Solution Proposal for 5 Challenges to be Resolved in Formalizing the Logical Format of Kampo-Based Diagnosis by Building Consensus Among 6 Medical Institutions Specialized in Kampo Herbal Medicine / 日本東洋医学雑誌

We are planning a study focused on the gathering of clinical data for the purpose of formalizing diagnostic logic at 6 institutions specialized in Kampo-based medical examinations. However, during the planning stage, it has been recognized that there are a large number of Kampo formulas to be studied, and differences among faculties and individuals exist regarding how to identify each Kampo formula, methods of gathering findings, and the evaluation of efficacy. Here we report the solution proposal reached after building consensus among all participating faculties on these issues. After raising the issues, conferences were held for each of them, until a unanimous consensus was obtained. As a result, the following conclusions were reached. Thirty-three Kampo formulas were selected as targets for the formalization of diagnostic logic. In addition, the range of dosage forms, crude drug ingredients, and permissible dosages for each Kampo formula were determined. Regarding clinical findings for these Kampo medicines, the items to be collected and evaluation criteria were also established. The criteria for evaluating the validity and safety of each Kampo medicine were decided, together with the grading and timing of evaluation. We hope that our solution proposal reached after building consensus becomes the basis for Kampo research in the future.

Community based study of reproductive tract infections among women of the reproductive age group in a rural community of Eastern India

Background: RTI/STIs have a profound impact on sexual and reproductive health worldwide, the symptoms of which often goes unnoticed and women suffers from devastating consequences. The present study was conducted to analyse the prevalence of RTIs based on a syndromic approach among women of 15 to 49 years age, supported by both laboratory and clinical diagnosis to measure the actual magnitude of morbidity associated with RTIs among the study population. The objective of the study were to study the prevalence of reproductive tract infection among the women of reproductive age group (15-49 years), to find out the etiological diagnosis and to assess the socio-demographic profile of the study population.Methods: A cross-sectional study was carried out among 312 women aged 15-44 years in a rural area in West Bengal, using the WHO-Syndromic Approach for diagnosis and management of RTIs/STIs.Results: The prevalence of RTIs among the reproductive age group women was 43.6% based on their symptoms of RTI, with majority having abnormal vaginal discharge. According to laboratory investigations the most common cause of RTI was bacterial vaginosis which was 67.4% (using Amsel’s criteria) and 31.7% (as per Nugent’s score), followed by Vulvovaginal candidiasis which was found in 12.4%.Conclusions: RTI among women of reproductive age is quite a common morbidity.It is the need of the hour to educate women about reproductive health issues and encourage them to seek treatment for their problems and wherever possible both clinical and laboratory findings should corroborate self reported morbidity to know the exact prevalence of any disease in the community.

Clinico-Histopathological Analysis In Patients With Abnormal Uterine Bleeding.

Background: Menstrual disturbance is one of the commonest gynecological problems for the curettage or hysterectomy specimen received by pathologist. During reproductive age group, approximately 9-30% of women suffer from menorrhagia or abnormal uterine bleeding & the incidence increases as age advances. Being most common gynecological problem, present study is aimed to know full spectrum of AUB and its pathological aspects. Methods: 200 cases were taken from NHL Municipal Medical College, Ahmedabad over a period of 3 years. Clinical history and radiological findings of cases of abnormal uterine bleeding were noted. Histopathological analysis was done. Data were analyzed and correlation between clinical and histopathological findings were studied. Results: Maximum numbers of patients were in 41-50 years (41.5%) of age group and next are in 31-40 years (38%) of age group. Proliferative pattern (24%) was most common pattern in non-structural causes of AUB and Leiomyoma (22.5%) was the most common structural cause of AUB. Pregnancy related causes of AUB were common in less than 40 years of age group. Malignancy was more common in more than 50 years of age group. Atrophic endometrium (33.33%) was the most common cause of post-menopausal bleeding. Conclusion: Endometrial specimen examination by histopathological evaluation is gold standard procedure to know the exact pathology for AUB and for further management of patients.[Falguni S NJIRM 2016; 7(5):14-17]

Validity of Clinical Signs and Symptoms in Diagnosis of Ovarian Mass.

