Causes and Predictive Factors Associated with “Diagnosis Changed” Outcomes in Patients Notified as Tuberculosis Cases in a Private Tertiary Hospital

( Byung Ju Kang ),( Kyung Wook Jo ),( Tai Sun Park ),( Jung Wan Yoo ),( Sei Won Lee ),( Chang Min Choi ),( Yeon Mok Oh ),( Sang Do Lee ),( Woo Sung Kim ),( Dong Soon Kim ),( Tae Sun Shim ) 대한결핵 및 호흡기학회 2013 Tuberculosis and Respiratory Diseases Vol.75 No.6

Background: The aim of our study was to evaluate the “diagnosis changed” rate in patients notified as tuberculosis (TB) on the Korean TB surveillance system (KTBS). Methods: A total of 1,273 patients notified as TB cases on the KTBS in one private tertiary hospital in 2011 were enrolled in the present study. Patients were classified into three groups: “diagnosis maintained”, “diagnosis changed” (initially notified as TB, but ultimately diagnosed as non-TB), and “administrative error” (notified as TB due to administrative errors). Results: Excluding 17 patients in the “administrative error” group, the “diagnosis maintained” and “diagnosis changed” groups included 1,097 (87.3%) and 159 patients (12.7%), respectively. Common causes of “diagnosis changed” were nontuberculous mycobacterial (NTM) disease (51.7%, 61/118), and pneumonia (17.8%) in cases notified as pulmonary TB, and meningitis (19.5%, 8/41) and Crohn`s disease (12.2%) in cases notified as extrapulmonary TB. Being older than 35 years of age (odds ratio [OR], 2.18) and a positive acid-fast bacilli stain (OR, 1.58) were positive predictors and a TB-related radiological finding (OR, 0.42) was a negative predictor for a “diagnosis changed” result via multivariate logistic regression analysis in pulmonary TB cases. Conclusion: Because of a high “diagnosis changed” rate in TB notifications to the KTBS, the TB incidence rate measured by the KTBS may be overestimated. Considering the worldwide trend toward increased NTM disease, the “diagnosis changed” rate may increase over time. Thus, when reporting the annual TB notification rate in Korea, the exclusion of “diagnosis changed” cases is desirable.

Causes and Predictive Factors Associated with "Diagnosis Changed" Outcomes in Patients Notified as Tuberculosis Cases in a Private Tertiary Hospital

Kang, Byung Ju,Jo, Kyung-Wook,Park, Tai Sun,Yoo, Jung-Wan,Lee, Sei Won,Choi, Chang-Min,Oh, Yeon-Mok,Lee, Sang-Do,Kim, Woo Sung,Kim, Dong Soon,Shim, Tae Sun The Korean Academy of Tuberculosis and Respiratory 2013 Tuberculosis and Respiratory Diseases Vol.75 No.6

Background: The aim of our study was to evaluate the "diagnosis changed" rate in patients notified as tuberculosis (TB) on the Korean TB surveillance system (KTBS). Methods: A total of 1,273 patients notified as TB cases on the KTBS in one private tertiary hospital in 2011 were enrolled in the present study. Patients were classified into three groups: "diagnosis maintained", "diagnosis changed" (initially notified as TB, but ultimately diagnosed as non-TB), and "administrative error" (notified as TB due to administrative errors). Results: Excluding 17 patients in the "administrative error" group, the "diagnosis maintained" and "diagnosis changed" groups included 1,097 (87.3%) and 159 patients (12.7%), respectively. Common causes of "diagnosis changed" were nontuberculous mycobacterial (NTM) disease (51.7%, 61/118), and pneumonia (17.8%) in cases notified as pulmonary TB, and meningitis (19.5%, 8/41) and Crohn's disease (12.2%) in cases notified as extrapulmonary TB. Being older than 35 years of age (odds ratio [OR], 2.18) and a positive acid-fast bacilli stain (OR, 1.58) were positive predictors and a TB-related radiological finding (OR, 0.42) was a negative predictor for a "diagnosis changed" result via multivariate logistic regression analysis in pulmonary TB cases. Conclusion: Because of a high "diagnosis changed" rate in TB notifications to the KTBS, the TB incidence rate measured by the KTBS may be overestimated. Considering the worldwide trend toward increased NTM disease, the "diagnosis changed" rate may increase over time. Thus, when reporting the annual TB notification rate in Korea, the exclusion of "diagnosis changed" cases is desirable.

