Risk assessment of gastric cancer associated with asbestosis: a case report

BACKGROUND: The International Agency for Research on Cancer classifies asbestos as belonging to Carcinogen Group 2A for gastric cancer. We herein report a case of gastric cancer associated with asbestosis and describe the work-related and risk assessments of asbestos exposure for gastric cancer. CASE PRESENTATION: The 66-year-old male patient in our case worked in asbestos spinning factories. His level of cumulated asbestos fiber exposure was estimated to be 38.0-71.0 f-yr/cc. Thus, the Excess Life Cancer Risk for lung cancer associated with asbestos exposure was 9,648x10-5, almost 9,600 times the value recommended by the United States of America Environmental Protection Agency (1 x 10-5). The relative risk of developing lung cancer for this patient was more than 25 f-yr/cc, a well-known criterion for doubling the risk of lung cancer. CONCLUSION: The patient's exposure to high-dose asbestos was sufficient to increase his risk of gastric cancer because as the risk of lung cancer increased, the risk of gastric cancer was due to increase as well. Therefore, occupational asbestos fiber exposure might be associated with gastric cancer in this case.

A Case of Onychia and Paronychia by Staphylococcus lugdunensis / 대한피부과학회지

Staphylococcus lugdunensis is part of the normal human skin flora and has the ability to establish primary infection in deep skin and vascular infections. A 41-year-old male presented with brittle, thick, crusted right thumb nail with yellow to brown discoloration and erythematous edema around the nail fold. We identified S. lugdunensis by bacterial culture for the pus. The lesion was improved after 2 months treatment of oral cefditoren and clarithromycin. We report a case of onychia and paronychia caused by S. lugdunensis.

A Case of Intractable Postherpetic Itch / 대한피부과학회지

Herpes zoster is an infective skin disease that is encountered commonly in dermatologic field. The best known complication of herpes zoster is postherpetic neuralgia (PHN). Also, many patients with herpes zoster experience neuropathic itch with or without pain. Those postherpetic itches (PHI) are rare, but some patients injure themselves by scratching skin with severe itching sensation, and with the loss of the protective sensation. So, PHI should be considered when evaluating a patient after an occurance of herpes zoster. Gabapentin has been successfully used to treat PHI in some cases. We report a case of postherpetic itch that has been successfully treated with gabapentin, as an unusual clinical presentation.

Clinical Aspects of Scabies / 대한피부과학회지

BACKGROUND: Scabies is an ectoparasite caused by the mite Sarcoptesscabiei var. hominis, an obligate human parasite. Although the incidence of scabies is decreased nowadays, it is not rare and it is difficult to diagnose without experience. OBJECTIVE: We conducted this study to evaluate clinical aspects of patients diagnosed with scabies in the last 4 years. METHODS: We evaluated 56 patients who were diagnosed with scabies with a skin biopsy or with the mineral oil test. Medical records and telephone-interviews were used for more information. RESULTS: There were 56 scabies patients, 28 males and 28 females. The mean age of the patients was 54 (male; 44.4/ female; 62.9) and 39.3% of patients were over 65 years. The most common affected site was the groin; common cutaneous lesions were pruritic papules and burrow. There was no seasonal variation in occurrence. The majority of suspected routes of infection were unknown but, nosocomial infection and communal living were also major causes. On average, 102 days were required to confirm scabies, which suggests the difficulty in early diagnosis of scabies. CONCLUSION: We suggest that dermatologists should consider scabies infection in patients who show pruritis that does not improve with ordinary treatment.

Facial Angioleiomyoma Mimicking a Hemangioma / 대한피부과학회지

Angioleiomyoma is a deep dermal or subcutaneous, benign tumor that originates from the vascular smooth muscle. It commonly presents between the third and sixth decades of life and it has a female preponderance. It mainly develops on the limbs and especially the lower legs. We experienced a case of angioleiomyoma that occurred on the chin, and this clinically mimicked hemangioma.

A Case of Spindle Cell Hemangioma / 대한피부과학회지

Spindle cell hemangioma is an uncommon variant of vascular tumor, and it was first described as a unique vascular lesion that's characterized by cavernous blood vessels separated by spindle cells. It is recently thought to be a benign hemangioma with a reactive process. It mostly affects the distal extremities and it present as single or multiple lesions that are often painful. Histologically, thin-walled cavernous vessels are seen to be intermixed with varying proportions of bland spindle cells with vesicular nuclei. We report here on an interesting case of spindle cell hemangioma in a 39-year-old woman.

