Anesthetic management during cesarean delivery in a pregnant woman with ruptured cerebral arteriovenous malformation: A case report

Although intracranial hemorrhage from arteriovenous malformation (AVM) during pregnancy is rare, it can have fatal consequences. Anesthetic techniques for these patients should ensure precise hemodynamic control, and the goals of anesthesia should include both fetal and maternal well-being. We report a case of anesthetic management for cesarean section in a 31-year-old woman who presented at 32 weeks gestation with an acute intracranial hemorrhage secondary to rupture of a previously diagnosed AVM. Our medical team decided to perform emergent cesarean section under regional anesthesia before transferring the patient to the neurosurgical intensive care unit for further monitoring and appropriate postoperative pain control. The patient was alert and cooperative during neuraxial anesthesia. The operation was successful, and the patient showed gradual improvement in neurosurgical status after several days. We concluded that in case of emergency, regional anesthesia can be a safe strategy for cesarean section in a pregnant woman with symptomatic AVM.

Application of Ventilating-Bronchoscopy-Adaptor by Fusing a Laparoscopic Trocar during Bronchial Thermoplasty under General Anesthesia

No abstract available.

Effects of Nefopam on Streptozotocin-Induced Diabetic Neuropathic Pain in Rats

BACKGROUND: Nefopam is a centrally acting non-opioid analgesic agent. Its analgesic properties may be related to the inhibitions of monoamine reuptake and the N-methyl-D-aspartate (NMDA) receptor. The antinociceptive effect of nefopam has been shown in animal models of acute and chronic pain and in humans. However, the effect of nefopam on diabetic neuropathic pain is unclear. Therefore, we investigated the preventive effect of nefopam on diabetic neuropathic pain induced by streptozotocin (STZ) in rats. METHODS: Pretreatment with nefopam (30 mg/kg) was performed intraperitoneally 30 min prior to an intraperitoneal injection of STZ (60 mg/kg). Mechanical and cold allodynia were tested before, and 1 to 4 weeks after drug administration. Thermal hyperalgesia was also investigated. In addition, the transient receptor potential ankyrin 1 (TRPA1) and TRP melastatin 8 (TRPM8) expression levels in the dorsal root ganglion (DRG) were evaluated. RESULTS: Pretreatment with nefopam significantly inhibited STZ-induced mechanical and cold allodynia, but not thermal hyperalgesia. The STZ injection increased TRPM8, but not TRPA1, expression levels in DRG neurons. Pretreatment with nefopam decreased STZ-induced TRPM8 expression levels in the DRG. CONCLUSIONS: These results demonstrate that a nefopam pretreatment has strong antiallodynic effects on STZ-induced diabetic rats, which may be associated with TRPM8 located in the DRG.

Lymphomatoid Papulosis Associated with Pregnancy / 대한피부과학회지

No abstract available.

Effects of Nefopam on Streptozotocin-Induced Diabetic Neuropathic Pain in Rats

BACKGROUND: Nefopam is a centrally acting non-opioid analgesic agent. Its analgesic properties may be related to the inhibitions of monoamine reuptake and the N-methyl-D-aspartate (NMDA) receptor. The antinociceptive effect of nefopam has been shown in animal models of acute and chronic pain and in humans. However, the effect of nefopam on diabetic neuropathic pain is unclear. Therefore, we investigated the preventive effect of nefopam on diabetic neuropathic pain induced by streptozotocin (STZ) in rats. METHODS: Pretreatment with nefopam (30 mg/kg) was performed intraperitoneally 30 min prior to an intraperitoneal injection of STZ (60 mg/kg). Mechanical and cold allodynia were tested before, and 1 to 4 weeks after drug administration. Thermal hyperalgesia was also investigated. In addition, the transient receptor potential ankyrin 1 (TRPA1) and TRP melastatin 8 (TRPM8) expression levels in the dorsal root ganglion (DRG) were evaluated. RESULTS: Pretreatment with nefopam significantly inhibited STZ-induced mechanical and cold allodynia, but not thermal hyperalgesia. The STZ injection increased TRPM8, but not TRPA1, expression levels in DRG neurons. Pretreatment with nefopam decreased STZ-induced TRPM8 expression levels in the DRG. CONCLUSIONS: These results demonstrate that a nefopam pretreatment has strong antiallodynic effects on STZ-induced diabetic rats, which may be associated with TRPM8 located in the DRG.

Green Nail Syndrome Treated with the Application of Tobramycin Eye Drop

Green nail syndrome (chromonychia) is a nail disorder characterized by onycholysis and green-black discoloration of the nail bed. This condition is often associated with chronic paronychia. Pseudomonas aeruginosa is the most commonly identified organism in cultures from the affected area. Despite the various treatment options available, removal of the nail is still necessary in many cases. A 35-year-old man presented with dark-greenish discoloration of the nail plate and onycholysis on the left thumbnail. He had been treated with oral antifungal and antibiotic agents for several months; however, the lesion showed no improvement. The diagnosis of green nail syndrome was established after a positive bacterial culture, and on the basis of the antibiotic sensitivity test result, tobramycin eye drop (Tobrex(R)) was then prescribed. Three weeks later, the nail discoloration almost vanished but the onycholysis remained. Herein, we recommend the application of tobramycin eye drop as an easy and safe treatment option for green nail syndrome.

