A Case of Recurred Herpes Zoster Oticus Concomitantly Occurred with Zoster Laryngopharyngitis Without Vocal Cord Palsy

Herpes zoster oticus is one of complication of varicella zoster virus (VZV) reactivation in the geniculate ganglion of the facial nerve, which is the most common presentation of herpes zoster in the head and neck region. However, VZV infection of the larynx has rarely been described in the literature compared with Herpes zoster oticus. Moreover, zoster laryngopharyngitis simultaneously occurred with recurred Herpes zoster oticus which has no newly developing motor dysfunction has not been reported yet. Therefore, these diseases are difficult to diagnose due to its rareness. However, distinctive appearances such as unilateral herpetic mucosal eruptions and vesicles are useful and essential in making a quick and accurate diagnosis. Thus, we report a characteristic case of zoster laryngopharyngitis simultaneously occurred with recurred Herpes zoster oticus not accompanied by any newly developing motor palsy.

Effectiveness of Specific Sublingual Immunotherapy in Korean Patients with Atopic Dermatitis

BACKGROUND: Sublingual immunotherapy (SLIT) with house dust mites (HDM) preparation has recently been proven to be beneficial for treating allergic rhinitis and asthma. However, there has been no report regarding the efficacy and safety of SLIT in Korean patients with atopic dermatitis (AD). OBJECTIVE: We intended to investigate the efficacy and safety of SLIT in Korean patients with AD. METHODS: A total of 34 patients with AD and immunoglobulin E (IgE)-proven HDM sensitization (Class ≥3) were recruited. Eczema area and severity index (EASI) score, total serum IgE level, specific IgE assays to Dermatophagoides pteronyssinus, D. farinae, and adverse effects were recorded during follow-up. "Responder" was defined as a patient with ≥30% improvement in EASI score after SLIT. RESULTS: Twenty-three patients continued SLIT for 12 months or more, whereas 3 patients (8.8%) dropped out because of exacerbation of dermatitis, and 8 patients (23.5%) were lost to follow-up. The average duration of SLIT treatment was 22.4 months (range, 12~32 months). EASI scores reduced significantly after 6 months of treatment (p<0.05) compared with those at baseline. A total of 18 patients were determined to be responders to SLIT after 6 months. Total and specific IgE serum levels did not significantly reduce after SLIT. No patients experienced serious adverse events, with the exception of two patients who developed transient lip and tongue swelling. CONCLUSION: Our study demonstrated that SLIT with HDM extracts is effective and tolerable in Korean patients with AD. Further controlled long-term trials are required to reinforce the current results.

Evidence-based guidelines for fall prevention in Korea

Falls and fall-related injuries are common in older populations and have negative effects on quality of life and independence. Falling is also associated with increased morbidity, mortality, nursing home admission, and medical costs. Korea has experienced an extreme demographic shift with its population aging at the fastest pace among developed countries, so it is important to assess fall risks and develop interventions for high-risk populations. Guidelines for the prevention of falls were first developed by the Korean Association of Internal Medicine and the Korean Geriatrics Society. These guidelines were developed through an adaptation process as an evidence-based method; four guidelines were retrieved via systematic review and the Appraisal of Guidelines for Research and Evaluation II process, and seven recommendations were developed based on the Grades of Recommendation, Assessment, Development, and Evaluation framework. Because falls are the result of various factors, the guidelines include a multidimensional assessment and multimodal strategy. The guidelines were developed for primary physicians as well as patients and the general population. They provide detailed recommendations and concrete measures to assess risk and prevent falls among older people.

Association of Bone Mineral Density With Hearing Impairment in Postmenopausal Women in Korea

OBJECTIVES: Previous studies examining the association between osteoporosis (OP) and hearing loss (HL) have shown conflicting results. The objective of the present study was to examine the association between hearing impairment and OP in postmenopausal women, using appropriate statistical analyses. METHODS: Total 1,009 participants were included in the current study. The propensity score matched (PSM) cohort was defined as the cohort including participants diagnosed with OP and participants without OP. Three statistical models were developed where model 1 was unadjusted, model 2 included age, and model 3 included age, body mass index, alcohol intake, smoking habit, diabetes mellitus, hypertension, high density lipoprotein cholesterol, triglyceride level, vitamin D, and alkaline phosphatase. RESULTS: There were 776 and 233 participants in the groups diagnosed without and with OP, respectively. For propensity score matching, 233 pairs were selected from the 776 participants without OP. In the total cohort, using statistical models 2 and 3, no significant difference in the four hearing thresholds was identified between the 2 groups. Logistic regression indicated that, in model 3, participants with OP had a 1.128 (P=0.323) increased risk HL. A significant HL risk was not observed in participants with OP. Using statistical model 3, there were no significant associations among lumbar spine or femoral neck T-scores and changes in the hearing thresholds. In the PSM cohort, statistical models also showed similar results. CONCLUSION: The current study did not demonstrate and association between bone mineral density and hearing impairment in the study population of postmenopausal Korean women.

