Clinical and Histopathologic Study of Confluent and Reticulated Papillomatosis by Anatomic Site and Age

BACKGROUND: Confluent and reticulated papillomatosis (CRP) is an uncommon dermatosis characterized by hyperpigmented scaly macules or papillomatous papules coalescing into confluent patches or plaques centrally with a reticular pattern peripherally. Few studies regarding this have been reported in the literature. OBJECTIVE: The purpose of this study was to investigate the clinical and histologic characteristics of CRP in Korean patients according to anatomic site and age. METHODS: We retrospectively reviewed the medical records, clinical photographs, and 40 histopathologic slides of 29 patients diagnosed with CRP. RESULTS: Sixteen adults and 13 adolescents were included. The predominantly involved anatomic sites were the trunk (89.7%) and axillae (27.6%); flexural area involvement was mainly found in the adolescent group. The mean disease duration was 2.3 times longer in the adult group than in the adolescent group. The histopathologic features included hyperkeratosis (95.0%), acanthosis (87.5%), and papillomatosis (77.5%) in the epidermis. In the adult group, only 10 specimens (52.6%) showed mild to moderate papillomatosis. There was no relationship between the histologic findings and disease duration; however, the former was associated with the anatomic site. CONCLUSION: The present study is the first to present the clinical and histologic features of CRP according to age and anatomic site in Korean patients. The patients in this study more frequently had fungal infections (31%) than patients in a previous study (12.8%). Histologic changes were more prominent in the adolescent group than in the adult group and in the flexural area than in the non-flexural area.

The Urate-lowering Efficacy and Safety of Febuxostat in Korean Patients with Gout

OBJECTIVE: To compare the urate-lowering efficacy and the safety of febuxostat, allopurinol and placebo in Korean patients with gout for 4 weeks. METHODS: Subjects (n=182) with gout were randomized to febuxostat (40, 80, 120 mg), allopurinol 300 mg, or placebo group. The primary end point was the proportion of subjects whose serum urate concentration fell to less than 6.0 mg/dL after the 4-week treatment. RESULTS: The primary end point was reached at 25.7%, 80.0% and 83.3% of patients receiving 40, 80 and 120 mg of febuxostat, respectively, 58.3% of those receiving 300 mg of allopurinol and none of the placebo (p<0.001: each febuxostat dose or allopurinol group versus placebo group, p=0.0484 and p=0.0196: febuxostat 80 and 120 mg compared with allopurinol, respectively). The number and proportion of subjects who developed adverse events (AEs) were 13 subjects (37%), 14 (39%) and 18 (50%) in the febuxostat of 40, 80 and 120 mg group, respectively, 21 (57%) in the allopurinol 300 mg group and 17 (46%) in the placebo group. No statistically significant differences in the incidence rates of adverse events were observed between the groups. There was no significant difference in gout flare-up incidence. CONCLUSION: Febuxostat, 80 mg or 120 mg, was more effective than allopurinol (300 mg) or placebo, when lowering the serum urate. The safety of febuxostat and allopurinol was comparable.

Insight into Striae Distensae with Cosmetic Concern in Korean Women / 대한피부과학회지

BACKGROUND: Striae distensae is a common skin condition that can happen to everyone. Most cases do not have serious problems, but those who are affected may suffer from strong cosmetic stress. There was an epidemiologic study of striae distensae in Korean adolescents. Up to now, variable treatment modalities have been tried including topical application of tretinoin and light-based therapy using pulsed dye lasers or fractional lasers. OBJECTIVE: To evaluate the prevalence of striae distensae in Korean women and estimate their understanding. METHODS: We carried out a survey targeting 256 healthy female adults without a history of medical disease and analyzed the results. RESULTS: The number of patients with striae distensae were 219 (86.0%). Striae distensae was mostly seen at the thigh and calf (84.0%) and longitudinal formed striae, with their long axis parallel to the lines of skin tension, was the most frequent shape (44.0%). The most common color of the striae distensae was white (56.0%) and 78% of patients had experienced this before adulthood. Striae distensae is caused by two major factors, overweight (70.0%) and growth spurts (24.0%), and 244 patients (76.0%) replied that they felt uncomfortable because of this disorder. Nineteen patients (8.6%) with striae distensae had gone through treatment. Among them, 11 (5.0%) had technical treatment in dermatologic clinics such as, pulse dye laser, fractional laser, and chemical peeling. Eight patients (3.7%) were treated with folk remedies including moxibustion and acupuncture therapy. However, 154 patients (71%) responded that they wanted treatment for the striae lesion, and 93 patients (43%) have great intention to treatment. CONCLUSION: A lot of patients are still suffering from striae distensae, but so far there is no appropriate treatment. The biggest problem is that there is very little understanding of striae distensae. Patients should be aware of their striae distensae and we should provide appropriate treatment.

