Lack of Association between Low Cumulative Dose of Hydroxyethyl Starch and Acute Kidney Injury in Patients with Acute Ischemic Stroke

Background@#Hydroxyethyl starch (HES, 6% 130/0.4) has been used as a volume expander for the treatment of cerebral hypoperfusion in acute ischemic stroke. Although HES use was associated with renal failure in sepsis or critical illness, it still remains to be elucidated whether HES is linked to renal adverse events in patients with acute ischemic stroke. @*Methods@#A total of 524 patients with acute ischemic stroke within 7 days of onset were included between January 2012 and May 2016. Renal function on admission and follow-up on day 7 ± 2 was assessed using serum creatinine (SCr) and estimated glomerular filtration rate (eGFR). Propensity score matching (PSM) was used to perform a 1:1 matched-pair analysis to minimize the group differences caused by covariates. The percentage of patients with newonset acute renal injury (AKI) using the Kidney Disease: Improving Global Outcomes or good functional outcome (modified Rankin Scale 0–2) at 90 days were compared between HES cohort and controls. @*Results@#Among the included patients (mean age, 68.6 years; male, 56.5%), 81 patients (15.5%) were HES cohort (median cumulative dose, 1,450 mL). Baseline renal function was better in HES cohort compared to that in the controls (SCr, 0.87 ± 0.43 mg/dL vs. 1.15 ± 1.15 mg/dL, P < 0.001; eGFR, 86.91 ± 24.27 mL/min vs. 74.55 ± 29.58 mL/min, P < 0.001), which became not significant in PSM cohort (72 pairs). The percentage of new-onset AKI did not differ between the HES cohort and controls (1.4% vs. 1.4%, P = 1.000). In addition, newonset AKI was not related to HES (odds ratio, 1.422; 95% confidence interval, 0.072–28.068; P = 0.817) after adjusting for confounders. HES cohort tended to have higher percentage of good functional outcome at 90 days compared to controls, which failed to reach statistical significance (68.1% vs. 54.2%, P = 0.087). @*Conclusion@#A low cumulative dose of HES was not associated with renal adverse events in patients with acute ischemic stroke.

A Case of Elephantiasis Nostras Verrucosa Treated with Oral Acitretin / 대한피부과학회지

Elephantiasis nostras verrucosa (ENV) is an uncommon condition caused by repeated inflammation and lymphatic obstruction. It occurs mainly in the lower extremities and is characterized by skin changes, including hyperkeratotic mossy papules and plaques, non-pitting edema, and cobblestone-like appearances. ENV can be diagnosed based on its typical clinical manifestations (pseudoepitheliomatous hyperplasia with enlarged lymphatic spaces, fibrous tissue proliferation, and chronic inflammation) and by skin biopsy. Although ENV is difficult to treat, reduction of lymphedema and use of keratolytic agents may be helpful. To our knowledge, only three cases of ENV have been reported. However, the case of ENV treated with oral acitretin has not been reported in domestic literatures. Therefore, we report the case of a 45-year-old woman who developed ENV. She had a past history of cellulitis and was successfully treated with oral acitretin.

Pagetoid Bowen's Disease on the Dorsum of Foot / 대한피부과학회지

No abstract available.

Recurrent Embolic Stroke Associated with Long-Latency Relapsing Cardiac Myxoma

No abstract available.

Intracranial Arterial Calcificationes Can Reflect Cerebral Atherosclerosis Burden

BACKGROUND AND PURPOSE: We investigated whether the intracranial arterial calcification status reflects the overall cerebral atherosclerosis burden. METHODS: Patients with acute cerebral infarction who were admitted to a single university hospital stroke center and underwent brain computed tomography angiography (CTA) between May 2011 and December 2015 were included. We reviewed their demographic, clinical, and imaging data. Cerebral artery calcification was assessed from the cavernous portion of both internal carotid arteries, and patients were categorized into three groups according to the calcification status. The cerebral atherosclerosis score was calculated as the sum of the degree of stenosis of the major intracranial and extracranial arteries on brain CTA. RESULTS: In total, 1,161 patients were included (age=67±13 years, mean±standard deviation), of which 517 were female. Intracranial arterial calcification and atherosclerosis were detected in 921 patients. The cerebral atherosclerosis score tended to increase with the calcification status (no calcification=2.0±3.0, mild=3.8±3.8, severe=6.5±4.8; p < 0.001 in analysis of variance followed by the Bonferroni test). Multivariable logistic regression analysis including age, sex, vascular risk factors, body mass index, estimated glomerular filtration rate, high-sensitivity C-reactive protein, and calcification status showed that intracranial calcification was independently associated with an advanced cerebral atherosclerosis burden in a dose-dependent manner (compared to no calcification: odds ratio=2.0 and 95% confidence interval=1.1–3.4 for mild calcification, and odds ratio=4.7 and 95% confidence interval=2.7–8.3 for severe calcification). CONCLUSIONS: This study found that the calcification status of the cavernous portion of an internal carotid artery can reflect the overall cerebral atherosclerosis burden.

