The Effectiveness of Dexmedetomidine in Vacuum-Assisted Breast Biopsy Under Monitored Anesthesia Care / 고신대학교의과대학학술지

OBJECTIVES: Vacuum-assisted breast biopsy (VABB) is a widely used technique for the diagnosis of breast lesions. It is carried out with local anesthesia, but procedural pain and stress are still problematic. Dexmedetomidine is a α-2 receptor agonist that can sedate without significant respiratory depression. The study aimed to report the effectiveness of sedation with monitored anesthesia care (MAC) using dexmedetomidine in VABB. METHODS: This was a retrospective chart review of patients who received VABB under MAC with dexmedetomidine. Forty-seven patients during the period of February 2015 to July 2016 were included. We collected data on patient characteristics, infusion drug and dose, induction to incision time, anesthetic, operation, and recovery time and other complications and vital signs. RESULTS: The mean operating time was 50.1 ± 24.9 minutes, and the anesthetic time was 71.2 ± 28.3 minutes. The mean time from induction to incision was 17.0 ± 5.2 minutes, and the recovery time was 20.1 ± 10.3 minutes. None of the patients needed an advanced airway management. Further, none of them showed hemodynamic instability. CONCLUSIONS: VABB was successfully performed with MAC using dexmedetomidine, and there was no respiratory depression or hemodynamic instability.

Pattern of Pharmacist Consultation among the Health Counseling Services via Internet Portal Sites: A Pilot Study

BACKGROUND: With the development of information and communication technology, there is a growing number of people looking for health information on the internet. This pilot study was performed to analyze the pattern of pharmacist consultation on the internet portal site. METHODS: Questions and answers posted on the portal site “Naver Jisik-iN” from March 1st to 31th in 2016 were collected. Medications asked were categorized into prescription drugs, nonprescription drugs, sanitary aids, emergency drugs, functional health foods, and others. Medications were subcategorized into 14 according to the anatomical therapeutic chemical classification system. Questions were divided into 10 categories based on Hepler's drug-related problems. RESULTS: Of the 955 cases, females accounted for 59.5% and inquirers from 11 to 40 years old, 89.4%. The number of prescription drugs, nonprescription drugs, sanitary aids, emergency drugs, functional health foods, and others were 428 (44.8%), 328 (34.3%), 31 (3.3%), 2 (0.2%), 122 (12.8%), and 44 (4.6%), respectively. Questions for drugs acting on alimentary tract and metabolism took up 27.4% followed by those on nervous system, 13.6% and anti-infectives for systemic use, 12.2%. Pharmacist consultation regarding drug information, drug interaction, and adverse reaction occupied 47.9%, 15.2%, and 12.3%, respectively. CONCLUSION: Health counseling through online is predicted to increase steadily, so pharmacists should broaden their boundaries beyond off-line pharmacies to meet social needs.

Treatment of Keratoacanthoma with 5% Imiquimod Cream

Keratoacanthoma is a rapidly growing tumor that histologically resembles squamous cell carcinoma. Surgical excision is a desirable therapeutic option, but several other treatment modalities are available. We report on two cases of keratoacanthoma that were treated with imiquimod 5% cream. Imiquimod was applied daily for the first 6 or 7 days, and then reduced to alternate days according to the tolerance and erythema severity of the patient. In both patients, the tumors fully regressed after five weeks of treatment.

Two Cases of Giant Keratoacanthoma Treated with Intralesional Methotrexate / 대한피부과학회지

Keratoacanthoma is a rapidly-growing tumor, which histologically resembles squamous cell carcinoma. Although it may regress spontaneously, keratoacanthoma is routinely treated by excision. Although excisional surgery is the treatment of choice, this can result in functional and cosmetic defects when large or strategically located lesions are treated. An effective nonsurgical treatment would be desirable in such cases. We report two cases of giant keratoacanthoma treated with intralesional methotrexate. Each case showed complete resolutions over 6 injections within 10 weeks. No recurrence occurred during the followup period. We suggest that intralesional injection of methotrexate is an effective and non-operative modality for the treatment of giant keratoacanthoma.

A Case of Spitz Nevus on the Ear Helix / 대한피부과학회지

Spitz nevi, benign melanocytic tumors, have some histologic resemblance to malignant melanoma. They usually appear as asymptomatic, solitary, reddish to pinkish, hairless, dome-shaped, round to oval, smooth-surfaced papules or nodules, measuring less than 1.0 cm in diameter. Histologically, these lesions display striking nests of large spindle cells and epithelioid cells, usually extending from the epidermis to the reticular dermis. Here in, we report a case of Spitz nevus on the helix of the right ear of a 23-year-old man which was treated with Er:YAG laser.

