Basic Therapeutic Approach for Patients with Plaque Psoriasis:Korean Expert Consensus Using the Modified Delphi Method

Background@#Currently, there is no consensus on the treatment of psoriasis in Korean patients. @*Objective@#This study aimed to establish a consensus on the basic therapeutic principles for Korean patients with plaque psoriasis. @*Methods@#Using the modified Delphi method, a steering committee proposed 53 statements for the first Delphi round, which covered five subjects: (1) the goal of treatment and evaluation of disease severity, (2) topical therapy, (3) phototherapy, (4) conventional systemic therapy, and (5) biologic therapy. The panel of dermatologists scored the level of agreement for each statement on a ten-point scale with scores ranging from 1 (strongly disagree) to 10 (strongly agree). After discussing the results of the first round, the committee reformulated 41 statements. Finally, consensus was defined as more than 70% of the second round scores being ≥7. @*Results@#The panel participants strongly agreed that the ideal treatment goals for Korean patients with plaque psoriasis should include complete skin clearance and high dermatological quality of life. A strong consensus was also reached on the use of topical agents for psoriasis of any severity, the consideration of phototherapy before biologics therapy, the conventional systemic agents for moderate-to-severe psoriasis, and the recommendation of biologic for retractable psoriasis to conventional systemic therapy and phototherapy. @*Conclusion@#This modified Delphi panel established an expert consensus on the therapeutic approach for Korean patients with plaque psoriasis. This consensus may improve the treatment outcomes for psoriasis in Korea.

Therapeutic Efficacy of Combination Therapy Using Oral Cyclosporine with a Dietary Supplement (Pantogar®) in Twenty-Nail Dystrophy

BACKGROUND: Twenty-nail dystrophy (TND) is an acquired idiopathic disease characterized by dull, thin, lusterless, and fragile nails with fissuring, small regular pits, and excessive longitudinal ridging. Although various treatment modalities have been performed in order to treat TND, the effects of these treatments are controversial. OBJECTIVE: To evaluate the effectiveness of oral cyclosporine in TND. METHODS: A total of 38 patients with TND were treated with combination therapy using oral cyclosporine with a pantothenic acid complex-based dietary supplement (Pantogar®; Merz Pharmaceuticals GmbH, Germany), whereas 44 patients were treated with the pantothenic acid complex-based dietary supplement alone. The therapeutic efficacy in each group was retrospectively evaluated using medical records and clinical photographs. RESULTS: The cyclosporine therapy group had significantly more patients whose improvement was rated as almost clear, marked, or moderate compared to the control group (p<0.001). While the mean CHATS (Color, Hyperkeratosis, Area, Thickness, Separation) score of the cyclosporine therapy group was decreased by 13.45 (from 30.95 to 17.5) after treatment, the mean CHATS score of the control group was only decreased by 8 (from 29.43 to 21.43, p<0.001). Moreover, greater Dermatology Life Quality Index changes after treatment were observed in the cyclosporine therapy group (p=0.085). CONCLUSION: Oral cyclosporine can be a valuable therapeutic option in patients with TND.

The Association between Taking Dietary Supplements and Healthy Habits among Korean Adults: Results from the Fifth Korea National Health and Nutritional Examination Survey (2010-2012) / 가정의학회지

BACKGROUND: Recently, the number of people interested in health in South Korea has increased, and the rate of dietary supplement use is rising. Researchers have hypothesized that the rate of practicing healthy habits is higher among those who use dietary supplements than those who do not. Therefore, this study aimed to discover the association between taking dietary supplements and practicing various healthy habits in the Korean, adult population. METHODS: The sample included 15,789 adults over 19 years old who participated in the fifth Korea National Health and Nutrition Examination Survey. The user group was defined as those taking dietary supplements for more than 2 weeks during the previous year or once during the past month. Measures for the seven healthy habits were based on those included in the Alameda study and were analyzed accounting for the complex sampling design. RESULTS: The rate of taking dietary supplements was significantly higher in women, middle aged participants, urban residents, those with a higher income, those with a higher education level, and nonsmokers as well as among women with a moderate subjective health status, women who limited their alcohol content, and women with dyslipidemia. In the adjusted analysis, the rate of performing three of the 'Alameda 7' habits-eating breakfast regularly, restricting snacking, and limiting drinking-was higher in the female dietary supplement user group than in the other groups. Women practiced more healthy habits and had a higher dietary supplement intake rate than men. CONCLUSION: We found that taking dietary supplements in Korean adults is highly associated with demographic and social factors. Taking dietary supplements had a relationship with dietary habits, and there was no significant association between dietary supplement and other healthy habits. Thus in the health clinic, we suggest that taking dietary supplements complements a patient's healthy habits, with the exception of dietary habits, for health promotion.

