Advances in brucellosis with osteoarthritis / 中华地方病学杂志

Brucellosis is a zoonotic disease caused by Brucella,and osteoarthritis can be caused when the bone and joint system is involved.In this paper,epidemiology,pathogenesis,clinical manifestation and diagnosis of brucellosis are discussed in detail.At the same time,a better understanding of the clinical characteristics of brucellosis helps clinicians in better diagnosis and treatment of brucellosis.

A Comparative Study of the Clinical Findings Associated with Herpes Zoster and According to Age / 대한피부과학회지

BACKGROUND: Patients with herpes zoster generally complain typical manifestations, including prodromal pain, a grouped vesicular rash and prickling pain on unilateral dermatomes. However, there have been a few reports showing clinical differences by age. OBJECTIVE: The purpose of this study was to evaluate the clinical differences among the various aged populations that suffer with herpes zoster. METHODS: The medical records of 921 patients who were diagnosed with herpes zoster at our institution between January 2002 and December 2008 were reviewed, and if necessary, telephone interviews were done. According to the age groups as classified with a decade-scale, the data was assessed with respect to gender, seasonal occurrence, the dermatomal distribution, prodromal pain, the chief symptom, the range of lesion, underlying diseases and postherpetic neuralgia. RESULTS: The mean age of the subjects was 57.7 and the ratio of males to females was 1:1.4. The proportions of female patients gradually increased in the over 40 year-old group (p<0.001). As one grows older, there is a trend for a higher occurrence of herpes zoster in winter (p=0.011). The likelihood of attacks on the trigeminal dermatome appeared to increase with age, but that of the spinal dermatomes, including the cervical, thoracic and lumbosacral area, showed a decrease with age (p=0.01). The rate of prodromal pain was higher with age (p=0.004). The rate of prickling pain increased with age, but that of pruritus decreased with age (p=0.001). The presence of widely involved lesion (p=0.013), an underlying disease (p<0.001) and postherpetic neuralgia (p<0.001) increased with age. CONCLUSION: The results of this study demonstrated that the clinical findings associated with herpes zoster were not always consistent in different aged populations. The rate of female patients, occurrence in winter, an attack on the trigeminal dermatome, prodromal pain, prickling pain, larger lesion, underlying disease and postherpetic neuralgia showed a tendency to increase with age.

A Study of Reconstruction Methods for 186 Cases after Complete Excision ofNonmelanoma Skin Cancers / 대한피부과학회지

BACKGROUND: Skin cancer is divided into two categories, melanoma and nonmelanoma skin cancer, by its malignant potential. The former is prone to be metastatic and it often requires regional lymph node dissection and chemotherapy, while the latter is rarely metastatic with no need for such further treatment. We report here on the reconstruction methods after surgical removal of skin cancers, with excluding melanoma. OBJECTIVE: Our purpose was to analyze the reconstruction methods according to the location and size of the lesions after surgical removal of nonmelanoma skin cancers and we report on the clinical findings. METHODS: We analyzed 186 cases of nonmelanoma skin cancers that were treated Between January, 2000 and December, 2006 at the Department of Dermatology, Chonbuk University Hospital. The cases were analyzed according to the reconstruction methods for the defects after surgery, the gender ratio, the age range, the lesion site and the lesion size. RESULTS: The mean age of onset was 67.7 years old. The ratio of men to women was 1:1.02. The most common nonmelanoma skin cancer was basal cell carcinoma (66.7%), followed by squamous cell carcinoma (22.1%), and Bowen's disease (4.3%). The most common site of all the nonmelanoma skin cancers was the face (68.8%), followed by the trunk (7.5%) and scalp (6.5%). The most common reconstruction method was local flap (40.3%), followed by primary closure (38.7%), skin graft (18.8%) and secondary intention (2.2%). In terms of location, the most commonly used method was local flap for the face (50.0%) and primary closure for the trunk (53.3%), scalp (83.3%) and the upper (44.4%) and lower extremities (63.6%). According to the lesions' size, the most common method was flap for tumor between 10 mm and 30 mm in diameter (95.1%), primary closure for tumor less than 10 mm in diameter (66.7%) and graft for tumor greater than 30 mm in diameter (66.7%). CONCLUSION: We offer this data for the reconstruction methods of nonmelanoma skin cancers and their clinical findings in Korea.

Clinical Findings of Genotypes in Korean Patients with Glycogen Storage Disease Type Ia / 소아과

