Autonomic Dysfunction in Sleep Disorders: From Neurobiological Basis to Potential Therapeutic Approaches

Sleep disorder has been portrayed as merely a common dissatisfaction with sleep quality and quantity. However, sleep disorder is actually a medical condition characterized by inconsistent sleep patterns that interfere with emotional dynamics, cognitive functioning, and even physical performance. This is consistent with sleep abnormalities being more common in patients with autonomic dysfunction than in the general population. The autonomic nervous system coordinates various visceral functions ranging from respiration to neuroendocrine secretion in order to maintain homeostasis of the body. Because the cell population and efferent signals involved in autonomic regulation are spatially adjacent to those that regulate the sleep-wake system, sleep architecture and autonomic coordination exert effects on each other, suggesting the presence of a bidirectional relationship in addition to shared pathology.The primary goal of this review is to highlight the bidirectional and shared relationship between sleep and autonomic regulation. It also introduces the effects of autonomic dysfunction on insomnia, breathing disorders, central disorders of hypersomnolence, parasomnias, and movement disorders. This information will assist clinicians in determining how neuromodulation can have the greatest therapeutic effects in patients with sleep disorders.

Childhood Trauma and Pharmacotherapy Retention among Outpatients with Panic Disorder / 정신신체의학

Objectives@#：This study investigated lifetime experiences of trauma, treatment retention, and psychiatric symptoms among outpatients with panic disorder after initiation of pharmacotherapy. Our research hypothesis was that panic patients with childhood trauma would display more severe symptoms and less treatment retention compared to those without such history. @*Methods@#：A total of 135 first-visit outpatients with DSM-IV panic disorder were approached during the period from March 2012 to August 2016. Fifty-three patients (39%) either refused or returned incomplete questionnaires, leading to a final sample size of 82. Participants completed the Trauma History Screen, the Beck Depression Inventory, the Beck Anxiety Inventory, and the Abbreviated PTSD checklist. @*Results@#：The number of lifetime trauma was significantly correlated with treatment retention (rho=-0.269, p=0.015). Among subtypes of trauma, only childhood physical abuse was significantly correlated with treatment retention (rho=-0.298, p=0.007). @*Conclusions@#：Our results indicated that psychological trauma, particularly of an interpersonal nature from childhood, can affect pharmacotherapy treatment retention in panic disorder. This may be mediated by poor patient- doctor relationships originating from trust issues among childhood trauma survivors or lack of perceived improvement due to the more severe symptoms and unfavorable course experienced by those with childhood trauma. Further studies are needed to explore the reasons for poor treatment adherence in this population.

A Case of Sexual Enhancer Induced Fixed Drug Eruption / 대한피부과학회지

Fixed drug eruption is a commonly reported mucocutaneous drug eruption. A 61-year-old male presented to our clinic with a complaint of an itchy round erythematous patch on the left hand dorsum with myalgia. On taking medical history, the patient correlated the episode with the intake of an oral sexual enhancer that he had obtained over the counter. We found the medicine contained tadalafil and sildenafil in combination with herbal ingredients. A short course of oral corticosteroid therapy resulted in the complete resolution of the lesion leaving residual hyperpigmentation of the skin involved. Various sexual enhancers with fancy names and attractive packaging are available without requiring a doctor's prescription. Most contain phosphodiesterase-5 inhibitors in various concentrations, often with herbal additions. These drugs are used erratically by the lay public, and often produce side effects. Herein, we report a case of fixed drug rash related to a sexual enhancer, which we believe to be the first report in Korea.

Secondary Cutaneous Follicular B-Cell Lymphoma Associated with Erythematous Swelling on the Leg: A Case Report / 대한피부과학회지

Cutaneous follicular B-cell lymphoma (CFBCL) is defined as the neoplastic proliferation of germinal center cells confined to the skin. Secondary CFBCL demonstrates a more aggressive clinical course compared to the primary form. We report the case of a 45-year-old man who presented with a 15-day history of lesions on his right leg. Clinical examination revealed multiple erythematous miliary/agminated papules on the right proximal thigh with erythematous swollen patches on the right lower leg. Biopsy of a thigh lesion revealed a massive dermal lymphocytic infiltrate with a follicular pattern. Immunohistochemical staining revealed atypical lymphocytes, which strongly expressed CD20, CD10, Bcl-2, Bcl-6 and Ki-67 proteins, but not CD3 and Cyclin D1. Additionally, further studies revealed that this cutaneous lesion had originated from a retroperitoneal lymph node. We treated the patient with systemic chemotherapy using a cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisone (CHOP) regimen and anti-CD20 monoclonal antibodies. This case illustrates a rarely reported example of secondary cutaneous follicular B-cell lymphoma showing peculiar clinical manifestations.

