Nafcillin-Associated Hypokalemia / 대한내과학회지

Hypokalemia is a common finding in various clinical settings; it is associated with diuretic use and loss of potassium via the gastrointestinal tract. Less common causes are renal tubular acidosis, diabetic ketoacidosis, excess insulin, primary hyperaldosteronism, and medications, such as amphotericin B. Nafcillin, a narrow-spectrum penicillin class antibiotic, which is selectively prescribed for methicillin-susceptible Staphylococcal aureus infections, and is commonly associated with gastrointestinal side effects, such as nausea, vomiting, and abdominal pain. However, in rare cases it can cause hypokalemia, which is usually overlooked. Severe hypokalemia was detected in a 59-year-old male patient hospitalized due to traumatic cerebral hemorrhage who received 12 g of nafcillin per day for more than 2 weeks for sepsis caused by methicillin-sensitive Staphylococcus epidermidis. We confirmed the association between nafcillin and hypokalemia through further evaluation and a review of the relevant literature. Clinicians should be aware of hypokalemia as a complication when using high doses of nafcillin.

Nafcillin-Associated Hypokalemia / 대한내과학회지

Hypokalemia is a common finding in various clinical settings; it is associated with diuretic use and loss of potassium via the gastrointestinal tract. Less common causes are renal tubular acidosis, diabetic ketoacidosis, excess insulin, primary hyperaldosteronism, and medications, such as amphotericin B. Nafcillin, a narrow-spectrum penicillin class antibiotic, which is selectively prescribed for methicillin-susceptible Staphylococcal aureus infections, and is commonly associated with gastrointestinal side effects, such as nausea, vomiting, and abdominal pain. However, in rare cases it can cause hypokalemia, which is usually overlooked. Severe hypokalemia was detected in a 59-year-old male patient hospitalized due to traumatic cerebral hemorrhage who received 12 g of nafcillin per day for more than 2 weeks for sepsis caused by methicillin-sensitive Staphylococcus epidermidis. We confirmed the association between nafcillin and hypokalemia through further evaluation and a review of the relevant literature. Clinicians should be aware of hypokalemia as a complication when using high doses of nafcillin.

Acute Kidney Injury after Administering Dapagliflozin to a Diabetic Patient with Acute Cerebral Infarction / 대한내과학회지

Dapagliflozin is a recently developed oral anti-diabetic drug and SGLT2 inhibitor with well-known cardioprotective and renoprotective effects. Although a reduction of the glomerular filtration rate is induced by volume depletion and tubule-glomerular feedback during the early period after administering a SGLT2 inhibitor, the renal prognosis improves more with a decrease of proteinuria. However, the risk of acute kidney injury increases in heart failure and hypovolemia patients, and in those taking certain drugs, such as non-steroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitor/angiotensin II receptor blockers, or diuretics. We report acute kidney injury after dapagliflozin administration in a diabetic patient with acute cerebral infarction accompanied by right hemiplegia, motor aphasia, and dysphagia.

Acute Kidney Injury after Administering Dapagliflozin to a Diabetic Patient with Acute Cerebral Infarction / 대한내과학회지

Dapagliflozin is a recently developed oral anti-diabetic drug and SGLT2 inhibitor with well-known cardioprotective and renoprotective effects. Although a reduction of the glomerular filtration rate is induced by volume depletion and tubule-glomerular feedback during the early period after administering a SGLT2 inhibitor, the renal prognosis improves more with a decrease of proteinuria. However, the risk of acute kidney injury increases in heart failure and hypovolemia patients, and in those taking certain drugs, such as non-steroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitor/angiotensin II receptor blockers, or diuretics. We report acute kidney injury after dapagliflozin administration in a diabetic patient with acute cerebral infarction accompanied by right hemiplegia, motor aphasia, and dysphagia.

