Trephine Transverse Colostomy Is Effective for Patients Who Have Previously Undergone Rectal Surgery

PURPOSE: Colostomy creation is an essential procedure for colorectal surgeons, but the preferred method of colostomy varies by surgeon. We compared the outcomes of trephine colostomy creation with open those for the (laparotomy) and laparoscopic methods and evaluated appropriate indications for a trephine colostomy and the advantages of the technique. METHODS: We retrospectively evaluated 263 patients who had undergone colostomy creation by trephine, open and laparoscopic approaches between April 2006 and March 2016. We compared the clinical features and the operative and postoperative outcomes according to the approach used for stoma creation. RESULTS: One hundred sixty-three patients (62%) underwent colostomy surgery for obstructive causes and 100 (38%) for fistulous problems. The mean operative time was significantly shorter with the trephine approach (trephine, 46.0 ± 1.9 minutes; open, 78.7 ± 3.9 minutes; laparoscopic, 63.5 ± 5.0 minutes; P < 0.001), as was the time to flatus (1.8 ± 0.1 days, 2.1 ± 0.1 days, 2.2 ± 0.3 days, P = 0.025). Postoperative complications (<30 days) were not different among the 3 approaches (trephine, 4.3%; open, 1.2%; laparoscopic, 0%; P = 0.828). In patients who underwent rectal surgery, a trephine colostomy was feasible for a diversion colostomy (P < 0.001). CONCLUSION: The trephine colostomy is safe and can be implemented quickly in various situations, and compared to other colostomy procedures, the patient's recovery is faster. Previous laparotomy history was not a contraindication for a trephine colostomy, and a trephine transverse colostomy is feasible for patients who have undergone previous rectal surgery.

Korean Addiction Treatment Guidelines (III) : Psychosocial Treatment of Alcohol Use Disorder / 신경정신의학

OBJECTIVES: The aim of this study is to develop guidelines for psychosocial treatment of alcohol use disorder. METHODS: According to the ADAPTE manual, the Korean alcohol use disorder treatment guidelines were developed by the guideline development committee. Recommendations from foreign guidelines were evaluated regarding the applicability and acceptability to domestic circumstances. In addition, a survey from experts was conducted, along with a review of Korean literature. By these means, recommendations of psychosocial treatment for alcohol use disorder were established. RESULTS: The main findings of the survey were as follows : 1) Although Group therapy was not recommended by foreign clinical guidelines, it was considered as a first-line treatment by Korean experts. 2) Among many psychosocial treatment programs, cognitive behavior therapy (CBT), coping skills training, 12-step facilitation, and Group therapy were commonly used programs in Korea. Finally, the following treatment methods were selected for recommendations : Group therapy, motivational enhancement treatment, CBT, behavioral self-management, alcoholic anonymous, 12-step facilitation, psychodynamic psychotherapy, psychoeducational intervention, continuous case management, and community residential rehabilitation program. CONCLUSION: Just as in treatment of chronic diseases such as hypertension, continuity is important for management of alcohol use disorder. Therefore, not only pharmacological treatment but also psychosocial treatment should be provided comprehensively after treatment of acute withdrawal symptoms.

A Case of Rectal Cancer in a Patient with Neurofibromatosis Type 1

A rectal cancer was found in a 67-year-old man with a history of neurofibromatosis type 1. A low anterior resection was performed, and he received concurrent chemoradiation for 6 months. Twelve months after the surgery, a tumor was found at the anastomotic site by positron emission tomography-computed tomography and colonoscopy and was mistaken as anastomotic site recurrence. The tumor was confirmed as an inflammatory myofibroblastic tumor through transanal excision.

Bezoar-induced Small Bowel Obstruction

PURPOSE: The aim of this study was to observe the clinical features of a bezoar-induced small bowel obstruction and to investigate the role of abdominal computed tomography (CT) in establishing the diagnosis. METHODS: We retrospectively reviewed 20 cases of bezoar-induced small bowel obstruction in our hospital from 1996 to 2010. RESULTS: Thirteen patients (65%) had a history of abdominal surgery. Nine patients (45%) were diagnosed with a bezoar before surgery, seven patients were diagnosed by using abdominal CT, and two patients were diagnosed with a small bowel series. Abdominal CT was performed in 15 patients, and the diagnostic accuracy was 47% (7/15). Surgery revealed ten bezoars in the jejunum and 11 in the ileum. Two patients had bezoars found concurrently in the stomach. Spontaneous removal took place in two patients. An enterotomy and bezoar extraction was performed in 15 patients. Fragmentation and milking, a small bowel resection, and a Meckel's diverticulectomy were performed in one patient each. Early operative treatment was possible (P = 0.036) once the bezoar had been diagnosed by using abdominal CT. There tended to be fewer postoperative complications in patients who were diagnosed with a bezoar by using abdominal CT, but the result was not statistically significant (P = 0.712). CONCLUSION: A preoperative diagnosis of bezoar-induced small bowel obstruction by using clinical features was difficult. Increased use of abdominal CT led to a more accurate diagnosis and to earlier surgery for bezoar-induced small bowel obstructions, thereby reducing the rate of complications.

