Syndrome pattern and its application in parallel randomized controlled trials / 中国结合医学杂志

Syndrome pattern (SP) is a core concept of Chinese medicine (CM) and is used to diagnose and treat patients based on an overall analysis of symptoms and signs. This study aimed to systematically review randomized controlled trials (RCTs) using the SP concept and to demonstrate how the SP concept could be applied to the study design of parallel RCTs, considering a gold standard of clinical research. After conducting a brief systematic review by way of a PubMed search, we analyzed how the SP concept was applied to the design of RCT in a CM herbal medicine trial. We then formulated possible research questions, applied the SP concept to answer the research questions, and suggested possible RCT designs to be used for conducting future trials. Fourteen RCTs were included in our systematic review, and three key points of the SP concept were formulated for the design of parallel RCTs: the time point of SP diagnosis between before and after randomization; the relationship between the international classification of diseases (ICD) and SP for the inclusion of target population; and the proper diagnostic method of SP. In this study, we formulated three possible research questions and then suggested perspectives for five possible RCT models arrived at using SP concepts. Future trials applying SP concept to RCTs should overcome the shortcomings of past SP trials, moving CM forward from experience-based to evidence-based medicine.

Immunotherapy of Malignant Melanoma with Tumor Lysate-Pulsed Autologous Monocyte-Derived Dendritic Cells

PURPOSE: Dendritic cell (DC) vaccination for melanoma was introduced because melanoma carries distinct tumor-associated antigens. The purpose of this study was to investigate the efficacy and safety of DC vaccination for melanoma in Korea. MATERIALS AND METHODS: Five patients with stage IV and one with stage II were enrolled. Autologous monocyte-derived DCs (MoDCs) were cultured and pulsed with tumor-lysate, keyhole limpet hemocyanin, and cytokine cocktail for mature antigen-loaded DC. DC vaccination was repeated four times at 2-week intervals and 2-4x107 DC were injected each time. RESULTS: Reduced tumor volume was observed by PET-CT in three patients after DC vaccination. Delayed type hypersensitivity responses against tumor antigen were induced in five patients. Tumor antigen-specific IFN-gamma-producing peripheral blood mononuclear cells were detected with enzyme-linked immunosorbent spot in two patients. However, the overall clinical outcome showed disease progression in all patients. CONCLUSION: In this study, DC vaccination using tumor antigen-loaded, mature MoDCs led to tumor regression in individual melanoma patients. Further standardization of DC vaccination protocol is required to determine which parameters lead to better anti-tumor responses and clinical outcomes.

A Case of Stewart-Treves Syndrome Associated with Disseminated Intravascular Coagulation / 대한피부과학회지

Stewart-Treves syndrome is an angiosarcoma that develops in chronic lymphedematous skin. Kasabach-Merritt syndrome is characterized by the occurrence of disseminated intravascular coagulation (DIC) in combination with benign angiomatous tumors in most cases, but angiosarcoma has also been reported to be associated with DIC in rare cases. Here we report on a case of a 74-year-old woman who had angiosarcoma on a large area of the right trunk and arm around a previous mastectomy site. She developed DIC after laminoplasty, and she finally expired from multiorgan failure 3 months after the initial diagnosis of DIC. Her preoperative laboratory findings were normal, and she did not have any other underlying diseases that were possibly related with the development of DIC, except the large area of angiosarcoma. In conclusion, we report here on a rare case of Stewart-Treves syndrome that co-occurred with DIC and we believe that accurate evaluation of a skin lesion is important for Stewart-Treves syndrome patients who display systemic symptoms.

The Production and Functions of Reactive Oxygen Species in Mouse Bone Marrow-derived Dendritic Cells by Various Haptens and Irritants / 대한피부과학회지