Expression of Ki-67, p27 and Laminin in Actinic Keratosis, Bowen's Disease, and Squamous Cell Carcinoma / 대한피부과학회지

BACKGROUND: In many cases, the distinction between actinic keratosis (AK), Bowen's disease (BD), and invasive squamous cell carcinoma (SCC) is not histologically clear. Tumor cells crossing the basement membrane was traditionally the boundary between AK and invasive SCC. However, this criteria may not be practical in day-to-day clinical situations. OBJECTIVE: The purpose of this study was to investigate the expression patterns and labeling index of the immunohistochemical staining of Ki-67, p27 and laminin in AK, BD and SCC, to ascertain whether differential expression patterns of Ki-67, p27 and laminin exist. METHOD: Seventeen cases of AK, 19 cases of BD and 16 cases of SCC were investigated. We performed immunohistochemical staining for Ki-67, p27 and laminin. The patterns of positive nuclear staining were noted as either marginal (positive nuclear staining in the basal and parabasal layers but sparing the granular zone) or diffuse (positive nuclear staining in the majority of cells throughout the full thickness of the epithelium or tumor aggregates) and scattered (positive nuclear staining of cells in the focal area of the tumor aggregates). RESULTS: For Ki-67, a marginal pattern of positive nuclear staining was found in the basal/parabasal cell layer of normal epidermis. In AK, Ki-67-stained nuclei were found in the basal/parabasal cell layers (marginal pattern), and the labeling index was 24.5%. In BD, Ki-67-stained nuclei were found throughout the full thickness of the atypical epidermis (diffuse pattern), and the labeling index was 70.5%. The invasive aggregates of SCC had a complex pattern of staining for Ki-67, being diffuse and scattered, and the labeling index was 43.5%. The p27 labeling index in AK, BD and SCC was 86.5%, 91.5% and 67.5%, respectively. The p27 labeling index was significantly decreased in invasive SCC, when compared with those of AK and BD. Laminin was stained strongly and continuously along the basement membrane of the epidermis and vessel walls of normal epidermis, AK and BD. In SCC, laminin was stained along the basement membrane of the tumor nest in well differentiated SCC, and weakly and interrupted in poorly differentiated SCC. CONCLUSION: There results show that the staining pattern of Ki-67 is helpful to differentiate BD (diffuse pattern throught the full thickness of atypical epidermis) from AK (marginal pattern affecting the basal and parabasal layers) and SCC (diffuse and scattered within the atypical aggregate), and increased Ki-67 labeling index is helpful to differentiate BD from AK and SCC. A reduced p27 labeling index is helpful to differentiate SCC from AK and BD. However, the staining pattern of laminin did not seem to be helpful in differentiating these diseases.

A Case of Large Vascular Plexiform Neurofibroma Associated with Giant Cafe-au-lait Patch and Scoliosis / 대한피부과학회지

Plexiform neurofibromas are benign proliferations arising from the peripheral nerves and represent one of the diagnostic features of neurofibromatosis type 1. We present a case of a 14-year-old boy, who had large vascular neurofibromatous elephantiasis associated with a giant cafe-au-lait patch on his lateral aspect of the left hemithorax. Although he had no perceptible symptoms, radiologic examination revealed mild thoracic scoliosis with left side convexity. Our treatment of the skin lesion was one-stage palliative tumor debulking.

A Case of Tubular Apocrine Adenoma / 대한피부과학회지

Tubular apocrine adenoma is a well-circumscribed, intradermal benign tumor, with tubular structures showing apocrine differentiation. Histologically, the characteristic features are various-sized dilated tubules with intraluminary papillary projection and apocrine decapitation secretion. It usually presents as a solitary lesion and is sometimes associated with nevus sebaceous and/or syringocystadenoma papilliferum. We have in report a case of tubular apocrine adenoma with epidermal cysts which developed in the right inguinal area of a 37-year-old man.

A Case of Verrucous Carcinoma Improved by 5% Imiquimod Cream / 대한피부과학회지

Verrucous carcinoma is a low grade, well differentiated, unusual variant of squamous cell carcinoma. It has been described to represent an intermediate lesion between condyloma acuminata and squamous cell carcinoma. Since malignant transformation of verrucous carcinoma has been reported to occur in 30-50% of cases, the first line treatment for verrucous carcinoma is surgery, preferably Mohs surgery. Herein, we describe a case of recurrent verrucous carcinoma on the right buttock of a man with a history of radical excision and radiotherapy of a previous perianal verrucous carcinoma. The patient was successfully treated with 5% imiquimod cream, an immune response modifier with potential antiviral and antitumor effects. Imiquimod may be an effective treatment for verrucous carcinoma and presents an alternative therapy to surgical excision.

