ABSTRACT
Cowden syndrome is caused by mutations in the phosphatase and tensin homolog (PTEN) gene and is part of the PTEN hamartoma tumor syndrome. Skin lesions including trichilemmomas, acral keratosis, mucocunateous neuromas and oral paillomas are the most prevalent feature found in patients with Cowden syndrome. It also possesses an increased risk of developing malignancies including breast, thyroid, endometrial, and colorectal cancers.Due to the increased risk of cancer, early diagnosis and regular surveillance are important for Cowden syndrome patients. Herein, we report a case of Cowden syndrome with diverse cutaneous manifestations and thyroid cancer.
ABSTRACT
Bullous pemphigoid (BP) is a chronic and recurrent bullous disorder that may be associated with the administration of certain drugs. Recently, bullous cutaneous adverse events after immunotherapy (IT) or targeted therapy have been increasingly reported. Here, we report a case of BP in a patient diagnosed with metastatic melanoma after treatment with pembrolizumab, dabrafenib, and trametinib. Histopathological examination showed a subepidermal blister with perivascular lymphocytic and eosinophilic infiltration; the accompanying findings of linear immunoglobulin G and C3 deposition by immunofluorescence microscopy were consistent with BP. Since IT agents may initiate immune dysregulation and pathologic autoantibody production, which are required for the pathogenesis of BP, the lesions were thought to be cutaneous adverse events caused by IT.
ABSTRACT
Background@#Scars in children are highly concerning to most parents who usually seek prompt treatment for these lesions. However, compared with adults, children show a greater tendency to develop hypertrophic scars and a higher likelihood of scar widening with increasing age. @*Objective@#We investigated the role of laser treatment for scars in pediatric patients in view of the fact that this approach is challenging in this age group. @*Methods@#This retrospective study included patients aged ＜17 years who visited the Samsung Medical Center between 2013 and 2018 for scar treatment. Of the 28 children who visited the center during this time, 14 presented within 4 to 5 weeks from scar onset and received laser therapy and 14 presented after 4 to 5 weeks and received topical treatment. The Stony Brook Scar Evaluation Scale (SBSES) was used to assess scar formation. @*Results@#The mean initial SBSES scores were lower in the laser than in the topical group (1.93±0.92 vs. 2.71±0.83, p=0.0363). No intergroup difference was observed in SBSES scores upon treatment completion (4.50±0.94 vs. 4.21±1.19, p=0.4673). Multivariable analysis after adjustment for age, sex, and initial SBSES scores showed that the type (laser vs. topical) of treatment was not significantly associated with an SBSES score=5 or duration of treatment. @*Conclusion@#Laser intervention may be useful for scar therapy in children who present early and can receive prompt treatment before scar maturation; however, further studies are warranted to validate our results.
ABSTRACT
Background@#Hydroa vacciniforme-like lymphoproliferative disorder (HVLPD) is rare Epstein-Barr virus (EBV)-associated disease. The classic form of HVLPD is a self-resolving disease, whereas the systemic form can progress to malignant lymphoma, resulting in fatal outcomes. However, the prognostic factors remain unclear. Objective: This study aimed to evaluate the clinical characteristics of HVLPD and the association between whole blood EBV DNA and clinical outcomes. @*Methods@#We retrospectively reviewed our 25-year experience involving 11 patients with HVLPD from a single tertiary center in South Korea and evaluated the clinical characteristics of HVLPD and the correlation between whole blood EBV DNA and clinical outcomes. @*Results@#Of the total 11 patients, 54.5% (6/11) manifested classic HVLPD that resolved with conservative treatment, while 45.5% (5/11) patients had systemic HVLPD, four of whom died of progressive disease or hemophagocytic syndrome. Five patients with systemic HVLPD manifested severe skin lesions such as prominent facial edema, deep ulcers and necrotic skin lesions involving sun-protected areas. Median EBV DNA levels at initial diagnosis were higher in three dead patients than in those alive (2,290 vs. 186.62 copies/μl). @*Conclusion@#When EBV DNA levels were high, patients showed severe skin lesions and when EBV DNA levels were low, skin lesions tended to improve. Thus, patients with high EBV DNA levels showed an increased risk of severe skin lesions and disease progression.
