An inexpensive, easy, and anatomically similar pericardiocentesis model manufacturing method using gelatin

Objective@#Cardiac tamponade with hemodynamic collapse requires immediate treatment, and ultrasound-guided pericardiocentesis is the treatment of choice. Although an essential skill for emergency physicians, there is a lack of training. We created a phantom that could practice ultrasound-guided pericardiocentesis using readily available materials. The pros and cons of the materials used were then compared. @*Methods@#Cardiac tamponade phantoms were made from gelatin, and included a heart, liver, and rib cage. We conducted a model-specific satisfaction questionnaire targeting 15 emergency physicians. The questionnaire was designed to be answered on a Likert 5-point scale. @*Results@#Creating the gelatin model took 6 hours. At room temperature, the gelatin model was able to retain its shape for 3 days. Fifteen physicians participated in the questionnaire, comprising five subjects having actual pericardiocentesis experience. In the questionnaire, our model achieved high satisfaction with all questions. @*Conclusion@#In our study, the pericardiocentesis phantom made from gelatin could maintain its shape for a long time, there was better recognition of the needle tip, and the model was more similar to the actual cardiac tamponade situation. Considering these positive characteristics, we recommend the phantom as a model for pericardiocentesis training.

Actual sweating as a significant predict factor of acute coronary syndrome

Objective@#This study aims to identify significant factors such as sweat that can be used as important predictors of acute coronary syndrome (ACS) in patients visiting the emergency department (ED) complaining of chest pain. @*Methods@#This observational, retrospective, registry-based study conducted from May 2020 to November 2020 evaluated patients who visited the ED due to chest pain. Parameters associated with ACS were investigated, and the clinical characteristics and symptoms were analyzed. @*Results@#A total of 230 patients visited the ED with chest pain. Of these, 94 (40.9%) were diagnosed with ACS. Univariate regression analysis showed that facial sweating (odds ratio [OR], 2.624; 95% confidence interval [CI], 1.241-5.549; P=0.012) and drench sweating (OR, 3.346; 95% CI, 1.602-6.991; P=0.001) were associated with ACS. Hence, we classified these patients as the actual sweating group. However, the sweaty feeling self-reported by patients with no visible sweat did not correlate with ACS. Multivariate logistic regression analysis showed that age (OR, 1.043; 95% CI, 1.016-1.071; P=0.002), quantum of smoking (OR, 1.023; 95% CI, 1.005-1.041; P=0.010), diastolic blood pressure (OR, 1.028; 95% CI, 1.004-1.049; P=0.009), squeezing chest pain (OR, 2.128; 95% CI, 1.000-4.531; P=0.050), and actual sweating (OR, 2.300; 95% CI, 1.209-4.374; P=0.011) were significantly associated with ACS. @*Conclusion@#Age, the quantum of smoking, diastolic blood pressure, squeezing chest pain, and actual sweating are useful predictors for ACS diagnosis. Unlike actual sweating, patient-reported sweating is not significantly related to the diagnosis of ACS. The results of this study will be beneficial in predicting ACS to ensure early and emergency medical care in the pre-hospital setting.

Early Predictors of High-Flow Nasal Cannula Oxygen Therapy Failure in the Emergency Room / 계명의대학술지

High flow nasal cannula (HFNC) oxygen therapy has become a substitute for other non-invasive ventilation (NIV) and mechanical ventilation in patients with respiratory failure. Despite its strong points, HFNC may result in failure of therapy, and delayed intubation leads to poor patient outcomes. This study is aimed to identify the variables that predicts HFNC oxygen therapy failure in order to increment success rate and prevent delayed intubation. The study was conducted in a retrospective manner, enrolling all non-traumatic patients over the age 20 who visited a single university-affiliated tertiary medical center emergency room and were treated with HFNC between March 1, 2016 to Feburary 28, 2017. Patients were classified into two groups: HFNC success group, and HFNC failure group: HFNC failure group was defined as patients who were treated with HFNC, and resulted in intubation and mechanical ventilation, or death. General characteristics, clinical features, and laboratory findings of the two groups were compared. Additionally, univariable logistic regression was done for statistically significant variables, and if the p-value was < 0.05, multivariable logistic regression analysis was conducted. 95 patients were enrolled in the study. Repeated-measure ANOVA was conducted for serial arterial blood gas samples during therapy. 62 patients were successful in the treatment, and the treatment failed in 33 cases. After multivariate logistic regression analysis, variable that showed statistically significant association with HFNC failure was initial hematocrits (p < 0.05). Repeated-measure ANOVA revealed low bicarbonate as a predictor of HFNC failure. Predictors of HFNC therapy failure are initial hematocrits, bicarbonate levels during therapy.

