Treatment of Nasal Telangiectasis with Carbon Dioxide(CO2) Laser

Telangiectasis is defined as permanent visible dilatation of the cutaneous blood vessels. Clinically, its diameter ranges from 0.1 to 1.0 mm which represents either an expanded venule, an capillary, or sometimes an arteriole on the face. Until now, many treatment methods have been reported such as various laser therapy, sclerotherapy, electrodessication and so on. We used superpulse CO2 laser to remove nasal telangiectasis in 8 patients between May 2004 and July 2007. Laser therapy was done in continual 5 sessions with intervals of 3 - 5 weeks. In each session, laser beam was shot to the point of the bifurcation, trifurcation of telangiectatic vessels or to the points of the widest diameter. In each point, shots of the laser beam were repeated 5 times to reach deep dermis. The laser setting was 7 W with 0.5 mm diameter in superpulse mode. Photographs were taken before and after procedures to ascertain the changes of nasal telangiectasis. Our results showed that the main lesions were cleared effectively. We think that irradiation of CO2 laser onto the bifurcating points can be a valuable tool to treat nasal telangiectasis.

An Anesthetic Experience of Intraoperative Hypercapnia in a Patient with Larsen Syndrome: A case report / 대한마취과학회지

Larsen syndrome is a rare congenital connective tissue disorder which is characterized by multiple dislocation of major joints, typical facial appearance, cervical spine narrowing and instability, and respiratory difficulties secondary to laryngotracheomalacia. We describe a case of general anesthesia for orthopedic operations in female infant consistent with Larsen syndrome. The patient showed hypercapnia intraoperatively, but recovered without any sequelae.

Clinical Features of Eczema Herpeticum in Comparison with Localized Herpes Simplex Virus Infection

No abstract available.

A Limited Polyarteritis Nodosa of the Breast / 대한류마티스학회지

Polyarteritis nodosa (PAN) is a chronic inflammatory disorder characterized by a necrotizing vasculitis of small and medium-sized artery, which can involve several organs, such as, the kidney, skin, peripheral nerves, muscle, heart, and gastrointestinal tract. In addition to systemic involvement of the classical PAN, a localized disease of the gallbladder, uterus, testis, and skin has been reported. In particular, a limited involvement of the breast is an unusual manifestation of PAN and usually runs a favorable prognosis when compared with the classical PAN. We describe a 64-year-old female patient who had a limited disease of PAN on both the breasts. She presented with mass-like lesions on both the breasts. After surgical excision of the breast lesions, she has been doing well with only a low dosage of prednisolone.

Three Cases with Cutaneous Polyarteritis Nodosa / 대한류마티스학회지

Systemic polyarteritis nodosa is a necrotizing vasculitis that involves small and medium-sized muscular arteries in the multiple organ systems, whereas cutaneous polyarteritis nodosa (CPAN) is a localized disease characterized by necrotizing vasculitis of small and medium-sized arteries in the skin without life-threatening organ involvement. CPAN is usually limited to skin, muscle, and joints. It is chronic but takes a benign course. The most common cutaneous manifestations include nodules, ulcers and a livedo reticularis pattern on the extremities. We describe three cases with CPAN showing necrotizing vasculitis on the skin without systemic symptoms or visceral involvement. In Korea, most previously published cases with CPAN have shown a good response to a short term of corticosteroids or colchicine administration. However, two of our three patients required another immunosuppressive agent in addition to corticosteroids to manage their intractable skin lesions, and the remaining one showed a good response to a short course of prednisolone. In addition, there was one patient with CPAN having hepatitis B surface antigen, which might be associated with his refractory skin disease.

Vasculo-Behcet's Disease Developing in a Patient with Ebstein Anomaly / 대한류마티스학회지

Behcet's disease (BD) is a chronic inflammatory disease, involving several organs. It is well known that there are the marked regional differences in the disease expression of BD. In case of the vascular involvement in BD, the frequency rate has been described in 25~30% among the patients from the MiddLe East, whereas it has been noted in 5~15% in our country. In general, BD associated with large vessel lesions is named vasculo-BD. On the other hand, the cardiac involvement in BD has rarely been reported in the literature. Ebstein anomaly is a kind of malformation that is characterized by a downward displacement of the tricuspid valve into the right ventricle. We reported a 54-year-old male patient with vasculo-BD who had inferior vena cava obstruction and Ebstein anomaly. The association of Ebstein anomaly with vasculo-BD is considered to be coincidental. To the best of our knowledge, this is the first case of Ebstein anomaly associated with BD.

