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Hyeon Sook Jee,Keoung Ah Kim,Woo Seog Sim,Dae Won Lee,Jin Young Lee 대한통증연구학회 2020 International Journal of Pain Vol.11 No.2
Spontaneous intracranial hypotension (SIH) is characterized by orthostatic headache, nausea, vomiting, and blurred vision. Rarely, behavioral or consciousness changes, parkinsonian symptoms, and/or coma manifest. The use of an epidural blood patch (EBP) is generally considered for sealing a cerebrospinal fluid (CSF) leak. Herein we report a case of progressive altered consciousness due to severe SIH that was managed with an EBP. Brain magnetic resonance imaging depicted diffuse pachymeningeal enhancement with bilateral subdural hemorrhage, consistent with SIH. She was diagnosed with brain sagging due to SIH. An EBP was performed at C7- T1 and she was discharged with improvement; however, 1 day after discharge she visited the emergency room exhibiting aggressive behavior and cognitive changes. Whole spine magnetic resonance imaging revealed CSF leakage at T1-T5, and she was diagnosed with recurred SIH with SDH. EBP was performed at T2-T3 level with autologous blood. Follow-up myelography depicted improvement of the CSF leakage at the T spine level. Targeted EBP may be suitable for alleviating severe SIH-induced confusion and altered consciousness.
( Hyeon Young Park ),( Je Jung Lee ),( Jee Bum Lee ),( Seong Jin Kim ),( Seung Chul Lee ),( Young Ho Won ),( Sook Jung Yun ) 대한피부과학회 2011 Annals of Dermatology Vol.23 No.2s
Castleman`s disease (CD) is an uncommon B-cell lymphoproliferative disorder characterized by lymph node hyperplasia with vascular proliferation. Cutaneous involvement in CD is rare. A 65-year-old man presented with a 7-year history of gradually developing multiple reddish to violaceous indurated plaques on the scalp, trunk, and legs. On physical examination, there were palpable enlarged cervical, axillary, and inguinal lymph nodes. Laboratory examination revealed anemia, thrombocytosis, hyperproteinemia, hypoalbuminemia, and polyclonal hypergammaglobulinemia. An inguinal lymph node biopsy and a skin biopsy were performed and the patient was diagnosed with the plasma cell type of CD. Chemotherapy was started and the lesions have responded to treatment. (Ann Dermatol 23(S2) S169~S174, 2011)
Anti PD-1 immunotherapy-induced psoriasis and vitiligo in cancer patients
( Hyeon Bin Kim ),( Seung-chul Lee ),( Young Ho Won ),( Jee-bum Lee ),( In-jae Oh ),( Sook Jung Yun ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1
A 59-year-old man presented with pruritic erythematous plaques on his scalp, abdomen, and right forearm from 1 month prior. The patient underwent total gastrectomy for gastric adenocarcinoma 1 year ago and received nivolumab(Opdivo<sup>®</sup>) treatment from 1 month after the surgery. Histopathologic findings were compatible with psoriasis. A 64-year-old man presented with whitish depigmented patches on hands and scrotum from 1 year prior. The patient had lung adenocarcinoma with brain metastasis and received pembrolizumab(Keytruda<sup>®</sup>) treatment from Sep 2017 to Oct 2018. The skin lesions appeared 5 months after 1st injection and partially improved after discontinuance of treatment. Melan-A stain was negative in skin biopsy and showed absence of melanocytes. Therefore, we diagnosed nivolumab-induced psoriasis and pembrolizumab-induced vitiligo respectively. Nivolumab and pembrolizumab are anti-programmed cell death protein 1 (PD-1) monoclonal antibody, known as immune checkpoint inhibitors. As PD-1 acts as an immune-modulating receptor that down-regulates T-cell activity, the inhibition of the PD-1 pathway can result in overactivation of T-cell function. These observations suggest that the psoriasis might have been induced by the up-regulated Th1/Th17 cell activities and vitiligo might have been induced by activation of cytotoxic T cell. Herein we report two cases of psoriasis and vitiligo induced by anti PD-1 immunotherapy in cancer patients
Hyeon-Young Park,Je-Jung Lee,Jee-Bum Lee,Seong-Jin Kim,Seung-Chul Lee,Young Ho Won,Sook Jung Yun 대한피부과학회 2011 Annals of Dermatology Vol.23 No.-
Castleman’s disease (CD) is an uncommon B-cell lymphoproliferative disorder characterized by lymph node hyperplasia with vascular proliferation. Cutaneous involvement in CD is rare. A 65-year-old man presented with a 7-year history of gradually developing multiple reddish to violaceous indurated plaques on the scalp, trunk, and legs. On physical examination, there were palpable enlarged cervical, axillary,and inguinal lymph nodes. Laboratory examination revealed anemia, thrombocytosis, hyperproteinemia, hypoalbuminemia,and polyclonal hypergammaglobulinemia. An inguinal lymph node biopsy and a skin biopsy were performed and the patient was diagnosed with the plasma cell type of CD. Chemotherapy was started and the lesions have responded to treatment. (Ann Dermatol 23(S2) S169∼S174, 2011)
Mortality and Comorbidity Profiles of Patients with Bullous Pemphigoid in Korea
( Hyeon Woo Jeon ),( Sook Jung Yun ),( Seung-chul Lee ),( Young Ho Won ),( Jee-bum Lee ) 대한피부과학회 2018 Annals of Dermatology Vol.30 No.1
