Clinical, Pathological, and Dermoscopic Features of Pityriasis Rotunda / 대한피부과학회지

Background@#Pityriasis rotunda (PR) is a rare dermatosis characterized by the presence of multiple, strikingly circular or oval-shaped, sharply demarcated, and scaly hyperpigmented patches. Its etiology remains poorly understood. To date, there have been no comprehensive analyses of PR in Koreans. @*Objective@#To investigate the clinical, pathological, and dermoscopic features of PR. @*Methods@#Sixteen patients with PR were evaluated. @*Results@#A female preponderance was observed (male:female ratio 1:7), and the mean age of the patients was 33.2±16.1 years (range, 15∼68 years), with the peak incidence observed in patients in their 20s. Notably, all the lesions developed on the trunk. The most common clinical diagnosis is PR. Histologically, PR appears similar to ichthyosis vulgaris. Hyperkeratosis was mainly ortho-keratotic, with plugs observed within hair follicles, elongated rete ridges, diminished stratum granulosum, enhanced pigmentation of the basal layer, pigmentary incontinence, and sparse superficial perivascular lymphoid cell inflammatory infiltrate. Periodic acid-Schiff staining was negative for fungi. Hyperpigmented patches with occasional scales were separated from each other by paler striae on dermoscopy. @*Conclusion@#PR commonly presents as multiple round lesions of variable sizes on the trunk of patients in their 20s. They showed characteristic findings, including hyperkeratosis with relative focal hypogranulosis, histopathologically, and some lesions showed dark and light brown polygonal patches with paler striae arranged dermoscopically, in a mosaic pattern. This was a retrospective single-center study with a small sample size; however, we believe that this paper will contribute to the clarification and understanding of PR.

Cutaneous Mycobacterium massiliense Infection Caused by Skin Coining ‘Gua Sha’ in Korean Healthy Female

Nontuberculous mycobacteria are ubiquitous environmental organisms that are rare pathogens in immunocompetent individuals. However, cutaneous nontuberculous mycobacteria infections have been increasingly associated with invasive procedures, including surgery, liposuction, filler injection, intramuscular injection, mesotherapy, piercing, acupuncture, and cupping therapy. Herein, we report the first case of cutaneous nontuberculous mycobacteria infection caused by the East-Asian traditional treatment ‘Gua Sha’, also known as scraping, coining or spooning in English. A 35-year-old healthy female presented with widespread, painful skin nodules and pustules on her upper and lower extremities that had developed after Gua Sha treatment for body contouring. Histopathologic examination of the lesions revealed granulomatous inflammation in the dermis and the culture isolates were identified as Mycobacterium massiliense with molecular identification. The patient was successfully treated with intermittent incision and drainage of persistent nodules and oral clarithromycin based on antimicrobial susceptibility testing. We recommend implementation of a standard safety protocol for Gua Sha practitioners to minimize the risk of infection transmission.

Sarcomatoid Squamous Cell Carcinoma of the Lower Lip: A Case Report / 대한피부과학회지

Sarcomatoid squamous cell carcinoma (SSCC) is a rare malignancy with distinct carcinomatous and sarcomatous features. SSCCs involving the lung, esophagus bladder, and skin have been reported as rare case reports. It may also occur infrequently in the oral region. Moreover, the lower lip is still one of the rare sites, and such a case has not been reported in Korean literature. An 82-year-old man presented an exophytic protruding, huge, warty crusted lesion on the entire lower lip. The lesion started as a small, tender, erosive papule and suddenly enlarged in recent months.His medical history was unremarkable. A biopsy revealed atypical squamous and sarcomatous components with transition zones between the two cell types. These two cell types also showed characteristic immunohistochemical features. Based on these findings, the lesion was diagnosed as SSCC. The study, including positron emission tomography-computed tomography, showed no metastasis. We recommended surgical excision, but the patient refused therapy.

Sarcomatoid Squamous Cell Carcinoma of the Lower Lip: A Case Report / 대한피부과학회지

Sarcomatoid squamous cell carcinoma (SSCC) is a rare malignancy with distinct carcinomatous and sarcomatous features. SSCCs involving the lung, esophagus bladder, and skin have been reported as rare case reports. It may also occur infrequently in the oral region. Moreover, the lower lip is still one of the rare sites, and such a case has not been reported in Korean literature. An 82-year-old man presented an exophytic protruding, huge, warty crusted lesion on the entire lower lip. The lesion started as a small, tender, erosive papule and suddenly enlarged in recent months.His medical history was unremarkable. A biopsy revealed atypical squamous and sarcomatous components with transition zones between the two cell types. These two cell types also showed characteristic immunohistochemical features. Based on these findings, the lesion was diagnosed as SSCC. The study, including positron emission tomography-computed tomography, showed no metastasis. We recommended surgical excision, but the patient refused therapy.

