Prolonged Low-dose Chlorpromazine Therapy Induced Skin Pigmentation and Corneal and Lens Opacities / 대한피부과학회지

No abstract available.

Increasing Prevalence of the Sensitization to Cat/Dog Allergens in Korea

BACKGROUND: Recently, the number of domestic pets has increased. As a consequence, sensitization to animal allergens, such as cat or dog allergens, has become a problem. OBJECTIVE: We studied the annual trends of sensitization to cats or dogs, and the characteristics of the patients. METHODS: We retrospectively analyzed the medical records of 7,469 patients who visited a dermatology clinic and underwent an allergic profile test, from January 2011 to December 2015. Specific immunoglobulin E (IgE) levels to cat or dog antibody greater than 3.50 IU/ml were regarded as positive results. RESULTS: In all, 274 patients showed significant increase in levels of specific IgE antibody to dog, and 307 revealed increase in levels of of specific IgE antibody to cat. The prevalence of these specific IgEs increased from 2011 to 2015. Independent risks for sensitization to cat allergens were sensitization to dog, but not to house dust, Dermatophagoides pteronyssinus, and D. farinae. Independent risks for sensitization to dog allergens were sensitization to cat, but not to house dust, D. pteronyssinus, and D. farinae. Total IgE level was not related to specific IgE level against either cats or dogs. CONCLUSION: In conclusion, the prevalence of sensitization to cat or dog has increased. Sensitization to cat or dog is related to each other, but is irrelevant to the total IgE level.

Congenital Non-Neural Granular Cell Tumor Mimicking Nevus Lipomatosus Superficialis

A 4-month-old infant presented with asymptomatic soft nodules on his right forearm, which had developed since birth. On the suspicion of nevus lipomatosus superficialis (NLS), biopsy was performed. Histopathologic findings showed monomorphic polygonal cells with abundant granular cytoplasm. Immunohistochemical stains for CD68 and vimentin were strongly positive, but were negative for S-100 protein. Based on the pathologic findings, the patient was diagnosed as non-neural granular cell tumor (NN-GCT). GCT can be divided into conventional and non-neural GCT by immunoreactivity for S-100 protein. NN-GCT is typically manifested as a well-circumscribed, papulo-nodular dermal mass, and is known to occur in a younger group than does in conventional GCT, but is rare among children. To our knowledge, there have been no case reports of NN-GCT which appeared at birth and presented as grouped nodules. Therefore, we report this interesting case of congenital NN-GCT clinically mimicking NLS.

A Case of Iatrogenic Kaposi's Sarcoma Developed in a Psoriasis Patient after a Long-term Use of Immunosuppressive Agents / 대한피부과학회지

No abstract available.

A Case of Iatrogenic Kaposi's Sarcoma Developed in a Psoriasis Patient after a Long-term Use of Immunosuppressive Agents / 대한피부과학회지

No abstract available.

Pulsed Versus Continuous Cyclosporine Regimens for Maintenance Therapy in Psoriasis: A Comparative Study / 대한피부과학회지

BACKGROUND: Psoriasis is a chronic recurrent disease requiring long-term treatment; therefore, special attention is warranted when prescribing cyclosporine A (CsA) for patients diagnosed with psoriasis. Various forms of maintenance therapy have been suggested to reduce the incidence of adverse events associated with CsA use. OBJECTIVE: We aimed to compare the efficacy and safety of the three aforementioned CsA therapies for management of patients with psoriasis. METHODS: Patients fulfilling our selection criteria were selected for the study. CsA therapy (2.5∼5 mg/kg/day) was administered for 12 weeks, and patients who showed remission following this treatment were administered maintenance therapy. Patients with successful induction of response were randomly assigned to three treatment groups. Group A was the continuous regimen group (2∼3 mg/kg/day). Group B was the pulsed regimen group (4 mg/kg/day for 4 days, 3 days of discontinuation). Group C was the weekend regimen group (5 mg/kg/day for 2 days, 5 days of discontinuation). Patients were followed up on an outpatient basis at 4-week intervals to monitor treatment effects. RESULTS: In each group, the Psoriasis Area and Severity Index (PASI) and body surface area (BSA) values decreased in a similar fashion from visit 1 to visit 4 and at the time of the final visit 7. In each group, dermatology life quality index (DLQI) values showed statistically significant differences between pre- and post-treatment states; however, no inter-group differences were observed. Although adverse events such as elevated blood pressure and serum creatinine levels were slightly higher in the intermittent group, there was no significant inter-group difference. CONCLUSION: The pulsed regimen did not show a major difference in treatment effects compared to the everyday use group. We propose that the patient's age, presence of underlying diseases, lifestyle patterns, and convenience of use should be considered while determining the type of regimen administered to a patient.

