Influences of Socioeconomic Status on Short Stature in Childhood / 고신대학교의과대학학술지

Objectives@#Short stature in childhood is defined to the cases in which the stature is below 3 percentiles of the standard value in accordance with that of those in the same age and gender group. The influence of the socioeconomic status on the short stature in childhood are analyzed. @*Methods@#154 children from the community child center in a region of poor socioeconomic status and 78 children in normal socioeconomic status who visited the Busan Medical Center due to the issue of short stature were selected for examination and analysis. @*Results@#The prevalence rate of short stature at the community child center in 2 municipalities in Busan was confirmed to be 7.3%. In the comparison of the average growth parameters of poor socioeconomic status and normal socioeconomic status in the short stature group, there was no observation of significant difference in terms of the chronological age, midparental height, bone age, bone age/chronological age, height standard deviation score (SDS), body mass index(BMI) percentile and insulin like growth factor binding protein 3 (IGFBP3) SDS. In the short stature suspicious group, there was observation of significant difference in the averages of bone age, weight, BMI percentile , IGFBP3 and IGFBP3 SDS. @*Conclusions@#Although the prevalence rate of short stature in children belonging to the poor socioeconomic class was observed to be higher than the existing results, there was no significant difference in the growth parameters associated with the growth of the height from those of the children in normal socioeconomic status.

Donor-Site Morbidity after Partial Second Toe Pulp Free Flap for Fingertip Reconstruction

BACKGROUND: In this study, we characterize the morbidity at the donor-site of partial second toe pulp free flaps in terms of wound management as well as long-term outcomes. METHODS: A single-institutional retrospective review was performed for patients who had undergone partial second toe pulp free flap transfer to the fingertip. Patient charts were reviewed for infection, skin necrosis, wound dehiscence, and hematoma for the donor site. Additionally, a questionnaire survey was given to patients who had a follow-up of longer than 1 year to characterize long-term postoperative pain and appearance. RESULTS: The review identified a total of 246 cases. Early wound complications were significant for wound dehiscence (n=8) and hematoma (n=5) for a wound complication rate of 5.3%. The questionnaire was distributed to 109 patients, and 54 patients completed the survey. Out of these 54 patients, 15 patients continued to have donor-site pain (28%) at a mean follow-up period of 32.4 months. However, the pain intensity was relatively low in the range between 2 to 5, on a 0-10 scale. None of these patients felt this donor-site pain interfered significantly with daily activity, nor did any patient require pain medications of any type. Donor-site appearance was satisfactory to most patients. CONCLUSIONS: The partial second toe pulp flap was associated with low rates of wound complications and favorable long-term outcomes. Given the functional and aesthetic gain in the recipient finger, donor-site morbidities appear acceptable in this patient population. This study can be helpful in counseling patients regarding donor-site morbidity during the informed consent process.

Characteristics between IgE mediated and non-IgE mediated atopic dermatitis in children

PURPOSE: Atopic dermatitis (AD) is a chronic inflammatory skin disorder with a association of genetic, environmental, and immunologic factors in the development of AD. And AD can be classified into IgE mediated and non-IgE mediated. We investigated a difference of clinical characteristics and immune response between the two groups. METHODS: From January 2008 to December 2011, we enrolled 125 children who visited Dong-A University Medical Center and Busan Medical Center, and were diagnosed as AD with the Haniffin and Rajka's criteria. We checked the history of combined asthma and allergic rhinitis and allergic disease of family in patients. We measured serum total IgE, specific IgE by ImmunoCAP or skin prick test. We measured serum interleukin (IL) 4 (IL-4), interferon-gamma (IFN-gamma), IL-10, and IL-17, which are associated with chronic inflammatory disorder by flow cytometry method (Luminex). RESULTS: Eighty (64%) were included in the IgE mediated group, while forty-five (36%) were included in the non-IgE mediated group. The frequency of combined allergic disorder and serum total eosinophil count were relatively higher in IgE mediated group (P=0.023, P=0.032). The incidence of a family history in allergic disease and the mean of SCORing Atopic Dermatitis index had no difference between the two groups. Serum IL-4, IFN-gamma, IL-10, IL-17 were higher in the IgE mediated group, but there were no statistically significant differences between two groups (P>0.05). CONCLUSION: IgE mediated AD showed higher total eosinophil count and higher incidence of bronchial asthma and allergic rhinitis than non IgE mediated AD.

