Anterior approach for a stab wound with penetrating rebar injury causing incomplete cauda equina syndrome in lumbosacral spine lesion: a case report and literature review.

PURPOSE: To report a unique case of incomplete CES following a rebar penetrating injury in perineal region with retro-pulsed fragment, which was treated with anterior approach and discuss suitable surgical approach. METHODS: Incomplete cauda equina syndrome caused by non-missile penetrating injury is extremely rare. A 26-year-old male patient presented incomplete cauda equina syndrome due to a penetrating rebar wound from his perineal region to the lumbosacral spine. Computed tomography demonstrated a bony fragment broken from S1 body compressing into the spinal canal. RESULTS: By anterior approach, we performed partial corpectomy of L5, decompression by retrieving the bony fragment and L5-S1 interbody fusion. The patient had a significant recovery, and no clinical complication was found after over 2-year follow-up. CONCLUSION: It is challenging to determine the optimal strategy of surgical treatment for penetrating spinal injuries with retained foreign bodies, here we suggest an anterior approach situation that has the advantage of being able to effectively perform decompression and prevent iatrogenic damages of thecal sac and nerve rootlets.

Proposition of Adaptive Read Bias: A Solution to Overcome Power and Scaling Limitations in Ferroelectric-Based Neuromorphic System.

Hardware neuromorphic systems are crucial for the energy-efficient processing of massive amounts of data. Among various candidates, hafnium oxide ferroelectric tunnel junctions (FTJs) are highly promising for artificial synaptic devices. However, FTJs exhibit non-ideal characteristics that introduce variations in synaptic weights, presenting a considerable challenge in achieving high-performance neuromorphic systems. The primary objective of this study is to analyze the origin and impact of these variations in neuromorphic systems. The analysis reveals that the major bottleneck in achieving a high-performance neuromorphic system is the dynamic variation, primarily caused by the intrinsic 1/f noise of the device. As the device area is reduced and the read bias (VRead ) is lowered, the intrinsic noise of the FTJs increases, presenting an inherent limitation for implementing area- and power-efficient neuromorphic systems. To overcome this limitation, an adaptive read-biasing (ARB) scheme is proposed that applies a different VRead to each layer of the neuromorphic system. By exploiting the different noise sensitivities of each layer, the ARB method demonstrates significant power savings of 61.3% and a scaling effect of 91.9% compared with conventional biasing methods. These findings contribute significantly to the development of more accurate, efficient, and scalable neuromorphic systems.

Surgical treatment of male breast cancer metastasis to thoracic spine: A case report.

PURPOSE: We present a rare clinical case of a metastatic spinal tumor in the 7th thoracic spine from male breast cancer (MBC). METHOD: A 62-year-old man was referred as an outpatient, complaining of continuous pain in the back and right flank that began 2 weeks earlier. The patient had no neurologic signs or symptoms but had a medical history of left breast modified radical mastectomy because of MBC. Computed tomography and magnetic resonance imaging showed metastasis in the T7 vertebra and no other metastasis on positron emission tomography/computed tomography or bone scan. Separation surgery was performed with posterior corpectomy of T7 (en bloc excision), followed by stabilization with an expandable titanium cage and pedicle screws. The pathological examination of the excised T7 vertebra confirmed metastatic carcinoma with neuroendocrine differentiation from the breast. Adjuvant chemo-radiotherapy was performed after surgery. RESULTS: The patient had no symptoms at the 21-month follow-up. Radiologic studies showed no evidence of recurrent or metastatic lesions. CONCLUSION: MBC is extremely rare, with fewer cases of spinal metastases. Among these, patients who undergo separation surgery are even rarer. This case shows that radical surgery can be an option for MBC with spine metastasis if indicated.

Efficacy of Laryngeal Rehabilitation Therapy on Dysphagia after Anterior Cervical Surgery: Prospective, Randomized Control Trial.

