Symposium 6-4 (SYP 6-4) : Histopathologic diagnosis of fungal infections

박준수 ( Joonsoo Park ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Dermatomycosis, generally known as fungal infection of skin, includes fungal infection to the subcutaneous tissue on a broader level. It is categorized into superficial and deep infection depending on the depth and the symptoms presented. One of the most common pathological diseases is tinea which is a type of superficial dermatomycosis. KOH smear and fungal culture are readily used for diagnosis whereas histopathological examination is often overlooked despite its high diagnostic values. Skin biopsy is one of the more basic diagnostic methods in the field of dermatology. However majority of dermatomycosis which is tinea dwells classical presentation and is often diagnosed through KOH test or fungal culture without histological examination. Skin biopsy is required when the symptoms are indecisive and vague. Since indicated skin biopsy often result in fungal infection, it is important to be aware of the clinical correlation and pathologic characteristics of fungal infection in order not to miss any possible fungal infection. Once it is overlooked, both diagnosis and treatment cannot be properly delivered. Generally the most common case of skin biopsy conducive in superficial dermatomycosis is tinea incognito which presents non-classical clinical traits caused by inappropriate use of steroids. In use of histological study, the examiner must carefully look for sandwich sign on stratum corneum and the hair follicle, a commonly invaded site in the skin. Deep fungal infection applies to fungal infection to the level below dermis or even to the muscular layer that may damage other organs as well. This level of infection usually takes a chronic course and often results in granulation change of the tissue. Therefore, a more discrete observation around the inflammation in addition to findings of non-inherent structures is helpful. In addition, the morphological components including the cell wall and other structures of the fungus are stained differently from that of the human. Therefore, special staining methods such as PAS/D-PAS, Grocott, Methenamine silver are known to be conducive in diagnosing fungal infections. Skin biopsy may not be an essential method in dermatomycosis. However, whenever the lesion is unclear or vague, skin biopsy generates a wide range of information. Characteristic information of fungal infection obtained through biopsy, however, is only meaningful under clinical suspicion for disease ultimately increasing sensitivity of the exam. Therefore it is crucial for a clinician to be aware of fungal infection every time for every biopsy performed.

AHP를 이용한 대안 평가의 유의성 분석

박준수(Joonsoo Park),김성철(Sung-Chul Kim) 한국전자거래학회 2017 한국전자거래학회지 Vol.22 No.1

공공사업 타당성 평가나 대안 선정에서는 대부분 AHP 기법을 활용하여 대안별 가중합 방식으로 최종 점수를 산정하고 그 값이 가장 큰 대안을 선택하고 있다. 특히 타당성 분석과 같은 경우에는 최종 점수가 0.5보다 큰 대안을 선택하게 되는데, 그 값이 0.5보다 얼마나 커야 의사결정이 의미있고 설득력있는 판단이라고 할 수 있는지에 대한 합리적인 기준 없이 적용되고 있다. 한국개발연구원(KDI)에서 제시한 방법론에는 사업진행 대안의 종합 점수가 0.5 근처에 있는 경우를 회색 영역으로 구분하여 신중한 결정을 하도록 제시하고 있는데, 세부 기준에 관한 이론적 검토는 빈약하다. 반면, 통계적 검정의 개념을 도입하여 시도된 분석 사례에서는 가중합 평가 점수의 확률분포로서 정규분포 또는 베타분포를 가정하였으나, 이에 대한 분포적 타당성은 제시되지 않았다. 본 논문에서는 현재 다양한 분야에서 적용되고 있는 가중합 평가 방식의 사례를 검토하여 그 결과의 통계적 검정의 필요성을 제기하고, 통계적 검정을 위하여 특정 분포를 가정하지 않는 비모수적 검정 방법을 제시한다. 그리고 본 연구에서 제시한 방법을 국방 분야의 사례에 적용하고 그 함의와 함께 향후 연구의 발전방향을 제안한다. The method of weighted sum of evaluation using AHP is widely used in feasibility analysis and alternative selection. Final scores are given in forms of weighted sums and the alternative with largest score is selected. With two alternatives, as in feasibility analysis, the final score greater than 0.5 gives the selection but there remains a question that how large is large enough. KDI suggested a concept of ‘grey area’ where scores are between 0.45 and 0.55 in which decisions are to be made with caution, but it lacks theoretical background. Statistical testing was introduced to answer the question in some studies. It was assumed some kinds of probability distribution, but did not give the validity on them. We examine the various cases of weighted sum of evaluation score and show why the statistical testing has to be introduced. We suggest a non-parametric testing procedure which does not assume a specific distribution. A case study is conducted to analyze the validity of our suggested testing procedure. We conclude our study with remarks on the implication of analysis and the future way of research development.

