Nodular Vasculitis That Developed during Etanercept (Enbrel) Treatment in a Patient with Psoriasis

Nodular vasculitis was introduced by Montgomery for cases of erythema induratum-like lesions that were not associated with tuberculosis. Nodular vasculitis has been associated with both nontuberculous infections and noninfectious conditions. However, there has been no report on the development of nodular vasculitis during tumor necrosis factor-alpha inhibitor treatment. A 28-year-old man visited our clinic for the treatment of severe psoriasis with a 20-year history. Subcutaneous injection of etanercept (25 mg, twice weekly) was started. One year later, erythematous nodules developed on his lower leg. A skin biopsy showed lobular panniculitis with extensive necrosis and vasculitis. To exclude latent tuberculosis, an assay specific for Mycobacterium tuberculosis antigens was performed, with a negative result. After stopping etanercept under the diagnosis of nodular vasculitis associated with etanercept, the lesions gradually disappeared, leaving depressed scars in 3 months. There has been no recurrence after 6 months of follow-up.

Nodular Vasculitis That Developed during Etanercept (Enbrel) Treatment in a Patient with Psoriasis

Nodular vasculitis was introduced by Montgomery for cases of erythema induratum-like lesions that were not associated with tuberculosis. Nodular vasculitis has been associated with both nontuberculous infections and noninfectious conditions. However, there has been no report on the development of nodular vasculitis during tumor necrosis factor-alpha inhibitor treatment. A 28-year-old man visited our clinic for the treatment of severe psoriasis with a 20-year history. Subcutaneous injection of etanercept (25 mg, twice weekly) was started. One year later, erythematous nodules developed on his lower leg. A skin biopsy showed lobular panniculitis with extensive necrosis and vasculitis. To exclude latent tuberculosis, an assay specific for Mycobacterium tuberculosis antigens was performed, with a negative result. After stopping etanercept under the diagnosis of nodular vasculitis associated with etanercept, the lesions gradually disappeared, leaving depressed scars in 3 months. There has been no recurrence after 6 months of follow-up.

Effect of Emollients Containing Vegetable-Derived Lactobacillus in the Treatment of Atopic Dermatitis Symptoms: Split-Body Clinical Trial

BACKGROUND: Atopic dermatitis (AD) patients suffer from xerosis. Proper skin care, including the use of emollients, may help improve xerosis and minimize disease exacerbation. Lactobacillus sakei probio 65, isolated from the Korean vegetable-based product kimchi, can decrease interleukin 4 and immunoglobulin E levels and inhibit Staphylococcus aureus. Moreover, it has reportedly shown positive dermatological effects in both animal and clinical studies. OBJECTIVE: To compare the effects of an emollient that contains Lactobacillus (treated) with a normal emollient (control) on AD. METHODS: This double-blind, randomized, split-body clinical trial involved 28 patients with AD. The patients applied the Lactobacillus-containing emollient on one side of their body and the control emollient on the other side twice daily for 4 weeks. Trans-epidermal water loss (TEWL) and skin capacitance were evaluated and investigator global assessment and the visual analogue scale (VAS) were administered on weeks 0, 1, 2, and 4. RESULTS: The treated sides had significantly lower TEWL and VAS values and significantly higher skin capacitance values over time than the control sides. CONCLUSION: Topical application of Lactobacillus-containing emollients may improve the skin permeability of patients with AD.

Eruptive Anetoderma in a Patient with Systemic Lupus Erythematosus

Anetoderma is a rare cutaneous disorder characterized by a loss of normal elastic tissue that presents clinically as atrophic patches located mainly on the upper trunk. Recent studies suggest immunological mechanisms may play a role in this process. Furthermore, a secondary form of macular atrophy occurs in the course of infectious diseases (e.g. syphilis and tuberculosis) and autoimmune disease (e.g. systemic lupus erythematosus [SLE]). Here, we report the case of a 20-year-old woman previously diagnosed with SLE, who presented with numerous well-circumscribed atrophic macules on the face and upper trunk. Histopathological examination showed decreased elastic tissues in the reticular dermis and mononuclear cells adhering to elastic fibers, consistent with anetoderma. Thus, the eruptive anetoderma localized widely on the face and upper trunk may have been caused by an autoimmune response of SLE.