Background: Bullous pemphigoid (BP) is a common autoimmune- mediated blistering skin disease that is significantly associated with mortality and morbidity. However, few studies regarding the mortality and comorbidity profiles of BP have been reported in Korea. Objective: To evaluate and compare the mortality, comorbidity profiles, and risk factors between patients with BP who visited our clinic and an age-matched general population of Korea. Methods: We retrospectively evaluated 103 patients diagnosed with BP between 2006 and 2013 at Chonnam National University Hospital in Gwangju, Korea. Results: The 1-year, 2-year, and 5-year mortality rates of the patients were 18.44%, 28.16%, and 42.00%, respectively. The median age was 76 years (range, 41∼96 years). The standardized mortality ratio of patients with BP was 1.83 times that of the age- and sex-matched general population of Korea. Old age at the time of diagnosis, cardiac disease and renal disease were associated with increased 5-year mortality. In addition, the prevalence of diabetes, stroke, dementia, and Parkinson’s disease was higher among BP patients than in the general population. Conclusion: The mortality rate of patients with BP is higher than that of the general Korean population. Korean patients with BP are more likely to have dementia, Parkinson’s disease, diabetes, and stroke. Risk factors for increased 5-year mortality include old age at the time of diagnosis and medical comorbidities, especially cardiac disease and renal disease. (Ann Dermatol 30(1) 13∼19, 2018)
A case of unilateral punctate plantar keratoderma accompanied with calcinosis cutis
( Hyeon Bin Kim ),( Sook Jung Yun ),( Seung-chul Lee ),( Young Ho Won ),( Jee-bum Lee ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1
A 1-year-old boy presented with yellowish diffuse hyperkeratotic patch with a lot of tiny pits and variable sized keratotic papules on the right sole since birth. There was no lesion on the other palm or sole. When he was born, there was only yellow patch on his right sole. However, many tiny pits and yellowish keratotic papules appeared on patch lesion as he grew. He has no family history or past history of genetic disorders. At the first visit, we treated him with topical antibiotics and urea cream. After 1 month follow-up, there was no remarkable improvement. Therefore, we performed skin biopsy and bacterial culture. The histopathologic examination of the papules showed hyperkeratosis and acanthosis with focal subepithelial calcification. Also, there was no growth of any bacteria on the sole. Therefore, He was diagnosed as punctate keratoderma with calcinosis cutis. We used topical keratolytics. The skin lesions were partially resolved. Punctate palmoplatar keratoderma manifests as multiple hyperkeratotic papules on both palms and soles. They are usually inherited in an autosomal dominant pattern. However, our case is unique in that, it occurred sporadically and confined to right sole. And also it was accompanied with calcinosis cutis. Herein, we report a rare case of unilateral punctate plantar keratoderma accompanied with calcinosis cutis in 1-year-old toddler.
[P492] Six cases of pigmented contact dermatitis caused by henna dyeing; Lichenoid dermatitis
( Hyeon Woo Jeon ),( Jee-bum Lee ),( Seong-jin Kim ),( Seung-chul Lee ),( Young Ho Won ),( Sook Jung Yun ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1
Henna is a natural dye made from the leaves of the tree Lawsonia inermis. Actually, henna has a very low allergic potential and contact dermatitis to pure henna hair dye has been reported extremely rarely. But recently, several cases of contact dermattitis due to henna were reported. We experienced 6 cases of pigmented contact dermatitis caused by henna dyeing. All patients are middle-aged women with recent history of henna dyeing. They presented with rapidly spreading dark brownish patches on the face and neck, which appeared several months to years ago. The histopathologic examination of these patients showed lichenoid dermatitis with inflammation and melanin incontinence in common. This histologic feature is like lichenoid drug eruption or lichenoid contact dermatitis. These diseases commonly manifest postinflammatory hyperpigmentation. The active ingredient of henna is lawsone (2-hydroxy-1, 4-naphthoquinone), which may induced lichenoid dermatitis like other agents inducing lichenoid drug eruption. We report these rare cases of pigmented contact dermatitis caused by henna dyeing and dermatologist shoud consider henna dyeing as the cause of pigmentation of the face and neck.
( Hyeon Woo Jeon ),( Eui Young Na ),( Sook Jung Yun ),( Seung-chul Lee ),( Jee-bum Lee ) 대한피부과학회 2018 Annals of Dermatology Vol.30 No.6
Background: Citron is well known for an abundance of antioxidative and anti-inflammatory ingredients such as vitamin C, polyphenol compounds, flavonoids, and limonoids. Objective: In this study, we aimed to evaluate the effects of citron essential oils on rosacea mediators in activated keratinocytes in vitro. Methods: Normal human epidermal keratinocytes (NHEKs) were stimulated with 1α, 25-dihydroxyvitamin D<sub>3</sub> (VD<sub>3</sub>) and interleukin 33 (IL-33) with LL-37 to induce rosacea mediators such as kallikrein 5 (KLK5), cathelicidin, vascular endothelial growth factor (VEGF), and transient receptor potential vanilloid 1 (TRPV1). These mediators were analyzed by performing reverse-transcription polymerase chain reaction (PCR), quantitative real-time PCR, immunocytofluorescence and enzyme-linked immunosorbent assay after NHEKs were treated with citron seed and unripe citron essential oils. Results: The messenger RNA (mRNA) and protein levels of KLK5 and LL-37 induced by VD<sub>3</sub> were suppressed by citron seed and unripe citron essential oils. Furthermore, the mRNA and protein levels of VEGF and TRPV1 induced by IL-33 with LL-37 were also suppressed by citron essential oils. Conclusion: These results show that citron essential oils have suppressive effects on rosacea mediators in activated epidermal keratinocytes, which indicates that the citron essential oils may be valuable adjuvant ther-apeutic agents for rosacea. (Ann Dermatol 30(6) 653∼661, 2018)