Usefulness of serial measurement of the mean platelet volume to predict multipleorgan dysfunction syndrome in patients with severe trauma

Objective@#The early prediction of multiple organ dysfunction syndrome (MODS) in trauma patients and provision ofprompt treatment may improve their outcomes. We investigated the efficacy of the mean platelet volume (MPV) for predictingMODS in cases of severe trauma. @*Methods@#This retrospective, observational cohort study was performed with patients prospectively integrated in a criticalpathway of TRAUMA. We analyzed the severe trauma patients admitted to the emergency department (ED), based onthe Advanced Trauma Life Support guideline, between January 1, 2011 and May 31, 2017. The outcomes were developedfrom MODS at least 48 hours after ED admission. @*Results@#A total of 348 patients were enrolled. An increase in the MPV at 12 hours (odds ratio [OR], 2.611; P8.6 fL (OR, 4.831; P<0.001). The area under the receiver operating characteristic curve(AUROC) value of the MPV at 12 hours (0.751; 95% confidence interval [CI], 0.687-0.818; P<0.01) was not inferior thanthat of Acute Physiology and Chronic Health Evaluation II score, injury severity score, lactate, and total CO2 for predictingMODS. @*Conclusion@#MPV was an independent predictor of MODS development in severe trauma patients. Emergency physicianscan use the MPV as an ancillary biomarker for predicting MODS.

The usefulness of lactate as an early predictor of the severity of emergency department patients with postpartum hemorrhage

OBJECTIVE: Only a few studies have examined the role of lactate reflecting on tissue hypoperfusion determining the severity of postpartum hemorrhage (PPH) patients in the emergency department (ED). This study evaluated the utility of the arterial lactate level as a prognostic marker of severity in PPH patients admitted to an ED. METHODS: This retrospective, observational cohort study was conducted on patients integrated prospectively in a critical pathway of SPEED (Severance Protocol to save postpartum bleeding through Expeditious care Delivery). Adult primary PPH patients admitted to the ED between July 1, 2010 and March 31, 2017 were analyzed. The outcomes were the development of severe PPH including death, hysterectomy, surgical treatment, and massive transfusion. RESULTS: A total of 112 patients were enrolled in this study. An increase in the arterial lactate value was a strong independent predictor of severe PPH. The increasing predictability of severe PPH was closely associated with an arterial lactate ≥3.15 mL/L at admission (odds ratio, 13.870; P < 0.001). CONCLUSION: Lactate is an independent predictor of severe PPH and is suitable for a rapid and simple estimation of the severity of PPH. Emergency physicians can use lactate to determine the initial treatment strategies more precisely.

Neonatal Erythema Multiforme: A Case Report

Erythema multiforme (EM) is an extremely rare condition in infancy. To the best of our knowledge, there have been only three cases of neonatal EM described in the literature, and no such cases have been reported in Korea. A preterm neonate born at 35 weeks and six days of gestation presented with multiple annular erythematous patches with a targetoid shape over his entire body at 36 days of age (corrected age of 7 days). He had no systemic symptoms except for transient mild fever. No triggering factor except for hepatitis B and BCG vaccination was found. Neutropenia was noted upon laboratory analysis. Skin biopsy specimens showed findings suggestive of erythema multiforme. The skin lesions improved rapidly upon administration of intravenous methylprednisolone; however, neutropenia continued for a much longer period. The significance of neutropenia with respect to the development of EM was not clarified. There has been no recurrence of skin lesions over a one-year follow-up period.