최근 30년간 스포로트리쿰증 임상 병형의 추세에 대한 관찰

임채성,권경술,장호선,정태안,오창근 대한의진균학회 1997 대한의진균학회지 Vol.2 No.1

Background: The clinical types of sporotrichosis are generally classified into four group: lymphocutaneous, fixed cutaneous, and cutaneous disseminated, and hematogenous. Of these, the lymphocutaneous variety is the most frequently encountered pattern, constituting 80% of sporotrichosis patients and the fixed cutaneous sporotrichosis is the next. Potassium iodide (KI) was the most commonly used drug for the treatment of sporotrichosis. Many studies about these clinical findings of sporotrichosis have been reported, but comparative study on the changes in clinical findings has not been reported. Objective: The purpose of this study is to clarify the changes of the clinical findings in sporotrichosis in Korea. Methods: A total of 58 patients with sporotrichosis who had visited the Department of Dermatology, Pusan National University were divided into 2 groups according to the period and then the clinical findings of sporotrichosis were compared. Results: The results of study are summarized as follows: 1. During this period, there were 58 cases of sporotrichosis. In the past period (1967~1979) there were 35 cases of sporotrichosis, and there were 23 cases in the recent period (1980~1997) 2. In the past period, most cases (71.4%) were lymphocutaneous type, however in the recent period, most cases (69.2%) were fixed cutaneous type. 3. The most commonly affected site was right upper extremity in the past period, but face fright upper extremity were the most commonly affected sites in the recent period. 4. In the past period, 2nd and 3rd decades were prevalent age group, but 5th to 7th decades were prevalent age group in the recent period. 5. In the treatment of sporotrichosis, potassium iodide (KI) was the choice of treatment in the past period, however itraconazole is gradually used in the recent period. Conclusion: According to this study, many changes in clinical findings of sporotrichosis were noted, especially in the clinical type. We found that clnical type of sporotrichosis changed from lymphocutaneous type to the fixed cutaneous type with time. And we suggest that further observation would be necessary to define the meaning of these changes.

Clinicopathological study on metastatic skin cancer

( Chang Il Kwon ),( Seo Mi Gon Jeong ),( Young Bin Shin ),( Yun Sun Moon ),( Eui Chang Jung ),( Chi Yeon Kim ),( Tae Jin Yoon ) 대한피부과학회 2020 대한피부과학회 학술발표대회집 Vol.72 No.1

Background: Various primary tumors can cause metastatic skin cancer. Metastatic skin lesion should be distinguished from other skin lesion. Objectives: We studied patients with metastatic skin cancer to find out average age, gender distribution, frequency of primary tumor, time interval between manifestation and primary cancer, and their clinical appearance, location and other metastatic sites. Methods: We reviewed the medical records, clinical photographs and histopathologic records of patients who had been diagnosed with metastatic skin cancer. Results: In the comparison according to clinical records, the mean age at the time of diagnosis was 60.6 years. The ratio of men to women was 1.05:1. The most frequent primary tumors were breast cancer (22.0%), lung cancer (17.0%), head and neck cancer (17%), melanoma (17.0%), gastrointestinal cancer (11%), urologic cancer (11%), and gynecologic cancer (6%). Metastatic skin cancers usually presented as discrete, painless, hard nodules, with sudden onset (88%). Conclusion: Based on the results of this study, it is believed that it is important to recognize the metastatic lesion between various skin lesion such as infections and granulomatous changes of other cause due to drugs and reactive changes.