Clinical Significance of Urine Dipstick Positive for Albuminuria in Urolithiasis / 계명의대학술지

Urolithiasis is suspected by flank pain, costovertebral angle tenderness, and hematuria, and confirmed by computed tomography (CT). Treatment strategy and likelihood of spontaneous passage of a stone were determined by size and position of ureteral calculi and complication detected by CT. In general, the purpose of urinalysis for urolithiasis is to confirm the hematuria and pyuria. However, sometimes albumin is detected by urine dipstick test in urolithiasis. Therefore, I performed this study to investigate the clinical significance of urine dipstick positive for albuminuria in urolithiasis. This study was a retrospective review of medical records of 150 patients who visited the emergency department and diagnosed with urolithiasis by CT between March 2010 and February 2014. The patients were divided into a albuminuria group and non-albuminuria group. General chracteristics, clinical features, laboratory results, and CT findings were compared. The incidence of stones >5 mm in diameter, hydronephrosis (≥grade 2) and upper ureter stone were significantly higher in albuminuria group than non-albuminuria group. In multivariate logistic regression analysis, hydronephrosis (≥grade 2) and upper ureter stone were significantly associated with albuminuria. Upper ureter stone and hydronephrosis (≥grade 2) are also known as predictors for failure of spontaneous passage of ureter calculi. If further studies are done, urine dipstick positive for albumin in urolithiasis can be used as a predictor for failure of spontaneous passage of ureter calculi.

What is the Clinical Significance of Initial Lactate Measurement Compared to Carboxyhemoglobin Measurement in Carbon Monoxide Poisoning?

PURPOSE: This study was performed to compare clinical significance between lactate and carboxyhemoglobin (COHb) in a patient with carbon monoxide (CO) poisoning. METHODS: We conducted a 13-year retrospective study on CO poisoning patients who visited the emergency departments of the Medical Center between October 2004 and January 2016. The patients were divided into two groups according to initial lactate levels. Patients with serum lactate levels of ≤2 mmol/L were classified as the normolactatemia group (n=14), and patients with serum lactate levels of >2 mmol/L were classified as the hyperlactatemia group (n=34). General characteristics, clinical features, and laboratory findings of the two groups were compared. In addition, we compared initial lactate levels with COHb levels according to complications, neurological disorder, myocardial enzyme elevation, and abnormal Glasgow Coma Scale (GCS) score in patients with CO poisoning. We also analyzed the correlation between laboratory parameters and lactate levels. RESULTS: Forty-eight patients were enrolled in this study. The hyperlactatemia group had significantly more neurological disorders and consciousness disorders than the normolactatemia group (p<0.001), and COHb, creatine phosphokinase MB, and troponin I levels were also significantly higher in the hyperlactatemia group (p<0.001, p=0.017, and p=0.007). Lactate levels were significantly elevated in patients with elevated cardiac enzymes (p=0.001), neurological disorders (p<0.001), complications (p=0.001), and abnormal GCS score (p<0.001), whereas COHb levels were not significantly increased in all subjects. The correlation between COHb and lactate levels was weak (r=0.313, p=0.030), and a positive correlation was found between lactate and bicarbonate (HCO3), white blood cell, and troponin I (p<0.001). The diagnostic value of lactate for severe CO poisoning was analyzed using a receiver operating characteristic curve. The optimal cut-off value of lactate was 2.2 mmol/L with 83.3% sensitivity and 91.7% specificity (p<0.001). CONCLUSION: Lactate has significant diagnostic efficacy in patients with CO poisoning. It is recommended that lactate level be measured for appropriate treatment and prognostic evaluation of CO poisoning.