Basal Cell Carcinoma on the Scrotum / 대한피부과학회지

No abstract available.

Bier Spots: Low-dose Nifedipine Therapy / 대한피부과학회지

No abstract available.

Nutritional Support for Neurocritically Ill Patients

Nutritional assessment and support are often overlooked in the critically ill due to other urgent priorities. Unlike oxygenation, organ dysfunction, infection, or consciousness, there is no consensus of indicators. Making it difficult to evaluate the effectiveness of an intervention. Nevertheless, appropriate nutritional support in the critically ill has been associated with less morbidity and lower mortality. But, nutritional support has been considered an adjunct, for body weight maintenance and to help patients during the inflammatory phase of illness. Thus, it has been assigned a lower priority, compared to mechanical ventilation or hemodynamic stability. Recent findings have shown that nutritional support may prevent cellular injury due to oxidative stress and help strengthen the immune response. Large-scale randomized trials and clinical guidelines have shown a shift from nutritional support to nutritional therapy, with an emphasis on the importance of protein, minerals, vitamins, and trace elements. Nutrition is also important in neurocritically ill patients. Since there are few studies or recommendations with regard to the neurocritical population, the general recommendations for nutritional support should be applied.

Periocular Allergic Contact Dermatitis Associated with the Use of Ofloxacin Ophthalmic Ointment: A Case Report / 대한피부과학회지

Allergic contact dermatitis is an inflammatory condition associated with periorbital erythema, edema, and pruritus. The periorbital skin is relatively thin compared with the skin over other facial areas; therefore, it is vulnerable to allergen penetration and may show a variety of cutaneous manifestations. Recently, vision enhancement surgery is a widely performed procedure, and the prevalence of senile cataract and glaucoma is increasing. The prevalence of periocular allergic contact dermatitis is increasing secondary to the growing use of topical ophthalmic medications. Several studies in Korea have reported periocular allergic contact dermatitis secondary to the use of topical ophthalmic medications including latanoprost (Latano®), fluorometholone (Tolon®), polymyxin B (Terramycin®), atropine sulfate (Atropine®), neomycin sulfate (Cambison®), and befunolol hydrochloride (Bentos®), among others. However, ofloxacin (Effexin®)-induced allergic contact dermatitis has not been reported in the domestic and/or foreign literature. We report a case of periocular allergic contact dermatitis secondary to the use of ofloxacin ophthalmic ointment.

Various Skin Tumors Originating from Disseminated Superficial Actinic Porokeratosis / 대한피부과학회지

Disseminated superficial actinic porokeratosis (DSAP) is a rare keratinization disorder. It is histopathologically characterized by the presence of coronoid lamellae and clinically by lesions showing central atrophy with elevated borders. Squamous cell carcinoma originating in the classical Mibelli subtype of porokeratosis is well-documented; however, few reports have described squamous cell carcinoma in DSAP lesions. We report the case of a 76-year-old woman with DSAP who developed Bowen's disease, actinic keratosis, and keratoacanthoma on her face.

A Case of Periocular Allergic Contact Dermatitis from Latanoprost Misdiagnosed as Cellulitis / 대한피부과학회지

No abstract available.

Bullous Cellulitis-like Sweet Syndrome in a Patient with Waldenstrom Macroglobulinemia / 대한피부과학회지

Neutrophilic dermatoses comprise a wide spectrum of inflammatory diseases with overlapping features characterized histologically by the presence of an aseptic neutrophilic infiltrate in the epidermis, dermis, and/or hypodermis and are often associated with systemic inflammatory and neoplastic disorders. Here we report a case of a 75-year-old man who developed painful indurated plaques with a vesicular, bullous, and even hemorrhagic appearance similar to cellulitis on his right leg along with a fever that raised his body temperature up to 39℃ and malaise.

