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After anaplastic large-cell lymphoma (ALCL) was first described by Stain in 1985, there have been several histological variants of ALCL reported. There are classified histological subtypes of ALCL, such as lymphohistiocytic, small cell, Hodgkin-like, composite pattern, and other less common variants including neutrophil-rich ALCL. A 63-year-old male patient presented with erythematous exophytic mass on the left lower leg. In the past, his condition had been diagnosed as abdominal primary cutaneous ALCL (pcALCL), which recurred as systemic ALCL (sALCL) in the left bronchus. After treatment, he achieved complete remission. Histopathologic examination showed large-sized pleomorphic, anaplastic mitotic tumor cells, several neutrophils, and a few lymphocytes. Neutrophil-rich ALCL is a rare histological variant of ALCL. It is characterized by the presence of CD30-positive anaplastic tumor cells with numerous neutrophil infiltrations. Neutrophil-rich ALCL responds well to treatment but tends to recur. There were four cases reported to have recurrent neutrophilrich ALCL. All cases were diagnosed with neutrophil-rich pcALCL prior to recurrence.Three cases had local recurrence, and only one case relapsed as sALCL. Herein, we present the first case of neutrophil-rich ALCL recurring as sALCL twice.
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Background@#Alopecia areata (AA) is common non-scarring hair loss disease. Sleep distrubance has been regarded as a triggering or aggravating factor for AA. However, objective evaluation of sleep disturbance and its clinical effect on AA has not been clearly demonstrated. @*Objective@#This study investigated objective sleep evaluation tool for AA patients and their clinical correlation. @*Methods@#Patients presenting with new-onset AA or recurrences of pre-existing AA were included, and those who reported sleep disturbance in the preliminary survey were designated as the sleep disturbance group (SD group). Sleep quality was investigated for them using three self-administered questionnaires: Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Epworth Sleep Scale (ESS). Demographic information and clinical features of AA were analyzed according to sleep quality. @*Results@#A total of 400 participants were enrolled, and 53 were categorized into the SD group. The incidence of stressful events was significantly higher in the SD group (54.7%) than in the non-SD group (25.1%) (p<0.001). Based on the PSQI, 77.3% of participants were objective poor sleepers (score of 5 or more), and they showed a significantly higher incidence of stressful events compared to good sleepers (p=0.019). The proportion of poor sleepers was significantly lower in patients with mild AA (S1) than in those with moderate to severe AA (S2~S5) (p=0.045). @*Conclusion@#This study demonstrated a positive correlation among stress, SD, and AA. The degree of SD was objectively represented by the PSQI score, showing different scores according to AA severity.
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Background@#Oral alitretinoin is effective in the treatment of chronic hand eczema (CHE), and ≥12 weeks of alitretinoin treatment has been shown to be effective in Korean patients.However, in the real world, a considerable number of patients discontinue alitretinoin, which leads to treatment failure. @*Objective@#To evaluate the compliance rate of alitretinoin treatment and explore common reasons for poor compliance in patients with CHE in the real world. @*Methods@#We retrospectively reviewed the electronic medical records of CHE patients treated with alitretinoin. We defined ‘poor-compliance’ as subjects who were treated with alitretinoin for ＜12 weeks and ‘good-compliance’ as subjects who were treated with alitretinoin for ≥12 weeks. We reviewed the demographics, dose, and duration of alitretinoin usage, efficacy, and reasons for poor compliance. @*Results@#A total of 137 subjects were enrolled, and 77 (56.2%) did not complete the 12-week treatment with alitretinoin. Among them, the non-improvement rate was significantly higher in the poor-compliance group than in the good-compliance group (p＜0.01). The main reasons for the alitretinoin cessation in the poor-compliance group were insufficient response (40.8%), followed by high cost (34.7%), and adverse events (24.5%). @*Conclusion@#Alitretinoin appears the preferred longterm treatment option for CHE. Although there are complaints about late efficacy, cost, and side effects, following proper explanation, these should not justify discontinuation. Physicians need to recognize the reasons for poor compliance with alitretinoin for each patient and suggest continuing alitretinoin for the successful treatment of CHE.