Prognostic Predictors of Outcome in Patients with Snake Bite, Based on Initial Findings in the Emergency Department

PURPOSE: This study was conducted to identify predictors of serious poisoning in patients with snake bite based on initial findings. METHODS: We conducted a retrospective study of patients with snake bite who were treated at the emergency department between January 2010 and December 2016. The patients were divided into two groups according to the severity of symptoms based on the traditional snakebite severity grading scale. The mild poisoning group (MP) was classified as those who had a grade I snakebite severity during the hospital stay, and the severe poisoning group (SP) was classified as patients who had grade I at the time of admission, but progressed to grade II-IV during hospitalization. Initial clinical manifestations and laboratory findings of the two groups were compared. RESULTS: Bite to hospital time intervals of SP were longer than those of MP (p=0.034), and the local effect score (LES) was higher in SP (p<0.001). Laboratory analyses revealed that creatine phosphokinase (p=0.044), creatine phosphokinase MB isoenzyme (CK-MB, p=0.011) and serum amylase (p=0.008) were significantly higher in SP. LES, CK-MB and serum amylase were significant prognostic predictors as indicated by univariate logistic regression analysis. Multivariate analysis revealed the following two significant predictors: LES (odds ratio=3.983, p<0.001) and serum amylase (odds ratio=1.020, p=0.017). CONCLUSION: In managing cases of snake bites, clinical manifestations and laboratory findings must be carefully evaluated. LES and serum amylase are predictive factors for severe poisoning, which is especially important to rapid determination of the intensive care of the patient.

The Effect of Standing and Different Sitting Positions on Lumbar Lordosis: Radiographic Study of 30 Healthy Volunteers

STUDY DESIGN: Radiographic review of healthy volunteers. PURPOSE: To determine the ideal sitting positions by measuring changes in lumbar lordosis (LL) and pelvic parameters (PPs) in various positions. OVERVIEW OF LITERATURE: Prolonged sitting is generally accepted as an important risk factor for low back pain (LBP). It is now recognized that spinopelvic alignment is important for maintaining an energy-efficient posture. METHODS: Lateral spine radiographs of thrirty healthy volunteers (male participants) were taken in standing and five sitting positions. Radiographic measurement of LL and PPs was performed in each position. Statistical analysis was performed to identify a correlation between changes in the LL and PPs in each positions. RESULTS: LL in standing was 48.5degrees+/-8.7degrees. Sitting significantly decreased LL and segmental angle when compared with standing (p<0.05). The lower lumbar segmental angles (L4-5 and L5-S1) significantly decreased in all sitting positions (p<0.05), but the decrease was relatively less on the chair with lumbar support and in the 90degrees-angled chair. The sacral slope (SS) decreased and the pelvic tilt increased with decreasing LL in the sitting positions. CONCLUSIONS: Sitting causes a reduction in LL and SS when compared with standing. It might cause a spinopelvic imbalance and result in chronic LBP. Our study showed that sitting on a chair with back support induced minimal changes to LL. Consequently, it is proposed that sitting on a chair with back support would be a much more ideal position than sitting on other types of chairs.

