Clinicopathological Study of 191 Cases of Metastatic Skin Cancers from Solid Cancer Diagnosed at the Department of Dermatology in a Tertiary Referral Cancer Center / 대한피부과학회지

Background@#Metastatic skin cancers occur when cancer cells metastasize to the skin as the primary cancer progresses, but few studies in Korea have included a large number of patients. @*Objective@#To analyze the clinicopathological characteristics of metastatic skin cancers originating from solid cancers. @*Methods@#A total of 191 patients with metastatic skin cancer diagnosed by skin biopsy from April 2004 to December 2021 were retrospectively analyzed. Data on age, sex, duration, symptoms, clinical manifestations, metastatic sites, and histopathological findings were obtained from medical records and photographs. @*Results@#The mean age of onset was 65.3 years, the male/female ratio was 80:111, and the mean duration was 3.3 months. Most patients were asymptomatic (65.4%), and the most frequent manifestation was nodular lesions (64.4%). Among the 191 metastatic skin cancers, the most common primary cancers were breast cancer (31.9%), lung cancer (25.7%), and melanoma (18.8%). The most common primary cancer in males was lung cancer (52.5%), and that in females was breast cancer (54.1%). The most common sites of metastatic skin cancer were the chest (26.6%), scalp (17.9%), abdomen (10.6%), and back (9.2%). The most common histopathological finding of metastatic skin cancer was adenocarcinoma (53.4%), followed by melanoma (18.8%) and squamous cell carcinoma (14.7%). @*Conclusion@#We believe that this study will be helpful in diagnosing metastatic skin cancer in patients with a history of cancer or a newly diagnosed primary cancer.

Study on the Development of Training Programs for Standardized Patients of the Practical Examination Portion of the National Dental Licensing Examination

Purpose@#The practical examination portion of the National Dental Licensing Examination (NDLE) is slated to be administered in the latter half of 2021 in the form of a clinical performance examination that comprehensively evaluates the patient-dentist interaction using standardized patients (SPs). The SPs should be equipped with the basic qualities and capacity as evaluators for a fair and reliable administration of the test. @*Materials and Methods@#In this study, we analyzed the existing training materials for SPs who participated in domestic and overseas practical tests for the development of training materials for SPs through seminars and surveys of 11 dentistry schools and colleges.Result: First, SPs should be selected according to the basic quality criteria and capacity, which they must possess, and the preliminary basic training about the details which they must have knowledge of and be provided through videorecorded cases before the implementation of the preliminary field training. Second, the roles of SPs and the calibration process of the evaluation result forms are needed when conducting the preliminary field training for SPs. After watching video-recorded scenario cases, the SPs participate in discussions about the watched videos before proceeding to calibration practices of evaluation result forms. Third, because the Type A questionnaire of the practical examination of the NDLE is dependent on the SPs’ capacity and training, the fairness of the practical test is largely dependent on the SPs. Therefore, practicing the roles as evaluators and evaluation training should be provided using practical test items that can improve the reliability of the test and show a high level of reproducibility about the same case. @*Conclusion@#The findings of this study will be utilized for the development of training materials for SPs, so they can participate in the administration of a fair and reliable practical examination of the NDLE.

A Case of Hereditary Hemorrhagic Telangiectasia / 대한피부과학회지

Hereditary hemorrhagic telangiectasia (HHT), also known as Osler–Weber–Rendu syndrome, is a rare autosomal dominant genetic disorder that results in vascular malformation in the skin, mucous membrane, and other internal organs, such as the gastrointestinal tract, lung, liver, and brain. A 49-year-old man presented with purpuric punctate, spider-like telangiectasia on the face, hands, and fingers. He had episodes of recurrent nasal bleeding. The family members of the patient had similar events of recurrent nasal bleeding and cutaneous telangiectasia. Abdominal computed tomography revealed multiple arteriovenous malformations and cysts in the liver. Gastroendoscopy and colonoscopy showed angiodysplasia of the fundus of the stomach and mucous membrane of the colon. Histopathologic examination revealed dilated vessels lined with flat endothelial cells in the dermis. We report herein the case of HTT because it is rare and significant for differential diagnosis.

