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Background@#The etiology and pathogenesis of lichen planus (LP) are not fully understood. Several studies have reported varying prevalence of anti-hepatitis C virus antibody (anti-HCV Ab) in LP. The relationship between LP and HCV infection remains controversial. @*Objective@#To investigate the relationship between LP and HCV infection in Busan and Gyeongnam, Korea. @*Methods@#We reviewed the medical records of 84 outpatients with LP and 84 control subjects (age- and sex-matched) from 2000 to 2020. Data on age, sex, duration of disease, distribution, shape, systemic diseases, and serology of anti-HCV Ab were collected. @*Results@#The prevalence of anti-HCV Ab was 1.2% and 9.5% in the control group and patients with LP, respectively. Compared with the control group, patients with LP had a higher risk of HCV infection with an odds ratio of 8.737 (p=0.034). The mean duration of disease for the eight patients with HCV-associated LP was 5.8 months, which was shorter than 15.8 months in 84 patients with LP alone. Mucosal erosive LP was observed most frequently in HCV-associated LP with an odds ratio of 9.273 (p=0.003). @*Conclusion@#HCV infection may be clinically relevant to the development of LP. Furthermore, HCV infection may accelerate the progression of LP and is possibly related to the mucosal erosive subtype. Therefore, dermatologists should perform an anti-HCV Ab screening test for patients with LP, disclosing the potential association between LP and HCV infection.
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Background@#The etiology and pathogenesis of lichen planus (LP) are not fully understood. Several studies have reported varying prevalence of anti-hepatitis C virus antibody (anti-HCV Ab) in LP. The relationship between LP and HCV infection remains controversial. @*Objective@#To investigate the relationship between LP and HCV infection in Busan and Gyeongnam, Korea. @*Methods@#We reviewed the medical records of 84 outpatients with LP and 84 control subjects (age- and sex-matched) from 2000 to 2020. Data on age, sex, duration of disease, distribution, shape, systemic diseases, and serology of anti-HCV Ab were collected. @*Results@#The prevalence of anti-HCV Ab was 1.2% and 9.5% in the control group and patients with LP, respectively. Compared with the control group, patients with LP had a higher risk of HCV infection with an odds ratio of 8.737 (p=0.034). The mean duration of disease for the eight patients with HCV-associated LP was 5.8 months, which was shorter than 15.8 months in 84 patients with LP alone. Mucosal erosive LP was observed most frequently in HCV-associated LP with an odds ratio of 9.273 (p=0.003). @*Conclusion@#HCV infection may be clinically relevant to the development of LP. Furthermore, HCV infection may accelerate the progression of LP and is possibly related to the mucosal erosive subtype. Therefore, dermatologists should perform an anti-HCV Ab screening test for patients with LP, disclosing the potential association between LP and HCV infection.
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Laparoscopic sleeve gastrectomy has become a standard procedure in bariatric surgery owing to its efficacy and simplicity. However, this procedure can cause life-threatening complications such as a gastric staple-line leak. A 24-year-old woman was transferred to the emergency department for evaluation of epigastric pain. Nine days prior to transfer, she underwent laparoscopic sleeve gastrectomy at another institution. Abdominal computed tomography (CT) revealed fluid collection with air density along the left subphrenic space and gastrosplenic ligament area. Intravenous antibiotics and total parenteral nutrition were initiated. She underwent percutaneous catheter drainage. On postoperative day 18, an esophagogastroduodenoscopy was performed to assess the site and size of the leak, and revealed a leak at the proximal staple line just below the gastroesophageal junction. A newly designed, fully covered antimigratory esophageal stent was placed to cover the leak from the distal esophagus to gastric midbody. Follow-up abdominal CT demonstrated improvement of the fluid collection at the location of the previous gastric leak. The stent was removed 3 weeks after insertion, and a barium study confirmed no more leakage. In this case, we experienced that the newly designed esophageal stent was safe and effective for preventing migration in the management of leak after laparoscopic sleeve gastrectomy.
