Supernumerary ovary on recto-sigmoid colon with associated endometriosis

A supernumerary ovary is a rare gynecological anomaly, and is usually excised due to its malignant transformation potential. We report a case of a supernumerary ovary and endometriosis situated on the anterior rectosigmoid colon. When laparoscopy was conducted, a firm, 5-cm mass was discovered on the anterior rectosigmoid colon along with normal ovaries. In this case, the discovery of a supernumerary ovary implied the presence of endometriosis. It is unusual for endometriosis and a supernumerary ovary to exist simultaneously.

Postoperative outcomes of natural orifice transluminal endoscopic surgery-assisted vaginal hysterectomy and conventional laparoscopic-assisted vaginal hysterectomy: a comparative study

OBJECTIVE: The present study aimed to determine the differences in outcomes between natural orifice transluminal endoscopic surgery-assisted vaginal hysterectomy (NAVH) and conventional laparoscopy-assisted vaginal hysterectomy (LAVH). METHODS: We retrospectively reviewed the charts of patients who between July 2012 and September 2015, were diagnosed as having benign uterine disease such as uterine myoma, endometriosis, or adenomyosis and managed via NAVH or LAVH in a single-center (Eulji University Hospital). Data such as age, body weight, height, parity, operation time, intra/post-operative complications, and uterus weight were obtained from the clinical charts. NAVH and LAVH recipients were matched 1:3 in terms of baseline characteristics, and the 2 groups were compared regarding surgical outcomes. RESULTS: Of the 160 patients with benign uterine disease included in the present study. Forty received NAVH and remaining 120 received LAVH. There were significant differences between the groups regarding operation time and hemoglobin change. Notably, although the operation time was shorter for LAVH, hemoglobin change was lower for NAVH. Additionally, although maximum hospitalization duration was shorter for LAVH, the average length of hospitalization was similar between NAVH and LAVH. There were no significant differences between the groups in terms of other variables. CONCLUSION: NAVH may become a new alternative surgical method of choice for hysterectomy, as it represents a clinically feasible and safe approach; moreover is superior to LAVH in terms of bleeding loss.

Pulmonary hemorrhage as an unusual initial manifestation of systemic lupus erythematosus

Pulmonary hemorrhage as the initial manifestation of systemic lupus erythematosus (SLE) has been rarely reported in children. We present the case of a 10-year-old girl who was admitted to Kangbuk Samsung Hospital with hemoptysis. She had a 5-day history of cough with dyspnea. On physical exam, breath sound was significantly decreased combined with rales on both lung fields. Blood tests revealed pancytopenia, decreased complement levels (C3, 21.28 mg/dL; C4, 3.10 mg/dL), positive antinuclear antibody (>1:640) and anti-double-stranded DNA antibody (262.5 IU/mL). Chest computed tomography revealed patchy ground glass opacity on both lung fields. She had proteinuria and diffuse lupus nephritis (International Society of Nephrology/Renal Pathology Society class IV-G(A)) confirmed by renal biopsy. High-dose methylprednisolone pulse therapy (30 mg/kg/day) was given for 3 days and then switched to a maintenance dose (1 mg/kg/day). Initially hemoptysis resolved after administration of methylprednisolone, but recurred on the 14th day of treatment. She was then treated with cyclophosphamide pulse therapy and hemoptysis subsided without recurrence. She was discharged on the 31st day of admission. She continued to receive monthly cyclophosphamide pulse therapy until the occurrence of leukopenia and then her regimen was switched to mycophenolate and hydroxychloroquine. SLE continues to be well controlled after 18 months of treatment. Recognition of pulmonary hemorrhage as a possible initial manifestation of SLE is crucial for early diagnosis. SLE was successfully treated with good outcome.

Relationship between serum interleukin-31/25-hydroxyvitamin D levels and the severity of atopic dermatitis in children

PURPOSE: Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease. Vitamin D and interleukin-31 (IL-31) are known to be related to the pathogenesis of AD with pruritus. The purpose of this study was to investigate the relationship between serum levels of 25-hydroxyvitamin D (25(OH)D) and IL-31 and the disease severity of AD in children with AD. METHODS: We recruited 160 children with AD and 42 controls. We used the SCORing Atopic Dermatitis (SCORAD) index to measure the severity of AD. Serum IL-31 and 25(OH)D levels were assayed using enzyme-linked immunosorbent assay and high-performance liquid chromatography, respectively. Serum levels of total IgE, specific IgE to common allergens and peripheral blood total eosinophil count were carried out in children with AD. RESULTS: Serum IL-31 level was significantly higher in AD group compared to control group and 25(OH)D level was significantly lower in AD group than control group. Serum IL-31 level showed the highest level in severe AD group followed by moderate and mild AD group, whilst serum 25(OH)D level was the lowest in severe AD group compared to moderate and mild AD group. There was no difference in serum IL-31 level between AD group and nonatopic dermatitis group. IL-31 level was positively correlated with subjective SCORAD index indicating pruritus in children with AD, and 25(OH)D was inversely correlated with SCORAD index. CONCLUSION: IL-31 and vitamin D may be related to the pathogenesis of AD, especially with regard to the pruritus.