A Survey on the Prevalence of Dermatologic Diseases and Skin Care Patterns in Elderly Outpatients at an Endocrinology Clinic / 대한피부과학회지

BACKGROUND: Advances in medicine and improved overall standard of living have brought people's attention to living a long healthy life. As a consequence, geriatric medicine is now gaining more and more attention in the field of medicine and dermatology is no exception. OBJECTIVE: The aim of this study was to examine features of the elderly in terms of the prevalence of dermatosis and general and medical skin care patterns. METHODS: A detailed survey and complete physical examination were performed on 525 patients aged over 65, who were treated at the endocrinology center at our hospital, from January to December 2011. RESULTS: The elderly gained most information on dermatologic diseases from their families and neighbors. The most common dermatologic disorder was senile lentigo (85.5%), followed by seborrheic keratosis (69.0%), xerosis cutis (63.0%), generalized pruritus (42.3%), onychomycosis (30.3%), and cherry angioma (26.9%). Furthermore, xerosis cutis was more often found in older patient groups among the elderly. When it comes to general skin care, one third of the elderly used moisturizers and 10.7% used sunscreens. Only 1.3% of the elderly received medical skin care. CONCLUSION: This study can be used as useful baseline data not only for the government to formulate a national health care plan but for each medical center to understand dermatologic disorders of the elderly and educate its staff members on the management of dermatologic problems of the elderly.

A Case of Plasma Cell Balanitis / 대한피부과학회지

Plasma cell balanitis (Balanitis circumscripta plasmacellularis or Zoon's balanitis) is an idiopathic, benign condition of the glans penis or prepuce. It occurs mostly as a solitary, persistent plaque among middle-aged to older uncircumcised males. It is characterized by chronic, shiny, smooth, red-orange plaques with small, dark red stippling. When the plasma cell balanitis is suspected clinically, diagnosis can be readily confirmed by microscopic examinations of the lesion. Differentiating this lesion from similar lesions such as premalignant, infective and other inflammatory penile lesions is important. The current preferred treatment is circumcision and this disorder can be treated relatively easily by circumcision. We, herein, report an interesting case of plasma cell balanitis on preputial mucosa.

A Case of Keratosis Follicularis Squamosa (Dohi) Treated with Topical 1% Pimecrolimus / 대한피부과학회지

Keratosis follicularis squamosa (Dohi) is a keratinizing disorder which is a separate clinical entity from keratosis follicularis (Darier's disease). It occurs predominantly in Japanese and appears clinically as scaly patches of 3~10 mm in diameter with brownish follicular plugs in the center, which are symmetrically scattered on the trunks and thighs. Scales on the margin, slightly detached from the underlying epidermis, look like 'lotus leaves on the water'. The efficacy of minocycline has already been confirmed in many cases. In this report, we describe a case of using 1% of pimecrolimus cream for keratosis follicularis squamosa (Dohi) instead of minocycline.

Neonatal Lupus Erythematosus Presenting with "Eye Mask" Facial Rash and Telangiectasia / 대한피부과학회지

Neonatal lupus erythematosus (NLE) is an autoimmune disease associated with the maternal anti-SSA/Ro and anti-SSB/La antibodies. NLE is characterized by cutaneous erythema, congenital heart block (CHB), hepatic dysfunction and hematological abnormalities. The characteristic cutaneous lesion is an annular or polycyclic erythematous patch or plaque. Individual annular lesions are often about 1 cm in diameter. We report a case of NLE in a 7-day-old female infant, born of a clinically asymptomatic mother, presenting "eye mask" shape rash and telangiectasia on her face. Periorbital rash with "eye mask" appearance presents in a few of NLE cases, and this cutaneous sign has been emphasized as a diagnostic clue to NLE. Her serological tests revealed high titers of anti-SSA/Ro, anti-SSB/La and antinuclear antibody. Based on these clinical and serological findings, the patient was diagnosed as NLE with characteristic periorbital skin findings.

A Nevus Comedonicus Symmetrically Developed on Both Eyelids in Middle Aged Man / 대한피부과학회지

Nevus comedonicus is a relatively rare hamartoma, which originates from pilosebaceous unit. The disease usually occurs at birth or during childhood and most commonly unilateral or along with Blascko line. A 59-year-old man presented with black grouped dilated pores, with keratin plug on both eyelids. A histopathologic finding showed multiple keratin filled epidermal invaginations. We herein report an unusual case of bilateral nevus comedonicus developed in middle aged persons.

