The Clinical Outcomes of Marginal Donor Hearts: A Single Center Experience

Background and Objectives@#Although the shortage of donor is a common problem worldwide, a significant portion of unutilized hearts are classified as marginal donor (MD) hearts. However, research on the correlation between the MD and the prognosis of heart transplantation (HTx) is lacking. This study was conducted to investigate the clinical impact of MD in HTx. @*Methods@#Consecutive 73 HTxs during 2014 and 2021 in a tertiary hospital were analyzed.MD was defined as follows; a donor age >55 years, left ventricular ejection fraction 240 minutes, or significant cardiac structural problems. Preoperative characteristics and postoperative hemodynamic data, primary graft dysfunction (PGD), and the survival rate were analyzed. Risk stratification by Index for Mortality Prediction after Cardiac Transplantation (IMPACT) score was performed to examine the outcomes according to the recipient state. Each group was sub-divided into 2 risk groups according to the IMPACT score (low <10 vs. high ≥10). @*Results@#A total of 32 (43.8%) patients received an organ from MDs. Extracorporeal membrane oxygenation was more frequent in the non-MD group (34.4% vs. 70.7, p=0.007) There was no significant difference in PGD, 30-day mortality and long-term survival between groups. In the subgroup analysis, early outcomes did not differ between low- and high-risk groups. However, the long-term survival was better in the low-risk group (p=0.01). @*Conclusions@#The outcomes of MD group were not significantly different from non-MD group. Particularly, in low-risk recipient, the MD group showed excellent early and longterm outcomes. These results suggest the usability of selected MD hearts without increasing adverse events.

Bronchogenic Cyst Occurring at the Postauricular Area: A Case Report and Literature Review / 대한피부과학회지

Bronchogenic cysts develop from tracheal diverticula or abnormal budding of the anterior foregut during embryological development. The most common extrapulmonary site of such cysts is the mediastinum; however, remote locations such as the lingual, intra-abdominal, and cutaneous regions have also been reported. Moreover, the postauricular location is an uncommon site for this entity. An 11-year-old boy visited our hospital with a long-standing mass in the postauricular area. Ultrasonography revealed a well-circumscribed anechoic nodule measuring 1.02×1.03 cm in size with posterior enhancement. The lesion was then completely excised. Pathological examination revealed a cystic lesion lined with ciliated pseudostratified columnar epithelium, consistent with a bronchogenic cyst. The patient had no local recurrence at 6th month follow-up. Herein, we report the first case of a bronchogenic cyst that developed in the postauricular area, and provide a review of the literature on cutaneous bronchogenic cysts.

A Clinical Study of Trichotillomania in 198 Cases: An Update and Cross-Time Comparison / 대한피부과학회지

Background@#Trichotillomania (TTM) is characterized by recurrent hair pulling, resulting in hair loss. TTM is typically encountered in dermatology settings; however, few reports on the clinical characteristics of TTM in a large population are available. @*Objective@#To evaluate the clinical characteristics of TTM. @*Methods@#We performed a retrospective chart review of patients diagnosed with TTM between 2006 and 2019. @*Results@#Clinical records of 198 patients were analyzed. The average age of TTM onset was 10.8 years, and 119 patients experienced childhood-onset (at ＜12 years). Sex prevalence showed a female predominance, and the proportion of females was lower in the childhood-onset TTM than in the late-onset TTM (onset at ≥12 years). Vertex was the most commonly involved site. A history of stressful situations was noted in 48 patients (24.2%). In the group with a poor prognosis, the number of patients with ≥25% scalp invasion was significantly more than the other group. The average duration of hair loss to more than 50% recovery was 4.88 months for childhood-onset TTM cases and 9.83 months for late-onset TTM cases. The prognosis was significantly better in the childhood-onset TTM than in the late-onset TTM. Nail biting and folliculitis were the most common co-occurring repetitive behavior and comorbid disease, respectively. @*Conclusion@#Unlike previous domestic studies, patients with childhood-onset TTM had a female preponderance. Moreover, the proportion of patients who experienced a stressful situation was higher than that reported in a previous study. In addition, patients with severe disease and late-onset TTM had a significantly poorer prognosis.