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Background@#Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit. Adapalene-benzoyl peroxide gel has been proven to be effective in the treatment of both inflammatory and comedonal acne. However, skin irritation characterized by erythema, scaling, and dryness may occur with the use of this formula. @*Objective@#This study aimed to investigate the effects and safety of a new formulation of adpalene-benzoyl peroxide in combination with multi-lamellar emulsion (MLE) for acne treatment. Methods: All patients were treated with adapalene-benzoyl peroxide with MLE once daily for 12 weeks on acne lesions. The subjects visited the hospital at baseline, 2 weeks, 4 weeks, 8 weeks, and 12 weeks, and clinical effects, patient satisfaction, and adverse effects were estimated. The severity of adverse effects was measured on a 4-point scale. @*Results@#A total of 30 subjects were enrolled. The number of lesions decreased significantly from 20.2 to 7.8 (p＜ 0.0001) after treatment. Investigator’s global assessment showed almost clear, and patient satisfaction increased from 3.57 to 4.13. The subjects had adverse effects such as tingling sensation (83.3%), scales (80.0%), erythema (63.3%), and dryness (63.3%). Severity of adverse effects had 1 point on average. Additionally, transepidermal water loss was found to be decreased. @*Conclusion@#This study suggests that adapalene-benzoyl peroxide with MLE is effective for treating acne lesions and shows high patient satisfaction. Hence, this new combination could be a safe and well-tolerated option for acne treatment.
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An 80-year-old woman presented with a yellowish to erythematous plaque that persisted on her left temple for several years. Histopathologic examination revealed a large area of atypical squamous cell infiltration into the epidermis and dermis and a small area of neoplastic basaloid and clear cell proliferation with nuclear atypia in the central portion of the lesion. Immunohistochemical staining was positive and negative for epithelial membrane antigen and cytokeratin 7, respectively, in both the squamous cell and central clear cell infiltration areas. The patient was diagnosed with sebaceous carcinoma associated with squamous cell carcinoma in situ and underwent surgical excision. There have been several reports of sebaceous carcinoma with coinciding tumors in the same lesion, including nevus sebaceous and actinic keratosis. Here, we report a case of sebaceous carcinoma with coexisting squamous cell carcinoma in situ in a patient with a previous history of actinic keratosis in the temple area.
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BACKGROUND: Recently, the number of nationwide medical researches on psoriasis using the National Health Insurance Service database has been on the rise. However, identification of psoriasis using diagnostic codes alone can lead to misclassification. Accuracy of the diagnostic codes and their concordance with medical records should be validated first to identify psoriasis patients correctly.OBJECTIVE: To validate the diagnostic codes of psoriasis (International Classification of Diseases, 10th Revision L40) and to find the algorithm for the identification of psoriasis.METHODS: We collected medical records of patients who received their first diagnostic codes of psoriasis during 5 years from five hospitals. Fifteen percent of psoriasis patients were randomly selected from each hospital. We performed a validation by reviewing medical records and compared 5 algorithms to identify the best algorithm.RESULTS: Total of 538 cases were reviewed and classified as psoriasis (n=368), not psoriasis (n=159), and questionable (n=11). The most accurate algorithm was including patients with ≥1 visits with psoriasis as primary diagnostic codes and prescription of vitamin D derivatives. Its positive predictive value was 96.5% (95% confidence interval [CI], 93.9%~98.1%), which was significantly higher than those of the algorithm, including patients with ≥1 visits with psoriasis as primary diagnostic codes or including ≥1 visits with diagnostic codes of psoriasis (primary or additional) (91.0% and 69.8%). Sensitivity was 90.8% (95% CI, 87.2%~93.4%) and specificity was 92.5% (95% CI, 86.9%~95.9%).CONCLUSION: Our study demonstrates a validated algorithm to identify psoriasis, which will be useful for the nationwide population-based study of psoriasis in Korea.