Coronary Spastic Angina and Life Threatening Arrhythmia despite Nitroglycerine Infusion / 이화의대지

Variant angina pectoris is characterized by chest symptoms at rest and transient ST elevation on the electrocardiography due to coronary artery spasm. Although most patients with coronary spasm respond well to medical treatment with vasodilators such as calcium channel blockers and nitrates, some patients show intractable attack of coronary vasospasm despite standard medical therapy. We experienced 50-year-old woman with intractable chest pain due to coronary artery spasm, who suffered from ventricular fibrillation despite continuous intravenous nitrate therapy.

Polyp Clearance via Operative and Endoscopic Polypectomy in Patients With Peutz-Jeghers Syndrome After Multiple Small Bowel Resections

Peutz-Jeghers syndrome is an autosomal dominant inherited disease that manifests as a combination of mucocutaneous pigmentation and gastrointestinal hamartomatous polyps that usually cause intussusception and intestinal hemorrhage. We report the case of a 40-year-old male patient who was diagnosed 20 years ago and had previously undergone 3 intestinal resection surgeries. This time, with the use of combined operative and endoscopic polypectomy, more than 100 polyps were removed. This technique is useful for providing a "clean" small intestine that allows the patient a long interval between laparotomies and reduces the complications associated with multiple laparotomies and resections.

Therapeutic Effects and Immunomodulation of Suanbo Mineral Water Therapy in a Murine Model of Atopic Dermatitis

BACKGROUND: Balneotherapy is widely used as an alternative treatment modality for AD. Although the clinical benefit of some mineral waters has been established, their mechanisms of action in alleviating AD are only partly understood. OBJECTIVE: The clinical modification and immunomodulatory or anti-inflammatory effects of mineral water from the Suanbo hot springs on the differentiation and cytokine production of Th1, Th2, and regulatory T cells (Treg) were investigated using spleen, skin tissue, and serum from NC/Nga mice. METHODS: The therapeutic effects of bathing in mineral water in a Dermatophagoides farinae body extract ointment (Dfb ointment)-induced AD mouse model were assessed by measuring the modified Scoring atopic dermatitis (SCORAD) index scores, transepidermal water loss (TEWL), histological and immunohistochemical changes of the skin lesion, serum levels of interferon (IFN)-gamma, interleukin (IL)-4, IL-5 and immunoglobulin E, mRNA expression of IFN-gamma, IL-4 and IL-5 of dorsal skin, and helper T cell differentiation in the spleen. RESULTS: Bathing in mineral water significantly reduced the modified SCORAD index scores, TEWL, epidermal hyperplasia, and inflammatory cell infiltration. IL-4 production and Th2 cell differentiation showed a decreasing tendency with mineral water bathing, but the Th1 cells did not. On the contrary, differentiation to Treg cells was promoted with mineral water bathing. CONCLUSION: Balneotherapy not only has anti-inflammatory activity, but also shows positive effects on cutaneous barrier homeostasis. These results suggest that the favorable effects of balneotherapy may be mediated by modifying the Th2 response, and possibly in part by inducing Treg cell differentiation.

An Unusual Case of Superior Vena Cava Syndrome Caused by the Intravascular Invasion of an Invasive Thymoma / 결핵및호흡기질환

Superior vena cava syndrome (SVCS) is usually caused by extrinsic compression or invasion of the superior vena cava (SVC) by malignant tumors involving mediastinal structures. Although thymomas are well-known causes of SVCS, cases of SVCS caused by malignant thymomas protruding into adjacent vessels draining the SVC with thrombosis have been very rarely reported worldwide. We experienced a 39-year-old female patient with SVCS that developed after the direct invasion of the left brachiocephalic vein (LBCV) and SVC by an anterior mediastinal mass with a high maximum standardized uptake value on the chest computed tomography (CT) and positron emission tomography-CT. Based on these results, she underwent en bloc resection of the tumor, including removal of the involved vessels, and was eventually diagnosed as having a type B2 thymoma permeating into the LBCV and SVC. We present this case as a very rare form of SVCS caused by an invasive thymoma.

