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In this study, we have successfully established a high-performance thin-layer chromatography (HPTLC) method for the quality assessment of Actinidiae Fructus Vermicultus, known as Mokcheonryo(ja) in Korea. This is the dried vermiculate fruit of Actinidia polygama and A. kolomikta, as stipulated by the Korean Herbal Pharmacopoeia (KHP). However, the Korean herbal market often witnesses the inclusion and distribution of ‘Mihudo’, an alternative herbal product sourced from the dried fruits of A. arguta, belonging to the same botanical genus. This confluence has raised substantial apprehensions concerning the veracity of quality. In response to this concern, we have meticulously developed an HPTLC analytical methodology capable of differentiation between Mokcheonryo and Mihudo by exploiting their distinct chemical profiles. We identified umbelliferone as a key marker compound for Mokcheonryo and quantified the content of umbelliferone in each sample using a TLC scanner. Throughout this study, we confirmed distinct fingerprints for Mokcheonryo and Mihudo, providing a reliable means to differentiate between these two herbal medicines. Furthermore, the presence of umbelliferone in Mokcheonryo serves as an indicator compound for quality assessment. The proposed HPTLC method offers a practical and effective tool for ensuring the quality and authenticity of Mokcheonryo in the herbal market.
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Objective@#This study tried to observe additional benefit of agomelatine (AGO) treatment for major depressive disorder (MDD) in routine practice. @*Methods@#Retrospective chart review (n = 63) was conducted for additional benefit of combination with or switching to AGO in MDD patients without full remission. The primary endpoint was the mean change of Clinical Global Impression-Clinical Benefit (CGI-CB) total scores from baseline to the endpoint. Additional secondary endpoints were also collected. @*Results@#The changes of CGI-CB (Z = −3.073, p = 0.002) and Montgomery-Åsberg Depression Rating Scale (Z = −3.483, p ＜ 0.001) total scores were significantly decreased from baseline to the endpoint, respectively. At the endpoint, the remission rate was 22.6% (n = 18) and 28.6% of patient had improvement in CGI-CB total scores at the endpoint.No significant adverse events were observed. @*Conclusion@#This study has shown additional benefit of AGO treatment as combination or switching agent for MDD patients without full remission in routine practice. However, adequately-powered and well-controlled studies are necessary for generalization of the present findings.
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Purpose@#To investigate the clinical results of vitrectomy alone as the primary treatment for rhegmatogenous retinal detachment (RD) in patients with atopic dermatitis (AD). @*Methods@#The medical records of patients with AD treated for rhegmatogenous retinal detachment (RD) were retrospectively reviewed. We investigated the characteristics of retinal breaks and detachments, applied surgical methods, and results. @*Results@#Twenty eyes of 14 patients with AD who presented with rhegmatogenous RD and treated by vitrectomy were included in this analysis. Sixteen eyes (80%) were treated with vitrectomy, either alone or in combination with cataract surgery, and the retina was successfully attached to 94% of the eyes. There were four cases in which vitrectomy was combined with encircling. Reoperation was needed in half of the eyes that received vitrectomy with encircling, which presented nearly total detachment, severe proliferative vitreoretinopathy, and pseudophakia. @*Conclusions@#Vitrectomy alone, in combination with cataract surgery, may be sufficient to treat rhegmatogenous RD in patients with AD. Additional encircling or buckling should still be considered in complicated cases.
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Juvenile gangrenous vasculitis is characterized by the abrupt onset of scrotal ulcerations in young males, preceded by fever and pharyngeal symptoms. The etiology of this disease is poorly understood. The course is benign and self-limiting within a few weeks with no relapse. Because of its rare incidence, physicians often confuse it with Fournier’s gangrene, which progresses rapidly to severe systemic symptoms requiring urgent surgical intervention. Herein, we report a rare case of juvenile gangrenous vasculitis of the scrotum and emphasize the importance of awareness of this diagnosis to avoid unnecessary invasive surgical intervention. A 17-year-old boy presented with painful and tender, diffuse erythema and swelling with a necrotic lesion on the scrotum for three days. Preceding the cutaneous manifestations, he had a fever and sore throat. Physical examination showed an about 2 cmsized well-demarcated necrotic lesion on the anterior scrotum. Laboratory findings revealed neutrophilic leukocytosis with an elevated C-reactive protein and erythrocyte sedimentation rate. On scrotal ultrasonography, only edematous skin thickening and an increase in vascularity were observed. Histopathological examination showed epidermal necrosis and dermal neutrophilic infiltration. Empirical antibiotic treatment with ampicillin/sulbactam and clindamycin was administered and a prompt clinical resolution was observed.