Comparison of Immune Response between Pediatric Bronchial Asthma and Sinusitis / 소아알레르기및호흡기학회지

PURPOSE: Bronchial asthma and sinusitis have been grouped together and classified as one airway-related disease, with the same underlying inflammatory etiology. Through serological examination, we ascertained a difference in the immune response between bronchial asthma and sinusitis. METHODS: We measured the peripheral blood eosinophil count, total IgE and specific IgE to 7 aeroallergens (Dermatophagoides pteronyssinus, Dermatophagoides farinae, Alternaria, cockroach, cat, dog and pollen), and interleukin (IL)-4 and interferon (IFN)-gamma of 118 school-aged patients who visited Dong-A University Medical Center and Busan Medical Center from March 2005 to February 2008. We divided these patients into 31 diagnosed with sinusitis (Group A), 36 diagnosed with bronchial asthma (Group B), and 51 diagnosed with both sinusitis and asthma (Group C). RESULTS: The peripheral blood eosinophil count and total IgE were markedly lower in group A. Dermatophagoides pteryonyssinus and Dermatophagoides farinae had higher sensitization rates than other aeroallergens in groups B and C. The sensitization rates to Alternaria and dog were higher in group C than in group B, and the sensitization rates to cat and pollen were higher in group B than in group C. In group C, clinical symptoms occurred evenly and allergic rhinitis was concurrent, similar to group B; however, the sensitivity of the bronchial provocation test was higher than in group B. Serum IL-4 in group B and C were significantly higher than in group A (P<0.001), and serum IFN-gamma was significantly higher in group A than in group C (P<0.027). CONCLUSION: Bronchial asthma was primarily related to IL-4 and Th2 cytokines, while sinusitis was primarily related to IFN-gamma and Th1 cytokines. According to the degree of association between the 2 diseases, various immune responses were observed.

Two Cases of Secondary Erythromelalgia Associated with Essential Hypertension / 대한피부과학회지

Erythromelalgia is a rare clinical syndrome characterized by redness and painful episodes of the feet and hands, which is triggered by heat or exercise. A 22-year-old male soldier presented with paroxysmal redness of the both feet associated with pain and tenderness upon heat stimulation, including wearing military shoes for periods of over 30 minutes. He had been treated of essential hypertension with dichlorothiazide and had a familial medical history of essential hypertension with his mother and brother. A 21-year-old male soldier also presented with paroxysmal redness of both feet and hands associated with pain and tenderness upon heat stimulation. By searching for the underlying or combined diseases of the erythromelalgia, he was also found to have essential hypertension. Herein, we report two cases of secondary erythromelalgia associated with essential hypertension.

Clinical usefulness of rapid antigen test to detect respiratory syncytial virus infection / 소아과

PURPOSE: Respiratory syncytial virus (RSV) is the most frequent cause of lower respiratory infections in infants and young children. Early detection allows quarantining of infected inpatients to prevent nosocomial transmission and to choose a treatment. To achieve rapid reporting, to facilitate prompt antiviral therapy, and to avoid unnecessary use of antibiotics, an easy, rapid diagnostic method for RSV is needed. We evaluated a lateral flow immunochromatography (RSV Respi-Strip test) and EIA (Enzyme immuno assay) compared to RT-PCR. METHODS: From April 2007 to March 2008, 112 consecutive respiratory specimens (nasopharyngeal aspirates, throat swabs, tracheal aspirates, sputum) from patients who were suffering from the clinical signs and symptoms of respiratory tract infection were enrolled in Busan. A total of 112 patients were tested with RSV Respi-Strip (Corio-BioConcept, Belgium), EIA, and RT-PCR at the same time. RESULTS: Of the 112 specimens tested, the number of children who showed positive results at RT-PCR and Respi-Strip were 45 and 42, respectively. The Respi-Strip rapid antigen test had a sensitivity of 88% and a specificity of 94%. The positive and negative predictive values were 90% and 92%, respectively. The agreement was 83%. CONCLUSION: In our study, the rapid antigen test had as much sensitivity as any method for detection of RSV. The test has many advantages such as easy performance, simple interpretation, and rapid results. If the rapid antigen test is widely applied in the clinical setting, the may be useful for diagnostic and epidemiological studies of RSV infection.

