Image Reconstruction of Eigenvalue of Diffusion Principal Axis Using Diffusion Tensor Imaging

PURPOSE: The objective of this work to construct eigenvalue maps that have information of magnitude of three primary diffusion directions using diffusion tensor images. MATERIALS AND METHODS: To construct eigenvalue maps, we used a 3.0T MRI scanner. We also compared the Moore-Penrose pseudo-inverse matrix method and the SVD (single value decomposition) method to calculate magnitude of three primary diffusion directions. Eigenvalue maps were constructed by calculating of magnitude of three primary diffusion directions. We did investigate the relationship between eigenvalue maps and fractional anisotropy map. RESULTS: Using Diffusion Tensor Images by diffusion tensor imaging sequence, we did construct eigenvalue maps of three primary diffusion directions. Comparison between eigenvalue maps and Fractional Anisotropy map shows what is difference of Fractional Anisotropy value in brain anatomy. Furthermore, through the simulation of variable eigenvalues, we confirmed changes of Fractional Anisotropy values by variable eigenvalues. And Fractional anisotropy was not determined by magnitude of each primary diffusion direction, but it was determined by combination of each primary diffusion direction. CONCLUSION: By construction of eigenvalue maps, we can confirm what is the reason of fractional anisotropy variation by measurement the magnitude of three primary diffusion directions on lesion of brain white matter, using eigenvalue maps and fractional anisotropy map.

A Case of Nodular Cystic Fat Necrosis Presenting as Highly Migrating Subcutaneous Nodules / 대한피부과학회지

Nodular cystic fat necrosis is a distinct benign subcutaneous nodule characterized by encapsulated necrosis of subcutaneous fat in which non-viable adipose cells are pathologically surrounded by fibrous tissue. We report a case of nodular cystic fat necrosis in a 47-year-old woman who presented with a 2-month history of had multiple highly- movable, subcutaneous nodules on both shins and posterior thigh. There was an absence of any noteworthy trauma history. Each lesion showed a highly-migratory property, and could easily be moved about 10 cm in any direction. Plain film revealed multiple radiopaque nodules on the right shin. Calcification and lipomembranous changes, in addition to typical features, were also found on histopathologic examination.

Report from ADRG: A Study on the Clinical Manifestations of Childhood Atopic Dermatitis in Korea / 대한피부과학회지

BACKGROUND: Atopic dermatitis (AD) is a chronic, relapsing disease with genetic and environmental background. Many factors may act as triggers and affect the course of the disease. However, little is known about the factors affecting the disease severities in Korean childhood AD. OBJECTIVE: The aim was to document the distinct characteristics of childhood AD in Korea and to determine which manifestations are prone to be present in the settings of different severity of the disease. METHOD: The clinical manifestations, past medical and family history, and inducing or aggravating factors were studied in patients, who participated in the open lectures for childhood AD patients in three provinces of Korea. The severity of the disease was evaluated using the Eczema Area and Severity Index (EASI) and the factors affecting the severity of the disease were determined. Skin prick tests with four allergens, Dermatophagoides pteronyssinus, milk, peanut and egg, were also carried out. RESULTS: Of the 93 patients, 38.7% had the disease onset between the age of three and six, while 17.2% had it between the age of seven and fifteen. Sixty-five percent of the patients had family members with a history of atopic diseases, such as AD, asthma, allergic rhinitis and allergic conjunctivitis. In order of frequency, the patients either had a history of or presently accompanying infantile eczema, allergic rhinitis, asthma or allergic conjunctivitis. Among the patients, 27% took herbal medication. The most frequently involved site was the flexural area. The most common aggravating factors were sweating in hot environment, wool fabric and stress. When AD patients were categorized into mild, moderate and severe groups by EASI, the older onset age, the longer duration, facial distribution, history of taking herbal medication, cholinergic condition, wool fabric and stress were found to be significant factors influencing the severity of the disease. Skin prick test with the four major allergens revealed the highest prevalence in Dermatophagoides pteronyssinus. CONCLUSION: The age of onset of AD was higher than that has been reported. Many suffered from infantile dermatitis and had other accompanying atopic diseases. Aggravating factors should be avoided to minimize the risk of disease aggravation. Based on the fact that late onset age, duration, facial distribution, history of taking herbal medication, cholinergic condition, wool and stress were the statistically significant factors, we may predict the severity or the course of the disease.

