Occupational Exposure to Pesticides and Lung Cancer Risk: A Propensity Score Analyses / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#Occupational exposure to pesticides is thought to be associated with lung cancer, but studies have yielded conflicting results. We performed a propensity score (PS) based analyses to evaluate the relationship between occupational exposure to pesticides and lung cancer risk in the Korea National Cancer Center community-based cohort study (KNCCCS). @*Materials and Methods@#During the follow-up period, 123 incidental lung cancer cases were identified, of the 7,471 subjects in the final statistical analysis. Information about occupational exposure to pesticides and other factors was collected at enrollment (2003-2010). Cox proportional hazards regression analyses were conducted. Four PS-based approaches (i.e., matching, stratification, inverse probability-of-treatment weighting, and the use of the PS as a covariate) were adopted, and the results were compared. PS was obtained from the logistic regression model. Absolute standardized differences according to occupational exposure to pesticides were provided to evaluate the balance in baseline characteristics. @*Results@#In the Cox proportional hazards regression model, the hazard ratio (HR) for lung cancer according to occupational exposure to pesticides was 1.82 (95% confidence interval [CI], 1.11 to 2.98). With all the propensity score matching (PSM) methods, the HRs for lung cancer based on exposure to pesticides ranged from 1.65 (95% CI, 1.04 to 2.64) (continuous term with PSM) to 2.84 (95% CI, 1.81 to 4.46) (stratification by 5 strata of the PS). The results varied slightly based on the method used, but the direction and statistical significance remained the same. @*Conclusion@#Our results strengthen the evidence for an association between occupational exposure to pesticides and the risk of lung cancer.

An Exploration Into Patients’ Experiences That Make Them Feel Safe During Hospitalization: A Qualitative Study

Background@#Patient safety is a crucial indicator of health care quality. It is necessary to check the subjective perception of patient safety from the patient’s point of view as a consumer of healthcare services. To identify patients’ experiences of safety and the themes that constitute the patients’ feeling of safety during hospitalization. @*Methods@#A qualitative study, comprising five focus group discussions (seven people each), was conducted in South Korea between May and July 2018. Patients who were hospitalized for at least three days within one year were included. Researchers analyzed the transcribed script, and a content analysis was performed to describe patients’ hospitalized experiences of safety. @*Results@#A total of 35 patients with an average age of 45.4 years participated in the study, and had experience of hospitalization for up to 32 days. The findings revealed four core themes and 14 sub-themes. Patients wanted to take initiative in controlling his/her reception of information and wanted healthcare providers to make the patient feel safe. Patients felt safe when hospitals provided unstinted and generous support. Also, public sentiment about national healthcare and safety made an effect on patient safety sentiment. @*Conclusion@#Patients felt safe during hospitalization not only because of the explanation, attitude, and professionalism of the healthcare providers but also because of the support, system, and procedure of the medical institution. Healthcare providers and medical institutions should strive to narrow the gap in patient safety awareness factors through activities with patients. Furthermore, the government and society should make an effort to create a safe medical environment and social atmosphere.

Understanding Physicians’ and Nurses’ Adaption of National-Leading Patient Safety Culture Policy: A Qualitative Study in Tertiary and General Hospitals in Korea

Background@#In Korea, the safety culture is led by national policy. How the policy ensures a patient safety culture needs to be investigated. This study aimed to examine the way in which physicians and nurses regard, understand, or interpret the patient safety-related policy in the hospital setting. @*Methods@#In this qualitative study, we conducted four focus group interviews (FGIs) with 25 physicians and nurses from tertiary and general hospitals in South Korea. FGIs data were analyzed using thematic analysis, which was conducted in an inductive and interpretative way. @*Results@#Three themes were identified. The healthcare providers recognized its benefits in the forms of knowledge, information and training at least although the policy implemented by the law forcibly and temporarily. The second theme was about the interaction of the policy and the Korean context of healthcare, which makes a “turning point” in the safety culture.The final theme was about some strains and conflicts resulting from patient safety policy. @*Conclusion@#To provide a patient safety culture, it is necessary to develop a plan to improve the voluntary participation of healthcare professionals and their commitment to safety.Hospitals should provide more resources and support for healthcare professionals.