Cigarette Smoke-Induced Interleukin-1 Alpha May Be Involved in the Pathogenesis of Adult Acne

BACKGROUND: Lipid peroxide (LPO) in comedones, which are produced as a result of sebum oxidation, might potentially induce interleukin-1alpha (IL-1alpha) and exacerbate comedogenesis and inflammatory changes in comedones. OBJECTIVE: To investigate the relationship of proinflammatory cytokines and LPO levels in the extracts of comedones with the acne of clinical difference between smokers and non-smokers, and with the severity and distribution of the acne lesions. METHODS: Twenty-two non-smoking and 21 smoking adult acne patients were evaluated by comedone extraction and measurement of proinflammatory cytokines and LPO levels. Acne severity and distribution of the lesions were also analyzed. RESULTS: Relative to the non-smoking group, smokers had significantly higher levels of IL-1alpha and LPO in comedones. Their levels showed a positive correlation. However, there were no statistically significant difference between the severity or distribution of the disease and the levels of LPO and IL-1alpha in comedones. CONCLUSION: Smoking may be involved in the pathogenesis of adult acne by increasing the oxidative stress that results in subsequent accumulation of LPO in comedones.

A Case of Cutis Marmorata Telangiectatica Congenita with Onychodysplasia

Cutis marmorata telangiectatica congenita (CMTC) is a rare congenital vascular disorder, and its pathophysiology is still unclear and most cases occur sporadically. Cutaneous lesions are observed at birth with a marbled bluish and deep-purple appearance. The associated anomaly is manifest as body asymmetry, macrocephaly, hydrocephalus, mental retardation, syndactyly and congenital glaucoma. We report our experience of CMTC1 in a female infant with the gestational age of 34 weeks and 6 days and birth weight of 2,300 g who was born by cesarean section with abnormal skin lesions. The cutaneous lesions covered most of the lower body and they faded as she continues to grow. She also had onychodysplasia in her left 2nd phalanges. In this case, close follow up by not only pediatricians but also ophthalmologist and neurologists to treat various forms of lesions involved, though the prognosis of CMTC is generally good.

Pyoderma-Pyostomatitis Vegetans without Inflammatory Bowel Disease / 대한피부과학회지

Pyodermatitis-pyostomatitis vegetans (PD-PSV) is a rare, benign pustular and vegetating mucocutaneous dermatosis with a tendency to affect the oral mucosa and the skin of the groin and axilla. The cutaneous lesions begin as crusted erythematous papulopustules, which coalesce to form large vegetating plaques, usually in the axillae, genital area and scalp. PD-PSV is known to be frequently associated with inflammatory bowel diseases (IBD), such as ulcerative colitis and Crohn's disease. We report a rare case of PD-PSV, which showed typical clinical and istopathological features, but was not accompanied by inflammatory bowel disease.

Tinea Capitis Caused by Trichophyton mentagrophytes with Rapid Progression / 대한의진균학회지

Tinea capitis, a dermatophyte infection involving the hair shaft on the scalp, is primarily a disease of preadolescent children. Trichophyton or Microsporum species of dermatophytes transmitted by humans or animals are commonly associated with this disease. Clinical presentations are seborrheic-like scale, 'black dot' pattern, inflammatory tinea capitis with kerion or tiny pustules in the scalp. We report an interesting case of tinea capitis with rapid progression caused by Trichophyton mentagrophytes in an 11-year-old girl. The patient was treated with 125 mg of oral terbinafine and topical flutrimazole cream for one month.