Prognostic Factors of Postherpetic Neuralgia

The investigation was aimed to determine prognostic factors related to postherpetic neuralgia (PHN), and treatment options for preventing PHN. The data showed 34 (17.0%) out of 188 patients with herpes zoster had severe pain after 4 weeks, and 22 (11.7%) after 8 weeks, compared with 109 (58.0%) at presentation. The age (>or=50 yr), surface area involved (>or=9%), and duration of severe pain (>or=4 weeks) might be the main factors that lead to PHN. On the other hand, gender, dermatomal distribution, accompanied systemic conditions, and interval between initial pain and initiation of treatment might not be implicated in PHN. The subjects were orally received antiviral (valacyclovir), tricyclic antidepressant (amitriptyline), and analgesic (ibuprofen) as the standard treatment in the group 1. In addition to the standard medication, lidocaine solution was sub- and/or perilesionally injected in the group 2, while lidocaine plus prilocaine cream was topically applied to the skin lesions in the group 3. The rates of PHN in the 3 treatment groups were not significantly different, suggesting adjuvant anesthetics may not be helpful to reduce the severity of pain.

Kaposi's sarcoma occurring during short-term dialysis: report of two cases

Kaposi's sarcoma (KS) appears to develop in association with kidney transplantation, but unlikely with dialysis. We report two cases of classic KS that occurred in patients receiving short-term (less than 3 yr) dialysis. They have been suffering from chronic renal failure due to tuberculosis and diabetes mellitus, respectively. Several to multiple, reddened-violaceous patches, plaques and nodules were found on the hand and the lower extremities. Laboratory studies showed no evidence suggesting immunosuppressed state and there was no history of taking immunosuppressive agents. The biopsies of the two cases revealed proliferation of spindle-shaped cells focally arranged in bundles and multiple dilated vascular spaces outlined by an attenuated endothelium with intravascular and extravasated erythrocytes. The specimens expressed positivity with CD34 antigen. Human herpesvirus 8 (Kaposi's sarcoma-associated herpesvirus) was detected in one case by polymerase chain reaction method.

Eosinophilic Cellulitis (Wells' Syndrome) Successfully Treated With Low-dose Cyclosporine

Eosinophilic cellulitis (Wells'syndrome) is an uncommon skin disorder. We report two adult male patients who had recurrent erythematous plaques and a nodular lesion on the abdomen. The histopathologic feature of their skin biopsies similarly indicated a marked infiltrate of eosinophils in the dermis with the fashion of "flame figures". One of the patients demonstrated blood eosinophilia. Given the clinicohistological findings, the patients fulfilled the criteria for the diagnosis of eosinophilic cellulitis. The skin lesions remained refractory to medications such as corticosteroids, sulfones, antihistamines, and minocycline. Considering the beneficial effect of cyclosporine in the treatment of eosinophilia-associated dermatoses, we speculated that eosinophilic cellulitis might respond to cyclosporine therapy. Thus, each of the two patients was given cyclosporine (microemulsion formulation) at a daily dose of 1.25 or 2.5 mg/kg, i.e., 100 or 200 mg, respectively. Complete remission of the skin eruptions was obtained in both patients during a 3- or 4-week period of treatment. No side effects were observed. Neither of the patients experienced relapse of the disease at least over 10 months after the discontinuation of the cyclosporine therapy. We suggest that administration of low-dose cyclosporine be a safe and useful therapeutic option in patients with eosinophilic cellulitis.

Rud's Syndrome

Rud's syndrome (RS), basically composed of ichthyosis, mental deficiency and hypogonadism, is a rare hereditary disease. Some varying dermatologic, neurologic, endocrinologic, ophthalmologic and musculoskeletal abnormalities have coincided with RS. No case of RS has been documented from Asian countries except one from Japan. We describe a 16-year-old girl who presented with lamellar ichthyosis, mental retardation, hypogonadism, short stature, alopecia, sparse eyebrows, strabismus, cataracts, and congenital dislocation of the hip. To our knowledge, RS coexisting congenital dislocation of the hip herein is the first case in English literature.

Gender Verification Test Based on PCR Determination of Y Chromosomal DNA: Experience in Genetic Sex Typing during the '99 Kangwon Asian Winter Games / 대한임상병리학회지

BACKGROUND: The aim of gender verification test is to maintain impartiality among female competitors by excluding males in women's sports competitions. Some microscopic methods such as X-chromatin test and Y-chromatin test had been used for this purpose. Because of their known shortcomings, the methods were replaced with the polymerase chain reaction(PCR)-based test. In this report we describe the assay used in the gender verification during the '99 Kangwon Asian Winter Games. METHODS: Buccal smear samples of 126 female competitors were obtained. These samples underwent digestion with proteinase K, and were followed by boiling treatment with Chelex resin. PCR was performed to detect the sex determining region of Y chromosome(SRY) in order to confirm the femininity, and beta globin region was coamplified for confirming that the DNA was extracted from buccal cells. An X-Y homologous region encoded amelogenin was also amplified so that the femininity could be reconfirmed. RESULTS: No SRY and Y-amelogenin like sequences were amplified in any of samples of 126 female competitors analysed. CONCLUSIONS: Established gender verification method based on PCR amplification of Y chromosomal DNA seems to be superior to others. Sampling is simple. The procedure of extracting DNA is simple, rapid, and does not require multiple tube transfers. False positivity and/or false negativity appear to be less. It appear that this method is useful and reliable for gender verification in international sports events.