Clinical Characteristics and Treatment of Oroantral Fistula / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Oroantral fistula is an epithelialized communication between the oral cavity and the maxillary sinus. The aim of this study is to investigate the clinical characteristics and treatment of oroantral fistula. SUBJECTS AND METHOD: Patients who have undergone treatment for oroantral fistula between May 1995 and December 2015 were enrolled in this study. The demographic data of these patients and characteristics of oroantral fistula were analyzed. Patients with oroantral fistula were initially administered oral antibiotics for 3 weeks. If fistula persists in spite of the medication, surgery (soft tissue flap with or without bone graft) was performed. The surgical results according to the presence of bone graft were compared. RESULTS: Twenty-two patients were in accordance with the inclusion criteria. The male to female ratio of patients was 12:10, with the mean age of 47.9±13.4 years. The main complaint of patients was pus discharge from the fistula. Two patients were successfully treated with antibiotics whereas 20 patients underwent surgery. Recurrence occurred in 3 patients, who were treated with soft tissue flap, but no recurrence developed in the patients treated with soft tissue flap and bone graft. Although dehiscence of soft tissue flap occurred in one patient treated with bone graft, it was successfully treated by secondary intention without an additional surgery. CONCLUSION: Bone graft bears the negative pressure of the oral cavity and the weight of secretions including the blood. In addition, it induces secondary intention for the dehiscence of the flap. In this regard, bone graft seems to contribute to the surgical success of oroantral fistula.

Diagnostic Utility of Ultrasound-Guided Core-Needle Biopsy Performed by a Head and Neck Surgeon for Mass Lesions with Inconclusive Result in Fine-Needle Aspiration Cytology / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To evaluate the diagnostic utility of ultrasound (US)-guided core-needle biopsy (CNB) (US-CNB) performed by a head and neck surgeon for mass lesions with inconclusive result in previous fine-needle aspiration cytology (FNAC). SUBJECTS AND METHOD: Forty six patients who had previously inconclusive results of non-diagnostic specimen, undetermined significance, and malignancy/suspicious malignancy with undetermined subtype were included in the study. They were divided into the repeating FNAC (rFNAC) group and CNB groups. Procedure time, success of targeting, and complications were evaluated in the CNB group. In addition, the diagnostic utility of CNB was compared with that of FNAC. RESULTS: US-CNB was successfully completed by a head and neck surgeon in all 23 cases without any major complications. The US-CNB group showed significantly lower rates of repeated non-diagnostic/undetermined results than in the rFNAC group (0% vs. 40.9%, p=0.001). In addition, CNB provided specific pathological diagnoses that permitted the surgeon to establish an appropriate treatment plan in 95.7% (22/23) of the CNB group, while rFNAC provided specific pathological diagnoses in 56.5% (13/23) of the rFNAC group (p=0.002). CONCLUSION: US-CNB can be performed safely by head and neck surgeons, providing better diagnostic results compared with those of rFNAC for mass lesions with inconclusive results in previous FNAC.

Evidence-Based Guideline for Fall Prevention in Korea

Falls and fall-related injuries are common amongst the elderly population and have deleterious effects on the quality of life or independence in daily living in the elderly. Falling is also associated with substantial morbidity, mortality, nursing home admission, and an increase in medical costs. Given that Korea has shown an extreme demographic shift with its population aging at the fastest pace among developed countries, assessment of fall risks and implementing intervention strategies to the high-risk population are getting more important. The guidelines for the prevention of falls were developed first by The Korean Association of Internal Medicine and The Korean Geriatric Society. These guidelines were developed by an adaptation process and the use of an evidence-based method; 4 guidelines were retrieved by systematic review and by the AGREE (appraisal of guidelines for research and evaluation) II process and 7 statements were made based on the grading of evidence, and these recommendations followed the GRADE (grades of recommendation, assessment, development, and evaluation) framework. Given that falls result from a various combination of many factors, the guidelines contain multidimensional assessment measures and multimodal strategies to prevent falls. These guidelines were developed not only for use by primary physicians but also for patients and the general population. Therefore, these guidelines provide detailed recommendations and concrete measures for the assessment of the risk of a fall and to prevent falls amongst the elderly population.