PURPOSE: Glycogen storage disease type Ia (GSD Ia) is an autosomal recessive disorder caused by the deficiency of glucose-6-phosphatase (G6Pase). The aim of the study was to investigate the spectrum of G6Pase gene mutations and relationship between genotype and clinical findings in Korean patients with GSD Ia. METHODS: Genomic DNA was extracted from peripheral leukocytes of 20 patients with GSD Ia. The five exons of G6Pase gene were amplified and PCR products were directly sequenced. The frequency of short stature, hypoglycemia, hypercholesterolemia, hyperuricemia, hypercalciuria, nephrocalcinosis and hepatic adenoma was compared between 727G> T homozygotes and 727G> T compound heterozygotes. RESULTS: A total of 5 different mutations were identified. The most common mutation was the 727G> T with an allele frequency of 80%. All patients were either homozygous (12/20) or heterozygous (8/20) for the 727G> T mutation. G122D was found in 3 patients, P178A in 1, G222R in 2, and S339R in 2. There was no difference in the frequency of short stature, hypoglycemia, hypercholesterolemia, hyperuricemia, nephrocalcinosis, and hepatic adenoma between 727G> T homozygotes and heterozygotes. CONCLUSION: Diagnosis of GSD Ia can be based on clinical and biochemical abnormalities combined with mutation analysis instead of enzymatic diagnosis that requires liver biopsy. Homozygosity for the 727G> T does not seem to alter the disease phenotype as compared with the heterozygous state.

Clinical Features of 27 Cases of Ingrowing Toenails and Treatment with Flexible Plastic Tube Insertion / 대한피부과학회지

BACKGROUND: Ingrowing toenail is one of common dermatological disorders causing significant daily disability. Clinical study of the disease seems not to be enough. OBJECTIVE: To elucidate clinical aspects of the disease and to evaluate the plastic tube insertion method for the treatment. METHOD: In 27 cases, clinical stages, sites and duration of lesions, duration and previous treatments were examined. The plastic tube insertion method was done in all of the cases and its results were evaluated. The method ws consisted of insertion of a longitudinally slitted soft flexible plastic tube between the lateral edge of the nail plate and the inflamed soft nail fold. RESULT: 1. Age distribution showed 96% (26 cases) were between 15 to 36 years with mean 25 years. 2. Average duration of illness was 18 months. 12 cases(45%) was previously treated with various operative methods. 3. 9 cases wre involved in both feet and 18 cases in unilateral foot. Among the unilateral 18 cases, 12 cases were in right foot and 6 cases in left foot. 4. In each involved toenail 8 cases showed both side lesions and 19 cases showed one side lesions. Among the 19 cases 6 cases had medial side lesions and 13 cases lateral side lesions. 5. By the plastic tube method, 96% (26 cases) had immediate relief of the pain. But 63%(17 cases) showed recurrence and needed other treatment within 6 months. CONCLUSION: Predilection age of the ingrowing toenail was between 15 to 36. The most common site is the lateral side of the right great toe. The rate of the cure by the plastic tube method was only 37%.

Clinical and Pathologic Findings of Dysplastic Nevus: Review of 15 Cases / 대한피부과학회지

BACKGROUND: The dysplastic nevus is a rare form of melanocytic nevus, but the clinical criteria and histopathologic finding are still debated. There are no studies of dysplastic nevus in korea except a few case reports. OBJECTIVE: This study was aimed to evaluate the clinical and histopathological characteristics of dysplastic nevus developed in korean. METHODS: We reviewed the clinical and histopathologic finding of 15 patients diagnosed as dysplastic nevus on the biopsy. RESULTS: The result were as follows ; 1. The incidence of dysplastic nevus in our study was 9.9 cases/100,000 population 2. The subjects consisted of 9 males and 6 females. 3. The common onset of age was 11-20. 4. The common site of dysplastic nevus was the trunk. 5. The common pattern of lesional change was asymmetry and color variegation. 6. The common clinical findings of the dysplastic nevus was multiple, 5-12mm size, multipapular surface, ill-demarcated margin and brown/black color. 7. The pathologic findings including shoulder phenomenon, melanocytic nest, patchy lymphohistiocytic infiltration, melanophage, scattered atypical epitheloid cell, random atypia, anisokaryosis and no mitosis was shown in all the patients, but eosinophilic hyperplasia was shown in 13 patients. 8. The mild atypia in the Duke grading system was the most common. There was significant positive correlation between architectural and cytologic scores(Pearson correlation test, P<0.05, r=0.97). CONCLUSION: Although the incidence of the dysplastic nevus in our study was much lower than that of the west, the clinicopathologic findings were not different.

Primary Hepatic Tumors in Children: Clinical Experience in a Single Institution / 대한소아혈액종양학회지