Clinical Study on Adult Onset Still's Disease / 대한피부과학회지

BACKGROUND: Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disease of an unknown etiology, and this is characterized by spiking fever, evanescent rash, arthritis and multiorgan involvement. OBJECTIVE: This study was conducted to better understand the clinical characteristics of patients with AOSD, and especially the cutaneous features. METHODS: We reviewed the medical records and cutaneous findings of 21 patients who were diagnosed with AOSD at our hospital from 2003 to 2009. The diagnosis of AOSD was based on the criteria proposed by Yamaguchi et al. RESULTS: Eighteen (86%) out of the 21 patients were women, and the age of onset ranged from 18 to 55 years. Fever occurred in 21 (100%) patients, skin rash in 20 (95%), arthralgia in 18 (86%), sore throat in 10 (48%) and lymphadenopathy in 7 (33%). The cutaneous features were as follows: typical maculopapular eruption (70%), urticaria (10%), petechia and purpura (10%), persistent plaques and linear pigmentation (5%) and acne-like lesions (5%). The most common sites of skin lesion were the trunk (80%) and thighs (80%). The histopathologic findings of 9 patients showed non-specific chronic inflammation with a perivascular mononuclear preponderance in 6 patients, and the others were consistent with urticaria or leukocytoclastic vasculitis. CONCLUSION: The various cutaneous features of this study suggest that dermatologists should consider AOSD in any patient with cutaneous eruption associated with fever and arthralgia.

Atrophying Pityriasis Versicolor: Is This a New Variant of Pityriasis Versicolor?

An atypical clinical form of pityriasis versicolor has been infrequently reported, in which cutaneous atrophy is associated with individual pityriasis versicolor lesions. The pathogenesis of this atrophy remains unclear, but is believed to be a delayed-type hypersensitivity reaction to antigens derived from the Malassezia species. A 60-year-old man presented with multiple, slightly scaly, and depressed maculopatches or plaques on the trunk and extremities. Our microscopic examination of the skin scrapings on a KOH preparation revealed numerous short hyphae and spores. The patient was treated daily with 200 mg of itraconazole in combination with topical antifungals, achieving clinical improvement and mycological recovery, which was confirmed upon follow-up 1 month later. This is the first case report of atrophying pityriasis versicolor in Korea. It needs to be differentiated from other atrophying disorders of the skin.

A Case of Elephantiasis Nostras Verrucosa

Elephantiasis nostras verrucosa (ENV) is a rare clinical condition associated with chronic non-filarial lymphedema caused by bacterial or non-infectious lymphatic obstruction. A variety of etiologies, including infection, tumor obstruction, trauma, radiation, chronic venous stasis, congestive heart failure, and obesity, can lead to chronic lymphatic obstruction and edema. Mossy papules, plaques, and cobblestone-like nodules are clinically impressive features of ENV, but biopsy reveals only moderately abnormal findings such as pseudoepitheliomatous hyperplasia, dilated lymphatic spaces, fibrous tissue hyperplasia, and chronic inflammation. We present a case of ENV in a 67-year-old man with a 10-year history of multiple nodules and verrucous plaques on both feet. Microbiology ruled out a filarial infection. Nodule biopsy revealed pseudoepitheliomatous hyperplasia, marked dermal fibrosis, and a chronic inflammatory infiltrate. No evidence of carcinoma was identified. Both venous stasis and recurrent cellulitis could contribute to the dermal fibrotic changes of the lesions. However, before the recurrent cellulitis, he did not have any nodular lesions on his feet despite a 10-year history of venous disease. Therefore, this case suggests that venous stasis alone cannot produce the fibrotic nodular lesions of ENV

A Case of CD30 (+)/ALK (-) Primary Systemic AnaplasticLarge Cell Lymphoma with Atypical Clinical Features / 대한피부과학회지

Anaplastic large cell lymphoma (ALCL) is a type of non-Hodgkin's lymphoma, and this tumor is predominantly composed of large lymphoid cells that have a strong expression of CD30. Two major groups of ALCL have been described. The first is a spectrum of CD30+ lymphoproliferative disorders, including primary cutaneous ALCL and lymphomatoid papulosis. The second is systemic nodal ALCL, which can be subdivided into two groups: anaplastic lymphoma kinase (ALK)-positive and ALK-negative. The relative frequency of ALCL in Korea is about 19% of all cutaneous lymphomas. Solitary or multiple large nodular tumoral lesions confined to one body compartment are the most common presentation. We report here on a case of CD30 (+)/ALK (-) primary systemic ALCL in a 77 year-old-male, and the skin lesion manifested as multiple papules, plaques and tumors on the trunk, buttocks and upper and lower extremities.

Generalized Pustular Psoriasis of Pregnancy Treated with Systemic Steroid and Narrowband UVB / 대한피부과학회지

Generalized pustular psoriasis of pregnancy (GPPP) is a rare form of pustular psoriasis that occurs in pregnant women during the third trimester. It is characterized by erythematous plaques, peripheral scale and sterile pustules, and this malady is associated with systemic symptoms such as fever, malaise, diarrhea and pain. A 34-year-old primigravida woman with an intermittent history of plaque psoriasis for 12 years presented with a two week history of increasingly widespread erythematous eruptions and associated peripheral pustules. The histopathologic findings were consistent with pustular psoriasis. She was diagnosed with generalized pustular psoriasis of pregnancy and she was treated with systemic and topical steroid, narrowband ultraviolet B phototherapy and wet dressings. 2 weeks after treatment, the patient demonstrated clinical and symptomatic improvement.

