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A 65-year-old Korean woman presented with a hyperkeratotic, firm, tender, and yellowish papule measuring 3 mm in diameter, which first appeared on the tip of her right thumb 2 months prior to presentation (Fig. 1A). She related a history of trauma at this site from an unknown sharp object at approximately the same time the lesion appeared. The lesion was clinically diagnosed as a foreign body reaction, excised with a skin punch, and examined histologically. Hematoxylin-eosin staining revealed that the wall of the cyst was lined with squamous cells, and the cavity was composed of keratinized lamellar material (Fig. 1B). We confirmed the diagnosis of an epidermal cyst on the distal tip of her thumb. Postoperative follow-up was unremarkable, without any complications or recurrence. Epidermal cysts have been termed infundibular cysts, suggesting that they arise from the infundibular portion of the hair follicle. Therefore, these cysts most commonly occur on hair-bearing areas of the body such as the scalp, face, neck, trunk, and scrotum. Additionally, they may rarely occur following traumatic implantation of epidermal elements into the dermis particularly on the palms and soles<sup>1-3</sup>. Burial of tissue, a secondary proliferative response to blunt trauma, and inflammation have been described as possible pathomechanisms for the development of traumatic epidermal cysts<sup>4</sup>. Human papillomavirus (HPV) infections may play a role in causing epidermal cysts. Egawa et al. have reported a case wherein an HPV-associated epidermal cyst was observed to have developed following epidermoid metaplasia of the eccrine duct epithelium<sup>5</sup>. Because our patient had a positive history of trauma with a sharp object, her cyst was clinically diagnosed as a foreign body reaction. Although histopathological examination revealed that it was an epidermal cyst, the precise mechanism of development of the cyst remains unclear. The time interval between the trauma and appearance of the lesion was too short for the growth of an epidermal cyst. Thus, we hypothesize that a traumatic or HPV-associated epidermal cyst already existed in this patient and subsequently increased in size following trauma, which acted as a trigger. Occurrence of epidermal cysts on fingers is extremely rare, and they can easily be misdiagnosed/confused with viral warts or calluses. Other differential diagnoses that should be considered for such lesions on the fingertip are ganglion cysts, mucous cysts, acquired digital fibrokeratomas, trichilemmal cysts, and glomus tumors<sup>6,7</sup>. This case highlights an unusual clinical manifestation of an epidermal cyst at an unexpected location. To the best of our knowledge, this is the first case of a hyperkeratotic, firm papule on the fingertip of a patient, which was diagnosed as a traumatic epidermal cyst. It is important that dermatologists should perform a careful physical examination without assuming a clinical diagnosis to correctly diagnose and appropriately treat papular lesions of the fingers.
A 49-year-old female patient presented with an 11-month history of edema and tenderness of the forehead. She had received an injection of a polymethylmethacrylate and crosslinked dextran filler (Licol-P<sup>Ⓡ</sup>, Chung Hwa MediPower Co. Ltd., Chunnam, Korea) to the forehead one year prior, and two additional injections were performed for correction of surface roughness. Physical examination revealed a 1.4 by 1.0 cm protruding skin-colored nodule on the forehead (Fig. 1A). A skin biopsy revealed filler material surrounded by multinucleated giant cells (Fig. 1B). This nodule was diagnosed as filler nodule. Filler nodules can form due to an inadequate injection technique and should not be confused with foreign body granulomas. Filler nodules typically appear as abrupt solitary lumps in the injected area that do not change in size over time. Often, they are well demarcated from surrounding tissue, not erythematous, and are harder than a foreign body granuloma. Intralesional steroid injections have a general tendency to be more difficult due to the nodule hardness1. They are frequently only marginally effective since the inflammatory reaction is not significant1. Filler nodules can be treated effectively with excision or wait for absorption1,2. Although multinucleated giant cells are not an emblematic indication of granulomas, they may nevertheless be created within the filler nodules in cases where the foreign material is too large to be enveloped and consumed by macrophages3. Unfortunately, the pathologic misdiagnosis of normal foreign body reactions is a significant factor leading to clinical confusion since the formation of foreign body granulomas triggered in response to fillers has not yet been well established. As a result, many dermatologists tend to misdiagnose a normal foreign body reaction to particulate material as a foreign body granuloma. To add to the confusion, particulate materials such as poly L-lactic acid, polymethylmethacrylate, and dextran filler are intentionally inserted to stimulate a foreign body reaction4,5. This case exhibits the typical clinical symptoms of a filler nodule. From a histological perspective, it was evident that the multinucleated giant cells had gathered in close proximity to the filler material. Due to this, we recommended excision of the nodule, however the patient refused treatment and preferred to wait for spontaneous absorption.
<P>Various meta-heuristic search methods have been employed to resolve the sensor arrangement problem, which is a type of NP-hard, combinational problem. However, the difficulty of weight tuning, when formulating a single objective function, is the chief obstacle to the use of the single-objective optimization methods. Although multiobjective optimization methods have been applied recently to avoid the difficulty involved in weight design, the original multiobjective optimization method still requires a greater number of generations for the solutions to converge to the optimal Pareto front. Moreover, unlike in previous works, we deal with four unknowns to define the sensor arrangement problem more practically: 1) The number of sensors is unknown, 2) no candidate is given for installation, 3) the coverage radii of sensors are variable, and 4) sensors cover a wide area in which obstacles exist in complicated arrangements. To improve the search approach for a sensor arrangement with these requirements, we first propose a representation scheme to encode the sensor arrangement problem as a set of chromosomes. Genetic operators and a repair scheme are also properly employed in the proposed encoding method. In addition, two strategies, i.e., the hierarchical fitness assignment strategy and the hybrid optimization strategy, are proposed to improve convergence. We also perform experiments with two commercial sensors to verify the proposed multiobjective optimization approach for sensor arrangement (MOASA). The results show that the proposed MOASA gives better performance than conventional search methods. The effects of the proposed strategies are investigated with additional experiments in terms of the quality of Pareto solutions.</P>
We report the case of a female patient with incomplete distal renal tubular acidosis with nephrocalcinosis. She was admitted to the hospital because of acute pyelonephritis. Imaging studies showed dual medullary nephrocalcinosis. Subsequent evaluations revealed hypokalemia, hypocalcemia, hypercalciuria, and hypocitraturia with normal acid-base status. A modified tubular acidification test with NH4Cl confirmed a defect of urine acidification, which is compatible with incomplete distal tubular acidosis. We treated our patient with potassium citrate, which corrects hypokalemia and prevents further deposition of calcium salts.