Secondary Cutaneous Follicular B-Cell Lymphoma Associated with Erythematous Swelling on the Leg: A Case Report / 대한피부과학회지

Cutaneous follicular B-cell lymphoma (CFBCL) is defined as the neoplastic proliferation of germinal center cells confined to the skin. Secondary CFBCL demonstrates a more aggressive clinical course compared to the primary form. We report the case of a 45-year-old man who presented with a 15-day history of lesions on his right leg. Clinical examination revealed multiple erythematous miliary/agminated papules on the right proximal thigh with erythematous swollen patches on the right lower leg. Biopsy of a thigh lesion revealed a massive dermal lymphocytic infiltrate with a follicular pattern. Immunohistochemical staining revealed atypical lymphocytes, which strongly expressed CD20, CD10, Bcl-2, Bcl-6 and Ki-67 proteins, but not CD3 and Cyclin D1. Additionally, further studies revealed that this cutaneous lesion had originated from a retroperitoneal lymph node. We treated the patient with systemic chemotherapy using a cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisone (CHOP) regimen and anti-CD20 monoclonal antibodies. This case illustrates a rarely reported example of secondary cutaneous follicular B-cell lymphoma showing peculiar clinical manifestations.

A Case of Papular Acantholytic Dyskeratosis Treated with Carbon Dioxide Laser / 대한피부과학회지

Papular acantholytic dyskeratosis is a collection of papular skin lesions that occur in the intertriginous and genital area. They show a characteristic histology of focal suprabasal acantholysis that distinguishes it from Hailey-Hailey disease or Darier disease. We describe a 50-year-old man with an asymptomatic papular eruption on the perianal area for several years. Histologically, a biopsy specimen showed diffuse hyperkeratosis and irregular acantholysis throughout the epidermis. We used carbon dioxide laser therapy as a therapeutic option. Despite causing a long and painful healing process, a considerable reduction of the symptoms was achieved. Although we do not know the precise nature or the incidence of this disease, papular acantholytic dyskeratosis should be included in the differential diagnosis of verrucous papules in perineal or perianal areas and carbon dioxide laser may represent a good therapeutic option.

Assessment of the Quality of Life in Korean Patients with Vitiligo / 대한피부과학회지

BACKGROUND: Vitiligo is a chronic disfiguring dermatosis and can cause significant psychosocial burden that affects quality of life (QOL). OBJECTIVE: The purpose of this study was to compare the QOL in patients with vitiligo and healthy controls by using general and dermatology-specific (DLQI) questionnaires: World Health Organization QOL Scale (WHOQOL-BREF) and Dermatology QOL Index (DLQI), respectively. METHODS: Vitiligo patients and healthy controls (104 of each) were recruited, all of whom completed the WHOQOL-BREF and DLQI. Total scores and scores of domains of the WHOQOL-BREF and DLQI in the two groups were compared. RESULTS: The scores of total DLQI and categories of symptoms and feelings, daily activities, and leisure of vitiligo patients were significantly higher than those of healthy controls (p<0.05). The QOL score and domains of physical, psychological health, and social relationships of the WHOQOL-BREF in patients with vitiligo were decreased compared with those in healthy controls (p<0.05). Clinical characteristics, including disease duration, treatment duration, vitiligo area, exposed site, self-reported severity, treatment unsatisfaction, Beck Depression Inventory, and Beck Anxiety Inventory showed significant impairment in the QOL of vitiligo patients according to the DLQI and WHOQOL-BREF (p<0.05). High disease activity and Koebner's phenomenon showed a negative correlation with QOL in patients with vitiligo according to the DLQI only (p<0.05). There was no association between the total DLQI and the QOL scores. CONCLUSION: In our study, QOL in patients with vitiligo was poorer than that of healthy controls. The severity of depression and anxiety was the most important predictor of QOL. Therefore, in managing patients with vitiligo, it is important for the dermatologist to consider the psychological aspects of QOL to provide satisfaction of life.

Cutaneous Metastasis from Pancreatic Cancer Simultaneously Developed on the Scalp and Chest / 대한피부과학회지

No abstract available.

