Erratum: Neutrophilic Dermatosis Confined to the Lymphedematous Area

We found that the year of Accepted for publication of the letter was published incorrectly.

Bilateral iliac and popliteal arterial thrombosis in a child with focal segmental glomerulosclerosis / 소아과

Thromboembolic complications (TECs) are clinically important sequelae of nephrotic syndrome (NS). The incidence of TECs in children is approximately 2%-5%. The veins are the most commonly affected sites, particularly the deep veins in the legs, the inferior vena cava, the superior vena cava, and the renal veins. Arterial thrombosis, which is less common, typically occurs in the cerebral, pulmonary, and femoral arteries, and is associated with the use of steroids and diuretics. Popliteal artery thrombosis in children has been described in cases of traumatic dissection, osteochondroma, Mycoplasma pneumoniae infection, and fibromuscular dysplasia. We report of a 33-month-old girl with bilateral iliac and popliteal arterial thrombosis associated with steroid-resistant NS due to focal segmental glomerulosclerosis. Her treatment involved thrombectomy and intravenous heparinization, followed by oral warfarin for 8 months. Herein, we report a rare case of spontaneous iliac and popliteal arterial thrombosis in a young child with NS.

Clinical Experience of Interferon Alfa-2a Treatment for Refractory Uveitis in Behcet's Disease

Behcet's disease (BD) involves multisystem vasculitis of unknown origin. Ocular manifestations of BD mostly include bilateral panuveitis and retinal vasculitis, which are very challenging to treat. Interferon alfa-2a (IFN) has been recently introduced for treating refractory Behcet uveitis, mainly in Germany and Turkey. Nonetheless, there is so far no consensus about the ideal treatment regimen of IFN for Behcet uveitis. We report our experience of IFN treatment in five Korean BD patients with refractory uveitis. All patients complained of oral ulcers; one patient had a positive pathergy test and 2 showed the presence of HLA-B51. Immunosuppressive agents used prior to IFN treatment included cyclosporine and methotrexate. The IFN treatment was commenced with a dose of 6-9 MIU/day for 7 days, adjusted according to individual ocular manifestations, tapered down to 3 MIU three times in a week, and then discontinued. All patients showed positive response to IFN treatment; 50% of them showed complete response without additional major ocular inflammation during the follow-up period. Other BD symptoms also improved after IFN treatment in most cases. After treatment, the relapse rate and the required dose of oral corticosteroid were decreased in most cases, showing a significant steroid-sparing effect. However, the visual acuity was not improved in most cases due to irreversible macular sequelae. Despite the small sample size of this study, we suggest that, in Korean patients, IFN is an effective treatment modality for BD uveitis as was observed in German and Turkish patients.

Changes in Melanin and Melanocytes in Mottled Hypopigmentation after Low-Fluence 1,064-nm Q-Switched Nd:YAG Laser Treatment for Melasma

No abstract available.

Neutrophilic Dermatosis Confined to the Lymphedematous Area

No abstract available.

Risk Factor for Massive Pulmonary Hemorrhage Occurring during the First Five Days after Birth in Extremely Low Birth Weight Infants

PURPOSE: Massive pulmonary hemorrhage(MPH) within the first five days after birth is a major cause of early death in extremely low birth weight(ELBW) infants. The objective of this study was to determine risk factors for MPH in ELBW infants. METHODS: Data were retrospectively collected from 115 ELBW infants admitted to Seoul National University Bundang Hospital between January 2007 and September 2012. MPH was defined as the presence of hemorrhagic fluid in the trachea accompanied by acute respiratory failure within the first five days after birth. Initial echocardiography and cranial ultrasonography were performed in all subjects before MPH. Clinical characteristics of ELBW infants with and without MPH were compared and the risk factors for MPH were investigated. RESULTS: MPH occurred at 54+/-30 h after birth and was more frequent in ELBW infants with lower gestational age and lesser birth weight. Older maternal age was also associated with MPH. The presence of patent ductus arteriosus diagnosed using initial echocardiography was not significantly associated with MPH. The presence of intraventricular hemorrhage diagnosed using serial cranial ultrasonography was significantly associated with MPH. Logistic regression analysis indicated that among the variables that preceded MPH, only lower gestational age was independently associated with MPH. CONCLUSION: Lower gestational age was found to be a risk factor for MPH within the first five days after birth in ELBW infants.