Relationship between Helicobacter pylori and rosacea: it may be a myth

Although it is debatable whether Helicobacter pylori may play a role in the pathogenesis of rosacea, some authors suggested that the treatment of H. pylori might have a beneficial effect. The aim of this investigation was to compare the prevalence of H. pylori between rosacea patients and controls, and to evaluate an effect of H. pylori eradication on rosecea by a 2-week triple therapy that was composed of amoxicillin, clarithromycin and omeprazole. H. pylori was detected by using gastroscopic biopsy with Warthin-Starry stain. Forty-two (84%) of 50 patients with rosacea and 39 (78%) of 50 controls had H. pylori, showing no significant difference in prevalence. The cure rates of H. pylori in rosacea patients and controls were 80% (16/20) and 85% (17/20), respectively. There was no significant decrease in the intensity of erythema in active treatment and placebo groups both during and after the treatment. Temporary improvement in papulopustules exclusively during the treatment (within 2 weeks) could be independent of H. pylori eradication. Overall, no significant reduction in the number of papulopustules was observed in active treatment and placebo groups after the treatment (in 2 months). Taken together, our study found no significant lessening of rosacea lesions by treating H. pylori infection, which conclusively does not concur with a view that H. pylori may be related to rosacea.

A case of coexisting Behcet's disease and ankylosing spondylitis

Behcet's disease (BD) is a chronic inflammatory condition involving several organs, such as skin, mucous membrane, eye, joint, intestine, lung and central nervous system. Ankylosing spondylitis (AS) is a prototype of seronegative spondyloarthropathy, and a chronic systemic inflammatory disorder of the axial skeleton, mainly affecting the sacroiliac joint and spine. In the latter, systemic complications may develop in addition to joint involvement. The coexistence of BD and AS has been rarely reported in the literature. The inclusion of BD among seronegative spondyloarthritides and whether sacroiliitis (SI) develops in BD are still being debated. We describe a 28-year-old man who has fulfilled the diagnostic criteria for BD and AS as well.

Fibroelastolytic Papulosis of the Neck

Fibroelastolytic papulosis of the neck(FEPN) was introduced by Balus et al in 1997. Before this term was used, white fibrous papulosis of the neck(WFPN) and pseudoxanthoma elasticumlike papillary dermal elastolysis(PDE) had differently been used. These two disease entities had clinical similarities such as asymptomatic, white to yellow discolored, papular eruptions on the neck in elderly persons. As names implicated, however, they showed variable histological findings, for examples, fibrosis in WFPN or elastolysis in PDE or both in FEPN. Taken into ac-count together, instead of using WFPN or PDE separately, FEPN might be preferred to describe these two kinds of skin diseases. We report a case of a 36-year-old male patient with papules compatible with FEPN, whose biopsy mainly showed elastolysis.

Sclerosing mesenteritis associated with skin panniculitis and pleural thickening / 대한내과학회지

Sclerosinng mesenteritis is a rare disease that occurs most often among middle aged man. Fewer than 200 cases have been reported in the literature. It is a benign mesenteric lesion characterized by fat necrosis, fibrosis and chronic inflammation. The pathogenesis of this disease is unclear through an autoimmune origin has been proposed. The disease is generally localized and self- limiting. Fatal case is rare but has been reported. In patients with biopsy proven sclerosing mesenteritis having a relentless downhill course, treatment with prednisolone and oral cyclophosphamide in isolated case report has lead to evident clinical and radiological responses. This is a report of a case of sclerosing mesenteritis, who presented to us with history of colicky abdominal pain and weight loss. She was treated with prednisone and intravenous cyclophosphamide pulse therapy and resulted in radiological and clinical improvement. Interestingly this case has associated with skin panniculitis and pleural thickening. The skin panniculitis also showed good response to prednisolone. Our case is the first in which sclerosing mesenteritis was associated with pleural thickening.