A Study on Intra-lesional Excision of Keloids / 대한피부과학회지

BACKGROUND: Keloid is one of the most frustrating clinical problems in wound healing. There are numerous treatments for keloids such as surgical excision, steroid injection, radiation therapy, laser, silicone gel application and so on. Surgical excision of a keloid is generally not accepted as a first treatment of choice. However, there have been many reports of successful cosmetic results from specialized surgical treatments such as intra-lesional/intra- marginal excision with or without post surgical adjuvant treatments. OBJECTIVE: The aims of this study areto evaluate the effectiveness of intralesional excision of keloids, the optimal surgical conditions and the proper adjuvant therapy after surgery. METHODS: We analyzed the medical records and clinical photographs of 20 patients who underwent intra-lesional excision of their keloids and who had regular follow-ups for at least for 3 months. The clinical outcomes were assessed by three independent physicians based on their interpretation of the photographs before and after surgery with using a global assessment 5 point scale that ranged from bad, poor, fair and good to excellent. RESULTS: General surgical outcomes after intra-lesional excision: the average improvement score was 4.05 after intra-lesional excision and adjuvant therapy. The average improvement score after intra-lesional excision was 4.71 for ear keloids and 2.83 for keloids in other areas (p=0.000). The average improvement score after intra-lesional excision was 5 for earlobe keloids and 4.42 for ear-helix keloids (p=0.014). The average improvement score was 3.92 for the steroid intra-lesional injection and topical silicone gel combination treatment group after intra-lesional excision and the average improvement score was 4.29 for the single topical silicone gel treatment group (p=0.858). CONCLUSION: Although surgery is not a first treatment of choice for the management of keloids, large recalcitrant keloids need massive surgical removal for faster clinical results. In this study, we found that surgery, and especially intra-lesional excision, is not an absolute contraindication for treating keloids and this is sometimes considered as the first treatment of choice, and especially for ear keloids. However, a more careful surgical approach is necessary for the case of keloids that develop in other areas. Further studies about the optimal surgical indications for keloids and the recommended adjuvant therapy after surgery are necessary.

The Results of Myringoplasty Using Cartilage Butterfly Technique(Inlay Tympanoplasty) / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Popular myringoplasty techniques include either an underlay or an onlay approach using tissues such as temporalis fascia or perichondrium as grafting materials. The "cartilage butterfly technique" using a tragal cartilage graft that resembled butterfly wings without incising canal skin was described by Eavey in 1998. This study describes the results of using this technique and analyzes the postoperative hearings. MATERIALS AND METHODS: Cartilage butterfly inlay tympanoplasty was carried out in 28 patients to close small-to-medium tympanic membrane perforations from October 1998 to December 2000. We excluded one patient due to accidental removal of graft at another clinic. We evaluated the success rate and postoperative hearing results. RESULTS: The graft take rate was 96.3% (26/27) at the end of the follow-up period (mean follow-up was 6.0 months). All of successful cases had cartilage grafts that were intact and dry at the last visit. One patient failed due to otorrhea and extruding graft. Two patients were not evaluated, because one had profound preoperative hearing loss and the other was a cerebral palsy patient. Mean air-bone gap (A-B gap) was improved from 16.3 dB to 9.8 dB. Ten patients had an A-B gap average between 0 and 10 dB, 14 patients between 11 and 20 dB, and no patient greater than 20 dB. CONCLUSION: The cartilage butterfly technique was effective to close tympanic membrane perforations in selected patients. It could provide advantages in high success rate, ease, speed and patient comfort.

A Case of White Superficial Onychomycosis by Microsporum canis / 대한피부과학회지

We present a case of white superficial onychomycosis(WSO) caused by Microsporum canis in a 15-year-old girl. She complained whitish patches and irregularly pitted surface of the right thumb nail, clinically suggesting WSO. On the mycologic studies, the nail lesion was diagnosed as WSO caused by Microsporum canis.

Three Cases of Livedoid Vasculitis Improved by Low-dose Danazol

Livedoid vasculitis is characterized clinically by smooth or depressed ivory-white scars surrounded by hyperpigmentation and telangiectasia with or without preceding purpuric in-filtrated papules and plaques and histologically by intravascular deposition of fibrin. Its pathophysiology is still obscure. Many treatment modalities have been used, but results are not satisfactory. Recently, there have been experiences of successful treatments with danazol, a synthetic androgen. We used danazol in three patients who presented with livedoid vasculitis and were relatively resistant to treatments with aspirin and/or pentoxifylline. After 4 to 8 weeks, there was remarkable clinical improvement in all three patients.

