Diagnosis and Treatment of GastroEsophageal Reflux Disease at the Primary Health Care Clinics in Korea / 대한소화기학회지

Background/Aims@#The prevalence of GERD and treatment costs are continuously rising in Korea, and the importance of primary health care clinics where the most treatment of actual patients is conducted is increasing. In this study, the diagnosis of GERD, selection of therapeutic drugs, and treatment methods in primary health care clininics were investigated through a large-scale multi-dimensional surveys. @*Methods@#From January 2015 to December 2018, the study data of 18,010 patients with GERD were retrospectively investigated based on eletronic medical record at 542 primary health care clinics in Korea. @*Results@#Among all GERD patients, endoscopy was used for diagnosis in 16.11% of cases, and the most frequently performed in gastroenterology department (28.85%). The average BMI and the proportion of patients in stages 1 to 3 of obesity were highest in the ERD group, and the majority of the severity of ERD group was mild. Symptoms of the patients with GERD were mainly heartburn, gastric acid reflux, and chest pain. Drug treatment was performed in most of the patients with GERD, and PPI was the main drug, and Esomeprazol was prescribed the most among the main ingredients, and the ratio of PPI alone was high. The rate of symptom improvement after GERD treatment was slightly higher in the ERD group (75.91%) and the NERD group (74.36%) than in the GERD diagnosed without endoscopy group (63.89%). @*Conclusions@#In domestic primary health care clinics, the majority were diagnosed with GERD without endoscopy on the basis of symptoms. The most preferred treatment for GERD was PPI, which was prescribed alone in the majority.

Colon Polyp Detection in Primary Health Care Institutions of Korea: Detection Rate and Issues with Following the Guidelines / 대한소화기학회지

Background/Aims@#There have been few multicenter studies on colonic polyps conducted by primary medical institutions. This study examined the detection rate of colonic polyps in primary health care institutions and the related factors while following the guidelines. @*Methods@#The medical records of 14,029 patients who underwent colonoscopy between January-June 2020 at 40 primary medical institutions in Korea were analyzed. High-risk adenoma was defined as advanced adenoma, carcinoma, or ≥3 adenomas. @*Results@#Most patients (71.2%) aged ≥50 years underwent re-colonoscopy within 5 years (51.3%) for diagnostic purposes (61.3%) in Korean primary medical institutions. The detection rates of colon polyps, adenoma, advanced adenoma, high-risk adenoma, and carcinoma was 59.9%, 38.9%, 5.9%, 11.4%, and 0.3% in all subjects and 59.8%, 37.5%, 8.5%, 12.9%, and 0.3% in average-risk patients, respectively. The incidences of adenoma in average-risk patients increased significantly with age (30s/40s/50s: 20.1%/29.4%/43% for adenoma, 4.4%/6.7%/10.3% for advanced adenoma, and 5.6%/9.5%/14.6% for high-risk adenoma; p<0.05). Before 50 years of age, high-risk adenoma was detected in 9.1% of patients in the first-time screening group, and the significant risk factors were being male and ≥40 years of age. The detection rate of high-risk adenoma in the normal index colonoscopy group within 5 years was 9.0%. The significant risk factors included older age, male sex, positive fecal occult blood test, stool form changes, and nonspecific symptoms (gas and indigestion). @*Conclusions@#More colonic adenoma studies targeting real-world clinical practice will be needed to revise the Korean guidelines for colorectal cancer screening and surveillance.

Venous Anastomosis with Dorsal Veins Using Additional Incisions after Wound Closure in Metacarpophalangeal Joint Level Replantation

In cases of replantation, accurate closure of all structures, including bone, tendons, arteries, nerves, and veins is essential. Among these, the vein is a weaker structure and is damaged severely in most amputation cases. After fixation of bone, repair of tendons, nerves, and arteries, surgeons often experience difficulty in performing venous anastomoses. We found that in such cases, venous anastomosis is easy to perform using an additional incision after closure of the original wound. In a 33-year-old male patient with amputation of all four fingers at the metacarpophalangeal joint level, venous anastomoses were performed with dorsal veins using additional incisions after completion of the fixation of bones and repair of all other structures and closure of the skin due to surgical site tension.

Bowen Disease Arising from Unilateral Systematized Linear Porokeratosis / 대한피부과학회지

No abstract available.