Determination of Herpes Simplex Virus Isotypes by Nested Polymerase Chain Reaction / 대한피부과학회지

BACKGROUND: Polymerase chain reaction(PCR) was developed to diagnose viral infections such as herpes simplex virus(HSV) more rapidly and accurately than the culture technique. Nested PCR, with knowingly higher sensitivity and specificity than the conventional PCR, has been recently applied to determine HSV isotyping. OBJECTIVE: We conducted this study to compare the prevalence of each HSV isotype among patients with HSV infections by nested PCR in relation to different age groups and body sites. METHODS: Specimens were collected with cotton-swabs from the lesions, and then snap frozen, and stored at -70 degrees C in a deep freezer until processed. They were innoculated into the monolayer of Vero(African green monkey kidney) cells, and later examined for cytopathic effects. DNAs were extracted from each specimen and were amplified by using nested PCR with the primers against the genes encoding gpD of HSV-1 and HSV-2, respectively. RESULTS: Of 127 patients, who had been diagnosed as HSV infections by the culture technique, all cases were positive in the nested PCR method. The positive cases of each isotype for HSV-1, HSV-2 and mixed infections (HSV-1 & HSV-2) were 77 (61%), 36 (28%) and 14 (11%), respectively. The prevalence of infections with HSV-1 in the age group under 19 years old was significantly higher than that in the age group over 20 years old (p<0.05). The prevalence of infections with HSV-2 in the age group over 20 years old was significantly higher than that in the age group under 19 years old (p<0.05). There was a close correlation between the HSV isotypes and their predilection sites of the body, showing HSV-1 for area above the waist including lips, oral cavity, eyes, face, fingers and chest, otherwise HSV-2 and mixed infections for area below the waist including genital organs and buttocks (p<0.001). CONCLUSION: It was suggested that the prevalence of each HSV isotype in certain age groups of the patients might be somewhat different from those reported in other studies. The affinity of HSV isotypes to the specific sites of the body was reconfirmed. This study indicated that nested PCR might be a relatively rapid and cost-efficient test with very high sensitivity and specificity for HSV isotyping.

A Case of Diffuse Scleroderma Associated with Primary Biliary Cirrhosis and Isolated Pulmonary Hypertension / 대한류마티스학회지

Primary biliary cirrhosis is frequently associated with a variety of disorders presumed to be autoimmune in nature, such as Sjogrens syndrome, scleroderma, rheumatoid arthritis, systemic lupus erythematosus, and autoimmune thyroiditis. Scleroderma has been recognized in association with primary biliary cirrhosis. Most cases present as the CREST (calcinosis cutis, Raynauds phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) syndrome. Isolated pulmonary hypertension develops in a small proportion of patients, nearly all of whom have limited cutaneous involvement. We report a case who has diffuse scleroderma associated with primary biliary cirrhosis and isolated pulmonary hypertension.

Adiposis Dolorosa (Dercum's diease) / 대한피부과학회지

The patient was a sixty-year-old obese woman with the long history of hypertension, amenorrhea and occasional psychic disturbances. She had eigbt, thumb to adult-fist sized, slightly movable, relatively soft, and painful subcutaneous nodules with tenderness and paresthcsia, of which overlying skin appeared to be normal except senile changes, on the abdomen and both upper extremities for 10 years. There was no evidence of inheritance in her family. Laboratory data revealed no abnormalities in lipid metabolism or in a variety of endocrinological functions. Microscopically, an excised mass from the forearm showed thin connective tissue capsule encircling numerous lobules cornposed entirely of the mature fat. cells vith minimal focal capillary proliferatios.

Treatment of Uncomplicated Male Gonococcal Urethritis with Norfloxacin / 대한피부과학회지

From November 18 to December 31, 1986, seventy-five male patients with unconplicated gonococcal urethritis at the Venereal Disease Clinic of Choong-ku Public Health Center in Seoul were allocated randomly into one of two treatment regimens, and seventy patients were followed. All thirty-five patients including PPNG infections, treated with single oral dose of norfloxacin 600mg, were recovered(100%). One of thirty-five patients treated with a single oral dose of norfloxacin 800mg, failed. This failed case was one of eighteen nonPPNG infections (failure rate of 5.6%). Susceptibility test with disks containing norfloxacin 10ug showed the inhibition zone greater than 30mm. It is suggested that a single oral dose of 600mg or 800mg norfloxacin has good effect in the treatment of gonococcal urethritis with minimal side effects. Because of high prevalence of PPNG, it can be recommended as the first line treatment for gonorrhoea in Korea.

Four Cases of Herpes - Associated Erythema Multiforme / 대한피부과학회지

We describe four patients with herpes-associated erythema multiforme, who had clinical and histopathological features consistent with the so-called erythema multiforme minor. The appearance of lesions of herpes simplex were followed with intervals between 6 and 10 days by the recurrent developments of erythema multiforme several times in a year in each patient. Sinee herpes simplex virus infection is considered one of the major factors provocating erythema multiforme one may have to pay more attention to patient's history to define the nature of erythema multiforme.