A Case of Halo Congenital Nevus / 대한피부과학회지

The term halo congenital nevus is a condition in which halo formation is associated with congenital melanocytic nevus. The regression of congenital melanocytic nevi is usually accompanied by the halo phenomenon and this is considered to be a rare event, although this may be underestimated. We describe here a 9-year-old boy with verrucous congenital nevus surrounded by a depigmented halo on the right upper arm. Histologically, the nevus lesion revealed a dense lymphocytic infiltration in the upper dermis intermingled with some remnants of nevus cell nests. Most of the infiltrating cells were CD8+ T lymphocytes. At the edge of the lesion, corresponding to the area of the halo, neither melanocytes nor melanin were found in any significant amounts.

Clinical Study of 27 Cases with Scabies / 대한피부과학회지

BACKGROUND: The incidence of scabies in Korea decreased during the past 20 years. This might have been due to improved personal hygiene and public sanitation. Recently, however, not only the incidence of scabies, but also delayed or missed diagnosis, is likely to increase again. OBJECTIVE: This study was conducted to obtain a better understanding of the clinical characteristics of recent scabietic patients. METHODS: We reviewed the medical records and clinical photographs of 27 outpatients who had been diagnosed with scabies in our department between August 2006 and August 2008. We investigated personal and clinical information, including age, sex, onset, past history and clinical manifestations. RESULTS: Of the 27 patients, 14 (51.9%) were female and 13 (48.1%) were male. Their ages ranged from 4 to 93 years (mean=47.2 years). Over half (51.9%) of the patients had been misdiagnosed at private hospitals. The average time from symptom presentation to diagnosis was 68 days. The most common site of skin lesions was the lower abdomen (77.8%), and the most common primary lesion was erythematous papules (96.3%). Atypical cases of scabies were as follows: 7 nodular scabies (25.9%), 1 crusted scabies (3.7%) and 4 scabies incognito (14.8%). CONCLUSION: Currently, atypical cases of scabies may be increasing and frequently misdiagnosed. We suggest that dermatologists should suspect scabies for any patient who presents with pruritus that is persistent or resistant to treatment.

Predictors for lumbar bone mineral density in premenopausal and postmenopausal women in Korea / 대한산부인과학회지

OBJECTIVE: The need for early and correct prescription for bone densitometry led to the research for decision model useful for clinicians to address women to bone densitometry. there are few studies that have focused on both pre- and postmenopausal groups simultaneously in healthy pre-and postmenopausal Korean women. METHODS: The authors analyzed the easily obtained biometrical variables such as factors used at clinical decision rules for BMD testing and evaluated predictive values and robustness of a decision model for prediction of lumbar BMD in total , pre-and postmenopausal Korean women. RESULTS: After stepwise multiple regression analysis, Lumbar BMD in total population is 1.083-0.153 (status of menopause)-0.007 (age of menopause)+0.0039 (body weight) (R2=0.52). Postmenopausal women is 0.563-0.0077 (duration after menopause)+0.0054 (body weight) (R2=0.30) and premenopausal women is 0.23+0.0048 (height) (R2=0.05). Although its validity (52%) in total population was sufficiently high for the prediction of lumbar BMD in clinical settings, In postmenopausal women only 30% of the decision model can be explained by the predictors of bone demineralization which is not completely satisfactory in determining lumbar BMD and in premenopausal women 5% is the very low explanatory value which is necessary for identifying possible factors influencing BMD. CONCLUSIONS: Because of difference in underlying risk, as well as differences in the distribution of different risk factors according to menopausal status, this study present different robustness of prediction models according to menopausal status and suggest that it be need to design prediction models divided by menopausal status. More research is needed for computer-based screening aids useful to clinician which overcome some limitation of our study.

