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We aimed to develop evidence-based recommendations for treating axial spondylarthritis (axSpA) in Korea. The development committee was constructed, key clinical questions were determined, and the evidence was searched through online databases including MEDLINE, Embase, Cochrane, KoreaMed, and Kmbase. Systematic literature reviews were conducted, quality of evidence was determined, and draft recommendations were formulated according to the Grading of Recommendations Assessment, Development, and Evaluations methodology. Recommendations that reached 80% consensus among a voting panel were finalized. Three principles and 21 recommendations were determined. Recommendations 1 and 2 pertain to treatment strategies, regular disease status assessment, and rheumatologist-steered multidisciplinary management. Recommendations 3 and 4 strongly recommend patient education, exercise, and smoking cessation. Recommendations 5–12 address pharmacological treatment of active disease using nonsteroidal anti-inflammatory drugs, glucocorticoids, sulfasalazine, biologics, and Janus kinase inhibitors. Recommendations 13–16 address treatment in stable disease. We suggest against spa and acupuncture as therapies (Recommendation 17). Recommendations 18 and 19 pertain to total hip arthroplasty and spinal surgery. Monitoring of comorbidities and drug toxicities are recommended (Recommendations 20 and 21). Recommendations for axSpA treatment in a Korean context were developed based on comprehensive clinical questions and evidence. These are intended to guide best practice in the treatment of axSpA.
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We aimed to develop evidence-based recommendations for treating axial spondylarthritis (axSpA) in Korea. The development committee was constructed, key clinical questions were determined, and the evidence was searched through online databases including MEDLINE, Embase, Cochrane, KoreaMed, and KMbase. Systematic literature reviews were conducted, quality of evidence was determined, and draft recommendations were formulated according to the Grading of Recommendations Assessment, Development, and Evaluations methodology. Recommendations that reached 80% consensus among a voting panel were finalized. Three principles and 21 recommendations were determined. Recommendations 1 and 2 pertain to treatment strategies, regular disease status assessment, and rheumatologist-steered multidisciplinary management. Recommendations 3 and 4 strongly recommend patient education, exercise, and smoking cessation. Recommendations 5~12 address pharmacological treatment of active disease using nonsteroidal anti-inflammatory drugs, glucocorticoids, sulfasalazine, biologics, and Janus kinase inhibitors.Recommendations 13~16 address treatment in stable disease. We suggest against spa and acupuncture as therapies (Recommendation 17). Recommendations 18 and 19 pertain to total hip arthroplasty and spinal surgery. Monitoring of comorbidities and drug toxicities are recommended (Recommendations 20 and 21). Recommendations for axSpA treatment in a Korean context were developed based on comprehensive clinical questions and evidence. These are intended to guide best practice in the treatment of axSpA.
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Macrophage activation syndrome (MAS) is a fatal complication of adult-onset Still’s disease (AOSD). Although anti-cytokine agents have been recommended for refractory AOSD or complicated with MAS, MAS cases have been rarely reported during anticytokine treatment. Herein, we describe the first AOSD case complicated with MAS during the treatment with tocilizumab in Korea. Two years after tocilizumab maintenance therapy, high fever and hypertransaminasemia recurred. MAS was diagnosed based on hyperferritinemia, elevated soluble IL-2 receptor levels, and the presence of hemophagocytic histiocytes in the bone marrow.However, she had normal white blood cell counts and acute phase reactant levels. High-dose glucocorticoid and anakinra therapies were not effective, but her disease improved with etoposide. This case shows that tocilizumab may not prevent MAS development and can modify clinical features making it challenging to diagnose. Cytotoxic therapy such as etoposide may be required in MAS cases that develop during anti-cytokine therapy.
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Sebaceous carcinoma is a malignant neoplasm that usually arises in the sebaceous glands of the eyelids. Its pathogenesis is unknown; however, irradiation history, immunosuppression, and use of diuretics are known risk factors. The mainstay of treatment for sebaceous carcinoma of the eyelid is wide surgical resection with a safety margin of 5 to 6 mm, which often results in full-thickness defects. The reconstruction of a full-thickness defect of the eyelid should be approached using a three-lamella method: a mucosal component replacing the conjunctiva, a cartilage component for the tarsal plate, and a flap or skin graft for the skin of the eyelid. In this case, a fullthickness defect of the upper eyelid was reconstructed after tumor removal using a combination of a nasal septum chondromucosal composite graft and a forehead transposition flap, also known as a “Fricke flap.” The flap was designed to include a line of the eyebrow on the lower margin of the flap to replace the eyelash removed during tumor excision. The wound healed completely, without any early or late complications, and the outcome was satisfactory.
