Long-Term Side Effects of Soft Tissue Filler Injection / 대한피부과학회지

Background@#Injectable soft tissue fillers are important elements in facial rejuvenation as they provide volume restoration without significant inconvenience to the patient or substantial associated recovery time. Complications can be classified into immediate, delayed, or late adverse reactions. Most complications are temporary and common throughout the filler classes. @*Objective@#To describe the long-term side effects of fillers. @*Methods@#A retrospective study of 10 patients who experienced long-term side effects of soft tissue filler injections between 2007 and 2018 was conducted. A long-term reaction was defined as a complication that occurred 1 year after soft tissue filler injection at any facial site. @*Results@#Ten patients were included in the study. All the patients visited our department because of a palpable subcutaneous nodular lesion on their face. The mean duration from receiving the filler injection to the appearance of side effects was 4.3 years (range, 1∼12 years). Based on their clinicopathological features, complications were roughly classified into granulomatous inflammation (60.0%), non-inflammatory palpable nodule formation (20.0%), abscess (10.0%), and dermal fibrosis with inflammation (10.0%). @*Conclusion@#Regardless of the filler type, side effects can appear up to 12 years after injection. The most common type is a granulomatous lesion; however, it can appear as a non-granulomatous lesion. Therefore, when a patient visits with a nodule or an edematous lesion without any recall reason, careful history taking is needed to find any associated clues. With close follow-up and appropriate treatment, complications associated with injectable soft tissue fillers can be limited and competently managed.

Coinfection between influenza and COVID-19 in neonates: A case report

Coinfection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with other respiratory pathogens may complicate diagnosis and treatment. Since the risk of coinfection with SARS-CoV-2 is expected to increase during the influenza epidemic period, it is necessary to study the clinical course of coinfection. To our knowledge, there have been a few cases of coinfection between SARS-CoV-2 and influenza virus in neonates. Here, we report the clinical course of a neonate who was coinfected with the influenza virus and SARS-CoV-2. A 20-day-old boy born with low birth weight presented with a fever. The patient was confirmed as positive with coronavirus disease 2019 (COVID-19) and influenza B by real-time polymerase chain reaction at admission, whereas his mother was only COVID-19 positive at that time. Initial chest x-ray revealed hyperinflation and increased peribronchial markings at the right lower lung bronchus, but slightly decreased lung sounds without crackle or wheezing at admission. We administered empirical antibiotics for neonatal sepsis and oseltamivir for influenza B. On the chest x-ray follow-up, the findings showed improvement. After discharge, the patient showed a stable general condition. Children ineligible for COVID-19 vaccination who are coinfected with SARS-CoV-2 and the influenza virus are more likely to develop severe symptoms. It is necessary to detect coinfections as some can be treated with antibiotics and antivirals in young infants.

Diagnostic Efficacy of Dermoscopy for Acute Diffuse and Total Alopecia:A 30-Case Study / 대한피부과학회지

Background@#Acute diffuse and total alopecia (ADTA) is characterized by rapid hair loss and rapid recovery without treatment. If a non-invasive method such as dermoscopy can identify ADTA, clinicians will be able to diagnose ADTA faster and reassure patients. @*Objective@#The purpose of this study was to evaluate the characteristics of ADTA using dermoscopy. @*Methods@#Patients with ADTA diagnosed by clinical and histological findings from October 2016 to November 2019 were examined by dermoscopy during their first visit to the Department of Dermatology at Kyung Hee University Hospital at Gangdong. @*Results@#Among 300 lesions observed via dermoscopy, yellow dots or black dots were observed in 225 (75.0%) and 240 (80.0%) lesions, respectively. Short vellus hairs or broken hairs were seen in 231 (77.0%) and 190 (63.3%) lesions, respectively. Exclamation mark hairs appeared in only 71 lesions (23.7%). @*Conclusion@#In this study, yellow dots, black dots, broken hairs, short vellus hairs, and exclamation mark hairs were observed in the ADTA cases as well as in previously reported Alopecia areata (AA) studies. These results could be due to the characteristic rapid disease progression of ADTA. Exclamation mark hairs are known to take a few weeks that the transformation of an anagen hair bulb to a club shape of exclamation mark hairs of alopecia areata.Therefore, exclamation mark hairs might be less commonly found at the very early stage of ADTA. There are some limitations in this study. The number of subjects was small, and we did not set up a control group for comparison.

