Extremely Severe Dysphagia Secondary to Tracheostomy: A Case Report / 대한연하장애학회지

We report an extremely severe case of dysphagia in an elderly patient. Tracheostomy alone was found to be the cause of severe upper esophageal opening dysfunction. An 84-year-old woman was admitted with dyspnea. During hospitalization, she had respiratory failure and underwent a tracheostomy. On day 41 in the hospital, she complained of dysphagia and was a swallowing evaluation was done at the rehabilitation department. We ruled out other etiologies of upper esophageal dysfunction through a brain magnetic resonance imaging (MRI) and endoscopic evaluation. Through follow-up tests, it was found retrospectively that extreme dysphagia could have occurred through the following mechanism: the airway was not protected at the time of the tracheostomy because the movement of the epiglottis did not appear to be normal. This was due to the reduction in laryngeal function affecting the upper esophageal opening after the tracheostomy, and at the same time, the power to push the bolus was weak. After 6 months, at the third test, she had improved enough to ingest a soft diet and fluid with thickeners, so she was able to start an oral diet without decannulation. It is thus important to recognize that tracheostomy alone can cause extremely severe aspiration. If these findings are observed in patients undergoing tracheostomy, it is necessary to check the movements of the epiglottis properly and evaluate whether the condition can be improved by rehabilitation treatment.

Citron Essential Oils Alleviate the Mediators Related to Rosacea Pathophysiology in Epidermal Keratinocytes

BACKGROUND: Citron is well known for an abundance of antioxidative and anti-inflammatory ingredients such as vitamin C, polyphenol compounds, flavonoids, and limonoids. OBJECTIVE: In this study, we aimed to evaluate the effects of citron essential oils on rosacea mediators in activated keratinocytes in vitro. METHODS: Normal human epidermal keratinocytes (NHEKs) were stimulated with 1α, 25-dihydroxyvitamin D3 (VD3) and interleukin 33 (IL-33) with LL-37 to induce rosacea mediators such as kallikrein 5 (KLK5), cathelicidin, vascular endothelial growth factor (VEGF), and transient receptor potential vanilloid 1 (TRPV1). These mediators were analyzed by performing reverse-transcription polymerase chain reaction (PCR), quantitative real-time PCR, immunocytofluorescence and enzyme-linked immunosorbent assay after NHEKs were treated with citron seed and unripe citron essential oils. RESULTS: The messenger RNA (mRNA) and protein levels of KLK5 and LL-37 induced by VD3 were suppressed by citron seed and unripe citron essential oils. Furthermore, the mRNA and protein levels of VEGF and TRPV1 induced by IL-33 with LL-37 were also suppressed by citron essential oils. CONCLUSION: These results show that citron essential oils have suppressive effects on rosacea mediators in activated epidermal keratinocytes, which indicates that the citron essential oils may be valuable adjuvant therapeutic agents for rosacea.

Clinicopathological Analysis of Pigmented Contact Dermatitis Caused by Henna Dyeing / 대한피부과학회지

BACKGROUND: Henna is a natural dye derived from the leaves of the tree Lawsonia inermis known for its very low allergic properties. Recently, however, cases of pigmented contact dermatitis after henna dyeing have been increasing. OBJECTIVE: To analyze the clinical and histologic features of pigmented contact dermatitis caused by henna dyeing. METHODS: We retrospectively reviewed the clinical and histopathologic features of patients diagnosed with pigmented contact dermatitis after henna dyeing from June 2014 to August 2017. RESULTS: A total of 22 patients with a history of henna dyeing were included. All patients were female, and mean age was 58.9±8.2 years. They presented with rapidly spreading dark brownish patches located mostly adjacent to the hairline, such as at the forehead, temple, and lateral cheek. The mean duration between symptom onset and henna dyeing was 4.52 months (0~15). Standard patch test and as is test using henna showed no significant results. There were 18 patients with pruritus, which was only present at the early stage. Histopathologic examinations showed lichenoid inflammation with dermal melanin incontinence, vacuolar alteration, epidermal apoptotic cells, and perivascular inflammation. CONCLUSION: These results suggest that pigmented contact dermatitis observed after henna dyeing was caused by the toxicity of henna itself, not by other additives. The active ingredient of henna is lawsone (2-hydroxy-1,4-naphthoquinone), which may have induced pigmented contact dermatitis by its own cellular toxicity. Dermatologists should consider henna dyeing as a potential cause of pigmentation of the face and neck.

A Case of Trichoblastoma, Tumor of the Follicular Infundibulum, Sebaceoma, and Sebaceous Hyperplasia Arising from Nevus Sebaceus / 대한피부과학회지

Nevus sebaceus is a congenital hamartoma with epidermal, follicular, and apocrine elements. Several skin appendage tumors can evolve secondarily from nevus sebaceus. Two different tumors often develop simultaneously on a nevus sebaceus lesion, but the growth of more than two tumors is rare. Herein, we report a case of four appendage tumors including trichoblastoma, tumor of the follicular infundibulum, sebaceoma, and sebaceous hyperplasia within a single nevus sebaceus lesion on the face of a 76-year-old female.

Bullae-Forming Pulmonary Metastasis from Choriocarcinoma Presenting as Pneumothorax

Gestational trophoblastic disease (GTD) is a condition of uncertain etiology, choriocarcioma, or placental-site hydatidiform moles, invasive moles, choriocarcinoma, and placental-site trophoblastic tumors. It arises from the abnormal proliferation of trophoblastic tissue and spreads beyond the uterus hematogenously. The early diagnosis of GTD is important to ensure timely and successful management and the preservation of fertility. We report the unusual case of a metastatic choriocarcinoma that formed bullae on the lung surface and presented as recurrent pneumothorax in a 38-year-old woman with elevated beta-human chorionic gonadotropin (hCG) levels. She underwent thoracoscopic wedge resection of the involved lung and four subsequent cycles of consolidation chemotherapy. No other evidence of metastatic disease or recurrent pneumothorax was noted during 22 months of follow-up. GTD should be considered in the differential diagnosis of spontaneous pneumothorax in reproductive-age women with an antecedent pregnancy and abnormal beta-hCG levels.