Eccrine Poroma Arising in Free-Flap Donor Site / 대한피부과학회지

No abstract available.

Assessment of the Quality of Life in Autoimmune Blistering Skin Disease Patients / 대한피부과학회지

BACKGROUND: Autoimmune blistering skin diseases such as pemphigus vulgaris, pemphigus foliaceus, bullous pemphigoid and epidermolysis bullosa acquisita substantially affect patients' daily life and psychosocial well-being. OBJECTIVE: The aim of this study was to evaluate the quality of life (QOL) in patients with autoimmune blistering diseases and to identify the factors that can influence their QOL by comparing them to healthy controls. METHODS: Forty patients with autoimmune blistering skin diseases and 40 healthy controls were interviewed using the Korean version of Skindex-29. The study assessed the clinical severity of the disease. RESULTS: The total, symptom, function, and emotion scores of Skindex-29 were significantly higher in patients with autoimmune blistering skin diseases (35.28, 40.78, 30.57, and 36.67, respectively) than in the healthy controls (6.90, 9.38, 5.47, and 6.60, respectively) (p<0.001). Higher disease severity had a negative correlation with QOL in patients with blistering skin diseases, and QOL was lower when patients had low levels of satisfaction with treatment. CONCLUSION: The results show that autoimmune blistering skin diseases can affect patients' QOL. In addition, disease severity and low satisfaction with treatment are important factors that reduce QOL. Development of new treatments should improve treatment efficacy and the QOL of patients with autoimmune blistering diseases.

Fibroadenoma Arising in the Accessory Breast Tissue of Axilla / 대한피부과학회지

No abstract available.

Drug Hypersensitivity Syndrome Induced by Leflunomide / 대한피부과학회지

No abstract available.

Extensive Fasciitis in Sclerotic-type Chronic Cutaneous Graft-versus-Host Disease / 대한피부과학회지

Fasciitis can occur very rarely with sclerotic-type chronic cutaneous graft-versus-host disease (GVHD). A 54-year-old woman presented with painful skin tightness on upper and lower limb with limited range of movement. She was diagnosed with chronic myelocytic leukemia 5 years ago and underwent allogeneic bone marrow transplantation. Histopathologically, the interlobular septum of subcutis and fascia were remarkably thickened with fibrosis and moderate inflammatory infiltrates accompanying the dilated lymphatic channels with considerable leakage of lymph fluids. Herein, we report a case of extensive fasciitis as a manifestation of chronic GVHD associated with poor prognosis.

Adverse Effects of Oral Cyclosporine in the Treatment of Skin Diseases / 대한피부과학회지

BACKGROUND: Cyclosporine (CS) is being successfully used for various skin diseases including psoriasis, atopic dermatitis, and chronic idiopathic urticaria. However, dermatologists have hesitated to use CSs in clinical practices due to possible adverse effects. OBJECTIVE: The aim of this study is to investigate the adverse effects of CS for dermatological uses. METHODS: We performed a retrospective study by including 1,335 patients with CS treatment. RESULTS: From 1,335 patients, 208 (15.6%) showed adverse effects and obvious laboratory changes. Twenty five patients experienced either two or more adverse effects. Gastrointestinal (GI) symptoms were the most common side effects. Other side effects included hypercholesterolemia (2.2%), hypertrichosis (2.2%), headache (1.3%), hypertension (0.9%), and hypertriglyceridemia (0.9%). Hypercholesterolemia is more frequently found in men but, GI symptoms and hypertrichosis are more frequent in women. Hypercholesterolemia, hypertriglyceridemia, and GI symptoms are more common in adults but hypertrichosis is more common in children and adolescents. Hypertension, hypercholesterolemia, and hypertriglyceridemia have been remarkable in psoriasis patients, and GI symptoms and hypertrichosis are found in patients with atopic dermatitis. GI symptoms and headaches occur more often within three months of the CS treatment; however, hypertension, hypercholesterolemia, and hypertriglyceridemia usually occur three months after. With regards to CS dose, the hypertrichosis is more common in the group with low initial dose. GI symptoms occur more often in the lower CS cumulative dose group; however, hypertension and hypertriglyceridemia are higher in the CS cumulative dose group. CONCLUSION: As compared with previous studies, the frequency of adverse effects after CS treatment in this study is proved to be low. Therefore, under dermatological fields, we suggest that CS is a relatively safe drug with periodic follow-ups and laboratory tests.