BACKGROUND: Various allergens and irritants induced the production of reactive oxygen species (ROS) in the well-established mouse dendritic cell (DC) line XS106 and this production of ROS was inhibited by antioxidants. OBJECTIVE: To investigate the production and functions of ROS in mouse bone marrow-derived DCs (BM-DCs) by various haptens and irritants, we examined the production of ROS, the expression of surface molecules, and the production of interleukin-12 (IL-12) in mouse BM-DCs. METHODS: Six to eight-week-old female C57/BL6 mice were used in this study. Mouse BM-DCs were co-cultured with DNFB, DNCB, TNBS, hydroquinone, NiSO4, CoCl2, MnCl2, thimerosal, SDS, and BKC. The production of ROS and the expression of surface molecules (CD40, CD80, CD86, and MHC-II) were measured by flow cytometry in chemical-treated mouse BM-DCs. In addition, the cells were pretreated with antioxidants to determine whether the production of ROS can be inhibited. The production of IL-12 was also measured in DNCB and SDS-treated mouse BM-DCs using ELISA. Results: The production of ROS in mouse BM-DCs was induced by various allergens, including DNFB, DNCB, TNBS, hydroquinone, MnCl2 and irritants like SDS, BKC. The expression of surface molecules was induced by various chemicals and NiSO4 was the most potent inducer of surface molecules in mouse BM-DCs. The production of ROS in DNCB and SDS-treated mouse BM-DCs was partially inhibited by diphenylene iodonium, but not by rotenone, vitamin E, allopurinol, glutathione. The production of IL-12 was not detected in DNCB and SDS-treated mouse BM-DCs. CONCLUSION: The production of ROS was induced in mouse BM-DCs by various allergens and irritants. The expression of surface molecules was also induced by various chemicals. The production of ROS was partially inhibited by DPI. The production of IL-12 was not detected.

Immunotherapy for Malignant Melanoma using Dendritic Cells / 대한피부과학회지

BACKGROUND: Malignant melanoma is a potentially lethal cancer that arises from melanocytes present in skin, mucosa, or the epithelial surfaces of eyes and ears, and its incidence has increased substantially. Although primary tumor excision can sometimes achieve complete remission, most melanomas are beyond surgical margins when diagnosed, and are usually resistant to chemotherapy and radiotherapy. Therefore, many other therapeutic modalities are being investigated, and one of them is dendritic cells (DC)-based immunotherapy. OBJECTIVE: The purpose of this study was to investigate the therapeutic effect of DC-based immunotherapy on malignant melanoma. METHODS: Malignant melanoma was induced in mice by subcutaneously inoculating B16F10 cell line, and fifteen mice were divided into 3 groups: 1) PBS-treated (n=5), 2) treated with DC (n=5), and 3) treated with tumor lysate (Ag)-pulsed DC (n=5). We identified that DC were able to present Ag to T cells with mixed lymphocyte reaction and induce Ag-specific immune response with delayed hypersensitivity. To evaluate the therapeutic effect, we examined changes of tumor size and survival rates. RESULTS: The following results were obtained: 1. Ag-pulsed DC generated much T cell proliferation (mixed lymphocyte reaction). 2. Ag-pulsed DC treatment induced only delayed hypersensitivity. 3. Ag-pulsed DC treatment decreased tumor size (PBS:703+/-49 mm3, DC:619+/-26 mm3, and Ag-pulsed DC: 463+/-25 mm3) and increased survival rates. CONCLUSION: Our results suggest that intratumoral injection of Ag-pulsed DC could be used to treat malignant melanoma.

Transition from Pemphigus Foliaceus to Pemphigus Vulgaris: Case Report with Literature Review

The transition between the main subtypes of pemphigus, pemphigus vulgaris (PV), and pemphigus foliaceus (PF) has rarely been reported. Moreover, the development of PV in a patient with PF is much more unusual than that of PF in a patient with PV. We report a 48-year-old man who presented with cutaneous lesions showing the typical clinical and histological features of PF. Five years later, his skin lesions became extensive and he developed oral erosions. His condition did not respond well to steroids and azathioprine. Histological examination of a vesicle disclosed suprabasal acantholysis in contrast to the subcorneal acantholysis discovered upon initial histological evaluation. Indirect immunofluorescence revealed IgG antikeratinocyte cell surface antibodies at a titer of 1:640. The titer was 1:160 at initial diagnosis. Upon immunoblotting, the patient's serum reacted with 130 kiloDalton (kDa) and 160 kDa proteins, suggesting desmoglein (Dsg) 3 and 1, respectively. We herein report an unusual case of PV that developed from PF during the disease's flare-up.

Two Cases of Eccrine Poroma on the Abdomen / 대한피부과학회지

No abstract available.

A Case of Herpetic Folliculitis / 대한피부과학회지

Although herpetic skin infections are very common, herpetic folliculitis is not often reported in the literature. It has varied presentations, some of which are clinically atypical requiring histopathological confirmation of follicular involvement. We report a case of herpetic folliculitis which developed on the left shoulder of a 36-year-old man with painful erythematous grouped papules, but without vesicles. On histopathologic examination of a papular lesion, viral cytopathologic changes such as ballooning degeneration and giant cell formation, were observed within the follicular epithelium, thus we could diagnose this case as a viral folliculitis. The patient was treated with an antiviral agent, and the lesions subsided within several days.

