Dermoscopic features of an unusual case of targetoid hemosiderotic nevus / 고신대학교의과대학학술지

Targetoid hemosiderotic nevus (THN) is a rare variant of melanocytic nevus, characterized by a sudden development of a targetoid ecchymotic halo around a pre-existing nevus. THN clinically raises concern for malignant transformation due to its abrupt change in color and size. THN should be distinguished from other diseases showing a peripheral halo, including targetoid hemosiderotic hemangioma, halo nevus, and Meyerson nevus. Dermoscopy can help clinicians to differentiate THN from these diseases. The typical dermoscopic features of THN are known to be divided into two distinctive areas: the central melanocytic area and the peripheral ecchymotic area. In our case, dermoscopy revealed a novel bull’s eye pattern composed of a central area with characteristic features of benign melanocytic nevus, an intermediated white circular ring, and a peripheral milky red area. When a sudden change occurs in a pre-existing nodule showing targetoid features, dermoscopy should be considered before conducting a biopsy or surgical intervention.

A Clinicopathologic Study of Lichenoid Drug Eruption / 대한피부과학회지

Background@#Lichenoid drug eruption (LDE) is a relatively rare form of cutaneous drug eruption and that resembles lichen planus on a clinical and histological basis. Although there are some studies on histopathological findings of LDE, studies on clinical findings of LDE are limited. @*Objective@#To investigate the clinical and histopathologic findings and prognosis of LDE. @*Methods@#We retrospectively investigated the clinicopathologic findings of LDE patients who visited Kosin University Gospel Hospital between 1990 and 2020. @*Results@#This study included 44 LDE patients (male:female=1.4:1). The most common causative drug was anti-tuberculous drugs (52.3%), followed by 5-fluorouracil (11.4%), and captopril (9.1%). There were pruritic erythematous scaly or lichenoid patches and plaques in all cases. The most frequently involved sites were trunk and extremities. Notably, 15 cases (34.1%) involving the scalp and 3 cases (6.8%) involving the oral mucosa. Treatment modalities included oral, topical corticosteroid, and oral antihistamines. Among 44 cases, 28 patients discontinued the causative agent, and 16 patients continued to use it after diagnosis of LDE. The mean duration of treatment for patients who discontinued or did not discontinue the causative drugs was 4, 10 weeks, respectively. The most commonly observed histopathologic findings were superficial and deep perivascular infiltration of inflammatory cells (100.0%) and eosinophil infiltration (93.2%). @*Conclusion@#LDE can be differentiated from idiopathic lichen planus by clinicopathologic findings. LDE appears to be a mild form of drug eruption in which symptoms can be controlled with conservative treatment, even without the cessation of causative drugs for the treatment of the underlying disease.

Radiation Exposure to Physicians During Interventional Pain Procedures

BACKGROUND: Fluoroscopy has been an integral part of modern interventional pain management. Yet fluoroscopy can be associated with risks for the patients and clinicians unless it is managed with appropriate understanding, skill and vigilance. Therefore, this study was designed to determine the amount of radiation received by a primary operator and an assistant during interventional pain procedures that involve the use of fluoroscopy METHODS: In order to examine the amount of radiation, the physicians were monitored by having them wear three thermoluminescent badges during each single procedure, with one under a lead apron, one under the apron collar and one on the leg during each single procedure. The data obtained from each thermoluminescent badge was reviewed from September 2008 to November 2008 and the annual radiation exposure was subsequently calculated. RESULTS: A total of 505 interventional procedures were performed with C-arm fluoroscopy during three months. The results of this study revealed that the annual radiation exposure was relatively low for both the operator and assistant. CONCLUSION: With proper precautions, the use of fluoroscopy during interventional pain procedures is a safe practice.

Treatment Experience with Polymyalgia Rheumatica: A report of two cases / 대한통증학회지

Polymyalgia rheumatica is characterized by bilateral shoulder or pelvic girdle pain, morning stiffness of greater than 45 minutes' duration, constitutional symptoms, an elevated erythrocyte sedimentation rate and a rapid response to prednisolone (< or = 20 mg/day). Although it is not a rare disease, many cases might be neglected and treated inappropriately in pain clinics. We describe here two cases of polymyalgia rheumatica that was neglected and treated inappropriately.

The Validity of Intraoperative Brainstem Auditory Evoked Potentials (BAEPs) for the Postoperative Hearing Impairments in Microvascular Decompression (MVD) / 대한마취과학회지

BACKGROUND: Intraoperative brainstem auditory evoked potentials reduced the sensorineural hearing loss (SNHL) after microvascular decompression (MVD) This study was performed to evaluate the validity of BAEP parameters of latency or amplitude to SNHL. METHODS: 557 patients out of 930 hemifacial spasm patients performed MVD, who were free from hearing impairment preoperatively, were enrolled in this study. Maximal changes of BAEPs wave V latency and amplitude during MVD were retrospectively sought according to postoperative SNHL. Sensitivity, specificity and positive predictability of wave V latency and amplitude were also sought according to the postoperative SNHL with a critical value of 1.0 msec prolongation and 40% decrease, respectively. RESULTS: Wave V latency of BAEPs prolonged less in patients with normal hearing outcome (0.44 +/- 0.63 msec) than in the patients with temporary or permanent SNHL (1.23 +/- 0.56 msec, 1.33 +/- 0.33 msec). Wave V amplitude also decreased less in the patients with normal hearing outcome (5.4 +/- 15.8%) than in the patients with transient or permanent SNHL (42.8 +/- 31.7%, 60.0 +/- 34.7%). While sensitivity, specificity and predictability of prolongation of wave V latency at a value of 1.0 msec for SNHL, were 52.5%, 76.4% and 14.7%, respectively, those of decrease in the amplitude of wave V for SNHL at a value of 40% were 35.0%, 93.6% and 29.8%, respectively. CONCLUSIONS: Decrease of the amplitude of wave V seems to have higher specificity, predictability and lower sensitivity for SNHL than the prolongation of wave V latency.

Sedative Effect and Cardiovascular Stability of Lidocaine during Endotracheal Intubation under Bispectral Index (BIS) Monitoring / 대한마취과학회지

BACKGROUND: Lidocaine's sedative effect has not been known well. The purpose of this study was to evaluate its sedative and cardiovascular effects during induction of anesthesia. METHODS: Twenty patients were randomly allocated to group I or II, with or without lidocaine 1.5 mg/kg intravenously (IV) before induction, respectively. The BIS, blood pressure and heart rate were measured at before and 2 minutes after lidocaine IV injection, preintubation, and 1, 2, 3 and 5 minutes after tracheal intubation. The enflurane concentrations were continuously maintained at 2 volume%. RESULTS: The BIS of group I was more decreased at 1 and 2 minutes after intubation than those of group II. The systolic blood pressures of group I were less increased at 1 and 2 minutes after intubation than those of group II. The diastolic blood pressures and heart rates of group I were not different from those of group II at each stage of the procedure. CONCLUSIONS: Lidocaine reduced BIS and blunted the intubation-induced systolic hypertensive response. In addition it is thought that it has a sedative effect and is effective to maintain cardiovascular stability after tracheal intubation.