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Background@#Atopic dermatitis (AD) patients usually wonder if their condition will worsen after vaccination or if they should continue with the treatment they are receiving. Considering that many patients treated with dupilumab had previously experienced severe AD symptoms and flares, the concerns are more understandable. @*Objective@#This study aimed to investigate the safety of the coronavirus disease 2019 (COVID-19) vaccination in patients with AD treated with dupilumab. @*Methods@#We enrolled 133 patients (101 dupilumab-treated and 32 systemic oral agentstreated as control group) with AD from six hospitals. Patients were asked about worsening pruritus and AD (5-point Likert scale) after vaccination. AD variables (eczema area and severity index [EASI], investigator’s global assessment [IGA], itch numerical rating scale [NRS], sleep NRS, and patient-oriented eczema measure [POEM]) were compared pre- and postvaccination. Adverse reactions to the COVID-19 vaccination were observed. @*Results@#The incidence of adverse reactions to COVID-19 vaccines and worsening AD symptoms in dupilumab-treated patients were not significantly different compared with that in the control group. The itch NRS score increased significantly after vaccination (p<0.001).However, there were no statistically significant differences between the pre-and post-EASI, IGA, and POEM scores. Eight patients (7.9%) had worse EASI scores and required rescue therapy; however, most were easily managed with low-dose steroids or topical agents. None of the patients discontinued dupilumab treatment. @*Conclusion@#No serious adverse reactions were observed in patients with AD after COVID-19 vaccination. Exacerbation of pruritus and AD symptoms was observed but was mostly mild and transient.
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Background@#Mohs micrographic surgery (MMS) is a surgical technique for skin cancer that has the advantage of increasing the cure rate while having a tissue-sparing property. @*Objective@#To investigate the benefits of MMS and the characteristics of various skin cancers that are increasing in incidence in Korea. @*Methods@#We retrospectively analyzed 1,013 cases treated with MMS, including slow MMS, from 2010 to 2020. Patient and tumor characteristics, reconstruction, recurrence, metastasis, and operation time were reviewed. @*Results@#Female (61.4%) outnumbered male (38.6%), and the mean patient age was 72.7 years. The most diagnosed skin cancer was basal cell carcinoma (BCC), followed by squamous cell carcinoma (SCC) and cutaneous melanoma. BCC and SCC showed significant differences in various variables, including age, tumor location and size, and MMS stages for clearance. Although BCC was smaller than SCC, it required more MMS stages for a clear margin (p ＜0.05). The recurrence rate was 2.2% (0.7%, 3.0%, and 7.7% for BCC, SCC, and cutaneous melanoma, respectively). There have been no reported recurrences of extramammary Paget’s disease and dermatofibrosarcoma protuberans. The mean number of MMS stages for a clear margin was 1.41±1.05, and clearance was achieved in the first stage in 72.6% of cases. The mean operation time was 123.7 minutes. @*Conclusion@#MMS is an efficient surgical method that can lower the recurrence rate in the treatment of various skin cancers, and there were statistically significant differences between BCC and SCC in various parameters.
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We report a case of delayed rupture of an anterior communicating artery (Acom) pseudoaneurysm following mechanical thrombectomy (MT) of a distal artery occlusion using a stent retriever. An elderly patient with right hemiparesis showed left proximal internal cerebral artery and middle cerebral artery occlusions. During MT, a fragmented thrombus moved to the anterior cerebral artery (ACA). A stent retriever was deployed to the occluded ACA, and the Acom and proximal ACA segment were significantly straightened. Additionally, we attempted a blind exchange mini-pinning (BEMP) technique, but a subarachnoid hemorrhage (SAH) occurred. Bleeding was almost entirely absorbed 9 days after the procedure, but the SAH recurred at 20 days, and computed tomography angiography revealed a new pseudoaneurysm formation in the Acom. We suggest that the proposed mechanism of pseudoaneurysm formation was likely due to the dislocation and avulsion of the Acom perforators when the ipsilateral ACA was pushed and pulled during MT.