Study on the Development of Training Programs for Standardized Patients of the Practical Examination Portion of the National Dental Licensing Examination

Purpose@#The practical examination portion of the National Dental Licensing Examination (NDLE) is slated to be administered in the latter half of 2021 in the form of a clinical performance examination that comprehensively evaluates the patient-dentist interaction using standardized patients (SPs). The SPs should be equipped with the basic qualities and capacity as evaluators for a fair and reliable administration of the test. @*Materials and Methods@#In this study, we analyzed the existing training materials for SPs who participated in domestic and overseas practical tests for the development of training materials for SPs through seminars and surveys of 11 dentistry schools and colleges.Result: First, SPs should be selected according to the basic quality criteria and capacity, which they must possess, and the preliminary basic training about the details which they must have knowledge of and be provided through videorecorded cases before the implementation of the preliminary field training. Second, the roles of SPs and the calibration process of the evaluation result forms are needed when conducting the preliminary field training for SPs. After watching video-recorded scenario cases, the SPs participate in discussions about the watched videos before proceeding to calibration practices of evaluation result forms. Third, because the Type A questionnaire of the practical examination of the NDLE is dependent on the SPs’ capacity and training, the fairness of the practical test is largely dependent on the SPs. Therefore, practicing the roles as evaluators and evaluation training should be provided using practical test items that can improve the reliability of the test and show a high level of reproducibility about the same case. @*Conclusion@#The findings of this study will be utilized for the development of training materials for SPs, so they can participate in the administration of a fair and reliable practical examination of the NDLE.

Different Clinical Courses of Idiopathic Isolated Hypoglossal Nerve Palsy / 대한임상신경생리학회지

No abstract available.

Osteocalcin Expression and Mineralization in Developing Tooth of Xenopus laevis

Osteocalcin (OC) is the most abundant noncollagenous protein of extracellular matrix in the bone. In an OC deficient mouse, bone formation rates are increased in cancellous and cortical bones. OC is known as a negative regulator of mineral apposition. OC is also expressed in the tooth of the rat, bovine, and human. However, little is known about OC during tooth development in Xenopus. The purpose of this study is to compare the expression of OC with mineralization in the developing tooth of Xenopus, by using von Kossa staining and in situ hybridization. At stage 56, the developmental stage of tooth germ corresponds to the cap stage, and an acellular zone was apparent between the dental papilla and the enamel organ. From stage 57, calcium deposition was revealed by von Kossa staining prior to OC expression, and the differentiated odontoblasts forming predentin were located at adjoining predentin. At stage 58, OC transcripts were detected in the differentiated odontoblasts. At stage 66, OC mRNA was expressed in the odontoblasts, which was aligned in a single layer at the periphery of the pulp. These findings suggest that OC may play a role in mineralization and odontogenesis of tooth development in Xenopus.

Radiological Predictors of Difficult Laryngeal Exposure in Laryngomicrosurgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Laryngeal microsurgery (LMS) is a common procedure for diagnosis and treatment of various laryngeal diseases. Sometimes, laryngeal exposure is poor and LMS may be impossible. The aim of this study was to investigate factors related to difficult laryngeal exposure in LMS. SUBJECTS AND METHOD: Three hundred patients who underwent LMS were enrolled in this study. The patients were categorized into 3 subgroups (easy exposure group, moderate exposure group, and difficult exposure group) according to the glottic visualization under suspension laryngoscopy. The 14 parameters on lateral extension neck X-ray in the closed and open mouth view were analyzed to evaluate laryngeal exposure. RESULTS: The study included 168 males and 132 female patients with the mean age of 48.36+/-12.39 (10-79) years. Of 300 patients, 244 patients were classified as the easy exposure group, 41 as the moderate exposure group, and 15 as the difficult exposure group. Patients with difficult laryngeal exposure were significantly higher in males (p<0.001). Among 14 radiologic parameters, thyroid incisor angle in closed mouth view (p=0.003) and sternum-mentum distance in open mouth view (p=0.04) were significantly related with difficult laryngeal exposure on the multivariate analysis. CONCLUSION: Being a male, having a narrow thyroid incisor angle in the closed mouth view and having a short sternum-mentum distance in the open mouth view are useful patient indications that serve to predict difficult laryngeal exposure in LMS.