Objective: The main aim for undertaking this study was to find out what was the appropriateness of clinical diagnosis of benign ovarian tumor and compare the results after Histopathological study. Material And Methods: Retrospective files study of 240 cases was carried out to analyze the clinical signs and symptoms and evaluation done of clinical findings, tumour marker study, ultrasonography, and the plan of treatment. Results: Laparotomy was done in 200 cases, clinically ovarian masses were diagnosed as benign in 75%, by Tumor marker i.e. CA125 in 80%, by sonography in 70% and by histopathology in 83%. The study was statistically analyzed. The values in diagnosis of ovarian mass clinically and comparing with other parameters was significant p value<0.05. Conclusion: Clinical signs and symptoms are still important predictors in reaching the diagnosis of benign Ovarian Mass.

Clinical Findings and Recurrence Rates according to Associated Factors in Prurigo Pigmentosa / 대한피부과학회지

BACKGROUND: Prurigo pigmentosa (PP) is a chronic recurrent dermatosis that occurs in young adults and is characterized by pruritic erythematous macules and papules that leave reticular hyperpigmentation. Although there have been a few comprehensive studies, the clinical characteristics and recurrence rates have not been fully elucidated. OBJECTIVE: The purpose of this study was to evaluate the clinical findings and recurrence rates according to the factors associated with PP. METHODS: We reviewed the medical records, photographs, and histopathological slides of 67 patients who were diagnosed with PP between March 2005 and March 2013. Statistical analysis was performed to compare the recurrence rates between the group without associated factors and the group with associated factors (contact, diet/weight loss, and sweat, respectively). RESULTS: PP associated with contact showed localized involvement and transverse direction of the lesions; however, the PP lesions associated with diet or weight loss showed diffuse involvement. PP associated with sweat showed a tendency to be distributed in the flexural area and depressed area with longitudinal direction of the lesions. The recurrence rate of the group with no associated factors was 45.7%, while that of the group with associated factors was 33.3%. Within this group, the recurrence rate was 23.1% (3/13) for the contact group, 27.3% (3/11) for the diet/weight loss group, and 50% (4/8) for the sweat group. However, the differences in recurrence rates were not statistically significant. CONCLUSION: We suspect that there are differences in the clinical characteristics according to the factors associated with PP. Although the differences in recurrence rates according to the factors associated with PP were not statistically significant, we suspect that further research with a larger sample size will show that the differences are in fact present.

Clinical Analysis of Epithelial Tumors of the Lacrimal Gland

PURPOSE: To analyze the clinical and radiologic findings and to evaluate the treatment and prognosis of epithelial tumor patients. METHODS: We retrospectively reviewed clinical and radiologic findings of 36 patients who had been histopathologically diagnosed with epithelial tumors of the lacrimal gland after biopsy and surgery at Seoul St. Mary's Hospital from May 2005 to October 2012. RESULTS: Among the patients with epithelial tumors of the lacrimal gland based on histopathological findings, there were 21 cases of pleomorphic adenoma, seven cases of dacryops, four cases of adenoid cystic carcinoma, two cases of adenocarcinoma, one case of benign oncocytoma, and one case of mucoepidermoid carcinoma. The characteristic clinical finding of epithelial tumors of the lacrimal gland was proptosis (52.7%). In contrast with benign epithelial tumors of the lacrimal gland, the characteristic clinical findings of malignant epithelial tumors of the lacrimal gland were limitation of motion (57.1%), diplopia (57.1%), ocular pain (42.9%), and decreased visual acuity (42.9%). The mean duration of the symptoms of malignant epithelial tumors (5.0 +/- 4.2 months) was shorter than that of benign epithelial tumors (11.2 +/- 11.1 months) (t-test, p = 0.034). In radiologic CT and MRI findings, there was minimal bony destruction in two cases of pleomorphic adenoma and calcification in one case of pleomorphic adenoma. Malignant epithelial tumors of the lacrimal gland, in contrast to benign tumors, showed characteristic bony destruction (57.1%), poorly marginated tumor outline (42.9%) and calcification (14.3%). The 57.1% of patients in this study with malignant tumors were treated with chemotherapy and radiotherapy after surgical treatment, and there was one case (14.3%) of recurrence after treatment. CONCLUSIONS: Careful analysis of clinical and radiologic findings can lead to early diagnosis of malignant tumors.