A Case of Coccidioidomycosis Showing Cutaneous and Pulmonary Nodules / 대한의진균학회지

Coccidioidomycosis is a systemic infection caused by inhalation of airborne spores of Coccidioides immitis, a fungus found in soil in the southwestern area of United States and in parts of Mexico and South America. Although its human infection has not been reported infrequently in nonendemic areas, it has rarely been done in Korea since first report of a case of systemic coccidioidomycosis with cutaneous lesions. The patient was a 32-year-old male with granulating cutaneous nodules on left side of upper back for 1 month. Three months ago, he had stayed at northern area of Mexico for 2 months with mild transient upper respiratory symptoms during his stay. After he returned to Korea, cervical lymphadenopathy and skin lesions developed. He had also respiratory symptoms such as chest discomfort and mild chest pain and chest X-ray revealed a solitary nodule. The cutaneous nodules of walnut size were removed surgically and he was recieved daily oral medication of itraconazole 400 mg for 10 months showing good clinical response. Even though lung nodule was not disappeared in radiological exam, repeated CT guided biopsy and fungal tissue culture of lung nodule were undertaken with no growth throughout 10 months. After 10 months itraconazole therapy, there was no evidence of clinical relapse and no change on chest film for following 16 months. We report a case of disseminated coccidioidomycosis involving lung, skin and lymph node simmultaneously and successfully treated with both surgical excision and systemic antifungal therapy.

Treatment of Discoid Lupus Erythematosus with Autologous Suction Blister Graft / 대한피부과학회지

Discoid lupus erythematosus (DLE) commonly develops on the sun-exposed area such as the bridge of the nose, malar areas, lower lip and ears. Typically lesions have well-defined discoid erythematous patches with adherent scales, horny plugs, telangiectasia, hypopigmentation and atrophy. Topical, systemic and intralesional injection of steroid and antimalarial drugs have been used. However, the most important treatments in DLE are avoidance of sunlight exposure and daily use of high SPF sunscreen. We treated two DLE patients with autologous suction blister graft (ASBG) which has been widely used for treatment of vitiligo. In general, grafted sites tend to be hyperpigmented after ASBG, so we adopted this characteristic to the treatment of DLE for the purpose of achieving natural sun protection. After one month of ASBG, not only increased pigmentation but also improved skin texture of the lesion was observed. We thought ASBG provided the biologically protective barrier to sunlight and somewhat improvement of DLE lesion. Therefore, ASBG could be regarded as one of the options in the therapeutic modalities of DLE.

Comparison of Results of Lactic Acid Sting Tests between Sensitive Skin and Nonsensitive Skin after Tape Stripping / 대한피부과학회지

