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전재헌 ( Jae Hun Jun ),이석종 ( Seok Jong Lee ),장용현 ( Yong Hyun Jang ),이원주 ( Weon Ju Lee ),김도원 ( Do Won Kim ),이재혁 ( Jae Hyuck Lee ) 대한피부과학회 2011 大韓皮膚科學會誌 Vol.49 No.8
Background: Epidermal cysts seldom arise on the palm or sole because of the absence of pilosebaceous apparatus in palmoplantar skin. Palmoplantar epidermal cysts (PPECs) are not included in this location`s tumor category, because they appear as slightly elevated, hardly movable dermal or subcutaneous nodules without a central punctum, unlike other epidermal cysts. As a result, PPECs often mimic corns, calluses, or verruca. Objective: The purpose of this study was to review the clinical features of PPECs and to explore the usefulness of ultrasonography as a diagnostic tool. Methods: We retrospectively reviewed the medical records and ultrasonographic findings of 31 patients with PPECs among 341 patients with a confirmed epidermal cyst. Among them, 12 patients were evaluated preoperatively by ultrasonography. The data were compared between the ultrasonographic diagnosis and the final diagnosis. Results: Unlike previous reports, PPECs were relatively common, and comprised 9.1% (31/341) of all epidermal cysts. They also appeared more on the sole than on the palm. In addition, PPECs were confused with corns, calluses, and other benign tumors at the first visit, because of their different clinical features from ordinary epidermal cysts. However, preoperative ultrasonography of 12 cases enabled us to make a correct diagnosis. After the operation, no recurrence was found at the last follow-up in any of the patients. Conclusion: PPECs have some different clinical features compared to typical epidermal cysts with a non-palmoplantar location. Therefore, it is often difficult to distinguish PPECs from other benign tumorous conditions. However, ultrasonography was useful for the preoperative diagnosis of PPECs because of its safety, low cost, non-invasiveness and, most importantly, its accuracy. (Korean J Dermatol 2011;49(8):707∼713)
4세 여아의 거대 선천멜라닌세포모반에서 발생한 악성흑색종
전재헌 ( Jae Hun Jun ),정한진 ( Han Jin Jung ),이석종 ( Seok Jong Lee ),이원주 ( Weon Ju Lee ),김도원 ( Do Won Kim ),박진영 ( Jin Young Park ),김명화 ( Myung Hwa Kim ),박병철 ( Byung Cheol Park ) 대한피부과학회 2011 대한피부과학회지 Vol.49 No.12
Melanoma may arise from a very giant congenital melanocytic nevus even in the first several years of life. Therefore, excision of a giant congenital melanocytic nevus should be considered as early as possible. However considering surgical and anesthetic risks, the surgery can wait until after the first 6 months of life. Unfortunately, surgical treatment does not completely prevent occurrence of melanoma from a giant congenital melanocytic nevus. Besides, several cases of melanoma occurring after blunt trauma or laser therapy have been reported. We report a case of malignant melanoma associated with a giant congenital melanocytic nevus in a 4-year-old female. The malignant melanoma occurred at the boundaries of the previous surgical excision and laser therapy sites for a giant congenital melanocytic nevus. This is the youngest case of malignant melanoma developed from a congenital melanocytic nevus in the Korean dermatological literature. (Korean J Dermatol 2011;49(12):1102~1106)
피부상처 또는 수술부 결손에서 Maggot을 이용한 생물학적 치료
전재헌 ( Jae Hun Jun ),정한진 ( Han Jin Jung ),임현정 ( Hyun Jung Lim ),이원주 ( Weon Ju Lee ),이석종 ( Seok Jong Lee ),김도원 ( Do Won Kim ) 대한피부과학회 2011 대한피부과학회지 Vol.49 No.10
Background: Maggots are larva of Phaenicia Sericata, the Green Blowfly, and treatments with maggot have recently become widespread revealing their effectiveness in the treatment of chronic wounds, such as diabetic ulcers and pressure sores, by removing necrotic tissue selectively and avoiding damage of healthy tissue. Objective: The aim of this study was to evaluate the usefulness and the adverse effects of maggot therapy in dermatology for the treatment of chronic wounds and rapid granulation tissue formation at postoperative defects before reconstruction. Methods: Fourteen patients with various kinds of skin wounds were included and applied a biobag containing therapeutic maggots on their wounds. Results: Four cases were included for treatment of acute and chronic skin wounds; 10 cases of surgical defects were included for reduction of the treatment period. Maggot therapy periods ranged from 4 to 17 days (mean: 8.3 days). Complete elimination of necrotic tissue was achieved in 7 cases (50%) and partial elimination was achieved in 7 cases (50%). There weren`t any cases of incomplete elimination or no response. Eight cases (57.1%) were in the ``excellent`` group which had shown rapid granulation tissue formation and 3 cases (21.4%) were in the ``good`` group, which had shown relatively rapid granulation tissue formation. But, there were 3 cases (21.4%) which had shown no difference from the previous time. Acute complications such as pain and bleeding had occurred in a few cases after maggot therapy. Conclusion: We suggest that the maggot therapy is a useful and effective method to use in the field of dermatology. (Korean J Dermatol 2011;49(10):901∼906)
임현정 ( Hyun Jung Lim ),전재헌 ( Jae Hun Jun ),이재철 ( Jae Chul Lee ),김병수 ( Byung Soo Kim ),이원주 ( Weon Ju Lee ),이석종 ( Seok Jong Lee ),김도원 ( Do Won Kim ) 대한피부과학회 2009 대한피부과학회지 Vol.47 No.7
