A Case of Treatment-Refractory Foreign Body Reaction after Autologous Hair Transplantation / 대한피부과학회지

Complications in autologous hair transplantation are rare, with minor complications that can follow any surgical intervention. A 37-year-old female presented with pruritic, solitary, 0.6-cm-sized, skin-colored nodule on the forehead at one month after autologous hair transplantation. Histopathological findings revealed diffuse dermal granulomatous reactions with multinucleated giant cells, histiocytes, and lymphocytes around the implanted hair follicles, suggestive of foreign body reaction. The patient was treated with 3 courses of 2.5 mg/mL triamcinolone intralesional injections at 4-week intervals. Despite treatment, the lesion remained, and a novel lesion appeared near the existing lesion.Total punch removal of the lesions was performed, and the lesions resolved without recurrence for 6 weeks. A foreign body reaction in hair transplantation surgery is thought to be a rare complication after implantation of the patient’s hair has replaced synthetic fibers. Herein, we report a case of foreign body reaction caused by hair transplantation treated with total removal of the lesion.

Multiple Warty Dyskeratomas of the Scrotum: A Case Report and Review of the Literature / 대한피부과학회지

Warty dyskeratoma (WD) is an uncommon skin tumor that histologically presents as focal acantholysis and dyskeratosis and is a common finding among acantholytic diseases such as Darier’s disease. WD most commonly occurs on the head or neck of adults as an isolated papule or nodule. To our knowledge, only 6 cases of WD in the genital area have been previously reported in the literature, and no case have occurred on the scrotum to date.We report the first case of multiple WD that occurred on the scrotum successfully treated with 0.025% tretinoin cream. A 55-year-old male presented with asymptomatic, multiple, 0.1∼0.2-cm-sized, skin-colored papules on the scrotum for the previous 6 months. A skin punch biopsy and human papillomavirus (HPV) polymerase chain reaction test were performed for a clinical suspicion of genital warts or bowenoid papulosis. The histopathologic examination showed cup-shaped epidermal invaginations with central keratotic plug. Prominent villi, acantholytic clefting and corps ronds were also shown. The patient tested negative for HPV and was diagnosed with WD with typical pathologic findings. The patient was treated with 0.025% tretinoin cream for 2 weeks, and the lesions decreased in both size and number.

Application of Deep Convolutional Neural Networks in the Diagnosis of Subcutaneous Masses Using Ultrasonography: A Pilot Study / 대한피부과학회지

Background@#Ultrasonography is an effective noninvasive imaging modality for the diagnosis of subcutaneous masses. To date, few studies have reported skin ultrasonography using deep convolutional neural networks (DCNNs).We investigated the accuracy of DCNNs for the diagnosis of epidermal cysts, lipomas, and other subcutaneous masses. @*Objective@#The purpose of this study was to evaluate whether DCNNs could diagnose subcutaneous masses with ultrasonographic images at level of competence comparable to dermatologists. @*Methods@#We created a dataset of 1,361 skin ultrasonography images obtained from 202 patients diagnosed with epidermal cysts, lipomas, and other subcutaneous masses, to train the DCNNs using ResNet18. Performance was compared with another set of 93 ultrasonographic images (24 epidermal cysts, 25 lipomas, and 44 other subcutaneous masses) from open-access articles. @*Results@#The DCNNs yielded 87.10% classification accuracy and 86.10% F1-scores. The area under the curve, sensitivity, and specificity were 0.92 (95% confidence interval [CI] 0.86∼0.98), 75.00%, and 98.55% for epidermal cysts; 0.93 (95% CI 0.88∼0.98), 80.00%, and 94.12% for lipomas; and 0.97 (95% CI 0.93∼1.00), 97.73%, and 85.71% for other subcutaneous masses, respectively. Analysis using gradient-weighted class activation mapping revealed that the DCNNs could detect specific ultrasonographic findings of epidermal cysts and lipomas. @*Conclusion@#We propose that DCNNs combined with ultrasonography may aid in the diagnosis of subcutaneous masses in outpatient settings.

