Retraction: Treatment of a Congenital Melanocytic Nevus by New Combined Therapy: Intense Pulsed Light and a Q-switched Nd:YAG Laser / 대한피부과학회지

This article has been retracted.

Multiple cross-reactivity to several types of neuromuscular blocking agents in a patient with rocuronium anaphylaxis / 대한마취과학회지

No abstract available.

Lupus Erythematosus Profundus Associated with Kikuchi's Disease / 대한피부과학회지

Kikuchi's disease (KD), histiocytic necrotizing lymphadenitis, is a rare self-limited lymphadenopathy, which usually affects young women. KD has been reported to precede, coexist with or follow the diagnosis of other entities, such as systemic lupus erythematosus (SLE), adult-onset Still's disease, Hashimoto's disease, and viral infections. In a few cases, KD is associated with cutaneous lupus erythematosus (CLE), without systemic involvement. Herein, we report the first Korean case of KD associated with lupus erythematous profundus in a 9-year-old boy.

A Case of Sarcoidosis in Oral Mucosa / 대한피부과학회지

Sarcoidosis is a systemic granulomatous disease of unknown origin that may affect multiple organs including the lung, mediastinal and peripheral lymph nodes, eyes, and skin. Although cutaneous manifestations occur in around 25% cases, to our knowledge, oral mucosal involvement is very rare as a leading symptom of sarcoidosis. A 28-year-old female presented with localized skin-colored to yellowish indurated papules and plaques on the lower lip mucosa. The lesions were presented for the past month and it progressively enlarged. Histopathologic examination revealed multiple, variable sized, well circumscribed, non-caseating granulomas in the dermis. Serum level of angiotensin converting enzyme was slightly elevated (63.0 U/L) and chest CT revealed bilateral hilar lymphadenopathies. Herein, we report an oral mucosal sarcoidosis, as an initial presentation of the systemic sarcoidosis.

The Effects of Humidifier Generating Nano-sized Water Particles on Skin Hydration and Transepidermal Water Loss of the Normal Human Skin / 대한피부과학회지

BACKGROUND: Nano-sized water particles have been thought to moisturize the skin more effectively. However, clear benefits of humidifier generating nano-sized water particles on the skin have not been studied. OBJECTIVE: The aim of this study is to examine the effects of humidifier generating nano-sized water particles on the skin by measuring the levels of the skin hydration state and skin barrier function with an objective, quantifiable method. METHODS: A 4-week, randomized, case-control study was conducted in 40 healthy Korean women, aged between 20 and 39, and they were divided into two groups, the experimental and control groups. The experimental group used humidifier generating nano-sized water particles for 8 hours every night, during 4 weeks. Skin hydration and transepidermal water loss (TEWL) were measured every week on the forehead and cheek using corneometer and tewameter, respectively. Safety evaluations were also performed at each visit. RESULTS: The baseline skin hydration and TEWL values showed no significant differences between the two groups. After 1 week of use, the experimental group showed significantly increased skin hydration values (p<0.001, p<0.0001) and decreased levels of TEWL values (p=0.017, p=0.025) as compared to the control group. During a 4-week study period, increased skin hydration and decreased TEWL were sustained in the experimental group. No adverse effects were observed in all the volunteers. CONCLUSION: These results show that humidifier, which generates nano-sized water particles, seems to positively affect skin hydration and skin barrier function. More studies and sufficient follow-up time are needed for the assessment of the humidifier generating nano-sized water particles.

Proliferative Nodule in a Giant Congenital Melanocytic Nevus / 대한피부과학회지

The proliferative nodules within a giant congenital melanocytic nevus (GCMN) are generally benign and may regress. However, atypical features cause great interest in dermatopathology. Especially, in neonate proliferative nodules with bleeding, ulceration on GCMN makes it difficult to differentiate the nodules from congenital malignant melanoma. Herein, we describe an interesting case of proliferative nodules in a GCMN of a newborn, which has not been previously reported in Korea.