Primary Cutaneous Cryptococcosis Mimicking Herpes Zoster / 대한피부과학회지

Primary cutaneous cryptococcosis (PCC) is a localized skin infection confined to one body region, without evidence of dissemination. The clinical presentation of PCC is so variable that its diagnosis requires a high index of suspicion. A 52-year-old woman presented with localized grouped erythematous papulovesicles on the left ear lobe for 6 months with wax and wane pattern. However, there were no signs of systemic cryptococcal infection. Histopathological examination showed numerous encapsulated round spores and budding yeasts in the dermis. Culture of aspirate from the wound and tissue samples revealed Cryptococcus neoformans. Herein, we report an interesting case of PCC on the left ear that clinically mimics herpes zoster.

Effect of air purifier on indoor air quality and atopic dermatitis

PURPOSE: High level of indoor air pollutant may cause aggravation of atopic diseases long with various allergic respiratory diseases especially in people who spend mostly of their lives indoors. The aim of this study was to evaluate the effect of air purifier on the reduction of relevant hazards in indoors and the improvement of atopic dermatitis (AD). METHODS: A total of 24 families, consisted of 18 AD families and 6 normal control families, were enrolled in this study. We examined air quality and AD severity before the installation of air purifiers and after twenty-four weeeks. The assessment of air quality included fine particles (particulate matter, PM2.5 and PM10), gaseous contaminants (CO, CO2, volatile organic compounds [VOCs], formaldehyde, NO2) and density of offloating microorganisms. Severity of AD was assessed by SCORing atopic dermatitis (SCORAD) index and transepidermal water loss (TEWL). RESULTS: At the end of study, particular air pollutants and VOCs of gaseous air pollutants decreased in both groups (P<0.01). In AD group, SCORAD index decreased from 23.45+/-4.34 to 15.42+/-6.53 (-18.5%) and TEWL decreased from 33.78+/-5.16 to 26.89+/-5.66 (-18.7%) (P<0.01 and P<0.01, respectively). However, the value of total immunoglobulin E and eosinophil did not show significant changes in both groups compared with baseline. CONCLUSION: These results suggested that air purifier may improve severity of AD by reducing air pollutants like fine particles and VOCs. Our preliminary study could provide a basis for using air purifier to prevent aggravation of AD.

Pityriasis Rotunda Treated with Combination of Topical and Oral Retinoid / 대한피부과학회지

Pityriasis rotunda (PR) is a rare disease characterized by persistent, sharply defined, oval, scaly patches of dry skin, localized mainly on the trunk and extremities. Its etiology remains unknown. However, several reports suggest that it is a form of acquired ichthyosis vulgaris or a skin manifestation of systemic disease, such as malnutrition, chronic illness, hepatic disease, and malignancies. Although a variety of treatment modalities, including topical lactic acid, urea, tars, emollients, and corticosteroid, have been applied to it, their efficacies are not satisfactory. Herein, we report a case of PR in a healthy man who was successfully treated with oral and topical retinoids.

Pityriasis Rotunda Treated with Combination of Topical and Oral Retinoid / 대한피부과학회지

Pityriasis rotunda (PR) is a rare disease characterized by persistent, sharply defined, oval, scaly patches of dry skin, localized mainly on the trunk and extremities. Its etiology remains unknown. However, several reports suggest that it is a form of acquired ichthyosis vulgaris or a skin manifestation of systemic disease, such as malnutrition, chronic illness, hepatic disease, and malignancies. Although a variety of treatment modalities, including topical lactic acid, urea, tars, emollients, and corticosteroid, have been applied to it, their efficacies are not satisfactory. Herein, we report a case of PR in a healthy man who was successfully treated with oral and topical retinoids.