Treatment of Extramammary Paget's Disease with Topical Imiquimod / 대한피부과학회지

BACKGROUND: Extramammary Paget's disease (EMPD) is an intraepidermal adenocarcinoma which usually affects elderly individuals. Due to its multifocal nature and indistinct demarcation from normal skin, recurrences are common, even after invasive surgical treatment. Topical application of imiquimod, an immune response modifier, has been reported to be effective in the treatment of not only anogenital warts, but also cutaneous malignancies such as actinic keratoses and basal cell carcinoma. There are only a few case reports on the treatment of EMPD with topical imiquimod in the literature. OBJECTIVE: The purpose of this study was to evaluate the effectiveness of topical imiquimod for the treatment of EMPD. METHODS: Seven elderly patients (6 male and 1 female), whose ages ranged from 60 to 81 years (average, 68.4 years), were diagnosed with anogenital EMPD, which were further confirmed by skin biopsy. None of the patients were found to have associated internal neoplasms. Considering the patients' ages and morbidity associated with invasive treatment options, they were instructed to topically apply 5% imiquimod cream on their skin lesions once to three times a week. Imiquimod was applied for an average of 29.5 weeks. The patients were followed up on a monthly or bimonthly basis for any adverse affects or changes to the lesions. Residual lesions were surgically excised in 2 patients after 5 and 8 months of imiquimod application. RESULTS: With long-term imiquimod application, all 7 subjects experienced transient irritation, erythema, focal erosion, or hypopigmentation of the application site. One patient experienced flu-like symptoms. Clinical cure was observed in all 7 patients during treatment, and/or early observation period. However, a pathologic cure was observed in 2 patients only. The lesions recurred in 3 patients during the follow-up period. CONCLUSION: Since imiquimod has strong advantages in the preservation of function and cosmetics, it could be an effective primary treatment option for primary limited cutaneous EMPD, especially in elderly patients.

Dermatosis in Human Immunodeficiency Virus Infected Patients in Korea / 대한피부과학회지

BACKGROUND: The number of patients infected with human immunodeficiency virus (HIV) in Korea has increased steadily. Cutaneous disorders are common during the course of HIV disease as a result of the acquired immunodeficiency or are related to treatment. However, there have only been a few studies on cutaneous disease in HIV infected patients in Korea. OBJECTIVE: The aim of the study was to investigate the characteristics of cutaneous disease in HIV infected patients in Korea. METHODS: We surveyed questionnaires answered by 35 human immunodeficiency virus (HIV) infected patients. Clinical data was also collected through physical examination by a dermatologist and, if available, medical records were reviewed. RESULTS: The most frequent and persistent cutaneous disease in HIV infected patients in Korea was seborrheic dermatitis. Oral candidiasis, folliculitis, condyloma accuminata, and syphilis were also common. About 30% of patients who received antiretroviral treatment complained of adverse drug effects related to antiretroviral treatment. There was a positive correlation between the duration of HIV infection and the frequency of cutaneous disorders. CONCLUSION: We found that HIV infected patients want to have more information on cutaneous disorders associated with HIV infection. The patient education should be focused on seborrheic dermatitis, oral candidiasis, folliculitis, condyloma acuminata, syphilis, and the adverse drug effects associated with antiretroviral treatment.

A Case of Subcutaneous Fat Necrosis of Newborn (SCFNN) Associated with Meconium Aspiration Syndrome / 대한피부과학회지

Subcutaneous fat necrosis of newborn (SCFNN) is a rare disease. Characteristically, full-term infants with associated perinatal problems such as hypoxia, hypothermia, and obstetric trauma are affected in the first week of life. We report a case of SCFNN, which presented as an erythematous subcutaneous mass on the back of a male neonate who suffered from meconium aspiration pneumonia with neonatal sepsis.

Study of the Photoinactivation Effect on Propionibacterium acnes after Light Irradiation with Variable Wavelengths / 대한피부과학회지

BACKGROUND: Phototherapy has been studied as an alternative option for the treatment of acne. Propionibacterium (P.) acnes produces endogenous porphyrins as a by-product of metabolism. Light of particular wavelengths activates the porphyrins and induces a photodynamic reaction which subsequently kills the P. acnes. OBJECTIVE: The purpose of this study was to evaluate and analyze the photoinactivation efficacy of different wavelengths against P. acnes in vitro. METHODS: Using an LED lamps to emit light of variable wavelengths (370 nm, 385 nm, 395 nm, 405 nm, 470 nm, 505 nm, 590 nm, 630 nm and 880 nm), we examined the change of P. acnes colonies on agar plates after irradiation for 1, 3, 6 and 12 hours. Further investigations were also performed by irradiation on liquid medium, once, twice or three times consecutively, with an interval of 24 hours. RESULTS: Light irradiation of wavelengths 385 nm, 395 nm, 405 nm and 470 nm, was found to decrease the number of P. acnes colonies on agar plates by about 50%. In liquid medium, we observed the photoinactivation effect of light irradiation on P. acnes with the wavelengths 370 nm, 385 nm, 395 nm, 405 nm and 470 nm. However, we observed no photoinactivation effect on P. acnes with the wavelengths 505 nm, 590 nm, 630 nm or 880 nm. CONCLUSION: By in vitro testing, we have demonstrated that light irradiation of wavelengths up to a maximum of 470 nm are effective in decreasing P. acnes and therefore may be a good alternative treatment modality for acne.