Clinical Investigation of Pityriasis Rosea in Korea; Comparison between Typicial Pityriasis Rosea and Atypical Pityriasis Rosea / 대한피부과학회지

Background@#Pityriasis rosea (PR) is a relatively common, self-limited papulo-squamous dermatosis. Not so rarely, an atypical eruption may develop, concerning several aspects about the morphology or distribution of the lesions, their symptomatology and evolution. @*Objective@#This study was done to review patients with PR and to compare the clinical and the laboratory characteristics of patients diagnosed with atypical PR and patients diagnosed with typical PR. @*Methods@#We retrospectively reviewed patients diagnosed with PR through clinical manifestations and skin biopsies from January 2006 to December 2019 in Kyung Hee University Hospital at Gangdong. Then, we compared differences between patients diagnosed with atypical PR and patients diagnosed with typical PR. @*Results@#We reviewed total of 236 patients diagnosed with PR (mean age, 32.5 years [range, 6∼77]). PR is prevalent in young adults and women. Also, it occurs more frequently in winter. Most of them (78.0%, 184/236) showed improvement within 3 months without recurrence. Secondary lesions were distributed predominantly in the trunk area, but some 12.7% of the patients had atypical distribution such as face, groins, axillae, and palms/sole. On the morphology of secondary lesions, 8.5% of patients showed atypical morphology such as urticaria-like, EM-like, and purpuric patterns. @*Conclusion@#Most of the patients with PR show a typical pattern. If the severity at the time of first visit is severe, the possibility of a longer duration or recurrence could be considered. Also, atypical rashes could occur more frequently at younger ages, and these durations could be slightly longer.

The Effectiveness on Prevention of Rehospitalization with Long-Term Psychosocial Interventions for Patients with Major Psychiatric Disorders / 대한정신분열병학회지

OBJECTIVES: This study aimed to elucidate the effectiveness of long-term psychosocial intervention in reducing the disabling period of patients with major psychiatric disorders by their rehospitalization rate. METHODS: Of the 210 patients with major psychiatric disorders received psychosocial interventions in a Mental Health and Welfare Center, 192 patients (147 with schizophrenia spectrum disorders, 45 with mood disorders) who received interventions more than 6 months were selected. Review of case management records was conducted to obtain information. RESULTS: The number and length of hospitalization and the hospital days per year significantly decreased after psychosocial intervention. Additional analysis of 102 patients followed up for more than 5 years suggested that the effectiveness of the intervention persisted for a sufficient period. However, no significant difference was observed in the number of rehospitalization in 45 patients with mood disorders, though the length of hospitalization significantly decreased. In addition, the hospital days per year of 21 patients with mood disorder followed up for more than 5 years also showed no significant decrease. CONCLUSION: Long-term psychosocial intervention had a significant effect on reducing the number and length of hospitalization for patients with major psychiatric disorder and the effectiveness maintained for more than 5 years.

Nodular Fasciitis on the Scalp: A Case Report and Literature Review / 대한피부과학회지

No abstract available.

Risk Factors of Socio-Demographic Variables to Depressive Symptoms and Suicidality in Elderly Who Live Alone at One Urban Region / 정신신체의학

OBJECTIVES: To understand the risk factors of demographic data in geriatric depression scale, and suicidality among in elderly who live alone at one urban region. METHODS: In 2009, 589 elderly who live alone(age> or =65) were carried out a survey about several socio-demographic data, Korean version of the Geriatric Depression Scale(SGDS-K) and Suicidal Ideation Questionnaire (SIQ). Statistical analysis was performed for the collected data. RESULTS: Mean age of elderly who live alone is 75.69(SD 6.17). 40.1% of participants uneducated, 31.4% graduate from elementary school, 12.9% graduate from high school, 11.7% graduate from middle school, 3.2% graduate from university. Religionless, having past history of depression or physical diseases, low subjective satisfaction of family situation, and not having any social group activity have significance to depressive symptoms of elderly who live alone. Having past history of depression, religionless, low subjective satisfaction of family situation have significance to suicidality. Especially, low subjective satisfaction of family situation and having past history of depression are powerful demographic factor both depressive symptoms and suicidality of elderly who live alone. CONCLUSIONS: When we take care elderly who live alone, we should consider many things, but especially the social support network such as family satisfaction and past history of depression for reducing or preventing their depression and suicide both elderly depression and suicide who live alone.