Analysis of QTc Prolongation Related to Arrhythmia in Patients with Aconitine Intoxication

PURPOSE: This study examined the association between the prolongation of heart rate-corrected QT (QTc) and arrhythmia in patients with aconitine intoxication. METHODS: A 13-year retrospective study of patients with aconitine poisoning treated at emergency departments between March 2002 and May 2013 was conducted. The EKGs obtained within 4 hours after the ingestion of aconitine were analyzed to measure the QT and QTc intervals. The QT interval was manually measured and QTc was obtained using Bazett's formula. The patients were divided into a normal QTc group and a prolonged QTc group (prolonged QTc interval defined as >450 ms in men and >470 ms in women). General characteristics, clinical features, laboratory results, and abnormal EKG findings of the two groups were compared. RESULTS: Forty-one patients were enrolled in this study. The mean QTc intervals of the normal QTc group (n=20) and prolonged QTc group (n=21) were 446.4+/-18.2 ms and 500.6+/-18.1 ms, respectively. The prolonged QTc group had a significant presence of arrhythmia compared with the normal QTc group. Arrhythmia occurred in two of the 20 normal QTc group patients and 17 of the 21 prolonged QTc group patients (p<0.001). Premature ventricular contractions were observed in one normal QTc patients and in 17 prolonged QTcpatients (p<0.001). Ventricular arrhythmias were the most common arrhythmia in both groups. A bundle branch block occurred in 12 patients, all from the prolonged QTc group (p<0.001). Eleven of 12 patients with a bundle branch block had their electrocardiogram return to normal. CONCLUSION: A prolonged QTc interval within 4 hours after ingestion of aconitine is a significant predictor of arrhythmia. Serial measuring of the QTc interval is recommended to predict arrhythmia.

Analysis of QTc Prolongation Related to Arrhythmia in Patients with Aconitine Intoxication

PURPOSE: This study examined the association between the prolongation of heart rate-corrected QT (QTc) and arrhythmia in patients with aconitine intoxication. METHODS: A 13-year retrospective study of patients with aconitine poisoning treated at emergency departments between March 2002 and May 2013 was conducted. The EKGs obtained within 4 hours after the ingestion of aconitine were analyzed to measure the QT and QTc intervals. The QT interval was manually measured and QTc was obtained using Bazett's formula. The patients were divided into a normal QTc group and a prolonged QTc group (prolonged QTc interval defined as >450 ms in men and >470 ms in women). General characteristics, clinical features, laboratory results, and abnormal EKG findings of the two groups were compared. RESULTS: Forty-one patients were enrolled in this study. The mean QTc intervals of the normal QTc group (n=20) and prolonged QTc group (n=21) were 446.4+/-18.2 ms and 500.6+/-18.1 ms, respectively. The prolonged QTc group had a significant presence of arrhythmia compared with the normal QTc group. Arrhythmia occurred in two of the 20 normal QTc group patients and 17 of the 21 prolonged QTc group patients (p<0.001). Premature ventricular contractions were observed in one normal QTc patients and in 17 prolonged QTcpatients (p<0.001). Ventricular arrhythmias were the most common arrhythmia in both groups. A bundle branch block occurred in 12 patients, all from the prolonged QTc group (p<0.001). Eleven of 12 patients with a bundle branch block had their electrocardiogram return to normal. CONCLUSION: A prolonged QTc interval within 4 hours after ingestion of aconitine is a significant predictor of arrhythmia. Serial measuring of the QTc interval is recommended to predict arrhythmia.

The Limitations of Thrombectomy with Solitaire(TM) AB as First-line Treatment in Acute Ischemic Stroke: A Single Center Experience

OBJECTIVE: A self-expanding retrievable intracranial stent, such as Solitaire AB, is useful for mechanical thrombectomy, producing novel results in the treatment of acute ischemic stroke. On the other hand, difficult situations can arise after a thrombectomy when using as in first-line treatment. METHODS: This was a retrospective, single-center study of 23 patients with an acute ischemic stroke attributable to a large artery occlusion within the first eight hours from symptom onset. The occlusion sites were the T segment in five patients, proximal middle cerebral artery in six patients, distal middle cerebral artery in three patients, vertebral and/or basilar artery in five patients, proximal internal cerebral artery in one patient and tandem in three patients. All patients underwent a mechanical thrombectomy using the Solitaire(TM) stent system as the first-line treatment but required additional procedures due to the unsatisfactory results of a thrombectomy. RESULTS: Only six patients achieved complete recanalization by a thrombectomy using the Solitaire. Permanent stent deployment after the thrombectomy was performed in ten patients. Stent and balloon angioplasty was performed after a stent-based thrombectomy in six patients. Balloon angioplasty after thrombectomy was performed in one patient. CONCLUSION: Mechanical thrombectomy with the Solitaire(TM) stent as a first-line treatment can produce unfortunate results that will require additional procedures.