Two Cases of Ocular Ischemia following Scleral Encircling

PURPOSE: To report two cases of ocular ischemia following scleral encircling. METHODS: A 21-year-old man with glaucoma and a 76-year-old woman without any medical problem were transferred to our department for surgery to treat retinal detachment. After retrobulbar anesthesia and limbal peritomy of conjunctiva, the 4-rectus muscles were isolated. Scleral encircling was performed with No. a 42 band (4.0 mm in width) after cryotherapy done completely around retinal tear. RESULTS: Following surgery, One patient experienced ophthalmic artery occlusion and while the other patient experienced central retinal artery occlusion. Vision was not restored in either cases despite IV injection of 250 ml of 15% mannitol solution and anterior chamber paracentesis. CONCLUSIONS: In the cases where patients are of old age or suffer from glaucoma, we strongly recommend that the surgeons perform the scleral encircling carefully.

A Case of Iatrogenic Tension Pneumoperitoneum following Colonoscopy in a Patient with Cytomegalovirus Colitis / 대한소화기학회지

Perforation of the colon occurs in 0.2 to 2% of all colonoscopic examinations. The most common sites of perforation are rectosigmoid junction and cecal area. Colonic perforation, leading to tension pneumoperitoneum in most cases, may be caused by direct trauma or pressurized air. It should be suspected in patients with hypotension, tachycardia and tachypnea during or after the colonoscopy. An 83-year-old woman was admitted due to pulmonary embolism and left cerebellar infarction. Colonoscopy was performed due to bloody diarrhea. She was diagnosed as cytomegalovirus (CMV) colitis. One week after the colonoscopy, colon perforation was incidentally found on ascending colon, and tension pneumoperitoneum occurred immediately after the procedure. The perforated site was primarily closed and the patient discharged 20 days later. Herein, we report a case of tension pneumoperitoneum following colonoscopy in a patient with CMV colitis.

Comparison of hypertonic saline treatment in meningitis with cerebral edema / 소아과

PURPOSE: Cerebral edema in meningitis is a potentially complication. Hypertonic saline of various concentrations are frequently used to treat cerebral edemas in meningitis. We analyzed the safety and efficacy of osmotic therapy in cerebral edema by comparison of various hypertonic saline concentrations and mannitol. METHODS: The medical records of 42 patients, who were followed up in the Department of Pediatrics, Busan Medical Center, from Jan. 2002 to Oct. 2005, were analyzed retrospectively. We measured intracranial pressure, mean flow velocity, and various laboratory parameters. RESULTS: In cerebral edema developed in meningitis, intracranial pressure and symptoms were improved in treatment of hypertonic saline and mannitol. Serial bolus infusion of 3 percent hypertonic saline resulted in the best outcome. There was not a statistically considerable difference on the mean values of the intracranial pressure gap. On transcranial doppler, mean flow velocity was increased and pulsatilty index was decreased. Laboratory findings (osmolarity, Na, Cl, pH, lactic acid, Ca) were diffenent during the treatment period as opposed to K, Hb, bicarbonate, base excess. There was not a specific form of hypertonic saline used in meningitis treatment with cerebral edema. CONCLUSION: The therapy for cerebral edema in meningitis remains largely empirical. Serial bolus infusion of 3 percent hypertonic saline is better than other hypertonic salines. Various concentrations and different infusion methods of hypertonic saline statistically does not influence the result of treatment. More research aimed at improving cerebral edema treatment is needed to identify new, effective forms of treatment.