A Case of Intravascular Papillary Endothelial Hyperplasia on Finger / 대한피부과학회지

Intravascular papillary endothelial hyperplasia (IPEH) is a benign vascular proliferative process characterized by proliferation of endothelial cells with papillary formation located within a vascular lumen. It could manifest as a primary or pure form that develops in a distended vessel or it could be associated with hemangiomas, pyogenic granulomas, and/or lymphangiomas. We report a case showing development of intravascular papillary endothelial hyperplasia on a patient's right fifth finger.

A Case of Intravascular Papillary Endothelial Hyperplasia on Finger / 대한피부과학회지

Intravascular papillary endothelial hyperplasia (IPEH) is a benign vascular proliferative process characterized by proliferation of endothelial cells with papillary formation located within a vascular lumen. It could manifest as a primary or pure form that develops in a distended vessel or it could be associated with hemangiomas, pyogenic granulomas, and/or lymphangiomas. We report a case showing development of intravascular papillary endothelial hyperplasia on a patient's right fifth finger.

Analysis of Dermatologic Consultation of Inpatients at the Gyeongnam Cancer Center / 대한피부과학회지

BACKGROUND: The number of patients diagnosed with cancer has increased, and so has the number of dermatological consultations for related skin diseases. OBJECTIVE: To purposes of this study was to analyze the frequency and characteristics of dermatologic consultations at the Gyeongnam Cancer Center over a 9-year period. METHODS: We reviewed the records of 1,273 cases referred for dermatologic consultation at the Gyeongnam Cancer Center from 2007 to 2015. RESULTS: Dermatologic consultations increased over the 9-year period, with overall trends increasing in spring and summer. The most common age group comprised the 60∼69-year-old group (27.34%) and the male-to-female ratio was 1:0.6. Lung cancer was the most common underlying disease (25.53%). The most frequent skin disorder was infectious disease (33.78%), followed by drug eruption, erythema and urticaria (20.42%), and eczema (19.48%). The most common procedure was dressing or wet dressing (25.95%) followed by the KOH test (22.79%). The main reasons for dermatologic consultations were dermatologic disease or conditions (81.23%), followed by skin lesions related to the treatment of underlying disease (16.81%). CONCLUSION: This study analyzed skin disease in cancer center inpatients. In conclusion, dermatologists should be responsible for the management of skin disease in cancer patients for more accurate examination and treatment.

Erythema Multiforme like Bullous Pemphigoid / 대한피부과학회지

No abstract available.

A Case of Pilomatricoma Arising at a DTP Vaccination Site / 대한피부과학회지

No abstract available.

Relapsing Polychondritis Presented with Encephalitis Followed by Brain Atrophy

Relapsing polychondritis (RP) is a rare autoimmune disease that is characterized by inflammatory reaction of unknown etiology and destruction of cartilaginous structures. Characteristic symptoms of this disease include cartilage inflammation of the ear, nose, larynx, trachea, bronchi, joints, eyes, heart and skin. Concomitance with neurologic symptom is very rare in RP, and the detailed underlying mechanism of neurological involvement associated with RP is not fully understood. We herein described an unusual recurrent case of inflammatory brain lesions associated with RP, with attention to clinical manifestations, autoimmune disease involvement, and therapeutic effects.

Calcineurin Inhibitor Induced Multiple Infarctions / 대한이식학회지

Tacrolimus is the most commonly used immunosuppressant after kidney transplantation. Here, we report a patient with multiple cerebral infarctions during tacrolimus treatment after kidney transplantation. A 54-year-old female was admitted due to sudden onset right leg weakness. Brain magnetic resonance imaging (MRI) showed multiple acute infarctions but normal vasculature. Evaluations of cardiac embolism were unremarkable. After 8 months, her weakness progressed and follow-up brain MRI showed additional multiple infarctions. We changed here medication from tacrolimus to mycophenolate mofetil, and her symptoms improved gradually.

A Case of Hypopigmented Mycosis Fungoides in a Patient with Ankylosing Spondylitis during Treatment with Infliximab / 대한피부과학회지

No abstract available.