Basal Cell Carcinoma Arising on the Palm / 대한피부과학회지

Basal cell carcinoma (BCC) is the most common type of skin cancer. It typically develops on sun-exposed and hair-containing areas of the body, such as the head and neck regions. The occurrence on the palms and soles is very rare. A 66-year-old Korean woman presented with a red elliptical ulcerative nodule on her left palm. Biopsy revealed basaloid cell mass and nests in the dermis with basal cells containing dark and elongated nuclei. She was diagnosed with basal cell carcinoma, and wide excision with full-thickness skin graft was performed. To the best of our knowledge, no case of basal cell carcinoma on the palm without basal cell nevus syndrome has been reported in Korean literature. Herein, we report this case owing to its rare occurrence on such location.

The Relationship between Cognitive Decline Elderly People and Blood Metal Levels : A Systematic Review

OBJECTIVES: There have been several previous studies that the pathology of Alzheimer's disease (AD) might be in part caused or exacerbated by metals. But inconsistent results are often seen in evaluation of levels of metals in Alzheimer's disease patient's blood and control group. So, we conducted a systematic review using a comprehensive search strategy to find out whether there is significant difference between cognitive decline elderly people and normal control group. METHODS: Studies were searched in Pubmed, CINAHL and EMBASE with predefined words according to MeSH and purpose of this study. 996 studies were selected as primary screening, and two reviewers extracted relevant data independent of each other. 172 studies fulfilled the inclusion criteria. 32 studies about aluminum, copper, lead, mercury, cadmium finally selected. The Newcastle-Ottawa Scale (NOS) was used for assessing the quality of studies. To synthesize the results of this study, summarized table was made. RESULTS: In most studies, blood levels of mercury were high in cognitive decline group. But the majority study shows lead was not that different between cognitive decline group and control group. Measurements of other metal levels in whole blood, plasma, serum were inconsistent. However, there are not enough evidences to generalize with just number of studies since the studies have various degrees of validity. CONCLUSION: There is lack of evidences, till now, to use blood levels of metals as diagnostic purpose or predicting prognosis. Further studies which are supplemented limitations of previous studies are needed.

Prediction of Target Motion Using Neural Network for 4-dimensional Radiation Therapy / 의학물리

Studies on target motion in 4-dimensional radiotherapy are being world-widely conducted to enhance treatment record and protection of normal organs. Prediction of tumor motion might be very useful and/or essential for especially free-breathing system during radiation delivery such as respiratory gating system and tumor tracking system. Neural network is powerful to express a time series with nonlinearity because its prediction algorithm is not governed by statistic formula but finds a rule of data expression. This study intended to assess applicability of neural network method to predict tumor motion in 4-dimensional radiotherapy. Scaled Conjugate Gradient algorithm was employed as a learning algorithm. Considering reparation data for 10 patients, prediction by the neural network algorithms was compared with the measurement by the real-time position management (RPM) system. The results showed that the neural network algorithm has the excellent accuracy of maximum absolute error smaller than 3 mm, except for the cases in which the maximum amplitude of respiration is over the range of respiration used in the learning process of neural network. It indicates the insufficient learning of the neural network for extrapolation. The problem could be solved by acquiring a full range of respiration before learning procedure. Further works are programmed to verify a feasibility of practical application for 4-dimensional treatment system, including prediction performance according to various system latency and irregular patterns of respiration.

Prediction of Target Motion Using Neural Network for 4-dimensional Radiation Therapy / 의학물리

Studies on target motion in 4-dimensional radiotherapy are being world-widely conducted to enhance treatment record and protection of normal organs. Prediction of tumor motion might be very useful and/or essential for especially free-breathing system during radiation delivery such as respiratory gating system and tumor tracking system. Neural network is powerful to express a time series with nonlinearity because its prediction algorithm is not governed by statistic formula but finds a rule of data expression. This study intended to assess applicability of neural network method to predict tumor motion in 4-dimensional radiotherapy. Scaled Conjugate Gradient algorithm was employed as a learning algorithm. Considering reparation data for 10 patients, prediction by the neural network algorithms was compared with the measurement by the real-time position management (RPM) system. The results showed that the neural network algorithm has the excellent accuracy of maximum absolute error smaller than 3 mm, except for the cases in which the maximum amplitude of respiration is over the range of respiration used in the learning process of neural network. It indicates the insufficient learning of the neural network for extrapolation. The problem could be solved by acquiring a full range of respiration before learning procedure. Further works are programmed to verify a feasibility of practical application for 4-dimensional treatment system, including prediction performance according to various system latency and irregular patterns of respiration.