Analysis of cranio-cerebral injuries by blunt force.

Despite current advances in public education and in automobile safety requirements, cranio-cerebral injuries continues to be a major cause of morbidity and mortality and accounts for significant portion of health care costs today. Trauma respects neither geography nor body systems. Consequently head injury occurs every 15 seconds and a patient dies from a head injury every 12 minutes, a day doesn’t pass that an emergency department physician is not confronted with a head injured patient. The present work is based on the observation and study made on 117 cases collected. These cases include 39 cases who died before being admitted to any hospital and were sent directly by the police to postmortem, Mysore Medical College, Mysore, and 78 cases that died in the hospital under medical care. Clinical data are available for 78 cases that died in the hospital after undergoing some treatment. An attempt is made in these cases to correlate clinical findings with the autopsy findings.

An Over-View of Tuberculosis of Female Genital Tract With Reference To Experience in a Medical College in Rural Set-Up in West Bengal: A Retrospective.

Aim: To determine frequency of female genital tract (FGT) tuberculosis (TB) in the gynecological biopsies received in the Department of pathology of a peripheral medical college. Methods: This is a retrospective study conducted in the Department of Pathology of Burdwan Medical College & Hospital. Histopathological records of two year (2008-2010) were retrieved and searched for the cases of female genital tract TB. Relevant histopathological findings and clinical data were recorded and analyzed. Results: There were 1537 cases of gynecological biopsy and 9 cases were diagnosed as FGT tuberculosis based on histopathological and clinical findings. Ovarian benign cystic teratoma was seen in one case along with ipsilateral tuberculous salpingitis, one case showed B/L ovarian tuberculosis with involvement of both the tubes. Bilateral fallopian tubes were involved in 2 cases and endometrial tuberculosis was diagnosed in 5 cases with 1 case showing simultaneous involvement of the cervix. In one case omental biopsy received along with tubal specimen showed tuberculous granulomas. Conclusion: FGT tuberculosis was usually seen in age 16-28 years and constituted 0.59% of total gynecological cases. Fallopian tubes, ovaries and endometrium and cervix were affected with the involvement of peritoneum or omentum, commonest being tuberculous endometritis. Histopathology, in association with clinical findings still remains gold standard for the diagnosis of FGT tuberculosis in our country despite advancement in diagnostic modalities; however, incidental histological detection in clinically unanticipated cases is not an uncommon event.

Clinicopathologic Study for 10 Cases of Cutaneous Angiosarcoma / 대한피부과학회지

BACKGROUND: Cutaneous angiosarcoma (CAS) is occasionally difficult to differentiate with other benign dermatoses, clinically, because of various clinical manifestations. OBJECTIVE: The aim of this study is to examine the clinical and histopathologic findings of CAS, and investigate specific clinicopathologic features to aid in the early diagnosis. METHODS: We reviewed photographs, medical records and biopsy specimen of 10 cases diagnosed as CAS for 5 years at our clinic. RESULTS: The male and female numbers were 7 and 3, and the mean onset age was 69.7 years old. The mean duration of disease was 5.7 months. The site of involvement was scalp or face in all patients. The most common clinical feature was erythematous or purpuric nodule, with surrounding erythematous or purpuric patch, without symptoms. Initial impressions based on clinical findings on the first visit of our clinic were CAS (n=6), squamous cell carcinoma (n=2), basal cell carcinoma (n=1), and erysipelas (n=1). Histopathologically, irregular vascular channels lined by atypical endothelial cell dissect between the collagen bundles were seen in 6 cases, malignant endothelial cells forming continuous sheets with epithelioid morphology in 3 cases, and mild vascular hyperplasia in 1 case. CD31 was positive on atypical endothelial cells in all patients. CONCLUSION: CAS should be included in differential diagnosis when cutaneous lesions show erythematous to purpuric nodule or patch with rapid progression on scalp or face of elderly patients. Histopathologically, CAS had wide spectrum from mild vascular hyperplasia to spindle cell tumors. As such, immunohistochemical stain, using endothelial markers, is valuable to diagnosis of CAS.

A Q fever case mimicking crimean-congo haemorrhagic fever.