A Case of Intravascular Papillary Endothelial Hyperplasia on Upper Lip / 대한피부과학회지

Intravascular papillary endothelial hyperplasia(IPEH) is a benign, non-neoplastic, vascular lesion, that is characterized histologically by papillary projections lined by proliferating endothelium in a vascular lumen. We describe a case of IPEH occuring on upper lip, an unusual site of the lesion, in 16-year-old man and stress the importance of an adequate understanding of this benign vascular disorder, since it resembles a low-grade angiosarcoma.

A Case of Generalized Syringoma / 대한피부과학회지

Generalized syringoma is a rare variant of syringoma. In generalized syringoma, numerous papules arise in successive crops on the anterior surface of the body involving the chest, neck, and abdomen. It usually occurs in adolescents and young adults. Males and females are almost equally affected. A 19-year-old man presented with multiple 2-3mm sized papules on the chest, abdomen, and upper back. There was no subjective symptom. Family history showed that his mother had similar lesions. Histopathologic examination showed numerous eccrine ducts of various shapes and sizes lined by a double layer of squamous epithelium. Herein, we present a case of generalized syringoma with a review of the literature.

Bath-8-MOP-UVA Therapy for Psoriasis / 대한피부과학회지

BACKGROUND: An alternative approach to oral PUVA therapy for psoriasis, psoralen bath plus UVA therapy(bath PUVA therapy) that avoids the adverse effects associated with oral PUVA therapy has increasingly been used during recent years. OBJECTIVE: This study was performed to evaluate the efficacy and safety of bath-8-MOP-UVA therapy in the treatment of psoriasis. METHODS: Twenty patients were enrolled in this study after determination of the minimal phototoxic doses(MPD). We evaluated the total treatment number, duration, final UVA dose and total cumulative UVA dose of bath-8-MOP-UVA therapy to reach grade 4 response and categorized each patient into clearing, improvement, or failure groups based on the therapeutic efficacy. We measured the PASI score at two week intervals. Blood samples were obtained from all twenty patients 2 hours after bath-8-MOP and plasma levels of 8-MOP were quantified by a reverse phase high performance liquid chromatography. RESULTS: The following results were obtained from this study. 1. Phototoxicity testing with bath-8-MOP-UVA elicited mean MPD value of 3.5+/-1.3J/cm2. 2. The mean PASI score at 10 weeks was significantly decreased to 5.8+/-1.3 from baseline PASI score 20.1+/-4.3. 3. Among 20 patients, clearing was shown in 13 patients(65%), 6 patients(30%) were improved and 1 patients(5%) showed failure. 4. In clearing and improvement groups, the mean treatment number, duration, final dose of UVA and total cumulative UVA dose reaching grade 4 were 19.3+/-5.4, 49.9+/-13.5days, 5.2+/-1.3J/cm2 and 68.6+/-30.1J/cm2, respectively. 5. Five patients experienced side-effects. Two patients had intense tan, one withdrawing because of it and the other continued treatment. Three had pruritus that was controlled on oral antihistamines. Phototoxic or other classic adverse effects of oral PUVA therapy, such as nausea, vomiting and headaches, were not observed in any of our 20 patients. 6. All twenty patients had an undetectable plasma 8-MOP level. The lower limit of detection level was 20ng/ml. CONCLUSION: Bath-8-MOP-UVA therapy for psoriasis is a very effective and safe alternative to oral PUVA therapy.

The Three-Dimensional Co-Culture of Cholesteatomatous Keratinocyte and Fibroblast / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There has been considerable research interest in cholesteatoma in recent years but an understanding of the pathophysiology has been handicapped by the lack of a suitable research model. Recent advances in culture methods have contributed to the study of normal physiology or pathogenesis at the level of cells. However, the conventional keratinocyte culture of cholestearoma has some weak points, since it is done under a condition that is different from cellular environments and it cannot investigate cellular interaction among keratinocytes and other cells of cholesteatoma. The purpose of this study is as follows : first, we organize a new study model for cholesteatoma using a three-dimensional (3-D) culture method; and then we study fibroblast effects on keratinocytes under the 3-D culture system. MATERIALS AND METHODS: Aural cholesteatomas were obtained during middle ear operations. The keratinocytes and fibroblasts were first cultured separately and then co-cultured three-dimensionally. The pureness of keratinocyte layer was examined immunohistochemically. We studied fibroblast effects on keratinocytes under the 3-D culture system from the viewpoint of proliferation and differentiation. RESULTS: We could establish 3-D culture of keratinocytes under the influence of fibroblasts. The keratinocytes of the co-culture system showed more proliferation and less differentiation than keratinocytes under the same conditions except for anchoring fibroblasts. CONCLUSION: In this study, we successfully organized the 3-D culture system, a new study model for cholesteatoma, and identified fibroblast effects on keratinocytes. This new study model might be an effective tool for research on the interactions among various cells of cholesteatoma: however, further investigation and development would he necessary.

