A case of esophageal perforation caused by suicidal caffeine poisoning in a teenager

Spontaneous esophageal perforation (also known as Boerhaave syndrome) is associated with sudden increase in intra-esophageal pressure by vomiting, coughing or straining at stool. This case describes a 13-year-old girl who developed the perforation after consuming 270 mg/kg of caffeine tablets for a suicide attempt. Presumably, the perforation was caused primarily by caffeine-induced severe vomiting, and secondarily by caffeine-induced gastric acid secretion with smooth muscle relaxation and by the large amount of caffeine-induced sudden increase in intra-esophageal pressure.

Trichostatin A Protects Liver against Septic Injury through Inhibiting Toll-Like Receptor Signaling

Sepsis, a serious clinical problem, is characterized by a systemic inflammatory response to infection and leads to organ failure. Toll-like receptor (TLR) signaling is intimately implicated in hyper-inflammatory responses and tissue injury during sepsis. Histone deacetylase (HDAC) inhibitors have been reported to exhibit anti-inflammatory properties. The aim of this study was to investigate the hepatoprotective mechanisms of trichostatin A (TSA), a HDAC inhibitor, associated with TLR signaling pathway during sepsis. The anti-inflammatory properties of TSA were assayed in lipopolysaccharide (LPS)-stimulated RAW264.7 cells. Polymicrobial sepsis was induced in mice by cecal ligation and puncture (CLP), a clinically relevant model of sepsis. The mice were intraperitoneally received TSA (1, 2 or 5 mg/kg) 30 min before CLP. The serum and liver samples were collected 6 and 24-h after CLP. TSA inhibited the increased production of tumor necrosis factor (TNF)-α and interleukin (IL)-6 in LPS-stimulated RAW264.7 cells. TSA improved sepsis-induced mortality, attenuated liver injury and decreased serum TNF-α and IL-6 levels. CLP increased the levels of TLR4, TLR2 and myeloid differentiation primary response protein 88 (MyD88) protein expression and association of MyD88 with TLR4 and TLR2, which were attenuated by TSA. CLP increased nuclear translocation of nuclear factor kappa B and decreased cytosolic inhibitor of kappa B (IκB) protein expression, which were attenuated by TSA. Moreover, CLP decreased acetylation of IκB kinase (IKK) and increased association of IKK with IκB and TSA attenuated these alterations. Our findings suggest that TSA attenuates liver injury by inhibiting TLR-mediated inflammatory response during sepsis.

A Survey on Customers' Perceptions of Nutrition Labeling for Processed Food and Restaurant Meal

Consumer perception of processed food and restaurant food's nutrient labelling was surveyed. The subjects of this survey consisted of 1,507 parents, whose ages were 20-59 years old. The ratio of the respondents that have known nutrition labelling on processed foods was 89.8% and the ratio of whom have checked the nutrition labelling at their point of purchase was 72.3%. The nutrients which were considered important for nutrition labelling were fat (57.1%), calorie (56.3%) and sodium (49.0%). Also nutrient which were able to be recognized at a glance by the subjects were in the order of trans fat (62.1%), cholesterol (26.9%), calorie (23.9%) and sodium (21.0%). If restaurant menu's nutrient labelling be enacted, the answer rate that the menu's nutrition labelling may affect their menu choice is 90.6% of the respondents. Besides of the Fastfoods that are enforcement, restaurants of that customers want the menu to be labeled were 'pizza and chicken restaurants'. Nutrients that customers preferred to be labelled were calorie (62.0%), fat (60.3%) and sodium (50.9%).

Carcinoma en Cuirasse on the Scrotum Originating from Gastric Adenocarcinoma / 대한피부과학회지

Cutaneous metastases originating from internal malignancy, including gastric adenocarcinoma, are uncommon. Although metastases may affect any cutaneous site, metastasis of the scrotum has very rarely been reported. It originates mostly from the kidneys and prostate. Carcinoma en cuirasse is a rare form of cutaneous metastasis characterized by a diffuse morphea-like induration of the skin. It is most commonly caused by breast cancer, but has occasionally been linked to the cancers of other organs. Herein, we report a rare case of carcinoma en cuirasse on the scrotum of a 53-year-old male patient, which developed from gastric adenocarcinoma.