Vesico-Amniotic Shunting in Fetal Posterior Urethral Valve Syndrome / 대한산부인과학회잡지

Fetal posterior urethral valve syndrome results in potentially lethal complications including renal dysplasia, pulmonary hypoplasia. Antenatal fetal vesicocentesis and amniotic fluid infusion may be useful to improve neonatal pulmonary function, however rapid recurrence of urinary retention and oligohydramnios usually required repetitive invasive procedures. We successfully treated a posterior urethral valve syndrome with vesico-amniotic shunt. Under ultrasonographic guidence, we inserted a Double-Basket Catheter into fetal urinary bladder through lower abdominal wall at second trimester. Shunt remained in place until the fetus was delivered at 35th gestational week. The vesico-amniotic shunt can improve fetal outcome and avoid repeated vesicocentesis before delivery.

The Relationships between the Caring Burdens of Caregivers and the Psychopathology of In-home Demented Elderlies, and the Needs of Caregivers for the Social Services / 신경정신의학

OBJECTIVES: This study was attempted to offer the foundation data to develop a specific and practical social service of caregiver-centered. For this purpose we assessed the cognitive functions of a group aged 65 or more using the Korean version of Mini Mental State Examination(MMSE-K) in a Dong area of urban community. And then we reassessed the relationships between the caring burdens of caregivers and the psychopathology of in-home demented elderlies, and the needs of caregivers for the social services. METHODS: Subjects in this study were over the age of 65 and resided in a Dong area of urban community. At first, their cognitive functions were screened by MMSE-K. Subjects, whose total score of MMSE-K were below 24 and met the diagnostic criteria of DSM-IV for dementia, were enrolled in this study and defined to be the patients with dementia. Their psychiatric symptoms were assessed by Brief Psychiatric Rating Scale(BPRS), Hamilton's Rating Scale for Depression(HDRS) and Hamilton's Rating Scale for Anxiety(HARS). At the same time, the caring burdens of caregivers and their needs for social services were assessed by caregiver`s burden inventory(CBI). Total 23 subjects completed all of the assessments and their data were analysed statistically by ANOVA, chi2-test, and Duncan's multiple range test using SAS program. RESULTS: 1) The mean total score of BPRS tended to be correlated positively with the mean score of social activity restriction subscale of caring burden dimensions. 2) Some of religions of the caregivers could affect differently and significantly on the negative changes of relationships between the demented elderlies and their caregivers(p<.05). Especially, the Christians experienced less negative changes of relationships between them than the others did. 3) When the demented elderlies were males, total burdens of caregivers and negative changes of relationships between the demented elderlies and their caregivers, and between the caregivers and their relatives were significantly higher than the other burden dimensions were(p<.05). 4) When the demented elderlies were more educated, the psychological burdens of their caregivers were more severe(p<.05). 5) The more were the total burdens of the caregivers, they wanted more social services for them(p<.05). 6) The more were the psychological and financial burdens of the caregivers, their needs for the education and counselling services were more than the needs for the other social services(p<.05). CONCLUSION: Caregivers living with male demented elderlies, who had more severe psychopathology, had more burdens of caregiving and restricted the social activities of the in-home demented elderlies more severely. As a result, the relationships between them became more worse. Our results suggested that free-home helper services for the severely demented elderlies and education counselling services including information-referral service for their caregivers were in needs. Consequently, we should develop more specific services for in-home demented elderlies and their caregivers according to the needs in their family environments.

A Case of Posttraumatic Biloma / 대한소화기내시경학회지

Biloma is defined as an extraductular collection of bile within a defined capsular space. Biloma usually occurs secondary to traumatic or iatrogenic injury including abdominal surgery, percutaneous catheter drainage, and transhepatic cholangiography. The diagnostic methods include clinical history and physical examination, abdominal ultrasound, abdominal CT scan, hepatobiliary scintigraphy, endoscopic cholangiography and percutaneous aspiration, Though definite treatment by percutaneous radiographic catheter drainage and endoscopic drainage with sphincterotomy are now feasible in many instances, surgical drainage is often needed. We report a case of posttraurnatic biloma which was developed after car accident. Liver scan and endoscopic cholangiography showed typical features of biloma in this patient.