Subject(s)
Humans , Classification , Electronic Health Records , International Classification of Diseases , Korea , Medical Records , National Health Programs , Prescriptions , Psoriasis , Sensitivity and Specificity , Vitamin DABSTRACT
A renal oncocytoma was diagnosed in an 8-year-old female Maltese dog with a history of renal cysts. Tumor cells were not detected until six months after observation of renal cysts. Nephrectomy was performed to treat the neoplasia. Tumor-like masses with numerous nodules were observed in the inner surface of cysts present in the caudal part of the left kidney. Histologically, the tumor consisted of cells with abundant eosinophilic cytoplasm. The diagnosis was based on histological features, periodic acid-Schiff reaction, and immunohistochemical cytokeratin staining. Based on a literature review, this is the first canine renal oncocytoma case reported in Korea.
Subject(s)
Animals , Child , Dogs , Female , Humans , Adenoma, Oxyphilic , Cytoplasm , Diagnosis , Eosinophils , Keratins , Kidney , Korea , Nephrectomy , Periodic Acid-Schiff ReactionABSTRACT
A renal oncocytoma was diagnosed in an 8-year-old female Maltese dog with a history of renal cysts. Tumor cells were not detected until six months after observation of renal cysts. Nephrectomy was performed to treat the neoplasia. Tumor-like masses with numerous nodules were observed in the inner surface of cysts present in the caudal part of the left kidney. Histologically, the tumor consisted of cells with abundant eosinophilic cytoplasm. The diagnosis was based on histological features, periodic acid-Schiff reaction, and immunohistochemical cytokeratin staining. Based on a literature review, this is the first canine renal oncocytoma case reported in Korea.
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Purpureocillium is a genus of saprophytic fungi that is commonly found in soil or rotting material. Although rarely a pathogen in humans, it can cause serious infections in immunocompromized patients. An 85-year-old woman presented with a 2-week history of pruritic erythematous plaques with yellowish crusts on her right forearm and dorsal hand. Histopathological analysis identified fungal hyphae and spores in the dermis, and Purpureocillium lilacinum was identified through tissue culture, polymerase chain reaction, and DNA sequencing. The skin lesion barely responded to 4 weeks of itraconazole treatment but improved upon the addition of terbinafine. The skin lesion was completely cured after 12 weeks, with no recurrence to date. Here, we report a rare deep cutaneous fungal infection caused by P. lilacinum in an immunocompetent patient and postulate that, in this case, the patient's agricultural lifestyle increased the possibility of P. lilacinum infection.
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Mediastinal teratoma is a rare mediastinal tumor. Patients with mediastinal teratoma are usually asymptomatic and are diagnosed incidentally with chest radiography or CT, but they may develop symptoms via a rupture into adjacent structures, which results in chemical pneumonia, massive hemoptysis, hemothorax, pericardial effusion, or respiratory distress. We report a case of a ruptured teratoma in a 31-year-old female presenting with cough and brown-colored sputum. Chest radiography and computed tomography of the chest showed an inhomogenous anterior mediastinal mass with fat and fluid component. It was successfully treated by surgical resection. Although mature teratomas are rare, we should be familiar with the unique CT features of a ruptured teratoma to make sure of a correct diagnosis.
Subject(s)
Adult , Female , Humans , Cough , Hemoptysis , Hemothorax , Mediastinum , Pericardial Effusion , Pneumonia , Rupture , Rupture, Spontaneous , Sputum , Teratoma , ThoraxABSTRACT
OBJECTIVE: This study aims to describe the basic features of Electronic Medical Records at the Seoul National University Hospital and Seoul National University Bundang Hospital and to discuss the process we developed and adopted the system. We also aim to suggest potential risks and success factors in our processes. METHODS: Seoul National University Hospital, a tertiary teaching hospital with 100-year-old history, 1000 medical staffs, and 1700 in-patient beds has successfully adopted Electronic Medical Records system from October 2004 and runs very well for more than one year. Our system is fully integrated with Computerized Physician's Order Entry (CPOE) and Picture Archiving and Communication System (PACS). RESULTS: We identified that the key step for the successful adoption of the full system was to overcome physicians' resistance to their use of Electronic Medical Records and to help their earlier accommodation to new practice environment. We then found that five important success factors were the clinical leadership, adoption strategy, young doctors' participation, outsourcing of the department of information technology and the accumulated domain knowledge. Our experience shows it is important to expose young medical staffs to the change before the main Electronic Medical Records system opens and "patient-centered" was the most important concept to make these reform processes successful. CONCLUSION: Development and adoption of Electronic Medical Records at large teaching hospital are not easy but are very important and powerful tool for patient-centered medical practice.