Coxiella burnetii is the bacterium that causes Q fever. Human infection is mainly transmitted from cattle, goats and sheep. The disease is usually self-limited. Pneumonia and hepatitis are the most common clinical manifestations. In this study, we present a case of Q fever from the western part of Turkey mimicking Crimean-Congo haemorrhagic fever (CCHF) in terms of clinical and laboratory findings.

Clinical analysis of the 118 Cases of Sporotrichosis Over 42 Years in Kwangju and Chonnam (1967~2009) / 대한의진균학회지

BACKGROUND: Sporotrichosis is a chronic, deep fungal infection caused by a dimorphic fungus, Sporothrix schenckii. It is widely variable in incidence, distribution and clinical pattern. Clinical manifestations are greatly variable, with important involvement of the skin and the superficial lymphatic system. Although sporotrichosis is the most common deep fungal infection in Korea, few reports have included a long term investigation and survey of sporotrichosis. OBJECTIVE: We investigated patients' records for 42 years to identify the prevalence, epidemiological features and changes in clinical findings on sporotrichosis. METHODS: We carried out a retrospective analysis of 118 patients with sporotrichosis for 42 years (1997~2009) by reviewing the medical records and making phone calls to patients if needed. RESULTS: The incidence of sporotrichosis is on a decreasing tendency at this time and incidents were more common for rural residents (80 cases, 67.8%) than urban residents (38 cases, 32.2%). Lymphocutaneous type (86 cases, 73%) is more common than fixed cutaneous type (32 cases, 27%) and the most frequent occupation of patients was farmer (71 cases, 60%). Seasonally, 42 cases (36%) occurred in winter (December to February), showing higher incidency than any other season. The most common site of the skin lesion was right upper extremity. CONCLUSION: We found considerable changes in prevalence, seasonal distribution and clinical findings of sporotrichosis over 42 years.

Hallazgos clínicos, endoscópicos e histológicos asociados a la infección por Helicobacter pylori considerando los genotipos CAG A y VAC A en pacientes con dispepsia: Servicio de Gastroenterología Hospital Central Universitario “Antonio María Pineda” Barquisimeto Estado Lara / Clinical, endoscopic and histological findings associated with helicobacter pylori infection considering genotypes CAG A and VAC A in patients with dyspepsia: Gastroenterology Department Hospital Central Universitario

La dispepsia afecta la calidad de vida de muchos pacientes y en muchos casos está asociada a la infección por Helicobacter pylori. Esta bacteria es reconocida como el agente causal de la gastritis crónica, se asocia al desarrollo de úlceras gástrica y duodenal y está relacionada con el desarrollo de cáncer gástrico. Como objetivo primario se planteó establecer los hallazgos clínicos, endoscópicos e histológicos asociados a la infección por Helicobacter pylori considerando los genotipos cag A y vac A en pacientes con dispepsia que acudieron al Servicio de Gastroenterología del Hospital Central Universitario “Antonio María Pineda”. Se trata de un estudio epidemiológico descriptivo de corte transversal. La población estuvo conformada por los pacientes con dispepsia que acudieron al servicio y el muestreo fue de tipo no probabilístico intencional, puesto que se tomó a la población que consultó con síntomas dispépticos y que cumplieron con los criterios de inclusión y exclusión establecidos. Dichos pacientes se interrogaron sobre síntomas dispépticos, se les realizó endoscopia digestiva superior, se describieron los hallazgos endoscópicos y se les tomó muestra para estudio histológico y de genotipificación. Se encontró una incidencia de infección por H. pylori de 98,5%, la infección predominó en el sexo femenino, los genotipos cag A positivos y las formas alélicas m1/s1 son los más frecuentes en la población estudiada y, los mismos se asocian con gastritis crónica, úlceras gástricas y metaplasia intestinal incompleta...

Dyspepsia affects quality of life for many patients and often is associated with Helicobacter pylori infection. This bacterium is recognized as the causative agent of chronic gastritis, is associated with development of gastric and duodenal ulcers and, with the development of gastric cancer. Primary objective was raised to establish the clinical, endoscopic and histological findings associated with Helicobacter pylori infection considering genotypes cag A and vac A in patients with dyspepsia who attended the Gastroenterology Service of Hospital Central Universitario “Antonio María Pineda”. This is a cross-sectional descriptive epidemiological study. The population consisted of patients with dyspepsia who attended the gastroenterology service. The sampling was intentionally non-probabilistic, since we only took the people who consulted with dyspeptic symptoms and met the established criteria of inclusion and exclusion. These patients were questioned about dyspeptic symptoms, underwent upper gastrointestinal endoscopy, endoscopic findings were described and samples were taken for histology and genotyping. We found an incidence of H. pylori of 98.5%, infection prevailed in females, the genotypes cag A positive and m1/s1 allelic forms are most frequent in the population studied and, the same is associated with chronic gastritis, gastric ulcers and intestinal metaplasia incomplete...