A Case of a Bitemporal Atrophic Scar induced by Morphea, and treated by Autologous Fat Transplantation / 대한피부과학회지

A contour change induced by a subcutaneous depleting disorder such as lupus or morphea can be corrected by filling the defect with an artificial or natural materials of the types of fillers, autologous fat is popularly utilized for volumetric correction. Autologus fat has many advantages, such as easy harvesting, free volume, and non-immunogenicity. Herein, we report a case who of a bilateral atrophic scar on the temple area induced by morphea which was successfully treated by autologous fat transplantation.

A Case of Pilar Sheath Acanthoma / 대한피부과학회지

Pilar sheath acanthoma is one of the benign follicular hamartoma, with a level of differentiation between trichofolliculoma and dilated pore of Winer. It differentiates toward infundibulum, isthmus, and rarely, sebaceous duct, apocrine, inner root sheath, and hair bulb components. It is a dome-shaped, symmetrical, sharply-circumscribed neoplasm that measures about 1cm in diameter. We herein report a case of pilar sheath acanthoma on the forehead of a 62-year-old male patient.

Use of Subcutaneous Pedicle Flap in Nasolabial Reconstruction / 대한피부과학회지

BACKGROUND: Surgery of the nasolabial area is susceptible to the distortion of lips, commissure and nasal ala. A subcutaneous pedicle flap is suitable for surgical treatment of mid-size facial defects. OBJECTIVE: To evaluate the effectiveness of a subcutaneous pedicle flap for surgical defects of the nasolabial area. METHOD: We reviewed the medical records and evaluated clinical aspects and surgical treatment outcomes. RESULTS: Total number of patients was 13, including 8 males and 5 females. Mean age was 67.7years-old. Surgical defects were present on the alar crease in 9 cases, and upper lip in 4 cases. Mean size of defects was 1.6 by 1.3 cm. Flaps were well adopted, and no surgical scars were visible. No distortion of the adjacent structures were left. However, the alar crease was slightly blunted in one patient. CONCLUSION: A subcutaneous pedicle flap is suitable for reconstruction of nasolabial area defects.

Reconstruction of Surgical Lip Defects after Malignant Tumor Excision / 대한피부과학회지

BACKGROUND: The lips have an asethetic and functional importance. There are various types of lip defects, and these are mainly due to tumor excision. Although there are numerous techniques available to repair the lips, no universal reconstruction method is presently available, and reconstruction of lip defects are inherently difficult. OBJECTIVE: To report surgical reconstruction results of lip defects. METHOD: Our study involved eleven patients, who had visited our dermatologic surgery clinic between 1995 and 2003, and had been histopathologically diagnosed as having either a basal cell carcinoma or squamous cell carcinoma on the lips. The medical records were reviewed, and clinical features, surgical methods, and cosmetic and functional results were evaluated. RESULTS: Wedge resection, resection with W-plasty, the subcutaneous pedicle flap, and dual mucosal flap technique were used to repair lip defects surgically. The vermilion border was aligned well in all the patients, and a post-operative scar was not apparent. However, a microstomia developed in one patient. CONCLUSION: The dermatologic surgeon should be familiar with various reconstruction options for lip defects. An appropriate choice depends on the size, location and depth of the defect. Specific functional and aesthetic aspects of the lips should be taken into account when planning and performing an operation.