Dysphagia is the most common complication of anterior cervical discectomy and fusion (ACDF). Several studies have reported dysphagia's incidence, severity, and prognosis after ACDF; however, few have investigated the objective effects of dysphagia management. We aimed to elucidate the efficacy of laryngeal rehabilitation therapy for dysphagia following ACDF. This prospective randomized control trial included 20 patients who underwent more than two-level ACDF. Laryngeal rehabilitation therapy was performed on 10 patients for 7 days, whereas the remaining 10 comprised the control group. Pharyngeal transit time (PTT) by videofluoroscopic swallowing study (VFSS) was performed to evaluate the objective state of swallowing. We analyzed Bazaz scale and total variance of prevertebral soft tissue swelling (PSTS) from C2 to C7 on lateral cervical radiographs during hospitalization and at 4 and 8 weeks post-surgery. The PTT of the rehabilitation group was shorter than that of the control group at 7 days and 4 weeks post-surgery (p-value; POD 7D = 0.003, POD 4W = 0.042, POD 8W = 0.097). Perioperative laryngeal rehabilitation therapy effectively reduces postoperative dysphagia after ACDF.

Anterior Dens Screw Fixation for Traumatic C1-2 Lateral Subluxation With 3-Part Fractures of the C2 Axis (Dens, Lateral Mass, and Hangman Fractures): A Case Report.

INTRODUCTION: To report the first case of traumatic C1-2 lateral subluxation with three-part fractures of the C2 axis (dens, lateral mass, and hangman fractures) that was successfully treated with only anterior dens screw fixation. METHODS: A 56-year-old man was admitted to the hospital complaining of neck and left arm pains caused by a pedestrian traffic accident. Radiologic examination revealed traumatic C1-2 lateral subluxation, type 3 dens fracture (Anderson and D'Alonzo classification), fracture of both C2 lateral masses, and type 1 hangman fracture (Levine and Edwards classification). RESULTS: Preoperative closed reduction of the C1-2 lateral subluxation was successfully achieved by skull traction using a Gardner-Wells tong. The patient underwent anterior dens screw fixation for type 3 dens fracture with posterior angulation. At the 2-year follow-up visit, good reduction of traumatic C1-2 lateral subluxation and solid fusion of all three-part fractures of the C2 axis were achieved with full range of motion and stability at the C1-2 joint. In addition, notable improvement of neck and left arm pains was achieved. DISCUSSION: Preoperative closed reduction and anterior dens screw fixation can be considered as a less invasive and motion-preserving surgery for traumatic C1-2 lateral subluxation with three-part fractures of the C2 axis.

Proposal of Treatment Strategy for Pedicle Fractures of the C2: An Analysis of 49 Cases.

Spine surgeons often confuse C2 pedicle fractures (PFs) with pars interarticularis fractures. In addition, little information is available about the characteristics and treatment strategies for C2 PFs. We sought to investigate the characteristics of C2 PFs and to propose an appropriate treatment strategy. A total of forty-nine patients with C2 PFs were included in this study. We divided these patients into unilateral and bilateral C2 PF groups. The incidence rates and characteristics of other associated C2 and C2-3 injuries, and other cervical injuries, were evaluated. In addition, treatment methods and outcomes were analyzed. Twenty-two patients had unilateral C2 PFs and twenty-seven patients had bilateral C2 PFs. Among the cases of unilateral C2 PFs, all patients had one or more other C2 fractures, and twenty patients (90.9%) had one or two C2 body fractures. Meanwhile, among the cases of bilateral C2 PF, all patients had two or more other C2 fractures and one or two C2 body fractures. In unilateral C2 PFs, three patients with C2-3 anterior slip or adjacent cervical spine (C1-3) injury underwent surgery and nineteen patients (86.4%) were treated with conservative methods. In bilateral C2 PFs, three patients with C2-3 anterior slip or SCI at C2-3 underwent surgery and twenty-four patients (88.9%) were treated with conservative methods. Our results showed that C2 PFs do not occur alone and are always accompanied by other associated C2 injuries. C2 PFs should, generally, be thought of as a more complex fracture type than hangman's fracture or dens fracture. Despite the complex fracture characteristics, most C2 PFs can be managed with conservative treatment. However, surgical treatments should be considered if the C2 PFs are accompanied by the C2-3 anterior slip and adjacent cervical spine injury.

Proposal of New Radiological Classification and Treatment Strategy for Transverse Fractures of the C2 Axis Body.

