Longitudinal Change in Trabecular Bone Score during and after Treatment of Osteoporosis in Postmenopausal Korean Women

BACKGROUND: The aim of this study was to evaluate the longitudinal changes of trabecular bone score (TBS) during and after bisphosphonate (BP) treatment in postmenopausal Korean women with osteoporosis. METHODS: We analyzed 191 patients who took BP and underwent bone mineral density (BMD) test for the period from January 2010 to December 2015. The mean follow up period during treatment and after treatment was 22.8 months and 18 months, respectively. The TBS and BMD values were evaluated by the percent changes relative to the baseline. RESULTS: In 191 patients, who treated with BPs, L-spine BMD increased 3.65±0.5% and TBS increased 0.26±0.4% from baseline during first 1 year. At 2 to 4 years, the changes of BMD and TBS from baseline gradually increased up to 9.3±3.25% and 2.69±0.98% and both results showed statistically significant correlation. In 86 patients who stopped BPs, L-spine BMD decreased -0.54±1.07% and TBS increased 0.33±1.96% from baseline during 3 years follow up period. CONCLUSIONS: Lumbar spine TBS increase over time with BPs treatment although the changes were less than that of BMD. Also, it preserve for years after stopping treatment, as the changes of lumbar spine BMD. The results of BMD and TBS showed significant correlation during treatment but not during drug withdrawal.

Association of Apolipoprotein B/Apolipoprotein A1 Ratio and Coronary Artery Stenosis and Plaques Detected by Multi-Detector Computed Tomography in Healthy Population

Despite the noninvasiveness and accuracy of multidetector computed tomography (MDCT), its use as a routine screening tool for occult coronary atherosclerosis is unclear. We investigated whether the ratio of apolipoprotein B (apoB) to apolipoprotein A1 (apoA1), an indicator of the balance between atherogenic and atheroprotective cholesterol transport could predict occult coronary atherosclerosis detected by MDCT. We collected the data of 1,401 subjects (877 men and 524 women) who participated in a routine health screening examination of Asan Medical Center. Significant coronary artery stenosis defined as > 50% stenosis was detected in 114 subjects (8.1%). An increase in apoB/A1 quartiles was associated with increased percentages of subjects with significant coronary stenosis and noncalcified plaques (NCAP). After adjustment for confounding variables, each 0.1 increase in serum apoB/A1 was significantly associated with increased odds ratios (ORs) for coronary stenosis and NCAP of 1.23 and 1.18, respectively. The optimal apoB/A1 ratio cut off value for MDCT detection of significant coronary stenosis was 0.58, which had a sensitivity of 70.2% and a specificity of 48.2% (area under the curve, 0.61; 95% CI, 0.58-0.63, P < 0.001). Our results indicate that apoB/A1 ratio is a good indicator of occult coronary atherosclerosis detected by coronary MDCT.

Various Oscillation Patterns of Serum Fibroblast Growth Factor 21 Concentrations in Healthy Volunteers

BACKGROUND: Fibroblast growth factor 21 (FGF21) was originally identified as a paroxysm proliferator activated receptor-alpha target gene product and is a hormone involved in metabolic regulation. The purpose of this study was to investigate the diurnal variation of serum FGF21 concentration in obese and non-obese healthy volunteers. METHODS: Blood samples were collected from five non-obese (body mass index [BMI] or =25 kg/m2) healthy young men every 30 to 60 minutes over 24 hours. Serum FGF21 concentrations were determined by radioimmunoassay. Anthropometric parameters, glucose, free fatty acid, insulin, leptin, and cortisol concentrations were also measured. RESULTS: The serum FGF21 concentrations displayed various individual oscillation patterns. The oscillation frequency ranged between 6 and 12 times per day. The average duration of oscillation was 2.52 hours (range, 1.9 to 3.0 hours). The peaks and troughs of FGF21 oscillation showed no circadian rhythm. However, the oscillation frequency had a diurnal variation and was lower during the light-off period than during the light-on period (2.4 vs. 7.3 times, P or =0.19 ng/mL). CONCLUSION: Various oscillation patterns in serum FGF21 concentration were observed, and reduced oscillation frequencies were seen during sleep. The oscillation patterns of serum FGF21 concentration suggest that FGF21 may be secreted into systemic circulation in a pulsatile manner. Obesity appeared to affect the amplitude of oscillations of serum FGF21.