Language Development in Profoundly Prelingually Deaf Children with Cochlear Implantation: Long-Term Outcomes / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is well established that cochlear implantation provides significant benefits for prelingually profound deaf children. However, there are few studies that examined the long-term outcome of cochlear implantation beyond 10 years in prelingually deaf children. The purpose of this study was to examine the long-term benefit of cochlear implantation for children with more than 10 years of experience of using cochlear implantation, regarding auditory performance and academic status. We then determined the age effect of cochlear implantation on auditory performance for prelingually deaf children. SUBJECTS AND METHOD: The longitudinal development of auditory performance of 119 deaf children was analyzed after cochlear implantation. Among the 119 children, 58 were included for analysis. RESULTS: The children who received cochlear implanst at younger age showed significantly better auditory performance. Age at which implantation had been performed had a significant effect on the development of auditory performance before 4 years of age. Many children continued to demonstrate improvements of auditory performance upto five years of implant use. Some showed development of auditory performance upto 10 years cochlear implantation. CONCLUSION: The present result indicates that speech perception and performance for children continue to improve over time from 5 upto 10 years while using cochlear implant. The use of earlier cochlear implantation was demonstrated to provide better auditory performance. The age at which implantation was performed was one of the important factors influencing the long-term outcome of cochlear implantation.

Efficacy and Safety of Calcipotriol/Betamethasone Dipropionate Ointment for the Treatment of Trachyonychia: An Open-Label Study

BACKGROUND: Despite efforts to treat trachyonychia, there is no promising treatment modality. OBJECTIVE: This study evaluated the efficacy and safety of calcipotriol plus betamethasone dipropionate ointment on trachyonychia. METHODS: A total of 39 patients with 432 nails affected by trachyonychia were enrolled. All patients applied calcipotriol/betamethasone ointment once daily without occlusion for 6 months. Outcome measures were assessed by physician's global assessment (degree of roughness: 0, clear; 1, mild; 2, moderate; 3, marked; 4, severe) at all time points. RESULTS: After 6 months of therapy, 98.6% (426/432) of nails showed significant clinical improvement; 4.2% were completely free from nail lesions. The mean physician global assessment score decreased significantly from 3.5 to 1.7 points (p< 0.05). No serious side effects were reported, except mild pruritus and erythema in 2 patients. CONCLUSION: This is the first study to prospectively evaluate the efficacy and safety of calcipotriol/betamethasone ointment for the treatment of trachyonychia. The results indicate topical calcipotriol/betamethasone is an effective and safe treatment for symptom improvement of trachyonychia.

Autologous Whole Blood Injection for the Treatment of Antihistamine-Resistant Chronic Spontaneous Urticaria

No abstract available.

Screening for Psoriatic Arthritis in Korean Psoriasis Patients Using the Psoriatic Arthritis Screening Evaluation Questionnaire

BACKGROUND: Psoriatic arthritis (PsA) is chronic seronegative inflammatory arthritis that causes irreversible joint damage. Early recognition of PsA in patients with psoriasis is important for preventing physical disability and deformity. However, diagnosing PsA in a busy dermatology outpatient clinic can be difficult. OBJECTIVE: This study aimed to validate the Psoriatic Arthritis Screening and Evaluation (PASE) questionnaire for the detection of PsA in Korean patients with psoriasis. METHODS: The PASE questionnaire was prospectively given to 148 patients diagnosed with psoriasis but without a previous diagnosis of PsA. All patients underwent radiologic and laboratory examinations, and a subsequent clinical evaluation by a rheumatologist. RESULTS: Eighteen psoriasis patients (12.2%) were diagnosed with PsA according to the Classification Criteria for Psoriatic Arthritis. The PASE questionnaire scores of differed significantly between PsA and non-PsA patients. Receiver operator characteristic analysis showed an area under the curve of 0.82 (95% confidence interval: 0.72, 0.92) for PASE score. A PASE score cut-off of 37 points had a sensitivity of 77.8% and specificity of 82.3% for the diagnosis of PsA. CONCLUSION: The PASE questionnaire is a simple and convenient screening tool for detecting PsA in Korean dermatology clinics. A PASE questionnaire score of 37 points appears to be an appropriate cut-off for screening Korean psoriasis patients.