Evaluation of Vestibular Function in Idiopathic Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is very important to evaluate vestibular function in patients with sudden sensorineural hearing loss (SNHL) because vertigo combined with sudden SNHL is well known as an important prognostic factor. However, the vestibular function test is not usually performed in sudden SNHL patients without vertigo. We investigated whether different vestibular function tests such as the results of vestibular evoked myogenic potential (VEMP) testing or caloric testing were correlated to prognosis in not only sudden SNHL patients with vertigo but also in sudden SNHL patients without vertigo. SUBJECTS AND METHOD: We enrolled in our study 47 patients with idiopathic sudden SNHL with vertigo or without vertigo. The degree of initial hearing loss was categorized as mild, moderate, moderate-severe, severe, and profound group. Types of initial audiograms were categorized as high tone loss, low tone loss, flat and scale out type. We analyzed the association of the VEMP and caloric test with degree of hearing loss, type of audiogram, and hearing recovery in two month. RESULTS: The more sever the hearing loss was, the more increased was the rate of abnormal VEMP response (p=0.003). The rate VEMP and caloric abnormality was higher in hearing loss types with high tone loss than in the types with only low tone loss. The rate of accompanying vertigo was high (p=0.017), when the hearing loss was more severe. There was significant correlation between the hearing recovery and vestibular dysfunction (p=0.000, r=0.563). CONCLUSION: VEMP and caloric test are useful in evaluating vestibular function and prognosis of sudden SNHL patients.

Surgical Approach for Oral Cavity Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In the treatment of oral cancer, appropriate surgical approaches should be chosen in order to eradicate cancer while preserving the function of oral cavity and facial contour. This study was performed to evaluate the usefulness and effectiveness of various surgical approaches in the surgical treatment of oral cancer. SUBJECTS AND METHOD: A total of 112 oral cancer patients, excepting those with lip cancer, and who underwent surgery from 1994 to Aug 2008, were enrolled. We reviewed medical records retrospectively and analyzed the primary sites, stage, surgical approaches, management of mandible and neck, reconstruction methods, recurrence and survival rates. RESULTS: Of the 112 patients, 64 were transoral, 23 pull-through, 6 mandibular lingual releasing, 6 upper cheek flap , 5 lower cheek flap , 6 mandibulotomy and 2 visor flap approach. Most of T1, T2 lesions could be resected by transoral (71.6%) or pull-through approach (21.0%). In the advanced T3, T4 lesions, transoral (21.9%), pull-through (37.5%), cheek flap (21.9%), mandibulotomy (15.6%) were used. There was no statistically significant difference with respect to locoregional recurrence and survival rate according to surgical approach. CONCLUSION: The transoral approach was the effective method for the surgery of T1, T2 and part of T3 oral cancer. The pull-through or mandibular lingual releasing approach was the effective method of surgery for T2, T3 tongue or floor of mouth (FOM) cancer while avoiding mandibulotomy.

A Case of Maxillary Actinomycosis

Actinomycosis is a very rare infectious disease caused by Actinomyces, which are gram-positive, predominantly anaerobic, non acid-fast bacillus. Actinomyces are normal flora in the upper and lower aerodigestive tracks but can become pathogenic after mucosal injuries such as tooth extraction and trauma to the mouth or jaw. Actinomycosis of the maxillary sinus is very difficult to diagnose due to its low incidence and lack of characteristic clinical findings. We recently experienced a case of maxillary actinomycosis in a 78-year-old immunocompetent male who underwent endoscopic sinus surgery 10 months previously and a molar tooth extraction 3 months previously. CT scans showed soft tissue density with a focal calcification and flexible fiberscopy indicated a brown-colored mass at the maxillary sinus floor. The maxillary sinus lesion was removed by sinus irrigation through the ostium and histopathology confirmed sulfur granules compatible with actinomycosis. The patient was treated with a 6-month course of oral augmentin-clavulanate. A diagnosis of actinomycosis should always be considered in a patient with unilateral intractable maxillary sinusitis, focal calcification in CT scans, and a history of molar tooth extraction.