Early course and Long term follow-up after Automated Percutaneous Lumbar Discectomy and Short term follow-up after Nucleoplasty / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study. OBJECTIVES: We wanted to compare the early course of APLD with the long term follow-up after APLD and also the long term follow up after APLD with the short term follow-up after nucleoplasty. SUMMARY OF LITERATURE REVIEW: We evaluated the postoperative clinical course of both APLD and nucleoplasty. The evaluation of the postoperative clinical course was performed by using the Oswestry Disability Index (ODI). MATERIALS AND METHODS: We studied 59 patients who underwent APLD and nucleoplasty from 1989 to 2004. We defined the 26 cases with less than 5 years follow up as the early course follow-up after APLD, the 20 cases with over 5 years follow up as the long term after APLD, and 13 cases with less than 5 years follow up as the short term follow up after nucleoplasty. We then compared three groups. We inspected the condition of the discs on MRI and the level of the operated disc. RESULTS: The most common type of disc was a protruded disc (69.4%). Its ODI was lower than that of the extruded type. 5 cases out of the total group underwent open discectomy after APLD. In our study, the extruded type patients underwent a worse clinical course than protruded type patients. The patients who under went procedures at two affected disc levels had higher ODI scores compared to patients who underwent procedures at one level. The ODI score of the early course follow-up after APLD was 12.4%, the ODI of the long term follow up was 6.9% and that of the short term follow-up after nucleoplasty was 4.6%. CONCLUSIONS: On the long term follow-up, the patients who underwent APLD had significant improvement for any of the clinical parameters, as compared with their preoperative status. The patients who underwent nucleoplasty had a better prognosis than those patient who underwent APLD with less than 5 years follow up.

Superficial Spreading Melanoma in A White Female Patient with a Family History of Melanoma / 대한피부과학회지

Recent days, many foreigners visit Korea and our dermatology clinics are not the exception. It is necessary to know the skin diseases of the foreigners, especially whose skin color is different from that of Korean. We are presenting the case of superficial spreading melanoma in a 31-year old white female. It was difficult to suspect her skin lesion as melanoma clinically. Her mother and sister had the history of malignant melanoma. We should remember that malignant melanoma is much more common in white persons and may look different from that of ours.

Clinical Study of 40 Cases with Mycosis Fungoides / 대한피부과학회지

BACKGROUND: Mycosis fungoides (MF) is the most common form of cutaneous T cell Lymphoma (CTCL). In Korea, the incidence rate of MF is very low and few clinical reviews have been done. OBJECTIVE: To investigate the clinical characteristics and treatment status of MF in Koreans. METHODS: A retrospective clinical study was made on 40 cases of MF patients. RESULTS: The mean age of onset was 45.3 years and the male to female ratio was approximately 1: 1. However, in the more advanced diseases, male patients were more frequent. According to the clinical stage by skin lesion at diagnosis, 26 were patch stage, 9 were plaque stage, and 5 were tumor stage patients. Two of the nine plaque stage patients had shown disease progression to the tumor stage. Twelve of the forty patients had been performed staging work up. The mean number of treatment modalities per patient was 1.53 with less in the early stages and more in the late stages being used. In the early stage, topical steroid was most commonly used and next were PUVA, UVB, and radiation therapy. For the advanced lesions, radiation therapy was most commonly used. The effect of chemotherapy was not good because it was used in refractory disease or extracutaneous diseases. In 40 MF patients, only one patient had died due to MF progression and most of the patients have shown stationary disease courses. Two patients have maintained complete remission. CONCLUSION: MF in Koreans shows some characteristics such as an earlier onset, less advanced stage, and better prognosis. It is necessary to perform staging work up at diagnosis not only for better patient care but also for more exact clinical studies.

A Case of Pyoderma Gangrenosum Treated with Topical Tacrolimus and Oral Cyclosporin / 대한피부과학회지

Pyoderma gangrenosum is a chronic inflammatory skin disease, characterized by the recurring destructive and painful skin ulcers. Although the mainstay of therapy is the systemic administration of high doses of corticosteroids, many other treatment modalities have been widely used. Recently, there have been several reports of the successful treatment of pyoderma gangrenosum using topical tacrolimus. We report a successful treatment of pyoderma gangrenosum with combination therapy of topical tacrolimus and systemic cyclosporin.