A Case of Cutaneous Aspergillus flavus Infection in a Immunocompetent Patient / 대한의진균학회지

Fungi of Aspergillus genus are widely distributed in nature, particularly in the soil and in decomposing vegetation. They are frequent opportunistic pathogens in immunocompromised patients, second only to Candida. The most common agent is A. fumigatus, followed by A. flavus, mainly in invasive disease in immunocompromised patients, and in nasal or paranasal sinus lesions. Cutaneous aspergillosis is a rare condition. There are several factors that predispose to Aspergillus infection: the most frequent are granulocytopenia, haematological disorders, diabetes, the neonatal period, local tissue injury, and any primary or acquired diseases that cause immunosuppression. A 25-year-old male was referred to department of dermatology for his skin lesions on the both axillary areas. The skin lesions showed localized erythematous to brownish scaly patches on the both axillary areas. A KOH mount fungal smear showed fungal hyphae, and Aspergillus species was grown in culture. rDNA ITS sequencing result was also consistent with A. flavus. He was treated with itraconazole 200 mg daily for 4 weeks, and showed a good response. This case is thought to be peculiar in that cutaneous aspergillosis is detected in an immunocompetent host.

The Sagittal Alignment of Spine in Conservatively Treated Osteoporotic Compression Fractures of Thoracolumbar Junction / 대한골다공증학회지

OBJECTIVES: To evaluate the radiological outcomes of conservative treatment for osteoporotic compression fractures in thoracolumbar junction. MATERIALS AND METHODS: 20 osteoporotic compression fracture cases of thoracolumbar junction (group I) which were treated conservatively using TLSO brace were evaluated compared with 20 osteoporotic spine cases (group II), between August 2010 and March 2012. The mean age was 65.3, ranging from 57 to 71 years old. The average follow up period was 27.4, ranging from 17 to 35 months. The bone marrow density (BMD) was recorded at the initial assessment. The lumbar lordotic angles with compression ratios on the initial and the last follow-up plain lateral radiograph were measured, and the sagittal alignments of spine were evaluated. RESULTS: In group I, the average compression ratios initially and at the last follow up were 23.5% and 33.7% respectively, and the average lumbar lordotic angles initially and at the last follow up were 30.8degrees and 22.6degrees respectively. In group II, the average lumbar lordotic angles initially and at the last follow up were 40.3degrees and 39.9degrees respectively. In group I, the compression ratio was significantly increased, and the lumbar lordotic angle was decreased at the final follow up. In group II, the difference of lumbar lordotic angles was not significant statistically. CONCLUSIONS: In most, the osteoporotic compression fractures can be successfully managed conservatively. But, in some cases of thoracolumbar junction, the further collapse of vertebral body and the change of lumbar lordotic angle can be developed, and then sagittal alignment of spine can be disrupted.

Spinal Cord Injury and Osteoporosis / 대한골다공증학회지

Osteoporosis is one of the major complications in patients with SCI (spinal cord injury). The neurologic lesion and subsequent immobilization induce early and acute bone loss. During the first months post-injury, demineralization occurs exclusively in the sublesional areas and predominantly in weight-bearing sites. The high bone loss associated with modification in bone matrix composition is very likely at the origin of the pathologic fractures occurring spontaneously or in response to minor trauma. The pathogenesis of osteoporosis after SCI was generally considered disuse. But, the lack of mechanical factors alone cannot explain the considerable bone loss. Currently, the pathogenesis of SCI-induced bone loss is considered the result of high rate of bone turnover characterized by bone formation-resorption uncoupling. But, the duration and patterns of bone loss after SCI remain still unknown. In addition the question of whether alterations in qualitative bone properties are confined to the paralyzed limbs or affect the whole skeleton remains open.