A Case of Exophytic Pilomatricoma with Perforating Figure / 대한피부과학회지

Pilomatricoma, also known as calcifying epithelioma of Malherbe, is a benign adnexal skin tumor arising from hair matrix cells. Clinically, pilomatricoma typically presents as a firm, bluish or red colored, deep-seated nodule with overlying normal skin. Several variants of pilomatricoma have been described including perforating, extruding, bullous, melanocytic, giant, keratoacanthoma-like, exophytic, lymphangiectatic, familial, anetodermic, and multiple. Among these, an extruding variant has been very rarely reported. A 10-year-old girl presented with a 2-month history of a rapid-growing, solitary, firm, skin-colored to pinkish, pedunculated papule with a central crusted perforation on the left cheek. Based on the clinical and histological findings, we made a diagnosis of exophytic pilomatricoma with perforating figure. She had no signs of recurrence of the lesion for 8 months after removal.

A Case of Solitary Fibrofolliculoma on the Antitragus of the Ear / 대한피부과학회지

Fibrofolliculoma is a benign perifollicular connective tissue tumor that usually occurs in the face. Most fibrofolliculoma present as multiple lesions and typically occur with trichodiscomas and acrochordons, constituting the Birt-Hogg-Dube syndrome. Solitary fibrofolliculoma is nonhereditary and unassociated with other cutaneous abnormalities. A 72-year-old man visited our clinic complaining of a solitary umbilicated nodule on the antitragus of the left ear. Skin biopsy from the lesion showed a central dilated follicular infundibulum with anastomosing bands of follicular epithelium extending into the fibrous stroma. The diagnosis of a solitary fibrofolliculoma was made based on the clinical and histopathological findings. No signs of lesion recurrence for 1 year after shave removal were noted. We report a rare case of solitary fibrofolliculoma that occurred on the antitragus of the ear.

Hydrochlorothiazide use and the risk of skin cancer in patients with hypertensive disorder: a nationwide retrospective cohort study from Korea

Background/Aims@#Recent studies have shown a cumulative dose-dependent association between the use of hydrochlorothiazide (HCTZ) and skin cancer, including melanoma and non-melanoma skin cancer (NMSC) in Western Europe. However, whether this pattern is present in East Asia countries is unknown. The aim of this study was to examine the association between HCTZ use and the risk of skin cancer among a cohort of hypertensive patients in South Korea. @*Methods@#This was a retrospective, population-based cohort study using the database from the Health Insurance Review and Assessment Service between January 1, 2007 and June 30, 2017 in South Korea. We identified patients diagnosed with melanoma and NMSC in the cohorts of essential hypertensive patients who were treated with HCTZ or antihypertensive agents other than HCTZ. Using Cox proportional hazards regression models, the hazard ratios (HR) for skin cancer associated with HCTZ users were calculated. @*Results@#The risk of melanoma was significantly lower in HCTZ-users compared with non-HCTZ users (HR, 0.85; 95% confidence interval [CI], 0.75 to 0.97; p = 0.016), and the risk of NMSC was lower in the HCTZ users but no statistically significant association was seen (HR, 0.96; 95% CI, 0.91 to 1.02; p = 0.236). High cumulative doses (≥ 50,000 mg) of HCTZ were associated with decreased risk of both NMSC (HR, 0.20; 95% CI, 0.10 to 0.38; p < 0.001) and melanoma (HR, 0.18; 95% CI, 0.04 to 0.70; p = 0.001), respectively. @*Conclusions@#High cumulative use of HCTZ may have a chemopreventive effect against the development of melanoma and NMSC with clear cumulative dose-response and duration-response relationships in South Korea.