Development of KVSS Test (Korean Version of Sniffin' Sticks Test) / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: As a society develops, olfactory disturbance increases with the increased industrial disaster, traffic accidents, upper respiratory tract infection, chronic sinusitis and allergic rhinitis from air pollution, Parkinson's disease and Alzheimer's disease from aging process. Nevertheless, there is no practical clinical test of olfactory function in Korea. Authors decided to develop the "Korean olfactory test" using the odorants which are familiar to Koreans. MATERIALS AND METHODS: KVSS Test (Korean Version of Sniffin' Sticks Test) is composed of KVSS Test I (screening test) and KVSS Test II (comprehensive test). KVSS Test I was performed on 120 controls with normosmia, 39 patients with hyposmia, and 24 patients with anosmia. KVSS Test II was performed on 117 controls with normosmia, 29 patients with hyposmia, and 22 patients with anosmia. The subjects ranged in ages from 20 to 69 years. RESULTS: In KVSS Test I, the range of scores (smell test) was 5.36-7.34 in normosmia, 3.41-6.73 in hyposmia, and 1.14-3.16 in anosmia. In KVSS Test II, the range of T.D.I. score (the sum of olfactory threshold score, odor discrimination score, and odor identification score) was 25.98-35.48 in normosmia, 17.01-30.63 in hyposmia, and 7.32-14.06 in anosmia (p<0.001). CONCLUSION: It is concluded that KVSS Test I and II are suitable for the routine clinical assessment of olfactory performance in Koreans.

A Case of Linear IgA Bullous Dermatosis of Childhood / 대한피부과학회지

Linear IgA bullous dermatoses(LABD) occurring in childhood is considered to be a childhood counterpart of LABD,rather than chronic bullous dermatosis of childhood. This disease characteristically involves the perioral area,lower trunk,pelvic region and the lower extremities. Immunopathologically,it is characterized by the linear deposits of IgA at the dermoepidermal junction of the perilesional skin. A 20-month-old female infant presented with multiple pruritic tense bullae on the face, lower trunk, both extremities and pelvic region of 2 weeks duration. She had no oral lesions or any specific signs or symptoms referable to the disease of the gastrointestinal tract. A skin biopsy revealed subepidermal blisters infiltrated with many neutrophils and a few eosinophils. Direct immunofluorescence demonstrated linear deposition of IgA at the dermoepidermal junction. An indirect immunofluorescence study using NaC1-split skin as the substrate revealed fluorescence for IgA in a linear pattern on the roof of the split at a titer of 1:40. The clinical diagnosis of LABD of childhood was confirmed and we started with a combined remedy of dapsone and corticosteroids; 10 weeks later almost all of the lesions had disappeared.

Primary Cutaneous Cryptococcosis Treated with Itraconazole / 대한의진균학회지

In most instances, Cryptococcosis is a systemic disease caused by the yeast-like fungus Cryptococcus neoformans through respiratory tract. The organism is worldwide in its distribution, is saprophytic, and is found in soil and in pigeon excretion. Primary cutaneous cryptococcosis is rare; skin lesion is the sole manifestation of the disease without preceding generalized or cerebrospinal involvement. We report a case of primary cutaneous crytococcosis. The patient was a 53-year-old female, who had had an erythematous ulcerated lesion with swollen border on the dorsum of right wrist. Histopathologic examination showed typical spores with capsules. Other physical examinations and laboratory findings were within normal limit. The lesion was successfully treated with oral itraconazole (200mg/dayx7weeks).