A Case of Acrodermatitis Enteropathica Localized on the Hands and Feet with a Normal Serum Zinc Level

Acrodermatitis enteropathica is classified as a congenital autosomal recessive type and an acquired transient type. This disease manifests as acral and periorificial dermatitis, alopecia, intractable diarrhea, and failure to thrive. Whereas the autosomal hereditary type is caused by malabsorption of zinc in the intestine, the acquired type is caused by low nutritional support or decreased peripheral release of zinc from blood. We experienced a case of a 5-month old, breast feeding, full-term female presenting with only acral bullous dermatitis without diarrhea, periorificial dermatitis and an abnormal serum zinc level.

A Case of Dowling-Degos Disease on the Vulva

Dowling-Degos disease (DDD) is an autosomal dominant genodermatosis and this disease is a genetically determined disturbance of epidermal proliferation. It is characterized by acquired, slowly progressive pigmented lesions that primarily involve the great skin folds and flexural areas such as the axilla, neck, limb flexures, the inframammary area and the inguinal folds. The vulva is an unusual location for DDD. A 41-year-old woman presented with a 10-year history of multiple, small, reticulated and brownish macules distributed symmetrically on the bilateral external genital regions. We found no other similarly pigmented skin lesions on her body, including the flexural areas. There was no known family history of similar eruptions or pigmentary changes. The histologic examination showed irregular rete ridge elongation with a filiform or antler-like pattern and basilar hyperpigmentation on the tips. Fontana-Masson staining showed increased pigmentation of the rete ridges and the S100 protein staining did not reveal an increased number of melanocytes in the epidermis. From these findings, we diagnosed this lesion as DDD.

A New Method for Investigation of the Hair Shaft: Hard X-Ray Microscopy with a 90-nm Spatial Resolution

Various methods have been used to investigate the hair shaft. In the ultrastructural hair field, scanning and transmission electron microscopies are widely used investigative methods, but they have some technical limitations. Recently, X-ray microscopes with sub-micron spatial resolution have emerged as useful instruments because they offer a unique opportunity to observe the interior of an undamaged sample in greater detail. In this report, we examined damaged hair shaft tips using hard X-ray microscopy with a 90 nm spatial resolution. The results of this study suggest that hard X-ray microscopy is an alternative investigative method for hair morphology studies.

Lumbar Pyogenic Spondylodiscitis and Bilateral Psoas Abscesses Extending to the Gluteal Muscles and Intrapelvic Area Treated with CT-guided Percutaneous Drainage: A Case Report

Bilateral psoas abscesses extending to the gluteal muscle and intrapelvic area are uncommon. We present our experience with computed tomography (CT)-guided percutaneous catheter drainage for the treatment of multiple aggressive abscesses in a diabetic patient. The abscesses completely resolved after the procedures. Psoas abscess should be considered in the differential diagnosis of older diabetic patients with fever, flank or back pain, and flexion contracture of the hip joint. CT scanning is a useful method in diagnosing abscesses, and CT-guided percutaneous catheter drainage is an effective treatment method in selected patients.

A Case of Atypical Hidroacanthoma Simplex / 대한피부과학회지

Hidroacanthoma simplex is a benign tumor believed to arise from the uppermost segment of the intradermal eccrine duct and the acrosyringium, and histologically shows intraepidermal focal growth. A malignant counterpart to this tumor is rare and named malignant hidroacanthoma simplex or porocarcinoma in situ. We report a case of atypical hidroacanthoma simplex, which is considered to be a malignant transformation of benign hidroacanthoma simplex in a 83- year-old female.