Herpes zoster is characterized by multiple groups of vesicles on an erythematous base located within the distribution of a single spinal or cranial sensory ganglion. Classically, herpes zoster occurs in elderly patients, distributed unilaterally within one dermatomal area. The response to antiviral treatment is usually good, with rare recurrence. Herein we report 5 cases of atypical herpes zoster, which showed non-ordinary clinical features of the onset age, location and distribution, clinical course and treatment response. Moreover, since herpes zoster is a viral disorder in dermatologic clinics, different treatment protocols according to various underlying conditions are crucial. Therefore, we reviewed pertinent remedies under such uncommon circumstances. (Korean J Dermatol 2009;47(7):803~810)
우측 엄지의 피부악성흑색종 치료 22년 후 발생한 우측 액와부의 전이성 흑색종으로 추정되는 Ultra-Late Recurrence의 가능성에 대한 고찰
임현정 ( Hyun Jung Lim ),전재헌 ( Jae Hun Jun ),김호연 ( Ho Youn Kim ),이원주 ( Weon Ju Lee ),김도원 ( Do Won Kim ),이석종 ( Seok Jong Lee ),채의수 ( Yee Soo Chae ) 대한피부과학회 2010 대한피부과학회지 Vol.48 No.4
The recurrence of late onset cutaneous melanoma is not a common phenomenon. Ultra-late recurrence, which is defined as recurrence more than 15 years after initial treatment, is especially rare. A patient presented with a 2-month history of firm subcutaneous tumors in his right axilla. He had been diagnosed with melanoma of his right thumb 22 years ago, treated with amputation of the right thumb and partial ipsilateral axillary node dissection; there had been no previous recurrences. The present biopsy of the right axilla revealed lymph nodes occupied by melanoma cells. Distant metastasis was revealed on PET-CT and included the lung, pancreas and abdominal lymph nodes. Three possible explanations were proposed: (i) ultra-late recurrence of primary melanoma; (ii) axillary metastases from primary malignant melanoma of internal organ(s); (iii) axillary metastases of another unknown primary cutaneous melanoma which had completely regressed. After careful consideration, we concluded the most probable diagnosis to be ultra-late recurrence and report this case with reviews of late and ultra-late recurrence of melanoma. (Korean J Dermatol 2010;48(4):334~338)
사구정맥기형(Glomuvenous Malformation) 5예
임현정 ( Hyun Jung Lim ),전재헌 ( Jae Hun Jun ),이재철 ( Jae Chul Lee ),김병수 ( Byung Soo Kim ),이원주 ( Weon Ju Lee ),이석종 ( Seok Jong Lee ),김도원 ( Do Won Kim ),정호윤 ( Ho Yun Chung ),배한익 ( Han Ik Bae ),이종민 ( Jong Min 대한피부과학회 2010 대한피부과학회지 Vol.48 No.3
Glomuvenous malformation (GVM), an uncommon variant of venous malformation (VM), reveals dilated venous channels lined by variable amounts of glomus cells histopathologically. It appears as compressible blue or blue-purple nodules or plaque(s), sometimes showing a familial tendency. GVM usually involves only the superficial layer of the cutis or subcutaneous tissue, unlike VM, which frequently involves deeper tissue. Although GVM shares features of VM and glomus tumor, their clinicopathological and/or genetic features are sufficiently distinctive to enable a differential diagnosis, which is important for management decisions. Herein, we report five patients who showed a large confluent patch or several scattered patches composed of tender bluish blebs. Two patients among them were siblings. Histopathological and immunohistochemical examinations confirmed GVM. (Korean J Dermatol 2010;48(3):220~227)
켈로이드와 비대흉터에서 스테로이드, 5-fluorouracil 병변내 주사 및 색소 레이저 병용요법에 관한 비교 연구
김호연 ( Ho Youn Kim ),임현정 ( Hyun Jung Lim ),전재헌 ( Jae Hun Jun ),최윤석 ( Yoon Seok Choe ),김병수 ( Byung Soo Kim ),이원주 ( Weon Ju Lee ),이석종 ( Seok Jong Lee ),김도원 ( Do Won Kim ) 대한피부과학회 2009 대한피부과학회지 Vol.47 No.6
Background: Despite the physical disfigurement, bothersome symptoms and psychological problemsfrom the proliferative scarring process of keloids and hypertrophic scars, there is currently no consensus regarding the best management of these lesions. Objective: The purpose of this study was to determine the therapeutic efficacy and safety of intralesional corticosteroid injection combined with 5-fluorouracil (5-FU) and/or pulsed dye laser (PDL) in Koreans with keloids or hypertrophic scars. Methods: Twenty-five patients with keloids and/or hypertrophic scars over 2 cm in size or who had more than 3 separated lesions were included in this study. Each scar was divided equally into 2 or more segments and these were treated with 1 of the following 3 different modalities: (1) intralesional injection of triamcinolone acetonide (TCA: 20 mg/ml weekly), (2) intralesional injection of TCA 0.1 ml (40 mg/ml) mixed with 5-FU 0.9 ml (50 mg/ml) weekly and (3) treatment #2 combined with PDL (585 nm, 5∼7.5 J/cm2) at baseline and at the 3rd and 7th weeks. We estimated the change of the height, the erythema, the pliability, the pruritus, the pain/tenderness scores, the patient-self assessment and the complications. This study was an 8-week prospective study and the assessment of relapse was done at 4 and 12 weeks after the last treatment. Results: There was a statistically significant improvement of the clinical signs and symptoms in all the treated groups. However, the 5-FU-treated groups had more sustained effects compared to the group that underwent TCA monotherapy with respect to flattening and pliability. Complications such as ulcerations, crusts and hyperpigmentation were more frequent in the 5-FU-treated groups. Conclusion: Although 5-FU may be preferable to TCA for improving the symptoms of keloids and hypertrophic scars, we believe it is prone to induce more complications in Koreans. (Korean J Dermatol 2009;47(6):658∼666)