Immunomodulatory Effects of Mesenchymal Stem Cells in a Murine Model of TNBS-Induced Colitis

PURPOSE: Mesenchymal stem cells (MSCs) are surfacing as a new method of treatment for various diseases that have poor outcome with drug treatments. In this study, we investigated the effects of MSCs in a murine intestinal inflammation model mimicking human Crohn's disease (CD) using 2,4,5-trinitrobenzene sulfonic acid (TNBS). METHODS: Colitis was induced by rectal administration of 2 mg of TNBS in 35% ethanol as experimental group compared to control group. Histological changes, surface molecules of T and B cells of the spleen and blood, and cytokine production (IFN-gamma, TNF-alpha, IL-4, IL-6, IL-10, and IL-12) were determined among 3 groups comprised of control group, TNBS group and TNBS/MSC group. RESULTS: In the mice treated with MSCs, there was a decrease in the wasting disease process and inflammatory histopathological changes. There was also a decrease in pro-inflammatory T-helper 1 (Th1) cytokines IFN-gamma and IL-12 and T-helper 2 (Th2) cytokine IL-4. Anti-inflammatory cytokine IL-10 increased in mice treated with MSCs compared to colitic mice. The blood CD4+CD25+ T-regulatory cells also increased and splenic CD19 B-cells decreased. CONCLUSION: The results of this study suggest that MSCs may have a therapeutic effect in controlling the Th1 and Th2 mediated immune response in patients with CD and aid in tissue regeneration.

A Case of Left Ventricular Outflow Tract Obstruction and Microangiopathic Hemolytic Anemia after Mitral Valve Repair

Many cases have been reported hemolytic anemia and left ventricular outflow obstruction with systolic anterior motion developing after bioprosthetic valve replacement. We report a case of hemolytic anemia and left ventricular outflow tract obstruction occured after mitral valve repair using Duran ring and were resolved by preservative therapy.

The Clinical Feature of Regional Wall Motion Abnormality on Apex of the Left Ventricle with Normal Coronary Angiogram

BACKGROUND AND OBJECTIVES: Stress induced cardiomyopathy has been reported as reversible left ventricular dysfunction with electrocardiographic changes. Although the exact mechanism of this dysfunction has not been clarified, catecholamine "surge" is suspected as a potential cause of this disease. It has not been undergone the studies about the effect of chronic or recurrent psychological stress on the myocardium. We suspect that reversible ischemic change of myocardium could be induced by chronic or recurrent emotional stress. MATERIALS AND METHOD: The clinical, echocardiographic and angiographic data of 189 patients (72 women) who presented with ischemic symptoms and eletrocardiographic changes were participated. BAI (Beck anxiety inventory) and BDI (Beck Depression inventory) were obtained and analyzed for evaluation of degree of psychological stress. RESULTS: 54 patients who had left ventricular apical wall motion abnormalities without significant angiographical stenosis in the coronary artery were younger than the others with left ventricular wall motion abnormalities and angiographic stenosis. And they increased the BAI and BDI as tools of evaluation of psychological stress (p<0.05). CONCLUSION: Data of this study suggested that psychological stress can be associated with myocardial dysfunction. It can be postulated that psychological stress should be considered as one of the cause of non-coronary myocardial injury.

Clinical Factors Associated with Functional Status at Discharge in Stroke Patients

OBJECTIVE: To investigate the clinical characteristics, risk factors and complications of stroke patients and their effect on the patient's functional outcomes at discharge. METHOD: We performed a prospective study during hospitalization on 1, 250 consecutive acute stroke patients discharged from Dong-Eui Hospital from June 2001 to May 2002. Glasgow outcome scale, status of upper extremity involved and status of ambulation were used to evaluate functional status. RESULTS: The variables of clinical characteristics identified as significant in functional status at discharge were the presence of occupation, interval between onset and visit to hospital arrival, type of first treatment after stroke, type of caregiver, type of stroke and location of infarction and intracranial hemorrhage. Positive functional outcomes were significantly related to a younger age, male, small amount of hemorrhage and short length of hospital stay. Among risk factors of stroke, abnormal ECG findings at admission and presence of previous stroke were negative prognostic factors. The complications influencing stroke outcome negatively were pneumonia, depression, urinary tract infection, myocardial infarction and recurrence of stroke in hospitalization. CONCLUSION: The results of this study should be considered during acute management and rehabilitation of stroke patients and are valuable as basic data of functional outcome after stroke.