OBJECTIVE: To investigate the characteristics of transverse fractures of the C2 axis body diagnosed on sagittal computed tomography (CT) and to propose new classification and appropriate treatment strategies. METHODS: A retrospective study was performed by enrolling 49 patients (26 men and 23 women) with transverse fractures of the C2 axis body who were treated at four national trauma centers of tertiary university hospitals from January 2000 to December 2017. The mean age of the patients was 60.8 years (ranging from 21 to 90 years). We classified 49 transverse fractures of the C2 body into three types based on fracture trajectories involving superior articular facet (SAF) and lateral cortex (LC) of the C2 body on coronal CT as follows: Type 1, involvement of C2 SAF on both sides; Type 2, unilateral involvement of C2 SAF on one side and LC on the other side; Type 3, involvement of LC on both sides. The characteristics, treatment methods, and results of 49 transverse fractures of the C2 body were analyzed. Mean follow-up was 12.6 months (ranging from 12 to 26 months). RESULTS: Twenty-six (53.1%) patients were Type 1, 21 (42.9%) were Type 2, and 2 (4.0%) were Type 3. Correlation coefficients for intra-observer and inter-observer reliabilities of classification were 0.723 and 0.598 (both, P < 0.001), respectively. About 40.8% (7 Type 1 and 13 Type 2) of the patients had fracture displacement >3 mm; Incidence of fracture displacement >3 mm was higher in Type 2 than Type 1 (61.9% vs 26.9%, P < 0.05). About 79.6% (20 Type 1, 17 Type 2 and 2 Type 3) of the patients were treated conservatively, and 20.4% (6 Type 1 and 4 Type 2) underwent surgery. At last follow-up, 47 out of 49 patients achieved fusion; overall fusion rate was 95.9%. All conservatively treated Type 1 and Type 3 patients achieved fusion. Out of 17 conservatively treated Type 2 patients, 15 achieved fusion but two developed nonunion; however, two nonunion patients opted not to undergo surgery. Subgroup analysis showed that Philadelphia brace caused nonunion significantly in fracture displacement >3 mm compared to Minerva brace/Halovest (100% vs 0%, P < 0.05). All surgically treated Type 1 and 2 patients achieved fusion. In terms of clinical outcomes, neck pain visual analog scale and neck disability index were significantly improved (both, P < 0.01). According to Odom's criteria, 93.9% (46/49) of the patients achieved satisfactory outcomes. No major complications occurred. CONCLUSIONS: The majority of transverse fractures of C2 body can be treated conservatively. However, surgery or rigid Minerva brace/Halovest should be considered for Type 2 transverse fractures of the C2 body with fracture displacement >3 mm.

Anterior C2-3 fusion surgery alone for highly displaced Hangman's fracture with severe angulation of C2-3 of more than 30°.

BACKGROUND: Highly displaced Hangman's fracture is a very rare and extremely unstable fracture of the C2 axis. Combined anteroposterior or posterior long-segment fusion surgery is typically performed for the treatment of highly displaced Hangman's fracture. However, these kinds of surgeries increase the risk of complications, loss of motion, and hospital costs. OBJECTIVE: We sought to investigate the surgical outcomes of anterior C2-3 fusion surgery alone for highly displaced Hangman's fractures with severe angulation of C2-3 by more than 30° and discoligamentous injury. METHODS: A total of five patients (four men and one woman) were included in this study with a mean age of 40.4 years (range, 26-70 years). The mean follow-up period after surgery was 37.2 months (range, 12-96 months). The fracture characteristics, treatment methods, and outcomes were retrospectively analyzed. RESULTS: All five patients had type II Hangman's fractures (according to the Levine and Edwards classification scheme). None of the included patients had neurologic deficit or other spine injury but all patients had complete C2-3 discoligamentous injury. Before surgery, all patients successfully achieved closed reduction by skull traction, followed by C2-3 anterior decompression and fusion (ACDF) with plating. For interbody grafting, three patients received a polyetheretherketone (PEEK) cage filled with an autogenous cancellous iliac bone graft and two received autogenous tricortical iliac bone grafts. Severe angulation (39.2° vs. 3.0°, P < 0.001) and severe displacement (76.1% vs. 4.0%, P < 0.001) of C2-3 were both significantly corrected after surgery. All patients had achieved solid fusion at last follow-up. In terms of clinical outcomes, the mean neck pain visual analog scale score was significantly improved (8.6 points vs. 1.8 points, P < 0.001). The mean neck disability index value was also significantly improved (45.4 points vs. 13.0 points, P < 0.01). According to Odom's criteria, all patients achieved satisfactory outcomes. No major complications occurred. One patient complained of dysphagia, but recovered after three months with conservative treatment. CONCLUSIONS: Preoperative closed reduction and anterior C2-3 fusion surgery alone should be considered as a less-invasive and useful surgical option for highly displaced Hangman's fracture with severe angulation of C2-3, which is an extremely unstable fracture of the C2 axis.