Correlation of Adjacent Segmental Disease with Tilt Angles of the Upper and Lower Instrumented Vertebra in the Degenerative Lumbar Scoliosis

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the correlation of adjacent segmental disease with tilt angles of the upper and lower instrumented vertebra after instrumented posterolateral fusion for degenerative lumbar scoliosis. SUMMARY OF LITERATURE REVIEW: There has been no study of radiologic measurement and decision of fusion level using the angle of pedicle screws inserted for treatment of degenerative lumbar scoliosis. MATERIALS AND METHODS: From 2004 to 2008, 74 patients that underwent decompression and posterolateral fusion for degenerative lumbar scoliosis were included in this study. In all cases, instrumentation and posterolateral fusion were both performed. The sex ratio was 31:43, the mean age was 68.7 years and the mean follow up duration was 37.4 months. The angle between each upper end plate of the upper vertebral body and lower end plate of the lower vertebral body of the fusion, and the line parallel to the axis of the sagittal line of vertebrae was each defined as UIV-a and LIV-b. The correlation of development of adjacent segment disease and UIV-a, and LIV-b angle was investigated. RESULTS: Sum of the absolute value of UIV-a and LIV-b had a statistically significant positive correlation with that of adjacent segment disease. Also, UIV-a alone, had a statistically positive correlation with the development of proximal adjacent segment disease. CONCLUSIONS: Since it is proven that adjacent segment disease has positive correlation with the sum of the absolute value of UIV-a and LIV-b, the extent of fusion should be adjusted to make the line parallel to the line perpendicular to the sagittal surface.

Operative Risk Assessment of Degenerative Spinal Disorder Comparing with Total Hip Replacement

STUDY DESIGN: Retrospective study. OBJECTIVES: To assess the operative risks and complications of posterior decompression and fusion for degenerative spine disorders, we compared single level posterior decompression and posterolateral fusion of lumbar spine with total hip arthroplasty which have been evaluated in many reports and articles on complications and operative risks. SUMMARY OF LITERATURE REVIEW: There has been no study comparing the relative risks of spinal surgery with total hip arthroplasty. MATERIALS AND METHODS: One hundred and thirty-six subjects (mean age 69.6 years) who received single level posterior decompression and posterolateral fusion for degenerative lumbar disorders from February 2000 to May 2010 were selected as group A, and 136 subjects (mean age 67.2 years) who received total hip arthroplasty during the same period were selected as group B. A comparative analysis was performed according to age, gender, pre-operative ASA status based on their underlying medical conditions, total operative time, blood loss, hospitalization period, incidence of major and minor complications and functional recovery at the time of final follow up using retrospective and statistical manners from medical records and radiologic evaluations. RESULTS: The total operative time and blood loss were longer in group A with statistical significance (P<0.01). Major complications were frequent in group B with 16 cases and in group A with 6 cases (P<0.05). There were no significant differences in the total hospitalization period, incidence of minor complications and post-operative functional recovery. CONCLUSIONS: The present study revealed no increased operative risks for surgery for degenerative lumbar disorders compared with total hip arthroplasty in similar age groups.

Differentiation of Osteoporotic Fracture from Metastatic Fracture in Spine using MRI / 대한골다공증학회지

OBJECTIVES: To determine that compression fracture of L5 and posterior convexity of the vertebral body on MRI are useful indicators of spinal metastasis. MATERIALS AND METHODS: Forty seven cases of vertebral compression fractures with magnetic resonance imaging (MRI) were reviewed. They were classified into two groups: the metastatic fracture (MF) group (n=23) and the osteoporotic fracture (OF) group (n=24). Each cases were evaluated according to their MRI findings of fracture site location, and the presence of posterior convexity of the vertebral body, intact midseptum and anterior signal change. Conventional T1 and T2 weighted images were obtained. Statistical analysis was done using the paired t-test and fisher's exact test. RESULTS: The MF group had 100% incidence of fracture in L5 (P<0.01). The incidence of positive posterior convexity was also 100%. The incidence of a positive anterior signal change was 67% (n=16) and intact septum was seen in 16 patients (67%). In the OF group, there were no fractures in L5 (16 cases with L1 fractures [67%]) and only 3 cases with posterior convexity (12.5%). Midseptum was intact in 19 cases (79%) and 6 patients with positive anterior signal change (25%). CONCLUSIONS: The location of vertebral fracture, especially in L5 and convex deformity of posterior vertebral body are reliable indicators of spinal metastasis.

