Skin Diseases among Patients with Type 2 Diabetes Mellitus:A Nationwide Population-Based Cohort Study / 대한피부과학회지

Background@#Diabetes mellitus (DM) is one of the most common endocrine diseases, and the relationship between diabetes and skin diseases is well-known and its mechanisms have been studied. @*Objective@#This study aimed to examine the association between DM and skin diseases. @*Methods@#We used the medical record database provided by the National Health Insurance Service. We constructed a cohort with 1,197,225 patients diagnosed with type 2 DM from 2011 to 2015. We analyzed 3,992,368 medical records of patients with DM who visited the hospital from January 1, 2009 to December 13, 2018 with skin and subcutaneous tissue diseases (ICD-10 code, L00-L99). After that, we compared the changes in skin and subcutaneous tissue diseases before and after the diagnosis of type 2 DM. @*Results@#The number of patients with skin diseases, after the diagnosis of type 2 DM was 1,629,756 (50.6%). The frequency of skin diseases increased after the diagnosis of type 2 DM compared to that before the diagnosis. Particularly, infectious diseases (＋29.03%,p＜0.001), vesiculobullous diseases (＋33.13%, p＜0.001) and ulcerrelated diseases (pressure sores [＋530.18%], and lower extremity ulcers [＋321.56%], p＜0.001) increased sharply whereas dermatitis and eczematous diseases (−9.96%, p＜0.001) and urticaria (−12.99%, p＜0.001) decreased. @*Conclusion@#Skin diseases increased following the diagnosis of diabetes, and there were changes in the pattern of skin diseases before and after the diagnosis of diabetes.

Three Cases of Erythema Induratum Diagnosed by Histopathology and Interferon-Γ Release Assay / 대한피부과학회지

Erythema induratum (EI) is a tuberculid caused by a hypersensitivity reaction against Mycobacterium tuberculosis or its metabolic products, but it is usually absent in skin lesions. Interferon-γ release assay (IGRA) has been used for diagnosing M. tuberculosis infection instead of the tuberculin skin test and mycobacterial culture, which have limitations for accurate diagnosis. EI was clinically suspected in our cases, and all of them had a family history of tuberculosis. Histopathological findings were consistent with those of EI. Mycobacterium-reverse blot hybridization assay conducted in two cases was positive for M. tuberculosis, and all cases were positive for IGRA. Herein, we report a case series of EI diagnosed by histopathology and IGRA and then successfully treated with anti-tuberculosis treatments.

The Clinical Significance of Simplified Scoring Criteria as a Diagnostic Tool for Overlap Syndrome in Korea / 대한내과학회지

BACKGROUND/AIMS: The diagnosis of primary billiary cirrhosis (PBC)-autoimmune hepatitis (AIH) overlap syndrome remains challenging. In 2008, a simplified scoring system was proposed by the International Autoimmune Hepatitis Group, which aimed for wider applicability in routine clinical practice. We evaluated the performance of the new simplified AIH scoring criteria as a diagnostic tool for overlap syndrome. METHODS: We retrospectively reviewed the clinical histories, chemistry, autoimmune studies, and liver biopsy results of 25 patients diagnosed with PBC who visited Soonchunhyang University Hospital, Bucheon and Seoul, between November 2004 and December 2009. Parameters relevant to the revised and simplified scoring criteria were recorded, and outcomes were compared between those with and without features of overlap syndrome. RESULTS: Of 25 patients with a definite diagnosis of PBC, five (20%) were diagnosed with overlap syndrome using the revised criteria, and 18 patients (72%) were diagnosed with the simplified criteria. Those patients diagnosed according to the simplified scoring criteria revealed an increased frequency of anti-nuclear antibody (p = 0.030) and serum IgG levels (p = 0.092). Additionally, advanced fibrosis was significantly more frequent in patients with overlap syndrome (p = 0.017). CONCLUSIONS: The simplified scoring criteria seemed to be useful as a diagnostic tool to recognize overlap syndrome in Korea. However, a relatively small number of patients were included in our study, so further clinical trials based on larger populations should be performed.