Anterior dislocation of THA after Iliopsoas tenotomy in spinopelvic imbalance: a rare case report.

BACKGROUND: Iliopsoas impingement is a complication of total hip arthroplasty that often manifests as groin pain during initial hip flexion. However, there are no reports of mechanical complications after iliopsoas tenotomy following total hip arthroplasty (THA). CASE PRESENTATION: We present the case of a 64-year-old woman with degenerative lumbar kyphosis who developed anterior hip dislocations after arthroscopic iliopsoas tenotomy for anterior impingement following THA. She ultimately required revision of the acetabular cup. CONCLUSIONS: Arthroscopic tenotomy for refractory iliopsoas tendinopathy may be appealing because of its less invasive nature. However, caution should be exercised in the setting of significant cup malpositioning and/or spinopelvic imbalance to avoid iatrogenic anterior instability.

Neglected extensor apparatus injury in the proximal interphalangeal joint: A case report.

RATIONALE: The extensor tendon of the proximal interphalangeal (PIP) joint is highly complex, and failure to ensure suitable balance during treatment following an injury is likely to produce poor outcomes. We have achieved good outcomes with the primary repair of neglected extensor tendon rupture in the PIP joint, and thus report the case along with a review of the relevant literature. PATIENTS CONCERN: A 40-year-old right-handed female who works at a meat shop visited our clinic due to pain and active limitation of the range of motion (ROM) of the PIP joint of her left long finger. She had previously experienced a cut on the dorsal aspect of the third PIP joint while cutting meat about a year earlier but did not receive any specific treatment for the injury. DIAGNOSIS: The patient was diagnosed with complete rupture of the central slip and lateral band in the PIP joint after investigation. INTERVENTION: We successfully debrided the ruptured tendon and performed extensor tendon repair using the modified Kessler technique and epitendinous cross-over repair technique. OUTCOME: At the 12-month follow-up, the patient was completely asymptomatic and had optimal PIP joint ROM (0°-90°) in her left long finger. LESSONS: Although the treatment of an extensor injury of the PIP joint area is difficult, satisfactory outcomes can still be achieved, even in cases of injuries which are neglected for over a year, using a repair technique that can properly balance the length and tension between the central slip and lateral bands with the selection of appropriate postoperative treatment strategies.

Multiple calcaneal fibrous dysplasia: A case report.

RATIONALE: Fibrous dysplasia (FD) is a benign bone tumor due to developmental failure in the process of primitive bone remodeling to mature lamellar bone. The most common locations of monostotic FD of the extremity bones are the proximal femur, tibia, humerus and the radius. FD in the calcaneus is extremely rare and usually manifests clinically as a single bone lesion. Moreover, no research has reported on multiple lesions in calcaneal FD. PATIENT CONCERNS: We report a 21-year-old man presented to our institution with pain upon walking for 2 months. DIAGNOSES: We diagnosed the patient with multiple calcaneal FD through histologic examination of the excised biopsy that revealed cellular, spindly stroma and woven bone without osteoblastic rimming resembling Chinese characters INTERVENTIONS:: Plain X-ray, computed tomography, magnetic resonance imaging and histologic examination. An excisional biopsy with extended curettage and bone grafting with allogenous bone and autogenous bone marrow aspirate concentrate were performed. OUTCOMES: No complications developed after surgery and during serial follow-ups at 3, 6 and 12 months. At a postoperative 12-month follow-up, a plain radiogram showed a well-consolidated bone graft in the lesions. LESSONS: Calcaneal FD is rare disease entity. This case can help guide clinical decision-making in the future.