A Correlation between Serum Level of Alkaline Phosphatase and Acne Severity in Children and Adolescents: A Retrospective Cross-Sectional Study

Background@#Acne is a chronic inflammatory disease of the pilosebaceous unit and usually affects adolescents when the peak concentrations of growth hormone, insulin-like growth factor 1, and androgen are demonstrated. The activity of alkaline phosphatase (ALP), which increases physiologically in growing children and adolescents, in the pilosebaceous unit has been reported. However, the correlation between the serum level of ALP and the number of acne lesions has not been studied. @*Objective@#The present cross-sectional study was designed to evaluate the correlation between serum level of ALP and the numbers of non-inflammatory and inflammatory acne lesions in children and adolescents. @*Methods@#For this study, 202 pediatric and adolescent patients clinically diagnosed with acne vulgaris were included. Age, sex, serum level of ALP, number of non-inflammatory acne lesions, number of inflammatory acne lesions, and number of total acne lesions were evaluated. Additionally, the serum level of dehydroepiandrosterone sulfate was evaluated in 117 patients. Multiple regression analysis was performed. Multicollinearity was quantified using the variance inflation factor. @*Results@#In the 202 patients, serum level of ALP was the only independent factor that significantly affected both the number of non-inflammatory acne lesions and of total acne lesions (regression coefficient=0.089 and 0.086, respectively, p＜ 0.001). @*Conclusion@#There was a significant correlation between serum level of ALP and the extent of acne (non-inflammatory acne lesions and total acne lesions).

Lichen Planus Developed During the Treatment with Nivolumab in a Patient with Lung Cancer: A Case Report and Literature Review / 대한피부과학회지

Nivolumab is a fully-humanized IgG4 monoclonal antibody that competitively binds to the programmed cell death receptor-1 protein (an immune check-point molecule) present on activated T cells. Nivolumab is approved for the treatment of advanced melanoma, lung cancer, and renal cell carcinoma. It attenuates the inactivation of cytotoxic CD8+ T cells and, produces an antitumor effect; however it may be associated with immune-related adverse events, including the development of lichen planus (LP). A 72-year-old man presented with a 2-month history of multiple, polygonal, purplish papules on the dorsal aspect of both hands. He was diagnosed with large cell neuroendocrine carcinoma (LCNEC) of the lung 4 years earlier and was treated with nivolumab (3 mg/kg every 2 weeks) for 9 months. By the 14th course of nivolumab therapy, the patient developed multiple rashes on the dorsal aspect of both hands, and biopsy was consistent with findings of LP. We report a rare case of LP in a patient with lung cancer treated with nivolumab.

Brain computed tomography angiography in postcardiac arrest patients and neurologic outcome

OBJECTIVE: This study aimed to analyze intracranial vessels using brain computed tomography angiography (CTA) and scoring systems to diagnose brain death and predict poor neurologic outcomes of postcardiac arrest patients.METHODS: Initial brain CTA images of postcardiac arrest patients were analyzed using scoring systems to determine a lack of opacification and diagnose brain death. The primary outcome was poor neurologic outcome, which was defined as cerebral performance category score 3 to 5. The frequency, sensitivity, specificity, positive predictive value, negative predictive value, and area under receiver operating characteristic curve for the lack of opacification of each vessel and for each scoring system used to predict poor neurologic outcomes were determined.RESULTS: Patients with poor neurologic outcomes lacked opacification of the intracranial vessels, most commonly in the vein of Galen, both internal cerebral veins, and the mid cerebral artery (M4). The 7-score results (P=0.04) and 10-score results were significantly different (P=0.04) between outcome groups, with an area under receiver operating characteristic of 0.61 (range, 0.48 to 0.72). The lack of opacification of each intracranial vessel and all scoring systems exhibited high specificity (100%) and positive predictive values (100%) for predicting poor neurologic outcomes.CONCLUSION: Lack of opacification of vessels on brain CTA exhibited high specificity for predicting poor neurologic outcomes of patients after cardiac arrest.

