Alternative Method of Retrocrural Approach during Celiac Plexus Block Using a Bent Tip Needle

BACKGROUND: This study sought to determine safe ranges of oblique angle, skin entry point and needle length by reviewing computed tomography (CT) scans and to evaluate the usefulness of a bent tip needle during celiac plexus block (CPB). METHODS: CT scans of 60 CPB patients were reviewed. Image of the uppermost margin of L2 vertebral body was used to measure the minimal and maximal oblique angles and the distances from the midline to skin puncture point. The imaginary needle trajectory distance was calculated by three-dimensional measurement. When the procedure was performed by using a 10degrees bent tip needle under a 20degrees oblique X-ray fluoroscopic view, the distance (GF/G'F) from the midline to the actual puncture site was measured. RESULTS: The imaginary safe oblique angle range was 26.4-34.2degrees and 27.7-36.0degrees on the right and left, respectively. The distance from the midline to skin puncture point was 6.1-7.6 cm on the right and 6.3-7.6 cm on the left. The needle trajectory distance at minimal angle was 9.6-11.6 cm on the right and 9.5-11.5 cm on the left. The distance of GF/G'F was 5.1-6.5 cm and 5.0-6.4 cm on the right and left, respectively. All imaginary parameters were correlated with BMI except for GF/G'F. All complications were mild and transient. CONCLUSIONS: We identified safe values of angles and distances using a straight needle. Furthermore, using a bent tip needle under a 20degrees oblique fluoroscopic view, we could safely perform CPB with smaller parameter values.

Two Cases of Cutaneous Infection by Alternaria alternata on Senile Purpura Site / 대한의진균학회지

Genus Alternaria is a species of dematiaceous fungi that is commonly found in the atmosphere or in the soil. It can cause hypersensitivity pneumonitis, bronchial asthma, or allergic rhinitis in immunocompromised host such as patient with organ transplantation or long-term steroid using patient. It can rarely cause skin infection. Case 1 was a 74-year-old man with well demarcated and elevated erythematous plaque with irregular scattered pustules on his right forearm. Case 2 was a 77-year-old woman with well demarcated elevated erythematous nodules within erythematous patch on her right forearm. In both cases, the lesions started at the senile purpura site. Herein, we report 2 rare cases of Alternaria alternata on senile purpura site to share the experience.

Erythema Multiforme-like Skin Lesions as an Initial Sign in Bullous Systemic Lupus Erythematosus / 대한피부과학회지

Bullous systemic lupus erythematosus (bullous SLE) is uncommon; distinctive clinical variant of SLE that is characterized by tense vesicles and bullae filled with fluid that occurs on either erythematous or normal skin. Although bullous SLE can accompany erythematous plaque with annular configuration, urticarial papules, and erythema multiforme (EM)-like lesions initially, there is no report of EM-like lesions as an initial sign of bullous SLE in the Korean literatures. Herein, we describe 31-year-old women with bullous SLE that showed EM-like skin lesions as the initial sign.

Erythema Multiforme-like Skin Lesions as an Initial Sign in Bullous Systemic Lupus Erythematosus / 대한피부과학회지

Bullous systemic lupus erythematosus (bullous SLE) is uncommon; distinctive clinical variant of SLE that is characterized by tense vesicles and bullae filled with fluid that occurs on either erythematous or normal skin. Although bullous SLE can accompany erythematous plaque with annular configuration, urticarial papules, and erythema multiforme (EM)-like lesions initially, there is no report of EM-like lesions as an initial sign of bullous SLE in the Korean literatures. Herein, we describe 31-year-old women with bullous SLE that showed EM-like skin lesions as the initial sign.

Generalized Hypertrichosis with Developmental Delay / 대한피부과학회지

Hypertrichosis is a condition of excessive hair growing in areas of the body where androgen is not predominantly dependent. It has been classified into localized and generalized based on the extent of distribution. Generalized hypertrichosis may occur as part of a syndrome or a metabolic disorder. A 55-month-old girl visited our department with accentuation of thick hairs on her mid-back and face since birth. She was diagnosed as developmental retardation at the age of 10 months. None of her family members had hypertrichosis. No abnormal findings were shown on chromosomal and laboratory studies. Therefore, we diagnosed her as generalized hypertrichosis with developmental delay.

A Case of Basal Cell Carcinoma of the Sole: Diagnosis Supported by Dermoscopic Features / 대한피부과학회지

Basal cell carcinoma (BCC) is the most frequent skin cancer, generally located in hair-bearing, sunlight exposed areas. BCC usually occurs on the head and neck, but very rarely on the sole. A 45-year-old man visited our department with 1 cm sized erythematous patch and erosion. The lesion has been enlarged over a period of 10 years. Dermoscopic examination showed arborizing vessels and blue-gray blotch. Herein, we report a rare case of BCC of the sole with consideration of its origin, cause and dermoscopic findings.