A Case of Endobronchial Aspergilloma Associated with Foreign Body in Immunocompetent Patient without Underlying Lung Disease / 결핵및호흡기질환

Aspergillus causes a variety of clinical syndromes in the lung including tracheobronchial aspergillosis, invasive aspergillosis, chronic necrotizing pulmonary aspergillosis, allergic bronchopulmonary aspergillosis, and aspergilloma. Aspergilloma usually results from ingrowths of colonized Aspergillus in damaged bronchial tree, pulmonary cyst or cavities of patients with underlying lung diseases. There are a few reports on endobronchial aspergilloma without underlying pulmonary lesion. We have experienced a case of endobronchial aspergilloma associated with foreign body developed in an immunocompetent patient without underlying lung diseases. A 59-year-old man is being hospitalized with recurring hemoptysis for 5 months. X-ray and computed tomography scans of chest showed a nodular opacity in superior segment of left lower lobe. Fiberoptic bronchoscopy revealed an irregular, mass-like, brownish material which totally obstructed the sub-segmental bronchus and a foreign body in superior segmental bronchus of the lower left lobe. Histopathologic examinations of biopsy specimen revealed fungal hyphae, characteristic of Aspergillus species.

Noninvasive predictors of nonalcoholic steatohepatitis in Korean patients with histologically proven nonalcoholic fatty liver disease

BACKGROUND/AIMS: The aims of this study were (1) to identify the useful clinical parameters of noninvasive approach for distinguishing nonalcoholic steatohepatitis (NASH) from nonalcoholic fatty liver disease (NAFLD), and (2) to determine whether the levels of the identified parameters are correlated with the severity of liver injury in patients with NASH. METHODS: One hundred and eight consecutive patients with biopsy-proven NAFLD (age, 39.8+/-13.5 years, mean+/-SD; males, 67.6%) were prospectively enrolled from 10 participating centers across Korea. RESULTS: According to the original criteria for NAFLD subtypes, 67 patients (62.0%) had NASH (defined as steatosis with hepatocellular ballooning and/or Mallory-Denk bodies or fibrosis > or =2). Among those with NAFLD subtype 3 or 4, none had an NAFLD histologic activity score (NAS) below 3 points, 40.3% had a score of 3 or 4 points, and 59.7% had a score >4 points. Fragmented cytokeratin-18 (CK-18) levels were positively correlated with NAS (r=0.401), as well as NAS components such as lobular inflammation (r=0.387) and ballooning (r=0.231). Fragmented CK-18 was also correlated with aspartate aminotransferase (r=0.609), alanine aminotransferase (r=0.588), serum ferritin (r=0.432), and the fibrosis stage (r=0.314). A fragmented CK-18 cutoff level of 235.5 U/L yielded sensitivity, specificity, and positive and negative predictive values of 69.0%, 64.9%, 75.5% (95% CI 62.4-85.1), and 57.1% (95% CI 42.2-70.9), respectively, for the diagnosis of NASH. CONCLUSIONS: Serum fragmented CK-18 levels can be used to distinguish between NASH and NAFL. Further evaluation is required to determine whether the combined measurement of serum CK-18 and ferritin levels improves the diagnostic performance of this distinction.

Contouring of Forehead and Temple Area with Auto-Fat Injection

PURPOSE: Facial contouring surgery for improving congenital, acquired deformity and senile change were attempt in past. Recently contouring surgery became more interested subject for improving the flat forehead and temple area. Many synthetic materials were used such as Collagen, silicon, polyacrylamide gel as liquid form and Gore-tex, silicon implant, endotine as solid form. But, these synthetic implants associate complications as foreign body reaction, infection, displacement, granuloma formation and absorption. Auto-fat injection are used for disfigurement of many part of body. We did auto-fat injection for facial contouring of forehead and temple region. Auto-fat injection is suitable without foreign body reaction, displacement, and toxic reaction. Also auto-fat is relatively simple to obtain from patient and less expensive and able to repeat surgeries. METHODS: From 2006 to 2009, 150 patients were treated with Auto-fat injection for facial contouring. For follow up, we sent questionnaire to all patients but 110 patients returned answer sheets. The patients consisted of 20 male patients and 90 female patients with an age ranged from 26 to 60, and the mean 43. Fat tissue were injected 6-8cc in forehead, 7-12cc in temple area and fat were harvested from thigh and abdomen. RESULTS: In follow up, all patients, showed absorption of injected fat varied degree and except two patients all patients underwent secondary fat injection. Complications were minimal and neuropraxia of facial nerve were recovered. Most of the patients were satisfied with result of procedure, and answered that they recommend same procedure to their friends and will do surgery again. CONCLUSION: Auto-fat injections were implemented for facial contouring in 150 patients and obtained satisfactory result. Auto-fat injection is relatively easy procedure and applicable widely. Even though, by passing time, some of the injected fats are absorbed, auto-fat injection could be choice of treatment for contouring forehead and temple. With accumulations of cases and development of surgical technique, better result could be expected.