Pilot study on a rewarming rate of 0.15°C/hr versus 0.25°C/hr and outcomes in post cardiac arrest patients

OBJECTIVE: Cerebral hemodynamic and metabolic changes may occur during the rewarming phase of targeted temperature management in post cardiac arrest patients. Yet, studies on different rewarming rates and patient outcomes are limited. This study aimed to investigate post cardiac arrest patients who were rewarmed with different rewarming rates after 24 hours of hypothermia and the association of these rates to the neurologic outcomes.METHODS: This study retrospectively investigated post cardiac arrest patients treated with targeted temperature management and rewarmed with rewarming rates of 0.15°C/hr and 0.25°C/hr. The association of the rewarming rate with poor neurologic outcomes (cerebral performance category score, 3 to 5) was investigated.RESULTS: A total of 71 patients were analyzed (0.15°C/hr, n=36; 0.25°C/hr, n=35). In the comparison between 0.15°C/hr and 0.25°C/hr, the poor neurologic outcome did not significantly differ (24 [66.7%] vs. 25 [71.4%], respectively; P=0.66). In the multivariate analysis, the rewarming rate of 0.15°C/hr was not associated with the 1-month neurologic outcome improvement (odds ratio, 0.54; 95% confidence interval, 0.16 to 1.69; P=0.28).CONCLUSION: The rewarming rates of 0.15°C/hr and 0.25°C/hr were not associated with the neurologic outcome difference in post cardiac arrest patients.

Characteristics of Acute Herbicide Poisoning: Focused on Chlorophenoxy Herbicide

PURPOSE@#Herbicide-related mortality has decreased since the complete ban of paraquat product sales in 2012, but there still have been other herbicides intoxications with relatively severe complications. Glyphosate and glufosinate herbicides are used widely, and considerable research has been conducted. Chlorophenoxy herbicide is another major herbicide that has shown poor outcomes and mortality without proper management, but research in this area is lacking. Therefore, this study compared the clinical features of chlorophenoxy herbicide with those of other herbicides.@*METHODS@#The medical records of patients exposed to herbicides at a tertiary academic university hospital in Korea from May 2014 to April 2019 were reviewed retrospectively. The demographic and clinical data of 135 patients were then analyzed to identify the recent herbicides intoxication trends after the paraquat sales ban, focusing mainly on chlorophenoxy herbicide poisoning.@*RESULTS@#Of the 135 patients, 13 patients (9.6%) had chlorophenoxy herbicide poisoning. No significant differences in all the variables were observed between the chlorophenoxy herbicide poisoning group and non-chlorophenoxy herbicides poisoning groups. Toxic symptoms after poisoning varied from nothing noticeable to confusion; none of the patients had severe complications after their treatments.@*CONCLUSION@#Acute chlorophenoxy poisoning is relatively less severe, with lower mortality rates than glyphosate and glufosinate poisoning.

A Case of Verruciform Genital-associated (Vegas) Xanthoma on the Scrotum / 대한피부과학회지

No abstract available.

Parry-Romberg Syndrome Augmented by Hyaluronic Acid Filler

Parry Romberg Syndrome (PRS), also known as idiopathic progressive hemifacial atrophy, is a rare neurocutaneous disorder characterized by loss of skin and subcutaneous fat of face, muscles, and bones causing unilateral atrophy. Most patients require only soft tissue augmentation although syndrome has varying grades of severity. In the majority of reported cases, it has been treated with surgical flap or autologous fat transplantation. However, these treatments need complicated surgical skills which take a lot of time and cost. Herein we report the first case of PRS augmented by hyaluronic acid (HA) filler in a 42-year-old female patient to suggest that HA filler could be a safe, simple, and even rational economic alternative to surgical treatment.