Fatores de risco, achados clínicos, laboratoriais e avaliação terapêutica em 36 bovinos com deslocamento de abomaso / Risk factors, clinical and laboratorial findings and therapeutic evaluation in 36 cattle with abomasal displacement

A contínua seleção genética para maior produção de leite em conjunto com o aumento da capacidade digestiva e profundidade corporal aumentou a susceptibilidade à ocorrência de abomasopatias, incluindo o deslocamento do abomaso. Este trabalho objetivou realizar um estudo retrospectivo sobre o deslocamento de abomaso em 36 bovinos atendidos na Clínica de Bovinos, Campus Garanhuns da Universidade Federal Rural de Pernambuco, durante o período de janeiro de 2000 a fevereiro de 2009. Foram diagnosticados 27 casos de deslocamento do abomaso à direita, seis casos de deslocamento do abomaso à esquerda e três casos de vólvulo abomasal. Onze casos considerados moderados, sem grave distensão abdominal, apetite presente para a forragem e delimitação de som metálico até o 8º espaço intercostal, foram tratados clinicamente; enquanto 20 casos com distensão abdominal moderada a severa, associada a distúrbios sistêmicos, foram considerados graves e tratados cirurgicamente. Duas vacas foram eutanasiadas devido peritonite difusa ou alterações graves na serosa do abomaso, totalizando 18 animais submetidos ao tratamento cirúrgico. Dois animais foram encaminhados para abate e três vacas chegaram prostradas e morreram sem receber nenhum tratamento. A análise dos fatores de risco identificou a estação chuvosa como estatisticamente significativa. O maior número de deslocamento do abomaso ocorreu em vacas mestiças com 24 casos (66,6 por cento), seguida por bovinos da raça Holandesa com 11 (30,5 por cento) e Gir com um (2,9 por cento) caso. A composição da alimentação oferecida variou bastante e caracterizou-se por conter excesso de carboidratos e, na maioria dos casos, fibra de baixa qualidade. Os sinais clínicos mais frequentes foram comportamento apático, desidratação, timpanismo ruminal leve a severo com motilidade ausente ou diminuída, som de líquido ao balotamento do flanco direito, som de chapinhar metálico e/ou observação de uma estrutura similar a uma víscera...

The continuous genetic selection for high milk production in association with greater digestive capacity and corporal depth increases the susceptibility for abomasopathies including abomasal displacement. The present work aimed to accomplish a retrospective study on abomasal displacement in 36 cattle attended at Bovine Clinic, Garanhuns Campus, Federal Rural University of Pernambuco, through January 2000 to February 2009. Twenty seven cases of right abomasal displacement, six cases of left abomasal displacement and three of abomasal volvulus were diagnosed. Eleven moderate cases, without severe abdominal distention, appetite for roughage and metallic sound (ôpingõ) reaching at the most the 8th intercostal space were treated conservatively, and 20 severe cases with moderate to severe abdominal distention associated to systemic disturbances were treated surgically. Two cows were euthanized due to diffuse peritonitis or severe alterations in the abomasal serosa totalizing 18 animals submitted to the surgical treatment. Two animals were slaughtered and three cows arrived prostrated and died without receiving any treatment. Risk factor analysis identified rainy season as statistically significant. The greater number of abomasal displacement was in crossbred cows with 24 cases (66.6 percent), followed by Holstein and Gir cattle with 11 (30.5 percent) and one (2.9 percent) cases, respectively. Food composition varied greatly and characterized by excess of carbohydrates and in most cases low quality fibers. Most frequent clinical signs were apathy, dehydration, light to severe ruminal bloat with reduced or absent motility, splashing sound during right flank ballottement, ping and a distended viscera-like structure in the side of the displacement; liquid, blackish and fetid feces. Hematology reveals leukocytosis with neutrophilia and hyperfibrinogenemia in most cases. Ruminal fluid analysis showed compromised flora and fauna dynamics and increased...