Linear Lichen Planus in Hypereosinophilic Syndrome / 대한피부과학회지

Hypereosinophilic syndrome (HES) is characterized by chronically increased peripheral blood eosinophil levels and organ damages related to eosinophilic infiltration. Cutaneous manifestations are common (>50%) and non-specific. It is generally manifested as erythematous pruritic eczema. Linear lichen planus has not been reported in HES. A 35-year-old woman was presented with linear brownish papules and plaques on her left arm. She had been diagnosed with HES three years earlier. Initially, the skin lesions were manifested as linear pruritic erythematous plaques, but they gradually transformed into shiny brownish plaques. Skin biopsy specimens showed irregular acanthosis of the epidermis and band-like infiltrations of lymphocytes and eosinophils with necrotic keratinocytes in the papillary dermis. We proposed that the eosinophil infiltration was caused by HES, and that the patient's histological and clinical manifestations should account for linear lichen planus.

Primary Cutaneous Amyloidosis with Familial Background / 대한피부과학회지

Primary localized cutaneous amyloidosis is classified as macular, lichen, and rarely nodular amyloidosis according to clinical manifestation. Most cases are sporadic, but several cases have been reported to be familial with autosomal dominant transmission. Herein, we report a patient with familial primary localized cutaneous amyloidosis suggesting autosomal dominant transmission. A 31-year old woman presented with pruritic brown hyperkeratotic papules on both legs which developed 5 years ago and gradually had spread around the knee. A skin biopsy showed an amorphous eosinophilic material in the papillary dermis that appeared pink with congo red stain. Her mother and older sister have also suffered from similar pruritic brown papules on the legs without any kind of manifestation suggesting the disease is systemic.

Arteriovenous Hemangioma Developed after Fine Needle Biopsy of Thyroid / 대한피부과학회지

Fine needle biopsy of nodules on the thyroid is simple diagnostic method and it is generally a safe procedure. The main side effect is pain and hematoma. Secondary hemangioma development after biopsy is extremely rare. A 63-year-old woman presented with a 5-year history of solitary erythematous papule on neck. Spontaneous bleeding recorded six times within 5 years. There is not vascular anastomosis in ultrasonographic imaging. A histopathologic study showed vessel-like arteriole around small veins in dermis. No arteriovenous hemangioma case has been previously reported to be related to fine needle biopsy. Our case showed possibilities of arteriovenous hemangioma developments after fine needle biopsy.

Interstitial Lung Disease That Occurred during Treatment with Etanercept (Enbrel(R)) of Psoriasis Patients / 대한피부과학회지

Etanercept is widely used to treat autoimmune rheumatic, digestive, and dermatologic diseases such as psoriasis. It acts as a competitive inhibitor of tumor necrosis factor (TNF)-alpha and has acceptable safety and tolerability profiles. However, patients occasionally experience serious adverse effects such as infection, malignancy, cardiovascular events, and pulmonary disease. A 43-year-old man with a 10-year history of psoriasis presented with cough and exertional dyspnea that had developed 4 months after the initial etanercept administration. His symptoms continued to aggravate, and chest radiography and high-resolution computed tomography showed a diffuse reticulonodular infiltrate and ground-glass attenuation. As these clinical and radiologic findings suggested drug induced interstitial lung disease, we withdrew etanercept and initiated oral prednisolone treatment. The patient showed gradual improvement of the disease. Interstitial lung disease, although rare, is a potentially fatal adverse effect of TNF-alpha inhibitor treatment. Therefore, we recommend considering the possibility of interstitial lung disease in patients suffering from pulmonary symptoms who are taking TNF-alpha inhibitors.