Comparative Efficacy and Safety of Long-acting Injectable and Oral Second-generation Antipsychotics for the Treatment of Schizophrenia: A Systematic Review and Meta-analysis

We aimed to compare the efficacy and safety of long-acting injectable (LAI) and oral second-generation antipsychotics (SGAs) in treating schizophrenia by performing a systematic review and meta-analysis. MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library, as well as five Korean databases, were systemically searched to identify studies published from 2000 to 16 April 2015, which compared the efficacy and safety of LAI and oral SGAs. Using data from randomized controlled trials (RCTs), meta-analyses were conducted. In addition, the GRADE (the Grading of Recommendations, Assessment, Development and Evaluation) approach was applied to explicitly assess the quality of the evidence. A total of 30 studies including 17 RCTs and 13 observational studies were selected. The group treated with LAI SGAs was characterized by significantly lower relapse rates, longer times to relapse and fewer hospital days, but also by a higher occurrence of extrapyramidal syndrome and prolactin-related symptoms than that in the group treated with oral SGAs. Our findings demonstrate that there is moderate to high level of evidence suggesting that in the treatment of schizophrenia, LAI SGAs have higher efficacy and are associated with higher rates of extrapyramidal syndrome and prolactin-related symptoms. Additionally, the use of LAI SGAs should be combined with appropriate measures to reduce dopamine D2 antagonism-related symptoms.

Serum markers and development of delayed neuropsychological sequelae after acute carbon monoxide poisoning: anion gap, lactate, osmolarity, S100B protein, and interleukin-6

OBJECTIVE: Reliable biomarkers of delayed neuropsychological sequelae (DNS) after acute carbon monoxide (CO) poisoning are lacking. This study investigated the associations between potential serum markers and the development of DNS after acute CO poisoning. METHODS: Retrospective chart reviews were conducted for patients diagnosed with acute CO poisoning during a 28-month period. The patients were divided into two groups according to the presence or absence of having developed DNS. Multivariate analysis was performed to identify predictors of DNS after CO poisoning. RESULTS: Of a total of 102 patients, 10 (9.8%) developed DNS. The levels of serum osmolarity, S100B protein, and serum lactate, as well as serum anion gap, were statistically significant in univariate analysis. Multiple logistic regression analysis showed that anion gap (adjusted odds ratio [AOR], 1.36; 95% confidence interval [CI], 1.11 to 1.88), serum lactate level (AOR, 1.74; 95% CI, 1.26 to 2.75), and serum S100B protein level ([AOR, 7.02×10⁵; 95% CI, 4.56×10² to 9.00×10¹⁰] in model 1, [AOR, 3.69×10⁵; 95% CI, 2.49×10² to 2.71×10¹¹] in model 2) were independently associated with DNS development. CONCLUSION: Based on our preliminary results, serum lactate level, serum anion gap, and serum S100B protein level in the emergency department could be informative predictors of DNS development in patients with acute CO poisoning. These markers might have the potential to improve early recognition of DNS in patients with acute CO poisoning.

Extragenital Lichen Sclerosus Et Atrophicus along the Blaschko's Lines of the Forehead / 대한피부과학회지

Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory dermatosis presenting as white papules and atrophic patches in the anogenital region. Extragenital LSA is rare and commonly affects the neck, thighs, and the trunk. A 68-year-old woman presented with a well-demarcated, whitish linear plaque on the forehead that was observed several months prior to presentation. A biopsy specimen showed hyperkeratosis and thinning of the epidermis and homogenization of collagen in the papillary dermis with a subepidermal cleft. Mild periappendageal lymphocytic infiltration and eccrine gland atrophy secondary to thickening of collagen bundles were observed in the deep dermis. Based on the clinical and histopathological findings, this patient was diagnosed with extragenital LSA and concomitant morphea along the Blaschko's lines.

A Case of Basal Cell Carcinoma on the Nostril Sill Reconstructed with Rotation Flap / 대한피부과학회지

No abstract available.