Erythrodermic Psoriasis Treated with Golimumab: A Case Report

Erythrodermic psoriasis (EP) is a very severe variant of psoriasis whose management poses a challenge to physicians, as currently available therapies often provide unsatisfactory results. Many biologics have been used to treat chronic plaque psoriasis, the most common form of psoriasis; however, their effectiveness for EP is poorly understood. A recently developed biologic, golimumab, has been extensively studied for the treatment of moderate-to-severe active rheumatoid arthritis, psoriatic arthritis, active ankylosing spondylitis, and chronic plaque psoriasis. However, no clinical trials have been performed for EP. Here, we report the case of a 32-year-old man who presented with severe psoriasis that previously failed to respond satisfactorily to methotrexate, cyclosporine, retinoid, narrow-band ultraviolet B phototherapy, and topical agents (i.e., steroids and calcipotriol). Skin lesions worsened progressively and developed into erythroderma. Psoriatic arthritis was also detected. Conventional therapies lacked efficacy. Therefore, we administered golimumab 50 mg. The skin lesions improved significantly according to the Psoriasis Area and Severity Index score after the first administration; lesions improved further throughout the treatment course. Although additional studies are required to fully evaluate the efficacy and safety of golimumab, this agent may be an alternative treatment strategy for some patients with recalcitrant EP.

Low Grade Myxofibrosarcoma on the Arm of an Elderly Patient / 대한피부과학회지

No abstract available.

Evidence-based Guideline for Fall Prevention in Korea / 대한내과학회지

Falls and fall-related injuries are common in older population and have deleterious effects to the quality of life or independence of daily living in the elderly. Falling is also associated with substantial morbidity, mortality, nursing home admission and the increase of medical costs. Because Korea has shown extreme demographic shift with its population aging at the fastest pace among developed country, assessment of fall risks and intervention to high risk population are getting more important. The guideline for prevention of falls was developed first by The Korean Association of Internal Medicine and The Korean Geriatric Society. This guideline was developed by adaptation process as evidence-based method; four guidelines were retrieved by systematic review and the Appraisal of Guidelines for Research and Evaluation II process, seven statements were made with the grading of evidence and recommendations followed the Grades of Recommendation, Assessment, Development, and Evaluation framework. Because falls result from various combinations of many factors, the guideline contains multidimensional assessment and multimodal strategy to prevent falls. This guideline was developed for not only primary physician but also patients and general population, therefore it provides detailed recommendations and concrete measures to assess the risk and prevent falls in older people.

Megalencephaly-capillary Malformation Syndrome / 대한피부과학회지

Megalencephaly-capillary malformation syndrome is a disorder characterized by megalencephaly or hemimegalencephaly, focal or generalized somatic overgrowth, and vascular malformations. Other characteristic features are neonatal hypotonia, hydrocephalus, developmental delay, syndactyly/polydactyly, frontal bossing, and connective tissue dysplasia. Previously reported patients exhibit wide phenotypic variability in clinical and neuroradiological findings. Differential diagnosis may be challenging for clinicians due to other similar neurocutaneous syndromes. Herein, we report an 11-month-old male infant that presented with extensive, diffuse, reticulated, erythematous patches on his face, trunk, and extremities. Physical examination revealed an increased head circumference (>97 percentile), frontal bossing, hypertrophy of the right arm and leg, and syndactyly on both feet. Borderline developmental delay was identified, and magnetic resonance imaging of the brain revealed an enlarged right cerebral hemisphere and non-obstructive ventriculomegaly. To our knowledge, this is the first report of megalencephalycapillary malformation syndrome in Korean literature.