Pustular Eruption Induced by Adalimumab in a Patient with Ankylosing Spondylitis: A Case Report / 대한피부과학회지

Many cutaneous adverse reactions including eczematoid dermatitis and lichenoid eruption have been reported with the increased usage of tumor necrosis factor-α inhibitors. However, there are very few reports of generalized pustular eruptions with adalimumab administration. A 44-year-old woman visited our clinic with multiple skin lesions scattered across her body. The patient developed these lesions three days after the initiation of adalimumab treatment. At the time of the patient’s visit, physical examination revealed multiple erythematous papules and pustules across the body. Histopathological findings revealed subcorneal neutrophilic microabscess formation with dense perivascular and perifollicular infiltration that was mainly composed of lymphocytes and neutrophils. We diagnosed the patient with cutaneous pustular eruptions due to adalimumab exposure and initiated treatment with prednisolone and discontinued adalimumab injections. After 1 month of treatment, the patient’s skin lesions improved. Herein, we report a case of generalized pustular eruptions, a rare cutaneous adverse reaction to adalimumab.

Sweet’s Syndrome Limited on the Palms and Soles: A Case Report

Sweet’s syndrome was first described as a reactive dermatosis characterized by sudden onset of fever, leukocytosis, and erythematous plaques infiltrated with neutrophils.Therefore, Sweet’s syndrome is also known as acute febrile neutrophilic dermatosis. However, subsequently, it became clear that fever and neutrophilia in Sweet’s syndrome vary depending on the case, and several other characteristics have been described. The lesions in Sweet’s syndrome are typically observed not only in the limbs but also in the face, neck, and upper trunk. A 28-year-old female without a specific medical history presented in a hospital following the complaint of painful erythematous patches and pustules on her palms and soles. She had no previous history of palmoplantar pustulosis and other infections or malignancies. A skin biopsy showed diffuse dermal infiltration of neutrophils.Laboratory tests showed increased neutrophil count and erythrocyte sedimentation rate. After systemic corticosteroid administration was initiated, the lesions gradually disappeared. The patient was subsequently diagnosed with Sweet’s syndrome according to histology, clinical feature, and response to treatment. However, there have been few reports of Sweet’s syndrome confined to the individuals’ palms and soles. According to the literatures, although the dorsum of the hand is frequently affected, the palmoplantar involvement as in our case appears to be rare.

Pustular Eruption Induced by Adalimumab in a Patient with Ankylosing Spondylitis: A Case Report / 대한피부과학회지

Many cutaneous adverse reactions including eczematoid dermatitis and lichenoid eruption have been reported with the increased usage of tumor necrosis factor-α inhibitors. However, there are very few reports of generalized pustular eruptions with adalimumab administration. A 44-year-old woman visited our clinic with multiple skin lesions scattered across her body. The patient developed these lesions three days after the initiation of adalimumab treatment. At the time of the patient’s visit, physical examination revealed multiple erythematous papules and pustules across the body. Histopathological findings revealed subcorneal neutrophilic microabscess formation with dense perivascular and perifollicular infiltration that was mainly composed of lymphocytes and neutrophils. We diagnosed the patient with cutaneous pustular eruptions due to adalimumab exposure and initiated treatment with prednisolone and discontinued adalimumab injections. After 1 month of treatment, the patient’s skin lesions improved. Herein, we report a case of generalized pustular eruptions, a rare cutaneous adverse reaction to adalimumab.