Risk Factors of Invasive Carbapenem-Resistant Acinetobacter baumannii Infection in Neonatal Intensive Care Unit during Outbreak

PURPOSE: Invasive carbapenem-resistant Acinetobacter baumannii (CRAB) infection is associated with high morbidity and mortality rates in critically ill patients and neonates. We aimed to determine the risk factors of invasive infection in neonates with CRAB colonization, and differences in clinical outcomes between CRAB colonization and infection groups during the CRAB outbreak. METHODS: We retrospectively collected data from 45 patients with CRAB during the outbreak at the Neonatal Intensive Care Unit of Seoul National University Children's Hospital from May 2011 until April 2012. RESULTS: CRAB infection developed in 7 neonates (15.5%). Clinically significant patent ductus arteriosus (colonization group, 57.9% vs. infection group, 100%; P=0.04) and intubation state at initial CRAB isolation (44.7% vs. 100%, respectively; P=0.01) were more prevalent in the infection group. Univariate analysis results showed that a 1-min Apgar score of 14 had odds ratios of 9.9 (P=0.04) and 24.0 (P=0.02), respectively, for invasive CRAB infection. Total lengths of intubation, central venous catheterization, and CRAB isolation were significantly longer in the invasive infection group than colonization group. As a clinical outcome, incidence of bacteremia other than CRAB (26.3% vs. 71.4%, P=0.03) was higher in the infection group, but there was no differences in the mortality rates between groups (15.8% vs. 42.9%, respectively; P=0.13). CONCLUSION: A 1-min Apgar score of 14, clinically significant patent ductus arteriosus, and intubation state at initial isolation were found to be risk factors for invasive CRAB infection during the outbreak. During CRAB outbreak, early and appropriate antimicrobial treatment should be administered to high-risk patients.

A Comparison of the Corticosteroid Intralesional Injections Alone versus Corticosteroid Intralesional Injections with Cryotherapy on Hypertrophic Scars and Keloids after Thyroidectomy: A Split-scar Study / 대한피부과학회지

BACKGROUND: Various treatment modalities for hypertrophic scars and keloids have been used. However, there is no consensus as to what the optimum approach should be. Most common treatments are corticosteroid intralesional injection (ILI) and cryotherapy as well as combination of these two modalities. To this date, however, there are no prospectively comparative, scar-split studies between steroid ILI monotherapy and combination of steroid ILI and cryotherapy. OBJECTIVE: The purpose of this article is to investigate and compare the efficacy of steroid ILI monotherapy and the combination of steroid ILI and cryotherapy. METHODS: Eighteen women who had thyroid operation scars were recruited. Patients received steroid ILI with cryotherapy on the right half, and steroid ILI monotherapy on the left half of the scar. Patients were treated for four sessions with three weeks of intervals. Subjects were evaluated on their scar status with the modified Vancouver scar scale (MVSS) and scar redness by using colorimeter at baseline and every visit day. RESULTS: After four treatment sessions, MVSS was significantly improved on both sides of scar. Significant improvement was observed after one treatment session on the right half, and after two treatment sessions on the left half. There was no significant difference between left and right side after four sessions of treatment. The scar redness of both sides of scar showed no significant differences between the baseline and at the end of the study. CONCLUSION: Both corticosteroid ILI with cryotherapy and corticosteroid ILI monotherapy are effective treatment modalities for hypertrophic scars. However, the results of the present study suggest that a combination therapy might lead to more rapid improvements.

