Comparison of the prevalence and histology between primary benign bladder tumors and recurrent benign lesions after transurethral resection of malignant bladder tumors / 고신대학교의과대학학술지

Background@#Benign bladder tumors are rare disease entities, and insufficient studies have assessed their epidemiological characteristics. The authors investigated the prevalence of benign bladder tumors by retrospectively investigating pathology reports of transurethral resection of bladder tumor (TURBT) procedures over the past 20 years. @*Methods@#We analyzed 1,674 pathology reports of TURBT conducted in 1,160 patients from January 1, 2000, to April 30, 2022. The prevalence of benign tumors and histological classification according to the presence of primary (group 1) and recurrent (group 2) bladder lesions were retrospectively investigated. @*Results@#The mean age of patients was 65.2±11.5 years, and 1,284 cases (79.1%) were in men. Benign bladder tumors comprised 278 cases (248 patients) accounting for about 17.1% of the total TURBT cases (278/1,624). Furthermore, 184 patients (16.0%, 184/1,147) belonged to group 1 and 78 patients (27.4%, 78/285) belonged to group 2. Among all benign lesions that underwent TURBT, cystitis was the most common (41.0%, 114/278), and this rate was higher in group 2 (64/184 [34.8%] vs. 50/94 [53.2%], p<0.001). The prevalence of non-neoplastic lesions was higher in group 1 (44/184 [23.9] vs. 11/94 [11.7%], p<0.001). There was no difference in the prevalence of noninvasive urothelial neoplasms between the two groups (22/184 [12.0%] vs. 8/94 [8.5%], p=0.86). @*Conclusions@#The probability of benign lesions in TURBT was 17.1%, among which cystitis was the most common. When TURBT was performed for recurrent lesions, the frequency of benign tumors was higher than that of primary benign bladder tumors.

The Importance of Lamina Size Measurement and Proper Implants Selection before Laminoplasty : Two Case Reports / 고신대학교의과대학학술지

Open door laminoplasty using plates is a safe and effective procedure for multi-level cord compression. To achieve stable laminar arch, various types of plate have been developed and used. Now, we introduce two rare complications related to the laminar shelf of plate. In the first case, we used the wider laminar shelf plate because the elevated lamina did not fit well into the usual laminar shelf. During follow-up, cord compression due to laminar shelf was observed. And in the second case, the laminar shelf of plate did not fit into the elevated lamina, so we inserted it with a little bit of force. But the patient’s symptom was not improved. On CT image, the inner cortical bone of the lamina was fractured. To prevent these complications, surgeons need to consider the thickness of the lamina and the size of the laminar shelf before surgery.

Calculation of Socioeconomic Cost of Depression in Korea in 2019 / 생물치료정신의학

Objectives@#：The high lifetime prevalence of depression in Korea is related to problems such as suicide and decreased productivity, as well as the cost of disease due to increased use of medical services, which can cause great socioeconomic loss. Therefore, in this study, the burden of disease of depression and the importance of managing mental health diseases, which are increasing day by day, are suggested to be helpful in determining priorities in health policy establishment. @*Methods@#：In this study, the socio-economic cost of depression was calculated by dividing it into direct cost and indirect cost. For statistical data, data from the National Health Insurance Service of the public and statistics on diseases of national interest were mainly used. @*Results@#：As a result, the socio-economic cost of depression in 2019 estimated in this study was calculated to be a total of KRW 4.83 trillion, with direct costs 692.9 billion won and indirect costs 4.13 trillion won. Among them, the cost due to decrease in work performance accounted for the largest portion, accounting for 65.5%. @*Conclusions@#：As the socio-economic burden due to depression is expected to increase in the future, it is necessary to establish a systematic funding plan for the treatment and management of depressed patients in daily life.

A Literature Review on the Public Program of Walking Promotion for Active Living / 農村醫學 地域保健

Objectives@#This study aimed to describe the current public programs for community walking in Korea and to discuss their challenges.Method: We identified the literature related to community walking including five laws, 22 white papers from government departments and 84 program reports from the Seoul Metropolitan Government. @*Results@#Korean law guarantees legal rights and validity to create safe, convenient and equitable environments for community walking. The government department, which has jurisdiction over legislation relating to community walking, has dominated community walking programs, and the role of public health department has been insufficient. Almost all sectors in the department of Seoul Metropolitan Government were involved in community walking programs. However, inter-sectoral cooperation system for community walking was insufficient. @*Conclusion@#It is necessary to revise the condolences of the National Health Promotion Act to establish the role and perspective of public health in community walking promotion. Institutional efforts should be made to expand the network structure between sectors of community walking programs by establishing an organizational, budget, and performance sharing system for inter-sectoral approach.