BACKGROUND: Sensitive skin has been described as a skin type showing higher reactivity than normal skin and developing exaggerated reactions when exposed to internal stimulants and external irritants. The Lactic acid sting test is a widely accepted method for evaluating sensitive skin and is employed for the selection of subjects experiencing invisible sensory irritation. Tape stripping of skin is a useful method for removing stratum corneum which plays a most important part in the barrier function of the skin. Measurement of the transepidermal water loss (TEWL) is the standard method to determine stratum corneum barrier status. A disturbed skin barrier is characterized by high TEWL. OBJECTIVE: The author performed this study to compare lactic acid sting test between sensitive skin and nonsensitive skin after tape stripping, not on the face but on the forearm. METHODS: A total of 40 individuals (20 individuals of the sensitive skin group and 20 individuals of the nonsensitive skin group) were selected by the method of self-assessment questionnaires related to sensitive skin. The individuals were tested a total of 6times, at internals of 2weeks, on the volar aspects of both forearms with 10% lactic acid after tape stripping, with or without a Hilltop chamber. The frequency of tape stripping was divided according to the TEWL into 3 groups as follows: mild(increase of TEWL> or = 5g/m2h compared to baseline TEWL), moderate (> or = 10g/m2h), and severe (> or = 20g/m2h). RESULTS: When 10% lactic acid sting tests were performed after mild and moderate tape stripping of skin, irrespective of the Hilltop chamber, there were more positive responders in the sensitive skin group (p<0.05). Also statistically, there was a significant difference between the sensitive skin group and the nonsensitive skin group in the comparison of the mean values of lactic acid sting scores (p<0.05). However, when 10% lactic acid sting tests were conducted after severe tape stripping of skin, irrespective of the Hilltop chamber, there were no statistically significant difference between two groups when comparison of the positive rates and the mean values were made. CONCLUSION: The Lactic acid sting test with the Hilltop chamber, after mild and moderate tape stripping is a useful method to discover sensitive skin.

Differential Gene Expression Screening Between Black and Gray Hairs Using Subtractive Library and DNA Chip / 대한피부과학회지

The identification of differential gene expression between gray and black hairs is an important study in modern hair pigment research. In this experiment, the authors have applied new methods by the integration of three updated molecular biological tools, T7 RNA polymerase-based RNA amplification, representational difference analysis (RDA), and microarray analysis, to screen the differentially expressed genes in gray and black hairs. The genes more abundantly expressed in black hairs were pigment related proteins, such as Pmel17, 95kD melanocyte-specific secreted glycoprotein, MART-1, tyrosinase, tyrosinase-related protein 1 etc. Also, expression of the selenium-binding protein (hSBP) gene and the spast gene for spastin protein were up-regulated in black hairs compared to those in gray hairs. In gray hairs, many kinds of genes related with keratin, trichohyalin and transmembrane glycoprotein were more expressed. In particular ch 17, hRPK.142_H_19 was expressed in gray hairs as high signal intensity.

A Case of Primary Cutaneous Adenoid Cystic Carcinoma / 대한피부과학회지

Adenoid cystic carcinoma of the skin is the rarest type of eccrine sweat gland carcinoma. Although it is mostly known as a neoplasm of the salivary gland, it could occur as a primary tumor of the skin. We report a case of primary cutaneous adenoid cystic carcinoma in a 75-year-old male patient with two local recurrences. It was a lobulated tender erythematous nodule on the scalp measuring 2.5x1cm. Histopathologic examination after total excision showed cribriform, tubular, and solid masses of various size and shape involving dermis and the upper part of subcutis including perineural invasion. They consisted of almost uniform basaloid cells surrounded by myxoid or slightly fibrotic stroma. Adjacent organ such as salivary gland, bronchus, esophagus, and regional lymph nodes were examined with no evidence of neoplasm. Systemic evaluation for metastasis were also negative.

A Case of Tumor Stage Mycosis Fungoides Treated with Combination of Surgical Excision and PUVA Therapy / 대한피부과학회지

This is a case of mycosis fungoides (MF) in a 60-year-old woman who showed a solitary painful tumor on the left thigh. Two years ago, she was diagnosed with MF for several scaly patches on trunk and thigh and was treated with PUVA therapy. After 8 months, the patch lesion almost disappeared and she stopped PUVA therapy. One year later, she revisited hospital with 3 x 3 cm sized painful tumor on left thigh which had developed for about 4 weeks. Histopathological examination of the tumor showed diffuse infiltration of atypical lymphocytes in the dermis, consistent with tumor stage MF. There was no systemic involvement. We removed tumor by surgical excision and started PUVA therapy instead of starting systemic chemotherapy or radiotherapy immediately. Until now, tumor has not recurred and she has been managed as patch/plaque stage for 12 months. We thought that aggressive treatment methods could be delayed by surgical excision of tumor in tumor stage MF.