A Case of Recalcitrant Hidradenitis Suppurativa Treated with Secondary Healing and a Split Thickness Skin Graft after Exteriorization / 대한피부과학회지

Hidradenitis Suppurativa (HS) is a chronic relapsing disease that involves the apocrine gland-bearing skin. It results in sinus tract formation, fibrosis and scarring. Many different treatments for HS have been reported, including topical and systemic antibiotics, intralesional steroids, systemic retinoids, hormonal therapies and immnunosuppressive agents, but they all have limited beneficial effects. Surgical treatments, including wide exteriorization with secondary intention, a skin graft and a flap can be effective treatments for recalcitrant HS. We present here the case of a 26-year-old man with recurred inguinal and axillary HS, and this was treated with secondary healing and a split thickness skin graft after exteriorization. Based on our experience, it is suggested that secondary healing and a split thickness skin graft after exteriorization are effective for recalcitrant HS with multiple interconnected tracts and abscesses.

Efficacy of Ultraviolet A1 Phototherapy in Recalcitrant Skin Diseases

BACKGROUND: Ultraviolet (UV) radiation has been used for decades to treat a variety of skin diseases. UVA1 was used initially as an effective treatment for acute exacerbated atopic dermatitis. Since then, UVA1 has been attempted for recalcitrant skin diseases. OBJECTIVE: This study examined the efficacy of UVA1 phototherapy in three recalcitrant skin diseases. METHODS: This retrospective study reviewed the efficacy and follow-up of 26 patients with atopic dermatitis (AD), mycosis fungoides (MF) and localized scleroderma (LS). SUPUVASUN 3000 (Mutzhas Co., Munich, Germany) and SELLAMED 3000 (Sellas Medizinische Gerate GmbH, Gevelsberg, Germany) were the UVA1 equipment used. Irradiation was performed in accordance with the disease. Low-dose (20 J/cm2), medium-dose (65 J/cm2) and high-dose regimens (100 J/cm2) of UVA1 therapy were employed. The frequency of the therapy ranged from 3 to 5 times weekly. The therapeutic effectiveness was assessed according to the clinical examination before and after the last treatment. RESULTS: In patients with AD, complete and partial remission was achieved in four (80%) and one (20%) patient, respectively. In patients with MF, complete and partial remission was observed in thirteen (86.7%) and two (13.3%) patients, respectively. In patients with LS, complete and partial remission was observed in three (50%) and three (50%) patients, respectively. CONCLUSION: UVA1 phototherapy is an effective treatment modality for acute exacerbated AD, MF and LS.

Management of Osteolysis around a Stable Harris-Galante Acetabular Cup: Retention vs Revision of the Acetabular Component

PURPOSE: We analyzed and compared 30 clinical cases of acetabular osteolysis around a stably fixed acetabular cup, and this was managed by changing the liner along with retaining or revising the cup. MATERIALS AND METHODS: We analyzed 30 patients who underwent acetabular component revision or retention with a bone graft for osteolysis around a stably fixed Harris-Galante acetabular cup and these patients were followed up for more than 2 years. There were 7 cases with a conserved the acetabular cup and only the liner was changed, and 23 cases with a totally revised acetabular component. We compared the size of the acetabular cup, the thickness of the polyethylene liner, the progression of osteolysis and the clinical outcomes. RESULTS: The Harris hip score was improved in both groups. In the retention group, during an average of 59.9 months of follow up, 7 cases showed stable fixation and 3 cases showed locally advanced osteolysis. In the revision group, during an average of 57.2 months of follow up, all 20 cementless acetabular cups showed stable fixation. CONCLUSION: We suggest that in patients with osteolysis around the stable cementless acetabular cup, both methods show satisfactory clinical outcomes. But considering recurrence of osteolysis, cup revision is more reliable than changing the liner with a bone graft.