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Feminino , Humanos , Adulto Jovem , Fístula Anastomótica , Antibacterianos , Cirurgia Bariátrica , Bário , Catéteres , Drenagem , Serviço Hospitalar de Emergência , Endoscopia do Sistema Digestório , Junção Esofagogástrica , Esôfago , Seguimentos , Gastrectomia , Ligamentos , Obesidade , Nutrição Parenteral Total , Stents , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND/AIMS: Percutaneous endoscopic gastrostomy (PEG) is a widely used method for long-term tube feeding. This study aimed to investigate the clinical characteristics and outcomes of patients who utilized long-term feeding tube via PEG. METHODS: The medical records of 137 patients who underwent PEG tube insertion at Ewha Womans University Mokdong Hospital between January 2002 and December 2013 were reviewed. RESULTS: PEG was indicated most frequently for cerebrovascular accidents (66 patients, 48.2%), followed by head and neck cancer (20 patients, 14.6%), and Parkinson's disease (10 patients, 7.3%). The tubes were endoscopically inserted in 133 patients (97.1%); 4 patients (2.9%) underwent radiologic intervention. The tubes of 90 patients (65.7%) were exchanged at least once during the follow-up period. At the first exchange, 71 patients (78.9%) had their tubes exchanged by endoscopy, 24 patients (16.7%) by manually, and 4 patients (4.4%) by radiologic intervention. Of the 61 patients (44.5%) who had their tubes exchanged twice, 44 patients (72.1%) changed their tubes by endoscopic exchange, 13 patients (21.3%) by manually, and 4 patients (4.4%) via radiologic intervention. The mean time interval between the initial insertion and the first exchange was 9.83±6.19 months, and that between the initial insertion and the second exchange was 10.7±6.25 months. Of all the 137 patients, acute complications at initial insertion occurred in only 18 patients (13.1%), with insertion site infection (9 patients, 6.6%) being the most common acute complication. CONCLUSIONS: PEG appears to be a safe procedure for providing long-term tube feeding. Our results may help to develop strategies for further management of subjects receiving feeding tubes via PEG.
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Feminino , Humanos , Endoscopia , Nutrição Enteral , Seguimentos , Gastrostomia , Neoplasias de Cabeça e Pescoço , Prontuários Médicos , Métodos , Estudo Observacional , Doença de Parkinson , Acidente Vascular CerebralRESUMO
BACKGROUND/AIMS: Appropriate sedation during endoscopy can significantly reduce the discomfort experienced by a patient when the procedure is performed; however, it is associated with several potential risks. Very few reports describe sedation-related adverse events occurring during endoscopy. Our study evaluated the current status of sedation-related adverse events during a diagnostic upper endoscopy. MATERIALS AND METHODS: We reviewed medical records of 5,564 cases of diagnostic upper endoscopy performed using midazolam for sedation at the Ewha Womans University, Mokdong Hospital, between January 2015 and March 2016. RESULTS: Among the 5,564 cases, sedation-related adverse events were reported in 56 cases (1.0%). Among these 56 patients, 30 patients (53.6.%) were men and 26 patients (46.4%) were women. Mean age of the patients was 63.7±15.4 years. The most common adverse event reported was hypoxia, which was observed in 37 patients (0.7%). Other adverse events included sedation failure (18 patients, 0.3%) and delayed discharge from the recovery room due to delayed recovery of consciousness (one patient, 0.02%). Among patients presenting with hypoxia, 35 patients recovered after administration of intravenous flumazenil and oxygen via nasal prongs. Administration of oxygen alone helped recovery in 2 patients. All patients recovered uneventfully with no mortalities registered. CONCLUSIONS: Our study showed that the use of sedative midazolam is relatively safe during an upper endoscopy. The rate of occurrence of adverse events was very low, and no fatal adverse events were observed. However, close observation and continuous monitoring is an essential component of safe sedation during endoscopy.