A case of HPV-16 positive squamous cell carcinoma arose in vulva

( Chang Il Kwon ),( Young Bin Shin ),( Jeong Won Jo ),( Yun Sun Moon ),( Eui Chang Jung ),( Chi Yeon Kim ),( Tae Jin Yoon ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Squamous cell carcinoma (SCC) is the second most common non-melanoma skin cancer. In SCC, ultraviolet radiation is known as typical risk factor and it is mainly found on sun-exposed areas such as face, neck, and arm. SCC that occurs in a female vulva is a rare cancer. It represents 3-5% of gynecological cancers with an incidence of 2 per 100,000 women/year. It can occur at any age, mainly in women of the 6th decade. Clinically, it is represented as an erythematous to whitish colored patch and it may also be nodular or ulcerative appearance. A 76-year-old woman visited our hospital with multiple erythematous erosive patch on labia minora 6 months ago. We performed biopsy and we can confirm the diagnosis as SCC with no other metastasis. In addition, there was HPV-16 positive in HPV genotyping. The prognostic significance of HPV in vulva SCC is not established firmly. Some studies of vulva SCC have shown that HPV-associated SCC have a better prognosis where as others have not. HPV-associated SCC occur typically in younger women and HPV-independent SCC occur more frequently in older women. Herein, we report a case of 76-year-old woman with HPV-associated SCC.

마우스 골수세포의 액체배양에서의 세포화학적 염색성에 관한 연구

김현태,박애자,장선택 중앙대학교 의과대학 의과학연구소 1988 中央醫大誌 Vol.13 No.4

The mouse bone marrow cells were cultured in liquid culture system to investigate the correlation of cytochemical changes and the number of colony forming unit granulocyte/macrophage(CFU-GM) and colony-forming unit megakaryocyte(CFU-Meg) colonies with cell maturation and platelet formation. The following results are obtained; 1. Total colony counts are markedly increased during 4-6 days of culture and reach the maximum number by 7th day (262.33 ± 192.33/ml). The number of cells are increased in each colonies without increase of total colony number after 5 days. 2. The mean ratio of acetylcholinesterase positive megakaryocyte colonies are 13.70 ± 7.04% of total colonies formed with no remarkable changes during 9 days culture period. The number of megakaryocyte colonies reach maximum level by 7th day (31.37 ± 25.73/ml), while that of nonmegakaryocytic colonies reach maximum level by 9th day (230.51 ± 81.90/m1). 3. Platelet count in medium are 5,000 ± 3,490/ml with no remarkable changes during 9 days of culture periods. 4. In acetylcholinesterase positive megakaryocytic colonies, the PAS stain show weak positive in few megakaryocyte by 3rd day, however about 40% of megakaryocytes show rather strong positivity by 7th day. The positivity of non-specific esterase and acid phosphatase are less than 10% until 9th flay of culture. Specific esterase positivity was not found during 9 days period of culture. 5. Non-specific esterase and acid phosphatase stain show lower positivies (11%, 5%) than PAS and specific esterase stain (21%, 55%) in non megakaryocyte colonies. In summary, the number of CFU-GM and CPU-Meg colonies in liquid culture are increased gradually and reached maximum by 7th day, forming large colonies from 5th days on In megakaryocytic colonies, no evidence of platelet formation were observed during 9 days period of culture. It is suggesed that the majority of CFU -GM colonies in liquid culture are mixed colonies according to the cytochemical stainabilities.

갑상선기능저하증에 동반된 가로선백색손발톱(Transverse Leukonychia)

장희선 ( Hee Sun Chang ),한태영 ( Tae Young Han ),이현경 ( Hyun Kyung Lee ),손숙자 ( Sook Ja Son ) 대한피부과학회 2011 대한피부과학회지 Vol.49 No.5

Transverse leukonychia, also termed leukonychia striata, usually occurs in association with trauma, nutritional deficiencies, exposure to toxin, and various combinations of chemotherapy. It also has been reported to be associated with various systemic diseases, including acute infection, myocardial infarction, lymphoma, hepatic failure, renal failure, and systemic lupus erythematosus. A 50-year-old woman with several months` history of nail changes presented with multiple discrete transverse white bands involving the entire width of the nail plates of her fingers. According to the patient`s medical history, she had experienced fatigue, constipation, and cold intolerance for 6 months, and antithyroid antibodies were detected before noticing these nail changes. The patient was diagnosed as having an autoimmune hypothyroidism. Repeated KOH microscopic examination did not demonstrate fungal infection. We diagnosed this case as transverse leukonychia associated with hypothyroidism. This case report underlines the possible association of transverse leukonychia with hypothyroidism. (Korean J Dermatol 2011;49(5):480∼482)