Effect of corosolic acid on apoptosis and angiogenesis in MDA-MB-231 human breast cancer cells / 한국영양학회지

Purpose@#Corosolic acid (CA), also known as 2α-hydroxyursolic acid, is present in numerous plants, and is reported to exhibit anti-cancer and anti-proliferative activities in various cancer cells such as osteosarcoma, hepatocellular carcinoma, lung adenocarcinoma, and colon cancer. However, the anti-cancer activity of CA on human breast cancer cells and the underlying mechanisms remain to be elucidated. The present study aimed to investigate the anticancer effects of CA in the human breast cancer cell line, MDA-MB-231. @*Methods@#Cell viability, reactive oxygen species (ROS) production, apoptosis marker protein expression, migration, invasion rate, and vascular endothelial growth factor (VEGF) levels were assessed by treating MDA-MB-231 cells to increasing concentrations of CA. @*Results@#The results showed that CA significantly inhibited the cell proliferation of MDA-MB-231 cells in a dose-dependent manner. To assess the effect of CA on apoptosis, nuclei of MDA-MB-231 cells were stained with DAPI solution. Chromatin condensation, which indicates apoptosis, was observed to increase dose-dependently. In addition, western-blot analysis revealed elevated levels of the apoptosis marker proteins (Bax and cleaved caspase 3) subsequent to MDA-MB-231 exposure to CA. ROS production was also increased in the CA-induced apoptosis in MDA-MB-231 treated cells. Interestingly, CA exposure resulted in significantly decreased migration and invasion rates in the MDA-MB-231 cells. Data further revealed that exposure to CA markedly decreased the VEGF concentration, thereby contributing to a reduction in angiogenesis. @*Conclusion@#Our results determined that exposure to CA induces anti-proliferation, apoptosis, and ROS production, and suppresses cell migration and invasion rate in MDA-MB-231 cells. Taken together, these results indicate the potential of CA to be applied as an effective chemotherapeutic agent for treating breast cancer.

Possible Role of Lysine Demethylase 2A in the Pathophysiology of Psoriasis

Background@#Psoriasis is a common chronic inflammatory skin disease. The development of psoriasis is dependent on many intercellular events such as innate immunity and T cell-mediated inflammation. Furthermore, genetic factors are strongly implicated in the pathophysiology of psoriasis. Although a variety of susceptible genes are identified, it is likely that many important genes remain undisclosed. @*Objective@#The aim of this study is to investigate the possible role of lysine demethylase 2A (KDM2A) in the pathophysiology of psoriasis. @*Methods@#We examined the expression of KDM2A using a well established imiquimod-induced psoriasiform dermatitis model. @*Results@#Immunohistochemistry analysis showed that expression of KDM2A was increased in imiquimod-induced psoriasiform dermatitis. Consistent with this result, KDM2A level was markedly increased in the epidermis of psoriatic patient. When keratinocytes were stimulated with TLR3 agonist poly(I:C), KDM2A was increased at both the mRNA and protein levels. Poly(I:C) increased the expression of psoriasis-related cytokines including tumor necrosis factor-α, interleukin-8, and CCL20, and KDM2A inhibitor daminozide enhanced the poly(I:C)-induced cytokine expression. Finally, topical co-application of imiquimod and daminozide exacerbated the imiquimod-induced psoriasiform dermatitis. @*Conclusion@#Together, these results suggest that KDM2A is increased to negatively regulate the inflammatory reaction of epidermal keratinocytes in psoriasis.

Virtual Preoperative Simulation for Excision of Spinal Tumors: Surgeon Processing of Medical Computer-Assisted Design Software

As medical computer-aided design (CAD) has improved, virtual 3-dimensional medical images have been gaining more easily without any special practice. These images can be applied to various clinical fields. This article illustrates virtual preoperative simulation for excision of spinal tumors using medical CAD software. The software was used directly by the surgeon. The process of virtual preoperative simulation for spinal tumor surgery was found to be not inordinately complicated. And, virtual simulation was helpful in determining surgical steps as well as understanding the surgical anatomy.