Delayed Anaphylactic Shock to Intravenous Cefotetan in a Pregnant Woman: A Case Report / 대한구급학회지

Anaphylactic reactions to agents administered intravenously usually occur within minutes. We present an unusual case of a delayed onset anaphylactic shock to intravenous cefotetan in a pregnant woman who underwent an epidural cesarean section. She sustained hypotension, tachycardia, bronchospasm, and rash 90 min after administering intravenous cefotetan. The possibilities of high epidural blocks or amnionic fluid embolisms were excluded by the height of sensory blocks or different presenting symptoms and signs, respectively. Allergic skin tests for exposed materials were performed 6 weeks after discharge and no immediate reactions occurred. However, delayed systemic allergic reactions, such as urticaria, rash, and edema on her face, neck, back, and abdomen, occurred 3 h after skin test to cefotetan.

Treatment of a Congenital Melanocytic Nevus by New Combined Therapy: Intense Pulsed Light and a Q-switched Nd:YAG Laser / 대한피부과학회지

A congenital melanocytic nevus (CMN) is present at birth in approximately 1% of newborn infants. Treating CMN with a single laser without complications is very difficult because of the deep nature of the pigments in this lesion. A 5-year-old girl presented with a single 3x6 cm sized dark brown plaque on the right lower leg; some black hairs were also evident inside the pigmented lesion. She received ten treatments with intense pulsed light and then four treatments with Q-switched Nd:YAG laser. In order to achieve the chemoexfoliation, a topically modified Kligman formula (Trilusta(R)) was applied to the pigmented lesion twice a day for 6 months. Complete pigment clearance and hair removal were obtained and no side effects were observed. These results have been maintained for up to 18 months follow-up. We suggest that this combined treatment will be a good option for treating CMN with minimal scarring.

Granuloma Annulare Induced by Adalimumab / 대한피부과학회지

Adalimumab is the first fully humanized monoclonal anti-tumor necrosis factor alpha (TNF-alpha) antibody. This drug has been shown to be of benefit in patients with inflammatory diseases in which TNF-alpha is involved, such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and Crohn's disease. As the use of adalimumab is becoming more widespread, cutaneous side effects are being increasingly reported. Various dermatologic adverse events have been reported in the literature, including injection site reactions, psoriasis-like eruption and pityriasis rosea. Herein, we describe a case of GA associated with adalimumab treatment for adult-onset Still's disease, which has not been reported in Korea.

Chronic Cutaneous Lupus Erythematosus Presenting with a Buccal Erythema

No abstract available.

A Sporadic Case of Mal de Meleda Caused by Gene Mutation in SLURP-1 in Korea

Mal de Meleda (MDM), also known as keratoderma palmoplantaris transgrediens, is a rare inherited form of palmoplantar keratoderma. It is characterized by erythema and hyperkeratosis of the palms and soles, extending to the dorsal aspects of the hands and feet. A 15-year-old Korean female presented with sharply demarcated hyperkeratotic plaques on the palms and soles, which extended to the dorsal surfaces of the hands and feet, in a "glove-and-socks" distribution. The histopathologic study showed marked hyperkeratosis, acanthosis, and normogranulosis, without epidermolysis. Her genetic study detected compound heterozygous mutation in exon 3 of the ARS gene encoding SLURP-1. Family history did not reveal any other affected members and no consanguineous relationship was found. In view of these findings, we diagnosed this case as the first reported sporadic case of MDM in Korea, the farthest location from the endemic island of Meleda.

A case of adenomyoma in distal common bile duct / 대한내과학회지

Adenomyoma is a nonneoplastic lesion that can be found anywhere in the gastrointestinal tract, but it's rarely found in the extrahepatic bile duct. To the best of our knowledge, it is a completely benign lesion, but making a clear distinction from malignancy on preoperative evaluation is very difficult. Its clinical importance mainly lies in the possibility that they may be confused with carcinoma, leading to unnecessarily extensive surgical resections. We report here on a case of distal common bile duct adenomyoma that presented with right upper quadrant abdominal pain, and the preoperative examinations could not reveal whether the tumor was benign or malignant. It was finally diagnosed by histological examination after performing pylorus preserving pancreaticoduodenectomy.