Withholding Enteral Feeding and Its Clinical Consequences in Extremely Low Birth Weight Infants during NICU Stay / 대한주산의학회잡지

PURPOSE: To evaluate the causes of nil per os (NPO) before reaching full enteral feeding and compare the clinical outcomes of extremely low birth weight infant (ELBWI) by NPO duration. METHODS: We retrospectively reviewed the medical records of 92 ELBWI who were born and admitted to Neonatal intensive care unit (NICU) of Seoul National University Children's Hospital from January 2009 to December 2011. We analyzed the perinatal factors and causes of NPO. To compare neurodevelopmental outcomes and growth, we used K-ASQ (Korean ages & stages questionnaires) and growth Z-score. RESULTS: There were total 163 fasting episodes before reaching full enteral feeding. Mean NPO time was 6.7+/-5.6 days and mean frequency of NPO was 1.8 episodes. Most common cause of NPO was the medication for patent ductus arteriosus (PDA) closure (47.5%) and the next was the feeding intolerance (25.3%). Longer NPO group (more than 7 days) showed longer time to full enteral feeding and hospital day. Incidence of necrotizing enterocolitis was significantly higher in the longer NPO group. But there was no difference between two groups in the incidence of sepsis, cholestasis, and osteopenia. Changes in height Z-score from birth to postmenstrual age 35 weeks were significantly higher in the longer NPO group. In longer NPO group, catch-up of weight Z-score at CA 8 months was poor. And number of patients with score under cutoff level in K-ASQ was higher. CONCLUSION: NPO duration seems to be related with long term growth and neurodevelopment. Effort to minimize fasting time is needed by keeping enteral feeding during PDA medication and active management for feeding intolerance.

Effects of Xanthium stramarium and Psoralea corylifolia Extracts Combined with UVA1 Irradiation on the Cell Proliferation and TGF-beta1 Expression of Keloid Fibroblasts

BACKGROUND: Xanthium stramarium (XAS) and Psoralea corylifolia (PSC), phototoxic oriental medicinal plants, has been used in traditional medicines in Asian countries. OBJECTIVE: The effects of highly purified XAS or PSC extract combined with ultraviolet A1 (UVA1) irradiation on cell proliferation and transforming growth factor-beta1 (TGF-beta1) expression of the keloid fibroblast were being investigated to define potential therapeutic uses for keloid treatments. METHODS: The keloid fibroblasts were treated with XAS or PSC alone or in the combination with UVA1 irradiation. The cell viability, apoptosis, and expression of TGF-beta1 and collagen I were investigated. RESULTS: XAS and PSC in combination with UVA1 irradiation suppressed cell proliferation and induced apoptosis of keloid fibroblasts. Furthermore, the XAS and PSC in combination with UVA1 irradiation inhibited TGF-beta1 expression and collagen synthesis in keloid fibroblasts. CONCLUSION: These findings may open up the possibility of clinically used XAS or PSC in combination with UVA1 irradiation for keloid treatments.

Effects of Xanthium stramarium and Psoralea corylifolia Extracts Combined with UVA1 Irradiation on the Cell Proliferation and TGF-beta1 Expression of Keloid Fibroblasts

BACKGROUND: Xanthium stramarium (XAS) and Psoralea corylifolia (PSC), phototoxic oriental medicinal plants, has been used in traditional medicines in Asian countries. OBJECTIVE: The effects of highly purified XAS or PSC extract combined with ultraviolet A1 (UVA1) irradiation on cell proliferation and transforming growth factor-beta1 (TGF-beta1) expression of the keloid fibroblast were being investigated to define potential therapeutic uses for keloid treatments. METHODS: The keloid fibroblasts were treated with XAS or PSC alone or in the combination with UVA1 irradiation. The cell viability, apoptosis, and expression of TGF-beta1 and collagen I were investigated. RESULTS: XAS and PSC in combination with UVA1 irradiation suppressed cell proliferation and induced apoptosis of keloid fibroblasts. Furthermore, the XAS and PSC in combination with UVA1 irradiation inhibited TGF-beta1 expression and collagen synthesis in keloid fibroblasts. CONCLUSION: These findings may open up the possibility of clinically used XAS or PSC in combination with UVA1 irradiation for keloid treatments.