ABSTRACT
A capillary hemangioma is a vascular tumor with small capillary sized vascular channel. Multiple capillary hemangioma in relation with drugs have been rarely reported. Here in, we report a case of multiple capillary hemangioma in patient diagnosed with chronic myeloid leukemia who received tyrosine kinase inhibitors (TKIs). Histopathological findings have shown capillary proliferation in the upper dermis, which is consistent with capillary hemangioma. Since TKIs can paradoxically activate the MEK/ERK pathway which is required for angiogenesis, we presumed that the lesions as the cutaneous side effects of TKIs.
ABSTRACT
Background@#Scars in children are highly concerning to most parents who usually seek prompt treatment for these lesions. However, compared with adults, children show a greater tendency to develop hypertrophic scars and a higher likelihood of scar widening with increasing age. @*Objective@#We investigated the role of laser treatment for scars in pediatric patients in view of the fact that this approach is challenging in this age group. @*Methods@#This retrospective study included patients aged ＜17 years who visited the Samsung Medical Center between 2013 and 2018 for scar treatment. Of the 28 children who visited the center during this time, 14 presented within 4 to 5 weeks from scar onset and received laser therapy and 14 presented after 4 to 5 weeks and received topical treatment. The Stony Brook Scar Evaluation Scale (SBSES) was used to assess scar formation. @*Results@#The mean initial SBSES scores were lower in the laser than in the topical group (1.93±0.92 vs. 2.71±0.83, p=0.0363). No intergroup difference was observed in SBSES scores upon treatment completion (4.50±0.94 vs. 4.21±1.19, p=0.4673). Multivariable analysis after adjustment for age, sex, and initial SBSES scores showed that the type (laser vs. topical) of treatment was not significantly associated with an SBSES score=5 or duration of treatment. @*Conclusion@#Laser intervention may be useful for scar therapy in children who present early and can receive prompt treatment before scar maturation; however, further studies are warranted to validate our results.
ABSTRACT
Background@#Hydroa vacciniforme-like lymphoproliferative disorder (HVLPD) is rare Epstein-Barr virus (EBV)-associated disease. The classic form of HVLPD is a self-resolving disease, whereas the systemic form can progress to malignant lymphoma, resulting in fatal outcomes. However, the prognostic factors remain unclear. Objective: This study aimed to evaluate the clinical characteristics of HVLPD and the association between whole blood EBV DNA and clinical outcomes. @*Methods@#We retrospectively reviewed our 25-year experience involving 11 patients with HVLPD from a single tertiary center in South Korea and evaluated the clinical characteristics of HVLPD and the correlation between whole blood EBV DNA and clinical outcomes. @*Results@#Of the total 11 patients, 54.5% (6/11) manifested classic HVLPD that resolved with conservative treatment, while 45.5% (5/11) patients had systemic HVLPD, four of whom died of progressive disease or hemophagocytic syndrome. Five patients with systemic HVLPD manifested severe skin lesions such as prominent facial edema, deep ulcers and necrotic skin lesions involving sun-protected areas. Median EBV DNA levels at initial diagnosis were higher in three dead patients than in those alive (2,290 vs. 186.62 copies/μl). @*Conclusion@#When EBV DNA levels were high, patients showed severe skin lesions and when EBV DNA levels were low, skin lesions tended to improve. Thus, patients with high EBV DNA levels showed an increased risk of severe skin lesions and disease progression.
ABSTRACT
A capillary hemangioma is a vascular tumor with small capillary sized vascular channel. Multiple capillary hemangioma in relation with drugs have been rarely reported. Here in, we report a case of multiple capillary hemangioma in patient diagnosed with chronic myeloid leukemia who received tyrosine kinase inhibitors (TKIs). Histopathological findings have shown capillary proliferation in the upper dermis, which is consistent with capillary hemangioma. Since TKIs can paradoxically activate the MEK/ERK pathway which is required for angiogenesis, we presumed that the lesions as the cutaneous side effects of TKIs.