A Case of Sarcoidosis in Oral Mucosa / 대한피부과학회지

Sarcoidosis is a systemic granulomatous disease of unknown origin that may affect multiple organs including the lung, mediastinal and peripheral lymph nodes, eyes, and skin. Although cutaneous manifestations occur in around 25% cases, to our knowledge, oral mucosal involvement is very rare as a leading symptom of sarcoidosis. A 28-year-old female presented with localized skin-colored to yellowish indurated papules and plaques on the lower lip mucosa. The lesions were presented for the past month and it progressively enlarged. Histopathologic examination revealed multiple, variable sized, well circumscribed, non-caseating granulomas in the dermis. Serum level of angiotensin converting enzyme was slightly elevated (63.0 U/L) and chest CT revealed bilateral hilar lymphadenopathies. Herein, we report an oral mucosal sarcoidosis, as an initial presentation of the systemic sarcoidosis.

Bullae and Sweet Gland Necrosis Concurrent with Nontraumatic Rhabdomyolysis in a Non-comatose Patient after Alcohol and Drug Intoxication / 대한피부과학회지

No abstract available.

Merkel Cell Carcinoma Concurrent with Bowen's Disease

Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous malignancy of the elderly and immunocompromised patients. It is occasionally found coexisting with other diseases, such as squamous cell carcinoma, basal cell carcinoma, actinic keratosis, miscellaneous adnexal tumors, and rarely Bowen disease. A 75-year-old woman presented with a 6-month history of an irregularly shaped erythematous patch on the left mandibular angle. Three months later, a 1.5x1.0 cm sized painless and rapidly growing erythematous nodule developed on the patch. Microscopically, the patch lesion was consistent with that of Bowen disease. The nodular lesion showed a number of small uniform hyperchromatic cells with scanty cytoplasm. It showed dense small-cell like nodular infiltration in the dermis. Immunohistochemical staining for cytokeratin 20 showed a positive result with a dot-like perinuclear pattern. Additionally, the result for thyroid transcription factor-1 was negative, which is positive in small cell neuroendocrine carcinoma. From these findings, we diagnosed this lesion as MCC concurrent with Bowen disease.

Proliferative Nodule in a Giant Congenital Melanocytic Nevus / 대한피부과학회지

The proliferative nodules within a giant congenital melanocytic nevus (GCMN) are generally benign and may regress. However, atypical features cause great interest in dermatopathology. Especially, in neonate proliferative nodules with bleeding, ulceration on GCMN makes it difficult to differentiate the nodules from congenital malignant melanoma. Herein, we describe an interesting case of proliferative nodules in a GCMN of a newborn, which has not been previously reported in Korea.

DNA Barcoding of Fish, Insects, and Shellfish in Korea

DNA barcoding has been widely used in species identification and biodiversity research. A short fragment of the mitochondrial cytochrome c oxidase subunit I (COI) sequence serves as a DNA bio-barcode. We collected DNA barcodes, based on COI sequences from 156 species (529 sequences) of fish, insects, and shellfish. We present results on phylogenetic relationships to assess biodiversity the in the Korean peninsula. Average GC% contents of the 68 fish species (46.9%), the 59 shellfish species (38.0%), and the 29 insect species (33.2%) are reported. Using the Kimura 2 parameter in all possible pairwise comparisons, the average interspecific distances were compared with the average intraspecific distances in fish (3.22 vs. 0.41), insects (2.06 vs. 0.25), and shellfish (3.58 vs. 0.14). Our results confirm that distance-based DNA barcoding provides sufficient information to identify and delineate fish, insect, and shellfish species by means of all possible pairwise comparisons. These results also confirm that the development of an effective molecular barcode identification system is possible. All DNA barcode sequences collected from our study will be useful for the interpretation of species-level identification and community-level patterns in fish, insects, and shellfish in Korea, although at the species level, the rate of correct identification in a diversified environment might be low.

'Rice Body' Containing Cystic Tumor Occurred at the Volar Aspect of the Finger / 대한피부과학회지

'Rice body' is a soft tissue nodule resembling shiny white rice-bean, which is occasionally observed at the juxta-articular area among patients with rheumatic arthritis and tuberculosis arthritis. A 45-year-old man was presented with tender cystic tumor on the volar aspect of the left third finger, which was noted 5 months prior to the visit. When performing a biopsy, numerous, whitish granular, 5~10 mm in size, and ovoid substances were observed, and found to be the major component of the cystic tumor. Histologically, the granules were consistent with the so-called 'rice bodies' (granules of inner acidophilic material surrounded by fibrin/collagen). With these findings, we report a case of rice body-containing cystic tumor clinically reminiscent of other cystic lesions, which can be seen on the finger around the joint structure.