Application of Deep Convolutional Neural Networks in the Diagnosis of Subcutaneous Masses Using Ultrasonography: A Pilot Study / 대한피부과학회지

Background@#Ultrasonography is an effective noninvasive imaging modality for the diagnosis of subcutaneous masses. To date, few studies have reported skin ultrasonography using deep convolutional neural networks (DCNNs).We investigated the accuracy of DCNNs for the diagnosis of epidermal cysts, lipomas, and other subcutaneous masses. @*Objective@#The purpose of this study was to evaluate whether DCNNs could diagnose subcutaneous masses with ultrasonographic images at level of competence comparable to dermatologists. @*Methods@#We created a dataset of 1,361 skin ultrasonography images obtained from 202 patients diagnosed with epidermal cysts, lipomas, and other subcutaneous masses, to train the DCNNs using ResNet18. Performance was compared with another set of 93 ultrasonographic images (24 epidermal cysts, 25 lipomas, and 44 other subcutaneous masses) from open-access articles. @*Results@#The DCNNs yielded 87.10% classification accuracy and 86.10% F1-scores. The area under the curve, sensitivity, and specificity were 0.92 (95% confidence interval [CI] 0.86∼0.98), 75.00%, and 98.55% for epidermal cysts; 0.93 (95% CI 0.88∼0.98), 80.00%, and 94.12% for lipomas; and 0.97 (95% CI 0.93∼1.00), 97.73%, and 85.71% for other subcutaneous masses, respectively. Analysis using gradient-weighted class activation mapping revealed that the DCNNs could detect specific ultrasonographic findings of epidermal cysts and lipomas. @*Conclusion@#We propose that DCNNs combined with ultrasonography may aid in the diagnosis of subcutaneous masses in outpatient settings.

Major Hepatectomy in the HCC Patient with an Indocyanine Green Retention Rate at 15 Minutes of 10% or Higher: Predictive Values of Postoperative Hepatic Failure

PURPOSE: Major hepatic resection is sometimes inevitable in patients with impaired liver function. We evaluated risk factors that cause postoperative liver failure after major hepatic resection in patients with over a 10% Indocyanine Green Retention rate at 15 minutes (ICGR15). METHODS: From Apr. 2002 to Aug. 2009, 32 patients who had over a 10% rate of ICGR15 underwent major hepatic resection (> or =4 Couinaud segments). Among the 32, 9 patients showed postoperative liver failure (less than 50% prothrombine time and/or 5 mg/dl or higher of total bilirubin). This high-risk group was compared to the rest who constituted a low-risk group. RESULTS: Patients with esophageal varix were more common in the high risk group (4 versus 2, p=0.043). Other clinicopathologic features showed no difference between the two groups. We had 2 in-hospital deaths in the high risk group. CONCLUSION: Great care is needed in patients with esophageal varix and limited liver function during major hepatic resection.

Cerebral infarction: Diagnosis and Assessment of Prognosis by TC-HMPAO & TC-DTPA brain SPECT

To evaluate the usefulness of brain SPECT as a tool with diagnostic and prognostic values m patients with acute cerebral infarction, twenty-four patients who were diagnosed as embolic(n=12) or thrombotic(n7-12) infarction by clinical manifestation and brain CT or MRI were selected. Both 99mTc-HMPAO & 99mTc-DTPA Brain SPECT were performed for each patients within 1 week after the attack Asymmetric index(Al) in both hemispheres was calculated as 200(l(right-left)l/(right+left)). Activities of daily livmg(ADL) was scored by Barthel Index on the admission day and the 21st day after the attack. The relationshiop between ADL index and Al of two types of brain SPECT was analysed by calculating correlation coefficient. 1.In embolic infarction, the Al of 99mTc-DTPA SPECT was markedly higher than that of 99mTc-HMPAO spect, but there was no difference in thrombotic type. 2. The AI of 99m'Tc-DTPA SPECT in embohc infarction was sigiuficantly higher than that m thrombotic type(p valu=.001), but the Al of 99mTc-HMPAO SPECT was similar in both types of infarction. 3.The correlation coefficient Al of 99mTc-DTPA Brain SPECT and ADL m the 21st day after stroke was statistically significated. These results suggested that the 99mTc-DTPA brain SPECT should be useful not only for the differemtial diagnosis between thrombotic and embolic infarctions but also for the prediction of prognosis in patients with ischemic stroke.