A Retrospective Study of the Effect of Superficial Cryotherapy on Alopecia Areata / 대한피부과학회지

BACKGROUND: There are some reports that superficial cryotherapy of alopecia areata could be an effective mode of treatment with many advantages. OBJECTIVE: We retrospectively evaluated the efficacy and side effects of superficial cryotherapy in patients with alopecia areata. METHODS: We retrospectively reviewed the clinical records of 153 patients with alopecia areata, who had been treated with superficial cryotherapy for more than 4 weeks, during the twelve years since 1993. We then evaluated the efficacy of superficial cryotherapy and its relationship with various clinical factors and side effects. Superficial cryotherapy using liquid nitrogen spray for 2~3 seconds was applied to the alopecic patches, and repeated three or four times per session. Positive therapeutic response was defined as the regrowth of terminal hairs. RESULTS: The results are summarized as follows: Positive therapeutic responses were noted in 105 (68.6%) of 153 patients reviewed. Patients who responded, vellus hair appeared within 4 weeks of treatment, terminal hair within 7 weeks, and a marked recovery was achieved within 12 weeks. A relatively good response rate was obtained in those patients who had less than 4 weeks of treatment, and the area of treatment was less than one fourth of the total scalp area, or less than two alopecic patches. On the other hand, those over 50 years of age and with more than 3 weeks of treatment interval seemed to have a relatively poor response rate. Other factors were not significant. There were no significant side effects, except slight pain, swelling and erythema. CONCLUSION: Superficial cryotherapy in patients with alopecia areata can be an effective treatment modality. It is a simple and convenient method, and has relatively good therapeutic response with less side effects. Therefore, we propose the superficial cryotherapy as a first-line treatment for patients with a milder form of alopecia areata, especially in children who are vulnerable to therapeutic side effects and pain.

Adult Onset Still's Disease / 대한피부과학회지

Adult onset Still's disease (AOSD) is a systemic inflammatory disorder of unknown etiology and pathogenesis, characterized by systemic symptoms including high fever, evanescent rash, arthritis and a sore throat. There is no single diagnostic test, therefore the diagnosis is based upon clinical criteria. Treatment consists of anti-inflammatory medication such as aspirin, NSAIDs, corticosteroids, anti-rheumatics and immunosuppresants. We report a typical case of AOSD, in which a 29-year-old female patient presented with high fever, typical Still's rash, arthritis and a sore throat.

Effects of Calcitonin Gene-Related Peptide on the Hair Growth in Human Hair Follicle Organ Culture / 대한피부과학회지

BACKGROUND: It has recently been reported that the peripheral nervous system has an important role in the hair growth and hair cycle change, which is mediated by neuropeptides. Furthermore, the expression of various growth factors and apoptosis-related molecules are important in the hair growth and hair cycle change. Therefore, it is important that the relationship between the influence of neuropeptides and expression of various factors that regulate hair growth is analysed. OBJECTIVE: The purpose of this study was to investigate the relationship between influence of neuropeptides and expression of various hair growth-related factors in the hair follicle, after pre- treatment of cultured hair follicles and dermal papilla cells with a calcitonin gene-related peptide (CGRP). METHOD: Normal human scalp samples were obtained, and anagen hair follicles and dermal papilla cells were isolated and cultured in Dulbeco?s Modified Eagle's Medium (DMEM) with several combinations of supplements, in an air incubator with an atmosphere of 5% CO2/95%. The culture plates were divided into two groups: a control group (DMEM only) and a CGRP group(10-7M CGRP dissolved in DMEM). The results were then evaluated by measuring the linear hair growth and hair follicle morphology under a light microscope. In addition, after pre-treatment of cultured hair follicles and dermal papilla cells with CGRP, we examined changes of expression of hair growth factors (FGF-7, IGF-1, VEGF), hair growth-inhibitory factors (IL-1alpha, IL-1beta) and apoptosis-related molecules (p53, caspase-3). RESULTS: The following results were obtained: 1. The CGRP did not have statistically significant effect on the rate of linear hair growth in cultured hair follicles. However, it shortened the anagen stage of the hair cycle. 2. In hair follicles, the expression of IL-1beta, a hair growth inhibitory factor, was increased in the CGRP group, compared to the control. The expression of caspase-3, an apoptosis-related molecule, was also found to be higher than the control. In dermal papilla cells, no change in morphology, expression of hair growth factors or apoptosis-related molecules were found. However the expression of IL-1beta was increased, compared to the control. CONCLUSION: From these results, we can conclude that CGRP has a growth-inhibitory effect, especially in shortening the duration of the anagen phase without affecting the linear hair growth rate. CGRP also shows a hair growth-inhibitory effect at the molecular level in hair follicles and dermal papilla cells.