Solitary Neurofibroma on the Lower Lip / 대한피부과학회지

No abstract available.

Clinical Predictors Associated with the Severity of Colonic Diverticulitis

BACKGROUND/AIMS: Colonic diverticular diseases are increasing in Korea due to aging of the population and westernization of people's lifestyle. The aim of this study was to investigate the clinical predictors associated with the severity of colonic diverticulitis in Korea. METHODS: We retrospectively reviewed the medical records of 107 patients who were hospitalized with diverticulitis and underwent abdominopelvic computerized tomography at Dankook University Hospital between March 2002 and August 2011. The severity of colonic diverticulitis was evaluated by using Modified Hinchey classification, stage 0 to stage Ia were classified as mild group and stage Ib to stage IV were classified as severe group. Patients??records were assessed for age, sex, underlying diseases, history of diverticulitis, associated symptoms, location of diverticulitis, white blood cells, and C-reactive protein (CRP). RESULTS: Male to female ratio was 1.6:1 with the mean age of 43.1 years. Eighty-three patients (77.6%) were in the mild group and 24 patients (22.4%) were in the severe group. In multivariated analysis, the clinical predictors associated with the severity of colonic diverticulitis were left location (odds ratio [OR], 7.268; P=0.030), duration of symptoms (> or =3 days; OR, 4.174; P=0.022), and elevated CRP (> or =5 mg/dL; OR, 4.576; P=0.018). CONCLUSIONS: Left location, duration of symptom, and elevated CRP were the meaningful predictors for severity of colonic diverticulitis. When confronting with patients with these risk factors, we should keep in mind about the possibility of severe diverticulitis.

A Clinical and Histopathological Study of 17 Cases of Cutaneous Pseudolymphoma / 대한피부과학회지

BACKGROUND: Although it is important to be aware of the clinicopathological features of pseudolymphoma of the skin to avoid misdiagnosis, there are few comprehensive studies on this disease entity in the Korean dermatologic literature. OBJECTIVE: The purpose of this study was to evaluate the clinical and histopathological features of pseudolymphoma. METHODS: We reviewed the medical records, photographs and histopathological slides of 17 patients, who had been diagnosed with cutaneous pseudolymphoma, between March 2001 and August 2011. RESULTS: The ratio of males to females was 1:3.3, and the mean age of onset was 47.8 years old. Ten patients (59%) had no symptom and the most commonly involved site was the head and neck (59%). Ten patients (59%) had a solitary lesion. Nobody had a family history or past history of pseudolymphoma or lymphoma. Of the 17 cases, 16 (94%) were idiopathic. The common microscopic feature of pseudolymphoma was diffuse and dense lymphocytic infiltration in the reticular dermis. In the immunohistochemical staining of 15 cases (88%), the infiltrating cells were positive for both B cell and T cell marker. The treatment included intralesional steroid injection, systemic steroids and excision. An average follow-up period was 38.4 months (from 2 to 107 months) for 13 patients. During this period, no recurrence or malignant transformation was observed in these patients. CONCLUSION: Our findings demonstrate that cutaneous pseudolymphoma is most common in middle-aged female, and it has a good response to steroid treatment or simple excision, without malignant transformation.

A Case of Cutaneous Horn-Like Cutaneous Focal Mucinosis / 대한피부과학회지

No abstract available.

A Case of Fibro-osseous Pseudotumor of the Digit / 대한피부과학회지

Fibro-osseous pseudotumor is an unusual ossifying fibro-proliferative lesion. Typically, this lesion affects the young adults, mainly women, and presents as a painful, localized, fusiform, and often erythematous swelling in the soft tissue of the fingers, especially the region of the proximal phalange. We present a case of fibro-osseous pseudotumor on the left index finger of a 22-year-old woman. Diagnosis was confirmed by histopathologic features, followed by complete excision of the lesion. At the 7-month follow-up, there was no recurrence. We suggest that fibro-osseous pseudotumor should be considered in the differential diagnosis of any digital mass.