A Case of Atypical Adult-onset Still's Disease That Presented with Unique Histopathologic Findings / 대한피부과학회지

Adult-onset Still's disease (AOSD) is an uncommon disorder characterized by fever, polyarthralgia, elevated white blood cell count, and maculopapular rash, the histologic features of which have not been well known. A 54-year-old woman presented with fever, arthritis, and persistent pruritic lichenified rash. These cutaneous lesions showed unique histological features such as dyskeratosis with a peculiar, distinctive distribution in the upper epidermis and cornified layers with hyperkeratosis. In addition, dermal mucin deposition was increased, with inflammation and minimal fibroblast proliferation. The patient was diagnosed with AOSD according to the diagnostic criteria of Yamaguchi. Herein, we present an atypical form of AOSD showing distinctive clinical and pathological manifestations.

Spitz Nevus on the Perianal Area of a Child: An Unusual Location

No abstract available.

A Case of Poroid Hidradenoma / 대한피부과학회지

Poroid hidradenoma is a benign tumor that is classified as a poroid neoplasm, and is so called because of its morphology, which is intermediate between the cytological features of a poroid neoplasm (poroid and cuticular cells) and the architectural features of a hidradenoma (solid and cystic areas, and tumor cells restricted to the dermis). As these tumors are cystic and superficially located, fine needle aspiration cytology has been useful, but the diagnosis relies on the histological examination. A 79-year-old woman presented with a solitary walnut-sized, soft, tender, reddish-to-bluish nodular lesion that had been enlarging steadily over a period of two years. Histopathologic examination of the cutaneous lesion showed a well-demarcated tumor composed of poroid and cuticular cells in the dermis not connected to the overlying epidermis, consistent with poroid hidradenoma. Herein, we present a rare case of poroid hidradenoma arising in an unusual location.

A Case of Vulvar Syringoma in a 9-year Old Child / 대한피부과학회지

No abstract available.

Leser-Trelat Sign Associated with Malignant Melanoma / 대한피부과학회지

Leser-Trelat sign is a rare paraneoplastic dermatosis that is characterized by the eruptive and rapid development of multiple seborrheic keratosis that coincides with an internal malignancy. Eruptive seborrheic keratosis can be pruritic and appear in a "Christmas-tree pattern." This sign occurs in association with a number of cancers, such as adenocarcinoma of the gastrointestinal tract and various lymphoproliferative disorders. However, Leser-Trelat sign associated with a malignant melanoma is very rare. A 58-year-old male patient presented with an asymptomatic black mass on the penile orifice and patch on the glans penis. He complained of gross hematuria. At the same time, he developed asymptomatic multiple brown papules and plaques on the back. The histopathologic findings of the glans and back lesions were consistent with malignant melanoma and seborrheic keratosis, respectively. Here, we describe a rare case of Leser-Trelat sign associated with malignant melanoma.

Cutaneous Crohn's Disease on the Groin / 대한피부과학회지

Crohn's disease is a systemic inflammatory and granulomatous disease, mainly involving the gastrointestinal tract with extraintestinal manifestations such as the skin, liver and bone. Cutaneous manifestations of Crohn's disease are relatively common; however, the groin is an unusual site for cutaneous Crohn's disease. A 36-year-old male presented with mild pruritic nodules on the left groin for 2 months. Nine years ago, he was diagnosed with intestinal Crohn's disease by endoscopic biopsy. Histopathologic examination of the cutaneous lesion showed non-caseating granulomatous reactions composed of multinucleated giant cells with lymphohistiocytic infiltration in the dermis. Staining for periodic acid-Schiff and acid-fast bacilli was negative. From these findings, we diagnosed these lesions as cutaneous Crohn's disease. The lesions were markedly improved with three rounds of intralesional steroid injection.

Infantile Erythema Annulare Centrifugum / 대한피부과학회지

Erythema annulare centrifugum is an inflammatory skin disorder of unknown etiology characterized by erythematous urticarial papules that enlarge in a centrifugal pattern to form annular appearance. These lesions are usually asymptomatic. Erythema annulare centrifugum generally tends to be a chronic condition. It develops most frequently in adults between 30 and 50 years of life, and only a few infantile cases have been reported in the English literature. Herein, we present an additional case of infantile erythema annulare centrifugum with a review of the literature.