A Case of Familial Cutaneous Collagenoma

Familial cutaneous collagenoma is a rare hereditary disease that is inherited in an autosomal dominant pattern. It is characterized by early onset of multiple, skin-colored, sometimes hypopigmented cutaneous nodules, which initially show a symmetrical arrangement on the trunk, and later on the neck and upper limbs. We report on a case of a 45-year-old female who presented with multiple oval to round hypopigmented papules measuring 5~15 mm on her trunk. Histopathologically, the lesions showed an increased amount of collagen fibers and decreased, fragmented elastic fibers in the dermis. The skin lesions were diagnosed as familial cutaneous collagenoma and no treatment was administered. To the best of our knowledge, our case is the first reported case of familial cutaneous collagenoma (FCC) in the Korean literature.

The Prevalence of Peripheral Arterial Disease in Korean Patients with Type 2 Diabetes Mellitus Attending a University Hospital

BACKGROUND: Peripheral arterial disease (PAD) is a common manifestation of systemic atherosclerosis and is associated with significant morbidity and mortality. Diabetes is known to increase the risk of PAD two- to four-fold. The prevalence of PAD in Korean diabetic patients has not been established. In this study, we investigated the prevalence of PAD in Korean patients with type 2 diabetes attending a large university hospital and analyzed the factors associated with PAD. METHODS: A total of 2,002 patients with type 2 diabetes who underwent ankle-brachial index (ABI) measurement in an outpatient clinic were enrolled. PAD was defined as an ABI < or =0.9. Clinical characteristics of 64 patients with PAD were compared with those of 192 age- and sex-matched control patients without PAD. RESULTS: Of the 2,002 type 2 diabetic patients, 64 (3.2%) were diagnosed as having PAD. PAD was associated with higher prevalences of retinopathy, nephropathy, neuropathy, cerebrovascular and coronary artery disease. Patients with PAD had higher systolic blood pressure and serum triglyceride level and reported higher pack-years of smoking. Multivariate analysis showed that the presence of micro- and macrovascular complications and high systolic blood pressure are factors independently associated with PAD. CONCLUSION: The prevalence of PAD in diabetic patients was 3.2%, suggesting that the prevalence in Korean diabetic patients is lower than that of patients in Western countries.

Improvement of Type 2 Diabetes after Bariatric Surgery in a Patient with Severe Obesity / 임상당뇨병

The prevalence of obesity is steadily increasing worldwide and is commonly associated with metabolic diseases including hypertension, hyperlipidemia, and type 2 diabetes as well as increased mortality. Bariatric surgery is an effective treatment modality for patients with severe obesity and type 2 diabetes that are refractory to conventional treatments. We performed bariatric surgery (biliopancreatic diversion with duodenal switch) in a 23-year-old man with severe obesity and uncontrolled type 2 diabetes. Before surgery, the patient experienced continuous weight gain and aggravated glycemic control despite dietary restrictions, exercise, and medications including high dose insulin. After surgery, his weight was reduced by 17 kg and he was able to stop insulin treatment. This case suggests that bariatric surgery is an effective therapeutic option when severe obesity and type 2 diabetes are refractory to usual treatments.

A Case of Familial Multiple Endocrine Neoplasia Type 1 with a Novel Mutation in the MEN1 Gene

Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant disorder characterized by the occurrence of multiple tumors in the parathyroid gland, pancreatic islet, and pituitary gland. This condition is caused by mutations of MEN1, a tumor suppressor gene. Thus far, 565 different germline and somatic mutations of the MEN1 gene have been reported. Herein, we describe the case of a 23-year-old woman who suffered from a repetitive loss of consciousness. After workup, the patient was diagnosed with MEN1 with insulinoma, hyperparathyrodism due to parathyroid adenoma, and non-functioning pituitary microadenoma. She underwent a partial parathyroidectomy and distal pancreatectomy. Familial screening of MEN1 revealed that her brother had prolactinoma, hyperparathyroidism, pancreatic gastrinoma and non-functioning adrenal adenoma. Her father had hyperparathyroidism, pancreatic tumor, and adrenal adenoma. Upon genetic analysis of the MEN1 gene, a novel mutation in the MEN1 gene (exon 1, c.251del; p.Ser84LuefsX35) was detected in the patient, as well as her father and brother.