An Immunohistochemical Study on the Macrophages in the Developing Corpora Lutea of the Rat / 대한해부학회지

Within the corpus luteum, macrophages exert luteotropic and luteolytic actions through secretion of TNF-alpha. However, the mechanisms of luteotropic actions on the development and maintenance of pregnant and nonpregnant corpora lutea are thoroughly unknown.In this experiment, TUNEL, macrophage, and TNF-alpha immunohistochemistry on the corpora lutea of pregnant and nonpregnant rats (Sprague-Dawley strain) were carried out to reveal the role of macrophages in the developing corpora lutea. The results were as follows; 1) In the nonpregnant corpora lutea, the number of macrophages was increased significantly, and the degree of ED1-immunoreactivity of macrophages was increased moderately. But lutein cells showed low-degree TNF-alpha-immunoreactivity. 2) In the pregnant corpora lutea, the number of macrophages was decreased significantly, and the degree of ED1- immunoreactivity of macrophages was low. But lutein cells showed moderate-degree TNF-alpha-immunoreactivity. Based on the above results, it was considered that macrophages in the nonpregnant corpora lutea exert phagocytic action mainly, and the macrophages in the pregnant corpora lutea exert TNF-alpha-secreting action to maintain the structure and function of lutein cells.

Low-dose Radiation-induced Hormetic Effect in the Rat Ovarian Follicle / 체질인류학회지

Hormesis is the generally-favorable biological responses to low exposures to toxins and other stressors. Radiation hormesis is the theory that ionizing radiation is benign at low levels of exposure, and that doses at the level of natural background radiation can be beneficial. The purpose of this study is to reveal the hormetic effect of low-dose radiation of ionizing radiation on the ovarian follicles of 4-week old female mice. Mice were grouped into control group, 2 cGy irradiated group, 2 cGy and 2 Gy irradiated group (2 cGY pre-exposure group), and 2 Gy irradited group. Mice were sacrificed by cervical dislocation 24 hours after irradiation, removed ovaries, fixed in neutral formaldehyde solution for 24 hours, embedded with paraffin, stained with hematoxylin and eosin and TUNEL immunohistochemically, and observed light microscopically the atretic follicles and normal follicles in various follicular developmental stages. In this experiment, the ratrio of atretic follicles to entire follicles in an ovary increased significantly in 2 Gyirradiated group compared with 2 cGY pre-exposure group, and the ratio of normal follicles to the entire follicles in an ovary in all the developmental stages were increased significantly in the 2 cGY pre-exposure group compared with 2 Gy-irradiated group. These results mean that low-dose radiation pre-exposure can induce the hormetic effect in the developing ovarian follicle.

Clinical comparisons of laparoscopically assisted vaginal hysterectomy and total vaginal hysterectomy / 대한산부인과학회지

OBJECTIVE: To compare the clinical results between laparoscopically assisted vaginal hysterectomy (LAVH) and total vaginal hysterectomy (TVH). METHODS: We reviewed the medical records of patients who underwent LAVH and TVH from January 2002 to December 2004 in 00 university hospital without the history of uterine prolapse or pelvic relaxation. We evaluated age, parity, previous abdominal operations, indication of hysterectomy, size of the uterus, operation time, hemoglobin change, hospital day, the degree of postoperative pain and initiation of diet and postoperative complications. RESULTS: The age and parity of the patients in both groups were not different statistically. There were history of previous abdominal operations in 20.8% of LAVH group and 25.3% of TVH group which didn't have statistic significance. Major indications of the operation were uterine myomas in both groups. The average weight of the extracted uterus were 272.9+/-114.5 gm and 225.6+/-87.0 gm in the LAVH group and the TVH group respectively which had significance, and the operation time were 81.1+/-23.4 minutes and 71.1+/-37.8 minutes respectively which had significance. There were no difference in the hemoglobin drop of the postoperative day 1, but the hemoglobin drop of the postoperative day 4 was larger in the LAVH group. Postoperative complications occurred more often in the TVH group (15.2%) than LAVH group (11.9%) but didn't have significance, and the complications were treated by conservative managements and observation of the progress. And also the hospital day, the degree of postoperative pain and initiation of diet had no significance. CONCLUSION: Both LAVH and TVH had no statistic difference in the postoperative morbidity and recuperation. Moreover the indications of operation for both surgeries had no statistic difference, but LAVH had a preference for the larger size of uterus. Furthermore in order to increase the satisfactions of patients and remedy the weak points of procedures, research on the indications and contra-indications between the operative approaches and training on the operative procedures are required.

Developed Extrapotine Myelinolysis after Hysteroscopic Myomectomy: A case report / 대한마취과학회지

Transcervical resection of endometrium is under-utilized in the treatment of dysfunctional uterine bleeding, uterine myoma and menorrhagia. The procedure is similar to transurethral resection of prostate in men with a possibility of substantial absorption of irrigation fluid. Absorption of a large volume of fluid can cause excessive intravascular volume, hyponatremia, cerebral edema and death. Severe hyponatremia leading to extrapontine myelinolysis is an extremely rare complication of this procedure. So, We report a case of developed extrapontine myelinolysis after hysteroscopic myomectomy which, however, showed complete recovery.