The Study of Characteristics of Cutaneous Manifestations of Kawasaki Disease in Korean Patients (2006-2010) / 대한피부과학회지

BACKGROUND: Kawasaki disease (KD) is an acute inflammation of middle-sized arteries such as the coronary artery. KD is an important disease due to its high mortality rate, which approaches 1-2% without appropriate treatment. Since the various mucocutaneous lesions of KD are related to the dermatologic field, dermatologists should take an interest in this disorder and understand the lesions. OBJECTIVE: To evaluate the characteristics of cutaneous lesions in Korean patients with KD. METHODS: A total of 919 patients with KD were assessed at the department of pediatric cardiology and dermatology, Myongji hospital between January 2006 and December 2010. RESULTS: Of the 919 patients, 566 (61.6%) were diagnosed with typical KD and 353 (38.4%) with atypical KD. KD was most frequent in the 4 year-old group (22.7%), and the ratio of male to female was 1.5:1. Among the mucocutaneous manifestations, erythema of the oropharyngeal mucosa (75.7%) occurred most frequently, followed by polymorphous trunk rash (41.7%), and changes of palms and soles (25.6%). A total of 606 patients (65.9%) with KD had associated diseases as follows: pneumonia (211 patients; 34.8%), pharyngotonsilitis (168 patients; 27.7%), gastroenteritis (132 patients; 21.8%), asthma (15 patients, 2.5%), atopic dermatitis (11 patients, 1.8%). CONCLUSION: Our study shows that change in the lips or oral cavity is the most common mucocutaneous manifestation in both classic and atypical KD. Also, morbiliform rash is the most common pattern of polymorphous rashes. Interestingly, erythema multiforme-like lesions occupied accounted for a considerable portion of KD cases compared to previous studies.

Epidemiologic and Clinical Features of Uveal Melanoma in Korean Patients

PURPOSE: To investigate the epidemiologic and clinical features of uveal melanomas in Korean patients. METHODS: The medical records of 35 patients (35 eyes) with the diagnosis of uveal melanoma between September 2004 and December 2006 were reviewed retrospectively. RESULTS: Of the 35 patients, 22 were males (62.9%) and 13 were females (37.1%), with a mean age at diagnosis of 48.2+/-14.1 years (range, 24-82 years). Decreased visual acuity was the most common symptom in 23 patients (65.7%), while 6 patients (17.1%) were detected without prior symptoms. The shape of the uveal melanoma was dome-shaped in 27 eyes (77.1%) and mushroom-shaped in 8 eyes (22.9%). The mean largest basal diameter of the tumors was 9.0+/-3.3 mm (2.4-19.0 mm), and the mean apical height was 6.2+/-2.6 mm (1.1-13.0 mm). The tumors were classified according to their size; a small melanoma was found in 4 eyes (11.4%), a medium melanoma in 29 eyes (82.9%), and a large melanoma in 2 eyes (5.7%). CONCLUSIONS: Uveal melanomas manifest earlier in Korean patients than in Caucasian patients. At the time of diagnosis, 33 eyes (94.3%) had small or medium melanomas that could be treated.