Basal Cell Carcinoma of the Umbilicus / 대한피부과학회지

Basal cell carcinoma (BCC) is the most common skin cancer in humans. It usually develops on sun-exposed areas of the head and neck but can occur anywhere on the body. The various clinical features include nodules, ulcers, bleeding, crust, or scale. Thus, it is important to distinguish BCC from other diseases with similar clinical features. The umbilicus is one of the sun-protected sites where BCC rarely develops. Herein, we describe 71-year-old woman with umbilical BCC initially misdiagnosed as pyoderma.

Persistent Pemphigus Vulgaris Showing Features of Tufted Hair Folliculitis

Pemphigus vulgaris is an autoimmune blistering disease that commonly involves the scalp. Lesions of pemphigus vulgaris that persist on the scalp for a long period may be accompanied by tufted hair folliculitis. Only two previous accounts of tufted hair folliculitis developing in a lesion of pemphigus vulgaris have been reported. We report a 51-year-old-man with erosions and clusters of hair on the scalp. The scalp lesion had persisted for about 20 years. A histopathological examination of the skin lesion on the scalp revealed separation of the epidermis and clusters of several adjacent hair follicles. The patient was diagnosed with persistent pemphigus vulgaris of the scalp showing features of tufted hair folliculitis.

Allergic Contact Dermatitis due to a Topical Antipruritic Containing Dibucaine / 대한피부과학회지

Dibucaine hydrochloride is an amide-type local anesthetic and it is well known to be a contact allergen. Although there are some reports of allergic contact dermatitis due to over-the-counter medications containing dibucaine in the foreign literature, there is only one report of it in the Korean literature. We report here on a case of allergic contact dermatitis due to an over-the-counter drug containing dibucaine in a 41-year-old-woman. The patch test with the preparation that she had used and the TRUE(R) test revealed positive reactions to the dibucaine mix and Moscool(R).

Myxoid Neurofibroma in the Right Inguinal Area / 대한피부과학회지

Myxoid neurofibroma is a histological variant of neurofibroma and represent a conventional neurofibroma with extensive deposition of stromal mucin. Myxoid neurofibroma may present as a sporadic lesion or in the context of neurofibromatosis I. The most common locations of the myxoid neurofibroma are the face, shoulders, arms, periungual area and in the feet. To the best of our knowledge, location in an inguinal area has been rarely reported. We report a case of a 37-year-old man with a solitary myxoid neurofibroma in the right inguinal area.

Congenital Melanocytic Nevus Combined with Cystic Change due to Recurrent Folliculitis / 대한피부과학회지

Nevus with cyst is defined as a single lesion in which there is the coexistence of an epidermoid cyst and a melanocytic nevus. Similar clinical and histopathologic changes can be observed when a hair follicle ruptures and subsequent folliculitis with supprative granulomatous reaction occurs beneath a melanocytic nevus. This cystic change due to inflammation is a different pathologic phenomenon from the formation of an epidermal cyst. Hence, it is necessary to differentiate between these two conditions. We report here on a case of congenital melanocytic nevus combined with cystic change due to inflammation in a 39-year-old man.

Kappa Chain Monoclonal Primary Cutaneous Plasmacytoma / 대한피부과학회지

Primary cutaneous plasmacytoma is a rare type of cutaneous B-cell lymphoma that arises primarily in the skin, and this is derived from clonally expanded plasma cells with various degrees of maturation and atypia. A 72-year-old man had an asymptomatic, solitary reddish to violaceous nodule on the back for about 4 months. The histologic finding of the skin biopsy specimen demonstrated an infiltration of variably matured plasma cells in the dermis, and these cells showed a monotypic expression of immunoglobulin kappa chains on immunohistochemical staining. Staging investigations excluded any extracutaneous manifestations of the disease. Only a few cases of primary cutaneous plasmacytoma have been published in the Korean dermatologic literature. Herein, we report on an interesting case of primary cutaneous plasmacytoma with monoclonality of kappa chains.

Two Cases of Trichophyton rubrum Syndrome / 대한의진균학회지

Trychophyton (T.) rubrum is the most prevalent pathogen among causative fungi of dermatophytosis. Primary infection of T. rubrum can be spread by autoinoculation or other reason and some suggests this generalized infection can be a syndrome. We report two cases of T. rubrum syndrome. The first patient, a 43-year-old male, had a tinea pedis with tinea unguium, tinea corporis, tinea cruris, and tinea manus. The second patient, a 73-year-old female, had a tinea pedis with tinea unguium, tinea manus, tinea corporis, tinea capitis, and tinea faciale. Causative pathogens were T. rubrum.