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Sebaceous carcinoma is a malignant neoplasm that usually arises in the sebaceous glands of the eyelids. Its pathogenesis is unknown; however, irradiation history, immunosuppression, and use of diuretics are known risk factors. The mainstay of treatment for sebaceous carcinoma of the eyelid is wide surgical resection with a safety margin of 5 to 6 mm, which often results in full-thickness defects. The reconstruction of a full-thickness defect of the eyelid should be approached using a three-lamella method: a mucosal component replacing the conjunctiva, a cartilage component for the tarsal plate, and a flap or skin graft for the skin of the eyelid. In this case, a fullthickness defect of the upper eyelid was reconstructed after tumor removal using a combination of a nasal septum chondromucosal composite graft and a forehead transposition flap, also known as a “Fricke flap.” The flap was designed to include a line of the eyebrow on the lower margin of the flap to replace the eyelash removed during tumor excision. The wound healed completely, without any early or late complications, and the outcome was satisfactory.
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The treatment outcome of advanced squamous cell carcinoma involving the head and neck is well known to be dire and usually needs multimodality treatment even including optimal reconstruction after ablative surgery. When a significant area of the soft tissue is resected, reconstruction of oral cavity or pharynx needs to minimize morbidities while achieving adequate functional outcomes. For the better functional outcome, invasive approaching procedures such as lip and jaw splitting, or extensive floor of mouth or pharyngeal muscle ablation should be avoided. Without these surgical procedures, reconstructive surgeons may encounter technical difficulties in flap inset due to deep and narrow space after head and neck cancer resection. In a deep and narrow surgical defect, accurate approximation and suture is extremely difficult. Eventually, repeated flap manipulation and stretch might be inevitable, and even pedicle kinking or injury could happen. Herein, we suggested the “parachute” technique, which was generally used in blood vessels or aortic valve suturing in a narrow surgical field and for avoiding mismatched suture. We applied this “parachute” technique for free-flap inset to head and neck defect, and we herein report our successful outcomes.
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Secretory carcinoma of salivary gland origin is a recently described tumor that harbors a characteristic ETV6-NTRK3 translocation that is identical to secretory carcinoma of the breast. The majority of tumors were located in the parotid gland and other major salivary glands, while the minority occurred in a minor salivary gland. We present a case of a 71-year-old female who was diagnosed with low-grade salivary gland cancer presenting in the soft palate accompanying lymph node metastasis. Peroral wide excision, selective neck dissection, reconstruction with radial forearm free flap was performed. The final pathology report indicated secretory carcinoma of the soft palate. The patient was followed-up without evidence of recurrence for one year. At present, it is difficult to accurately assess prognosis and treatment for the secretory carcinoma of the minor salivary gland origin. Continuous follow-up with various cases is needed further.
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Purpose@#A fourth degree burn is a full-thickness burn of the skin usually accompanied by damage to deep structures and commonly results in extensive damage to surrounding tissues which makes the treatment of the wound difficult. Coverage of these wound using free flap is known to effective but not commonly used. The purpose of our study is to review our experience and suggest early application of free flap surgery. @*Methods@#A retrospective review was performed from 2010 to 2019, on a total of 34 fourth degree burn patients undergone free flap surgery as primary treatment in our hospital. We reviewed the location of the injury, etiology, TBSA (%), Presence of osteomyelitis, flap choice, complications, period of injury to surgery and healing. @*Results@#Using free flap as a primary reconstrcuction, the outcome is satisfactory. The treatment period was shortened, and there was less loss of function due to complications. Also the incidence of osteomyelitis and amputation was significantly low. @*Conclusion@#Applying free flap surgery as soon as possible in fourth degree burns is effective, such as reducing complications such as infection, reducing amputation, shortening treatment period, and preventing severe sequelae.
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Secretory carcinoma of salivary gland origin is a recently described tumor that harbors a characteristic ETV6-NTRK3 translocation that is identical to secretory carcinoma of the breast. The majority of tumors were located in the parotid gland and other major salivary glands, while the minority occurred in a minor salivary gland. We present a case of a 71-year-old female who was diagnosed with low-grade salivary gland cancer presenting in the soft palate accompanying lymph node metastasis. Peroral wide excision, selective neck dissection, reconstruction with radial forearm free flap was performed. The final pathology report indicated secretory carcinoma of the soft palate. The patient was followed-up without evidence of recurrence for one year. At present, it is difficult to accurately assess prognosis and treatment for the secretory carcinoma of the minor salivary gland origin. Continuous follow-up with various cases is needed further.