A case of infective endocarditis with endophthalmitis and septic arthritis caused by pneumococcal bacteremia / 대한내과학회지

Pneumococcal endocarditis accompanied by pneumococcal bacteremia is a rare condition. However, its clinical course is typically aggressive and associated with high morbidity and mortality rates. We report a case of a 67-year-old male who had small cell lung cancer and was undergoing concurrent chemoradiation therapy, and who presented with pneumococcal bacteremia complicated by infective endocarditis, endogenous endophthalmitis, and septic arthritis of the wrist. He presented with fever, sudden blindness, and a systolic cardiac murmur. Blood cultures were positive for penicillin susceptible Streptococcus pneumoniae. Despite appropriate treatment with intravenous and intravitreal antibiotics, destructive changes still appeared in his vitreous, mitral, and aortic valves. He underwent a vitrectomy and mitral and aortic valve replacement. We were able to prevent further embolic events with antibiotics and early surgical management.

Langerhans Cell Histiocytosis That Improved with Oral Isotretinoin Therapy / 대한피부과학회지

Langerhans cell histiocytosis (LCH) is a reactive disease in which abnormal Langerhans cells accumulate in various body sites. We report here on a 51-year-old male patient with LCH that was classified as single-system disease (restricted LCH). The skin lesions were a small, deep ulcer in the right inguinal area and multiple erythematous papules scattered on the lower abdomen, and the patient had these lesions for 1 year. The histopathologic examination revealed a dense histiocytic infiltration in the dermis, and most of the cells showed the characteristics of "LCH" cells. The immunohistochemistry for S-100 protein and CD1a complex all showed positive results. The patient was much improved after surgical excision of the inguinal ulcer and administering oral isotretinoin (20 mg daily) for 8 months, and there was no recurrence. We think retinoid is an effective treatment option for LCH, especially for single system disease.

Multiple, Giant Soft Fibromas in the Labium Majus / 대한피부과학회지

Soft fibromas are benign fibrous tissue tumors of the dermis. In general, they appear as small, soft, pedunculated or sessile tumors and they are mostly located on the axillae, lateral neck and inguinal region. Although large sized soft fibromas may occur in the groin or upper thighs, and especially in patients with diabetes, they rarely exceed 2 cm in size. We report herein a case of multiple giant soft fibromas, including an unusually huge, giant lesion in the labium majus of a healthy, middle-aged woman, and such fibromas on the labium majus are very rare.

A Case of Accessory Tragus on the Nasal Vestibule

We present a case of accessory tragus (AT) which developed at an unusual site, the nasal vestibule, of a 1-day-old girl. To our knowledge, this is the first report of an accessory tragus that appears on the nasal vestibule.

Evaluation of the Quality of Life in the Patients with Chronic Urticaria / 대한피부과학회지

BACKGROUND: Chronic urticaria (CU) is one of the most common skin disorders. This disease commonly induces emotional, social and psychological problems due to the erythematous lesion and intense pruritus. But there has been inadequate objective evaluation of the quality of life (QOL) of the patients with CU in Korea. OBJECTIVE: The purpose of this study was to investigate the QOL of the Korean patients with CU by means of a new disease-specific tool and to assess the association between the QOL and the severity of disease. METHODS: A total of 118 patients with CU were interviewed using the CU QOL questionnaire (CU-Q2oL). Their symptoms were evaluated with the urticaria severity score. We analyzed the relationship between the severity score and the CU-Q2oL score with Pearson's correlation test. RESULTS: The average score of the CU-Q2oL was 50.08+/-18.68. It was high when the patients had high severity scores (p<0.01). The severity score was increased in the patients with old age and when they were married. Comorbid systemic and skin diseases, a long duration of urticaria and systemic symptoms accompanying urticaria were also related to a high severity score. CONCLUSION: This study showed that CU has a significant impact on the QOL of Korean patients with CU in proportion to the disease severity. Clinicians need to consider the QOL and the CU severity of their patients to achieve the ideal goals of treatment.