Joon-Seok Chae(채준석), Eun-Jeong Heo(허은정), Jin-Ho Park(박진호), Kyoung-Seong Choi(최경성), J. Stephen Dumler Sung-Soo Lee(이성수), Tae-Young Kang(강태영), Jae-Hyuk Yang(양재혁), Do-Young Kim(김도영), Joon-Gyu Kim(김준규), Gui-Cheol ) 한국임상수의학회 2009 한국임상수의학회지 Vol.26 No.6
국내 전주, 광주 그리고 제주에서 고양이, 더러브렛 말, 홀스테인 소로부터 진드기 매개성 인수공통 병원체인 Anaplasma phagocytophilum과 Ehrlichia chaffeensis에 대한 항체가 조사를 위하여 면역형광항체법을 이용하였다. 본 연구를 위하여 254마리의 혈청(33마리의 애완 및 길거리 고양이, 92마리의 방목장 말 그리고 129마리의 방목장 소)을 수집하였다. 33마리의 고양이 중에서 6마리가 A. phagocytophilum(titer ≥ 80)에 대한 양성항체가 검출되어 18.2%의 양성율을 나타내었으며, 1마리에 있어서는 E. chaffeensis에 대한 항체가 검출되어 3%의 양성율을 나타내었다. 소에 있어서는 129마리 중에서 1마리에서 그리고 말에 있어서는 92마리 중에서 2마리에서 A. phagocytophilum에 대한 양성항체가 검출되어 각각 0.8%와 2.2%의 양성율을 나타내었으나 E. chaffeensis에 대한 항체는 모두 음성 결과를 나타내었다. 이 결과는 국내 사육 고양이, 말 그리고 소에 있어서 A. phagocytophilum과 E. chaffeensis에 대한 혈청학적 양성결과로서 국내에서 처음 보고되는 자연감염 예이며, 진드기 서식지역의 방목동물에서는 이들 질병의 감염으로 경제성 손실이 우려되며 예방대책이 마련되어야 할 것으로 판단된다. Antibodies to Anaplasma phagocytophilum and Ehrlichia chaffeensis were detected by the immunofluorescent antibody (IFA) test in sera collected from cats, thoroughbred horses and Holstein cattle in Gwangju, Jeonju and Jeju Island of Korea. Two hundred fifty four sera (33 feral and pet cats, 92 grazing horses and 129 grazing cattle) were obtained from Republic of Korea. Antibodies to A. phagocytophilum (titer ≥ 80) were detected in 6 of the 33 feral and pet cats (18.2%), and 1 seropositive cat (3.0%) also had antibodies to E. chaffeensis. Only 1 of 129 (0.8%) cattle and 2 of 92 (2.2%) horses had antibodies to A. phagocytophilum. Antibodies to E. chaffeensis were not detected in either of these animals. This is the first report of serological evidence of A. phagocytophilum and E. chaffeensis from cats, cattle and horses in Korea. These rickettsial agents could have an important impact on human health or impact animal health with economic losses among industrial grazing animals in Korea.
Background: The clinical skin tightening benefits of high intensity focused ultrasound (HIFU) have been established, but its mechanisms of action in pigmented skin disorders remain unknown. Objectives: We aim to investigate macroscopic andhistopathological changes after HIFU at different exposure doses in hyperpigmentation. Methods: We applied HIFU irradiation at 0.1 and 0.2 J/cm2 to UVB-induced hyperpigmentation in guinea pig skin. The therapeutic effects of HIFU were judged based on gross appearance using photography, dermoscopy and chromametry during a period of 3 weeks after HIFU irradiation. Histological assessments were performed using H&E and Fontana-Masson staining 1 day before and 3 weeks after HIFU irradiation. Results: Macroscopically, UVB-induced hyperpigmentation was significantly reduced 3 weeks after HIFU with 0.1 and 0.2 J/cm2. Histopathologically, the heavy deposition of melanin in the epidermis induced by UVB exposure was reduced 3 weeks after HIFU irradiation. Conclusion: We confirmed that HIFU decreases UVB-induced hyperpigmentation as well as mechanical destructive activity. We suggest that HIFU may be useful as an alternative modality for patients suffering from skin pigmentary conditions.
Joon,Seong,Park,Doo-ho,Lee,Jin-Young,Jang,Youngmin,Han,Dong,Sup,Yoon,Jae,Keun,Kim,Ho-Seong,Han,Yoo,Seok,Yoon,Dae,Wook,Hwang,Chang,Moo,Kang,Ho,Kyong,Hwang,Woo,Jung,Lee,Jin,Seok,Heo,Ye,Rim,Chang,Mee,Joo 한국간담췌외과학회 2015 한국간담췌외과학회 학술대회지 Vol.2015 No.9