Skin biopsy and special stains

박준수 ( Joonsoo Park ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Latest updates on bacterial skin and soft tissue infections: Cellulitis, erysipelas, necrotizing fasciitis

박준수 ( Joonsoo Park ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

Bacterial skin and soft tissues infections often determine acute disease and frequent emergency recovering, and they are one of the most common causes of infection among groups of different ages. Although specific bacteria may cause a particular type of infection, a considerable overlap in clinical presentations remains. According to the depth of the infection, bacterial skin infections can be classified into superficial infections, involving epidermis and.or dermis, and deep infections, extending from deep dermis to subcutaneous adipose tissue, muscular fascia and muscle. This review discusses about the differences among cellulitis, erysipelas and necrotizing fasciitis and provide a rational diagnostic and therapeutic approach to these infections. 1) Erysipelas : A soft tissue infection involving the upper dermis. When compared with other soft tissue skin infections erysipelas has more distinct margins. Patients with mild infection may be treated with oral penicillin or amoxicillin. Macrolides have also traditionally used but may not be adequate therapy in area with relatively high resistance rates among ß-hemolytic streptococci. Patients with systemic manifestations such as fever or chills, should be treated with parenteral therapy and appropriate choices include ceftriaxone or cefazolin. 2) Cellulitis : A skin infection involving the deeper dermis and subcutaneous fat. Typical cases without systemic signs of infection should be treated with antistreptococcal antimicrobial agents (cephalexin, dicloxacillin, penicillin, amoxicillin/clavulanate, clindamycin) and vancomycin or other agents (linezolid and tedizolid) with activity against both streptococcal and MRSA infections should be used in severe cases of cellulitis. In cases of cellulitis unresponsive to conventional therapy, antibiotic resistance, atypical cases, or pseudocellulitis should be considered. 3) Necrotizing fasciitis : A deep skin infection that results in progressive destruction of the muscle fascia. The affected area may be erythematous, swollen, warm and exquisitely tender. Pain out of proportion to exam findings may be observed. The diagnosis is established surgically with visualization of fascial planes. Management of the infection begins with broad-spectrum antibiotics (ampicillin/surbactam, 3rd or 4th generation cephalosporins, clindamycin, metronidazole, carbapenems), but early and aggressive drainage and meticulous debridement constitute the mainstay of treatment.

Quiz 1

박준수 ( Joonsoo Park ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

A 29-day-old infant presented with multiple targetoid erythematous patches for 3 weeks. The patient had no specific complication of birth history and the mother had no underlying medical condition at the latest medical checkup. Initially the lesion started as multiple targetoid patches overlying the scalp, face, neck and extremities. Antibiotics had already been prescribed from another hospital and were ineffective. After two weeks, the lesions were reduced in number. However, the remaining lesions had progressed with scales and displayed large round edematous plaques featuring shapes of an owl`s eye.

The effect of electric stimulation on fungal growth

박준수 ( Joonsoo Park ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Infectious diseases of various pathogens are commonly encountered conditions in the field of dermatology. Numerous studies have been investigated for achieving precision and efficacy of the diagnosis. However a large number of studies are heavily focused on modification and precision of bacterial growth, with limited modalities precise for fungal differentiation. Although, the optimal method of identifying fungal infection is through culture study, it is time consuming and defers appropriate time for diagnosis. Recently micro-current electricity has been reported to accelerate the growth of bacteria with limited underlying mechanism to be clarified. The authors have applied the same method to fungal species and have scrutinized positive outcome. Lower intensities of electric current caused faster fungal growth. Based on the results of our study, micro-current electric stimulation may be applied to fungal culture and generate potential clinical benefits in respect. In elaboration, the time elapsed for colonization of fungus could be considerably reduced and provide appropriate manage to the patients in a more prompt manner.

Quiz 8

박준수 ( Joonsoo Park ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Rib이 설치된 나선형 코일에서의 열전달 증진

오인선(Inseon Oh),박준수(Joonsoo Park),김일권(Ilgwon Kim),강창우(Changwoo Kang) 대한기계학회 2021 대한기계학회 춘추학술대회 Vol.2021 No.11

The heat transfer in a helical coil with ribs of triangular cross-section periodically mounted on the wall in the streamwise direction is examined by numerical simulations. The pitch ratio and curvature of the helical coil is fixed, while the distance of neighboring ribs is varied to investigate the effect of the mounted ribs on the flow and heat transfer. The heat transfer and friction coefficients are evaluated for various values of pitch between neighboring ribs. It turns out that the periodic ribs enhance the heat transport in the core of the helical coil.