A Case of Basal Cell Carcinoma of the Nose Successfully Treated with 5% imiquimod Cream / 대한피부과학회지

Basal cell carcinoma is the most common malignant skin lesion. The major aim in the treatment of basal cell carcinoma is the curative treatment, which is best done by Mohs excision of the neoplastic tissue. Despite the effectiveness of surgical excision, non-surgical treatment modalities may be preferred for large tumor size or poor patient performance status. Imiquimod may offer an alternative to surgical excision. Imiquimod is an immune modulator acting as IFN-alpha and other cytokine inducer, stimulating the innate immune response. Imiquimod's anti-tumor effect may be mediated by IFN-alpha, IFN-gamma, IL-12. At this time, there is no published experience on the treatment of basal cell carcinoma with imiquimod in Korea. We report a case of basal cell carcinoma of the nose successfully treated with topical 5% imiquimod cream.

The Development of an Illuminator with High Brightness LED for Super-Macro Mode of Digital Camera / 대한피부과학회지

BACKGROUND: With increasing use of digital cameras, it is needed to develop a better method of taking photographs that meet the dermatologists' demand. Recent digital cameras have super-macro mode capability, but that mode is only available in very bright conditions such as sun shining locations because flashing is unavailable. OBJECTIVE: To develop a better method of taking delicate and reproducible super-macro mode photographs using digital cameras under ordinary hospital or clinic settings. METHODS: We planned to develop an illuminator with a high brightness light emitting diode for the super-macro mode of a digital camera. To be economical, convenient, and lightweight, the illuminator was designed to plug into the USB port of a personal computer for the power source. We have applied the illuminator to three different camera models. The light emitting diodes were arranged in some different ways for better results. RESULTS: When we took super-macro photographs with this device, patients felt no discomfort, such as dazzling, which they have experienced with a camera flash. And, the photographs showed more delicate zoomed-in images and were reproducible. The image quality was enhanced with the more optimal arrangement of diodes. We named the small space in front of the camera lens, `micro studio', because we can modify the lighting method for better illumination. The users may maximize the capability of the digital camera using this device. CONCLUSION: We developed an economically appealing and flexible digital camera device that enables us to take super-macro mode images of a much more enhanced quality. It may be useful for many dermatologists who use digital cameras.

A Case of Sclerosing Panniculitis treated with Stanozolol / 대한피부과학회지

Sclerosing panniculitis refers to indurated erythema with hyperpigmented scleroderma-like hardening on the medial lower third of the legs. It has been called indurated cellulitis, chronic cellulitis, hypodermitis sclerodermiformis or lipodermatosclerosis. It has been suggested that sclerosing panniculitis is associated with venous insufficiency. The treatment of sclerosing panniculitis is very difficult. Stanozolol is valuable in treating intractable sclerosing panniculitis, giving relief of pain, reducing induration, inflammation, tenderness and pigmentation by its fibrinolytic activity. We report a case of sclerosing panniculitis, clinically improved by stanozolol.

A Case of Kimura's Disease: Approach by Immunohistochemical Study and Analysis of Clonality / 대한피부과학회지

Kimura's disease is a chronic, inflammatory disorder of unknown origin. It is characterized by clinically recurrent painless swelling on head and neck region, histopathologically multiple lymphoid follicles, increased serum IgE levels, and eosinophilia of tissue and peripheral blood. It has been known that Kimura's disease is the reactive immunological disease. Recently, however, it was suggested the clonal T cell proliferation might contribute to the pathogenesis in the Kimura's disease. But, it is still uncertain that Kimura's disease is of reactive nature or neoplastic origin. A 71-year-old woman visited our clinic with painless violaceous swelling on her right cheek. Skin biopsy was performed and, taken together, Kimura's disease was diagnosed. Tissue section was examined with immunohistochemical stains with markers of lymphocytes, plasma cell, and periendothelial cell, and polymerase chain reaction for the TCR gene rearrangement was performed. We present a case of Kimura's disease investigated by the immunohistochemical study and TCR gene rearrangement test and suggest this case is in the limited favor of the reactive nature of Kimura's disease.