Simultaneous Endovascular Treatment of Ruptured Cerebral Aneurysms and Vasospasm

OBJECTIVE: The management of patients with ruptured cerebral aneurysms and severe vasospasm is subject to considerable controversy. We intended to describe herein an endovascular technique for the simultaneous treatment of aneurysms and vasospasm. MATERIALS AND METHODS: A series of 11 patients undergoing simultaneous endovascular treatment of ruptured aneurysms and vasospasm were reviewed. After placement of a guiding catheter within the proximal internal carotid artery for coil embolization, an infusion line of nimodipine was wired to one hub, and of a microcatheter was advanced through another hub (to select and deliver detachable coils). Nimodipine was then infused continuously during the coil embolization. RESULTS: This technique was applied to 11 ruptured aneurysms accompanied by vasospasm (anterior communicating artery, 6 patients; internal carotid artery, 2 patients; posterior communicating and middle cerebral arteries, 1 patient each). Aneurysmal occlusion by coils and nimodipine-induced angioplasty were simultaneously achieved, resulting in excellent outcomes for all patients, and there were no procedure-related complications. Eight patients required repeated nimodipine infusions. CONCLUSION: Our small series of patients suggests that the simultaneous endovascular management of ruptured cerebral aneurysms and vasospasm is a viable approach in patients presenting with subarachnoid hemorrhage and severe vasospasm.

Predictors of Asthma Control by Stepwise Treatment in Elderly Asthmatic Patients

The geriatric population is increasing, and asthma severity increases with age. We determined the predictors of asthma control, exacerbation, and the factors that affect asthma-specific quality of life (A-QOL) in elderly asthmatic patients. This was a prospective, multicenter, real-life study for 6 months with stepwise pharmacologic treatment based on the Global Initiative for Asthma (GINA) guideline. A total of 296 asthmatic patients aged > or = 60 yr were recruited from 5 university centers in Korea. The improved-asthma control group was defined as the group of patients who maintained well-controlled or improved disease and the not-improved asthma control group was defined as the remaining patients. Fewer number of medications for comorbidities (2.8 +/- 3.3 in the improved vs. 4.5 +/- 4.4 in the control) and higher physical functioning (PF) scale (89.8 +/- 14.2 in the improved vs. 82.0 +/- 16.4 in the control) were significant predictors in the improved-asthma control group (OR = 0.863, P = 0.004 and OR = 1.028, P = 0.018, respectively). An asthma control test (ACT) score of < or = 19 at baseline was a significant predictor of asthma exacerbation (OR = 3.938, P = 0.048). Asthma duration (F = 5.656, P = 0.018), ACT score (F = 12.237, P = 0.001) at baseline, and the presence of asthma exacerbation (F = 5.565, P = 0.019) were significant determinants of changes in A-QOL. The number of medications for comorbidities and performance status determined by the PF scale may be important parameters for assessing asthma control in elderly asthmatic patients.

The Allergenic Potency of Japanese Hop Pollen Is Increasing With Environmental Changes in Korea

PURPOSE: The sensitization rate to Japanese Hop (Hop J) in respiratory allergy patients has increased in recent years in Korea. We evaluated changes in the allergenic potency of Hop J pollen collected in 1998 and 2009. METHODS: Thirty-five patients with allergic rhinitis and/or asthma were enrolled. Group I included 21 subjects sensitized to Hop J at an initial visit and group II included 14 subjects who developed a new sensitization. Hop J pollens were collected in 1998 and 2009 (98 and 09 extracts) and both urban and suburban environments (urban and suburban extracts). Serum specific IgE levels to Hop J pollen extracts were compared using an enzyme-linked immunosorbent assay (ELISA). IgE binding components were compared by IgE immunoblot analysis. RESULTS: Serum specific IgE levels to the 09 and urban extracts in both groups increased significantly compared to those of the 98 and suburban extracts. IgE immunoblot demonstrated that the major 10 kDa allergen was intensified in group I, while it was newly generated in group II with additional components ranging from 12-95 kDa. When the 98 and 09 extracts were compared, intensification of the major allergen of 09 extract had occurred in both groups. The IgE binding components of the urban extract was stronger than those of suburban one. CONCLUSIONS: The allergenic potency of Hop J pollen may be increased with environmental changes.