A Case of Pseudolymphoma Syndrome Induced by Vancomycin / 대한피부과학회지

We report here on a case of a patient who experienced fever, skin eruption and lymphadenopathy 1 month after the beginning of vancomycin treatment. Generalized mild pruritic erythematous pin-head to rice-grain sized confluent scaly papules and plaques appeared on the whole body. Skin biopy showed the characteristic findings of pseudolymphoma mimicking mycosis fungoides. The skin lesions and general symptoms improved after discontinuation of vancomycin and starting steroid therapy. The patient was diagnosed with pseudolymphoma syndrome due to vancomycin. Pseudolymphoma syndrome shows clinical features that are different from those of usual drug eruptions, and the histologic findings are similar to mycosis fungoides. Thus, a thorough understanding of the clinical and histologic features of this entity may aid making a diagnosis, establishing treatment plans and determining the prognosis.

A Case of Episodic Angioedema with Eosinophilia / 대한피부과학회지

Angioedema with eosinophilia is classified as the episodic and transient types according to the clinical course, the presence of recurrence and the response to treatment. Episodic angioedema with eosinophilia is characterized by recurrent angioedema, urticaria, periodical weight gain, peripheral eosinophilia and fever. The pathophysiologic mechanism is unknown, but it has been suggested that T-lymphocytes, eosinophils and cytokines may be the causes of this disorder. We report here on a 35-year-old woman with episodic angioedema and weight gain that she experienced about 3 days before the onset of menstruation.

The Inhibitory Effect of Phytoclear-EL1 on Melanogenesis

BACKGROUND: Phytoclear-EL1, an extract from Euphorbia lathyris seeds, has a whitening effect due to inhibition of tyrosinase activity. OBJECTIVE: The purpose of this study was to investigate the inhibitory effect of phytoclear-EL1 on melanogenesis. METHODS: Cultured B-16 melanoma cells and 30 human volunteers were used for in vitro and in vivo studies, respectively. Phytoclear-EL1 was added to the cultured B-16 melanoma cells, and applied to UVB-induced hyperpigmented lesions of human volunteers twice daily for 7 weeks. Changes in the number of B-16 melanoma cells, as well as changes in morphology, melanin content, and tyrosinase activity, were measured and then compared with the normal control and the 10(-3)M arbutin groups. Also, the effect of phytoclear-EL1 on UVB-induced hyperpigmented lesions was examined through subjective and objective measurements. RESULTS: In the in vitro study (p<0.05), the number, melanin content, and tyrosinase activity of cultured B-16 melanoma cells were decreased in the 5microgram/ml phytoclear-EL1 group compared to the control group. On objective assessment with a chromameter, the 0.2% phytoclear-EL1 group had a larger difference in the mean L values before and 7 weeks after applying phytoclear-EL1 as compared to the other groups. On subjective assessment by both the researchers and subjects 7 weeks after applying experimental materials, the 0.2% phytoclear-EL1 group and positive control (3% arbutin) had higher scores than the placebo groups. These results demonstrated that phytoclear-EL1 in vivo and in vitro had an inhibitory effect on melanogenesis. CONCLUSION: Phytoclear-EL1 may be a candidate extract in the control of hyperpigmentary disorders.

A Case of Delayed Hypersensitivity Reaction due to Hyaluronic Acid (Restylane(R)) / 대한피부과학회지

Hyaluronic acid fillers have been proposed as an alternative to other temporary skin fillers for treating facial skin lines and providing soft tissue augmentation. There is no antigenic specificity for species or tissue; thus, these agents have a low potential for allergic or immunogenic reaction. However, there are a few reports about allergic hypersensitivity reactions to hyaluronic acid. We report here on the case of a woman who developed a delayed hypersensitivity reaction to the non-animal stabilized hyaluronic acid filler, Restylane(R).