Effect of saline irrigation used in combination with antimicrobial agents on salivary bacterial counts

INTRODUCTION: The aim of the present study was to investigate the effect of mechanical irrigation in combination with mouthwash of antimicrobial agents on salivary bacterial counts. MATERIALS AND METHODS: This study was performed with a randomized study employing a panel of 40 healthy volunteers (20 males and 20 females) between the age of 26 and 32 years. Volunteers were randomly put in one of four treatment groups. In the first group, 0.2 mL of non-stimulatory saliva was collected from every subjective person. Then, saliva was collected after rinsing with chlorhexidine (CHX) for 1 minute. In the second group, non-stimulatory saliva was collected, and then saliva was collected after rinsing with CHX and irrigation with saline. In the third and fourth groups, the same procedures as the first and second groups were performed with povidone iodine (PVI) instead of CHX. All of these samples were cultured for 48 hours aerobically. The reduction rates of colony-forming units (CFU) were calculated for each group. The reduction rate between each group was tested statistically using student t-test. RESULTS: Using CHX in combination with saline irrigation showed a significant decrease of the salivary bacterial CFU when compared with only using CHX.(P0.01) CONCLUSION: It was concluded that the CHX or PVI used with saline irrigation made the salivary bacterial counts reduced more than when CHX or PVI was used alone as an oral antiseptic agent.

Experimental study on the effects of local irrigation and systemic heparin administration on microvascular anastomosis of the rabbit femoral artery with intended crush injury

Oral Tegafur-uracil Plus Folinic Acid versus Intravenous 5-fluorouracil Plus Folinic Acid as Adjuvant Chemotherapy of Colon Cancer

To compare, in terms of compliance, toxicity, quality of life (QOL) and efficacy, intravenous 5-fluorouracil plus folinic acid with oral tegafur-uracil plus folinic acid as postoperative adjuvant chemotherapy after curative resection in patients with Dukes' stage B2 and C2 colon cancer. Among all patients with adenocarcinoma of the colon operated on between July 1997 and June 1999, 122 with Dukes' stage B2 or C2 colon cancer were enrolled in this study. Fifty-three patients were treated with intravenous 5-fluorouracil plus folinic acid (5-FU group) and 69 with oral tegafur-uracil plus folinic acid (UFT group). Compliance, toxicity, QOL and efficacy were evaluated. Compared with the 5-FU group, patients in the UFT group experienced a lower incidence of grade 1 toxicity. The incidences of grade 2-4 toxicity were similar in the two treatment groups. However, severe toxicity (grade 3 or 4) was rare in both groups. A steady and significant increase of the QOL score, both during and after therapy, was evident in both groups suggesting that chemotherapy is quite tolerable and does not deteriorate the patients' QOL. At the median follow-up duration of 28 months, the survival rate and disease free survival rate for the UFT and 5-FU groups were 94.9% vs. 92.5% and 87.5% vs. 84.1%, respectively (p > 0.05). These data suggest that oral tegafur-uracil modulated with oral folinic acid as an adjuvant chemotherapy in patients with Dukes' stage B2 and C2 colon cancer may be a good alternative to infusional 5- fluorouracil.

A case of minimal deviation adenocarcinoma originated from uterine endocervix / 대한산부인과학회잡지

Minimal deviation adenocarcinoma (adenoma malignum) is a variant of adenocarcinoma and is expressed from uterine endocervix. As a result of ever reported cases in the world, it is rare enough to occur in 1 to 2% of invasive cervical adenocarcinoma. Minimal deviation adenocarcinoma is well-differentiated form of adenocarcinoma in which the cytoplasmic mucin is rich and the glandular pattern simulates that of normal endocervical glands. Because of this, the tumor may not be recognized as malignant in small specimens, thereby causing delay in diagnosis. But recent studies have found a favorable prognosis if the disease is detected early. We experienced a case of minimal deviation adenocarcinoma, rare disease in the world, so we report with a brief review of literature.

A case of minimal deviation adenocarcinoma originated from uterine endocervix / 대한산부인과학회잡지

Minimal deviation adenocarcinoma (adenoma malignum) is a variant of adenocarcinoma and is expressed from uterine endocervix. As a result of ever reported cases in the world, it is rare enough to occur in 1 to 2% of invasive cervical adenocarcinoma. Minimal deviation adenocarcinoma is well-differentiated form of adenocarcinoma in which the cytoplasmic mucin is rich and the glandular pattern simulates that of normal endocervical glands. Because of this, the tumor may not be recognized as malignant in small specimens, thereby causing delay in diagnosis. But recent studies have found a favorable prognosis if the disease is detected early. We experienced a case of minimal deviation adenocarcinoma, rare disease in the world, so we report with a brief review of literature.