Impacts of climate change on aeroallergens

Climactic changes are key environmental issues affecting allergic diseases. Temperature and CO2 content have been found to be increasing together with climate changes, which could increase pollen production, extend the pollination period, and augment the allergenic components of major pollens. Changes in the distribution of major trees and weeds have been noted. Severe weather events such as thunderstorm winds and precipitation could increasingly cause pollen grains to burst, releasing allergenic particles and leading to extensive mold growth. Air pollutants can increase the concentration of allergen released from pollen grains and allow for easier penetration into airway mucosa. Future studies will be essential to investigate the mechanisms by which allergenic contents can be changed in response to climate change. A better understanding of how aeroallergens interact with air pollutants is needed. Climate change has a significant impact on aeroallergen levels and content in ways which may accelerate the development of allergic diseases. Future strategies will be crucial in preventing the allergic diseases associated with climate changes.

Comparison of Myringoplasty for the Chronic Small Tympanic Membrane Perforations: Fat versus Perichondrium / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are several techniques to perform myringoplasty for tympanic membrane perforations as an outpatient procedure. The aim of this study is to compare the results of fat and perichondrium myringoplasty for the treatment of chronic small tympanic membrane perforations. SUBJECTS AND METHOD: This investigation included 46 patients with chronic tympanic membrane perforations smaller than 3 mm. The patients were equally divided into 2 main groups according to surgical procedures. The patients underwent fat, or perichondrium myringoplasty without skin incision via transcanal approach under local anesthesia. The healing results of perforation and hearing improvement were investigated. RESULTS: Closure rates of the perforations in the fat, perichondrium myringoplasty groups were all the same as 87% (20/23). There were no significant differences between techniques in tympanic membrane closure rates with regard to size and location and in hearing improvement. However, the recovery time was a little faster in perichondrium myringoplasty during follow up. CONCLUSION: Conservative myringoplasty using fat and perichondrium is a feasible procedure that can be perfomed on outpatient basis for chronic small tympanic membrane perforations.

Concurrent Hypertensive Intracerebral Hemorrhage and Rupture of a Previously Clipped Intracranial Aneurysm / 대한뇌혈관외과학회지

Simultaneous occurrence of remote intracerebral hemorrhage (ICH) and intracranial aneurysmal subarachnoid hemorrhage is very rare. We report on a case of concurrent hypertensive ICH at the left thalamus and rupture of an intracranial aneurysm at the bifurcation of the single A2 segment of the anterior cerebral artery in a 64-year-old woman, which was clipped previously, with review of the literature. To our knowledge, this is the first case report demonstrating bleeding of previously clipped aneurysm with simultaneous hypertensive ICH. Hypertensive crisis following ICH seems to have provoked rupture of the residual aneurysm.

A Case of Occupational Rhinitis Caused by Rice Powder in the Grain Industry

Rice is the major staple food in a large part of the world, especially in Asia. Hypersensitivity reactions to rice are rare. Moreover, cases of occupational allergies induced by inhalation of rice powder are uncommon. We report a 31-year-old male with work-related rhinitis and conjunctivitis symptoms caused by occupational exposure to rice powder in the grain industry. He showed positive responses to rice extracts on a skin prick test, and a high level of serum specific IgE to rice was detected by ELISA. Occupational rhinitis was confirmed by a nasal provocation test with rice extracts. An IgE ELISA inhibition test showed cross-creativity between rice and various grass pollen extracts. These findings suggest that the inhalation of rice powder can induce IgE-mediated occupational rhino-conjunctivitis, which may be derived from cross-reactivity to major grass pollens.

A Case of Occupational Rhinitis Caused by Rice Powder in the Grain Industry

Rice is the major staple food in a large part of the world, especially in Asia. Hypersensitivity reactions to rice are rare. Moreover, cases of occupational allergies induced by inhalation of rice powder are uncommon. We report a 31-year-old male with work-related rhinitis and conjunctivitis symptoms caused by occupational exposure to rice powder in the grain industry. He showed positive responses to rice extracts on a skin prick test, and a high level of serum specific IgE to rice was detected by ELISA. Occupational rhinitis was confirmed by a nasal provocation test with rice extracts. An IgE ELISA inhibition test showed cross-creativity between rice and various grass pollen extracts. These findings suggest that the inhalation of rice powder can induce IgE-mediated occupational rhino-conjunctivitis, which may be derived from cross-reactivity to major grass pollens.