PURPOSE: The frequency and clinical characteristics of primary childhood hepatic tumors diagnosed in a single institution were reviewed. Method: From January 1991 to June 2000, 33 patients were diagnosed with primary hepatic tumor. Retrospective analysis of the medical records of the various primary hepatic tumors was performed. RESULTS: Among the total of 33 patients with primary hepatic tumor, twenty five (76%) were malignant and eight (24%) were benign. The mean age of patients with hepatoblastoma (HB) was 32 months (12 of 16 patients were less than 3 years), 12.8 years in hepatocellular carcinoma (HCC) (all of them were older than 11 years), 2 months in hemangioendothelioma (HE), and 3 months in hamartoma. The ratio of male to female was 1:1 in HB, and 4:1 in HCC. The presence of hepatitis B infection was detected in 80% (4/5) of HCC and in 13% (2/16) of HB. The common presenting symptoms at diagnosis were the palpable mass, abdominal pain and jaundice. Many tumors were found incidentally without any presenting symptoms. Of 33 patients, 22 had involvement at right lobe. HCC had more necrosis and hemorrhage within the tumor than HB on imaging study. HE had a distinct feature of contrast enhancement increasing from the peripheral portion of the mass to central portion. Hamartoma showed a feature with multiple cysts and septums within the mass. To confirm the diagnosis, a tissue biopsy was done in 23 patients (70%). A significantly elevated level of serum alpha-fetoprotein (AFP) is found in 88% (mean 386,000 ng/mL) of HB cases and 100% (mean 369,000 ng/mL) of HCC. The mean AFP level in HB patients was 391,000 ng/mL at diagnosis, 52 ng/mL after the preoperative chemotherapy, 8.3 ng/mL at postoperative follow-up, and 2.8 ng/mL at completion of chemotherapy. In HCC, the AFP level decreased temporarily after chemotherapy or chemo- embolization, but increasesd at recurrence in most case. Patients resectable at the time of diagnosis or after preoperative chemotherapy were 12 (75%) in HB, and 10 of them are were alive with median the follow-up of 34 months (5 mo.~8 yrs 7 mo.). All the HCC patients were unresectable or had metastatic lesion at diagnosis, and all of them were assumed dead following discharge. Conclusions: Among the primary hepatic tumors in children, malignant tumors are more frequent than benign. Age of onset, AFP level and imaging studies all play an important role in diagnosis, and biopsy is usually confirmative. HCC has an extremely poor prognosis in childhood. HB patients with complete surgical resection enjoy a relatively high long term survival.

Clinical Finding of MDR Tuberculosis and Frequency of MOTT / 결핵

BACKGROUND: The frequency of MOTT has risen as the prevalence of tuberculosis has been declining. Our country has been also. The most of MOTT was resistant to the major anti-tuberculous drugs. METHOD: To compare clinical characteristics and frequencies of MDR tuverculosis with MOTT, the author studied 65 patients showing AFB culture positive with sputum. The data were collected from 176 patients who had been admitted at the National Masan Tuberculosis Hospital from May to June, 1997 to April, 1998. RESULTS: The frequency of MDR tuberculosis was 43.1% and that of MOTT was 9.2%. Among 65 isolated my-cobacteria, 3 cases were M. intracellulare, 2 cases were M. fortuitum, and 1 case was unidentified MOTT. The most frequent age group in 65 culture positive patients was 4th decade and the mean age was 44. The mean age was 61 in MOTT and 42 in M. tuberculosis and bad significant difference(p<0.01). The numbers with past history of treatment were 2.3 in MDR tuberculosis and 1.7 in non-MDR tuberculosis and had significant difference(p<0.05). At the time of admisson, the most frequent regiment for the theatment of MDR tuberculosis was 24 months regimen(85.7%) with the 2nd line anti-tuberculosis drugs. For non-MDR tuberculosis, 9 or 12 months regimen (72.9%) with the 1st line anti-tuberculosis drugs and had significant difference(p<0.01). At the time of admission, the symptom of weight loss was shown in 84.7% of M. tuberculosis and 50.0% in MOTT and there was significant difference(p<0.05) between them. All of the MOTT were identified to be resistant against INH and PAS. Drug resistane rates to INH, OFX(p<0.01) and PAS(p<0.05) in MOTT were higher than in MDR. All of three M. intracellulare strains were resistant to INH, RFP, PAS and OFX. All of two M. fortuitum strains were resistant to most anti-tuberculosis drugs. And the other MOTT was resistant to INH, EMB and PAS. CONCLUSION: MOTT was more common in elderly patients than M. tuberculosis. MOTT cases should be considered to be the probability of multiple drug resistance and treatment failure during the 1st treatment because they showed more resistance to anti-tuberculosis drugs than M. tuberculosis cases. Therefore, there should be more careful investigations for clinical characteristics, natural history of disease, and efficient management for MOTT.

The Clinical and Histopathologic Review of Lacrimal Gland Tumors

We performed retrospective review of charts in 26 patients who had been confirmed to have lacrimal gland tumor at korea University Guro hospital from March, 1984 to March, 1996 for evaluating the correlation between clinical findings and histopathologic diagnosis. This study was focused on incidence of lacrimal gland tumors, age, sex, symptoms and signs and ists duratio, radiologic findings, presence and location of metastases, and prognosis. There were 6 cases of benign mixed tumor(23%), 6 cases of malignant mixed tumor(23%), 4 cases of adenoid cystic carcinoma(15.4%), 4 cases of inflammatory pseudotumor(15.4%) and 6 cases of pseudolymphoma(23%). The characteristics of clinical findings of malignant lacrimal gland tumor were pain (70%), the duration of symptom less than 6 months (90%) and bony destruction detected in radiologic findings(75% of malignant mixed tumor and 50% of adenoid cystic carcinoma). All cases of malignant tumor patients had local or distant metastasis. Among them, 2 cases of malignant mixed tumor and 2 cases of adenoid cystic carcinoma had pulmonary metastasis and were died of pulmonary metastasis. This study showed good correlations between clinical diagnosis and pathologic diagnosis, and will help in making early diagnosis and treatment of malignant lacrimal gland tumors.