Long second toe: its nail and skin changes

( Geun-hwi Park ),( Woo-il Kim ),( Min-young Yang ),( Won-ku Lee ),( Tae-wook Kim ),( Sung-min Park ),( Hyun-joo Lee ),( Gun-wook Kim ),( Hoon-soo Kim ),( Hyun-chang Ko ),( Byung-soo Kim ),( Moon-bum 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Nail can be affected by trauma, infection, and systematic disorders. In particular, the toe nails are exposed to the repeated and cumulative minor traumas, which usually result in thickened, splitted, and discolorated nails. Considering these, it can be inferred that the long second toe can be related to various nail and skin changes by repeated minor traumas such as friction in shoes, but the study or report on this topic hasn’t been done yet. Objectives: The purpose of this study was to introduce various nail and skin changes on long second toe. Methods: We analyzed the kinds of nail/skin changes of 50 patients with long second toe, enrolled at Pusan National University Hospitals (Busan and Yangsan) from 2013 to 2018. Results: There was no significant difference in the incidence of left and right toe and toenail, and 7 (14%) patients presented bilateral distribution. The most common nail change on long second toe was melanonychia (23, 46%), followed by subungual hematoma (15, 30%), onycholysis (2, 4%), subungual hyperkeratosis (2, 4%), onychomadesis (1, 2%), and retronychia (1, 2%). The most common skin change was corn (9, 18%), followed by paronychia (2, 4%). Twenty (20/50, 40%) patients also had other toe or toenail changes. Among them, the most common site was big toe/nail (13, 62%), and the most common change was subungual hematoma (8, 42%). Conclusion: Through this study, the dermatologists can recognize and diagnose the nail and skin changes of long second toe.

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.

불응성 자가면역질환에서의 자가조혈모세포이식

민도준,양동원,민창기,김완욱,이상헌,박성환,김동욱,이종욱,조철수,민우성,김범생,김호연,김춘추 대한조혈모세포이식학회 2001 대한조혈모세포이식학회지 Vol.6 No.1

배경: 기존의 치료에 불응하고 예후가 불량한 자가면역질환 환자들에게 최근 고용량 면역억제 및 조혈모 세포이식이 새로운 치료방법으로 대두되고 있다. 저자들은 다발성 경화증(multiple sclerosis, MS) 및 류마티스 관절염(rheumatoid arthritis, RA) 등 2명의 자가면역질환 환자들에서 자가조혈모세포 이식을 시행하였다. 방법: 말초혈액 조혈모세포 가동화를 위하여 cyclophosphamide (4 g/㎡) 및 granulocyte colony stimulating factor (10 g/kg/day)를 투여하였고, CD34+ 세포를 분리·채집 하였다, 이식 전처치로 MS 환자에서 BEAM 및 antihymocyte globulin (ATG) (3.75 mg/kg), RA 환자에서 fludarabine (180 mg/㎡), ATG (10 mg/kg)와 busulfan (8 mg/kg)을 투여하였다. 결과: 호중구 수가 500/㎕ 이상으로 회복되는 기간은 MS 환자에서 9일, RA 환자에서 15일이었다. 혈소판이 20.000/㎕ 이상으로 회복되는 가간은 RA 환자에서 9일 이었고, MS 환자에서는 혈소판 감소증이 발생하지 않았다. 비혈액학적 독성으로 MS 환자에서 WHO 1도의 오심 및 점막염이 관찰되었다. MS 환자는 이식 6개월 후까지 시력감소가 남아있었으나, 이식전에 관찰되던 감각이상 및 운동장애 등의 신경학적 이상 소견은 더 이상 관찰되지 않았다. RA 환자는 이식 1개월 후 관절 증상 및 검사소견의 호전을 보였다. 결론: 불응성 자가면역질환 환자에서 고용량 면역억제 및 조혈모세포이식은 적은 독성으로 높은 치료효과를 기대할수 있으며, 향후 이 시술의 임상적 의의를 규명하기 위하여 전향적이고 장기적인 연구가 필요할 것으로 사료된다. Background: High-dose immunosuppressive therapy followed by autologous hemathpoietic stem cell transplantation (HSCT) has been proposed as a new approach to treat severe, refractory autoimmune diseases. We describe two patients with refractory autoimmune diseases (one multiple sclerosis 〔MS〕and one rheumatoid arthritis〔RA〕) who underwent T-cell-depleted autologous peripheral bleed stem cell transplantation for the first time in Korea. Methods: We mobilized autologous stem cells with cyclophisphamide (4 g/㎡) and granulocyte colony-stimulating factor (10 ㎍/kg/day). Stem cells were enriched ex vivo using CD34-positive immunoselection and reinfused after high-dose chemotherapy with BEAM and antithymocyte globulin (ATG) (3.75 mg/kg) in MS, or fludarabine (180 mg/㎡), ATG (10 mg/kg) and busulfan (8 mg/kg) in RA. Results: The engraftment with an absolute nerutrophil count greater than 500㎕ occurred on day 9 in MS and 15 in RA, respectively. The time to nontransfused platelet count greater than 2.000/㎕ was 9 day in RA. MS patient did not show ant episode of thrombocytopenia. Regimen-related non-hematopoietic toxicity was minimal. For 6 months since HSCT, them patient with MS had been free from previously existed sensory and motor abnormalities except decreased visual acuity. Then patient with RA and only one tender joint and two mildly swollen joints with improvement in laboratory parameters at one month after HSCT. Conclusion: These results underscore the feasibility and potential efficacy of intensive immunosuppression followed by autologous HSCT for treatment of intractable autoimmune diseases. The durability of remission, however, remains to be clarified.