A Case of Mucoepidermoid Carcinoma in Nasopharynx / 대한이비인후과학회지

Mucoepidermoid carcinoma of nasopharynx, a kind of primary adenocarcinoma of the the nasopharynx, is very rare and about 21 cases of mucoepidermoid carcinoma occurring in the nasopharynx were reported to date in the English literature. We recently experienced a case of mucoepidermoid carcinoma of the nasopharynx in a 31-year-old woman, who presented with nasopharyngeal mass and left lateral neck mass. We present this case with a review of the literature.

A case of hemimegalencephaly with congenital foot deformity / 대한주산의학회잡지

Hemimegalencephaly is a rare congenital malformation of the cortical development arising from abnormal proliferation of anomalous neuronal and glial cells. The characteristic clinical manifestations are macrocephaly, psycomotor retardation, intractable seizure and hemihypertrophy of face, body and extremities, but musculoskeletal deformities are reported only in case of epidermal nevus syndrome. We report a case of hemimegalencephaly that was associated with foot deformity, without symptoms and signs of epidermal nevus syndrome.

Effect of Pdx1 Expression after Sox9 Depletion in the Early Pancreatic Development in African Clawed Frog (Xenopus laevis) / 대한해부학회지

The pancreas is a mixed exocrine and endocrine gland involved in the control of many homeostatic functions.During embryogenesis,the pancreas arises from dorsal and ventral evaginations of the foregut,which subse- quently fuse into a single organ.The characterization of early genes expressed in the developing pancreas is critical to understand its specification and differentiation.Pdx1 is one of the earliest markers of pancreatic development and a key molecule in its development.Sox proteins form a large class of transcriptional regulators implicated in the control of a variety of developmental processes.One member of this family,Sox9,is expressed in the developing pancreas, but little is known about the function of Sox9 in the developing pancreas.We further investigated Sox9 function during pancreatic development in Xenopus .Using a hormone-inducible inhibitory mutant of Sox9 ,we found that Pdx1 expres- sion was reduced in the ventral pancreatic buds in Sox9-depleted embryos.We suggest that Sox9 gene expression may be involved in pancreatic development in Xenopus.

Histochemical Characteristics and Ultrastructure of Mast Cells in Pheasant (Phasianus colchicus) / 대한해부학회지

This study describes the histochemical characteristics and ultrastructure of mast cells from tongue, proventriculus, ileum and fabricius bursa, in pheasant (Phasianus colchicus) by light and electron microscopy. We compared the stainability of 4 different methods, toluidine blue, alcian blue, congo red and alkaline Giemsa, to stain mast cell granules from fixed pheasant organs in three different fixatives, 10% neutral buffered formalin, Carnoy's solution or half-strength Karnovsky's solution. Mast cells in all experimental organs were not stained with 4 different staining methods after fixation in 10% neutral buffered formalin but well stained in fixed organs with half-strength Karnovsky's solution. The mast cells had many metachromatic granules stained with toluidine blue or alkaline Giemsa and orthochromatic granules stained with alcian blue or congo red in tissues fixed in half-strength Karnovsky's solution. In electron microscopy, pheasant mast cells were oval, triangular, spindle-like or irregular and had a few finger-like cytoplasmic processes. There were the membrane-bounded secretory granules and the well-developed organelles in mast cells. Internal large granules were oval or irregular, and had variable shape; some higher or lower electron density with homogeneous appearance; some had a particular appearance, and a few showed reticular or spongy-like structure. This indicates that 10% neutral buffered formalin or Carnoy's fixation may be inadequate for detection of mast cells in pheasant, whereas the half-strength Karnovsky's fixation provides metachromatic or orthochromatic staining of mast cell granules.

Effect of Retinoic Acid on the Expression of PDGF Receptors During Palatogenesis / 대한해부학회지

Although cleft lip and palate are one of the most common craniofacial malformation, little is still known about the mechanism of the palate formation. Retinoic acid (RA) is known a teratogen, and cleft palate is induced by retinoic acid administration in the secondary palate formation stage. Many growth factors and their receptors are involved in the formation of the secondary palate. Here, we investigated the expression of PDGFR-alpha, and PDGFR-beta during palatogenesis after retinoid acid administration in mice by RT-PCR and immunohistochemistry. At E15.5, the opposing palatal shelves fused with one another in the control group, but the palatal shelves were not elevated and cleft palate was induced in the RA-treated group. In RT-PCR, PDGFR-beta was downregulated during palatogenesis after RA administration. In immunohistochemical experiment, PDGFR-alpha and PDGFR-beta were reduced in RA-induced group. Taken together, we suggest that PDGF receptors may be molecules involved in palate formation.