A Case of Lentigo Maligna Melanoma Treated with Mohs Surgery Adopting Lateral Based Transposition Flap / 대한피부과학회지

Lentigo maligna melanoma (LMM) is the least common type of melanoma and most commonly affects the sun-exposed skin of the elderly. We herein report a case of LMM located on the left lower eyelid of an 86-year-old woman. This female patient presented with a longstanding irregular brownish patch containing black macules consistent with LMM. There are several treatment modalities for removing the LMM lesion. However, considering the functional and the aesthetic aspect of the lower eyelid, we performed Mohs micrographic surgery to remove the lesion, and lateral based transposition flap was employed to reconstruct the resultant defect on the left lower eyelid.

A Case of Dermal Melanocyte Hamartoma / 대한피부과학회지

Dermal melanocytosis is characterized by the presence of ectopic melanocytes in the dermis. Dermal melanocytosis assumes several morphologic forms, including the Mongolian spot, the blue nevus, the nevus of Ota, the nevus of Ito and dermal melanocytic hamartoma. Differential diagnostic features of these dermal melanocytic lesions depend on onset, course, distribution, histologic features, uniformity of pigmentation, etc. In our case, an 18-year-old girl had asymptomatic 5x3cm sized ill-defined bluish patch on left forearm since birth. Histologic examinations revealed marked increased infiltrate of pigment cells mainly in the upper dermis in Hematoxylin & eosin stain . Fontana-Masson stain and Gp 100 stain revealed marked infiltrate of melanin-containing cells in upper dermis. We report a rare case of dermal melanocyte hamartoma.

A Case of Diffuse Plane Xanthoma Associated with Monoclonal Gammopathy of Unknown Significance and Normolipoproteinemia / 대한피부과학회지

Diffuse plane xanthoma is a group of plane xanthomas that appear as yellow-brown flat patches or slightly elevated plaques with a wide-spread distribution. Cutaneous xanthomas may occur either hyperlipoproteinemic or normolipoproteinemic states. Diffuse plane xanthoma with normolipoproteinemia is often associated with multiple myeloma, other reticulo-endothelial malignancies and monoclonal gammopathy of unknown significance(MGUS). We report a case of diffuse plane xanthoma associated with monoclonal gammopathy of unknown significance(MGUS) and normolipoproteinemia.

Quantitative Analysis of Hair Minerals in Vitiligo Patients / 대한피부과학회지

BACKGROUND: Although vitiligo is generally recognized as a single entity, the etiology is complex. There have been three hypotheses to explain vitiligo, (1) neural hypothesis, (2) the self-destruct hypothesis, and (3) the autoimmune hypothesis. And recently, there have been several reports about mineral status in vitiligo patients. Hair minerals may provide a continuous record of nutritional status and exposure to heavy metal pollutants. So, analysis of hair minerals in vitiligo patients may help to explain the etiology of vitiligo. OBJECTIVE: The purpose of this study is to compare the hair mineral concentrations between vitiligo patients and normal controls. METHODS: Hair mineral concentrations were measured in 30 normal controls and 30 vitiligo patients. We measured the contents of fifteen nutritional elements (Ca, Mg, Na, K, Cu, Zn, P, Fe, Mn, Cr, Se, B, Co, Mo, S), eight toxic elements (Sb, U, As, Be, Hg, Cd, Pb, Al), and fifteen additional elements (Ge, Ba, Bi, Rb, Li, Ni, Pt, Tl, I, V, Sr, Sn, Ti, W, Zr) by an inductive coupled plasma mass spectrometry. RESULTS: In vitiligo patients, the contents of Fe, Mg, P, Cr, Se, Zr were significantly higher than normal controls, and B, Al, W were significantly lower than normal controls. In male patients, K, Cr, B, Rb contents were higher than female and in female patients, Ca, Ba, Sr contents were higher than male. In vitiligo patients, Hg showed positive relationship with increasing age, and B, Pb, Sn, Zr contents showed negative relationship with age. CONCLUSION: Hair mineral analysis was performed with vitiligo patients and normal controls. We concluded that the hair mineral analysis will be useful in researching various skin diseases including vitiligo and may give the clues of etiology of various skin diseases.

A Case of Leukemia Cutis at the site of Invasive Cutaneous Candidiasis: Wolfs Isotopic Response / 대한피부과학회지

The isotopic response defined by Wolf et al. describes the occurrence of a new skin disorder at the site of another, unrelated and already healed skin disease. In most of the reported cases, the first diseases were herpes zoster. We report a case of leukemia cutis developed on the exact same site of previous invasive cutaneous candidiasis, regarded as Wolfs isotopic response.