Sweet’s Syndrome Limited on the Palms and Soles: A Case Report

Sweet’s syndrome was first described as a reactive dermatosis characterized by sudden onset of fever, leukocytosis, and erythematous plaques infiltrated with neutrophils.Therefore, Sweet’s syndrome is also known as acute febrile neutrophilic dermatosis. However, subsequently, it became clear that fever and neutrophilia in Sweet’s syndrome vary depending on the case, and several other characteristics have been described. The lesions in Sweet’s syndrome are typically observed not only in the limbs but also in the face, neck, and upper trunk. A 28-year-old female without a specific medical history presented in a hospital following the complaint of painful erythematous patches and pustules on her palms and soles. She had no previous history of palmoplantar pustulosis and other infections or malignancies. A skin biopsy showed diffuse dermal infiltration of neutrophils.Laboratory tests showed increased neutrophil count and erythrocyte sedimentation rate. After systemic corticosteroid administration was initiated, the lesions gradually disappeared. The patient was subsequently diagnosed with Sweet’s syndrome according to histology, clinical feature, and response to treatment. However, there have been few reports of Sweet’s syndrome confined to the individuals’ palms and soles. According to the literatures, although the dorsum of the hand is frequently affected, the palmoplantar involvement as in our case appears to be rare.

Effect of isoflavone-enriched whole soy milk powder supplementation on bone metabolism in ovariectomized mice

BACKGROUND/OBJECTIVE: There is intense interest in soy isoflavone as a hormone replacement therapy for the prevention of postmenopausal osteoporosis. A new kind of isoflavone-enriched whole soy milk powder (I-WSM) containing more isoflavones than conventional whole soy milk powder was recently developed. The aim of this study was to investigate the effects of I-WSM on bone metabolism in ovariectomized mice. MATERIALS/METHODS: Sixty female ICR mice individually underwent ovariectomy (OVX) or a sham operation, and were randomized into six groups of 10 animals each as follows: Sham, OVX, OVX with 2% I-WSM diet, OVX with 10% I-WSM diet, OVX with 20% I-WSM diet, and OVX with 20% WSM diet. After an 8-week treatment period, bone mineral density (BMD), calcium, alkaline phosphatase (ALP), tartrate-resistant acid phosphatase (TRAP) 5b, osteocalcin (OC), procollagen 1 N-terminal propeptide (P1NP), and osteoprotegenin (OPG) were analyzed. RESULTS: BMD was significantly lower in the OVX group compared to the Sham group but was significantly higher in OVX + 10% I-WSM and OVX + 20% I-WSM groups compared to the OVX group (P < 0.05). Serum calcium concentration significantly increased in the OVX + 10% and 20% I-WSM groups. Serum ALP levels were significantly lower in the OVX + 10% and 20% I-WSM groups compared to the other experimental groups (P < 0.05). OC was significantly reduced in the OVX group compared to the Sham group (P < 0.05), but a dose-dependent increase was observed in the OVX groups supplemented with I-WSM. P1NP and OPG levels were significantly reduced, while TRAP 5b level was significantly elevated in the OVX group compared with the Sham group, which was not affected by I-WSM (P < 0.05). CONCLUSIONS: This study suggests that I-WSM supplementation in OVX mice has the effect of preventing BMD reduction and promoting bone formation. Therefore, I-WSM can be used as an effective alternative to postmenopausal osteoporosis prevention.

Long-term Functional Outcome and Related Factors in Stroke Patients

OBJECTIVE: To investigate long-term functional changes and its underlying factors in stroke patients. METHOD: Data were collected retrospectively from the stroke patients who had been completed at least 2 times of functional evaluation after discharge. 60 stroke patients were included and we investigated long-term change of motor, cognition and activities of daily living score at 6 months from the onset and the last score during the follow up period. The motor function included manual function test (MFT), Korean version of Berg balance scale (K-BBS), cognitive function by Korean version of mini-mental status examination (K-MMSE), activities of daily living by Korean version of modified Barthel index (K-MBI). To identify the factors influencing long-term function outcome after stroke, biographical data and risk factors were collected and bivariate correlation analysis was performed. RESULTS: The mean duration of follow-up was 23.4 months and MFT, BBS, MMSE, and K-MBI scores showed no significant difference between 6 months from the onset and final evaluation. History of recurrent stroke (p = 0.007) and hypertension (p = 0.017) were significantly related with decline of cognition during follow up period. All the other independent variables were not statistically significant. CONCLUSION: None of the function showed significant changes during the 2 year of mean follow-up period. Recurrent stroke and hypertension were significant predictor for decline of cognitive function. Our results suggest that secondary prevention including blood pressure control is important to prevent decline of cognitive function after stroke.