Expression of eotaxin in 3T3-L1 adipocytes and the effects of weight loss in high-fat diet induced obese mice

Eotaxin is an important inflammatory chemokine in eosinophil chemotaxis and activation and, thus, is implicated in asthma. Recently, obesity was associated with an increased prevalence of asthma, but the relationship between obesity and eotaxin expression has only been partially understood in obese mice and human studies. Therefore, we studied the expression patterns of eotaxin in 3T3-L1 preadipocytes/adipocytes to determine whether eotaxin levels are influenced by body weight gain and/or reduction in diet-induced obese mice. First, we investigated eotaxin expression during differentiation in 3T3-L1 adipocytes. Then, we treated 3T3-L1 preadipocytes/adipocytes with tumor necrosis factor-alpha (TNF-alpha), eotaxin, interleukin (IL)-4, IL-5, or leptin. To examine the effects of weight loss in high-fat diet induced obese mice, we fed C57BL/6 mice a high-fat diet or a normal diet for 26 weeks. Then, half of the high-fat diet group were fed a normal diet until 30 weeks to reduce weight. Epididymal adipose tissue, visceral adipose tissue, serum, and bronchoalveolar fluid of mice were examined for eotaxin expression. The results showed that eotaxin expression levels increased with adipocyte differentiation and that more eotaxin was expressed when the cells were stimulated with TNF-alpha, eotaxin, IL-4, IL-5, or leptin. An in vivo study showed that eotaxin levels were reduced in visceral adipose tissues when high-fat diet fed mice underwent weight loss. Taken together, these results indicate a close relationship between eotaxin expression and obesity as well as weight loss, thus, they indirectly show a relation to asthma.

A Case of Subungual Bizarre Parosteal Osteochondromatous Proliferation of the Toe / 대한피부과학회지

Bizarre parosteal osteochondromatous proliferation (Nora's lesion) is a rare lesion with a tendency to recur. It is usually a solitary lesion that most often develops on the hands and feet. We now present a case of bizarre parosteal osteochondromatous proliferation initially misdiagnosed as subungual exostosis on the left great toe of a 13-year-old boy. The diagnosis was confirmed by radiologic and histopathologic features, followed by complete excision of the lesion. He had a relapse after two months and was treated with re-excision. We suggest that bizarre parosteal osteochondromatous proliferation should be considered in the differential diagnosis of any digital mass.

A Case of Atypical Spitz Nevus / 대한피부과학회지

A 6-year-old boy presented with a fast-growing, 0.8x0.7 cm-sized, dome-shaped, erythematous nodule on the back. Histopathologically, the lesion showed a spitzoid melanocytic proliferation from the dermo-epidermal junction to the reticular dermis. Melanocytes arranged in nests were epithelioid and spindle-shaped with abundant eosinophilic cytoplasm. The histopathological and clinical features were consistent with atypical Spitz nevus in that they showed no Kamino body, prominent cellular density, more than three mitoses per high power field, a high Ki-67 level, large size, and the lesion was located at an unusual location. Herein, we report a case of an atypical Spitz nevus on the back of a 6-year-old boy.

Surgical Treatment of AO Type C Distal Femoral Fractures Using Locking Compression Plate (LCP-DF, Synthes(R))