A Study on the 71 Cases of Sporotrichosis over 38 Recent Years (1968~2005) / 대한피부과학회지

BACKGROUND: Sporotrichosis is a subacute to chronic, deep fungal infection caused by Sporothrix schenckii and has a wide variety of clinical presentations. Although sporotrichosis is the most common deep fungal infection in Korea, few reports have included a long term investigation and survey of sporotrichosis. OBJECTIVE: We analyzed patients' records for 38 recent years to identify the incidence and changes in clinical findings on sporotrichosis. METHODS: We conducted a retrospective analysis of 71 patients with sporotrichosis for 38 recent years (1968~2005) by reviewing the medical records and making phone calls to patients if needed. RESULTS: The incidence of sporotrichosis is currently on a decreasing trend and incidents were more common for rural residents (43 cases, 60.6%) than urban residents (28 cases, 39.4%). The most frequent occupation of patients was 'farmer' (37 cases, 52%). Seasonally, twenty seven cases (38.0%) occurred in winter (December to February), showing higher incidence than any other season. Lympho-cutaneous type (53 cases, 74.6%) is more common than fixed cutaneous type (18 cases, 25.4%) and the most common site of the initial lesion was left upper extremity. Of 47 patients who had primary lesion on upper extremity, 39 (83%) were of the lympho-cutaneous type, and of 15 patients who had primary lesion on face, 9 (60%) were of the fixed cutaneous type. CONCLUSION: According to this study, some changes in clinical findings and prevalence of sporotrichosis over the study period were noted. Further observation and analysis are required to clarify the meaning of these changes.

Clinical Manifestations and Prognostic Factors for Tetanus in the Emergency Department

PURPOSE: Tetanus is difficult for emergency physician to diagnosis at an early stage because of its low incidence and atypical initial clinical features. Therefore, we reviewed the clinical features of 54 tetanus cases and attempted to identify factors associated with prognosis in order to improve early diagnosis and treatment. METHODS: We carried out a retrospective chart review of 54 adult tetanus patients who presented to the ED of Chonnam National University Hospital between January 1996 and December 2005. We collected information on demographics, SAPS II score, clinical feature, course of infection and prognosis. We divided the patients to two groups according to the survival and compared their data statistically. RESULTS: Fifty four patients, 33 men and 21 women, were included in the study. The mean age was 50.97+/-15.95. The most common initial diagnosis in ED were electrolyte imbalance (n=15), neck and facial dystonia (n=9). The mean incubation period was 10.27+/-6.47 days. The initial SPAS II score 17.29+/-8.45 and the Wood score was 3.12 +/-1.47. Most commonly symptom was dyspnea and dysarthria. Twenty one patients were supported by mechanical ventilation, and the duration of mechanical ventilation was 5.92+/-4.52 days. On multivariate logistic regression analysis, four variables were found to be associated with the prognosis: incubation period, Wood score, Time interval from initial symptom to mechanical ventilation, initial SAPS II. CONCLUSION: Four variables correlated well with the prognosis: Incubation period, Wood score, Time interval from initial symptom to mechanical ventilation, initial SAPS II score.

Epidemiology and Clinical Findings of Behcet's Disease: Statistical Analysis of Patients in the Jeonnam Province from 1997 to 2004 / 대한피부과학회지