A Study of Predisposing Factors and Treatment Responses in Streak Type Onychomycosis / 대한의진균학회지

BACKGROUND: Human nails bear longitudinal furrows on both upper and lower surface. These furrows are formed as the nails grow and correspond to parallel dermal ridges irregularly distributed on the nail bed. Often there is fungal invasion in a longitudinal narrow band according to the furrows of the nail bed, clinically recognized streak type onychomycosis. OBJECTIVE: Our purpose was to investigate the clinical features, causative organisms, and predisposing factors and to evaluate the treatment responses of oral antifungal agent in streak type onychomycosis. METHODS: The study was conducted with 387 cases of onycomycosis (45 cases of streak type, 342 cases of non-streak type) and 50 normal controls examined at Department of Dermatology, Hanyang University Guri Hospital from June, 2001 to May, 2004. Streak type onychomycosis was devided into three clinical presentations: distal type (20 cases), lateral type (19 cases), and multiple type (6 cases). RESULTS: In the groups of distal and multiple type of streak type onychomycosis, the longitudinal nail furrows were deep compared to the groups of non-streak type onychomycosis and normal control (p 0.05). In the groups of distal and lateral type of streak type onychomycosis, the treatment responses were poor compared to the group of non-streak type onychomycosis (p< 0.05). CONCLUSION: Treatment response is poor in streak type onychomycosis, therefore, extra treatments in addition to oral antifungal agents should be considered. If the patients who have deep longitudinal nail furrow are affected with tinea pedis, effective therapies in early stage should be considered to prevent to progress to streak type onychomycosis.

A Case of Lichen Spinulosus with an Histologic Finding of Follicular Mucinosis

No abstract available.

The change of prevalence of diabetes mellitus for 3 years and incidence of diabetes in Koreans over 60 years old / 대한내과학회지

BACKGROUND: As elderly people increasing, prevalence of diabetes will increase but there was paucity of data on the epidemiology of diabetes in Korean elderly population. In this study (Southwest Seoul, SWS study) we investigated the change of prevalence of diabetes mellitus for two points in time (the years 1999 and 2002) and 3-year incidence of diabetes in elderly Korean population of southwest area of Seoul. METHODS: A sampling of 1,652 subjects in 1999 and 1,214 subjects in 2002 who are over 60 years old in southwest area of Seoul were investigated. All subjects underwent a 75 g oral glucose tolerance test (OGTT), biochemical study and anthropometric measurements. Among the 1,652 subjects in 1999, 350 subjects were followed up for 3 years and 294 subjects without diabetes at baseline examination participated in retrospective cohort study. RESULTS: Prevalence of diabetes in 1999 was 20.5% [previous diagnosed people (11.9%), newly diagnosed people (8.6%)] and in 2002 was 22.1% [previous diagnosed people (15.2%), newly diagnosed people (6.9%)]. Prevalence of impaired fasting glucose (IFG) or impaired glucose intolerance (IGT) was 22.8% in 1999 and 27.8% in 2002. In 350 subjects were followed up for 3 years, prevalence of diabetes was 16.0% in 1999 and increased to 23.4% in 2002 (p=0.014). In retrospective cohort study, the annual incidence rate of diabetes was 2.9% (age and sex adjusted rate 2.5%). CONCLUSION: Prevalence of diabetes in elderly Korean population of southwest area of Seoul was 20.5% in 1999 and increased to 22.1% in 2002. Prevalence of IFG or IGT was 22.8% in 1999 and increased to 27.8% in 2002. This report supports that impaired glucose regulations and diabetes mellitus of elderly Korean population will increase in the future as aged Korean population increases.

A Cases of Bowen's Disease Arising in an Old Burn Scar / 대한피부과학회지

It is known that Bowen's disease is a representative precancerous lesion of squamous cell carcinoma, along with actinic keratosis. Chronic sun-exposure and arsenism are main causes of Bowen's disease. Also trauma, radiation, and viral infection are associated. Up to now, it is not yet reported that burn scar can induce Bowen's disease. We report an unusual case of Bowen s disease, which arose in an old burn scar.