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Feminino , Humanos , Masculino , Hipóxia , Sedação Consciente , Estado de Consciência , Endoscopia , Flumazenil , Prontuários Médicos , Midazolam , Mortalidade , Oxigênio , Sala de RecuperaçãoRESUMO
Degos disease, also referred to as malignant atrophic papulosis, was first described in 1941 by Köhlmeier and was independently described by Degos in 1942. Degos disease is characterized by diffuse, papular skin eruptions with porcelain-white centers and slightly raised erythematous telangiectatic rims associated with bowel infarction. Although the etiology of Degos disease is unknown, autoimmune diseases, coagulation disorders, and vasculitis have all been considered as underlying pathogenic mechanisms. Approximately 15% of Degos disease have a benign course limited to the skin and no history of gastrointestinal or central nervous system (CNS) involvement. A 29-year-old female with history of systemic lupus erythematosus (SLE) presented with a 2-year history of asymptomatic lesions on the dorsum of all fingers and both knees. The patient had only skin lesions and no gastrointestinal or CNS vasculitis symptoms. Her skin lesions were umbilicated, atrophic porcelain-white lesions with a rim of erythema. On the basis of clinical, histologic, and laboratory findings, a diagnosis of Degos-like lesions associated with SLE was made. The patient had been treated for SLE for 7 years. Her treatment regimen was maintained over a 2 month follow-up period, and the skin lesions improved slightly with no development of new lesions.
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Adulto , Feminino , Humanos , Doenças Autoimunes , Sistema Nervoso Central , Diagnóstico , Eritema , Dedos , Seguimentos , Infarto , Joelho , Lúpus Eritematoso Sistêmico , Papulose Atrófica Maligna , Pele , Vasculite , Vasculite do Sistema Nervoso CentralRESUMO
BACKGROUND/AIMS: Mesenchymal stem cells (MSCs) are multipotent progenitor cells currently under investigation for its efficacy as the treatment for inflammatory bowel disease. In this study, we evaluated the efficacy of tonsil-derived mesenchymal stem cells (T-MSCs) as a novel source of mesenchymal stem cells and traced their localization in a murine model of acute colitis induced by dextran sulfate sodium (DSS). METHODS: C57BL/6 mice were randomly assigned to the following three groups: the normal control group, DSS colitis group (DSS+phosphate buffered saline), and T-MSC group (DSS+T-MSCs, 1×106). The severity of colitis was assessed by determining the severity of symptoms of colitis, colon length, histopathologic grade, and levels of inflammatory cytokines. T-MSCs labeled with PKH26 were traced in vivo. RESULTS: The T-MSC group, compared with the DSS colitis group, showed a significantly lower disease activity index (11.3±1.5 vs. 8.3±1.9, p=0.015) at sacrifice and less reduction of body weight (-17.1±5.0% vs. -8.1±6.9%, p=0.049). In the T-MSC group, the histologic colitis score was significantly decreased compared with the DSS colitis group (22.6±3.8 vs. 17.0±3.4, p=0.039). IL-6 and IL-1β, the pro-inflammatory cytokines, were also significantly reduced after a treatment with T-MSCs. In vivo tracking revealed no PKH26-labelled T-MSCs in the colonic tissue of mice with acute colitis. CONCLUSIONS: In the acute colitis model, we demonstrated that the administration of T-MSCs ameliorates inflammatory symptoms and histology. Moreover, the anti-inflammatory activities of T-MSCs were independent of gut homing.
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Animais , Camundongos , Peso Corporal , Colite , Colo , Citocinas , Sulfato de Dextrana , Dextranos , Doenças Inflamatórias Intestinais , Interleucina-6 , Células-Tronco Mesenquimais , Tonsila Palatina , Células-TroncoRESUMO
BACKGROUND: An epidermal cyst is a common keratin-filled epithelial-lined cyst. The treatment of choice for epidermal cysts is surgical excision. If the cyst becomes ruptured, incision and drainage with oral antibiotic therapy or intralesional steroid injection are required. OBJECTIVE: To analyze the dermoscopic features that can differentiate between ruptured and unruptured epidermal cysts. METHODS: The clinical and dermoscopic features of the pathologically confirmed epidermal cysts of two subgroups of 38 patients, 20 with unruptured cysts and 18 with ruptured cysts, were reviewed. RESULTS: With regard to the dermoscopic features, an ivory- white background color and punctum were commonly found in both groups (p>0.05). The unruptured-cyst group showed higher frequencies of pore sign (p0.05), no vascular structure, and arborizing telangiectasia (p0.05) and peripheral linear branched vessels (with an erythematous rim) (p<0.05). CONCLUSION: Dermoscopy is helpful in differentiating between ruptured and unruptured epidermal cysts.