Neutrophilic Panniculitis in a Patient with Myelodysplastic Syndrome / 대한피부과학회지

Myelodysplastic syndrome (MDS) is a heterogeneous group of stem cell disorders characterized by morphological abnormalities of the erythroid, granulocytic, and megakaryocytic cells. Cutaneous lesions associated with MDS are classified as either specific or non-specific. Specific leukemic infiltrates are often referred to as leukemia cutis, and non-specific inflammatory lesions, historically called leukemids, include cutaneous infections, vasculitis, and neutrophilic dermatoses. We report the case of a 53-year-old man who had been diagnosed with MDS 8 months ago when he developed multiple erythematous tender nodules on the trunk and upper extremities for 8 days. Histopathologic findings from an erythematous nodule on his chest showed lymphohistiocytic and neutrophilic infiltration in the septa and periphery of the fat lobules consistent with neutrophilic panniculitis. Most neutrophils observed in our case had the pseudo-Pelger-Huet anomaly. Herein we present a rare case of neutrophilic panniculitis associated with MDS showing specific groups and the pseudo-Pelger-Huet anomaly.

A Case of Soft Fibroma of the Nipple with a Cauliflower-Like Appearance

No abstract available.

Mycobacterium massiliense Infection after Liposuction / 대한피부과학회지

Mycobacterium massiliense is a new emerging pathogen within the M. chelonae-M. abscessus group that has been described recently. Mycobacterium massiliense usually causes pulmonary or skin and soft tissue infections in immunocompromised patients; however, cutaneous infections have also been reported in healthy individuals following surgical procedures or laparoscopic surgery. This potentially hazardous microorganism should not be overlooked because it often shows resistance to conventional antibiotics. A 25-year-old woman presented with erythematous nodules on her left leg, which was a liposuction site. A histopathological examination showed suppurative granulomas with mixed cellular infiltrations within the dermis and fat layer. Rod-shaped bacilli were detected within the clear spaces of the dermis using Ziehl-Neelsen stain. An acid-fast bacterial culture showed colony formation, and using the polymerase chain reaction-restriction fragment length polymorphism analytical method and the ERM gene, we identified M. massiliense. After surgical excision and the systemic administration of medication comprising clarithromycin and linezolid for 6 months, all of the cutaneous lesions improved and no new lesions occurred.

A 10-year Experience at a Single Center / 대한피부과학회지

BACKGROUND: A variety of benign and malignant tumors can occur in the nail apparatus, causing nail deformities and growth disorders. Clinical diagnosis of nail apparatus tumors can be difficult because of their similar clinical appearance. OBJECTIVE: The aim of this study was to determine the types and frequency of nail apparatus tumors and to assess the types and frequency of nail alterations induced by tumors. METHODS: We retrospectively reviewed the medical records, clinical photos, and histologic slides of 165 patients with nail apparatus tumors who had visited Pusan National University Hospital between January 2002 and August 2012. RESULTS: The most frequently diagnosed benign tumors were digital mucous cysts (22.4%), glomus tumors (21.8%), and subungual exostoses (8.5%). The most common malignant tumors were melanomas (17.0%), squamous cell carcinomas (4.9%), and Bowen's disease (3.0%). We observed nail plate alterations in 80.6% of the cases. All cases of melanomas, fibrous tumors, and subungual exostoses produced nail alterations. Most tumors were treated with surgical management. CONCLUSION: Although the sample size of this study was small, this is the first Korean dermatologic trial to identify nail apparatus tumors. The study findings may prove useful in the clinical diagnosis of various nail apparatus tumors.

Characterization of antimicrobial resistance and application of RFLP for epidemiological monitoring of thermophilic Campylobacter spp. isolated from dogs and humans in Korea / 대한수의학회지

An antimicrobial susceptibility test was conducted to compare the resistance rates among Campylobacter spp. isolates from dogs (n = 50) raised under diverse conditions and humans (n = 50). More than 60% of Campylobacter (C.) jejuni from dogs and humans showed resistance to nalidixic acid, enrofloxacin and ciprofloxacin. C. jejuni isolates from humans showed higher resistance to tetracycline (83.3%) and ampicillin (91.3%) than those from dogs. None of the C. jejuni or Campylobacter coli isolates from humans or dogs were resistant to erythromycin. Overall, 85% of Campylobacter spp. isolates showed a multidrug resistant phenotype. Nucleotide sequencing analysis of the gryA gene showed that 100% of NA(R)/CIP(R) C. jejuni isolates from dogs and humans had the Thr-86th-Ile mutation, which is associated with fluoroquinolone resistance. flaA PCR restriction fragment length polymorphism (RFLP) typing to differentiate the isolates below the species level revealed 12 different clusters out of 73 strains. The human isolates belonged to eight different RFLP clusters, while five clusters contained dog and human isolates.