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Collision tumors in which two different skin tumors appear in one lesion have often been reported. The cause of the collision tumor is not clearly known, but there is an opinion that it is a simple coincidence, and other authors assumed that one tumor will cause another. This rare but well-documented phenomenon often presents a diagnostic challenge to dermatologists due to its unusual and nonspecific presentation. We experienced a case of a 32-year-old woman who came to our hospital with a 1.5×1.5-cm-sized red-brown nodule with a surrounding brown patch on her right posterior shoulder that had been present since her childhood. Histologically, this lesion was thought to be a collision tumor with dermatofibroma and Ito nevus in the same lesion. No further treatment was done for this patient and a close follow-up is ongoing. Herein, we reported a first case of collision tumor with dermatofibroma and Ito nevus.
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Background@#The phenotypic heterogeneity of psoriasis is suspected to reflect differences in its pathogenesis, but not yet completely elucidated. Studies of the Th1 and Th17 cytokines associated with different phenotypes of psoriasis have yielded inconsistent results. @*Objective@#To investigate the tissue expression levels of Th1 and Th17 cytokines among patients with chronic plaque psoriasis, acute guttate psoriasis, and healthy control. @*Methods@#A total of 20 patients with psoriasis (10 with chronic plaque type and 10 with acute guttate type) and 5 healthy controls were enrolled. The tissue mRNA and protein levels of following cytokines were measured: interleukin (IL)-12, IL-2, interferon (IFN)-γ, IL-23, IL-17A, and IL-22. @*Results@#The tissue mRNA levels of IL-12, IFN-γ, IL-23, IL-17A, IL-22 and the protein levels of IL-12, IL-2, IFN-γ, IL-17A, IL-22 were significantly increased in the psoriasis patients compared with the healthy controls. In comparisons of the subtypes, the tissue mRNA level of IFN-γ was increased in acute guttate psoriasis, whereas the protein levels of IL-12 and IL-17A were significantly increased in chronic plaque psoriasis. The cytokine ratios of IL-17A/IL-2 and IL-22/IL-2 were significantly higher in chronic plaque psoriasis than in acute guttate psoriasis. @*Conclusion@#We confirmed that the tissue levels of Th1 and Th17 cytokines were increased in psoriasis patients compared with healthy controls. The increased IFN-γ mRNA level in acute guttate psoriasis and increased IL-12 and IL-17A protein levels in chronic plaque psoriasis suggest that an imbalance between Th1 and Th17 cytokines may play a role in the phenotypic transition of psoriasis.
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Background@#Contrast media have been widely used for the diagnosis of numerous diseases. Although they are generally safe, the reported number of hypersensitivity reactions to contrast media has increased annually. @*Objective@#We aimed to investigate the incidence of hypersensitivity reactions due to intravenous nonionic contrast media. Also, we investigated whether the risk of contrast media-associated hypersensitivity was increased by specific types of contrast agents. @*Methods@#We performed a retrospective review of patients who had hypersensitivity reactions after enhanced computed tomography scans at Bucheon St. Mary’s Hospital, Bucheon, Korea from January 2016 to December 2019.We classified the hypersensitivity reactions into immediate (＜1 hour) or delayed (≥1 hour) reactions. All demographic data and information regarding the hypersensitivity reactions were obtained from the electronic medical records. @*Results@#The overall incidence of hypersensitivity reactions to contrast media was 0.49% (262 cases resulting from 53,733 exposures). The incidence increased annually from 0.19% in 2016 to 0.86% in 2019. Among the 262 cases, 199 cases (76.0%) were immediate-type while the delayed-type accounted for 63 cases (24.0%). The immediate hypersensitivity reaction incidence was not significantly different among contrast agents. However, the incidence of the delayed-type was significantly different (ranging from 0.02% for iomeprol to 0.25% for iodixanol, p＜0.05). @*Conclusion@#This study found that the hypersensitivity reaction incidence has increased annually. Immediate hypersensitivity reactions occurred at a higher rate than delayed hypersensitivity reactions. The incidence of delayed hypersensitivity reactions was significantly greater in patients who received iodixanol than in those who received the other types.