Effect of epidural corticosteroid injection on magnetic resonance imaging findings

( Min Soo Kim ),( Tae Yoon Jeong ),( Yu Seon Cheong ),( Young Wook Jeon ),( So Young Lim ),( Seong Sik Kang ),( In Nam Kim ),( Tsong Bin Chang ),( Hyun Ho Seong ),( Byeong Mun Hwang ) 대한통증학회 2017 The Korean Journal of Pain Vol.30 No.4

Background: Magnetic resonance imaging (MRI) of the spine is the preferred diagnostic tool for pathologic conditions affecting the spine. However, in patients receiving epidural corticosteroid injection (ESI) for treatment of spinal diseases, there is a possibility of misreading of MR images because of air or fluid in the epidural space after the injection. Therefore, we defined the characteristics of abnormal changes in MRI findings following an ESI in patients with low back pain. Methods: We reviewed the medical records of 133 patients who underwent MRI of the lumbar spine within 7 days after ESI between 2006 and 2015.All patients were administered an ESI using a 22-gauge Tuohy needle at the lumbar spine through the interlaminar approach. The epidural space was identified by the loss of resistance technique with air. Results: The incidences of abnormal changes in MRI findings because of ESI were 54%, 31%, and 25% in patients who underwent MRI at approximately 24 h, and 2 and 3 days after ESI, respectively. Abnormal MRI findings included epidural air or fluid, needle tracks, and soft tissue changes. Epidural air, the most frequent abnormal finding (82%), was observed in 41% of patients who underwent MRI within 3 days after injection. Abnormal findings due to an ESI were not observed in MR images acquired 4 days after ESI or later. Conclusions: Pain physicians should consider the possibility of abnormal findings in MR images acquired after epidural injection using the interlaminar approach and the loss of resistance technique with air at the lumbar spine. (Korean J Pain 2017; 30: 281-6)

High-performance Liquid Chromatographic Analysis for Quantitation of Marker Compounds of Artemisia capillaris Thunb

( Kyung Min Park ),( Ying Li ),( Bora Kim ),( Haiyan Zhang ),( Kyong Hwangbo ),( Dong Gen Piao ),( Mei Juan Chi ),( Mi Hee Woo ),( Jae Sue Choi ),( Je Hyun Lee ),( Dong Cheul Moon ),( Hyeun Wook Chang 영남대학교 약품개발연구소 2013 영남대학교 약품개발연구소 연구업적집 Vol.23 No.0

Two stable high-performance liquid chromatography (HPLC) methods were developed that could quantitatively analyze 10 major marker compounds of Artemisia capillaris Thunb and could also distinguish among `Injinho` and `Myeon-injin` and `Haninjin`--A. capillaris collected in autumn, A. capillaris collected in spring and A. iwayomogi, which can be misused as `Injinho` in Korean herbal drug markets. The first HPLC method was a reversed-phase chromatography using a C18 column with an isocratic solvent system of phosphoric acid (0.05%) and acetonitrile at the flow rate of 1.0 mL/min, ultraviolet (UV) detection wavelength at 254 nm and column temperature at 40°C. Calibration andquantitation were made by using acetaminophen as an internal standard (I.S-A) and chlorogenic acid (1) was determined within 20 min. The second HPLC method was a reversed-phase chromatography using a C18 column with a gradient solvent system of phosphate buffer (0.015 M, pH 6) and acetonitrile at the flow rate of 1.0 mL/min, UV detection wavelength at 254 nm and column temperature at 40°C. Calibration and quantitation were made by using ethylparaben as an internal standard (I.S-B) and 3,5-di-O-caffeoylquinic acid (2), 3,4-di-O-caffeoylquinic acid (3), 4,5-di-O-caffeoylquinic acid (4), hyperoside (5), isoquercitrin (6), isorhamnetin 3-O-robinobioside (7), isorhamnetin-3-O-galactoside (8), isorhamnetin-3-O-glucoside (9) and scoparone (10) were determined within 60 min. Pattern recognitionanalysis of data from the 60 samples classified them clearly into three groups. These assay methods could be applied for QA/QC of A. capillaris and Artemisia iwayomogi.