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Humanos , Dermoscopia , Diagnóstico Diferencial , Drenagem , Cisto Epidérmico , TelangiectasiaRESUMO
BACKGROUND: An epidermal cyst is a common keratin-filled epithelial-lined cyst. The treatment of choice for epidermal cysts is surgical excision. If the cyst becomes ruptured, incision and drainage with oral antibiotic therapy or intralesional steroid injection are required. OBJECTIVE: To analyze the dermoscopic features that can differentiate between ruptured and unruptured epidermal cysts. METHODS: The clinical and dermoscopic features of the pathologically confirmed epidermal cysts of two subgroups of 38 patients, 20 with unruptured cysts and 18 with ruptured cysts, were reviewed. RESULTS: With regard to the dermoscopic features, an ivory- white background color and punctum were commonly found in both groups (p>0.05). The unruptured-cyst group showed higher frequencies of pore sign (p0.05), no vascular structure, and arborizing telangiectasia (p0.05) and peripheral linear branched vessels (with an erythematous rim) (p<0.05). CONCLUSION: Dermoscopy is helpful in differentiating between ruptured and unruptured epidermal cysts.
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Humanos , Dermoscopia , Diagnóstico Diferencial , Drenagem , Cisto Epidérmico , TelangiectasiaRESUMO
No abstract available.
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Humanos , Neoplasias da Mama , Mama , Doença Cardiopulmonar , Microangiopatias TrombóticasRESUMO
We report on a 64-year-old man with leptomeningeal metastasis (LM) from an epidermal growth factor receptor (EGFR)-mutated adenocarcinoma of the lung. He was treated with paclitaxel, cisplatin. After completion of chemotherapy, he complained of headache, nausea, and vomiting. EGFR-mutated tumor cells were identified from the cerebrospinal fluid (CSF). Second-line therapy with gefitinib, methotrexate was started. After receiving gefitinib for 4 weeks, he had no more headaches or vomiting. Eleven months after initiation of gefitinib, he developed headache and nausea. Chest computed tomography showed aggravation of bone metastasis. Third-line therapy was started with gemcitabine and carboplatin. Two weeks later, he experienced disorientation. After a fourth relapse within the central nervous system, the therapy was switched to erlotinib and significant improvement of LM was achieved. This case shows that LM can be diagnosed by detecting EGFR mutation in CSF and EGFR tyrosine kinase inhibitors are effective for LM from EGFR mutant non-small cell lung cancer.
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Humanos , Pessoa de Meia-Idade , Adenocarcinoma , Carboplatina , Carcinoma Pulmonar de Células não Pequenas , Sistema Nervoso Central , Líquido Cefalorraquidiano , Cisplatino , Tratamento Farmacológico , Fator de Crescimento Epidérmico , Cloridrato de Erlotinib , Cefaleia , Neoplasias Pulmonares , Pulmão , Metotrexato , Náusea , Metástase Neoplásica , Paclitaxel , Fosfotransferases , Proteínas Tirosina Quinases , Receptores ErbB , Recidiva , Tórax , VômitoRESUMO
No abstract available.
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Humanos , Falência Renal Crônica , Porfiria Cutânea Tardia , Porfirias , Diálise RenalRESUMO
No abstract available.
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Condiloma Acuminado , Dermoscopia , Diagnóstico Diferencial , Linfangioma , VulvaRESUMO
Spitz nevus is a benign melanocytic nevus, common in children or young adults, and it has histological features that are confused with those of malignant melanoma. Polypoid Spitz nevus is the benign counterpart of polypoid malignant melanoma. A 22-year-old woman presented with a solitary 1.5×1.5 cm-sized firm polypoid erythematous nodule on the left thigh. On dermoscopy, pink to yellowish lagoons intermingled by white fibrous septa were found but milky red globules or irregular linear vessels were not found. Therefore, melanoma almost could be ruled out cautiously. Histopathology showed symmetrical, well-circumscribed, polypoid architecture with predominant dermal nests of spindle cells. Immunohistochemically, the nevus cells were strongly positive for S-100 protein and negative for HMB-45. Thus, the diagnosis of polypoid Spitz nevus was made. Herein, we report a case of polypoid Spitz nevus that was differentiated from polypoid melanoma by histopathologic and dermoscopic findings.