Long-term Functional Outcome and Related Factors in Stroke Patients

OBJECTIVE: To investigate long-term functional changes and its underlying factors in stroke patients. METHOD: Data were collected retrospectively from the stroke patients who had been completed at least 2 times of functional evaluation after discharge. 60 stroke patients were included and we investigated long-term change of motor, cognition and activities of daily living score at 6 months from the onset and the last score during the follow up period. The motor function included manual function test (MFT), Korean version of Berg balance scale (K-BBS), cognitive function by Korean version of mini-mental status examination (K-MMSE), activities of daily living by Korean version of modified Barthel index (K-MBI). To identify the factors influencing long-term function outcome after stroke, biographical data and risk factors were collected and bivariate correlation analysis was performed. RESULTS: The mean duration of follow-up was 23.4 months and MFT, BBS, MMSE, and K-MBI scores showed no significant difference between 6 months from the onset and final evaluation. History of recurrent stroke (p = 0.007) and hypertension (p = 0.017) were significantly related with decline of cognition during follow up period. All the other independent variables were not statistically significant. CONCLUSION: None of the function showed significant changes during the 2 year of mean follow-up period. Recurrent stroke and hypertension were significant predictor for decline of cognitive function. Our results suggest that secondary prevention including blood pressure control is important to prevent decline of cognitive function after stroke.

Application of Percutaneous Cervical Nucleoplasty Using the Navigable Disc Decompression Device in Patient of Cervical Herniated Intervertebral Disc: A Case Report

Recent years, various percutaneous procedures including cervical nucleoplasty have been developed for disc decompressions to relieve radicular pains caused by disc herniations. We report the application of percutaneous cervical nucleoplasty (PCN) by using the navigable disc decompression device in two patients of cervical herniated intervertebral discs (HIVD). A 38-year-old female diagnosed with C4-C5 disc extrusion with bilateral C5 roots impingement received nucleoplasty twice at C4-C5 disc level. After second procedure, her pain was improved from 6-7/10 to 1-2/10 by visual analog scale (VAS). The second case, a 51-year-male was diagnosed with C6-C7 disc extrusion with right C7 roots impingement and received the procedure at C6-C7 disc level. The pain improved from 8/10 to 3-4/10 by VAS. Successfully, we decompressed cervical herniated discs in 2 HIVD patients without major complications. The PCN with the navigable device will be recommended as an alternative treatment method for cervical HIVD.

Tracheal obstruction and compromised ventilation due to mechanical compression by mediastinal mass during anesthetic induction :A case report

At the confluence of the superior, anterior, and middle mediastinum are the middle portion of the superior vena cava, the tracheal bifurcation, the main pulmonary artery, the aortic arch, and parts of the cephalad surface of the heart.Tumors in this region can cause compression and obstruction of tracheobronchial tree in the region of tracheal carina even though there is no sign and symptom related to respiratory failure in preinduction period.We experienced airway (tracheal) obstruction due to mechanical compression by mediastinal mass during anesthetic induction.She is 24-year old who had no symptom of respiratory distress in preinduction period.

Tracheal obstruction and compromised ventilation due to mechanical compression by mediastinal mass during anesthetic induction :A case report

At the confluence of the superior, anterior, and middle mediastinum are the middle portion of the superior vena cava, the tracheal bifurcation, the main pulmonary artery, the aortic arch, and parts of the cephalad surface of the heart.Tumors in this region can cause compression and obstruction of tracheobronchial tree in the region of tracheal carina even though there is no sign and symptom related to respiratory failure in preinduction period.We experienced airway (tracheal) obstruction due to mechanical compression by mediastinal mass during anesthetic induction.She is 24-year old who had no symptom of respiratory distress in preinduction period.