Augmentation Rhinoplasty with Dermofat Graft & Fat Injection

PURPOSE: Even though Augmentation rhinoplasty is very popular surgical procedure, it is not easy to obtain ideal materials for augmentation. Many different synthetic materials are used but frequent complications are seen such as infection, extrusion, deform, and dislocation. Autologous tissues were used for augmentation rhinoplasty. We used dermofat graft and fat injection in augmentation rhinoplasty minimizing these problems. METHODS: From 2006 to 2009, we used autologous tissues in augmentation rhinoplasty in 40 patients, 20 patients with dermofat graft and other 20 patients were treated with fat injection only. Dermofats were harvested from sacral area. gluteal fold, groin and preexisting scar tissue. Dermofats were inserted with small stab wound and fat tissues were injected as Coleman's technique. The patients were followed up 6 months to 5 years. RESULTS: Most of the patients were satisfied in shape and height the nose. Early complications such as hematoma, infection and seroma were not found. Secondary fat injection was performed in 3 patients (15%) of dermofat graft group instead of 7 patients (35%) of fat injection only group. CONCLUSION: We obtained satisfactory results in augmentation rhinoplasty with dermofat graft and fat injection. Secondary fat injections were more often in fat injection group than dermofat graft group. Dermofat graft and fat injection could be another alternative technique for augmentation rhinoplasty and fat injection could be a secondary adjunctive treatment for undercorrection due to absorption.

Osteochondroma of the Metacarpal Head in a Child: A Case Report

The osteochondroma is the most common benign bone tumor which occurs in the metaphyseal portion of long bone. The osteochondroma is rare in hand and extremely rare in the intraarticular location of the hand. We present a case of intraarticular osteochondroma which occurred at the fourth metacarpal head of the hand in a child patient.

Usefulness of Real-time Semi-quantitative PCR, JAK2 MutaScreen (TM) Kit for JAK2 V617F Screening / 대한진단검사의학회지

BACKGROUND: Real-time PCR for quantification of JAK2 V617F has recently been introduced and used to evaluate the importance of mutant allele burden in both diagnosis and disease progression in myeloproliferative diseases (MPDs). We evaluated the usefulness of JAK2 MutaScreen(TM) kit that uses a real-time semiquantitative PCR method and has been designed to screen JAK2 V617F mutant allele burden. METHODS: Forty MPD patients were included in this study. We screened JAK2 V617F and determined the mutant allele burden using JAK2 MutaScreen(TM) kit. The mutant allele burden was estimated by six-scaled standards of JAK2 V617F mutant allele (2%, 5%, 12.5%, 31%, 50%, and 78%). For evaluation of test performance, an allele-specific PCR (AS-PCR) was carried out in all samples by using Seeplex JAK2 Genotyping kit. We assessed the clinical differences in distinct disease entities of MPDs according to JAK2 V617F mutant allele burden. RESULTS: JAK2 V617F mutation was detected in 30 cases, including 10 of 11 cases (91%) of polycythemia vera (PV), 13 of 20 cases (65%) of essential thrombocythemia (ET), and 2 of 3 cases (67%) of chronic idiopathic myelofibrosis (CIMF). The concordance rate between the two tests was 95% (38/40). JAK2 V617F mutant allele burden was greater than 50% in 17 cases, and 10 of them (59%) were PV. In contrast, mutant allele burden was less than 50% in 13 cases and 11 of them (85%) were ET. CONCLUSIONS: JAK2 MutaScreen(TM) kit that utilizes a real-time semi-quantitative PCR method is a useful tool for diagnosing MPDs precisely. It can be used to assess the grade of mutant allele burden as well as to screen JAK2 V617F simultaneously.

The usefulness of transient elastography to diagnose cirrhosis in patients with alcoholic liver disease / 대한간학회지

