Risk factor leading to complicated appendicitis: pelvic position of the appendix

Objective@#Several factors contribute to the progression of complicated appendicitis (CA) in patients diagnosed with acute appendicitis. The goal of this study was to investigate whether the pelvic location of an appendix may be a new prehospital risk factor associated with CA. @*Methods@#The study retrospectively reviewed 375 patients who underwent surgery for appendicitis from January 2013 to December 2013. Patients were divided into two groups: patients diagnosed with uncomplicated appendicitis (UA) and patients with CA. Demographics, clinical and laboratory findings, duration of symptoms, and the location of the appendix were evaluated. Univariate and multivariate statistical analyses identified risk factors leading to CA. @*Results@#Of the 375 patients, 46 (12.3%) had CA. The univariate analysis confirmed that the patients diagnosed with CA had a higher body temperature (BT), longer duration of symptoms (DOS), and complained of left lower quadrant abdominal (LLQ) pain more frequently. Furthermore, compared to the UA group, the appendix was more frequently located in the pelvic region in the CA group. Multivariate analysis confirmed that BT >37.5°C (odds ratio [OR], 3.29; 95% confidence interval [CI], 1.64-6.61; P<0.01), LLQ pain (OR, 2.78; 95% CI, 1.16-6.69; P=0.02), DOS ≥48 hours (OR, 3.87; 95% CI, 1.94-7.71; P<0.01), and the pelvic location of appendix (OR, 3.18; 95% CI, 1.49-6.75; P<0.01) were risk factors for CA. @*Conclusion@#The pelvic location of an appendix may be a new prehospital risk factor associated with CA.

Risk factor leading to complicated appendicitis: pelvic position of the appendix

Objective@#Several factors contribute to the progression of complicated appendicitis (CA) in patients diagnosed with acute appendicitis. The goal of this study was to investigate whether the pelvic location of an appendix may be a new prehospital risk factor associated with CA. @*Methods@#The study retrospectively reviewed 375 patients who underwent surgery for appendicitis from January 2013 to December 2013. Patients were divided into two groups: patients diagnosed with uncomplicated appendicitis (UA) and patients with CA. Demographics, clinical and laboratory findings, duration of symptoms, and the location of the appendix were evaluated. Univariate and multivariate statistical analyses identified risk factors leading to CA. @*Results@#Of the 375 patients, 46 (12.3%) had CA. The univariate analysis confirmed that the patients diagnosed with CA had a higher body temperature (BT), longer duration of symptoms (DOS), and complained of left lower quadrant abdominal (LLQ) pain more frequently. Furthermore, compared to the UA group, the appendix was more frequently located in the pelvic region in the CA group. Multivariate analysis confirmed that BT >37.5°C (odds ratio [OR], 3.29; 95% confidence interval [CI], 1.64-6.61; P<0.01), LLQ pain (OR, 2.78; 95% CI, 1.16-6.69; P=0.02), DOS ≥48 hours (OR, 3.87; 95% CI, 1.94-7.71; P<0.01), and the pelvic location of appendix (OR, 3.18; 95% CI, 1.49-6.75; P<0.01) were risk factors for CA. @*Conclusion@#The pelvic location of an appendix may be a new prehospital risk factor associated with CA.