Delayed Epidural Mucin Collection after Surgery for Spinal Metastatic Pancreatic Adenocarcinoma

A rare case of delayed large epidural mucin collection causing neurologic deficit after surgery for metastatic pancreatic cancer is reported. A 65-year-old man presented with intractable upper-thoracic back pain radiating to the chest and gait disturbance. He had a history of subtotal pancreatectomy due to intraductal papillary mucinous neoplasm (IPMN) of the pancreas and concurrent chemotherapy. Eight months after pancreatectomy, multiple thoracic spinal metastasis was diagnosed with routine up positron emission tomography-computed tomography. Radiotherapy for spinal metastasis and subsequent chemotherapy was carried out. Sixteen months after pancreatectomy, gait disturbance occurred and follow-up thoracic magnetic resonance imaging (MRI) showed aggravation of metastasis at T2 and T4 compressing the spinal cord. We performed a decompressive laminectomy with subtotal resection of the tumor masses and pedicle screw fixation at C7–T6. Neurologic status improved after the operation. Histopathologic examinations revealed the tumor as metastatic mucin producing adenocarcinoma. Three months after surgery, motor weakness and pain was reappeared. MRI showed large amount of epidural fluid collection. We performed wound revision and there was large amount of gelatinous fluid at the epidural space. We suggest that postoperative mucin collection and wound problems should be considered after surgery for mucin producing metastatic pancreatic tumor.

Spontaneous Epidural Hematoma Associated with Venous Phlebolith in Cervical Spine and Possible Pathogenesis

Although the etiology of spontaneous spinal epidural hematoma (SSEH) is unclear, SSEH is known to be associated with anticoagulants, coagulopathy, vascular malformation, hypertension, and pregnancy. However, no report has been issued on the relation between SSEH and venous phlebolith. Here, the authors present an extremely rare case of SSEH associated with phlebolith in the cervical spine and suggest a possible pathogenesis. A 36-year-old man without any relevant medical history presented with neck pain and numbness and severe radiating pain on the left arm. Magnetic resonance imaging showed epidural hematoma at the C5–7 level, and computed tomography revealed a calcified nodule in the left epidural hemorrhage at C6 level. During left partial laminectomy, epidural venous plexus, and thick epidural hematoma were found, and hematoma removal revealed a white, ovoid, smooth, hard mass of diameter 3 mm. Histopathologic examination confirmed the mass as a venous phlebolith. The presence of a calcified solitary nodule in dorsal epidural space indicates the presence of phlebolith and the risk of SSEH. In such cases, the authors recommend spine surgeons should take into consideration the possibility of epidural hemorrhage.

Effect of Modic Changes in Cervical Degenerative Disease

OBJECTIVE: Modic changes are signal intensity changes in adjacent vertebral bone marrow on magnetic resonance imaging. Few studies have investigated these changes with regard to the cervical spine. In this study, we investigated the associations between cervical degenerative disease and Modic changes. METHODS: We conducted a retrospective collection of radiological data in patients with neck pain at Pusan National University Yangsan Hospital from January 2010 to December 2014. A total of 169 patients were included in this study. Disc herniation grade, disc space height and global cervical lordosis (C2–C7 Cobb angle) were measured and analyzed. If Modic changes were present, we recorded the Modic change type based on the literature, vertebral level, age, sex, and surgical requirement. RESULTS: Sixty-six patients exhibited Modic changes in the cervical spine. Out of these 66 patients, Modic change type II (56 patients, 84.8%) and C5–6 vertebral level (23 patients, 34.8%) were the most predominant categories. Patients with Modic change showed worse outcomes in regard to disc herniation grade, disc space height and global cervical lordosis than patients without (p<0.01). Among 169 patients, 18 patients had undergone anterior cervical discectomy with fusion (ACDF). Patients with Modic changes (10 of 66 patients, 15.1%) had a greater probability of undergoing ACDF than those without (8 of 103 patients, 7.8%; p<0.01). CONCLUSION: Modic changes refer cervical degenerative changes, and incidence of ACDF is higher when the Modic changes are occurred.