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 Isolated Ventricular Septal Rupture Following Non-penetrating Chest Trauma

Traumatic ventricular septal rupture following traffic accident is presummed to occur by external compression of the heart during late diastole or isovolumetric systole when the ventricular chambers are full and the valves are closed. Isolated ventricular septal rupture following non-penetrating chest trauma is known to be extremely rare. We report a 29-year-old man with suddenly developed ventricular septal rupture follwing nonpenetrating chest trauma by traffic accident, which he was died suddenly due to cardiac arrest in front of an operation.

A Case of carbamazepine induced bronchiolitis obliterans organizing pneumonia / 결핵

BOOP(Bronchiolitis Obliterans Organizing Pneumonia) is an inflammatory reaction that follows damage to the bronchiolar epithelium of the small conducting airways. BOOP is characterized by the pathologic finding of excessive proliferation of granulation tissue within the respiratory bronchioles, alveolar duct and spaces, accompanied by organizing pneumonia. BOOP may result from diverse causes such as toxic fumes, connective tissue disorders, infections, organ transplantation and drugs or appear idiopathically. Drug induced BOOP has been described in association with acebutolol, amiodarone, cephalosporin, bleomycine, tryptophan, gold salts, barbiturates, sulfasalazine, and carbamazepine. Carbamazepine is an iminostilbene derivative that is used as both and anticonvulasnt and pain reliever for pains associated with trigeminal neuralgia. It is structually related to the tricyclic antidepressants. To our knowledge, there have been no previously reported case that has described development of BOOP during carbamazepine treatment in Korea, and only two cases have been reported in the world. We report a case of carbamazepine-induce BOOP with a brief review of literature.

The effects of estrogen on experimental tooth movement in ovariectomized rats / 대한치과교정학회지

The purpose of this study was to evaluate the effect of estrogen on the periodontium and alveolar bone tissue response during experimental tooth movement in ovariectomized rats. Eighty female rats, 250gm in body weight, were classified into four groups ; sham operated group(NN), ovariectomized group(ON), ovariectomized & estrogen injected group(OE), sham operated & estrogen injected injected group(NE), Rats were ovariectomized before 3 weeks to begin the experiment, which resulted in estrogen-deficient osteoporosis. In OE group & NE group, estrogen was injected 50microgramg/kg B.W. every other days. The left maxillary 1st molar was moved mesially with 60g force. Each four rats were sacrificed after 1, 3, 7, 15 days from application of orthodontic appliance and after additional 7 days from removal of orthodontic appliance. Histological findings on mesial roots of upper 1st molar in pressure and tension side are observed. The results were summarized as follows ; 1. In pressure side of alveolar bone, the number of osteoclasts and Howship's lacuna of ON group was significantly more than that of NN group from 1 day to 15 days(P0.05). The amount of tooth movement of ON group between 7 days and 15 days was significantly greater than those of other groups(P0.05).

Chronic Radiation Dermatitis Accompanied by Acrosclerosis and Loss of Digits due to Osteoradionecrosis / 대한피부과학회지

Chronic postirradiation changes of skin reflect the injury of dermal structures particularly the vasculature and connective tissue. The clinical signs include atrophy, partial or complete destruc tion of cutaneous appendatges, telangiectasis, sclerosis of underlying tissue, pigrnentary changes, and in rare instances, ulceration with or without var ious premalignant and malignant neoplasms. The patient, was a 65-year-old man, who had been exposed to a large amount. of X-ray irradi- ation on his hands incidentally or accidentally for a long time. The skin changes of his hand were thickening and hardening of all digits loss or focal consttict,ion of digits, and keratotic papules. Epidermal hyperplasia and fibrous thickening of collagen bundles were found on skin biopsy. Gradual narrowingal of the bony caliber with eventual resorption was noticed on radiologic examination. It has been rarely reported in the literature that chronic radiation dermatitis develops severe and unusal manifestions such as acrosclerosis and loss of digit due to osteoradionecrosis.