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Background@#and Purpose Patients with acute large vessel occlusion (LVO) presenting with mild stroke symptoms are at risk of early neurological deterioration (END). This study aimed to identify the optimal imaging variables for predicting END in this population. @*Methods@#We retrospectively analyzed 94 patients from the prospectively maintained institutional stroke registry admitted between January 2011 and May 2019, presenting within 24 hours after onset, with a baseline National Institutes of Health Stroke Scale score ≤5 and anterior circulation LVO. Patients who underwent endovascular therapy before END were excluded. Volumes of Tmax delay (at >2, >4, >6, >8, and >10 seconds), mismatch (Tmax >4 seconds – diffusion-weighted imaging [DWI] and Tmax >6 seconds – DWI), and mild hypoperfusion lesions (Tmax 2–6 and 4–6 seconds) were measured. The association of each variable with END was examined using receiver operating characteristic curves. The variables with best predictive performance were dichotomized at the cutoff point maximizing Youden’s index and subsequently analyzed using multivariable logistic regression. @*Results@#END occurred in 39.4% of the participants. The optimal variables were identified as Tmax >6 seconds, Tmax >6 seconds – DWI, and Tmax 4–6 seconds with cut-off points of 53.73, 32.77, and 55.20 mL, respectively. These variables were independently associated with END (adjusted odds ratio [aOR], 12.78 [95% confidence interval (CI), 3.36 to 48.65]; aOR, 5.73 [95% CI, 2.04 to 16.08]; and aOR, 9.13 [95% CI, 2.76 to 30.17], respectively). @*Conclusions@#Tmax >6 seconds, Tmax >6 seconds – DWI, and Tmax 4–6 seconds could identify patients at high risk of END following minor stroke due to LVO.
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Background@#Syphilis is an infectious and sexually transmitted disease caused by Treponema pallidum. The diagnosis and treatment of syphilis may be delayed because of the various clinical features. @*Objective@#The purpose of this study was to investigate the epidemiological changes and clinical features of syphilis in Korea. @*Methods@#We conducted a retrospective analysis of 303 subjects with positive venereal disease research laboratories results, including 208 syphilis patients who visited the Dermatology Department of Chosun University Hospital between 2008 and 2019. The analysis was performed based on variables, such as age, sex, serological results, and clinical stages. @*Results@#During the study period, the mean reactive rate of the serum venereal disease research laboratories test was 0.14%, and the annual incidence rate tended to decrease. Of the 208 syphilis patients, the male:female ratio was 1:2.7 among those aged 0 to 19 years and 2.3:1 among those aged 50 to 59 years. Eighty-six patients (41.3%) were diagnosed with symptomatic syphilis, which accounted for the highest proportion (63.6%) among those aged 0 to 19 years. The incidence tended to decrease with increasing age (p＜0.001). Maculopapular syphilis was the most commonly observed form of secondary syphilis (44.6%). One hundred and twenty-two patients (58.7%) were diagnosed with latent syphilis, and the rate tended to increase with age (p＜0.001). @*Conclusion@#Although the number of patients with syphilis is declining, the number of young and female patients is increasing compared to the past. Therefore, education and caution against syphilis by dermatologists may be necessary, especially for younger people.
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Background@#Syphilis is an infectious and sexually transmitted disease caused by Treponema pallidum. The diagnosis and treatment of syphilis may be delayed because of the various clinical features. @*Objective@#The purpose of this study was to investigate the epidemiological changes and clinical features of syphilis in Korea. @*Methods@#We conducted a retrospective analysis of 303 subjects with positive venereal disease research laboratories results, including 208 syphilis patients who visited the Dermatology Department of Chosun University Hospital between 2008 and 2019. The analysis was performed based on variables, such as age, sex, serological results, and clinical stages. @*Results@#During the study period, the mean reactive rate of the serum venereal disease research laboratories test was 0.14%, and the annual incidence rate tended to decrease. Of the 208 syphilis patients, the male:female ratio was 1:2.7 among those aged 0 to 19 years and 2.3:1 among those aged 50 to 59 years. Eighty-six patients (41.3%) were diagnosed with symptomatic syphilis, which accounted for the highest proportion (63.6%) among those aged 0 to 19 years. The incidence tended to decrease with increasing age (p＜0.001). Maculopapular syphilis was the most commonly observed form of secondary syphilis (44.6%). One hundred and twenty-two patients (58.7%) were diagnosed with latent syphilis, and the rate tended to increase with age (p＜0.001). @*Conclusion@#Although the number of patients with syphilis is declining, the number of young and female patients is increasing compared to the past. Therefore, education and caution against syphilis by dermatologists may be necessary, especially for younger people.
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We report a case of anterior choroidal artery territory infarction due to internal carotid artery dissection presumably caused by scuba diving. A 44-year-old man presented with left facial palsy and hemiparesis. He had a history of scuba diving for 18 months. His last dive was 7 days ago, and he skipped decompression practice at that dive. We assumed that repetitive traumas and microbubbles during scuba diving, which made endothelium vulnerable to damage may have caused a carotid dissection.