경동맥 내막 절제술중 뇌보호와 신경생리학적 검사의 의의

신용삼,김선호,김종훈,민경태,김동익,유선국,이규창 대한신경외과학회 1998 Journal of Korean neurosurgical society Vol.27 No.8

A survey of counseling and behavior regarding skin cancer

( Young Bin Shin ),( Chang Il Kwon ),( Jeong Won Jo ),( Yun Sun Moon ),( Eui Chang Jung ),( Chi Yeon Kim ),( Tae Jin Yoon ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.2

Background: As the incidence of skin cancer increases, more information and education on skin cancer are needed. Although skin cancer is not rare, most patients are little known about general awareness of skin cancer. Objectives: The purpose of this study is to investigate the post-education effects on skin cancer in our hospital outpaitents and carers. Methods: We reviewed a written questionnaire and patients’ self-checked records including patients’ basic medical information and knowledge of skin cancer protective modalities. Results: In total 340 cases, 215 (63.2%) patients were female and 125 (36.8%) patients were male. 6 people in their teens, 56 people in their 20s and 30s, 156 people in their 40s and 50s, 122 people in their 60s or older. Before education, 142 people said sunlight can cause a skin cancer and 178 did not. After education, 246 people said Yes and 94 people did not. When asked how you wanted to get more information on skin cancer, 104 (30.6%) people said that they were printed handout, 142 (41.8%) were visit to dermatologists, 52 (15.3%) were photos of skin symptoms, and 42 (12.3%) were phone calls. Conclusion: This result showed that people are little known about risk factor of skin cancer such as sunlight and artificial tanning. However, we found that through education, people's perceptions could change. The education on behavior for skin cancer prevention should be continued so that the awareness of the risk of skin cancer can be changed.

급성 심근경색 : Gd-DTPA 조영증강 자기공명영상 Gd-DTPA Enhanced Magnetic Resonance Imaging

정경일,김제현,이창호,이영주,김한수,소동문,이영돈,박경주,왕희정,탁승제,이철주,김선용,김옥화,임태환,문창현,최병일,서정호 아주대학교 의과학연구소 1996 아주의학 Vol.1 No.1

This study was undertaken to determine the value of gadolinium dimeglumine (Gd-DTPA) enhanced MRI in the diagnosis of acute myocardial infarction. Seven cats were subjected to 2 hours of left anterior descending coronary arteryocclusion (group 1) and 8 cats to 1 hour of occlusion (group 2). Reperfusion was followed by taking Tl-weighted MR images at 5, 15, 30, 45, 60 minutes after Gd-DTPA (0.2 mmol/kg) injection. Myocardial enhancement patterns were categorized into three zones (central ischemic, peripheral ischemic, and normal) or two zones (ischemic and normal) and the presence of injured myocardium in each zone was confirmed by 2,3,5-triphenyltetrazolium chloride (TTC) staining. Signal intensity (SI) of each zone was evaluated relative to back muscle in regard to its chronological changes and difference among the zones. Group 1 displayed three zones of enhancement in 6 cats whereas 1 cat in group 1 and all in group 2 showed two zones of enhancement. Intermediate SI central zone was compatible but smaller than TTC nonstained area, and determined to be a persistently occlusive injury. High SI peripheral zone in group 1 and high SI ischemic zone in group 2 were stained and determined as reperfused injury although reversibility was not definite. The peak SI, occurring 15 minutes after Gd-DTPA injection, of 2.47±0.48 at peripheral zone was greater than that of 1.66±0.36 at central zone in group 1 and of 1.81±0.41 at ischemic zone in group 2 (p < 0.05). SI of injured myocardium increased more rapidly and decreased more gradually than that of normal myocardium. That the features of SI change with time in injured myocardium was compatible with the results of other studies using different contrast agents. Gd-DTPA enhanced MRI differentiated persistently occlusive injury as central intermediate SI, and reperfused injury as homogenous high SI, with the maximal contrast between the two at 15 minutes after contrast injection, thus indicating the value of Gd-DTPA enhanced MRI in the diagnosis of acute myocardial infarction.