Flushing in a Young Woman: Skin Manifestation of Carcinoid Syndrome / 대한피부과학회지

Carcinoid tumors are derived from enterochromaffin cells that are capable of producing a wide range of neuroendocrine mediators including serotonin or 5-hydroxytryptamine. Carcinoid syndrome occurs when mediators produced by the tumor and normally metabolized by the liver escape into the systemic circulation. The syndrome classically involves the gastrointestinal tract, respiratory system, cardiovascular system and the skin. Flushing is almost universal in the syndrome. A 23-year-old woman came to our hospital presenting with flushing on face and trunk. The patient had experienced flushing for 2 years and it was aggravated by emotional change, stress, exercise, and eating spicy food. The patient also had abdominal pain, diarrhea, weight loss and hepatomegaly. Urinary 5-hydroxyindoleacetic acid was elevated (81.5 mg/day). Abdominal computed tomography scans showed multiple hepatic masses diagnosed as a carcinoid tumor by computed tomography-guided needle biopsy. Physicians should consider carcinoid syndrome when patients present with flushing and systemic symptoms.

Cutaneous Metastasis of Lung Angiosarcoma to the Scalp / 대한피부과학회지

Angiosarcoma is a rare malignant tumor of an endothelial cell derivation and it accounts for less than 2% of all sarcomas. It is a highly aggressive neoplasm with a poor prognosis and most patients die within a short period after presentation. Although angiosarcoma may occur in any location on the body, it rarely arises from major vessels, but has a decided predilection for the skin and superficial soft tissue. A 39-year-old man was referred to our department with an asymptomatic, firm, ulcerative nodule on his scalp that was noticed almost 2 months previously. He had been diagnosed with lung angiosarcoma 9 month earlier. Histopathologically, the skin specimen showed angiosarcoma. The histological findings of the metastatic skin cancer are usually the same as that of the primary cancer. Metastatic cutaneous angiosarcoma is uncommon. Based on these clinical and histopathological findings, our case seems to be skin metastasis at the scalp from the lung angiosarcoma.

A Case of Trauma-Induced Single Xanthelasma Palpebrarum

A 33-year old Korean man visited our department complaining of single mildly pruritic yellowish flat-topped papule on left upper eyelid. Lipid profile including low density lipoprotein-cholesterol and triglyceride level was above normal range. He remembered that the site was scalded by boiling oil about eight months ago. The patient was diagnosed with xanthelasma palpebrarum (XP) based on the clinical and histopathological findings, including diffuse infiltrate of large, pale-staining cells which have abundant foamy cytoplasm in the dermis. He was treated with CO2 laser ablation followed by application of 70% trichloroacetic acid with wooden stick. After a month, the skin lesion showed moderate improvement with disappearance of yellowish color and flat-topped elevation. So far, case of XP developed after minor trauma has not been reported. This case illustrates that minor trauma could be a trigger factor in the development of the disorder.

A Case of Type 1 Pachyonychia Congenita (Jadassohn-Lewandowsky Syndrome) / 대한피부과학회지

Pachyonychia congenita (PC) is characterized by hypertrophic nail dystrophy, focal palmoplantar keratoderma and blistering, oral leukokeratosis, cyst formation, palmoplantar hyperhydrosis, and follicular keratoses on the trunk and extremities. PC is diagnosed by clinical findings and molecular genetic studies. A 26-year-old man presented with hypertrophic nail dystrophy and subungual debris of all 20 nails, hyperkeratotic plaques on the heels of both soles, and oral leukokeratosis. He had no family history of similar clinical findings. The patient's clinical presentation and history were consistent with PC. Herein we report on a rare case of pachyonychia congenita with a review of literature.

Vulvar Skin Metastasis of Lung Squamous Cell Carcinoma

In this study, we examined a case where lung cancer metastasized to the vulvar area. A 79-year-old woman that was a heavy smoker was referred to our department with a short (two-week) history of dyspnea, and with a painful nodule on her right labium majora, which she had noticed almost three years earlier. Histopathologically, the specimen appeared as a poorly differentiated squamous cell carcinoma. The chest X-ray, chest computerized tomography scan, and percutaneous transthoracic needle biopsy via bronchoscopy revealed squamous cell carcinoma in the right upper lobe of the lung. Based on these clinical and histopathological findings, we concluded that her condition was skin metastasis at the right labium majora from the lung cancer, which occurs very rarely.

Comparison of Surgical Results According to Surgical Methods in Simulated Divergence Excess Exotropia

PURPOSE: Surgeons perform either symmetrical lateral rectus recession or monocular recession of the lateral rectus and resection of the medial rectus (recession/resection procedure) in order to correct simulated divergence excess intermittent exotropia, X(T). We compared the results of these two procedures using surgical outcomes. METHODS: A total of 49 patients with simulated divergence excess X(T) were included in this study; among these 49, 32 underwent symmetrical lateral rectus recession and 17 underwent recession/resection procedure. Surgery was defined successful when the horizontal angle of deviation was within 8 prism diopters or less at distance and near at the last follow-up. RESULTS: The rate of success at the time of final follow-up was 68.8% in those who underwent symmetrical lateral rectus recession and 70.6% in those who underwent recession/resection procedure, showing no statistically significant difference between the two groups (p>0.05). Furthermore, there were also no significant differences in the undercorrection, overcorrection rates and the decrease in the deviation at distance and near between the two surgical procedures (p>0.05). CONCLUSIONS: No difference was present between the two methods examined in this study; thus, either of the two methods would be suitable for the correction of simulated divergence excess X(T).