Treatment of acute carbon monoxide poisoning with induced hypothermia

OBJECTIVE: The effect of induced hypothermia on severe acute carbon monoxide (CO) poisoning remains to be addressed further. We investigated the effect of induced hypothermia on severe acute CO poisoning. METHODS: Retrospective chart review was conducted for patients who diagnosed as severe acute CO poisoning in emergency department and underwent induced hypothermia from May 2013 to May 2014. Hospital courses with critical medication and major laboratory results were investigated through the chart review. RESULTS: Among total 227 patients with acute CO poisoning during the period of study, patients with severe acute CO poisoning were 15. All patients underwent induced hypothermia with a temperature goal 33°C. Initial and follow-up levels of S100B protein after induced hypothermia were 0.47 μg/L (interquartile range, 0.11 to 0.71) and 0.10 μg/L (interquartile range, 0.06 to 0.37), respectively (P = 0.01). The mean Glasgow Coma Scales at emergency department admission was 6.87 ± 3.36. Except 1 patient who expired after cardiopulmonary resuscitation, Glasgow Coma Scales at 30-day of hospital discharge were 15 in 10 patients (71.4%), 14 in 1 patient (7.1%), 13 in 1 patient (7.1%), and 6 in 2 patients (14.2%). Seven patients (46.7%) developed delayed neurologic sequelae. Four patients showed mild types of delayed neurologic sequelae and 3 showed moderate to severe types of delayed neurologic sequelae. CONCLUSION: Most of patients underwent induced hypothermia had a good recovery from severe acute CO poisoning. Therefore, induced hypothermia may be considered as a possible treatment in severe acute CO poisoning.

Radiosurgery Compared with External Radiation Therapy as a Primary Treatment in Spine Metastasis from Hepatocellular Carcinoma : A Multicenter, Matched-Pair Study

OBJECTIVE: The aim of this multicenter, matched-pair study was to compare the outcomes of stereotactic radiosurgery (SRS) and conventional external radiation therapy (RT) when used as a primary treatment in spine metastasis from hepatocellular carcinoma (HCC). METHODS: From 2005 to 2012, 28 patients underwent SRS as the primary treatment in spine metastasis from HCC. Based on sex, age, number of spine metastasis, Child-Pugh classification, interval from original tumor to spine metastasis, and year of treatment, 28 patients who underwent RT were paired. Outcomes of interest were pain relief, progression free survival, toxicities, and further treatment. RESULTS: The perioperative visual analog scale (VAS) decrease was larger in SRS group than in RT group, but the difference was not significant (3.7 vs. 2.8, p=0.13). When pain medication was adjusted, the number of patients with complete (n=6 vs.3) or partial (n=12 vs.13) relief was larger in SRS group than in RT group; however, the difference was not significant (p=0.83). There was no significant difference in progression free survival (p=0.48). In SRS group, 32.1% of patients had 1 or more toxicities whereas the percentage in RT group was 63.0%, a significant difference (p=0.04). Six SRS patients and 7 RT patients received further intervention at the treated segment. CONCLUSION: Clinical and radiological outcome were not significantly different between the two treatments. Toxicities, however, were more prevalent in the RT group.

Successful Transplantation of Organs from a Donor with Bacterial Meningitis Caused by Streptococcus pneumonia: A Case Report / 대한구급학회지

The number of organs transplanted worldwide is increasing annually. As a result, there is a shortage of available donor organs. This scarcity has led to the progressive broadening of donor organ criteria. The expanded criteria include infections such as bacterial meningitis. A 55-year old male visited our emergency room with cardiac arrest and recovered after cardiopulmonary resuscitation. The cause of the cardiac arrest was bacterial meningitis caused by Streptococcus pneumoniae. While proper antibiotics were applied, the patient met the clinical criteria for brain death. Prophylactic antibiotics were administered to the recipients, and liver and kidney transplantations were done successfully.