Subepidermal Calcified Nodule of the Finger / 대한피부과학회지

Subepidermal calcified nodule is a rather uncommon, but peculiar subtype of calcinosis cutis. It presents as a single asymptomatic, hard, yellowish white nodule which commonly occurs on the face of children. Histopathologic examination reveals the multifocal various-sized papillary dermal collection of dark blue amorphous globular deposits confirmed by von Kossa stain for calcium. We report a 42-year-old man who had small white hyperkeratotic papule on finger tip for more than 20 years. He could recall neither preceding trauma nor systemic illness. Excisional biopsy, with the clinical impression of verruca or corn, showed typical histopathologic features of the subepidermal calcified nodule.

Increased Sensitivity of Keratinocytes to Oxidative Stress in Vitiligo / 대한피부과학회지

BACKGROUND: Vitiligo, a disease presenting as white patches on the skin, is caused by selective destruction of melanocytes, which are completely absent in established lesions. There are many theories about the etiology of vitiligo including the self-destruct, biochemical, neural, autoimmune and genetic hypotheses. Oxidative stress has been implicated in vitiligo as a causative factor. OBJECTIVE: To examine the susceptibility of vitiligo keratinocytes to external oxidative stress, H2O2, we compared survival rates in cultured keratinocytes according to the different concentration and exposure time of H2O2. METHODS: Keratinocytes were prepared from normal control volunteer, and the center of lesion and non-lesional skin of vitiligo patients. It was evaluated in cultures at the second and third passages. And, keratinocytes were exposed to various concentrations of hydrogen peroxide (H2O2) for 10, 20 and 40 minutes. Finally, the 96 wells plate containing cells were performed MTT assay. RESULTS: Compared to normal keratinocytes, vitiligo keratinocytes, both non-lesional and lesional, showed markedly lower survival rate. At the concentration of 0.01, 0.1 and 1 mM H2O2, survival rates did not significantly affect viability of keratinocytes after neither exposure times. On the contrary, vitiligo keratinocytes, both non-lesional and lesional, were more susceptible to the toxic effect of H2O2 after the period of exposure at concentration of 10mM H2O2 compared with normal keratinocytes. The survival rate of at concentration of 10mM H2O2 inversely correlated with the exposure period in all experiments. CONCLUSIONS: Our results demonstrate the presence of an imbalance in the anti-oxidant system in vitiligo keratinocytes and provide further support for oxidative damage as a pathogenic event in vitiligo.

Skin Metastasis of Neuroendocrine Carcinoma Arising in the Uterine Cervix / 대한피부과학회지

Neuroendocrine carcinoma is known to have features of neuroendocrine and epithelial differentiation through immunochemical and biochemical investigation and Merkel cell carcinoma is a rare primary malignancy of the skin belonging to the broad spectrum of tumors of the neuroendocrine system. Small cell carcinoma of uterine cervix, also a kind of neuroenodcrine carcinoma, is rarely reported and it is much more exceptional in the world that cervical carcinoma metastases to distant skin. Further more this may be the first case of a uterine neuroendocrine carcinoma metastasizing to the skin in Korean medical literature. We report a case of 74-year-old woman who presented with a somewhat fixed subcutaneous nodule measuring 2.5 cmX0.8 cm on the left side of forehead. A biopsy of the nodule revealed a poorly differentiated carcinoma under the muscle without involvement of upper structures and it showed neuroendocrine differentiation by immunohistologic studies. Before appearing as cutaneous manifestation 2 months ago, she had showed a history of abnormal vaginal bleeding and diagnosed as a cervical neuroendocrine carcinoma, especially small cell carcinoma histologically.