An Evaluation of Websites about Endoscopy under Conscious Sedation / 대한소화기내시경학회지

BACKGROUND/AIMS: The internet has become an important source of medical information not only for doctors but also for patients. Therefore, this study evaluated the quality of medical information on endoscopy under conscious sedation on the internet in Korea. METHODS: 147 patients (mean age: 51 years, male:female 76:71) who visited the gastroenterology clinic were surveyed using a questionnaire about use of medical information on the Internet. The first 20 Internet sites using the key word 'endoscopy under sedation' were retrieved from the 5 most frequently used Internet search engines. The quality of information from a total of 63 websites was evaluated using a checklist. RESULTS: Among a total 63 sites about endoscopy under sedation, 46 sites (73.0%) were made by private hospitals or private clinics and 60 sites (95%) were made for patients. The definition of endoscopy under conscious sedation was accurately mentioned in only 7 sites (11%). The complications and risk factors were mentioned in 29 sites (46%). CONCLUSIONS: Most websites made by private hospitals or private clinics overempha sized the merits of sedation. Websites with a more balanced point of view by official organizations may help improve the quality of medical information on the Internet.

Clinical Usefulness of Rockall Scoring System in Patients with Bleeding Peptic Ulcer-Comparison with Forrest Classification / 대한소화기학회지

BACKGROUND/AIMS: The Rockall risk assessment score was developed to predict the risk of rebleeding and death in patients with upper GI hemorrhage. The validity of this score, however, was not established in Korea. We tried to assess the reliability of the Rockall score to predict outcomes in patients with bleeding peptic ulcer. METHODS: Medical records of 175 patients with benign peptic ulcer bleeding treated in Samsung Medical Center from January 2000 to May 2003 were retrospectively analyzed. They were classified into three groups: no rebleeding rebleeding, and death and mean Rockall score was compared. Forrest classification was also compared with the Rockall score regarding the clinical usefulness of predicting poor outcomes in patients with bleeding peptic ulcer. RESUTLS: One hundred forty five patients did not show rebleeding, with mean Rockall score of 3.5 (SD=1.5). On the other hand, rebleeding occurred in 25 patients and the mean score was 6.4 (SD=1.44). There were 13 deaths with mean score of 7.0 (SD=1.08). The differences between the three groups were significant (p<0.001). In multivariate analysis, Rockall score was a independent risk factor of rebleeding and mortality (odds ratio, OR=2.73 and OR=8.74). CONCLUSIONS: The Rockall scoring system is useful to predict poor outcome such as rebleeding and death in patients with bleeding peptic ulcer.

Relations Among Coronary Flow Reserve, Left Ventricular Mass and Diastolic Function in Patients with Chest Pain and Normal Coronary Angiograms

BACKGROUND AND PURPOSE: Left ventricular hypertrophy (LVH) is a well known cardiovascular risk factor, independent of hypertension, even in the absence of epicardial coronary artery disease. Possible mechanisms have been proposed, including increased LV mass, reduced coronary flow reserve (CFR) and diastolic filling abnormalities. However, the relations among LV hypertrophy, diastolic function, hypertension and coronary flow reserve (CFR) in patients with chest pain and normal coronary angiograms have not been well defined. SUBJECTS AND METHOD: Twenty-six patients with chest pain and normal coronary angiograms were included. LV mass, isovolumic relaxation time (IVRT), deceleration time (DT) and E/A ratio were assessed by 2-D echo-cardiography. Coronary blood flow velocity before and after intracoronary adenosine were measured using intracoronary Doppler wire (FIoWire). CFR was defined as ratio of peak flow velocity after adenosine to baseline flow velocity. Subjects were devided into 4 groups according to presence of LVH and hypertension and the parameters were compared among groups. RESULTS: FR was lower (p<0.01) in the groups with either hypertension or LVH or both than in the groups without them. The decrement in CFR was not linearly related to the degree of LVH (r=0.31, p=0.135). Although there were modest increment in IVRT and DT and decrement in E/A ratio in the groups with hypertension or LVH or both, there was no statistical significance. CONCLUSION: These findings suggest that the underlying mechanism of impaired CFR in patients with LVH or hypertension may be the consequence of primary coronary microvascular lesion rather than the process of left ventricular hypertrophy.