Subject(s)
Humans , Electronic Health Records , Hospitals, Teaching , Leadership , Medical Staff , Outsourced Services , SeoulABSTRACT
Most epileptic patients have commonly suffered from recurrent seizures for many years. These seizures are usually associated with inhibitory synaptic reorganization of the hippocampal region, but it is not known whether cerebellar inhibitory synaptic changes can be induced by seizure activity. We sought to determine the pattern of cerebellar alterations in the cerebellar inhibitory interneurons (basket and stellate cells) and then tested if the alterations are associated with their synaptic transmission at the cerebellar GABAergic synapses between inhibitory interneurons and Purkinje cells after systemic kainic acid administration by immunohistochemistry, western blot analysis, dot blot analysis and confocal microscopy. A dramatic increase of the intensity of GAP-43 immunostaining was obvious in the pinceau structures following KA-induced seizures and the intense GAP-43 immunoreaction involved in high expression of PKC-sigma. The activation of the presynaptic terminal at the cerebellar inhibitory synapse is accompanied with strong GABA immunoreactivity in pinceau region (especially 48 h) after KA-seizures. These results suggest a possibility that KA-seizures increase the release of GABA at the cerebellar inhibitory presynaptic terminal and it would be contribute to the depression of Purkinje cell activity, disinhibition, during the epileptogenesis.
Subject(s)
Humans , Blotting, Western , Depression , gamma-Aminobutyric Acid , GAP-43 Protein , Immunohistochemistry , Interneurons , Kainic Acid , Microscopy, Confocal , Presynaptic Terminals , Purkinje Cells , Seizures , Synapses , Synaptic TransmissionABSTRACT
This study investigated that the effect of rewetting agent on dentinal microtensile bond strength (microTBS). Human molars were sectioned to expose the superficial dentin surfaces. Samples were divided into two groups according to type of adhesives-Single Bond (S) and One-Step (O)], and again subdivided into five groups by different dentin surface treatment-dry for 15s (D), blot dry (BD) or dry for 15s, and rewet with different rewetting agents [distilled water (DW), Gluma Desensitizer (GD) and Aqua-Prep (AP)] for 30s. After application of adhesive, composite resin was built up on the bonding surface. Each tooth was sectioned to obtain stick with 1 mm2 cross sectional area and the microTBS was determined by EZ test. In the S group, the mean microTBS of GD, AP and BD group was significantly higher than that of DW and D group (p < 0.05). In the O group, the mean microTBS of AP, GD, BD and DW group was significantly higher than that of D group (p < 0.05). The data suggested that Gluma Desensitizer and Aqua-Prep could be successfully used as rewetting agents, and Distilled water could be acceptable in aceton based adhesive system only.
Subject(s)
Humans , Adhesives , Dentin , Molar , Tooth , WaterABSTRACT
This study evaluated the marginal microleakage of five single step adhesives. Class V cavity preparations with occlusal margins in enamel and gingival margins in dentin were prepared on both buccal and lingual surfaces of extracted human molar teeth. Prepared teeth were randomly divided into five groups and restored using one of the single step adhesives and composite resins: Prompt L-Pop/Filtek Z-250 (Group 1), AQ Bond/Metafil CX (Group 2), One-Up Bond F/Palfique Toughwell (Group 3), Futurabond/Admira (Group 4), Xeno III/Spectrum TPH (Group 5). The restored teeth were thermocycled. Microleakage was assessed by dye penetration using 2% methylene blue dye solution. The teeth were bisected buccolingually and evaluated for microleakage under steromicroscope. The data were statistically analysed by Kruskal-Wallis test and Mann-Whitney tests. The results of this study were as follows; 1. Microleakage of enamel margins in group 3 was statistically higher than that in groups 1, 2, 4, 5 (p < 0.05). 2. Microleakage of dentin margins in group 1 was statistically higher than that in groups 2, 5, and that in group 3 was statistically higher than that in groups 2, 4, 5 (p < 0.05). 3. Dentin marginal microleakage was higher than enamel marginal microleakage in all experimental groups. In conclusion, Prompt L-Pop showed the least leakage at enamel margin, and AQ Bond showed at dentin margin in this study. Marginal miroleakage in dentin was higher than that in enamel.