BACKGROUNDS/AIMS: It is not easy to differentiate between patients with cirrhosis and those with alcoholic liver disease. Liver biopsy is generally considered the gold standard for assessing hepatic fibrosis; however, this protocol frequently carries a risk of severe complications and false-negative results. Transient elastography (Fibroscan, Echosens, Paris, France), which is a noninvasive method of measuring liver stiffness, has become available for assessing liver fibrosis. Liver stiffness reportedly differs markedly with the cirrhosis etiology. The aim of this study was thus to determine the diagnostic accuracy of the Fibroscan in the detection of cirrhosis in patients with alcoholic liver disease. METHODS: We enrolled 45 patients with alcoholic liver disease. Fibroscan, abdominal ultrasonography, aspartate aminotransferase/platelet ratio index (APRI), and liver biopsy were performed on all patients. Fibrosis stage was assessed using the Batts-Ludwig scoring system. RESULTS: The stage of fibrosis (F1-F4) was distributed among the cohort as follows: 5 patients at F1, 4 patients at F2, 7 patients at F3, and 29 patients at F4. Liver stiffness differed significantly between each fibrosis stage (P<0.001). For the diagnosis of cirrhosis, the area under the receiver operating characteristic curve was 0.97 for transient elastography (95% confidence interval, CI, 0.93-1.01), 0.81 for ultrasonography (95% CI, 0.68-0.94), and 0.83 for APRI score (95% CI, 0.70-0.95). The optimal cut-off value of liver stiffness for detecting cirrhosis was 25.8 kPa, with a sensitivity of 90% and a specificity of 87%. CONCLUSIONS: Transient elastography is a useful method for diagnosing cirrhosis in patients with alcoholic liver disease.

Atlantoaxial Joint Syndrome Misconceived as an Idiopathic Neuralgia: A case report / 대한통증학회지

Although the atlantoaxial joint is the most common site of rheumatoid arthritis, our patient had no symptoms or signs suggestive of rheumatoid arthritis. The atlantoaxial joint is frequently involved in degenerative osteoarthritis, especially in elderly patients. An 81-year old man presented with severe intermittent electric shock like, lancinating pain from the occipital to the temporal and parietofrontal areas. He also had neck pain and a limited range of motion. After many examinations and laboratory tests, at the department of neurology and neurosurgery, he was diagnosed with idiopathic neuralgia. The diagnosis of atlantoaxial joint syndrome was confirmed, and treated successfully with atlantoaxial joint block.

Third Occipital Neurotomy for Suboccipital Neuralgic Pain: A case report / 대한통증학회지

Suboccipital pain can be caused by problems relating to muscles, tendons, ligaments, joints, discs and nerves of the upper cervical structures. History taking, symptomatological evaluations and physical examinations, and even radiological studies are often unavailable when making an exact diagnosis for the treatment of cervicogenic headaches. Therefore, diagnostic blockades have recently become essential for the diagnosis and treatment of nonspecific cervicogenic headaches. A third occipital neurotomy was successfully performed after diagnostic blocks were administered to a patient who had suffered from suboccipital neuralgic pain and referred pain to the temporal and retroocular areas.

One-Lung Ventilation Using a Fogarty Catheter in a Patient with Tracheostomy after Pharyngectomy and Laryngectomy: A case report / 대한마취과학회지

One lung ventilation with a double-lumen endotracheal tube or Univent tube may be achieved difficultly or dangerously in some patient such as young age, anatomic anomaly, low body weight and tracheostomy patient. Bronchial blocker with a Fogarty catheter has been used successfully for such situations. Here, we reported the clinical experience in using a Fogarty embolectomy catheter as a bronchial blocker in patient with tracheostomy after pharyngectomy and laryngectomy. The patient was received left upper lobectomy with thoracotomy due to metastatic lung cancer.

The Efficacy of Radiofrequency Neurotomy of the Ramus Communicans Nerve for Intractable Chronic Discogenic Pain / 대한마취과학회지

BACKGROUND: Chronic discogenic pain is commonly intractable to various conservative treatments and anatomic correction through operation. Nowadays, a radiofrequency thermocoagualation technique applying the pathophysiologic mechanism that cause discogenic pain and the pathways of transmission of discogenic pain have been successfully tried. This study was performed to evaluate the efficacy of radiofrequecy thermocoagulation of the ramus communicans nerve in patients who suffered from intractable discogenic pain even after intradiscal electrothermal therapy. METHODS: The authors evaluated 13 cases in which radiofrequency thermocoagulation of the ramus communicans nerve was used for patients suffering from chronic discogenic pain even after intradiscal electrothermotherapy. Ten weeks after the procedure, we compared VAS scores of the pre- procedure and post-procedure state. RESULTS: Fifty-four percent of patients had an excellent decrease in the VAS score (VAS < 3). One patient complained of a mild motor weakness of the lower extremity but recovered completely by postoperative day 26. CONCLUSIONS: In the cases of intractable chronic discogenic pain, it is valuable to perform a rhizotomy of the ramus communicans nerve with radiofrequency.