A Prospective Study of Reperfusion Arrhythmias in Primary Coronary Angioplasty for Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: Arrhythmia is known to be a major cause of death in acute myocardial infarction (AMI). Reperfusion arrhythmias (RA) may also occur during angioplasty or thrombolysis. As yet, the clinical significances of RA and angiographic characteristics of the patients who develop RA during primary angioplasty and stenting are not clearly defined. METHODS: The study group consisted of 60 patients treated with primary angioplasty or stenting for AMI (angioplasty 13, stenting 47 patients). The patients were classified into 2 groups according to RA [RA (-) N=36/RA(+) N=24]: demographic and angiographic characteristics including time to reperfusion and incidence of pre-infarct angina were analyzed. RESULTS: The RA occurred in 40% of patients undergoing primary angioplasty or stenting (24/60 patients). The minor arrhythmias were more common after reperfusion (transient bradycardia 14, accelerated idioventricular rhythm 11, premature ventricular contraction 4 cases): major arrhythmias were uncommon (ventricular tachycardia/fibrillation 5, asystole 1 case). In the two groups, baseline clinical characteristics were similar except for pain to reperfusion time [RA (-): RA (+)=490.8+/-291.7: 252.9+/-109.2 minutes, P=0.001]. There was a trend toward a greater incidence of RA in the right coronary infarct-related artery [RA (-): RA (+)=16.7: 41.7%, P=NS]. The RA occurred in totally occluded artery (TIMI 0) with a giant thrombus and first ballooning in 19/24 patients (79.2%). The RA disappeared with conservative managements including pacemaker insertion and cardiopulmonary resuscitation and there were no differences in major adverse cardiac events in the two groups during follow-up. CONCLUSIONS: These findings suggest that the RA are frequent events during primary angioplasty but unrelated to clinical and angiographic characteristics except for reperfusion time and do not influence short-term prognosis in AMI.

Feasibility of Low-Molecular-Weight-Heparin (Fraxiparine) for Primary Stenting in Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: The optimal anti-thrombotic strategy for primary stenting in acute myocardial infarction (AMI) is still controversial. We evaluated prospectively the efficacy and safety of low-molecular-weight-heparin (LMWH) for primary stenting in AMI. MATERIALS AND METHOD: From 1/1997 to 7/1998, 54 AMI pts underwent primary stenting with 96% of procedural success rate (52/54). Of these, five pts were excluded from the study for warfarinization or use of GP II b/ III a inhibitor despite of successful stenting (TIMI 3 flow and less than 30% of residual stenosis). In 47 pts included in the study, 5,000-10,000 U of unfractionated heparin was administered (IV/bolus) bofore primary stenting. After sheath removal, LMWH(Fraxiparine, 7500 U/S.C.BID) maintained for 10.6+/-5.7 days. Aspirin and ticlopidine (500mg/day for > or =4 weeks) were given before stenting. Pts were followed to determine early (0-30 days) and late (31-180 days) major adverse cardiac events (MACE). Subsequent revascularization involving other coronary arteries did not constitute an end point. RESULTS: In 47 Pts (M:F=32:15, age=57.7+/-11.3 yrs, range: 37-88), 50 stents (Nir:38, micro:7, Jo:5, LAD:LCX:RCA-=24:9:14) were implanted. Their immediate post-stenting MLD and diameter-stenosis (%) were 2.9+/-0.4 mm, 4.3+/-8.7%, respectively. No patient showed sub-acute stent thrombosis or major bleeding requiring blood transfusion or surgery. During 0-30 days, the primary combined end point occurred in 2 (4.2%):one repeated angioplasty for in-stent restenosis; one hospital death for pump failure (1 of 2 Killip IV pts at admission). 44 patients were followed for 180 days and additional three TVR (3/44(6.8%), one CABG, one repeated angioplasty and one recurrrent myocardial infarction)occurred between 30-180 days due to recurrent ischemia. CONCLUSION:Anti-thrombotic therapy with LMWH (Fraxiparine) is safe and feasible for primary stenting in AMI. But to illuminate the impact on the clinical outcomes such as major adverse cardiac events and restenosis, we need more large and controlled study.