The Clinical, Histopathologic and Mycologic Characteristics of Dermatophytosis Which were Initially Diagnosed by Skin Biopsies / 대한피부과학회지

BACKGROUND: Dermatophytosis is sometimes difficult to definitively diagnose if it has atypical clinical characteristics or the mycological tests are negative. For these cases, skin biopsy will be helpful to diagnose a fungal infection. OBJECTIVE: The purpose of the present study was to evaluate the clinical, histopathologic and mycologic characteristics of dermatophytosis patients who were initially diagnosed by skin biopsies. METHODS: We performed a retrospective study of the clinical characteristics and the histopathologic and mycologic features of 16 patients with dermatophytosis and who were initially diagnosed by skin biopsy. RESULTS: The final diagnosis of dermatophytic infections were tinea incognito (7 cases) and Majocchi's granuloma (9 cases). The main symptoms were pruritus (4 cases) and pain (2 cases). The skin lesions of tinea incognito and Majocchi's granuloma mimicked inflammatory skin disease, lupus vulgaris or deep mycosis. The most common site of involvement was the face. The possible predisposing factors causing tinea incognito and Majocchi's granulomas appeared to be application of steroid ointment (6 cases), physical trauma (2 cases) and diabetes mellitus (1 case). The histopathologic features of tinea incognito revealed the sandwich sign (100%) and neutrophils in the epidermis (71.5%) and dermis (71.5%). Majocchi's granuloma showed rupture of hair follicles (88.9%) and suppurative folliculitis (66.7%). With Periodic acid Schiff and methenamine silver staining, hyphae and spores could be identified on the horny layers, within the hair follicles and/or on the dermis in the biopsy specimens of all the cases. Culture of the causative organisms using dermal fragments and skin scales on Sabouraud media demonstrated Trichophyton rubrum (4 cases), T. mentagrophytes (3 cases) and Microsporum canis (3 cases). Systemic treatment with itraconazole or terbinafine for 2~10 weeks was effective, except for two cases. CONCLUSION: We consider that the histopatholgic findings may be of great help to diagnose a dermatophytosis that has atypical clinical characteristics or negative mycological tests. Fungal culture is also important for making an accurate diagnosis of dermatophytosis.

A Case of Telangiectatic Cutaneous Metastasis from Carcinoma of the Breast / 대한피부과학회지

The incidence of cutaneous metastases of primary tumor has been reported to be rare, as compared with metastasis of other internal organ. Carcinoma of the breast is most common cause of cutaneous metastasis in women. We report here on a case of telangiectactic metastatic breast carcinoma in a 65-year-old female who had violaceous plaques and vesicles over the right side of the neck. Histopathological examinations of the cutaneous lesion revealed aggregations of tumor cells within the dilated blood vessels in the dermis.

A Case of Primary Cutaneous Anaplastic Large Cell Lymphoma Mimmicking Keratoacanthoma / 대한피부과학회지

Pseudoepitheliomatous hyperplasia with a massive neutrophil infiltrate associated with primary cutaneous anaplastic large cell lymphoma has been rarely reported. Herein we report on a 33-year-old man who presented with multiple asymptomatic erythematous walnut-sized rapidly growing tumors on the axilla, trunk and left inguinal area for 1 month. The histopathologic features showed a keratoacanthoma-like epithelial hyperplasia in the epidermis and several large atypical lymphoid cells with nuclear plemorphism and abundant cytoplasm in the dermis. The atypical cells were obscured by a rich infiltrate of neutrophils and some eosionophils. Immunohistochemical studies confirmed the majority of the large anaplastic cells in the dermis were CD30+ cells. In addition, the expressions of anaplastic lymphoma kinase (ALK) and epithelial membrane antigen (EMA) were negative. There was no evidence of extracutaneous involvement. The patient was diagnosed with primary cutaneous anaplastic large cell lymphoma (ALCL) and he was treated with low dose methotrexate (15 mg/week). We think that this case was challenging both clinically and histologically.