Two Cases of Nontuberculous Mycobacterial Lung Disease in Heart Transplant Recipients / 결핵및호흡기질환

Nontuberculous mycobacterial (NTM) diseases are increasing worldwide. However NTM lung disease in organ transplant recipients has been rarely reported. Here, we report 2 cases of NTM lung disease in heart transplant recipients. A 37-year-old man, who had undergone a heart transplant one year previous, was admitted to hospital due to a cough. Chest CT scan showed multiple centrilobular nodules in both lower lungs. In his sputum, M. abscessus was repeatedly identified by rpoB gene analysis. The patient improved after treatment with clarithromycin, imipenem, and amikacin. An additional patient, a 53-year-old woman who had undergone a heart transplant 4 years prior and who suffered from bronchiectasis, was admitted because of purulent sputum. The patient's chest CT scan revealed aggravated bronchiectasis; M. intracellulare was isolated repeatedly in her sputum. Treatment was successfully completed with clarithromycin, ethambutol, and ciprofloxacin. NTM lung disease should be considered as a potential opportunistic infection in organ transplant recipients.

Two Cases of Nontuberculous Mycobacterial Lung Disease in Heart Transplant Recipients / 결핵및호흡기질환

Nontuberculous mycobacterial (NTM) diseases are increasing worldwide. However NTM lung disease in organ transplant recipients has been rarely reported. Here, we report 2 cases of NTM lung disease in heart transplant recipients. A 37-year-old man, who had undergone a heart transplant one year previous, was admitted to hospital due to a cough. Chest CT scan showed multiple centrilobular nodules in both lower lungs. In his sputum, M. abscessus was repeatedly identified by rpoB gene analysis. The patient improved after treatment with clarithromycin, imipenem, and amikacin. An additional patient, a 53-year-old woman who had undergone a heart transplant 4 years prior and who suffered from bronchiectasis, was admitted because of purulent sputum. The patient's chest CT scan revealed aggravated bronchiectasis; M. intracellulare was isolated repeatedly in her sputum. Treatment was successfully completed with clarithromycin, ethambutol, and ciprofloxacin. NTM lung disease should be considered as a potential opportunistic infection in organ transplant recipients.

A Case of Milia Occurring on Superficial Basal Cell Carcinoma of the Face / 대한피부과학회지

We report here on a 71-year-old female who had well-demarcated erythematous patches, along with some pearly papules, on the right cheek. Histopathological examination of the lesions revealed a basaloid cell mass, which appeared to be a superficial basal cell carcinoma, and a small keratin-filled cyst that appeared to be a milium. A part of the milium was surrounded by the basaloid cells of tumor islands and milia later developed on the lesion of basal cell carcinoma. We suggest that basal cell carcinoma may be one of the causes of secondary milia.

A Case of Recurrent Pancytopenia due to Parvovirus B19 Infection in a Renal Transplant Recipient / 대한신장학회지

Pure red cell aplasia due to parvovirus B19 infection after renal transplantation has been rarely reported, and few have been described about pancytopenia due to parvovirus B19. We report a case of recurrent pancytopenia due to parvovirus B19 infection in a renal transplant recipient. Ten days after transplantation, the patient developed severe pancytopenia (WBC 400/mm3, platelet 29,000/mm3, hemoglobin 6.8 g/dL) and his blood sample was positive for parvovirus B19 DNA PCR. Two weeks after 5-day administration of IVIG 400 mg/kg/day, pancytopenia resolved and tacrolimus was converted to cyclosporine A for reducing immunosuppressant potency. However, recurrent pancytopenia developed two months after IVIG treatment. Both blood and bone marrow samples were positive again for parvovirus B19 DNA PCR. Although pancytopenia persisted after another 5-day administration of IVIG 400 mg/kg/day, excellent hematological response has been achieved with single dose of IVIG 1 g/kg/day. Our case suggested that parvovirus B19 infection should be considered in renal transplant recipients with unexplained severe pancytopenia. High dose IVIG would be an effective therapeutic option, if the infection is recurrent or refractory to the usual dose of IVIG.