ABSTRACT
A 74-year-old male patient was conducted total thyroidectomy with functional neck dissection and final pathologic report confirm occult thyroid carcinoma. Although the frequency of occult thyroid cancer (OTC) has decreased owing to developments in cervical ultrasonography and improved accuracy of histological tests, rare cases are still reported. Due to the decreased frequency of OTC, a benign cervical neck lymph node mass is sometimes diagnosed, which can result in delays to more accurate diagnoses and appropriate treatment. Therefore, we report our case.
Subject(s)
Aged , Humans , Male , Diagnosis , Lymph Nodes , Neck Dissection , Neck , Neoplasm Metastasis , Thyroid Gland , Thyroid Neoplasms , Thyroidectomy , UltrasonographyABSTRACT
PURPOSE@#This study aimed to examine the levels of compassion fatigue/satisfaction, communication efficacy, and job satisfaction among integrated nursing and care services (INCS) units, and to analyze the factors affecting their job satisfaction.@*METHODS@#This descriptive study was conducted between January 1 and February 15, 2019 with 174 nurses working at INCS units. Data were analyzed using independent t-test, one-way ANOVA, Pearson`s correlation coefficient, and hierarchial multiple regression with SPSS/WIN 23.0.@*RESULTS@#Job satisfaction was significantly different according to age, marital status, monthly income, total clinical career, and job position. Job satisfaction was positively correlated with compassion satisfaction (r=.72, p<.001) and communication efficacy (r=.52, p<.001) and showed a negative correlation with compassion fatigue (r=.-25, p<.001). Factors affecting job satisfaction were compassion satisfaction (β=.61, p<.001) and communication efficacy (β=.18, p=.004). Overall, approximately 58.9% of the variability in job satisfaction was explained by these two variables in this study.@*CONCLUSION@#Compassion satisfaction has the effect of maintaining an emotional balance in the nurse's interprofessional relationships. High communication efficacy among professionals in the INCS ward is a necessary factor to increase nurses' job satisfaction. These results suggest that programs to improve compassion satisfaction and communication efficacy are needed to enhance nurses' job satisfaction.
ABSTRACT
PURPOSE: The purpose of this study was to investigate the relationship of sleep quality, lifestyle and successful aging in the elderly. METHODS: The subjects of this study were 125 elderly people, aged 65 years and older, who attended a senior welfare center in Cheongju city, Korea. They completed a structured self-reported questionnaire comprising measures of quality of sleep, lifestyle, and successful aging. Data were analyzed using t-test, ANOVA, Scheffé's test, Pearson's correlation coefficient, and hierarchical linear multiple regression analysis with SPSS/WIN 20.0. RESULTS: Lifestyle showed a positive correlation with the quality of sleep, and successful aging showed a significant positive correlation with quality of sleep and lifestyle. Pin money (β=.32), quality of sleep (β=.20) and lifestyle (β=.55) were strong influential factors in successful aging. Hierarchical multiple regression analysis showed the determinant variables account for 35.9% of the variation in successful aging (F=35.11, p < .001). CONCLUSION: Successful aging depends on controllable factors such as the willingness to change the lifestyle of choosing one's life and how one copes with applying appropriate sleep hygiene. These results suggest that improvement of the quality of sleep and lifestyle will be helpful to the successful aging process.
Subject(s)
Aged , Humans , Aging , Hygiene , Korea , Life StyleABSTRACT
PURPOSE: The purpose of this study was to investigate relationships among uncertainty, meaning of life, and anxiety in preoperative cancer patients. METHODS: Study participants were 90 adult patients with thyroid, breast, gastric, or colorectal cancer who were admitted to the general surgery ward and daily operation center in a university-affiliated hospital. Data were collected using Mishel's Uncertainty in Illness Scale, Meaning in Life Questionnaire, and State-Trait Anxiety Inventory. Data were analyzed using t-tests, one-way ANOVAs, Pearson's correlation coefficient, and a multivariate linear regression analysis (backward stepwise) with SPSS version 24. RESULTS: Anxiety showed a positive correlation with uncertainty in illness (r=.59, p < .001) and a negative correlation with meaning of life (r=−.49, p < .001), and uncertainty had a negative correlation with meaning of life (r=−53, p < .001). The regression model explained 40.0% variance of preoperative cancer patients' anxiety (F=20.55, p < .001). Significant factors were uncertainty (β=.43, p < .001), meaning of life (β=−.20, p < .001), and low income level (β=.18, p < .001). CONCLUSION: Our study's findings show that cancer patients' anxiety can be reduced within 24 hours before surgery through psychological nursing interventions aimed at reducing uncertainty and improving the meaning of life.