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Total excision is the treatment of choice of congenital melanocytic nevus. However, it is often infeasible, laser therapy is being explored as a useful therapeutic approach. A 26-year-old woman presented with a solitary, skin-colored plaque surrounded by whitish patches on her right calf. She was diagnosed with a congenital melanocytic nevus and underwent 84 laser treatment sessions using a 1,064 nm Nd:YAG laser over 7 years. Histopathological examination of the whitish plaque revealed small foci of nevus cells that penetrated the tissue to a depth that was 12-fold higher than the epidermal depth (1,260 μm). No report in the literature describes histopathological findings of a congenital melanocytic nevus treated with 84 sessions of laser therapy. This case report highlights the depth of penetration of pigment laser to treat a congenital melanocytic nevus. Our findings will serve as useful clinical guidelines to perform laser treatment for congenital melanocytic nevi.
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Objective@#We report the results of pharmacogenomics-based antidepressant treatment (PGXt) results in treating treatment-resistant major depressive disorder (TRD) patients in real practice. @*Methods@#Nine patients were prescribed NeuropharmagenⓇ for selection of antidepressants for individual patient and their clinical outcomes were followed. @*Results@#After treatment by PGXt results from current antidepressants, substantial reduction of depressive symptoms was observed at some point and maintained during observation period in six patients. @*Conclusion@#Our case series potentially shows the clinical utility and benefit of PGXt for treatment of TRD patients.
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In Asian countries, acupuncture with gold threads has been widely used in the treatment of pain. However, several reports have suggested that the implanted gold threads can become fragmented and migrate to other parts of the body, damaging surrounding tissues. A 75-year-old female presented with diffuse erythematous edema with multiple vesicles on the right lower leg for 3 days. She had previously suffered from cellulitis on the same region twice for the last 1year. Her past medical history included acupuncture with gold threads on the back due to lumbar herniated nucleus pulposus (HNP) about 10 years ago. Histopathological examination demonstrated marked subepithelial edema and diffuse perivascular infiltrate of inflammatory cells in the dermis. Simple radiography of the leg revealed numerous radiodense threads in the soft tissue. Since the patient did not receive acupuncture on any other sites except on the back, we hypothesized that the gold threads injected on the back may have migrated through the vessels to the leg. These metal fragments can cause inflammatory reaction and make the tissues more susceptible to secondary infections. The lesion gradually improved after treatment with systemic steroid and antibiotics for 1 week.
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Background@#Contrast media have been widely used for the diagnosis of numerous diseases. Although they are generally safe, the reported number of hypersensitivity reactions to contrast media has increased annually. @*Objective@#We aimed to investigate the incidence of hypersensitivity reactions due to intravenous nonionic contrast media. Also, we investigated whether the risk of contrast media-associated hypersensitivity was increased by specific types of contrast agents. @*Methods@#We performed a retrospective review of patients who had hypersensitivity reactions after enhanced computed tomography scans at Bucheon St. Mary’s Hospital, Bucheon, Korea from January 2016 to December 2019.We classified the hypersensitivity reactions into immediate (＜1 hour) or delayed (≥1 hour) reactions. All demographic data and information regarding the hypersensitivity reactions were obtained from the electronic medical records. @*Results@#The overall incidence of hypersensitivity reactions to contrast media was 0.49% (262 cases resulting from 53,733 exposures). The incidence increased annually from 0.19% in 2016 to 0.86% in 2019. Among the 262 cases, 199 cases (76.0%) were immediate-type while the delayed-type accounted for 63 cases (24.0%). The immediate hypersensitivity reaction incidence was not significantly different among contrast agents. However, the incidence of the delayed-type was significantly different (ranging from 0.02% for iomeprol to 0.25% for iodixanol, p＜0.05). @*Conclusion@#This study found that the hypersensitivity reaction incidence has increased annually. Immediate hypersensitivity reactions occurred at a higher rate than delayed hypersensitivity reactions. The incidence of delayed hypersensitivity reactions was significantly greater in patients who received iodixanol than in those who received the other types.
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Total excision is the treatment of choice of congenital melanocytic nevus. However, it is often infeasible, laser therapy is being explored as a useful therapeutic approach. A 26-year-old woman presented with a solitary, skin-colored plaque surrounded by whitish patches on her right calf. She was diagnosed with a congenital melanocytic nevus and underwent 84 laser treatment sessions using a 1,064 nm Nd:YAG laser over 7 years. Histopathological examination of the whitish plaque revealed small foci of nevus cells that penetrated the tissue to a depth that was 12-fold higher than the epidermal depth (1,260 μm). No report in the literature describes histopathological findings of a congenital melanocytic nevus treated with 84 sessions of laser therapy. This case report highlights the depth of penetration of pigment laser to treat a congenital melanocytic nevus. Our findings will serve as useful clinical guidelines to perform laser treatment for congenital melanocytic nevi.