Two Cases of Generalized Pustular Psoriasis Improved with Combination Treatment of Mycophenolate Mofetil / 대한피부과학회지

Mycophenolate mofetil(MMF) is a new immunosuppressant which non-competitively and reversibly blocks the de novo synthesis of guanine nucleotides required for DNA and RNA synthesis during lymphocyte proliferation. So MMF selectively inhibits lymphocyte proliferation and it has less side-effects than other immunosuppressants. We described 2 cases of generalized pustular psoriasis improved with MMF. We administered MMF combined with cyclosporin in case 1 and acitretin in case 2. Both patients markedly improved with MMF administration 3 days after and had no severe side-effects. Thus the authors thought that MMF appears to be an effective therapeutic alternative in the treatment of generalized pustular psoriasis.

The Earlobe Keloid Treated by Compression Therapy with Earring after Shaving Excision / 대한피부과학회지

Keloid is a benign proliferative growth of dermal collagen which extends beyond the original wound. Although there are several available methods of treatment including intralesional corticosteroid injection, cryotherapy, surgical excision, laser therapy, pressure, radiotherapy, interferon-alpha injection and so on, no effective modality to prevent the recurrence of keloids may be present. We have done shaving excision of keloids on the earlobes of 4 patients and then recommended earring made to order for home compression over 4~5 months therapy with no recurrence for 1~3 years. It is suggested that compression therapy with earring following shaving excision may be proven to be not only a simple but effective method for prevention of recurrence after removal of keloid on the earlobe.

Statistical Observation of Sensitive Skin and Evaluation of Subjective Irritation Using Lactic Acid Sting Test / 대한피부과학회지

BACKGROUND: Sensitive skin has been described as a skin type showing higher reactivity than normal skin and developing exaggerated reactions when exposed to internal stimulants and external irritants. The lactic acid sting test is widely accepted as a marker of skin sensitivity and employed for the selection of subjects experiencing invisible sensory irritation. OBJECTIVE: To carry out an epidemiological study to assess the prevalence and possible related factors of sensitive skin in a regional population, and to examine the relationship between sensitive skin and subjective irritation using the lactic acid sting test. METHODS: A total of 514 people responded to self-assessment questionnaires composed of questions about the self-perception, related factors, symptoms and signs of sensitive skin. We assessed subjective irritation using the lactic acid sting test in 54 volunteers. RESULTS: The results are summarized as follows: 1. The incidences of self-reported sensitive skin were 55.7% for women, 38.9% for men and 51.0% for all responders. 2. The family history and seasonal variation of sensitive skin were significantly more common in sensitive skin group. 3. The face especially the cheek area was the most sensitive portion of body, cosmetics were common irritants. 4. The lactic acid stinging scores were significantly higher in the sensitive skin group. CONCLUSION: Our survey indicated that sensitive skin is a common problem for people and a complex problem with genetic, individual, environmental implications and the lactic acid sting test is a valuable method to define skin sensitivity.

Clinical Study of Halo Nevi / 대한피부과학회지

BACKGROUND: There have been few clinical studies of halo nevi. OBJECTIVE: The purpose of this study was aimed at evaluating the clinical and histopathologic features of halo nevi and correlation between halo nevi and vitiligo. METHODS: The medical records of 40 patients with halo nevi and biopsy specimens of 30 patients with halo nevi were reviewed. RESULTS AND CONCLUSION: 1.The ratio of male to female patients was 1:1.5. 2.The mean age of the onset was 20.1 years (male : 11.5, female : 25.9). 3.Multiple halo nevi were present in 32.5%(male : 25%, female : 37.5%). 4.The areas in which the lesions developed were head and neck(39.1%), back(32.8%), anterior chest(12.5%), abdomen(10.9%), groin(3.1%), and lower extremity(1.6%) in descending order. 5.The mean duration of each color in central nevus was as follows: black(2.7 years), pink(3.5 years), gray(4.9 years) 6.The most common pathology of the central nevus was intradermal(80%). 7.The halo nevi associated with vitiligo were 21 cases(52.5%) out of 40 patients. Among them, the cases with non-segmental vitiligo were 13(61.9%), the cases with segmental vitiligo were 8(38.1%). 8.Out of the 21 cases with halo nevi associated with vitiligo, the cases with halo nevi prior to vitiligo were 4(19.1%), concurrent onset 12(57.1%) and the cases with halo nevi after vitiligo were 5(23.8%).