Estimation of obstructive pathologies in patient with chronic otitis media: comparison between the estimated volume by impedance audiometry and radiologic findings / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Impedance audiometry is a clinically useful method for measuring the physical volume of pneumatized middle ear and mastoid medial using a hermetically sealed probe tip. This study was performed to evaluate the obstructive pathologies of middle ear and mastoid by measuring their volumes in patients of chronic otitis media. MATERIALS AND METHODS: The volume of middle ear and mastoid was measured in 37 ears with dry eardrum perforation by chronic otitis media. For control, we measured the volume in 23 ears with the traumatic tympanic membrane perforation. A comparison was made between the volumes and pneumatization in the mastoid X-ray, the soft tissue density in the computed tomography of temporal bone, and the obstruction site at operative findings. RESULTS: The mean volume of the traumatic tympanic membrane perforation was 6.75+/-0.42 ml. The mean volume of chronic otitis media was 3.36+/-2.19 ml and the volume of the sclerotic group was significantly smaller than that of the pneumatic group in the mastoid X-ray. The pathological group had significantly smaller volume than the non-pathological group at operative findings. CONCLUSIONS: The impedance audiometry enables a rapid and valuable evaluation of the presence or absence of obstructive pathologies in the middle ear and mastoid in chronic otitis media with dry tympanic perforation.

Usefulness of Buccinator Myomucosal Flap for Intraoral Reconstruction / 대한이비인후과학회지

BACKGROUND: The myomucosal flap from the buccinator muscle is known to be useful for the reconstruction of intraoral defects. We used the buccinator myomucosal flap for the treatment of mild to moderate defects after intraoral tumor resection. This paper represents the versatility of the buccinator myomucosal flap for intraoral reconstruction and to introduce our clinical experience. METHODS: The flap was applied clinically in 5 patients to reconstruct intraoral defects from January, 1999 to December, 1999, with an average follow-up of 6 months. We evaluated these patients retrospectively. RESULTS: The buccinator myomucosal flap was used in the reconstruction of 5 defects of soft palate, retromolar trigone, and posterior pharyngeal wall. All flaps survived completely. There was no flap necrosis and fistula. The results were functionally and esthetically satisfactory. CONCLUSION: The buccinator myomucosal flap was used for mild to moderate intraoral defect reconstruction. It has many advantages and versatilities. It is reliable and safe. It does not require microsurgical technique, and rapid healing can be achieved due to its mucosal nature. The buccinator myomucosal flap, the only myomucosal flap that can be used for intraoral reconstruction, can be widely used.

Effects of Cytokines on Proliferation Responses of Th1 Cells to Mitogen / 대한면역학회지

Thl cloned cell line 28-4 which is an I-A + KLH - specific Th1 type clone of (C57BU6xC 3H) F1 origin was kindly provided by professor Tomio Tada. In these studies, employing these cloned cells, the author investigated both proliferation responses of Thl cells in the presence of various concentrations of cytokines, such as IL-2, IL-4 or IL-6 and proliferation of Thl cells to various concentration of mitogens such as PHA, ConA or PWM. In addition, the author also investigated the proliferation response of Th1 cells to the optimal dose of PHA, ConA or PWM in the presence or absence of above mentioned cytokines. It was found that IL-2, IL-4 or IL-6 alone their growth stimulation degree was dependent on cytokine concentration and that PHA, ConA or PWM stimulated Thl cell proliferation and optimal dose of PHA ConA and PWM was 3 g, 4 g and 2 g per ml, respectively. In addition, proliferation response of Th1 cells to ConA or PWM in the presence of IL-2 was significantly enhanced, but the proliferation response to PHA was not increased significantly. However, IL-4 did not significantly modulate mitogen-activated Thl cell proliferation response. Interestingly, IL-6 decreased PHA- or ConA-activated proliferation of Thl cells, but did not change PWM-activated proliferation. Taken together, these studies strongly suggested that IL-2, IL-4 or IL-6 itself clone stimulated the Thl cell proliferation and that PHA, ConA or PWM also stimulated Thl cell proliferation. In addition, these studies also indicated that IL-2 increased ConA- or PWM-activated Thl cell proliferation, but IL6 inhibited PHA- or ConA-activated Th1 cell proliferation and that IL-4 did not significantly change the mitogen-activated Th1 cell proliferation.

Nd-YAG laser and CO2 laser application in general surgery

No abstract available.

Long term(5 year) results of surgical treatment of stomach cancer

No abstract available.