus. @*Methods@#We retrospectively reviewed the clinical and histopathological features of 25 patients diagnosed with vulvar lichen sclerosus et atrophicus, who visited the dermatologic department between January 2009 and June 2017. @*Results@#The average age was 54.2 years, and the disease duration was mostly less than 1 year. The major clinical features were diffuse patch, followed by diffuse plaque and multiple macules. It often presented with diabetes mellitus, thyroid disease, and hypertension. Itching was the most common symptom, followed by pain and burning sensations. Histopathological findings were hyperkeratosis with follicular plugging; atrophy and loss of rete ridge elongation in the epidermis; liquefaction degeneration and keratinocyte necrosis in the dermo-epidermal junction;collagen fibers hyalinization; and infiltration of inflammatory cells in the dermis. Antihistamines and topical steroids were used in most cases for treatment. @*Conclusion@#Vulvar lichen sclerosus et atrophicus causes discomfort and diminishes the quality of life in older women. Early diagnosis and prompt treatment are vital in preventing disease progression and complications. This study will provide valuable data on vulvar lichen sclerosus et atrophicus to dermatologists.
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Background@#Lichen sclerosus et atrophicus is an uncommon, benign, chronic lymphocyte-mediated inflammatory dermatosis that occurs mainly in the genital area. It causes substantial discomfort and morbidity, mostly in adult women. @*Objective@#To investigate the clinicopathological characteristics of patients with vulvar lichen sclerosus et atrophicus. @*Methods@#We retrospectively reviewed the clinical and histopathological features of 25 patients diagnosed with vulvar lichen sclerosus et atrophicus, who visited the dermatologic department between January 2009 and June 2017. @*Results@#The average age was 54.2 years, and the disease duration was mostly less than 1 year. The major clinical features were diffuse patch, followed by diffuse plaque and multiple macules. It often presented with diabetes mellitus, thyroid disease, and hypertension. Itching was the most common symptom, followed by pain and burning sensations. Histopathological findings were hyperkeratosis with follicular plugging; atrophy and loss of rete ridge elongation in the epidermis; liquefaction degeneration and keratinocyte necrosis in the dermo-epidermal junction;collagen fibers hyalinization; and infiltration of inflammatory cells in the dermis. Antihistamines and topical steroids were used in most cases for treatment. @*Conclusion@#Vulvar lichen sclerosus et atrophicus causes discomfort and diminishes the quality of life in older women. Early diagnosis and prompt treatment are vital in preventing disease progression and complications. This study will provide valuable data on vulvar lichen sclerosus et atrophicus to dermatologists.