A Novel Compound Rasatiol Isolated from Raphanus sativus Has a Potential to Enhance Extracellular Matrix Synthesis in Dermal Fibroblasts

BACKGROUND: The fibrous proteins of extracellular matrix (ECM) produced by dermal fibroblast contributes to the maintenance of connective tissue integrity. OBJECTIVE: This study is carried out to identify the bioactive ingredient from natural products that enhances ECM production in dermal fibroblasts. METHODS: Bioassay-directed fractionation was used to isolate the active ingredient from natural extracts. The effects of rasatiol (isolated from Raphanus sativus) on ECM production in primary cultured human dermal fibroblasts was investigated by enzyme linked immunosorbent assay and western blot analysis. RESULTS: Rasatiol accelerated fibroblast growth in a dose-dependent manner and increased the production of type 1 collagen, fibronectin and elastin. Phosphorylation of p42/44 extracellular signal-regulated kinase, p38 mitogen-activated protein kinase, and Akt was remarkably increased by rasatiol, indicating that enhanced ECM production is linked to the activation of intracellular signaling cascades. CONCLUSION: These results indicate that rasatiol stimulates the fibrous components of ECM production, and may be applied to the maintenance of skin texture.

A Novel Compound Rasatiol Isolated from Raphanus sativus Has a Potential to Enhance Extracellular Matrix Synthesis in Dermal Fibroblasts

BACKGROUND: The fibrous proteins of extracellular matrix (ECM) produced by dermal fibroblast contributes to the maintenance of connective tissue integrity. OBJECTIVE: This study is carried out to identify the bioactive ingredient from natural products that enhances ECM production in dermal fibroblasts. METHODS: Bioassay-directed fractionation was used to isolate the active ingredient from natural extracts. The effects of rasatiol (isolated from Raphanus sativus) on ECM production in primary cultured human dermal fibroblasts was investigated by enzyme linked immunosorbent assay and western blot analysis. RESULTS: Rasatiol accelerated fibroblast growth in a dose-dependent manner and increased the production of type 1 collagen, fibronectin and elastin. Phosphorylation of p42/44 extracellular signal-regulated kinase, p38 mitogen-activated protein kinase, and Akt was remarkably increased by rasatiol, indicating that enhanced ECM production is linked to the activation of intracellular signaling cascades. CONCLUSION: These results indicate that rasatiol stimulates the fibrous components of ECM production, and may be applied to the maintenance of skin texture.

Encephalocraniocutaneous Lipomatosis without Neurologic Anomalies

No abstract available.

The Impact of Implementing Critical Care Team on Open General Intensive Care Unit / 결핵및호흡기질환

BACKGROUND: There are a plethora of literatures showing that high-intensity intensive care unit (ICU) physician staffing is associated with reduced ICU mortality. However, it is not widely used in ICUs because of limited budgets and resources. We created a critical care team (CCT) to improve outcomes in an open general ICU and evaluated its effectiveness based on patients' outcomes. METHODS: We conducted this prospective, observational study in an open, general ICU setting, during a period ranging from March of 2009 to February of 2010. The CCT consisted of five teaching staffs. It provided rapid medical services within three hours after calls or consultation. RESULTS: We analyzed the data of 830 patients (157 patients of the CCT group and 673 patients of the non-CCT one). Patients of the CCT group presented more serious conditions than those of the non-CCT group (acute physiologic and chronic health evaluation II [APACHE II] 20.2 vs. 15.8, p<0.001; sequential organ failure assessment [SOFA] 5.5 vs. 4.6, p=0.003). The CCT group also had significantly more patients on mechanical ventilation than those in the non-CCT group (45.9% vs. 23.9%, p<0.001). Success rate of weaning was significantly higher in the CCT group than that of the non-CCT group (61.1% vs. 44.7%, p=0.021). On a multivariate logistic regression analysis, the increased ICU mortality was associated with the older age, non-CCT, higher APACHE II score, higher SOFA score and mechanical ventilation (p<0.05). CONCLUSION: Although the CCT did not provide full-time services in an open general ICU setting, it might be associated with a reduced ICU mortality. This is particularly the case with patients on mechanical ventilation.