Subject(s)
Adult , Humans , Anxiety , Breast , Colorectal Neoplasms , Linear Models , Nursing , Preoperative Period , Thyroid Gland , UncertaintyABSTRACT
PURPOSE: The purpose of this study was to determine quality of life (QOL) related factors in Alcoholics Anonymous (AA) members based on PRECEDE Model. METHODS: A cross sectional survey was conducted with participants (N =203) from AA meeting in 11 alcohol counsel centers all over South Korea. Data were collected using a specially designed questionnaire based on the PRECEDE model and including QOL, epidemiological factors (including depression and perceived health status), behavioral factors (continuous abstinence and physical health status and practice), predisposing factors (abstinence self-efficacy and self-esteem), reinforcing factors (social capital and family functioning), and enabling factors. Data were analyzed using t-test, one way ANOVA, Tukey HSD test and hierarchical multiple regression analysis with SPSS (ver. 21.0). RESULTS: Of the educational diagnostic variables, self-esteem (β=.23), family functioning (β=.12), abstinence self-efficacy (β=.12) and social capital (β=.11) were strong influential factors in AA members' QOL. In addition, epidemiological diagnostic variables such as depression (β= - .44) and perceived health status (β=.35) were the main factors in QOL. Also, physical health status and practice (β=.106), one of behavioral diagnostic variables was a beneficial factor in QOL. Hierarchical multiple regression analysis showed the determinant variables accounted for 44.0% of the variation in QOL (F=25.76, p <.001). CONCLUSION: The finding of the study can be used as a framework for planning interventions in order to promote the quality of life of AA members. It is necessary to develop nursing intervention strategies for strengthening educational and epidemiological diagnostic variables in order to improve AA members' QOL.
Subject(s)
Humans , Alcoholics Anonymous , Alcoholics , Causality , Cross-Sectional Studies , Depression , Korea , Nursing , Quality of LifeABSTRACT
It has been found that acetylcholine releases at least two different substances from the vascular endothelial cells, i.e., relaxing factor and hyperpolarizing factor. The present study was armed to investigate whether and to what extent these factors are involved in the relaxation of the corpus cavernosum. The corpus cavernosum was isolated from male New Zealand white rabbits and suspended longitudinally in an organ bath. The corporal strips were precontracted with phenylephrine, tetraethylammonium (TEA) or potassium chloride, and their responses to electrical field stimulation (EFS) or exogenously-administered acetylcholine were examined. EFS caused a frequency-dependent relaxation of the corpus cavernosum precontracted with phenylephrine, which was significantly inhibited or abolished in the presence of procaine (3.5 x 0.0001mol/L) or ouabain (0.0001mol/L). The corporal preparation precontracted with TEA also showed a frequency-dependent relaxation, however, the degree of which was lower than that precontracted with phenylephrine. EFS was without a significant effect on the corporal preparation precontracted with KCl (3 x 0.01mol/L). Acethylcholine elicted a concentration-dependent relaxation of the corpus cavernosum, the magnitude of which was significantly diminished in the presence of L-NAME (0.0001 mol/L). The relaxation response to EFS of the corporal preparation precontracted with phenylephrine was significantly attenuated in the presence of L-NAME (0.0001 mol/L), in which the residual relaxation was completely abolished by glibenclamide (0.00001mol/L). The relaxation of the corpus cavernosum in response to EFS was reversed into a contraction by methylene blue (0.0001mol/L) or TEA (0.01mol/L). These results suggest that endothelium-derived relaxing and hyperpolarizing factors released upon neural stimulation mediate the relaxation of the corpus cavernosum. It is also suggested that EDRF activates soluble guanylate cyclase and EDHF does ATP-sensitive potassium channels.