Comparative Study of Aminolevulinic Acid Photodynamic Therapy Plus Pulsed Dye Laser versus Pulsed Dye Laser Alone in Treatment of Recalcitrant Viral Warts / 대한피부과학회지

BACKGROUND: Recurrent recalcitrant warts are likely to increase gradually, and require more aggressive and effective treatment for remedy. According to recent foreign research materials and literature, aminolevulinic acid photodynamic therapy (ALA-PDT) is reported to prove to show high curative performances, but there has been little relevant research in Korea to date. OBJECTIVE: This study will evaluate the efficiency and side effects of ALA-PDL and PDL in treating recalcitrant viral warts. METHODS: 120 warts from 44 people were selected and sorted by their locations such as hand, foot, and periungual area, and then randomly divided into 2 groups: ALA-PDL group and PDL group. The ALA-PDL group used 20% 5-ALA as a photosensitizer, and PDL for the light-source, the other group used PDL. The setting of PDL being used in both groups is as follows: wavelength of 585 nm, spot size of 7 mm, and energy density of 7.0~10 J/cm2. RESULTS: After 3 treatment sessions, the complete clearance of ALA-PDL and PDL groups was 44/59 (74.6%), 18/61 (29.5%), partial clearance-good was 8/59 (13.6%), 20/61 (32.8%), partial clearance-poor was 7/59 (11.9%), 21/61 (34.4%) and no response was 0/59 (0%), 2/61 (3.3%). The average treatment sessions were 2.32 and 2.97 times. ALA-PDL group showed pain in 27/59 (45.8%) for the first and second treatment sessions, and postinflammatory hyperpigmentation (PIH) in 11/59 (18.6%). The PDL group showed only PIH in 3/61 (4.9%). CONCLUSION: PDT is an efficient treatment modality in recalcitrant viral warts. Especially in the case of periungual warts, it is very safe and cosmetically satisfactory without serious side effects such as nail deformity.

A Case of a Solitary Type of Congenital Self-healing Reticulohistiocytosis / 대한피부과학회지

Congenital self-healing reticulohistiocytosis (CSHRH) typically presents at birth or in the first few weeks of life as a widespread eruption of cutaneous red-brown papulonodules that resolve spontaneously without involvement of other organs. While multiple lesions are common, a solitary lesion is rare. We describe a solitary type of CSHRH in a full-term, male neonate. He had an erythematous papule with a yellowish crust on the left heel without any systemic symptoms. Four weeks later, the skin lesion had disappeared spontaneously.

A Case of Bullous Eosinophilic Cellulitis / 대한피부과학회지

Eosinophilic cellulitis is a rare recurrent inflammatory dermatosis, characterized clinically by well-circumscribed erythematous plaques. The histopathologic features of the lesions are dermal edema, infiltration of eosinophils and development of 'flame figures' in the dermis. A 64-year-old female presented pruritic erythematous plaques, with associated bullae, on her right hand and wrist. Histopathologic examination showed infiltration of eosinophils and characteristic flame figures in the dermis. The clinical presentation and histopathologic alterations are consistent with the diagnosis of eosinophilic cellulitis. Herein, we report a case of bullous eosinophilic cellulitis which is an uncommon variant of eosinophilc cellulitis.

Acquired Reactive Perforating Collagenosis in a Chronic HCV Hepatitis Patient Who was Treated with Interferon Alpha / 대한피부과학회지

Reactive Perforating Collagenosis (RPC) is a kind of perforating dermatosis, which shows transepidermal elimination of altered collagens. Acquired form is developed in an adult without family history, is favorably developed in scratched region due to pruritic sense. Acquired RPC has been reported to be associated with various systemic disorders, such as diabetes mellitus, liver disease, chronic renal failure, lymphoma, AIDS, hypothyroidism, hyperparathyroidism, and neurodermatitis, accompanied by itching & scratching. We report a case of acquired RPC in a patient with HCV hepatitis who was treated with interferon alpha. Skin lesions showed multiple erythematous centrally umbilicated, crusted papules of variable sizes on the extensor surfaces of both shins.