Clinical and Histopathologic Study of Seborrheic Keratosis / 대한피부과학회지

BACKGROUND: Although seborrheic keratosis is one of the most common epidermal tumors, there are only rare studies on the clinicohistopathologic features of seborrheic keratosis in Korea. The majority of cases of typical seborrheic keratosis can be clinically differentiated with ease from other dermatoses such as melanocytic nevi, lentigo, basal cell carcinoma and melanoma. However, its differential diagnosis can sometimes be difficult. OBJECTIVE: This study was designed to investigate the clincohistopathologic characteristics of seborrheic keratosis, the frequency of biopsy and the accuracy of making the clinical diagnosis, as well as to analyze the cases where there is a mismatch between the clinical diagnosis and the histological diagnosis. METHODS: We conducted a retrospective study and we searched for patients who were clinically diagnosed as having seborrheic keratosis between January 2000 and December 2008. The search found 1,248 patients and the patients were divided into two groups: a non-biopsy group (n=891) and a biopsy group (n=357). The clinical features, including age, gender, the anatomic site of lesion and the treatment method, were investigated in each group. In addition, the frequency of biopsy, the accuracy of the clinical diagnosis and the histopathological features were studied in the biopsy group. RESULTS: Between the two groups, we found that the clinical features, including the proportions between the involved body sites, such as trunk/face, and the treatment methods were different. However, these differences might be partly attributed to the clinical decisions such as the frequency of performing biopsy for making the differential diagnosis of skin malignancy. In both groups, the most frequent age period was in the seventh decade and the most common anatomical site was the face. Only one-third of patients who were clinically diagnosed as having seborrheic keratosis received biopsy for histopathologic confirmation and the lesions were mostly located on the face. The clinical diagnosis matched the histological diagnosis in 282/357 (79.0%) patients. In 75 patients who revealed a mismatch between the clinical and histological diagnosis, the skin lesion most frequently involved the face (57.3%) and the most common final diagnosis was basal cell carcinoma (13.3%). The frequency of a mismatch for the sun-exposed lesion was significantly higher than that of the non-sun exposed lesion (p=0.035). CONCLUSION: We present the clinical and histopathological features of seborrheic keratosis. If the lesion is presented with an atypical appearance or it located on a sun-exposed area and so it requires a differential diagnosis from other premalignant diseases or cutaneous malignancies, then we should perform a biopsy to make the differential diagnosis.

Clinical and Histopathologic Analysis of Labial Diseases in Korea / 대한피부과학회지

BACKGROUND: Labial diseases are common in dermatology. However, few studies have reported the clinical and histopathologic features of labial diseases in Korea. OBJECTIVE: This study was designed to investigate the clinical and histopathologic features of labial diseases. METHODS: We retrospectively reviewed 242 patients who received biopsy for labial diseases between January 2005 and May 2010. We compared clinical and histopahtologic diagnoses and analyzed the rate of concurrence. In addition, clinical features, including age, sex, and location, associated cutaneous lesions of 11 major labial diseases, which were confirmed by histopathology, were investigated. RESULTS: The mean age of the patients was 52.2 years. The male to female ratio was 1:1.5. Lower lip was the most commonly involved (77.4%). The most frequent final diagnosis was venous lake, followed by nonspecific inflammation, labial melanotic macule, plasma cell cheilitis, postinflammatory hyperpigmentation, squamous cell carcinoma, lichen planus, mucocele, Fordyce's disease, pyogenic granuloma, and actinic cheilits. Venous lake showed the highest match rate (86.3%), whereas cheilitis simplex exhibited the lowest match rate (0.0%). We also analyzed the clinical features of 11 major labial diseases. The majority of labial diseases occurred in old patients, except for mucocele, Fordyce's disease, or labial melanotic macule. Most diseases occurred predominantly in females, whereas squamous cell carcinoma, plasma cell cheilits, and Fordyce's disease were male-dominant. The most commonly involved location was the lower lip, except for Fordyce's disease. Associated skin lesions, such as ulcers, hyperkeratosis, or whitish patches, were observed in squamous cell carcinoma, plasma cell cheilitis, actinic cheilitis, and lichen planus. CONCLUSION: Compared to previous studies, the actual frequency of actinic cheilitis and squamous cell carcinoma was relatively lower while that of plasma cell cheilitis was relatively higher. We suggest that actinic cheilitis and squamous cell carcinoma are less frequently confirmed than previously expected and that plasma cell cheilitis should be included in the differential diagnosis of labial lesions, especially when they are located on the lower lip and occur in old patients.

Lupus Pernio as the Early Cutaneous Presentation of Sarcoidosis / 대한피부과학회지

Lupus pernio is the most characteristic cutaneous lesion of sarciodosis and this presents as an indurated red to blue-purple, swollen, shiny lesion that is often localized on the nose, cheeks, lips or ears of middle-aged female adults. It is a chronic malady that rarely shows spontaneous remission, and it sometimes causes deformity. It generally occurs as cutaneous lesions of sarcoidosis patients with a long duration of disease, and not as early cutaneous lesions of sarcoidosis. This case concerns a 43-year-old woman who presented with a 1 year history of firm erythematous and violaceous plaque with multiple erythematous and violaceous papules on the collumella and right nasal cavity. Skin biopsy showed noncaseasting granuloma. Herein, we report on a typical case of lupus pernio as the early cutaneous presentation of sarcoidosis, which has rarely been reported in the Korean literature. We suggest that early diagnosis and treatment is necessary to prevent deformity.