Targeted Broadband UVB Phototherapy forthe Treatment of Localized Vitiligo

BACKGROUND: Several new treatments appear to have higher success rates than previous therapies for the treatment of vitiligo, and targeted phototherapy is an alternative that may prove to be time-efficient and an effective therapeutic option for the management of this condition. OBJECTIVE: The aim of this study was to evaluate the efficacy of targeted broadband UVB phototherapy for the treatment of localized vitiligo. METHODS: Fifty-three vitiliginous patches on thirty-five patients (16 males, 19 females) were treated using a targeted broadband UVB phototherapy device. Treatment was started at 70% of the minimal erythema dose, and then gradually increased. Lesions were treated twice a week for a maximum of 60 treatment sessions. RESULTS: Subjects tolerated treatment well. Forty-one of the fifty-three patches (77.4%) achieved repigmentation on > or =75% of the treated areas. Best results were obtained on the face and neck; 20 of the 24 patches (83.3%) concerned achieved > or =75% repigmentation. The least response was on the hands and feet; 3 of 6 patches (50%) showed > or =75% repigmentation. The results were better for focal type than segmental type vitiligo. CONCLUSION: Targeted broadband UVB phototherapy appears to be highly effective at restoring pigmentation in patients with localized vitiligo.

Chordoid Glioma of the Third Ventricle with Unusual MRI Features

Chordoid glioma is a rare primary brain tumor of the third ventricle, and was recently characterized as a novel tumor entity. Typical radiological features of chordoid gliomas include; a solid, round-to-ovoid, wellcircumscribed, contrast-enhancing mass of the hypothalamus and anterior third ventricle. Despite being classified as WHO grade 2, the third ventricular chordoid glioma has been reported to have a poor clinical outcome because of its anatomical location. The authors report a case of chordoid glioma of the third ventricle in a 48-year-old man with unusual radiological features of cystic component and ill defined circumscription.

Treatment Outcome in Patients with Pediatric Encopresis

PURPOSE: The causes of encopresis are complex and multifactorial. Through application of new sophisticated techniques and armamentarium, it has been possible to find more specific aspects of the anorectal function in pediatric patients with refractory defecation disorders. However, quality research of which therapeutic option could be suitable, is still lacking. The current study was designed to assess outcome of treatment according to the treatment algorithm based on the clinical and physiologic findings. METHODS: 22 patients (15 boys, 7 girls) with encopresis were analyzed, retrospectively. For exclusion of the organic cause, barium contrast study and anoscopy were carried out in all cases. Patients were categorized and made treatment algorithm by using leading symptoms and findings of anorectal physiologic tests. Treatment outcomes were analysed in the basis of respective therapeutic options. RESULTS: Patients were categorized as constipation dominant group (n=15) and incontinence dominant group (n=7). Suggested etipathogeneses were as follows; fecal impaction and/or motility disorder (n=7), overflow incontinence (n=6), sensory defect of the rectum (n=4), puborectalis incoordination (n=3), anal hypertonia (n=2). Treatment options were as follows; conventional therapy (CT) only (n=7), CT plus biofeedback (n=9), CT plus balloon sensory retraining (n=4), and CT plus internal sphincterotomy or Nitroglycerine application (n=2). All patients were undertaken a toilet training and psychologic consultation. Regarding to the therapeutic outcome, 19 (86 percent) of overall 22 patients were improved in the mean period of 2.5 (range, 0.1-7) years follow-up. CONCLUSIONS: If therapy could be undertaken according to the optional algorithm based on the clinical and physiologic findings, it could be useful guide for clinical decision making to help the therapy. Moreover, through the combination therapy including medication, psychological consultation, and biofeedback treatment, encopretic children achieve acceptable outcome with a long-term compliance.

Study on the Effects of the Nursing Intervention Program for Perimenstrual Discomfort of the Female University Students / 간호학회지

Management of perimenstrual discomfort could be an effective strategy for women's health promotion. This study was designed to develop and test the nursing intervention program for the reduction of the perimenstrual discomfort. The data were collected from a group of 76 female university students(34 in the intervention group, 42 in the control group) during November 20, 1997 and March 10, 1998. Measurements were taken concerning perimenstrual discomfort, self care behavior, and perimenstrual discomfort from both groups, at pre and post intervention. Intervention program involves education, support, counselling, and relaxation training, via individual and group levels over a twelve- week period. Listed are the summarized results: 1. The intervention group had more knowledge concerning perimenstrual discomfort(t=2.290, p=.025), self care behavior(t=3.198, p=.000), and lower perimenstrual discomfort score(t=-4.446, p=.000) than the control group at post intervention. 2. The intervention group showed an enhancement on the knowledge on perimenstural discomfort(t=2.35, p=.025), and decreased the perimenstrual discomfort score(t=-7.36, p=.000). However change of self care behavior was not significant during the intervention. According to this study a developed nursing intervention program is effective for reduction of the perimenstrual discomfort. For a future research, it is necessary that experiments concerning menstruation, and a correlational study of perimensturual discomfort and stress will be performed.