BACKGROUND: Behcet's disease (BD) is a multisystem disease, which manifests with mucocutaneous, ocular, articular, vascular, intestinal, urogenital, and neurologic symptoms. It is highly prevalent in the Far East, including Korea. OBJECTIVE: The epidemiology and clinical findings of BD patients in the Jeonnam Province, including Gwangju city, was evaluated from 1997 to 2004. METHODS: We retrospectively evaluated the clinical findings of 137 BD patients followed up at Jeonnam University Hospital. For the analysis of epidemiology and clinical findings, the patients were classified into complete, incomplete and suspected types, according to the diagnostic criteria of the Behcet's Syndrome Research Committee of Japan. Demographic data of the 137 patients were analysed with respect to age, sex, family history, and clinical characteristics. RESULTS: There was a female predominance, with a male-to female ratio of 0.49:1 and the average age of onset was 32.6 years for males and 27.1 years for females. The greatest study indicated that the incidence of BD had increased in recent years, and the prevalence of male patients had increased relatively since 2001. The most frequent initial symptom was an oral ulcer (92%). Cutaneous manifestations included erythema nodosum-like lesions in 65 patients (47.4%), folliculitis (acne-like lesions) in 43 patients (43%), cutaneous hypersensitivity in 11 patients (8.0%), subcutaneous thrombophlebitis in 7 patients (5.1%), and erythema multiform-like lesions in 2 patients (1.5%). They were grouped into suspected type (47.4%), incomplete type (46.0%) and complete type (6.6%). In the suspected type, as initial major symptoms, the combination of oral ulcer and genital ulcer were most frequent in female patients and the combination of oral ulcer and skin lesions in male patients. CONCLUSION: This is the first clinical study of BD patients in Gwangju and the Jeonnam Province. The new trend in the incidence and sex ratio of BD patients should further be evaluated in the whole of Korea. Further investigation and follow-up study are necessary to better understand the epidemiology and clinical findings of BD.

Clinical and Electrophysiological Study on Guillain-Barre Syndrome / 영남의대학술지

BACKGROUND: Guillain-Barre syndrome is defined as a recognizable clinical entity that is characterized by rapidly evolving symmetric limb weakness, the loss of tendon reflexes, absent or mild sensory signs, and variable autonomic dysfunctions. This study evaluated the clinical and electrophysiological findings retrospectively. MATERIALS AND METHODS: Forty-five patients with Guillain-Barre syndrome, who were admitted to the Yeungnam University Hospital for six years from Jan. 1994 to Dec. 1999 were investigated. The correlation between the clinical manifestation and the electrophysiological study was evaluated. RESULTS: The male to female ratio was 1.8: 1 and there was a peak seasonal incidence in the winter. A preceding illness was noted in 66.7% of cases, and an upper respiratory tract infection was the most common one. The most common clinical manifestations were a loss of tendon reflex and ascending muscle weakness and paralysis. The cerebrospinal fluid examinations revealed, albuminocytologic dissociation in 33 cases (73.3%). Intravenous immunoglobulin therapy was performed in 29 cases (64.4%). The sequential electrophysiological abnormalities were most marked at 2 to 4 weeks after onset. At that time the most significant change was a decrease in the compound muscle action potential amplitude. These 45 patients with Guillain-Barre syndrome were subclassified using the clinical and electrophysiological data. CONCLUSION: The result in this study, concured with other research on the clinical and electrophysiological data of Guillain-Barre syndrome. However, an extensive and dynamic investigation is necessary to determine the reason for the peak seasonal incidence in winter.

Clinicopathologic Findings of Metastatic Skin Cancer / 대한피부과학회지

BACKGROUND: The incidence of metastatic skin cancer has been reported to be relatively low. Because the diagnosis is not so difficult, cutaneous metastasis could be an important clue to discover the hidden internal malignancy, if found before recognizing primary cancer, or play a significant role to determine therapeutical plans and prognosis if found after diagnosis of primary cancer. MATERIAL AMD METHODS: This study was made upon the 68 cases of metastatic skin cancer, which had been confirmed histopathologically in the department of dermatology, Kosin University Gospel hospital from January, 1986 to August, 2003. Age and sex distributions, sites of primary cancer, time of detection, localization of the lesions, morphologic and histopathologic findings were examined by the review of medical records, clinical photographs, and pathologic slides. RESULTS: 1. The mean age at the time of diagnosis was 56.6 years and most patients were distributed over 5 decades. The male to female ratio was 1: 1.3. 2. Metastasis from breast carcinoma consisted of 19 cases, this was the most common primary cancer, followed by lung cancer, melanoma, and stomach cancer. In men, lung cancer and stomach cancer were the most common primary neoplasm, while breast cancer was the most frequent in women. 3. 50 of the cases were detected after diagnosis of primary cancer and during therapy. The other 18 cases were detected before the internal malignancy was recognized. 4. The localization of metastatic skin cancer was widespread over the whole body. The majority of cutaneous metastasis was predisposed to the surface near primary cancer, but distant metastases such as alopecia neoplastica on the scalp were also observed. 5. The most common morphologic features were single or multiple nodules, while inflammatory and indurated plaques were also found. 6. Histopathologic examination revealed that adenocarcinoma was the most common pathologic type, followed by squamous cell carcinoma and melanoma. The histopathologic features of cutaneous metastasis generally mimicked that of primary tumors. CONCLUSION: Generally, metastatic skin cancer is detected after the diagnosis of primary cancer showing subsequent treatment failure and poor prognosis. In some cases, however, cutaneous metastasis can be the earliest sign to recognize internal malignancy. Especially in the cases of metastatic skin cancer originating from the kidney, liver and thyroid gland, cutaneous features are the most significant evidences to presume the site of origin without any other findings. Therefore, it is important to recognize the clinical and histopathologic findings of metastatic skin cancer for the most successful diagnostic, therapeutic and prognostic determination.