Surveillance of Stool Samples for the Presence of Enterobacter sakazakii among Korean People

PURPOSE: Enterobacter sakazakii (E. sakazakii) infections are an important cause of life-threatening meningitis, septicemia, and necrotizing enterocolitis in infants. Dried infant formula milk is an important vehicle for E. sakazakii infection. E. sakazakii was isolated in Korea from dried infant formula milk. Although E. sakazakii infection of infants may occur in Korea, its prevalence has not yet been documented. Therefore, we determined the prevalence of E. sakazakii and documented symptoms. MATERIALS AND METHODS: Between March and October 2006, 1,146 stool samples were collected from patients at Uijeongbu St. Mary's Hospital. Each fecal swab was dissolved in 10mL of buffered peptone solution, and enriched culture was streaked onto Druggan-Forsythe-Iversen (DFI) agar. Presumptive E. sakazakii colonies that exhibited a blue-green color during culture on DFI medium were selected. The identity of colonies that developed yellow pigment during culture on TSA was determined using the Vitek system and PCR. RESULTS: We isolated 4 E. sakazakii strains whose 16S rRNA sequence alignments had a similarity of 99% with those of 3 E. sakazakii ATCC strains. CONCLUSION: This is the first report on isolation of E. sakazakii from stool samples and to document the symptoms of Korean patients.

Transradial Approach for Coronary Angiography and Interventions: Practical Applicability at a High-volume Laboratory and Safety in Korean Patients

BACKGROUND AND OBJECTIVES: Radial approach was introduced as a route for coronary angiography or interventions. We assessed clinical applicability at a high-volume laboratory and safety. MATERIALS AND METHOD: Procedure-related results were compared between phase I period including learning curve and phase II period in 326 patients, in whom coronary angiography or interventions were performed by radial approach. RESULTS: 1) Success rate was 90% (292/326) in all patients, which significantly increased to 95% (246/259) during phase II compared to 69% (46/67) during phase I. 2) Time from local anesthesia to sheath placement and time for first coronary cannulation were 4.3+/-2.7min, 3.1+/-1.9min, respectively, in all patients, which significantly decreased to 3.8+/-3.6min, 2.7+/-2.4min during phase II compared to 7.0+/-3.2min, 5.7+/-4.7min during phase I. Total examination time was 21.7+/-5.5min in all patients, which significantly decreased to 20.4+/-6.2min during phase II compared to 28.3+/-8.0min during phase I. 3) Overall procedural success rate of coronary interventions was 94% (98/104). Guidewire didn't pass in 5 (5%) patients with chronic total occlusion and stent wasn't delivered in 1 (1%) due to poor guiding backup. 4) During follow-up of 61+/-25 days, weak or absent radial pulse, abnormal reverse Allen test were observed in 13 (5%), 3 (1%), 15 (6%) patients, respectively, but no claudication observed. CONCLUSION: Coronary angiography and interventions by radial approach was safe and performed without more time delay after learning curve.

A Study on the Comparison of Disease Status between Foreign Patients and Korean Patients / 한국역학회지

The objective of this study is to identify any differences in disease status between foreign patients staying in Korea and Korean patients. The study results are : First, more foreign stayers than Korean in their 20's and 30's seek medical services but those after age of 60 show the opposite pattern. This difference seems to feflect cultural difference in the concept of medical services and health seeking behavior. Second, foreign pateints were much more frequently(almost threee times) diagnosed as having an acute disease, and the fact that the most common diseases were "diseases of the respiratory system" can suggest the seriousness of air pollution problem in Korea. And, the fact that foreign stayers, especially those from developed countries, tend to take more periodic general physical examina-tion indicated that their health maintenance efforts place emphasis on prevention. Foreign patients seek more medical services during the spring and summer time when compared to Korean patients, and Korean patients visited the clinic more frequently during the autum time. Also, the review of the number of outpatients seeking medical services and the average duration of outpatient follow-up mainten-ance after discharge suggest that foreigners suffer less severe diseases than Koreans do. Finally, in contrast to the usual practice of Koreans of coming to the center without prior calling for reservation, most foreign patients tend to make reservations before coming(usually a day before) in general. This is also reflective of cultural difference related to the way of utilizing medical services.