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BACKGROUND: Age-related changes in facial skin is a major concern in women. This study aimed to objectively evaluate normal skin elasticity and age-related differences in the faces of East Asian women. There are no standard values for data related to normal skin on East Asian women. METHODS: We studied 129 healthy East Asian women without a history of cosmetic procedures or surgeries. Skin elasticity was assessed at the cheek and lower eyelid points, which were assessed on both the right and left sides of the face. RESULTS: The age of the subjects showed significant negative correlations with the R2 and R7 parameters, which represent skin elasticity after deformation. CONCLUSION: We therefore concluded that the primary decrease in skin elasticity in East Asian women occurs in the midface region.
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Feminino , Humanos , Povo Asiático , Bochecha , Elasticidade , Pálpebras , Rejuvenescimento , Envelhecimento da Pele , PeleRESUMO
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Humanos , Discriminação Psicológica , Métodos , Odorantes , Medicina de Precisão , Prevalência , Estudos Prospectivos , OlfatoRESUMO
The central venous cannulation is commonly performed in the operating rooms and intensive care units for various purposes. Although the central venous catheter (CVC) is used in many ways, the malpositioning of the CVC is often associated with serious complications. We report a case of an unexpected malposition of a CVC in the jugular venous arch via external jugular vein.
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Cateterismo , Cateteres Venosos Centrais , Unidades de Terapia Intensiva , Veias Jugulares , Salas CirúrgicasRESUMO
Hyperkalemic periodic paralysis is characterized by episodic flaccid paralysis of the skeletal muscles due to an increase in serum potassium concentrations. Primary hyperkalemic periodic paralysis is caused by point mutations in SCN4A, encoding a voltage-gated skeletal muscle sodium channel. However, hyperkalemia-related diseases, such as renal failure, adrenal insufficiency, hypoaldosteronism, and chronic diuretic use, can induce secondary hyperkalemic periodic paralysis. Diagnosis of this disease is based on clinical features, nerve conduction studies, and a DNA sequence analysis. In cases of diagnostic uncertainty, a provocation test can be used to ensure the correct diagnosis. Here, we report a case of secondary hyperkalemic periodic paralysis with hyperkalemia that was induced by diabetic nephropathy, and review the relevant literature.
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Insuficiência Adrenal , Nefropatias Diabéticas , Sacarose Alimentar , Hiperpotassemia , Hipoaldosteronismo , Músculo Esquelético , Condução Nervosa , Paralisia , Paralisia Periódica Hiperpotassêmica , Mutação Puntual , Potássio , Insuficiência Renal , Análise de Sequência de DNA , Canais de Sódio , IncertezaRESUMO
Stents are frequently used throughout the human body. They keep pathways open in vascular or nonvascular duct for a long time. Therefore its stability is very important factor. In recent years, aconsiderable amount of research has been carried out in order to estimate mechanical properties of the stent such as expansion pressure behavior, radial recoil and longitudinal recoil using FEM (Finite element analyses). However, published works on simulation of stent fatigue behavior using FEM are relatively rare. In this paper, a nonlinear finite-element method was employed to analyses the compression of a stent using external pressure and fatigue behavior. Finite element analyses for the stent system were performed using NASTRAN FX. In conclusion this paper shows how the stent is behaved in the body, and its fatigue behavior.
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Fadiga , Análise de Elementos Finitos , Corpo Humano , StentsRESUMO
In this study, the paclitaxel eluting stent (PES) was prepared by coating a biliary stent with paclitaxel using various biopolymer such as poly (vinyl acetate) (PVAc), poly (lactic-co-glycolic acid) (PLGA), Silicone rubber for restenosis prevention in gastrointestinal disease by a dip-coating method. Drug contents of PES were increased as surface area of stent, concentration and molecular weight of coating polymer increase. In 1H-NMR specta, we know that drug did not change by confirming specific peaks of paclitaxel in PES. As shown in SEM image, PES prepared using various biopolymer is coated clearly and regularly except Silicone rubber coating polymer. In in vitro cell cytotoxicity test, bare stent showed low cytotoxic effect against CT-26 colon carcinoma cell line on 3 day. However, PES coated with PLGA 502H showed the highest cytotoxicity because PLGA 502H is biodegradable polymer and has less molecular weight than other coating polymer. These results suggest that PES coated various biopolymer can be prevented restenosis in gastrointestinal disease.