Clinical Analysis on 13 Korean Cases of Darier's Disease / 대한피부과학회지

BACKGROUND: Darier's disease is an autosomal dominant disoder in keratinizing process. Clinically, patients present with warty to hyperkeratotic plaques with predilection of seborrheic area. OBJECTIVES: The purpose of this study was to analyze the clinical findings of Darier's disease in Koreans with literature review. METHODS: Thirteen cases of Darier's disease were reviewed by retrospective study. We analyzed the patients in terms of their clinical features, such as age, sex, family background, location of present or initial lesions, severity, clinical types, and treatment or prognosis. RESULTS: Darier's disease in Koreans was predominant in male with a sex ratio between male : female of 10 : 3. Three patients had a family history of Darier's disease among siblings and ancestors. Young patients under 30 years old were 79% with average onset of 24 years old. Typical seborrheic type was found in 9 cases, and flexural and linear/nevoid types were 2 cases, respectively. Characteristic nail deformities were observed in 5 cases, all of them showed V-shaped nicking. Focal types responded well to retinoic acid treatment, while seborrheic type was poor to treatment. CONCLUSION: We reviewed clinical characteristics of Darier's disease in Koreans patients. Interestingly, male-dominance of Darier's disease in Korean suggests the possibility that genetic patterns vary among countries or races in Darier's disease.

A Clinical and Histopathologic Study of Syringoma / 대한피부과학회지

BACKGROUND: Syringoma is a relatively common benign appendageal tumor derived from the intraepidermal eccrine ducts. It occurs predominantly in women at puberty or later in life. The lesions usually are multiple and may be present in great numbers. Histopathologically, numerous small ducts are embedded in a fibrous stroma and their walls are lined by two rows of epithelial cells. OBJECTIVE: The aim of this study is to investigate clinical and histopathologic features of syringoma in Koreans. METHODS: Total 32 patients were included in this study. Data complied were sex, age, onset of disease, symptoms, family history, localization, distribution, and some histopathologic findings including acanthosis, basal hyperpigmentation, proliferation of fibrous stroma, vacuolization of cells, keratin-filled cyst, and characteristic tad-pole appearance. RESULTS: 1. It was observed predominantly in females as the sex ratio of 31:1. The mean age at diagnosis was 37.5-years-old. 2. The age of onset was in the 2nd decade in 9 patients, 3rd decade in 10 patients, 4th decade in 7 patients, 5th decade in 5 patients, and 7th decade in 1 patient. 3. Only two patients complained of mild itching. 4. Family history was noted in 14 patients. 5. It occurred most frequently in the upper and lower eyelids(28 cases), and followed by forehead(5 cases), genitalia(3 cases), temple(2 cases), cheek(1 case), and neck(1 case). 6. The distribution was bilateral except two patients. 7. The color of lesion showed skin-colored(23 cases), yellowish(6 cases), and brownish (3 cases). 8. Twelve cases of acanthosis, 11 cases of basal hyperpigmentation, 26 cases of proliferation of fibrous stroma, 13 cases showing vacuolization of inner cell layer of ducts, 8 cases showing keratin-filled cysts and 15 cases showing characteristic tad-pole appearance were observed. CONCLUSION: According to our study, syringoma predominantly occurs in eyelids of women as bilateral asymptomatic skin-colored papules and histopathologic findings frequently shows keratin-filled cysts.