정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

Acral calcified angioleiomyoma: a rare clinicopathologic variant of cutaneous angioleiomyoma

( Kihyuk Shin ),( Woo-il Kim ),( Min-young Yang ),( Won-ku Lee ),( Tae-wook Kim ),( Sung-min Park ),( Hyun-joo Lee ),( Hoon-soo Kim ),( Hyun-chang Ko ),( Byung-soo Kim ),( Moon-bum Kim ),( Gun-wook Ki 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Cutaneous angioleiomyomas are benign tumors with vascular smooth muscle differentiation. The tumor usually involves the lower extremity, but acral sites such as toes, fingers, feet, and hands are rarely affected. Leiomyoma of deep soft tissue commonly shows regressive changes including prominent fibrosis, and calcification, however, cutaneous angioleiomyoma rarely manifests these changes. A 61-year-old female presented with subcutaneous nodule on the right heel. The lesion began to develop 3 months ago without history of trauma or infection, and the patient reported no subjective symptom. The lesion was totally excised, and histopathology revealed a well-circumscribed, non-encapsulated tumor composed of interlacing fascicles of spindled cells with elongated blunt-ended nuclei. A major finding was extensive calcifications, which dominated over the cellular component. On immunohistochemical examination, the spindle cells expressed strong immunoreactivity for α -smooth muscle actin. Based on these findings, a diagnosis of acral calcified angioleiomyoma was made. We have described a rare clinicopathologic variant of angioleiomyoma which has a predilection for acral locations and shows extensive calcifications predominating over the tumor itself. To our knowledge, this is the first report of a patient with acral calcified angioleiomyoma in Korean dermatologic literature.

Salt and pepper appearance of the skin associated with mixed connective tissue disease

( Sang-hyeon Won ),( Woo-il Kim ),( Min-young Yang ),( Won-ku Lee ),( Tae-wook Kim ),( Sung-min Park ),( Hyun-joo Lee ),( Gun-wook Kim ),( Hoon-soo Kim ),( Hyun-chang Ko ),( Byung-soo Kim ),( Moon-bum 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

The salt-and-pepper appearance of skin is composed of salt (vitiligo-like depigmentation) and pepper(perifollicular pigmentation). This characteristic feature can be a clinical clue for the diagnosis of systemic sclerosis. Mixed connective tissue disease(MCTD) is a distinct disease entity with mixed features of systemic lupus erythematosus, systemic sclerosis, myositis and rheumatoid arthritis with high titers of antibodies to U1 small nuclear ribonucleoprotein(U1 snRNP). Therefore, MCTD is known to have a wide spectrum of cutaneous manifestations which may be the presenting signs of the disease. However, there are few reports of pigmentary changes in MCTD. A 51-year old woman presented with variably sized hypopigmented macules along with relative hyperpigmentation of the perifollicular areas. She was diagnosed with MCTD by Raynaud’s phenomenon and high titer anti-RNP corresponding to a speckled antinuclear antibody of 1:1280 in Rheumatology clinic. A biopsy specimen showed dermal sclerosis. Pigment loss and melanophages were observed in the papillary dermis. Hypo- and hyperpigmentation were confirmed histologically by S100 and Fontana-Masson stain. To our knowledge, ‘salt and pepper appearance of the skin’ has rarely been reported in MCTD. The diagnosis of MCTD can be challenging due to its diverse characteristics. Therefore, we suggest that MCTD should be regarded as a differential diagnosis in patient with this pigmentary change.

Bone Marrow T Cells are Superior to Splenic T Cells to Induce Chimeric Conversion After Non-Myeloablative Bone Marrow Transplantation

( Hyun Sil Park ),( Seok Goo Cho ),( Min Jung Park ),( So Youn Min ),( Hong Seok Chang ),( Hee Je Kim ),( Seok Lee ),( Chang Ki Min ),( Jong Wook Lee ),( Woo Sung Min ),( Chun Choo Kim ),( Ho Youn Kim 대한내과학회 2009 The Korean Journal of Internal Medicine Vol.24 No.3

Background/Aims: The bone marrow functions not only as the primary B-lymphocyte-producing organ but also as a secondary lymphoid organ for CD4 and CD8 cell responses and a site of preferential homing and persistence for memory T cells. Bone marrow T (BM-T) cells are distinguished from peripheral blood T cells by surface phenotype, cytokine secretion profile, and immune functions. In this study, we evaluated the alloreactive potential of donor lymphocyte infusion (DLI) using BM-T cells in mixed chimerism compared to that using spleen T (SP-T) cells. Methods: Cells were prepared using established procedures. BM-T cells were obtained as a by-product of T-cell depletion in BM grafting and then cryopreserved for subsequent DLI. We performed DLI using BM-T cells in allogeneic mixed chimera mice on post-BMT day 21. Results: When the same dose of T cells, 5-10×105 (Thy1.2+), fractionated from BM and spleen were administered into mixed chimeras, the BM-T group showed complete chimeric conversion, with self-limited graftversus-host disease (GVHD) and no pathological changes. However, the SP-T group showed persistent mixed chimerism, with pathological signs of GVHD in the liver and intestine. Conclusions: Our results suggest that DLI using BM-T cells, even in small numbers, is more potent at inducing chimeric conversion in mixed chimerism than DLI using SP-T cells. Further study is needed to determine whether cryopreserved BM-T cells are an effective cell source for DLI to consolidate donor-dominant chimerism in clinical practice without concerns about GVHD. (Korean J Intern Med 2009;24:252-262)