Etiology and Related Factors of Postoperative Delirium in Orthopedic Surgery.

BACKGROUND: Delirium is a serious complication for elderly patients after orthopedic surgery. The purpose of this study was to assess the etiology and related factors of delirium after orthopedic surgery in Korea. METHODS: We retrospectively reviewed the medical records of 3,611 patients over 50 years who had orthopedic surgery. The age of patients (50s, 60s, 70s, and > 80s), type of anesthesia (general, spinal, and local), operation time (more than 2 hours vs. less than 2 hours), surgical site (spine, hip, knee, or others), and etiology (trauma or disease) were compared to determine possible risk factors of delirium after orthopedic surgery. RESULTS: Of 3,611 patients, 172 (4.76%) were diagnosed with delirium after orthopedic surgery. Postoperative delirium occurred in 1.18% in their 50s, 3.86% in their 60s, 8.49% in their 70s, and 13.04% in > 80s (p < 0.001). According to anesthesia type, 6.50% of postoperative delirium occurred after general anesthesia, 0.77% after spinal anesthesia, and 0.47% after local anesthesia (p < 0.001). More than 2 hours of operation was associated with higher occurrence of delirium than less than 2 hours was (5.88% vs. 4.13%, p = 0.017). For the etiology, 8.17% were trauma cases and 3.02% were disease (p < 0.001). Postoperative delirium occurred in 22 of 493 patients (4.46%) after spine surgery, 18 of 355 patients (5.07%) after hip surgery, 17 of 394 patients (4.31%) after knee surgery, and 15 of 1,145 patients (1.31%) after surgery at other sites (p < 0.001). CONCLUSIONS: Postoperative delirium was more common in older patients who had surgery under general anesthesia, whose surgery took more than 2 hours, and who were hospitalized through the emergency room.

Relationship between magnetic resonance imaging findings and spinal cord injury in extension injury of the cervical spine.

OBJECTIVE: The purpose of this study was to determine the relationship between magnetic resonance imaging (MRI) findings and neurologic symptoms in cervical spine extension injury and to analyze the MRI parameters associated with neurologic outcome. MATERIALS AND METHODS: This study included 102 patients with cervical spine extension injury, whose medical records and MRI scans at the time of injury were available. Quantitative MRI parameters such as maximum spinal canal compression (MSCC), maximum cord compromise (MCC), and lesion length showing intramedullary signal changes were measured. Furthermore, intramedullary hemorrhage, spinal cord edema, and soft tissue damage were evaluated. Fisher's exact test was used for a cross-analysis between the MRI findings and the three American Spinal Injury Association category groups depending on the severity level of neurologic injury: complete (category A), incomplete (categories B-D), and normal (category E). RESULTS: MSCC accounted for 23.05, 19.5, and 9.94 % for the complete, incomplete, and normal AIS categories, respectively, without showing statistically significant differences (P = 0.085). MCC was noted in 22.05, 15.32, and 9.2 %, respectively, with the complete-injury group (AIS category A) showing significantly higher. In particular, cases of complete injury had >15 % compression, accounting for 87.5 % (P < 0.001). The mean intramedullary lesion length was significantly higher in complete-injury patients than in incomplete-injury patients (24.22 vs. 8.24 mm). Intramedullary hemorrhage and spinal cord edema were significantly more frequently observed in complete-injury cases (P < 0.001). The incidence of complete injury was proportional to the severity of soft tissue damage. CONCLUSION: MCC, intramedullary lesion length, intramedullary hemorrhage, and spinal cord edema were MRI parameters associated with poor neurologic outcomes in patients with cervical spine extension injury.

The clinical efficacy of short-term steroid treatment in multilevel anterior cervical arthrodesis.