Arthroscopic Analysis of the Radiologic Abnormalities of the Hip Associated with Anterior Femoroacetabular Impingement

PURPOSE: We wanted to arthroscopically analyze the femoral osseous abnormalities (bumps) in hips with anterior femoroacetabular impingement (FAI) and the other radiologic abnormalities of the hip joint associated with this. MATERIALS AND METHODS: We retrospectively reviewed the radiographs of 45 patients (51 hips) who underwent arthroscopic treatment under the impression of FAI from January to August, 2008. The indications for surgery included persistent hip pain, the absence of advanced osteoarthritis, physical examination or MRA findings consistent with an acetabualr labral tear. Preoperative and postoperative plain radiographs (pelvis AP, frog-leg lateral, cross table lateral and the false profile view) were taken. As the occasion demanded, 3D-CT or MRA were performed. RESULTS: For the radiologic findings, a decreased head-neck offset (<8 mm) was seen in 15 hips. Femoral bumps were seen in 26 hips and among them, 11 hips were associated with acetabular retroversion, 5 hips were associated with a prominent acetabular rim and 13 hips were located on the flattening of the neck due to a decreased offset. Pistol grip deformity was found in 21 hips and acetabular retroversion was done in 32 hips. Regarding the secondary changes, spurs on the acetabulum of the femur were found in 14 hips and femoral bony cysts were found in 23 hips. Arthroscopically, all the hips had acetabular degenerative labral tear and the acetabular cartilage was injured in 32 hips (62.7%). Among them, 25 hips underwent acetabular retroversion. CONCLUSION: Femoral osseous abnormalities are seen in various locations and these abnormalities have various shapes. A considerable number were associated with pincer impingement and they could produce a 'kissing lesion' between the acetabulum and femur. Identification of these abnormalities on radiographs aids confirming FAI in hips with symptomatic early osteoarthritis.

Correlation Analysis of BMD in Proximal Femur and Spine According to Age / 대한골다공증학회지

OBJECTIVES: To analogize the test results through analyzing the correlation of bone mineral density (BMD) values between 2 sites (proximal femur and lumbar spine). MATERIALS AND METHODS: Among the 1557 cases that underwent BMD test on their proximal femur and lumbar spine without history of trauma or disease of the hip or lumbar region, according to their age, they were divided into 4 groups, and the T-score and Z-score of the proximal femur and lumbar spine were each investigated. RESULTS: The correlation figured out through the regression analysis was that, considering the lumbar spine value as the independent variable (L), and the proximal femur value as the dependant variable (H), the T-score was H=0.508xL-0.723 in group 1, H=0.445xL-0.649 in group 2, H=0.363xL-1.124 in group 3 and H=0.404xL-1.467 in group 4. The correlation coefficient of T-score value of the 2 sites of each group was 0.58, 0.59, 0.47, 0.54 each, and which were statistically significant. Z-score was H=0.485xL-0.514 in group 1, H=0.451xL-0.141 in group 2, H=0.390xL-0.401 in group3, L=0.897xH-0.481 in group 4. CONCLUSION: On the BMD test performed in an age group of over 40 years old, T-score and Z-score each showed significant increase and this is thought to be related to low bone mineral due to bone mineral decrease because of the old age. Also, in cases with lesion in the hip joint or spine, there is a clinical usefulness of analogizing the result of the other region with a result of a single region.

Effects of Frozen Gauze with Normal Saline and Ice on Thirst and Oral Condition of Laparoscopic Cholecystectomy Patients: Pilot Study

PURPOSE: The purpose of this study was to examine the effects of using gauze frozen with normal saline or ice on thirst-relief and oral condition of laparoscopic cholecystectomy patients. METHODS: A quasi-experimental nonequivalent control group, pretest-posttest design was used. Participants (n=53) received either gauze frozen with normal saline (n=17), ice (n=18) or wet gauze (n=18) for thirst-relief. The subjective thirst level and oral condition of the participants were assessed before the intervention, 15 min after the first intervention and 15 min after the second intervention. RESULTS: After oral care was provided twice, there were significant differences in thirst level among the groups. When oral care was provided twice, the oral condition of tongue, saliva, mucosal membrane, and gingiva was improved in patients receiving gauze frozen with normal saline or ice. CONCLUSION: Gauze frozen with normal saline and ice can be effective for oral care in reducing the thirst level and improving the condition of the oral cavity.