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In Asian countries, acupuncture with gold threads has been widely used in the treatment of pain. However, several reports have suggested that the implanted gold threads can become fragmented and migrate to other parts of the body, damaging surrounding tissues. A 75-year-old female presented with diffuse erythematous edema with multiple vesicles on the right lower leg for 3 days. She had previously suffered from cellulitis on the same region twice for the last 1year. Her past medical history included acupuncture with gold threads on the back due to lumbar herniated nucleus pulposus (HNP) about 10 years ago. Histopathological examination demonstrated marked subepithelial edema and diffuse perivascular infiltrate of inflammatory cells in the dermis. Simple radiography of the leg revealed numerous radiodense threads in the soft tissue. Since the patient did not receive acupuncture on any other sites except on the back, we hypothesized that the gold threads injected on the back may have migrated through the vessels to the leg. These metal fragments can cause inflammatory reaction and make the tissues more susceptible to secondary infections. The lesion gradually improved after treatment with systemic steroid and antibiotics for 1 week.
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Immunoglobulin G4-related disease (IgG4-RD) is a recently discovered condition that was first reported in 2001. It is characterized by IgG4-positive plasma cell infiltration. Cutaneous involvement is rare but increasingly reported. A 48-year-old male presented with multiple, black-brown, indurated plaques on his trunk and axillae. Laboratory examination revealed anemia of unknown etiology and hyperglobulinemia with markedly elevated serum IgG and IgG4 levels. Histopathologic examination showed lymphoplasmacytic infiltration with abundant IgG4-positive plasma cells. The bone marrow biopsy results were consistent with the skin biopsy. Computed tomography demonstrated multiple lymph node involvement. Under the care of the rheumatology department, the patient has been treated with a systemic steroid and immunosuppressive agents, and he has shown gradual improvement in the laboratory findings.
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Lipoma is a very common benign tumor of the adipose tissue, but it occurs infrequently in the oral cavity. A 66-year-old man presented with an asymptomatic, solitary, 1×1-cm-sized yellowish mass on the lower lip, since 2 years. For differential diagnosis, skin biopsy was performed, and histopathologic examination showed features indicative of lipoma. We herein report a rare case of oral lipoma occurring on the lower lip.
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Objective@#To test clinical effectiveness and tolerability of Korean Red Ginseng augmentation (RGA) in major depressive disorder (MDD) patients with difficult-to-treat. @*Methods@#Thirty six patients were enrolled in this 6 weeks, prospective, clinical trial. Rating scales were MontgomeryÅsberg Depression Rating Scale (MADRS), Patient Health Questionnaire-15, Clinical Global Impression-improvement (CGI-I), and Patient Satisfaction Score. The primary endpoint was a remission rate measured by MADRS score at the end of study (≤ 10). Clinical outcomes and tolerability were assessed at baseline, week 2, and week 6. @*Results@#Among 36 patients, 26 patients completed the study and 28 patients had post-baseline visit data. The remission rate by MADRS score was 39.3% (11/28) and 57.1% by CGI-I scores of 1 or 2 at the end of the study. The mean change of MADRS score was significantly decreased by 44.4% from baseline to the end of study. The most frequent adverse events were headache (7/28, 25.0%) during the study. @*Conclusion@#Our study indicates the putative effectiveness and tolerability of RGA for treating MDD with difficult-to-treat in clinical practice. However, adequately powered, randomized, controlled trials will be needed to confirm these results.