The Predictable Factors of the Postoperative Kyphotic Change of Sagittal Alignment of the Cervical Spine after the Laminoplasty

OBJECTIVE: Laminoplasty is an effective surgical method for treating cervical degenerative disease. However, postoperative complications such as kyphosis, restriction of neck motion, and instability are often reported. Despite sufficient preoperative lordosis, this procedure often aggravates the lordotic curve of the cervical spine and straightens cervical alignment. Hence, it is important to examine preoperative risk factors associated with postoperative kyphotic alignment changes. Our study aimed to investigate preoperative radiologic parameters associated with kyphotic deformity post laminoplasty. METHODS: We retrospectively reviewed the medical records of 49 patients who underwent open door laminoplasty for cervical spondylotic myelopathy (CSM) or ossification of the posterior longitudinal ligament (OPLL) at Pusan National University Yangsan Hospital between January 2011 and December 2015. Inclusion criteria were as follows: 1) preoperative diagnosis of OPLL or CSM, 2) no previous history of cervical spinal surgery, cervical trauma, tumor, or infection, 3) minimum of one-year follow-up post laminoplasty with proper radiologic examinations performed in outpatient clinics, and 4) cases showing C7 and T1 vertebral body in the preoperative cervical sagittal plane. The radiologic parameters examined included C2–C7 Cobb angles, T1 slope, C2–C7 sagittal vertical axis (SVA), range of motion (ROM) from C2–C7, segmental instability, and T2 signal change observed on magnetic resonance imaging (MRI). Clinical factors examined included preoperative modified Japanese Orthopedic Association scores, disease classification, duration of symptoms, and the range of operation levels. RESULTS: Mean preoperative sagittal alignment was 13.01° lordotic; 6.94° lordotic postoperatively. Percentage of postoperative kyphosis was 80%. Patients were subdivided into two groups according to postoperative Cobb angle change; a control group (n=22) and kyphotic group (n=27). The kyphotic group consisted of patients with more than 5° kyphotic angle change postoperatively. There were no differences in age, sex, C2–C7 Cobb angle, T1 slope, C2–C7 SVA, ROM from C2–C7, segmental instability, or T2 signal change. Multiple regression analysis revealed T1 slope had a strong relationship with postoperative cervical kyphosis. Likewise, correlation analysis revealed there was a statistical significance between T1 slope and postoperative Cobb angle change (p=0.035), and that there was a statistically significant relationship between T1 slope and C2–C7 SVA (p=0.001). Patients with higher preoperative T1 slope demonstrated loss of lordotic curvature postoperatively. CONCLUSION: Laminoplasty has a high probability of aggravating sagittal balance of the cervical spine. T1 slope is a good predictor of postoperative kyphotic changes of the cervical spine. Similarly, T1 slope is strongly correlated with C2–C7 SVA.

Typical Sweet Syndrome at the Site of Postmastectomy Lymphedema: Two Cases and a Literature Review / 대한피부과학회지

Sweet's syndrome (SS) or acute febrile neutrophilic dermatosis has been reported to occur in association with many conditions. We report two cases of SS at the site of a postmastectomy lymphedema. A localized variant of SS restricted to an area of postmastectomy lymphedema is an often unrecognized complication of breast cancer. Moreover, attempts to treat SS using various methods might prolong the duration of treatment. Therefore, SS should not be confused with other disorders such as erysipelas, cellulitis, herpes zoster, and contact dermatitis.

A Case of Halo Phenomenon Induced by Molluscum Contagiosum / 대한피부과학회지

Halo nevi (HN), also known as Sutton's nevi or leukoderma acquisitum centrifugum, are nevomelanocytic nevi surrounded by a rim of depigmentation. A 9-year-old female presented with an asymptomatic solitary flesh-colored 0.75-cm-sized papule surrounded by depigmentation on the right cheek 1 month ago. The excisional biopsy demonstrated molluscum contagiosum and decreased basal layer pigmentation on Fontana-Masson stain. The halo phenomenon is often associated with an acquired nevus cell nevus, but has also been associated with a congenital nevus cell nevus, non-neuroectodermal lesions such as angiomas, seborrheic keratoses, lichen planus, sarcoid, psoriasis, involuting flat warts, and histiocytoma. Our patient had an unusual association of molluscum contagiosum with the halo phenomenon. We suppose that the halo phenomenon in this patient might have been provoked by the molluscum contagiosum virus. A halo nevus-like appearance suggests the possibility of disease other than nevus. In such cases, skin biopsy is required for confirmation.