BACKGROUND CONTEXT: Dysphagia is the most common complication of anterior cervical discectomy and fusion (ACDF), and it is closely related to prevertebral soft-tissue swelling (PSTS). A few studies have found that local or systemic methylprednisolone is effective against laryngopharyngeal edema and airway obstruction. PURPOSE: To assess the effectiveness of short-term use of systemic methylprednisolone in relieving dysphagia and decreasing PSTS during the hospitalization period. STUDY DESIGN: A prospective study. PATIENT SAMPLE: Forty patients who underwent multilevel (more than three levels) ACDF with same plate fixation. OUTCOME MEASURE: Radiologic and clinical measures. METHODS: Twenty of these patients were given 250 mg of methylprednisolone intravenously (IV) four times a day only for 24 hours after the operation (at 6-hour intervals), whereas the remaining 20 did not receive methylprednisolone and served as controls. We used the Bazaz scale to compare the degree of dysphagia between groups during the hospitalization period. We used the C-spine lateral view to assess the degree of pre- and postoperative PSTS from C2 to C7. At the final follow-up, we assessed the relationship between the occurrence of complications and steroid use. RESULTS: The degree of dysphagia according to the Bazaz scale was less severe in the group that received methylprednisolone (p values; postoperative Day [POD] 2∼5<.05, POD 6=.014, POD 7=.019). Prevertebral soft-tissue swelling was also significantly lower in the group that received methylprednisolone (p values; POD 2∼POD 5 <.005, POD 1=.061, POD 6=.007, POD 7=.091). The amount of PSTS and dysphagia did not differ according to sex, age, smoking history, or length of surgery. The period of hospitalization in the experimental group was shorter than in the control group. No complications related to steroid use were found at the final follow-up. CONCLUSIONS: The short-term use of systemic methylprednisolone after ACDF appears to be effective in relieving dysphagia and decreasing the PSTS. Furthermore, the short-term use of methylprednisolone was not associated with any adverse effects of short-term IV steroid usage, such as peptic ulcer disease or postoperative infection. The clinical use of methylprednisolone in relieving dysphagia and decreasing PSTS deserves consideration during the early postoperative period.

Applicability test of methods for discrimination between external and internal contamination using an ORTEC whole body counter.

Whole-body counters (WBCs) are generally used for monitoring internal radioactive contamination of radiation workers in nuclear power plants. However, it has been found that external contamination is occasionally counted as internal contamination. The previous study was conducted to provide guidance on measuring the exact internal radioactivity using a Canberra WBC. However, there is strong need to verify the application of the previous study to whole-body counting using a different type of WBC, ORTEC StandFAST II. Thus, in this study, several experiments were conducted focusing on the discrimination between external and internal contamination. Finally, it was found that counts from the front and back are still effective to distinguish external contamination from internal contamination for whole-body counting.

Radiological effluents released and public doses from nuclear power plants in Korea.

As of the end of 2010, there were 20 commercially operating nuclear reactors in Korea. Releases of radioactive effluents from nuclear power plants (NPPs) have increased continuously; the total radioactivity of effluent amount released in 2010 was 547.12 TBq. From 2001 to 2010, the annual average radioactivity of gaseous and liquid effluents per reactor was 11.61 TBq for pressurised water reactors and 118.12 TBq for pressurised heavy water reactors. Most of the radioactivity from gaseous and liquid effluents came from tritium. Based on the results of release trends and analyses, the characteristics of effluents have been investigated to improve the management of radioactive effluents from NPPs.

Transcription elongation factor Tcea3 regulates the pluripotent differentiation potential of mouse embryonic stem cells via the Lefty1-Nodal-Smad2 pathway.

Self-renewal and pluripotency are hallmark properties of pluripotent stem cells, including embryonic stem cells (ESCs) and iPS cells. Previous studies revealed the ESC-specific core transcription circuitry and showed that these core factors (e.g., Oct3/4, Sox2, and Nanog) regulate not only self-renewal but also pluripotent differentiation. However, it remains elusive how these two cell states are regulated and balanced during in vitro replication and differentiation. Here, we report that the transcription elongation factor Tcea3 is highly enriched in mouse ESCs (mESCs) and plays important roles in regulating the differentiation. Strikingly, altering Tcea3 expression in mESCs did not affect self-renewal under nondifferentiating condition; however, upon exposure to differentiating cues, its overexpression impaired in vitro differentiation capacity, and its knockdown biased differentiation toward mesodermal and endodermal fates. Furthermore, we identified Lefty1 as a downstream target of Tcea3 and showed that the Tcea3-Lefty1-Nodal-Smad2 pathway is an innate program critically regulating cell fate choices between self-replication and differentiation commitment. Together, we propose that Tcea3 critically regulates pluripotent differentiation of mESCs as a molecular rheostat of Nodal-Smad2/3 signaling.