Carcinoma en Cuirasse on the Scrotum Originating from Gastric Adenocarcinoma / 대한피부과학회지

Cutaneous metastases originating from internal malignancy, including gastric adenocarcinoma, are uncommon. Although metastases may affect any cutaneous site, metastasis of the scrotum has very rarely been reported. It originates mostly from the kidneys and prostate. Carcinoma en cuirasse is a rare form of cutaneous metastasis characterized by a diffuse morphea-like induration of the skin. It is most commonly caused by breast cancer, but has occasionally been linked to the cancers of other organs. Herein, we report a rare case of carcinoma en cuirasse on the scrotum of a 53-year-old male patient, which developed from gastric adenocarcinoma.

A Case of Pigmented Fungiform Papillae of the Tongue / 대한피부과학회지

The fungiform papillae are generally described as being pink or red in colour. Pigmented fungiform papillae of the tongue (PFPT) are characterized clinically by pigmentation confined to these papillae and histopathologically by melanophages in the lamina propriae. PFPT appears to be relatively common among the black population, whereas this entity has rarely been reported in Asians. We report a case of PFPT in a 35-year-old Korean woman who had black dots, exclusively involved with fungiform papillae, on the anterior dorsolateral side of the tongue. The patient also had iron deficiency anemia. Histopathologic findings revealed an increase of melanophages in the upper dermis within the fungiform papillae.

A Case of Norwegian Scabies in a Patient with Down's Syndrome / 대한피부과학회지

Norwegian, or crusted scabies, is a fulminant and highly infectious form of scabies in which a large number of Sarcoptes scabiei mites infest the epidermis. This is often seen in senile or mentally retarded patients with poor cutaneous sensation, in subjects with severe systemic disease, or immunosuppressed patients. This form of scabies differs from ordinary scabies due to the hyperkeratotic, scaly, and crusted aspect of the lesions. We report a case of Norwegian scabies in 14-year-old boy with Down's syndrome. It is the first reported case in Korea.

Wound Healing Effect of Silatranes on Experimental Rat Ulcers: Comparison with Tretinoin Tocoferil and Centella Asiatica Extract / 대한피부과학회지

BACKGROUND: As silicon compounds including silatranes are known to be able to stimulate regeneration of collagen, many studies on the influence of silatranes on the process of wound healing have been conducted. OBJECTIVE: The purpose of this study was to compare the effects of two new silatrane compounds (silatrane I, 1-vinylsilatrane; silatrane VII, 1-alkylsilatrane), tretinoin tocoferil (TT), and Centella asiatica extract (CAE) on the wound healing of experimental rat ulcers. METHOD: Twenty four male rats (weighing about 250-300g) were used in this study. Two full-thickness excised wounds were created on the back of each rat under anesthesia, and they were divided into the following eight groups (each group had 3 rats), according to the treatment modalities; Group 1: treated with silatrane I on the left ulcer and TT on the right ulcer; Group 2: treated with silatrane I on the left and CAE on the right; Group 3: treated with silatrane VII on the left and TT on the right; Group 4: treated with silatrane VII on the left and CAE on the right; Group 5: treated with silatrane I on the left and ointment base (control) on the right ; Group 6: treated with silatrane VII on the left and ointment base on the right ; Group 7: treated with TT on the left and ointment base on the right ; Group 8: treated with CAE on the left and ointment base on the right. Wound surface areas were measured daily and three parameters were compared; the percentage of wound contraction, speed of healing and complete healing time. RESULTS: The percentage of wound contraction in the two silatrane compounds and TT treated groups at the 7th day was greater than that of the control group. However, the ulcers treated with CAE did not show any statistically significant difference, as compared to the control. The speed of healing in the first 7 days for the two silatranes and TT treated groups was faster than that of the control group. But, the ulcers treated with CAE did not show any statistically significant difference, as compared to the control group. The woourds took less time to completely heal in the silatrane VII and TT treated groups than in the control. Nevertheless, the ulcers treated with the silatrane I and CAE did not show any statistically significant difference, as compared to the control. CONCLUSION: The Two silatrane compounds are as effective as TT in the treatment of rat skin ulcers.

Efficacy of Prophylactic Antibiotics in Dermatological Punch biopsy / 대한피부과학회지

BACKGROUND: Punch biopsy has been used frequently as a diagnostic method in dermatologic field. However dermatologist administrated antibiotics is routine for the prevention of wound infection. OBJECTIVE: The purpose of this study was to evaluate the efficacy of prophylactic antibiotics in punch biopsy. METHODS: Four hundred and one patients undergoing punch biopsy were studied prospectively. Patients were randomly split in to two groups: group I received prophylactic antibiotics after punch biopsy (197 patients), group II didn't receive any antibiotic after punch biopsy (204 patients). Wound infection was defined as a condition of erythema, edema, and pain or purulent discharge. RESULTS: Patients demographics and skin disease were similar between two groups. Biopsy site were infected in 3 patients of group I and 5 patients of groups II. Staphylococcus aureus, Staphylococcus epidermidis and Bacteroides fragilis were isolated from the infected biopsy site. There was no significant difference of infection rate between two groups. CONCLUSION: This result suggests that the routine use of prophylactic antibiotics after skin punch biopsy is unnecessary.