Analytic Study of the Patients Registered at Seoul National University Hospital Acne Clinic / 대한피부과학회지

BACKGROUND: Acne is a common skin disorder which affects both adolescents and adults. However, there have been few Korean epidemiological studies conducted. OBJECTIVE: The purpose of this study was to analyze the prevalence, demographic factors, clinical features and aggravating factors of acne. We also investigated the relationship of these factors. METHODS: Epidemiological and clinical data was obtained by interviewing 657 acne patients, newly enrolled at Seoul National University Hospital Acne Clinic between 1996 and 2004. RESULTS: Most patients were found to have facial acne, and the forehead and cheeks were the most common sites where acne first developed. Males tended to visit the hospital because of social problems compared to females. We identified some significant correlations with sex, age of onset, disease duration, first affected site, seborrhea, and family history. Acne lesions developed earlier and disease duration was longer in the group with a family history of acne or severe seborrhea. More than 80% of patients were found to have subjective symptoms, including pain and itching which were most frequent. The degree of seborrhea was higher and the aggravation after sun exposure was more frequent in the group where complete remission of acne had not been achieved. Aggravation of acne was most frequent in summer, followed by winter. CONCLUSION: We could investigate the epidemiological and clinical features of acne patients, including the age of onset, motive of treatment, subjective symptoms, plus outcome of treatment according to remission history of acne, as these factors have never been reported in the Korean literature before.

A Case of a Bitemporal Atrophic Scar induced by Morphea, and treated by Autologous Fat Transplantation / 대한피부과학회지

A contour change induced by a subcutaneous depleting disorder such as lupus or morphea can be corrected by filling the defect with an artificial or natural materials of the types of fillers, autologous fat is popularly utilized for volumetric correction. Autologus fat has many advantages, such as easy harvesting, free volume, and non-immunogenicity. Herein, we report a case who of a bilateral atrophic scar on the temple area induced by morphea which was successfully treated by autologous fat transplantation.

Effects of Ascorbic Acid on Keratinocyte and Epidermalization of Skin

BACKGROUND: There are different models of skin substitutes, but no skin substitutes have the characteristics of native skin. It was reported that the incubation of skin substitutes in medium containing ascorbic acid extends cellular viability and promotes formation of an epidermal barrier in vitro. OBJECTIVE: The purpose of this study is to observe the effects of ascorbic acid on the proliferation of keratinocytes and on the reconstruction of epidermis. MATERIALS AND METHODS: Normal human keratinocytes and fibroblasts were isolated and used for culturing living skin equivalent (LSE). RESULTS: When ascorbic acid was added, the expression of p63 and a6 integrin was definitely increased compared to control models. In addition, ascorbic acid increased the proliferation of normal human keratinocytes at a dose dependent manner. Especially, ascorbic acid induced the phosphorylation of ERK and up-regulation of EGF-R CONCLUSION: Results suggest that ascorbic acid is essential in the control of keratinocyte proliferation and basement membrane formation. Ascorbic acid-related keratinocytes proliferation is seemed to be mediated by ERK phosphorylation and EGF-R up-regulation.

Clinical and radiological observation of the lower urinary tract injury

A clinical and radiological obsevation was made on 62 cases of urinary tract injury in the Dept. of urology,Chosun Universtiy hospital during the period from January 1979 to December 1983. The results were as follows; 1.Age distribution of the lower urinary tract injury was the highest in the age 41 to 50(39.6%). The sex ratio, maleto female was 6.8:1. 2. The most common cause of the L.U.T.I. was traffic accident in 23 cases (37.1%) and othersare fall down in 15 cases (24.2%), blunt trauma in 13 cases (21.0%), saddle injury in 8 cases(12.9%). 3. Theradiological finding of the bladder injury shows intraperitoneal extravasation in 11 caess(64.7%), extraperitonealextravasation in 5 cases(29.4%), and deformity of bladder in 12 cases(70.6%). 4. The radiological finding of theurethral injury shows extravasation of contrast media in 44 cases(97.8%). venous intravasation in 11 cases(24.4%),penile urethra in 1 case(2.3%). 6. The L.U.T.I. was associated with pelvic bone fracture in 33 cases (53.2%) esp.pubic bone fracture in 24 cases(38.7%). 7. The complication of the L.U.T.I. was urethral stricture in 24cases(38.7%), fistula formation in 3 cases(4.8%), incontinence in 2 cases(3.2%).