Relation between Coronary Flow Reserve and Myocardial Perfusion State and Change of Coronary Flow Reserve in Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: The state of the coronary microcirculation is one of the major determinants of the prognosis of patients who have had successful reperfusion for acute myocardial infarction (AMI). We investigated whether the vasodilatory reserve in the infarcted myocardium correlated with the perfusion state at early recovery phase in 12 anterior wall AMI patients. MATERIALS AND METHOD: We measured coronary flow variables with Doppler wire, after successful revascularizaiton by PTCA within 2 weeks following AMI and 13+/-0.5 months later, in the infarct related artery of AMI pts who received successful thrombolytic therapy. Myocardial perfuison state was evaluated by semiquantitative method (opacification score and opacification index) with myocardial contrast echocardiography (MCE) at the same time. Patients were divided into two groups according to initial perfusion status (perfusion defect group (PD (+), n=7), no-perfusion defect group (PD (-), n=5)). RESULTS: 10 minutes after completion of the intervention, the coronary flow reserve (CFR) was 2.0+/-0.4 (mean+/-SD): it increased to 2.7+/-0.7 (p=0.002) at follow up. The difference of initial CFR was not significant between PD (+) and PD(-) group. However, it significantly improved in the PD (-) group compared to PD (+) group at follow up (3.19+/-0.39 vs. 2.39+/-0.7, p=0.046). Opacification index and initial CFR were significantly correlated (r=0.79, p<0.05). CONCLUSION: The perfusion state of infarcted myocardium was significantly correlated with coronary flow reserve in anterior wall AMI and CFR was significantly improved in patients with relatively preserved myocardial perfusion.

A Case of Insulinoma which was treated by Laparoscopic Enucleation / 대한내분비학회지

Insulinoma is a functional endocrine tumor arising from the beta cells of islets of Langerhans of pancreas. The only effective treatment of insulinoma was surgical removal of the tumor. Recently, laparoscopic surgery for islet cell tumors of the pancreas is introduced. Laparoscopic enucleation or resection of benign islet tumors results in a shorter hospital recovery and is a good alternative to open surgery We report a case of insulinoma that was treated sucessfully by laparoscopic enucleation.

Hemodynamic Responses during Dobutamine Stress Echocardiography according to Stage Duration in Normals

BACKGROUND: The 3 minutes increment of dobutamine dose protocol is most commonly used method in dobutamine stress echocardiography (DSE). But the precise hemodynamic response to dobutamine dosage and its difference by extending stage duration have not been well elucidated. MATERIALS AND METHOD: Nineteen healthy voluntary subjects with a mean age of 23.9+/-4.7 years were included. All subjects underwent 3-minutes incremental and 5-minnutes incremental protocol of DSE at random order in a same day. Heart rate, blood pressure, stroke volume, fractional shortening, rate-pressure product and cardiac output were measured every 3 minutes in 3-min protocol of DSE. In 5-min protocol, same variables were measured at 3 minutes of each stage as well as at 5 minutes. RESULTS: 1) Heart rate did not increase until 10 microgram/kg/min dose and increased thereafter by increment of dobutamine dose. 2) Fractional shortening and stroke volume increased markedly from the 5 microgram/kg/min until 20 microgram/kg/min dose and showed slow increase or plateau at a higher dobutamine dose. 3) Systolic blood pressure, cardiac output and rate-pressure product increased continuously from initial dose to maximal dose. 4) Although by extending stage duration to 5 minute in 5-min protocol produced greater hemodynamic effects than those measured at 3 minutes of each stage, there were no significant difference in the results of 3-min and 5-min protocol of DSE. CONCLUSION: The increase of cardiac contractility most contributed to increase of cardiac output until 20microgram/kg/min dose and the increase of herat rate contributed dominantly thereafter, thus the hemodynamic variables showed different responses to increment of dobutamine dose. There were no significant difference in hemodynamic effects between the two protocols. So it is considered that 3-min protocol of DSE gives similar hemodynamic information as 5-min protocol and is more time-saving method.