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Objective@#There has been a lack of data regarding the usefulness and clinical characteristic between patients-treated with and without antidepressants (Pw/Pwo ADs). @*Methods@#One hundred and eighty inpatients were recruited and observed for a 6-month. The depressive, cognitive, daily activity, and motor symptoms were evaluated at baseline and tracked at month 6, with the use of rating scales including Beck Depression Inventory (BDI), Mini Mental State Examination (MMSE), Global Deterioration Scale (GDS), modified Rankin Scale (MRS), modified Barthel Index (MBI), and Berg Balance Scale (BBS). @*Results@#Among 178 patients, 84 (47.2%) were treated with ADs. PwAD had numerically or significantly higher depressive cognitive, and motor symptoms along with daily activity impairment (8.3 point higher in BDI score, p ＜ 0.001;3.6 point lower in MMSE, p = 0.003; 0.8 point higher in GDS score, p = nonsignificant; 8.2 point lower in BBS score, p = 0.053, and 0.4 point higher in MBI score, p = nonsignificant) than PwoAD. Psychiatric consultation was also significantly higher in PwAD than in PwoAD (p ＜ 0.001). The numbers need to treat for good clinical outcomes between PwAD and PwoAD were 5.8, 6.0, and 7.5, respectively, by MRS, MBI, and BBS scores. @*Conclusion@#Our findings suggest the potential utility of AD treatment and different clinical parameters between patients-treated with and without ADs. Adequately-powered and well-controlled further studies are mandatory to confirm and fully elaborate such association.
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Acquired periungual fibrokeratoma, first reported by Cahn in 1977, is a rare, benign fibrous tissue tumor located in the periungual area. The pathophysiology of acquired periungual fibrokeratoma is unknown. In general, trauma is often thought to be a predisposing factor. A 57-year-old woman presented with a 15-year-old asymptomatic, solitary, 1.8×1.5-cm, skin-colored mass on the Lt. thumb nail. The patient reported that they had been wounded on the nail root and the mass had since grown. For differential diagnosis and to determine the extent of the tumor, MRI of the finger was performed. Radiologic presentation showed a non-enhancing T2 low, T1 low signal mass above the nail plate. Histopathologic examination demonstrated a dome-shaped tumor consisting of thick dermal collagen bundles with increased capillaries. Through clinical, radiological, and histopathologic findings, we diagnosed the tumor as acquired periungual fibrokeratoma, and the lesion was removed through complete excision. Herein, we present a rare case of acquired fibrokeratoma covering whole thumb. The specific diagnosis was aided by MRI more through the acquisition of more accurate information about the location and signal characteristics that reflect underlying pathological features.
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PURPOSE: This study evaluated the clinical and radiological results of 6.5 mm full threaded cancellous bone screw fixation of calcaneal fractures. MATERIALS AND METHODS: Thirty seven patients diagnosed with Sanders type II or III calcaneal fractures, who underwent open reduction and internal fixation with a 6.5 mm full threaded cancellous bone screw between August 2014 and August 2017, were analyzed. Both the preoperative and postoperative Böhler angle and Gissane angle were measured radiographically. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale on the final follow-up were also assessed. RESULTS: The mean age of the patients was 52.7 years and the mean follow-up period was 29.5 months. In the Sanders classification, type II and III were 16 and 24 cases, respectively. The Böhler and Gissane angles improved from 21.2° and 122.6° preoperatively to 21.6° and 120.3°, respectively, in the postoperative radiographs. All cases achieved bony union, and the AOFAS ankle-hindfoot scale was 90.7 and 91.3 in Sanders type II and III, respectively, at the final follow-up. CONCLUSION: The treatment of calcaneal fractures using a 6.5 mm full threaded cancellous bone screw can reduce the complications with minimally invasive surgery and achieve firm fixation.
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Humanos , Tobillo , Tornillos Óseos , Calcáneo , Clasificación , Estudios de Seguimiento , Pie , Procedimientos Quirúrgicos Mínimamente InvasivosRESUMEN
Metastatic calcinosis cutis refers to the deposition of calcium salts in normal tissue secondary to an underlying defect in calcium and/or phosphate metabolism. It commonly affects periarticular areas in patients with chronic renal failure. We report a case of a 51-year-old man with a past medical history of peritoneal dialysis for chronic renal failure, who presented with multiple yellowish nodules on his right thumb. In view of the asymptomatic non-inflamed fluctuating nodules, the differential diagnoses included bacterial, tuberculous, atypical mycobacterial, or fungal infections. Histopathological and radiological examinations revealed calcifications in the right thumb and shoulder with elevated serum phosphorus and parathyroid hormone levels. The lesions improved after the patient was switched from peritoneal dialysis to hemodialysis. We report a case of metastatic calcinosis cutis in a patient with chronic renal failure. We emphasize the importance of imaging for accurate diagnosis and follow-up of calcinosis cutis and that hemodialysis scores over peritoneal dialysis in the treatment of this condition.