Neutrophilic Eccinre Hidroadenitis in Acquired Immune Deficiency Syndrome / 대한피부과학회지

Neutrophilic eccrine hidradenitis (NEH) usually occurs in patients receiving chemotherapy for acute myelogenous leukemia or other malignant diseases. We experienced a case of NEH occurring in an HIV (human immunodeficiency virus)-positive 35-year-old male patient. The patient presented with a 1-year history of recurrent erythematous papule on his upper extremity. Laboratory studies showed that Anti-HIV is positive and HIV RNA PCR is 1.02x106. Histopathologic study showed neutrophilic infiltration within and around the eccrine glands and degeneration of the eccrine glands.

Unilateral Demodicidosis in a Patient with Seborrheic Dermatitis / 대한의진균학회지

Demodex mites are considered part of the normal skin flora. Typically, Demodex is harmless and causes no clinical symptoms. We present a 43-year-old woman with pruritic erythematous plaque and papulopustular eruptions on the right cheek. The patient was treated seborrheic dermatitis in face from several years ago. However, the lesion was aggravated after continuous topical steroid usage for several months at a local clinic. Histological examinations revealed Demodex mites in the follicular ostia with perivascular and perifollicular lymphohistiocytic inflammation. Treatment was initiated with metronidazole at a dose of 250 mg three times per day and then crotamiton ointment once daily. The lesion showed marked improvement after six weeks of treatment with mild residual erythema. The findings presented here indicate that Demodex infestation should be considered in the differential diagnosis of unilateral follicular eruptions of the face.

Clinical Benefits of Preoperative Percutaneous Transhepatic Gallbladder Drainage in Patients Older than Sixty with Acute Cholecystitis

PURPOSE: The purpose of this study was to evaluate the clinical benefits of preoperative percutaneous transhepatic drainage (PTGBD), especially regarding morbidity and mortality, in patients aged 60 or older with acute cholecystitis. METHODS: A retrospective study was done on a series of elderly patients (>60 years old; n=132) who had been diagnosed between January 2007 and December 2009 as having acute cholecystitis. The patients were divided into 4 groups; cases in which only laparoscopic cholecystectomy (LC) was done (Group 1, n=84), cases in which LC was done after preoperative PTGBD (Group 2, n=15), cases in which only open cholecystectomy was done (Group 3, n=23), and cases in which open cholecystectomy was done after preoperative PTGBD (Group 4, n=10). We analyzed between group differences in surgical outcomes including periods of postoperative fast and postoperative hospital stay, OP. morbidity, and open conversion rate. RESULTS: Patients in Group 1 had fewer underlying medical problems and lower ASA scores than patients in groups 2, 3, or 4 (p<0.05). Mean operating time in Group 2 (113.66+/-107.5 min) was significantly longer than in group 1 (72.02.9+/-34.2 min) (p<0.05) and the open conversion rate was higher (8.33% vs 26.67%). But, blood loss (ml) and OP time in Group 2 were lower than in Group 3 or 4 (p<0.001). Postoperative recovery progression (periods of postoperative fasting and length of postoperative hospital stay) of Group 2 were better than in groups 3 or 4 (p<0.001). CONCLUSION: Pre-operative PTGBD procedures in elderly patients with acute cholecystitis is a good clinical option as a pretreatment to a cholecystitis operation.