Photodynamic Therapy with Ablative Carbon Dioxide Fractional Laser for Treating Bowen Disease

BACKGROUND: Topical photodynamic therapy (PDT) has been increasingly used to treat malignant skin tumors including the Bowen disease. However, patients could be displeased with the long incubation time required for conventional PDT. OBJECTIVE: We evaluated the efficacy and safety of PDT with a short incubation time of ablative CO2 fractional laser pretreatment for treating Bowen disease. METHODS: Ten patients were included. Just before applying the topical photosensitizer, all lesions were treated with ablative CO2 fractional laser, following the application of methyl aminolevulinate and irradiation with red light (Aktilite CL 128). Histological confirmation, rebiopsy, and clinical assessments were performed. Adverse events were also recorded. RESULTS: Five of the ten (50%) lesions showed a complete response (CR) within three PDT sessions. After four treatment sessions, all lesions except one penile shaft lesion (90%) achieved clinical and histological CR or clinical CR only. The average number of treatments to CR was 3.70+/-1.70. The treatments showed favorable cosmetic outcomes and no serious adverse events. CONCLUSION: The results suggest that pretreatment with an ablative fractional CO2 laser before PDT has similar treatment efficacy and requires a shorter photosensitizer incubation time compared with the conventional PDT method.

Photodynamic Therapy with Ablative Carbon Dioxide Fractional Laser for Treating Bowen Disease

BACKGROUND: Topical photodynamic therapy (PDT) has been increasingly used to treat malignant skin tumors including the Bowen disease. However, patients could be displeased with the long incubation time required for conventional PDT. OBJECTIVE: We evaluated the efficacy and safety of PDT with a short incubation time of ablative CO2 fractional laser pretreatment for treating Bowen disease. METHODS: Ten patients were included. Just before applying the topical photosensitizer, all lesions were treated with ablative CO2 fractional laser, following the application of methyl aminolevulinate and irradiation with red light (Aktilite CL 128). Histological confirmation, rebiopsy, and clinical assessments were performed. Adverse events were also recorded. RESULTS: Five of the ten (50%) lesions showed a complete response (CR) within three PDT sessions. After four treatment sessions, all lesions except one penile shaft lesion (90%) achieved clinical and histological CR or clinical CR only. The average number of treatments to CR was 3.70+/-1.70. The treatments showed favorable cosmetic outcomes and no serious adverse events. CONCLUSION: The results suggest that pretreatment with an ablative fractional CO2 laser before PDT has similar treatment efficacy and requires a shorter photosensitizer incubation time compared with the conventional PDT method.

Simultaneous Involvement of Nervous and Gastrointestinal Systems in Behcet's Disease

No abstract available.

Recovery and Adsorption Rate of Murine Norovirus Using NanoCeram(R) Filters

This study investigated the recovery and absorption rates of murine norovirus, a surrogate for human norovirus, by using NanoCeram(R) filters which served as a tool for recovering viruses. In the study, two types of NanoCeram(R) filters were employed: one was a cartridge type and the other was a disc type (phi 47 mm) whose surface area is 75 times smaller than the cartridge type. The analytical method was the real-time reverse transcription-polymerase chain reaction (RT-PCR). The study found that the average recovery rates of the cartridge type and the disc type were 30.9% and 29.5% respectively. Since these two rates were very close to each other, the adsorption rate of the cartridge type could be predicted with the disc type. Analyzing recovery and absorption rates of the disc type based on different filtered volumes showed that when the volume increased from 0.5 L to 20 L, the average recovery rate rose from 14.78% to 30.41 %, while the average absorption rate dropped from 56.33% to 10.48%. The increase in turbidity from less than 1 NTU to less than 3 NTU raised the average recovery rate from 47.23% to 82.84%.

Subcutaneous Dermatofibrosarcoma Protuberans on the Breast / 대한피부과학회지

Dermatofibrosarcoma protuberans (DFSP) is a dermal spindle cell neoplasm of intermediate malignancy. It typically forms a brown indurated plaque on which firm nodules subsequently arise, sometimes with ulceration. Atypical DFSP presentations are not unusual, including atrophic, pedunculated, morphea-like and angioma-like forms. However, subcutaneous variant of DFSP that may either arise without dermal involvement or with minimal dermal involvement is very rare. A 36-year-old man presented with a palpable nodule without surface change around the right nipple. Microscopically, the neoplasm was composed of spindle cells with monomorphic storiform arrangement. The superficial part of the neoplasm was located in the subcutaneous tissue. Immunohistochemical staining showed strong cytoplasmic positivity for CD34, but not for factor XIIIa. Dermatologists should pay careful attention to these unusual variant of DFSP, which can be confused with other soft tissue tumors.