Subject(s)
Humans , Adhesives , Composite Resins , Dental Enamel , Dentin , Methylene Blue , Molar , ToothABSTRACT
This study evaluated the influence of application time of self-etching primers on microtensile bond strength (microTBS) to dentin using three self-etching primer adhesive systems. Dentin surfaces were exposed from forty-eight human molars. They were conditioned with three self-etching primers (Clearfil SE Bond [SE], Unifil Bond [UF], Tyrian SPE + One Step Plus [TY]) and different primining times (10s, 20s, 30s and 40s). Composite resins were bonded to dentin surfaces and specimens were made. microTBS was tested and statistically compared using by one-way ANOVA and Tukey's Test The results of this study presented that priming time for 10s in SE and UF groups and for 30s and 40s in TY group was highly decreased microTBS to dentin.
Subject(s)
Humans , Adhesives , Composite Resins , Dentin , MolarABSTRACT
The purpose of this study was to compare the microhardness and the fluoride content of enamel and dentin around fluoride- or non fluoride-containing restorations. Forty extracted human teeth were used and prepared cervical cavities on proximal surface. Experimental teeth were divided into five groups. Group 1 : Prime & Bond NT and Z100, Group 2 : Prime & Bond NT and F2000, Group 3 : Scotchbond Multi-Purpose and Z100, Group 4 : Scothcbond Multi-purpose and F2000, Group 5 : Fuji II LC. The cavities were filled with dentin adhesives and restorative materials. After each tooth was bisected, one half was tested microhardness and the other half was analyzed the fluoride at the enamel and dentin by an EPMA-WDX device. The results were as follows: 1. There was no statistical difference among the microhardness of enamel surface in all group. 2. The microhardness at dentin of 100 microm point in Group 2 and 20 microm point in Group 4 was lower than that of normal dentin (p>0.05). 3. There was no statistical difference among the fluoride content of enamel surface in all group. 4. The fluoride content at the dentin of 30 microm point in Group 2 and 5 were higher than those at 100 microm and 200 microm point in Group 2 and normal dentin (p<0.05). 5. At the dentin of 30 microm point, Group 2 showed higher fluoride content than Group 1 and 3, and Group 5 showed higher fluoride content than other groups.
Subject(s)
Humans , Adhesives , Dental Enamel , Dentin , Fluorides , ToothABSTRACT
This study evaluated the microleakage and interfacial gap between enamel and composite resin under the dry and wet condition of the enamel surface. V shaped class 5 cavities were prepared on the occlusal portion of extracted human molars. Samples were divided into three groups: D group (air dry for 10-15 s), BD group (blot dry with moist cotton pellet), and DR group (air dry for 10-15 s and rewet with Aqua-Prep F for 20 s). Cavities were filled using Aelitefil composite resin after applied One-Step. Microleakage was tested by 2% methylene blue dye solution and the data were statistically analysed by Kruskal-Wallis test and Mann-Whitney test. Also Enamel-resin interface was observed under SEM. Group BD showed statistically lower microleakage than group D (p 0.05). At the enamel-resin interface, group D showed the gap of 2 microm thickness, but group BD and DR showed close adaptation. In conclusion, the use of blot dry and rewetting agent (Aqua-Prep F) resulted in decreased microleakage and improved adhesion between enamel and resin when using One-Step.