A Case of Herpes Zoster Duplex Bilateralis / 대한피부과학회지

Herpes zoster classically occurs unilaterally within the area of skin innervated by a single sensory ganglion. Simultaneous involvement of two noncontiguous dermatomes is very rare and it has been referred to as zoster duplex unilateralis or bilateralis, depending whether one or both halves of the body are involved. A 47-year-old woman presented with painful grouped vesicles on the right chest and the left lower back. The tzanck smear and the skin biopsy were consistent with herpetic infection. She was treated with intavenous acyclovir without any significant complications. We report a rare case of zoster duplex bilateralis.

A Case of Nicolau Syndrome Due to Diclofenac Sodium / 대한피부과학회지

Nicolau syndrome is defined as local cutaneous and sometimes muscular necrosis observed at the injection site of intramuscular preparations. It is characterized by severe pain immediately after the injection and variable degrees of skin necrosis. The only treatment is conservative. A 46-year-old man presented with painful skin necrosis on his buttock after the injection of diclofenac sodium. Histopathologic examination showed necrosis of the epidermis and upper 2/3 of the dermis. The lesion was treated conservatively with topical antibiotic ointment. We report a rare case of Nicolau syndrome due to diclofenac sodium.

A Case of Multiple Lentigines Sydrome with a Family History of Multiple Lentigines / 대한피부과학회지

Multiple lentigines syndrome is an autosomal dominant disorder of variable penetrance and expressivity. LEOPARD has been used to describe the main features of the syndrome, including lentigines, electrocardiographic abnormalities, ocular hypertelorism, pulmonary stenosis, abnormalities of genitalia, retardation of growth and deafness. We describe a case of multiple lentigines syndrome with a family history of multiple lentigines. A 15-year-old boy presented with multiple brown macules and patches on the whole body, which had developed since the age of 3. He also had hypertrophic cardiomyopathy, EKG abnormalities and retarded growth. His maternal grandfather, maternal uncle and mother also presented with multiple brown macules scattered over the body. The biopsy specimen taken from the macule revealed elongated rete ridges, increased melanin deposition and increased number of melanocytes.

A Case of Subungual Exostosis of the Finger / 대한피부과학회지

Subungual exostosis is a benign osteochondral tumor usually involving the distal phalanx of the great toe. It rarely occurs on other toes or the fingers. We report a case of a 26-year-old male who presented with a growing painful nodule on his right 4th finger. Diagnosis was confirmed by radiologic and histopathologic studies, followed by complete excision of the lesion. At the 13-month follow-up, there was no sign of recurrence. We think that subungual exostosis should be considered in the differential diagnosis of any digital mass.

Therapeutic Effect of Silatranes on Mouse Skin Ulcers / 대한피부과학회지

BACKGROUND: Silicon compounds, especially silatranes, are known to stimulate the regeneration of connective tissue, especially collagen. This has led to a great deal of research on the effects that new silatranes have on wound healing. OBJECTIVE: The purpose of this study is to compare efficacies of new silatrane ointments, an ointment-base (vaseline-lanoline), and a mupirocin ointment (Bactroban(R)) on ulcer healing. METHODS: Two groups of mice, composed of 10 mice each, were included in this study. Three ulcers were made on the back of each mouse and ointments were applied twice daily. For each mouse of Group I, silatrane ointment (-vinyl) was applied to the first ulcer, the ointment-base (vaseline-lanoline) to the second, and the mupirocin ointment (Bactroban(R)) to the third. Ointments were applied to the mouse of Group II in the same manner using silatranes ointment (-allyl), the ointment-base, and the mupirocin ointment. We compared the time it took for each ulcer to heal, the percent change over time of the wound area from baseline (as a reduction of percentage area), and mean healing rate. RESULTS: The results are as follows: 1. Two silatrane ointments (-vinyl, -allyl) brought about a faster healing time than either the ointment-base or the mupirocin ointment did. 2. Two silatrane ointments led to a greater reduction in the percentage area from baseline over time than the ointment-base and the mupirocin ointment. 3. Two silatrane ointments provided better results in terms of total area healed per day during the first 7 days than the ointment-base and mupirocin ointment did. CONCLUSION: Two Silatrane ointments (-vinyl, -allyl) are effective in the treatment of mouse skin ulcers.