A serologically diagnosed human case of cutaneous larva migrans caused by Ancylostoma caninum

A 15-year-old boy, who had recently arrived back from a trip to Cambodia for a missionary camp, presented with several serpiginous thread-like skin lesions that began as small papules on the left upper extremities 2 weeks before his visit to Hospital. The skin lesions were pruritic and erythematous, and had migrated to the chest and abdomen. The histopathological findings showed only lymphocytic and eosinophilic infiltrations in the dermis of the biopsied skin lesion. The patient's serum reacted strongly to the Ancylostoma caninum antigen by an ELISA method. Therefore, he was diagnosed with cutaneous larva migrans by A. caninum. After the oral administration of albendazole and ivermectin, the skin lesions resolved without recurrence. This is the first reported case of a cutaneous larva migrans caused by Ancylostoma canimum diagnosed serologically using ELISA in Korea.

Alteration of Interleukin-6 Levels in Serum and Cerebrospinal Fluid after Head Injury in Adults

OBJECTIVE: The cytokine interleukin-6(IL-6) plays a major role in initiating the acute phase response, especially in the production of acute phase reactants. The objective of this study is to determine whether serum IL-6 and cerebrospinal fluid(CSF) IL-6 levels were elevated at time of admission after head injury, serum IL-6 and CSF IL-6 levels related temporally to clinical improvement, severity of head injury with Glasgow Coma Scale(GCS) score and increased intracranial pressure(IICP). METHODS: All 21 patients(19 males and 2 females) with brain injury, managed in our institute between Aug 1996 and Jun 1998 were included in this study. Serum samples from all the 21 patients and CSF samples from 12 patients with low GCS score were analyzed for IL-6. IL-6 determination with enzyme-linked ELISA kits obtained from Quantikine(r). RESULTS: The values of IL-6 in serum and CSF in 21 patients with GCS score between 4 and 14(mean=9) were observed for 3-5 days after head injury. Peak elevation of serum IL-6 was observed on first day(8.2+/-4.9pg/ml) and then decreased to 4.0+/-3.6pg/ml on fifth day. Serum IL-6 levels decreased significantly faster in patients with GCS score of 8 through 11, compared with those of GCS score below 8. The patients showed markedly elevated and variable CSF IL-6 levels on admission(46.6+/-4.2pg/ml;normal, below 20.6+/-5.8pg/ml). CONCLUSION: This study demonstrates that the IL-6 level is related to the severity of traumatic brain injury.

Alteration of Interleukin-6 Levels in Serum and Cerebrospinal Fluid after Head Injury in Adults

OBJECTIVE: The cytokine interleukin-6(IL-6) plays a major role in initiating the acute phase response, especially in the production of acute phase reactants. The objective of this study is to determine whether serum IL-6 and cerebrospinal fluid(CSF) IL-6 levels were elevated at time of admission after head injury, serum IL-6 and CSF IL-6 levels related temporally to clinical improvement, severity of head injury with Glasgow Coma Scale(GCS) score and increased intracranial pressure(IICP). METHODS: All 21 patients(19 males and 2 females) with brain injury, managed in our institute between Aug 1996 and Jun 1998 were included in this study. Serum samples from all the 21 patients and CSF samples from 12 patients with low GCS score were analyzed for IL-6. IL-6 determination with enzyme-linked ELISA kits obtained from Quantikine(r). RESULTS: The values of IL-6 in serum and CSF in 21 patients with GCS score between 4 and 14(mean=9) were observed for 3-5 days after head injury. Peak elevation of serum IL-6 was observed on first day(8.2+/-4.9pg/ml) and then decreased to 4.0+/-3.6pg/ml on fifth day. Serum IL-6 levels decreased significantly faster in patients with GCS score of 8 through 11, compared with those of GCS score below 8. The patients showed markedly elevated and variable CSF IL-6 levels on admission(46.6+/-4.2pg/ml;normal, below 20.6+/-5.8pg/ml). CONCLUSION: This study demonstrates that the IL-6 level is related to the severity of traumatic brain injury.