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Background@#and Purpose Endovascular recanalization therapy (ERT) is becoming increasingly important in the management of acute ischemic stroke (AIS). However, the hospital volume threshold for optimal ERT remains unknown. We investigated the relationship between hospital volume of ERT and risk-adjusted patient outcomes. @*Methods@#From the National Health Insurance claims data in Korea, 11,745 patients with AIS who underwent ERT from July 2011 to June 2016 in 111 hospitals were selected. We measured the hospital’s ERT volume and patient outcomes, including the 30-day mortality, readmission, and postprocedural intracranial hemorrhage (ICH) rates. For each outcome measure, we constructed risk-adjusted prediction models incorporating demographic variables, the modified Charlson comorbidity index, and the stroke severity index (SSI), and validated them. Risk-adjusted outcomes of AIS cases were compared across hospital quartiles to confirm the volume-outcome relationship (VOR) in ERT. Spline regression was performed to determine the volume threshold. @*Results@#The mean AIS volume was 14.8 cases per hospital/year and the unadjusted means of mortality, readmission, and ICH rates were 11.6%, 4.6%, and 8.6%, respectively. The VOR was observed in the risk-adjusted 30-day mortality rate across all quartile groups, and in the ICH rate between the first and fourth quartiles (P<0.05). The volume threshold was 24 cases per year. @*Conclusions@#There was an association between hospital volume and outcomes, and the volume threshold in ERT was identified. Policies should be developed to ensure the implementation of the AIS volume threshold for hospitals performing ERT.
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BACKGROUND: At most centers, general anesthesia (GA) has been preferred for endovascular treatment (EVT) of ruptured intracranial aneurysms (RIAs). In this study, we analyzed procedural results, clinical outcomes, and follow-up angiographic findings for patients undergoing EVT for RIA under local anesthesia (LA) with conscious sedation (CS). METHODS: We retrospectively evaluated 308 consecutive patients who underwent EVT for RIAs at a single institution between June 2009 and February 2017. EVT under LA with CS was considered for all patients with aneurysmal subarachnoid hemorrhage, regardless of Hunt and Hess (HH) scale score. RESULTS: EVT was performed for 320 aneurysms in 308 patients with subarachnoid hemorrhages. The mean patient age was 55.5±12.6 years. Moderate (III) and poor (IV, V) HH grades were observed in 75 (24.4%) and 77 patients (25%), respectively. Complete occlusion immediately after EVT was achieved for 270 (84.4%) of 320 aneurysms. Thromboembolic complications and intraprocedural ruptures occurred in 25 (7.8%) and 14 cases (4.3%), respectively. The morbidity rate at discharge (as defined by a modified Rankin scale score of 3 or greater) was 27.3% (84/308), while the mortality rate was 11.7% (36/308). Follow-up angiographic results were available for 210 (68.1%) of 308 patients. Recanalization was observed in 64 (29.3%) of 218 aneurysms in 210 patients. CONCLUSION: Based on our experience, EVT for RIAs under LA with CS was feasible, regardless of the clinical grade of the subarachnoid hemorrhage. Complication rates and follow-up angiographic results were also comparable to those observed when GA was used to perform the procedure.
Subject(s)
Humans , Anesthesia, General , Anesthesia, Local , Aneurysm , Conscious Sedation , Endovascular Procedures , Follow-Up Studies , Intracranial Aneurysm , Mortality , Retrospective Studies , Rupture , Subarachnoid HemorrhageABSTRACT
No abstract available.
Subject(s)
Diabetic Neuropathies , Lumbosacral Plexus , Magnetic Resonance ImagingABSTRACT
Ocular flutter is a relatively rare eye movement disorder that refers to occasional bursts of involuntary horizontal oscillation around the point of fixation, characterized by rapid, repetitive, horizontal, symmetrical and sinusoidal oscillation without inter- saccadic interval. It is known to be associated with disorders of the cerebellum and brainstem resulting from various pathological conditions, but it's anatomical and pathophysiological basis remains unclear. Here, we present the case of a patient who had severe ocular flutter associated with Merkel cell carcinoma.
Subject(s)
Humans , Brain Stem , Carcinoma, Merkel Cell , Cerebellum , Ocular Motility Disorders , Paraneoplastic SyndromesABSTRACT
Insulinomas are very rare tumors. Diagnosis of insulinoma is often delayed or misdiagnosed because of its various symptoms. We report a patient with hypoglycemic encephalopathy who had repetitive behavior changes, diagnosed as a pancreatic insulinoma. A 52 years old man was referred to a memory and dementia clinic for evaluation of his repetitive abnormal behavior changes. He has threatened his wife with violent acts and showed aggressive behaviors, but he couldn't remember when he was recovered to normal state. During the hospitalization, we noticed that his repetitive abnormal behaviors were correlated to severe hypoglycemia. After we corrected glucose level, his symptoms were disappeared. We performed an abdomen-pelvis CT scan, revealing pancreatic head tumor. After he took surgical treatment, His symptoms were fully recovered. Our case demonstrates that various neurological symptoms, such as abnormal behavior, rarely occur due to recurrent hypoglycemia in patient with insulinoma.