PURPOSE: To analyze the surgical results of AO type C distal femoral fractures using locking compression plate. MATERIALS AND METHODS: From February 2006 to June 2008, 14 patients 15 cases were included. Injury mechanisms, combined injuries, radiologic and clinical results and postoperative complications were analyzed. RESULTS: The mean age was 59.6 (30~77) years. The mean follow up period was 25 (12~40) months. AO types were 3 of C1, 5 of C2 and 7 of C3. Injury mechanisms were 9 of traffic accident, 5 of slip down and 1 of fall from a height. Four cases were combined with other extremity injuries or fractures. The mean radiologic union was obtained at postoperative 15 (13~20) weeks. The mean Neer's functional score was 74.2 (58~97); 3 of excellent, 5 of satisfactory and 7 of unsatisfactory. Postoperative complications were 2 of infection and 1 of nonunion. There were no mechanical failures or fixation loss with locking compression plate at the final follow up. CONCLUSION: Internal fixation using locking compression plate for AO type C distal femoral fractures provided excellent fixations. At the final follow up, the clinical results were variable. The affecting factors on the final results seemed to be joint congruencies after anatomical reduction and active rehabilitation.

Cementless Bipolar Hemiarthroplasty for Unstable Intertrochanteric Fractures in Elderly Patients

BACKGROUND: Bipolar hemiarthroplasty for unstable intertrochanteric fractures in elderly patients is a viable option that can prevent the complications of an open reduction, such as nonunion and metal failure. This study evaluated the clinicoradiological results of cementless bipolar hemiarthroplasty for unstable intertrochanteric fractures in elderly patients. METHODS: Forty hips were followed for more than 2 years after cementless bipolar hemiarthroplasty using a Porocoat(R) AML Hip System. The mean age was 78.8 years and the mean follow-up period was 40.5 months. The Harris hip score and postoperative hip pain were analyzed clinically. The radiological results were assessed using a range of indices. RESULTS: At the last follow-up, the mean Harris hip score was 80.6 points. There were one case of hip pain and one case of thigh pain. Twenty-four cases (60%) showed no decrease in ambulation capacity postoperatively. Radiologically, there were 23 cases (57.5%) of fixation by bone ingrowth and 17 cases (42.5%) of stable fibrous fixation. There were no cases of osteolysis. Eleven cases (27.5%) of new bone formation were found around the stem. All stems were stable without significant changes in alignment or progressive subsidence. CONCLUSIONS: The short-term results of cementless bipolar hemiarthroplasty in elderly patients with unstable intertrochanteric fractures were satisfactory.

Calcification of Intervertebral Discs of the Cervical Spine in Children: Report of 2 Cases / 대한정형외과학회잡지

Calcification of intervertebral discs of the cervical spine in a child is an uncommon disorder, and is often associated with clinical symptoms. The etiology is still unknown, but the natural history has been reported as having a self-limiting course with an excellent prognosis. Here we report two cases of symptomatic cervical disc calcification in a child and provide a literature review.

Treatment of Hallux Valgus with Distal Chevron Metatarsal Osteotomy / 대한족부족관절학회지

PURPOSE: The authors intended to analyze the operative results of mild to moderate hallux valgus treated with distal chevron metatarsal osteotomy. MATERIALS AND METHODS: Twenty six feet of twenty three patients were followed for more than 1 year after the distal chevron metatarsal osteotomy. Biplanar osteotomy with wedge resection was done when the distal metatarsal articular angle (DMAA) was increased. The mean age was 39 years, and the mean follow up period was 27 months. Clinically preoperative and postoperative AOFAS hallux MP-IP scale and satisfaction after the surgery were analyzed. Radiologically hallux valgus angle, the 1st intermetatarsal angle, DMAA and sesamoid position before and after the operation were analyzed. RESULTS: Distal chevron osteotomy was done in 15 cases and biplanar osteotomy was done in 11 cases. Clinically AOFAS scale was increased from 65.3 points preoperatively to 92.2 points postoperatively. Two patients were not satisfied with the results. Radiologically hallux valgus angle was decreased from 21.9degrees preoperatively to 8.5degrees postoperatively. The first intermetatarsal angle was decreased from 11.8degrees preoperatively to 6.7degrees postoperatively. DMAA was decreased from 11.8degrees preoperatively to 5.5degrees postoperatively. There was one case of minor wound infection. CONCLUSION: Distal chevron metatarsal osteotomy appears to be safe and satisfactory procedure for mild to moderate hallux valgus.