Subject(s)
Humans , Male , Rabbits , Acetylcholine , Arm , Baths , Endothelial Cells , Glyburide , Guanylate Cyclase , KATP Channels , Methylene Blue , NG-Nitroarginine Methyl Ester , Ouabain , Phenylephrine , Potassium Chloride , Procaine , Relaxation , Tea , TetraethylammoniumABSTRACT
The present study was aimed at investigating the atrial natriuretic peptide (ANP) and urinary responses to acute perturbations in fluid balance and the vascular function in diabetes mellitus (DM). DM was induced in rats by treatment with streptozotocin (50 mg/kg, i.p.). Ten weeks later, the plasma ANP concentration measured in the conscious state was significantly higher in DM group (27.5 +/- 3.9 pg/mL) than in the control (15.4 +/- 2.6 pg/mL), while the atrial tissue contents of ANP were lower. In response to acute extracellular volume expansion (VE), amounting up to 5% of body weight over 45 min, under thiopental anesthesia (50 mg/kg, i.p.), the magnitude of increase in plasma ANP was lower in the DM group than in the control (56.8 +/- 25.2 vs. 189.1 +/- 53.6% increases over the basal). Urinary sodium excretion during VE was also lower in the DM group. Acetylcholine-induced relaxation of the isolated aortic rings was attenuated in the DM group, which was partially restored by L-arginine-supplementation (2 g/L in drinking water). These results suggest that body fluid homeostasis and vascular functions are unfavorably altered in DM.
Subject(s)
Animals , Male , Rats , Aorta/drug effects , Atrial Natriuretic Factor/blood , Diabetes Mellitus, Experimental/blood , Heart Atria/metabolism , Plasma Volume , Rats, Sprague-Dawley , Vasodilation/drug effectsABSTRACT
BACKGROUND: To explore an interaction(s) of endothelin with other blood pressure regulating systems, effects of either a high concentration of sodium chloride vehicle or pretreatment with atrial natriuretic peptide (ANP) on the pressor response to endothelin were investigated in rats. METHOD: Sprague-Dawley rats were anesthetized with thiopental (50mg/kg, IP) and were cannulated into left lateral cerebral ventricle. The left femoral artery and vein were also catheterized to measure blood pressure and to serve as an infusion route, respectively. Endothelin (10pmol) dissolved in either normal (0.15M) or high concentration (3.0M) of NaCl vehicle with ANP (1 nmol, ICV). For intravenous (IV) infusion, endothelin(1pmol/min) dissolved either in normal or high concentration of NaCl vehicle was infused for 20min. RESULT: ICV endothelin caused an increase of arterial pressure, in which the NaCl did not affect but ANP-pretreatment significantly attenuated the pressor magnitude. IV endothelin also increased the arterial pressure, which was potentiated by NaCl, ie, the maximum increase caused by the IV endothelin in the high NaCl vehicle was greater than the sum of that induced by endothelin (infused in normal NaCl vehicle) and that induced by high NaCl vehicle only. CONCLUSION: These results suggest that endothelin has separate central and peripheral pressor actions, in which the former is not affected by high NaCl but is attenuated by the ANP system and the latter is potentiated by high NaCl.
Subject(s)
Animals , Rats , Arterial Pressure , Atrial Natriuretic Factor , Blood Pressure , Catheters , Cerebral Ventricles , Endothelins , Femoral Artery , Rats, Sprague-Dawley , Sodium Chloride , Sodium , Thiopental , VeinsABSTRACT
Hyponatremia following the subarachnoid hemorrhage has been attributed to the syndrome of inappropriate secretion antidiuretic hormone or salt wasting syndrome. Recently discovered atrial natriuretic peptide(ANP) is known to contol sodium and extracellular fluid homeostasis by increasing renal excretion of sodium. To investigate whether the hyponatremia following the subarachnoid hemorrhage(SAH) is due to changes in plasma ANP, plasma ANP, serum sodium concentration and central venous pressure were measured in 10 patients(CSF ANP as well in some patients) with subarachnoid hemorrhage. The results obtained were as follows. 1) Plasma ANP concentration increased during the acute stage of SAH, being recovered to control levels after 8 days of SAH. 2) ANP concentration was significantly higher in plasma than in CSF. 3) No significant correlation was noted between the plasma ANP and CVP or serum sodium concentration. These results suggest that ANP is not involved in the development of hyponatremia during the acute stage of SAH.