Relation of placental size to large-for-gestational-age infants in women with gestational diabetes mellitus controlled with insulin / 대한산부인과학회잡지

OBJECTIVE: To determine if the placental size is disproportionately increased in the large-for-gestational age infants in pregnancies complicated by impaired glucose tolerance controlled with insulin. PATIENS AND METHODS: A retrospective study was performed on 104 singleton pregnancies complicated by gestational impaired glucose tolerance controlled with insulin. The cases were categorized by the infant birthweight percentile into three groups, i.e. small-for-gestational age (90th percentile). Maternal and infant anthropometric data, glycemic status, and placental weight-to-birthweight ratio were compared among three groups. RESULTS: The maternal glucose level just after delivery, infant body mass index and placental weight showed a significant increment from the small-for-gestational age to the large-for-gestational age groups (p<0.05). The placental weight-to-birthweight ratio was significantly higher in the small-for-gestational group. On the other hand, there was no significant difference in the values of the oral glucose test, hemoglobin A1c and maternal body mass index among three groups. Maternal body mass index showed a increasing trend from the small-for gestational age to the large-for-gestational age groups. Placental weight-to-birthweight ratio was not significantly correlate with maternal glucose level. CONCLUSIONS: The results indicate that the placenta is disproportionately bigger, and rigid control of maternal blood glucose does not prevent the development of placental overgrowth. Maternal obesity in well- controlled gestational diabetes mellitus may be more significant than glucose control in the development of large-for-gestational-age infants. Different management strategies for women with gestational diabetes mellitus with different pregravid weights are warranted.

A Case of Juvenile Granulosa Cell Tumor of the Ovary / 대한산부인과학회잡지

Juvenile granulosa cell tumor is a well-known sex-cord stromal ovarian neoplasm different in appearance and behavior from the adult granulosa cell tumor and occurs most (80%) frequently in the first two decades. The prognosis of juvenile granulosa cell tumor in children is good in most cases, but correlated with stage, size, the presence of ruptures, the grade of nuclear atypia, the degree of mitotic activity. The surgery remains the principal line of treatment for low stage juvenile granulosa cell tumor in children, but for those patient with high stage juvenile granulosa cell tumor or recurrence, the best treatment has yet to be determined and tumor sensitivity to radiation therapy and chemotherapy is not clearly. We present a case of juvenile granulosa cell tumor with brief review of literatures.

A Case of Mucinous Cystadenocarcinoma Arising from a Mature Cystic Teratoma in the Right Ovary / 대한부인종양콜포스코피학회잡지

A case of mucinous cystadenocarcinoma arising from a mature cystic teratoma in the right ovary of a 37-year-old woman is reported. Malignant transformation of a mature teratoma is a rare event and the commonest malignant neoplasm to develop is squamous cell carcinoma.(83%) Adenocarcinoma occurs with less frequency.(6.8%) The patient was treated by staging operation followed by adjuvant chemotherapy. After six courses of combination chemotherapy, oncological investigations, including chest X-ray, abdominopelvic CT scan and tumor markers, all revealed no evidence of recurrence.

Chorioamnionitis and Fetal Death with Intact Membranes Involving Staphylococcus aureus at term / 대한산부인과학회잡지

It has been believed that the intact placental membranes are a good barrier to ascending infection, but this may be only partly true.` Neonatal infection without premature rupture of the amniotic membranes occurs in 1-2% of births. The prevalence of membranes inflammation among births at term is approximately 10%.2-4 Chorioamnionitis is a frequent cause of fetal death mostly as a silent chorioamnionitis without maternal signs of infection.4 Below we present a case of subclinical acute chorioamnionitis in a woman admitted because of labor pain at 39weeks with intact membranes and subsequent sudden intrauterine fetal death. Culture specimens from the endometrium and uterine cervix showed growth of Staphylococcus aureus.