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Criança , Feminino , Humanos , Adulto Jovem , Dermoscopia , Diagnóstico , Melanoma , Nevo , Nevo de Células Epitelioides e Fusiformes , Nevo Pigmentado , Proteínas S100 , Coxa da PernaRESUMO
Vinorelbine, a vinca alkaloid anticancer drug, is widely used to treat various cancers. Several dermatological side effects of vinorelbine, such as acral erythema, phlebitis, and severe extravasation reactions, have been reported. Vinorelbine is categorized as non-DNA binding vesicant that undergoes high metabolism and clearance, which limits the degree of tissue injury if extravasation occurs. A 73-year-old male presented with erythematous linear patches on his left wrist and a 51-year-old male presented with erythematous eroded patches and bullae on his right forearm. Histopathologic study showed interface changes with basal vacuolar degeneration and epidermal dysmaturation. Separation of the dermis from the epidermis was observed, as well as interstitial and perivascular inflammatory infiltrates in the dermis. Both patients were being treated with vinorelbine for lung cancer. Before the onset of the skin lesions, accidental intravenous extravasation of vinorelbine had occurred. Herein, we report two cases of chemotherapy induced drug reaction due to extravasation of vinorelbine.
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Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Citocromo P-450 CYP1A1 , Derme , Tratamento Farmacológico , Epiderme , Eritema , Antebraço , Neoplasias Pulmonares , Metabolismo , Flebite , Pele , Vinca , PunhoRESUMO
Portal biliopathy is defined as abnormalities in the extra- and intrahepatic ducts and gallbladder of patients with portal hypertension. This condition is associated with extrahepatic venous obstruction and dilatation of the venous plexus of the common bile duct, resulting in mural irregularities and compression of the biliary tree. Most patients with portal biliopathy remain asymptomatic, but approximately 10% of them advance to symptomatic abdominal pain, jaundice, and fever. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography are currently used as diagnostic tools because they are noninvasive and can be used to assess the regularity, length, and degree of bile duct narrowing. Management of portal biliopathy is aimed at biliary decompression and reducing the portal pressure. Portal biliopathy has rarely been reported in Korea. We present a symptomatic case of portal biliopathy that was complicated by cholangitis and successfully treated with biliary endoscopic procedures.
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Humanos , Masculino , Pessoa de Meia-Idade , Abdome/diagnóstico por imagem , Colangiopancreatografia Retrógrada Endoscópica , Colestase/diagnóstico , Hipertensão Portal/diagnóstico , Veia Porta , Stents , Tomografia Computadorizada por Raios XRESUMO
Eosinophilic pustular folliculitis (EPF) is an inflammatory disease characterized by pruritic follicular papulopustules of unknown etiology. EPF is clinically characterized by annular configurations on the face, trunk, and extremities. EPF rarely affects the palms and soles where hair follicles are absent. Histopathologically, a number of eosinophils infiltrate around and into hair follicles. A 44-year-old man visited us with pruritic plaques on the face, crusted patches and pustules on the both palms and soles. Histopathologic findings of the pustule on the palms and soles showed spongiosis and intraepidermal vesicular formations containing numerous eosinophils, with dermal perivascular infiltrates consisting of eosinophils and lymphocytes. Histopathologic findings of facial lesion showed dense eosinophils and lymphocytes around hair follicles. Another patient who 28-year-old man visited us with pruritic papules and pustules on the face, trunk, and soles. Histopathologic findings of the pustules on the sole and face were similar with those of the preceding patient. The diagnosis of EPF with palmoplantar involvement was made. The patients were treated with oral dapsone, resulting in a significant improvement in skin lesions. Herein we report two cases of EPF manifested on the face and palmoplantar areas.