Effects of P/S Ratio of Fatty Acids and Antioxidants Supplement on Serum Lipids Levels and Hepatic Antioxidants Enzyme Activities in Rats

The aim of this study was to investigate the effects of P/S ratio of fatty acid and antioxidant (vitamin E, selenium) supplements on the serum lipid levels and hepatic antioxidant enzyme activity in rats. Female 16-week-old Sprague-Dawley rats were fed 6 different experimental diets for 4 weeks. While the peroxidizability index (PI) levels of fatty acids in the experimental diets were fixed at 81.22, the levels of P/S ratio of fatty acids were formulated at 0.38, 1.00, 4.81 (LP, MP, HP). These diets were supplemented with vitamin E (1,000 mg/kg diet) and selenium (2.5 mg/kg diet) (LP-S, MP-S, HP-S). This study showed that the serum concentrations of total-cholesterol and HDL-C increased with the increasing of the P/S ratio in the diet (p<0.05). Antioxidant supplementation significantly lowered the concentrations of triglyceride (TG) and VLDL-C of serum (p<0.05). Levels of thiobarbituric acid reactive substance (TBARS) in the liver tended to decrease with the increasing of the P/S ratio in the diet (p<0.001), but antioxidant enzyme activity in the liver was not significantly different. In addition, antioxidant supplementation significantly lowered TBARS level in the liver (p<0.05), but had no effect on antioxidant enzyme activity except for glutathione reductase (p<0.05). In conclusion, it is necessary to consider the properties of dietary fatty acids and antioxidants supplementation for the prevention of cardiovascular diseases.

Seizure -Related Change of NADPH -diaphorase and Calcium Binding Protein Positive Neurons in the Brain of Rats / 체질인류학회지

Nitric oxide (NO) is a gaseous messenger that plays a role in neurotransmission, long term potentiation, depression and cerebral blood flow. Increases in intracellular calcium levels activate the enzyme NOS, and the NO released then diffuse to adjacent cells and activate guanylate cyclase. NO mediates the increase in cerebral blood flow during seizure activity. Therefore, the present study was aimed to investigate the change of NOS and calcium binding proteins in the rat cerebral cortex following seizure. Rats were injected with kainate (KA) and killed at 6 hours, 1, 3, 5 and 10 days after seizure. Expressional change of nNOS, calbindin D28k and parvalbumin was assessed by histochemistry, immunohistochemistry and microdensitometry in the rat brain. The intensity of the NADPH -d staining in rat cortical neurons showed a marked susceptibility to KA administration. At 6 hours and 3 days after seizure, the optical density of the NADPH -d staining was increased relative to the signal in saline treated control rats. At 5 and 10 days after seizure, the optical density of NADPH -d staining was not significantly different in most cortical regions compared to controls. In the hippocampus, the optical density of NADPH -d staining was highest at 5 days after seizure. The optical densities of calbindin D28k and parvalbumin positive neurons were various in the cerebral cortex, hippocampus and caudatoputamen during postseizure period. These results indicate that the calcium binding proteins investigated here are not essential for determining the activation of nNOS/NADPH -d positive neurons in the cerebral cortex and striatum.

Epidemiologic Study of Fracture in Stroke Patients

OBJECTIVE: Fracture has been reported as one of complicated problems in stroke patients. The purpose of this study is to provide epidemiologic data on fractures in stroke patients and investigate the specific feature of these fractures. METHOD: Stroke patients treated in Dong-Eui hospital due to fracture after stroke from March 1990 to March 1999 were enrolled in this study, and the retrospective study of fracture was performed on these patients. RESULTS: Subjects were 73 fracture patients with history of previous stroke. There were 50 patients with ischemic stroke and 23 patients with hemorrhagic stroke. And 35 patients were right hemiplegia, 38 patients were left hemiplegia. In this study, the causes of fracture were slip (63 cases, 86.3%), fall (6 cases, 8.2%), range of motion exercise (3 cases, 4.1%), and crushing injury (1 case, 1.4%). The frequency of fracture in patients who walk independently or with minimal to moderate assist was higher than in patients who walk with maximal assist or were bed-ridden state. In 65 patients, the fracture occured on the same side of hemiplegia. The distribution of fracture site was femur (45 cases, 61.6%), humerus (12 cases, 16.4%), and radius (3 cases) in the order of frequency. The interval between stroke and occurrence of fracture were less than 6 months in 34 cases (46.6%), 6 months to 1 year in 10 cases (13.7%), 1 to 2 years in 13 cases (17.8%), and 2 to 20 years in 16 cases (21.9%). CONCLUSION: As with our study, the fracture in stroke patient tend to occur within the first year after a stroke as a result of slip and the most frequently affected site is femur of hemiplegic side.