A Study of an Autologous Serum Skin Test in Patients with Atopic Dermatitis: Relationship between the Autologous Serum Skin Test and Total Serum IgE Levels, Disease Severity, Disease Duration, and Multiple Allergen Simultaneous Test (MAST) Results in Atop / 대한피부과학회지

BACKGROUND: The autologous serum skin test (ASST) is a simple test for detecting functional circulating autoantibodies. In addition, immunoglobulin E (IgE) autoreactivity seems to play a role in the pathogenesis and disease course of atopic dermatitis (AD). OBJECTIVE: The aim of this study was to examine whether the ASST results were positive in AD patients and to find the relationship between ASST and total serum IgE levels, disease severity, disease duration, and multiple allergen simultaneous test (MAST) results in AD. METHODS: Fifty-two patients with AD who underwent ASST were included in this study. We analyzed total serum IgE concentrations, severity, duration of disease, and allergen frequencies between the ASST-positive and -negative groups. Disease severity was evaluated using the Rajka and Langeland eczema severity score. RESULTS: ASST results were positive in 34.0% (17/52) of patients, and the positivity rates of ASST in IgE-mediated AD patients was 39.0% (16/41), which was significantly higher than in non-IgE-mediated AD patients. Additionally, IgE-mediated AD patients with positive ASST results showed greater disease severity, longer disease duration, and a greater number of allergens than ASST-negative patients (p<0.05). CONCLUSION: This is the first study to evaluate the results of ASST in patients with AD. According to our results, ASST would be a useful test in AD and could be related to autoimmunity, severity, and disease course of AD, especially in IgE-mediated AD. Further studies with more patients are needed to confirm these findings.

Lymphomatoid Papulosis with Mycobacterium Other Than Tuberculosis / 대한피부과학회지

No abstract available.

Lymphomatoid Papulosis with Mycobacterium Other Than Tuberculosis / 대한피부과학회지

No abstract available.

Economic Impact of Atopic Dermatitis in Korean Patients

BACKGROUND: Atopic dermatitis is a global public health concern owing to its increasing prevalence and socioeconomic burden. However, few studies have assessed the economic impact of atopic dermatitis in Korea. OBJECTIVE: We conducted a cost analysis of atopic dermatitis and evaluated its economic impacts on individual annual disease burden, quality of life, and changes in medical expenses with respect to changes in health related-quality of life. METHODS: The cost analysis of atopic dermatitis was performed by reviewing the home accounting records of 32 patients. The economic impact of the disease was evaluated by analyzing questionnaires. To handle uncertainties, we compared the results with the data released by the Health Insurance Review & Assessment Board on medical costs claimed by healthcare facilities. RESULTS: The direct cost of atopic dermatitis per patient during the 3-month study period was 541,280 Korean won (KRW), and expenditures on other atopic dermatitis-related products were 120,313 KRW. The extrapolated annual direct cost (including expenditures on other atopic dermatitis-related products) per patient was 2,646,372 KRW. The estimated annual indirect cost was 1,507,068 KRW. Thus, the annual cost of illness of atopic dermatitis (i.e., direct+indirect costs) was estimated to be 4,153,440 KRW. CONCLUSION: The annual total social cost of atopic dermatitis on a national level is estimated to be 5.8 trillion KRW.

Actinic Granuloma Arising from the Pulsed Dye Laser-Treated Skin in a Patient with Capillary Malformation

No abstract available.

Solitary Cavernous Sinus Neurosarcoidosis Mimicking Neurosyphilis

A differential diagnosis between neurosarcoidosis and neurosyphilis is particularly problematic in patients with a positive serologic result for syphilis. We report here a patient with a solitary cavernous sinus sarcoidosis who had a history of syphilis and showed rapidly progressing cavernous sinus syndrome. A transsphenoidal biopsy was performed and a histopathologic examination revealed a non-caseating granuloma with an asteroid body. His facial pain disappeared after steroid therapy. He received oral prednisolone for one year. A follow-up magnetic resonance imaging of the brain revealed resolution of the mass over the cavernous sinus. Particularly in patients with a history of syphilis, neurosyphilis should be included in a differential diagnosis of neurosarcoidosis.

Necrobiotic Xanthogranuloma with Monoclonal Gammopathy / 대한피부과학회지

Necrobiotic xanthogranuloma (NXG) is a rare, progressive, histiocytic disease characterized by destructive cutaneous lesions, a close association with paraproteinemia, multiple myeloma, hypertension, and multiple extracutaneous manifestations. Multiple indurated yellow-red plaques or nodules are commonly present in this disorder. The pathogenesis of NXG is poorly understood. Histopathologically, NXG features with hyaline necrosis or necrobiosis are present. We describe a patient with typical cutaneous and histologic findings of NXG with an associated monoclonal gammopathy.