Abdominal Computed Tomography in Patients with Right Lower Quadrant Pain

PURPOSE: This study was performed to evaluate the usefulness of abdominal computed tomography (CT) for patients with right lower quadrant (RLQ) pain. METHODS: Between January 2006 and July 2008, 191 consecutive patients with RLQ pain underwent abdominal CT (CT group). Forty-two patients who had undergone abdominal ultrasound (US group) and 52 patients without abdominal CT or abdominal ultrasound for RLQ pain (clinical Dx group) underwent emergent operations. Using the Alvarado scoring system, we scored all patients. The abdominal CT was performed in the abdominal and pelvic area with contrast. RESULTS: One hundred twenty-one (63.4%) of the 191 patients in the CT group were preoperatively diagnosed as having acute appendicitis and underwent surgery. There were three cases of negative appendectomy (1.6%). In the US group and the clinical Dx group, the negative appendectomy rates were 4.8% and 3.8%, respectively. The sensitivity of the abdominal CT was 96.7%. In the CT group, in addition to acute appendicitis, colitis, nonspecific enteritis, diverticulitis, urinary stone, ovary, uterine, and diseases were indentified. CONCLUSIONS: In this study, abdominal CT scans in patients with RLQ pain were useful for the diagnosis acute appendicitis and for the differential diagnosis of other diseases presenting with RLQ pain. The false positive rate was significantly lower in the CT group than in the other groups.

Clinical Study of Synchronous Multiple Gastric Cancer

PURPOSE: Gastric cancer is the most common cancer in Korea, occurring in 20.8% of all cancer patients, most frequently at the antrum, followed by the body and fundus. Multiple synchronous gastric cancers are reported in 0.8 to 8.3% of all gastric cancers. This study aimed to investigate their clinicopathological features and prognosis. METHODS: Out of 6068 patients that underwent a gastrectomy for gastric cancers at the Department of Surgery, Samsung Medical Center between September 1994 and December 2002, 108 multiple synchronous gastric cancers patients, with more than two lesions, were investigated using a clinicopathological evaluation. RESULTS: The mean age of the subjects was 59.8 years with a male to female ratio of 4.68: 1. The majority of subjects had two lesions , but some had as many as five. A subtotal gastrectomy was performed in 67 and a total gastrectomy in 41 cases. Early stage and advanced gastric cancers were present in 164 and 68 patients, respectively. Fifty-four patients had multiple lesions only at an early stage, 10 at an advanced stage and 44 at both stages. The average tumor sizes of the main and secondary lesions were 39.1 and 23.5 mm, respectively. The lesions were mostly located in the lower two-thirds of the stomach, with 54 having different regions for the main and accessory lesions; one in the each of the upper, middle and lower regions, and seven in the upper and lower regions only. The overall five year survival rate was 89.8%. CONCLUSION: With the generalization of an endoscopic diagnosis, gastric cancers can be diagnosed more quickly and accurately. Despite the rare occurrence of multiple synchronous gastric cancers, the possibility of further lesion, especially in early gastric cancers, should be considered.

The Change of Arterial Stiffness According to Dialysis in Patients with End-Stage Renal Disease

BACKGROUND AND OBJECTIVE: In dialysis patients, the cardiovascular mortality is 10 to 20 times higher than that in the general population. The increased arterial stiffness in patients with end-stage renal disease (ESRD) is an independent predictor of all-cause mortality. The arterial stiffness and atherosclerotic markers were evaluated in patients with ESRD treated with and without hemodialysis (HD) or peritoneal dialysis (PD). SUCJECTS AND METHODS: 14 hemodialysis (mean dialysis duration 19.6 months), 14 peritoneal dialysis (mean dialysis duration 26.1 months) and 14 patients with ESRD prior to initiation of dialysis, and 27 age-sex matched controls were enrolled. The calculated central pulse pressure, plasma homocysteine, serum C-reactive protein, left ventricular mass index and aortic pulse wave velocity (PWV) were measured. RESULTS: Patients with ESRD treated with and without dialysis had greater increases in their arterial stiffness and advanced atherosclerosis compared with the controls. However, there was no difference in the arterial stiffness and atherosclerotic markers before and after the dialysis treatment, or in the dialysis modality (HD, PD) of patients with ESRD. In a multiple regression model, PWV in patients with ESRD was explained by the level of plasma homocysteine (beta=0.396;p=0.027). CONCLUSION: Atherosclerosis and arterial stiffness in patients with ESRD may not be affected by dialysis treatment or modality. In patients with ESRD, the level of plasma homocysteine is independently associated with arterial stiffness.

A Case of Female Urethral Bilobed Diverticulum, which is diagnosed by using positive pressure urethrogram

No abstract available.