A Case of Ant Sting by Crematogaster Matsumurai Vagala

Reactions from stinging insects are significant to dermatologists because of the wide variety of clinical presentations from mild local reaction to severe anaphylactic reaction. Although ant sting commonly occurs, it has been rarely reported in the literatures. We experienced a unique case with allergic reactions by the ant of the Cremawgaster iw6w urai vagala, subfamily Myrmicinae, family Formicidea, order Hymenoptera that has not been previously reported.

A Case of Multiple Myeloma First Presenting as Cutaneous Plasmacytoma / 대한피부과학회지

Cutaneous extramedullary plasmacytomas are rare in patients with multiple myeloma, they usually indicate a large tumor cell burden and fatal outcome. A 55-year-old man presented with multiple cutaneous tender nodules or masses on whole body. A biopsy specimen of cutaneous nodule showed dermal infiltration by well differentiated plasma cells. Many atypical and immature plasma cells were found in a bone marrow smear and biopsy. A serum protein electrophoresis revealed elevated quantities of Ig G-globulin with type lambda light chain. The patient was treated with VAD(vincristine, adriamycin, dexamethasone) chemotherapy, but died with pulmonary edema and acute respiratory distress syndrome. We report a fatal case of multiple myeloma first presenting as multiple extramedullary cutaneous plasmacytomas.

Epidemiological Characteristics of Measles Outbreakin 2000~2001, Korea / 감염

BACKGROUND: In 2000~2001 there was a nationwide outbreak of measles in the Republic of Korea. Since supplementary vaccination program was implemented in 2001, the control strategy of this measles outbreak has been stepped up from the control phase to the elimination phase. We here present the result of survey for the epidemiologic characteristics of the nationwide outbreak of measles in 2000~2001. METHODS: Using the data based on the sheet of epidemiologic investigation, incidences rates per 100,000 population and distributions of cases with vaccination history were investigated by the age. The seasonal or regional distribution were also studied with the onset days of cases. RESULTS: In 2000~2001, a measles outbreak occurred with 52,897 reported cases. The incidence rate per 100,000 population of measles was 111.9 cases and that of geopolitical unit (province) was high nationwide, 35.9~386.3 cases. The incidence rates were very high in less than 12 months and 10 years of age, 954.4 and 714.9, respectively. The 1st vaccination rate of measles/mumps/rubella (MMR) in 1~3 years old was 26.3~77.1%, and especially, that of 1 year old showed very low coverage, 26.3%. However, there was no special propensity in the 1st vaccine coverage in the age of 7~15 years, which had 87.7~91.4%. On the other hand, the 2nd MMR vaccination rate of the cases was very low, 17.7% at the age of 7~10 years. From the 21st May, 2001 a mass catch-up campaign with measles/rubella (MR) vaccine was launched, resulting in prominent reduction in the incidence of measles case. CONCLUSION: This survey showed that the measles outbreak in 2000~2001 had a high incidence nationwide from October 2000 to April 2001 and in less than 12 month and 10 years of age. Our results also showed that no routine immunization made the age group under 1 year vulnerable to measles infection. In cases of school-age group after 7 years of age, some cases with vaccination history were also infected. The characteristics of recent outbreaks indicates the need for the introduction of a specific vaccination programme at that age group. This survey was helpful to establish the effective vaccination strategy and it would be used as reference data on survey continuously for the epidemiologic characteristics of measles case for elimination of indigenous measles transmission in Republic of Korea.

Primary Cutaneous Aspergillosis Complicating the Grafted Skin after Burn / 대한피부과학회지

A 60-year-old healthy man was consulted with dark brown eschars and purulent discharges on the grafted skin of a burn scar on the posterior aspect of both lower extremities which had developed two weeks after the skin graft. Aspergillus fumigatus was isolated by repeated fungal cultures from pus and tissue pieces. Also septate hyphae branching at an acute angle are seen in the dermis in PAS-stained section. After two weeks therapy with fluconazole and itraconazole, the patient accepted skin graft again. The skin lesion was improved after prophylactic itraconazole treatment for three weeks.

Multiple Pilomatricomas Associated with Myotonic Muscular Dystrophy in Brother and Sister / 대한피부과학회지

Pilomatricoma is a tumor with differentiation toward hair cortex cells. There have been a few cases of multiple familial pilomatricomas in association with myotonic muscular dystrophy. We report two members of the family(brother and sister) with association of multiple pilomatricomas and myotonic muscular dystrophy. Multiple familial pilomatricomas may be a cutaneous manifestation of the myotonic syndrome.