Trichostasis Spinulosa within an Intradermal Melanocytic Nevus / 대한피부과학회지

Trichostasis spinulosa is a relatively common follicular disorder that results from the retention within a single follicle of successive vellus hairs. It is characterized clinically by numerous follicular spines resembling comedones located on the seborrheic areas. On histologic examination, trichostasis spinulosa is characterized by dilated hair infundibula containing numerous hair shafts enveloped in a keratinous sheath. We report a case of trichostasis spinulosa within an intradermal melanocytic nevus, which developed in a 44-year-old man.

A Case of LEOPARD Syndrome / 대한피부과학회지

LEOPARD syndrome is an autosomal dominantly inherited multiple congenital anomaly syndrome with high penetrance and a markedly variable expression. LEOPARD is an acronym of lentigines, electrocardiographic conduction defects, ocular hypertelorism, pulmonary stenosis, abnormalities of the genitalia, retardation of growth, and deafness. We report a typical case of LEOPARD syndrome which developed in an 11-year-old girl who had symptoms of lentigines, EKG abnormality, ocular hypertelorism, pulmonary stenosis, growth retardation, and sensorineural hearing loss.

A Case of Palisaded Encapsulated Neuroma of the Eyelid / 대한피부과학회지

Palisaded encapsulated neuroma (PEN) is a rare intraneural neuroma. It usually occurs as a solitary asymptomatic skin-colored papule, and commonly affects the butterfly area of the face of middle-aged adults. We report a case of PEN which developed on the right upper eyelid of a 30-year-old man. It was a 3 mm-sized skin colored papule, and histologically, there was a well- defined encapsulated nodule in the dermis, composed of spindle cells with basophilic and plump nuclei in a palisading pattern. On immunohistochemical staining, the tumor cells of the nodule were positive for S-100 protein, while the capsule of the nodule was positive for epithelial membrane antigen.

Antinuclear Antibodies in Patients with Behcet's Disease / 대한피부과학회지

BACKGROUND: Behcet's disease has features consistent with an immunopathogenic mechanism, but the autoreactivity in pathogenesis is unclear. OBJECTIVE: This study was to investigate the association of antinuclear antibodies (ANA) with Behcet's disease. METHODS: The patients in this study were diagnosed at Severance Hospital Behcet's Disease Specialty Clinic from May, 1998 to May, 2002. We evaluated the frequency, titers and immunofluorescence patterns of ANA in patients with Behcet's disease, and compared the frequency with a healthy control group. According to the positivity of ANA, we compared the frequency of minor symptoms to investigate the association of the severity of disease with ANA. RESULTS: 1. Of the 554 cases of Behcet's disease, 46 cases (8.3%) were ANA positive, however, of the 271 cases of healthy control group, only 5 cases (1.8%) were ANA positive. (p=0.0003) 2. In ANA titers 38 cases (82.6%) showed low titer (1: 40+, 1: 160-), 5 cases (10.9%) intermediate titer (1: 160+, 1: 640-), and 3 cases high titer (>1: 640+). There was no significant difference in intermediate and high titers between complete (17.9%) and incomplete type (14.3%). 3. In immunofluorescence patterns of ANA, 17 cases (37%) were speckled pattern, 5 cases (10.9%) homogeneous pattern, 3 cases (6.5%) centromere pattern, 2 cases (4.3%) nucleolar pattern and 19 cases (41.3%) unknown pattern. 4. Of 508 cases with negative ANA patients, 272 cases (53.5%) had minor symptoms, however, of 46 cases with positive ANA patients, 14 cases (30.4%) had minor symptoms (p=0.0027). CONCLUSION: From this study ANA was more prevalent in Behcet's disease. However, it was not related to severity of disease and most of them were low titer. ANA, herein, might play a minor role in pathogenesis of Behcet's disease.