Pigmented Photoallergic Contact Dermatitis Due to Musk Ambrette / 대한피부과학회지

Pigmented photoallergic contact dermatitis is a disease usually resulting from recurrent cutaneous exposure to cosmetic photoallergens which produce bizarre dark brown hyperpigmentation. Histologicnl examination of this condition reveals liquefaction of the basal cells of the epidmis and melanophages in the upper dermis. A 50-year-female developed dark brownish mottled hyperpigmented patches on her face after using a soap named O.E. and taking a nap every afternoon for 4 years. The histological fmding on the lesion site was consistent with pigmented photoallergic contact dermatitis. The cosmetic photopatch test with, O.E. soap, and the Scandinavian scries resulted in a positive reaction only on one side where 5 J/cm2 lights were applied by using Waldman 800UV machine. The other side howed a negative finding. We fmally diagnosed pigmented photoallergic contact dermatitis based on the patients histoty of using the soap containing musk ambrette, a histological examination of a biopsy and the results of photopatch tests. We report rare case of pigmented photoallergic contact dermatitis.

Comparison of Perceptual Analysis and Laryngeal Stroboscopic Evaluation in Breathiness / 대한이비인후과학회지

BACKGROUND: Perceptual evaluation is fundamental to assessment of vocal quality but is it one of the most cotroversial subjects in voice evaluation. The main reason of this problems is the versality of the subjective feeling of listner in the perception of abnormal voice quality. In contrast with perceptual evaluation, the laryngostroboscopical examination is objective method of vocal function analysis. OBJECTIVES: The aim of this study was to determine the most important vibratory pattern abnormalities that may lead to different grades in the perceptual evaluation of breathiness quality. MATERIALS AND METHOD: We analysed the perceived breathiness and laryngeal video-stroboscopic evaluation in 33 male and 49 female voice disordered subjects ranging in age from 25 to 69 years. RESULTS: A strong relationship between perceived breathiness grade and stroboscpic rating parameters was found in the asymmetry of phase, asymmetry of the arytenoid region, supraglottic compensation and glottic chink size. CONCLUSION: The result suggest that the static size and dynamic shape variation of incomplete glottal closure is the most important determining factors of perceptual evaluation of breathiness.

The Effect of Topical Calcium Gluconate Jelly in Hydrofluoric Acid Burn / 대한피부과학회지

BACKGROUND: Calcium gluconate intralesional injection which is widely used as topical treatment of hydrofluoric acid burn gives doctors some inconvenience, since it requires a certain care about the quantity and pressure of infiltration and so on. Therefore we made calcium gluconate jelly, as the suggestion of Kono, for the convenience of topical use. OBJECTIVE: The purpose of this study was to evaluate the therapeutic effect of calcium gluconate jelly in hydrofluoric acid burn. METHODS: After carefully shaving off the hair of the back of guinea pigs, each side of the back were burned by three concentrations(5%, 25%, 50% ) of hydrofluoric acid. Left side of guinea pigs back(control group) was treated with saline and hyamine lavage, right side(treated group) was applied with calcium gluconate jelly after hyamine lavage. Then we evaluate the clinical and histologic feature accorriing to each time. RESULTS: Clinical findings : In 5% hydrofluoric acid burn, both group showed no clinical response until 5 days. In 25% hydrofluoric acid burn, a mild erythema began from 3 hours after exposure in control group, but it began from 12 hours in treated group. In 50% hydrofluoric acid burn, moderate degree skin ulcer developed after 2 days in control group, but it developed after 3 days in treated group. Histopathological findings: In 5% hydrofluoric acid burn, only some inflammatory cell infiltrates in upper dermis were observed in both group after 5 days. In 25% hydrofluoric acid burn, both group showed epidermal cell damage after 6 hours. After 5 days subepidermal bullae and inflammatory cell infiltrates in upper dermis were observed in control group, but only shallow subcorneal bullae and inflammatory cell infiltrates were observed in experimental group. In 50% hydrofluoric acid burn, control group showed epidermal cell damage after 3 hours and subcutaneous fat necrosis were observed after 5 days. But in experimental group epidermal cell damage began after 6 hours, and only subepidermal bullae and inflammatory cell infiltrates in mid dermis were observed after 5 days. Subcutaneous fat necrosis was not observed until 5 days in experimental group. CONCLUSION: Calcium gluconale jelly and hyamine solution showed the same therapeutic effect in low concentration(5%) hydrofluoric acid burn. But, in mid to high concentration(25%, 50%) hydrofluoric acid burn, topically applied calcium gluconate jelly significantly reduce the tissue damage comparing with hyamie solution. It suggest the therapeutic effect of calcium gluconate jelly in hydrofluoric acid burn treatment is more convenient form.