Parotid Gland Sparing Radiotherapy Technique Using 3-D Conformal Radiotherapy for Nasopharyngeal Carcinoma / 대한방사선종양학회지

PURPOSE: Although using the high energy photon beam with conventional parallel-opposed beams radio-therapy for nasopharyngeal carcinoma, radiation-induced xerostomia is a troublesome problem for patient. We conducted this study to explore a new parotid gland sparing technique in 3-D conformal radiotherap (3-D CRT) in an effort to prevent the radiation-induced xerostomia. MATERIALS AND METHODS: We performed three different planning for four clinically node-negative naso-phar yngeal cancer patients with different location of tumor(intracranial extension, nasal cavity extension, oropharyngeal extension, parapharyngeal extension), and intercompared the plans. Total prescription dos <. Was 70.2 Gy to the isocenter, For plan-A, 2-D parallel opposing fields, a conventional radiotherapy technique, were employed. For plan-B, 2-D parallel opposing fields were used up until 54 Gy an < 3 afterwards 3-D non-coplanar beams were used. For plan-C, the new technique, 54 Gy was delivered b r 3-D conformal 3-port beams (AP and both lateral ports with wedge compensator; shielding both superficial lobes of parotid glands at the AP beam using BEV) from the beginning of the treatment and early spinal cord block (at 36 Gy) was performed. And bilateral posterio r necks were treated with electron after 36 Gy. After 54 Gy, non-coplanar beams were used for cone-down plan. We intercompared dose statistic; Dmax, Dmin, Dmean, D95, D05, V95, V05, Volume receiving 46 Gy) and dose volume histograms (DVH) of tumor and normal tissues and NTCP values of parotid glands for the above three plans. RESULTS: For all patients, the new technique (plan-C) was comparable or superior to the other plans in target volume isodose distribution and dose statistics and it has more homogenous target volume, coverage. The new technique was most superior to the other plans in parotid glands sparing (volume receiving 46 Gy: 100, 9 B, 69% for each plan-A, B and C). And it showed the lowest NTCP value of parotid glands in all patients (range of NTCP; 96-100%, 79-99%, 51-72% for each plan-A, B and C). CONCLUSION: We conclude that the new technique employing 3-D conformal radiotherapy at the beginning of radiotherapy and cone down using non-coplanar beams with early spinal cord block is highly recommended to spare parotid glands for node-negative nasopharygeal cancer patients.

The Role of Adjuvant Postoperative Radiotherapy in Curative Resectable Sigmoid Colon Carcinoma / 대한치료방사선과학회지

PURPOSE: To evaluate the role of postoperative radiation therapy after curative resection of sigmoid colon cancer MATERIALS AND METHODS: From 1988 to 1993, a total of 93 patients with curative resectable sigmoid colon cancer of modified Astler-Coller (MAC) stage B2, B3, C2, C3 was divided into two groups on the basis of those who received radiation treatment and those who did not. Forty-three patients who treated by surgery alone were classified as postop RT ( group. The remaining 50 patients who underwent postoperative radiotherapy were classified as postop RT (+) group. In all patients in postop RT (+) group, radiation therapy was delivered using 4 or 10 MV linear accelerators to treat the tumor bed with approximately 5cm margin to a total dose 50.4-61Gy (median 54Gy) in 1.8Gy per fraction. Thirty-two patients were treated with 5- Fluorouracil based adjuvant chemotherapy at least 3 cycles, but these was no significant difference between two groups. Treatment failure pattern, 5-year local failure-free survival rates (LFFS), and 5-year disease-free survival rates (DFS) were compared between two groups. RESULTS: Five year LFFS and DFS were 85.1%, 68.5%, respectively. In postop RT (-) group, LFFS was 76.2%, compared with 91.7% in postop RT (+) group. Improved LFFS and DFS were seen for patients with stage C3 sigmoid colon carcinoma with postoperative radiation therapy compared with postop RT (-) group (P=0.01, P=0.06 respectively). In stage B3, LFFS washigher in postop RT (+) group than that in postop RT (-) group, although it was not significant. Especially, local control was higher in stage T4 in postop RT (+) group than that in postop RT (-) group. CONCLUSION: This study showed significantly improved LFFS and DFS in MAC Stage C3 and improved tendency of LFFS and DFS in MAC Stage B3 disease. Large scale prospective study is required to verify the role of adjuvant radiation therapy in resectable sigmoid colon cancer.