Effects of Substance P on the Expression of Various Factors to control Hair Growth in Human Hair Follicle Culture / 대한피부과학회지

BACKGROUND: Among constituents of the skin, hair follicle is an organ where nerve fibers with the most highest density are distributed. Recently, it has been reported that neuropeptides, which are secreted by nerve fibers, have important roles in the hair growth and hair cycle change, and that, the expression of various growth factors and apoptosis-related molecules are important in the hair growth and hair cycle change. Therefore, it was thought of import to analyse the relationship between the effect of neuropeptides and the expression of various factors to control hair growth in the hair follicle and hair follicle cells. OBJECTIVE: The purpose of this study was to investigate the relationship between the effect of neuropeptides and the expression of various hair growth-related factors at the level of hair follicle after pretreatment of cultured hair follicles and dermal papilla cells with SP. METHODS: Normal human scalp samples were obtained, and anagen hair follicles and dermal papilla cells were isolated and were cultured in Dulbeco's Modified Eagle's Medium (DMEM) with several combination of supplements in an atmosphere of 5% CO2/95% air incubator. We divided the culture plates into two groups; i.e. control group (DMEM only) and SP group (10-6M SP dissolved in DMEM). The results were evaluated by measuring linear hair growth and hair follicle morphology under a light microscope. Also, after pretreatment of cultured hair follicle and dermal papilla cells with SP, we examined changes of expression of hair growth factors (FGF-7, IGF-1, VEGF), hair growth-inhibitory factors (IL-1alpha, IL-1beta), and apoptosis-related molecules (p53, caspase-3). RESULTS: The following results were obtained. 1. SP did not have any statistically significant effect on the rate of linear hair growth in cultured hair follicles. However, it prolonged the anagen stage of hair cycle. 2. In hair follicles, the expression of FGF-7, a hair growth factor, was increased more than control, while the expression of caspase-3, an apoptosis-related molecule, was decreased more than control. Also, morphological changes as well as the changes of expression of hair growth factors and apoptosis-related molecules were not found in dermal papilla cells. However, the expression of IL-1beta, a hair growth-inhibitory factor, was decreased more than control. CONCLUSION: We can conclude from the results that SP has growth-stimulatory effect and especially prolongs the duration of anagen phase without affecting the rate of linear hair growth. Also, in hair follicles and dermal papilla cells, SP shows hair growth-stimulatory effect at the molecular levels.

A Case of Congenital Adrenal Hyperplasia due to 11beta-Hydroxylase Deficiency / 대한내분비학회지

Congenital adrenal hyperplasia refers to a group of autosomal recessive disorders that is defective in the synthesis of cortisol. The enzymes most often affected are 21-hydroxylase and 11beta hydroxylase. The low levels of cortisol stimulate the pituitary gland to release ACTH. Chronic elevation of the ACTH level causes bilateral adrenal hyperplasia and a secondary increase in androgen formation. We examined a 19 year-old woman presented with clitoral hypertrophy and vaginal spotting. The subjects basal level of serum cortisol was low, but the serum levels of ACTH, 17a-hydroxyprogesterone, deoxy-corticosterone were elevated. The urinary excretions of 17-ketosteroids and 17-hydroxycorticosteroids were also increased. The karyotyping study and transrectal ultrasonography showed normal findings. The patient underwent clitoris reduction surgery and received hydrocortisone. To the best of our knowledge, this is the first case of 11beta-Hydroxylase deficiency in Korea.

Two Cases of Fordyce's Spots Treated with Combination of CO2 Laser and Trichloroacetic Acid / 대한피부과학회지

Fordyce's spots are ectopically located sebaceous glands, clinically characterized by minute orange or yellowish pinhead-sized macules or papules on the mucosa of the lips, cheeks, and less often, on the gums. Similar lesions may occur on the areola, glans penis, and labia minora. Because it is asymptomatic and inconsequential, treatment should be undertaken only if there are significant cosmetic problems. We could not find any remarkable therapeutic modality in textbooks or literatures satisfying both patients and physicians. We report herein the combination use of CO2 laser and chemical agent (Trichloroacetic acid) as new therapeutic modality.

Multiple Lichen Aureus / 대한피부과학회지

Lichen aureus appears usually as asymptomatic golden to purpuric colored lesion and consists of lichenoid papules, patches, and plaques. This disease is regarded as a variant of pigmented purpuric dermatitis. The main cause remains largely unknown. It is common on the lower extremity, and generally occurs as a solitary lesion, however, also rarely occurred as a zonal, bilateral or segmented form. We present a 28-year-old man who had multiple, variable sized, red-brownish to purpuric colored papules and patches on both lower extremities, ankles and forearms. On histopathological examination, the lesion revealed features of lichen aureus. This patients condition was improved by treatment with oral and topical corticosteroid agent. Since this case appeared to be a very unique case of multiple lichen aureas, we reported the case herein.