청소년 정신과 입원 환자들의 피부과 자문 의뢰에 관한 행태 분석 및 고찰

권현정,조현영,김영일,박경덕,정현,박준수,Kwon, Hyunjung,Jo, Hyunyoung,Kim, Youngil,Park, Kyungduck,Chung, Hyun,Park, Joonsoo 한국정신신체의학회 2015 정신신체의학 Vol.23 No.1

연구목적 정신신체의학의 발전으로 최근에는 모든 신체적 질환에 대해 생물정신사회적 접근을 추구하고 있다. 그 중 피부과 영역에서는 원형탈모증, 아토피 피부염, 발모벽, 인공 피부염, 다한증, 만성 담마진, 건선, 심상성 좌창 등의 질환과 정신과적 질환과의 연관성이 특히 강조되며, 정신 피부질환(Psychocutaneous disease)이라는 명칭이 사용되나 아직 이에 대한 연구가 미미하다. 청소년기는 2차 성징으로 인해 많은 피부 증상이 발생할 수 있으며, 이는 자아상 형성에 영향을 미칠 수 있으므로, 청소년의 피부질환에 대한 적절한 중재 및 치료의 중요성이 더욱 강조된다. 이에 저자들은 정신과 청소년 환자들의 피부과적 질환의 특성을 알아보기 위해 정신과에서 피부과로 자문 의뢰되는 청소년 환자들의 자문의뢰의 행태를 분석하고자 하였다. 방 법 대학병원에서 정신과에 입원중인 청소년 환자 중 피부과에 의뢰된 22명의 환자와 타과에서 의뢰된 108명의 환자를 대상으로 연령별 및 성별 분포, 자문율, 이환된 피부질환, 자문이유를 비교 분석하였다. 결 과 정신과 입원 환자 중 피부과로 자문 의뢰된 환자들의 평균나이는 15.9세로 관찰되었으며, 남성과 여성의 비율은 1:1.44로 관찰되었다. 정신과에서 의뢰된 청소년 환자들의 진단의 경우 정신과적으로는 기분장애(59.1%), 피부과적으로는 여드름(40.9%)이 가장 많았다. 타과 청소년에 비해 정신과 청소년 환자의 피부과로의 자문율이 유의하게 높았고(11.8% vs. 1.5%), 환자의 요청에 의해 자문이 의뢰되는 비율도 높은 것으로 나타났다(49.9% vs. 16.7%). 결 론 다양한 정신병리적인 문제와 피부과적 질환이 연관되어 환자에게 영향을 미칠 수 있다. 피부과에서는 환자의 거부나 의사의 항정신약물 사용 시작에 불편감을 이유로 질환 치료가 지연될 수 있고, 정신과에서는 피부 문제를 경미한 증상으로 생각하여 간과할 수 있으므로, 두 과 간의 적절한 정보 교환 및 협진 체계를 마련하여 생물정신사회적 접근이 필요할 것으로 보인다. Objective:To review the patterns of the dermatologic consultations of psychiatric adolescent inpatient and to explore the relationship between the dermatologic disorders and psychiatric disorders. Methods:We retrospectively studied the data from 22 cases referred by psychiatric adolescent for a dermatologic consultation over 10 years in Daegu Catholic University Medical Center and compared with the data from 108 cases referred by the other department adolescent patients. Results:The mean age of patients was 15.9. The male to female ratio was 1:1.44. The most common psychiatric and dermatologic disorder was major depressive disorder and acne, respectively. The most frequent reason for consultation was to ask for dermatologic disease or condition(54.5%) followed by to perform cosmetic procedure of patients need(40.9%) and to perform dermatologic test(4.6%). Conclusions:More than just a cosmetic disfigurement, dermatologic disorders are associated with a variety of psychopathologic problems that can affect the patient. Increased understanding of biopsychosocial approaches and liaison among psychiatrists and dermatologists could be beneficial.

VDRL 역가 변화를 기준으로 시행한 Syphilis 치료 약제의 효과 비교

이정수 ( Jeongsoo Lee ),나누리 ( Nuri Na ),박준수 ( Joonsoo Park ) 대한피부과학회 2020 大韓皮膚科學會誌 Vol.58 No.9

Background: Despite the increasing number of syphilis cases, there has been a considerable lack of recent data comparing the efficacy and duration of benzathine penicillin G, ceftriaxone, and tetracycline in Korean patients. Objective: To compare the efficacy and duration of benzathine penicillin, ceftriaxone, and tetracycline in Korean patients with syphilis. Methods: We retrospectively reviewed 145 cases of syphilis from 2004 to 2019 and statistically analyzed the treatment efficacy and duration. Results: Patients in the benzathine penicillin, ceftriaxone, and tetracycline treatment groups showed no significant statistical difference in terms of treatment rate (chi-square test, p=0.962). Similarly, treatment duration among groups was not statistically significant (one-way analysis of variance, p=0.792). Co-infection with human immunodeficiency virus resulted in reduced treatment rate (p=0.016) and increased treatment duration (p=0.007). Conclusion: This retrospective study showed no significant difference between penicillin, ceftriaxone, and tetracycline in terms of treatment rate and duration. However, a difference in treatment rate and duration was evident between the non-infection and HIV co-infection groups. (Korean J Dermatol 2020;58(9):590∼595)