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서수홍 ( Soo Hong Seo ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2
Accurate tissue mapping with representative tissue orientation is a fundamental element of MMS. Inaccurate mapping, including misorientation of the tissue, results in falsely negative subsequent layers and may account for some of the recurrences. Mapping errors include misoriented specimen relative to the patient and/or map and incorrectly inked specimen with reversal of colors. Tumors in difficult anatomic locations such as the ear or medial canthus and large tumors are especially prone to mapping errors. It may be helpful to transpose the map onto a digital photograph of the lesion. Digital and polaroid photographs produce the most detailed representations of defects, the excised tissue, and their interrelationship. Most of Mohs micrographic surgeons divide specimen within four pieces at first stage. When the tissue is cut into more pieces, more time and expense are required in processing and slide reading. Smaller pieces increase the likelihood of obtaining complete epidermal margins and enhance the specificity of mapping. The number of specimens depends on the size of the tumor, but the numbering sequence of the tissue specimens should be consistent from patient to patient. The clockwise numbering pattern is the one historically and most commonly used, starting at the 1 o’clock position. When specimens contain cartilage or bone, or subcutaneous tissue without any skin edge, this should be indicated on the map. Color coding is necessary to orient the specimen to the map and body location. Two or more inks are applied to the cut medial edges and drawn on the Mohs map as well in order to preserve the orientation after sectioning. Maintaining the same color coordination each time (such as blue for superior and medial and red for inferior and lateral) reduces the chances of a processing error and disorienting the specimen. It is important that the ink be applied sparingly as ink bleeding from one area to another may lead to confusion and inability to differentiate how the specimen should be correlated to the surgical site.
Educational Lecture 2-3 (EL 2-3) : Local and regional anesthesia
서수홍 ( Soo Hong Seo ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1
For the surgical procedure, proper anesthesia is a necessary condition. Most of dermatologic surgical procedures can be optimally performed with local anesthesia. Local anesthesia provides the benefits of rapid onset of action, ease of use, decreased cost, and minimal associated morbidity and mortality. To perform effective local anesthesia, you need to be familiar with local anesthetics, methods, and adverse effects. Local anesthetics are structurally composed of three components: an aromatic portion, an intermediate chain, and an amine portion. According to intermediate chain, they are classified into two groups, ester-type and amide-type. Ester-type compounds tend to have shorter duration of action and more allergic reaction compared to amide-type. Individuals with compromised liver function are more susceptible to the toxic effects of amide anesthetics. Epinephrine and sodium bicarbonate can be added to improve efficacy and to reduce pain on injection. Variables to select appropriate anesthetics are the onset of action and the duration of anesthesia, which are dependent on procedures, and patient factors such as history of allergy or renal or hepatic impairment. For simple procedures like laser treatment and shave biopsy, topical anesthesia is enough. Procedures on a wide area naturally need a large amount of anesthetics, increasing the risk of adverse effects. To overcome this shortcoming, regional nerve block or tumescent anesthesia is a useful method. Dermatologic surgeons need to be well acquainted with adverse effects of local anesthesia. Local adverse effects can be prevented technically with caution. Systemic adverse effects include vasovagal reaction, epinephrine reaction, allergic reaction, and systemic toxicity. Vasovagal reaction may be relieved with Trendelenburg position and epinephrine should be avoided in patients with hyperthyroidism, severe hypertension, and pheochromocytoma. Ester-type provokes allergic reaction more commonly than amide-type because of its metabolite, para-aminobenzoic acid (PABA). The first symptoms of systemic toxicity are circumoral and digital paresthesias. During a procedure, a surgeon should monitor patient’s condition and always be ready to recognize abnormal symptoms and to deal with them promptly in a proper way.
전신홍반루푸스와 이차성 항인지질항체 증후군에 동반된 타카야수동맥염
서수홍 ( Soo Hong Seo ) 대한류마티스학회 2008 대한류마티스학회지 Vol.15 No.2
Takayasu`s arteritis (TA) is an uncommon, chronic inflammatory disease of elastic arteries such as the aorta, its larger branches and the pulmonary artery trunk, and develops into an obstructive process. Antiphospholipid syndrome (APS) is characterized by obstetric and thrombotic complications in the presence of antiphospholipid antibodies. It can happen in an isolated way or in association with connective tissue diseases, mainly systemic lupus erythematosus (SLE). The association of APS and SLE with TA is rarely described in the foreign reports, but not yet in Korea. We described a case of TA in a patient with APS secondary to SLE.
일차성 쇼그렌증후군 환자에서 나타나는 자가항체와 선외증상의 양상
서수홍 ( Soo Hong Seo ),김현숙 ( Hyun Sook Kim ),곽승기 ( Seung Ki Kwok ),주지현 ( Ji Hyeon Ju ),김상현 ( Sang Hyon Kim ),윤종현 ( Chong Hyeon Yoon ),김호연 ( Ho Youn Kim ),박성환 ( Sung Hwan Park ) 대한류마티스학회 2007 대한류마티스학회지 Vol.14 No.1
Objective: To investigate the extraglandular manifestations and serological features of Korean patients with primary Sjogren`s syndrome (pSS). Methods: Clinical and laboratory data of 125 patients with pSS attending rheumatology clinic of Kangnam St. Mary`s hospital, with a mean follow-up period of 64.8 months, were assessed retrospectively. Results: Arthralgia was the most common extraglandular manifestation of pSS. Other extraglandular manifestations, such as myalgia, peripheral neuropathy, Raynaud`s phenomenon, and hypothyroidism were frequently presented, but lymphoma was rare manifestation in Korean patients with pSS. Some extraglandular manifestations of pSS were associated with hypocomplementemia and antibodies against Ro, and La, and antinuclear antibody. Conclusion: The clinical manifestations and extraglandular manifestations of Korean patients with pSS patients were similar to other studies except low prevalence of lymphoma. Positivity of anti-Ro/SS-A, anti-La/SS-B antibodies and hypocomplementemia were closely associated with extraglandular manifestations in patients with pSS.
서수홍(Soo Hong Seo),김일환(Il Hwan Kim),송해준(Hae Jun Song),오칠환(Chil Whan Oh) 대한피부과학회 2001 대한피부과학회지 Vol.39 No.10
An 34-year-old woman was referred to our outpatient clinic because of 3-year history of diffuse hair loss. According to her, the hair loss tatalled more than 300 hairs daily and she had not been given any systemic medication. There was no history of hair disease in the family except for her father with androgenetic alopecia. On clinical examination there was diffuse alopecia of the frontal and parietotemporal scalp. There were no signs of scalp inflammation or scarring and were no short or broken hairs. The condition did not affect the eyebrows or eyelashes. The nails and teeth were normal. The hair was dry and lusterless, and numerous hairs were easily and painlessly pulled out after exerting soft traction. Light microscopic examination of these hairs showed them to be in anagen with pigmented, twisted hair bulbs and no internal or external root sheaths. Ruffling of the cuticle was seen on a short part of the proximal hair shaft, the rest of the hair being normal in appearance. The incisional biopsy showed fragmented inner root sheath. We diagnosed her for loose anagen hair and educated her to treat her hair gently. She has shown no improvement for two month follow up and is lost after then. (Korean J Dermatol 2001;39(10): 1157~1161)