Epidemiologic Study of Malassezia Yeasts in Acne Patients by Analysis of 26S rDNA PCR-RFLP.

BACKGROUND: Although acne is a common follicular inflammatory dermatosis, studies of the relationship between Malassezia yeasts and acne have rarely been conducted. OBJECTIVE: We sought to identify Malassezia yeasts from acne patients and establish a relationship between specific types of species of Malassezia and acne. METHODS: Sixty acne patients were enrolled. Each strain obtained was identified as one of eleven species by 26S rDNA PCR-RFLP. We then compared these data with those of age- and sex-matched healthy subjects. RESULTS: Growth of Malassezia was evident in fewer patients with acne (50%) in comparison to controls (70.6%). M. restricta was dominant in patients with acne (23.9%), whereas M. globosa was most common (26.7%) in healthy controls. In the patients group, the rate was the highest (71.7%) in the twenties and, in terms of body site, the rate was the highest (60%) in the chest. In the control group, the rate was the highest (75.0%) in the thirties and in the forehead (85.0%). CONCLUSION: The detection rate of Malassezia yeasts was conspicuously low in the acne patients group. Statistically significant differences were observed between the patient and the control groups in the twenties and thirties, and in terms of body site, in the forehead and chest.

Epidemiologic Study of Malassezia Yeasts in Patients with Malassezia Folliculitis by 26S rDNA PCR-RFLP Analysis.

BACKGROUND: So far, studies on the inter-relationship between Malassezia and Malassezia folliculitis have been rather scarce. OBJECTIVE: We sought to analyze the differences in body sites, gender and age groups, and to determine whether there is a relationship between certain types of Malassezia species and Malassezia folliculitis. METHODS: Specimens were taken from the forehead, cheek and chest of 60 patients with Malassezia folliculitis and from the normal skin of 60 age- and gender-matched healthy controls by 26S rDNA PCR-RFLP. RESULTS: M. restricta was dominant in the patients with Malassezia folliculitis (20.6%), while M. globosa was the most common species (26.7%) in the controls. The rate of identification was the highest in the teens for the patient group, whereas it was the highest in the thirties for the control group. M. globosa was the most predominant species on the chest with 13 cases (21.7%), and M. restricta was the most commonly identified species, with 17 (28.3%) and 12 (20%) cases on the forehead and cheek, respectively, for the patient group. CONCLUSION: Statistically significant differences were observed between the patient and control groups for the people in their teens and twenties, and in terms of the body site, on the forehead only.

A case of fibroelastolytic papulosis on the neck of a young man.

Fibroelastolytic papulosis of the neck (FEPN) encompasses a spectrum of two disorders that were previously reported as pseudoxanthoma elasticum-like papillary dermal elastolysis (PXE-PDE) and white fibrous papulosis of the neck (WFPN). The clinical presentation of FEPN is asymptomatic to mildly pruritic whitish-yellow papules that may coalesce into cobblestone patterned plaques that resemble pseudoxanthoma elasticum (PXE). The histology is characterized by a decrease or loss of elastic fibers in the papillary dermis and this is sometimes accompanied by a minimal or nodular increase of dermal collagen fibers. We report here on a 28-year-old Korean man with asymptomatic, multiple, skin-colored to slightly yellowish, match-head sized, cobblestone-patterned papules on the neck, and these were histologically consistent with FEPN and the papules showed slightly increased dermal collagen associated with decreased and fragmented elastic fibers, elastin and tropoelastin. The pathogenesis of FEPN in this case might have been related with mild dermal inflammation, followed by fragmentation, elastolysis and increased dermal collagen.