Clinical and Statistical Survey of Skin Changes in Korean Neonates / 대한피부과학회지

A total of 748 newborns delivered at the Fatima Hospital, Taegu, Korea, over period of 8 months were examined for the presence of skin lesions within 48 hours of birth. The frequencies of the type of birthmarks were: salmon patch, 61.8%; portwine stain, 0.7%; mongolian spot, 99.1%; cafe-au-lait spot, 0.5%; congenital nevomelanocytic nevus, 0.5%; milia, 44.5%; sebaceous hyperplasia, 76.9%; nevus sebaceus, 0.9%; erythema toxicum neonatorum, 29.3%; genital hyperpigmentation, 49.7%. Erythema toxicum neonatorum was less common in premature infants and more frequent on the second day of life than first one. Genital hyperpigmentation was observed predominantly in the male neonate. There was positive relationship between genital hyperpigmentation and birthweight.

A Case of Subcutaneous Phaeohyphomycosis Caused by Exophiala Jeanselmei / 대한피부과학회지

We report a case of subcutaneous phaeohyphomycosis caused by Exophiala(E,) jeanselmei in a 66-year-old female, who showed a mild tender, 4.5x3.5cm sized, erythematous cystic mass with satellite lesions on the left forearm for 4 months. Histopathologically, suppurative granulomatous inflammation, brownish conidia in a chain and hyphae were observed. Fungal culture grew out the typical black-gray velvety colonies of E. jeanselmei after 2 weeks. The isolate grow well at 25 C, but very poorly at 37 C. No growth could be observed at 40 C. Sporulation adequate for evaluation was present on the malt extract agar. We confirmed E. jeanselmei by colony and microscopic morphology, temperature tolerance and sugar assimilation tests. The patient had been treated with itraconazole for 6 momths. Complete remission was observed.

A Case of Tuberculous Gumma / 대한피부과학회지

An 80-year-old woman was admitted because of ag avation of preexisting dyspnea and was refened to the dermatology deparbnent for evaluation of three tender nodules on her extremitiom. A chest X-ray and CT scan suggested pulrnonaxy tuberculosis wikh an endobromchial sprtad, Her past medical histary showed congeative heart failure, treated pulmonery tuberculosis and corticstertoid medication for arthralgia. Acid-fast bacilli were observed in tissue smears and a biopsy specimen. Mycobacterium tubereulosis was recovered from cultures. We suggest that this case was a tuberculous gumma following pulmonary tuberculosis and that a tissue or pus smear for acid-fast bacilli is a very useful diagnostic toal in tuberculous gumma because tubercle bacilli are copious in numbcr.

Latent Multiple Noncontiguous Pyogenic Spondylitis: a case report / 대한정형외과학회잡지

Spinal disc surgery has been the most common cause of iatrogenic disc infection, resulting in pyogenic spondylitis. The diagnosis is usually difficult because of the infrequency of occurrence of pyogenic spondylitis. If three or more vertebrae are involved, the diagnosis of osteomyelitis is unlikely to be correct. Especially involvement of multiple non-contiguous vertebrae indicates metastatic tumor. Therefore, we report a rare case of latent multiple non-contiguous pyogenic spondylitis following spinal surgery. The actual cause of infection in this case is unknown. CT guide biopsy may be needed to rule-out tuberculosis spondylitis and metastatic tumor in such case of multiple spinal involvement. In conclusion, the possibility of latent spinal infection must be considered even though surgery had been done several years ago.