Lyme Disease

Lyme disease is a vector-borne infection primarily transmitted by Ixodes ticks and is caused by at least three different but closely related species of borrelia. Although it is the most common arthropod-borne disease in the U.S. and Europe, reports of the clinical cases have been relatively rare in Korea. The disease may affect different organs, such as nervous system, joints, heart or eyes, and the clinical pictures include meningitis, cranial neuritis, arthritis, temporary atrioventricular block, and conjunctivitis. The cutaneous manifestations are erythema(chronicum) migrans, borrelial lymphocytoma, and acrodermatitis chronica atrophicans. Early localized infection occurs a few weeks after a tick bite, and erythema migrans is a classic cutaneous manifestation at this stage of infection. Several weeks later, early disseminated infection occurs with bacterial dissemination. Multiple erythema migrans-like skin lesions, neuroborreliosis, arthritis, and carditis can develop. Without treatment, the disease can progress to late or chronic infection, and then acrodermatitis chronica atrophicans may develop in addition to the systemic manifestations. The disease can be diagnosed with serologic tests such as indirect immunofluorescence test or ELISA. The recommended treatment is oral doxycycline or amoxicillin, and the treatment period is variable depending on the organ involved and the duration of the disease. A vaccine for the Lyme disease is approved for adults and commercially available in the Unites States. However, protection from tick bites by the use of protective clothing in risk areas and body inspection and removal of any attached ticks as soon as possible are the most important prophylactic methods. Chemoprophylaxis after a tick bite is also available.

Halo Dermatitis Around a Compound Nevus / 대한피부과학회지

Halo dermatitis was first described as a halo-shaped eczematous change around a nevocellular nevus. However, other cases developed around various kinds of lesions including seborrheic keratosis or lentigo were reported later on, so it is now considered not to be specific for melanocytes or nevus cells. It has never been reported to be associated with regression of central lesion, in contrast to halo nevus. We report a case of halo dermatitis developed around a compound nevus in a 20-year-old male patient. On histopathologic examination, the central lesion was a compound nevus and the surrounding lesion was consistent with chronic eczematous dermatitis.

A Case of Systemic Fungal Infection due to Fusarium oxysporum in a Patient with Acute Lymphocytic Leukemia / 대한의진균학회지

Fusariosis is a rare infectious disease caused by species of the genus Fusarium that has been increasingly documented as an emerging agent of opportunistic infections in immunocompromised patients and, occasionally, immunocompetent hosts. We describe an 18-year-old Korean male, previously diagnosed as acute lymphocytic leukemia, presented with 2~4 cm-sized erythematous to necrotic papulonodules on the trunk and extremities for a week. White blood cell count was 200 cells/L and biopsy specimen showed structures resembling fungal elements in the dermis and subcutaneous fat. Cultures from a biopsy sample growing whitish cottony colonies contained fusoid multiseptated macroconidia. He was diagnosed as fusariosis and treated with intravenous amphotericin B. But white blood cell count and clinical symptoms didn't improve and he was expired after 6 days of treatment.

A Case of Palisaded Encapsulated Neuroma of the Lower Lip / 대한피부과학회지

Palisaded encapsulated neuroma(PEN) is a rare intraneural neuroma. It usually occurs as a solitary, asymptomatic, skin-colored papule, and commonly affects the butterfly area of the face of middle-aged adults. However, it rarely involves oral mucosa including lip and should be differentiated from mucosal neuromas which generally occur as multiple small nodules of the lips and the anterior part of the tongue. We report a case of PEN occurring on the lower lip in a 33-year-old male. Histopathologically, it appeared as a well-circumscribed, encapsulated round nodule in the dermis. The nodule was composed of well-developed fascicles of wavy spindle cells separated by a loose matrix. Nuclear palisades were ill defined. On immunohistochemical staining, most tumor cells of the nodule were positive for S-100 protein and about 30% of tumor cells were positive for neural filament, but the capsule was negative for them. Epithelial membrane antigen was focally and discontinuously reactive on the capsule of the nodule.

Weber-Christian Disease Treated with Steroid Pulse Therapy / 대한피부과학회지

Weber-Christian disease is an inflammatory disease of subcutaneous fat tissue which is characterized by relapsing, febrile tender nodules and histologically lobular panniculitis. Many cases originally considered as examples of Weber-Christian disease were later found to be other diseases when lobular panniculitis was reclassified, and some authors believe that Weber-Christian disease should no longer be considered as a distinctive entity. However, there are still occasional cases which cannot be diagnosed as other specific diseases but have the characteristic manifestations of Weber-Christian disease, and they attest to the fact that Weber-Christian disease could be a distinctive disease entity. We report here a case of Weber-Christian disease in a 22-year-old female who was treated successfully with steroid pulse therapy.