Risk Factors Associated with Stroke Recurrence

OBJECTIVE: This study was done to evaluate the risk factors associated with recurrence after first-ever stroke. METHOD: We retrospectively studied 256 first-ever stroke patients treated in Dong-Eui hospital from March 1997 to February 1998. Telephone or out-patient interviews were performed with these patients regarding stroke recurrence and treatment for hypertension and diabetes mellitus. These were divided into two groups, those with recurrence and those without. Evaluated risk factors for stroke recurrence were the following: history of diabetes mellitus, hypertension, heart disease, smoking, alcohol drinking, and transient ischemic attack; clinical findings at admission of hypertension, diabetes mellitus, hyperlipidemia, heart disease, type and location of stroke; treatment compliance for diabetes mellitus and hypertension after discharge. RESULTS: The recurrence rate after first-ever stroke was 12.9%. In univariate analysis, significant risk factors for stroke recurrence were history of smoking, clinical findings at admission of diabetes mellitus, atrial fibrillation, ischemic heart disease, and non-compliance with therapy for diabetes mellitus and hypertension after discharge (p<0.05). In multivariate analysis, significant risk factors for stroke recurrence were atrial fibrillation at admission (odds ratio=3.43) and non-compliance with therapy for hypertension after discharge (odds ratio=7.51)(p<0.05). CONCLUSION: History of smoking, clinical findings at admission of diabetes mellitus, atrial fibrillation, ischemic heart disease, and non-compliance with therapy for diabetes mellitus and hypertension after discharge are considered to be important factors for recurrence of stroke. So treatment and education for those factors associated with stroke recurrence are needed during rehabilitation program.

Sequential Change of Nitric Oxide Synthase in Rat Hippocampus after Kanic Acid-induced Seizure / 대한해부학회지

We have investigated the neural cell damage and the change in the expression of NOS in the rat hippocampus, one of the brain structures most vulnerable to seizures. Rats were injected with kainic acid (KA) and sacrificed 6 h, 1 d, 3 d and 6 d after KA administration. The neural cell damage and the expression pattern of NOS was studied using silver impregnation, NADPH-diaphorase (NADPH-d) histochemistry and reverse transcription-polymerase chain reaction (RT-PCR) analysis. Silver impregnation revealed that kainic acid caused pyramical cell damage which was most severe in the CA1/CA2 subfield and hilus and to a lesser degree in the CA3 region. The optical densities of NADPH-d-positive neurons in the CA1, CA3 and dentate gyrus (DG) regions of the hippocampus were shown to have increased in samples obtained 1 d and 3 d after injection of KA. The number of NADPH-d-positive neurons in the CA1 and CA3 regions of the hippocampus was shown to have decreased in samples obtained 3 d and 6 d after injection of KA. However, the number of NADPH-d-positive neurons in the DG region did not change significantly. The increase in the levels of nNOS, iNOS and eNOS mRNA reached maximal values in samples obtained 1 d after KA treatment. Our findings indicate that the KA-induced seizures induce neural cell damage, increase NOS activity and upregulate the expression of NOS mRNA, which suggests the possibility of a functional role of NOS in bringing about changes in the cells in the hippocampus following seizures.

Expressional Change of Endothelial Nitric Oxide Synthase in Rat Cerebral Cortex after Kainic Acid-Induced Seizure / 대한해부학회지

Administration of kainic acid (KA) results in induction of epileptiform activity and motor seizures. Nitric oxide (NO) mediates the increase in cerebral blood flow during seizure activity. However, the production site of NO has not been clearly defined. Recent studies showed that constitutive nitric oxide synthase may be induced under certain conditions. Therefore, this study was aimed to investigate the change in endothelial nitric oxide synthase (eNOS), neuropeptide Y (NPY) and vasoactive intestinal polypeptide (VIP) since these are involved in cerebral blood flow. Rats were treated with KA and killed at 6 hours, 1, 3, 6 and 12 days after seizure. Expressional changes were assessed by immunohisto-chemistry and RT-PCR. eNOS was detected in the blood vessels of the cerebral cortex of the control group, but was not detected in neurons. eNOS-positive neurons were induced in the cerebral cortex at 1 and 3 days after seizure and found in specific cortical areas, such as primary motor cortex, secondary motor cortex, primary somatosensory cortex, secondary somatosensory cortex, insular cortex, ectorhinal cortex, parietal association cortex, temporal association cortex, auditory cortex and visual cortex. The levels of eNOS mRNA increased at 1 and 3 days after seizure compared to controls. The staining intensity of eNOS-positive microvessels was elevated in samples obtained 1, 3, and 6 days after seizure compared to the control group. However, NPY- and VIP-positive neurons, and glial fibrillary acidic protein-positive astrocytes were not induced in the cerebral cortex after seizure. Therefore, specific neuroactive substances may be induced in the cerebral cortex after seizure. Nitric oxide, a free radical synthesized in the brain by NOS, is a messenger molecule that mediates vascular dilatation and neural transmission. Therefore, neurons showing induced eNOS-positivity and upregulated eNOS-positive microvessels may affect the cerebral blood flow and neuronal activity in the cerebral cortex after seizure.