Background: Atopic dermatitis (AD) is a common skin disease with a wide range of symptoms. Due to the rapidly changing treatment landscape, regular updates to clinical guidelines are needed. Objective: This study aimed to update the guidelines for the treatment of AD to reflect recent therapeutic advances and evidence-based recommendations. Methods: The Patient characteristics, type of Intervention, Control, and Outcome framework was used to determine 48 questions related to AD management. Evidence was graded, recommendations were determined, and, after 2 voting rounds among the Korean Atopic Dermatitis Association (KADA) council members, consensus was achieved. Results: This guideline provides treatment guidance on advanced systemic treatment modalities for AD. In particular, the guideline offers up-to-date treatment recommendations for biologics and Janus-kinase inhibitors used in the treatment of patients with moderate to severe AD.It also provides guidance on other therapies for AD, along with tailored recommendations for children, adolescents, the elderly, and pregnant or breastfeeding women. Conclusion KADA’s updated AD treatment guidelines incorporate the latest evidence and expert opinion to provide a comprehensive approach to AD treatment. The guidelines will help clinicians optimize patient-specific therapies.

Background: Atopic dermatitis (AD) is a common skin disease with a wide range of symptoms. Due to the rapidly changing treatment landscape, regular updates to clinical guidelines are needed. Objective: This study aimed to update the guidelines for the treatment of AD to reflect recent therapeutic advances and evidence-based practices. Methods: The Patient characteristics, type of Intervention, Control, and Outcome framework was used to determine 48 questions related to AD management. Evidence was graded, recommendations were determined, and, after 2 voting rounds among the Korean Atopic Dermatitis Association (KADA) council members, consensus was achieved. Results: The guidelines provide detailed recommendations on foundational therapies, including the use of moisturizers, cleansing and bathing practices, allergen avoidance, and patient education. Guidance on topical therapies, such as topical corticosteroids and calcineurin inhibitors, is also provided to help manage inflammation and maintain skin barrier function in patients with AD. Additionally, recommendations on conventional systemic therapies, including corticosteroids, cyclosporine, and methotrexate, are provided for managing moderate to severe AD. Conclusion KADA’s updated AD guidelines offer clinicians evidence-based strategies focused on basic therapies, topical therapies, and conventional systemic therapies, equipping them to enhance quality of care and improve patient outcomes in AD management.

Background: In 2006, the Korean Atopic Dermatitis Association (KADA) working group released the diagnostic criteria for Korean atopic dermatitis (AD). Recently, more simplified, and practical AD diagnostic criteria have been proposed. Objective: Based on updated criteria and experience, we studied to develop and share a consensus on diagnostic criteria for AD in Koreans. Materials and Methods: For the diagnostic criteria, a questionnaire was constructed by searching the English-language literature in MEDLINE and the Cochrane Database of Systematic Reviews. A modified Delphi method composed of 3 rounds of email questionnaires was adopted for the consensus process. Fifty-four KADA council members participated in the 3 rounds of votes and expert consensus recommendations were established. Results: Diagnostic criteria for AD include pruritus, eczema with age-specific pattern, and chronic or relapsing history. Diagnostic aids for AD encompass xerosis, immunoglobulin E reactivity, hand–foot eczema, periorbital changes, periauricular changes, perioral changes, nipple eczema, perifollicular accentuation, and personal or family history of atopy. Conclusion This study streamlined and updated the diagnostic criteria for AD in Korea, making them more practicable for use in real-world clinical field.

OBJECTIVE: To determine the optimal injection site in the flexor digitorum longus (FDL) muscle for effective botulinum toxin injection. METHODS: Fourteen specimens from eight adult Korean cadavers were used in this study. The most proximal medial point of the tibia plateau was defined as the proximal reference point; the most distal tip of the medial malleolus was defined as the distal reference point. The distance of a line connecting the proximal and distal reference points was defined as the reference length. The X-coordinate was the distance from the proximal reference point to the intramuscular motor endpoint (IME), or motor entry point (MEP) on the reference line, and the Y-coordinate was the distance from the nearest point from MEP on the medial border of the tibia to the MEP. IME and MEP distances from the proximal reference point were evaluated using the raw value and the X-coordinate to reference length ratio was determined as a percentage. RESULTS: The majority of IMEs were located within 30%-60% of the reference length from the proximal reference point. The majority of the MEPs were located within 40%-60% of the reference length from the proximal reference point. CONCLUSION: We recommend the anatomical site for a botulinum toxin injection in the FDL to be within a region 30%-60% of the reference length from the proximal reference point.
Adult ; Botulinum Toxins* ; Cadaver ; Hammer Toe Syndrome ; Humans ; Tibia

A pleurobiliary fistula is an abnormal communication between the biliary system and the pleural space. It has rarely been reported after percutaneous transhepatic gallbladder drainage (PTGBD). Here, we report the case of an 88-year-old man with bilious pleural infection via pleurobiliary fistula following PTGBD. The patient had a fever, dyspnea and right pleuritic chest pain. The PTGBD was performed 2 months prior to treat acute cholecystitis with large gallstones. Chest radiography demonstrated a right pleural effusion and a computed tomography of the abdomen showed a pleurobiliary fistula tract associated with the previous PTGBD. A drainage tube was inserted into the right pleural effusion, and the bilious pleural fluid infected with Escherichia coli was drained. Careful approach to PTGBD procedure and reducing duration of catheter placement should prevent fistula formation. As a rare complication of PTGBD, practitioners should be aware of the potential of pleural infection by a pleurobiliary fistula tract.
Abdomen ; Aged, 80 and over ; Biliary Fistula ; Biliary Tract ; Catheters ; Chest Pain ; Cholecystitis, Acute ; Drainage* ; Dyspnea ; Escherichia coli ; Fever ; Fistula* ; Gallbladder* ; Gallstones ; Humans ; Pleural Effusion ; Radiography ; Thorax

PURPOSE: We have performed both open partial nephrectomy (OPN) and laparoscopic radiofrequency ablation (RFA) on selected patients since January 2007 and have been following these patients through serial laboratory assessments and computed tomography (CT). The purpose of the present study was to evaluate long-term oncologic outcomes and renal function status for laparoscopic RFA versus OPN at a minimum follow-up of 3 years. MATERIALS AND METHODS: A total of 55 patients with exophytic, single small renal masses were treated with either OPN (n=14) or laparoscopic RFA (n=41) by a single surgeon. The indications for laparoscopic RFA were as follows: 1) cases with the greatest dimension of the renal mass <3 cm, and 2) cases in which the collecting system, renal calyx, and great vessels were free from the tumor margins by 1 cm. RESULTS: The estimated blood loss (EBL), the operation time, and the mean number of hospital days was significantly lower in the laparoscopic RFA group than in the OPN group. Oncologic data did not differ significantly between the two groups. Creatine clearance levels did not differ significantly compared with those before the operation in either group. CONCLUSIONS: Our data suggest excellent therapeutic outcomes with laparoscopic RFA with achievement of effective operative times, hospital stays, and EBL compared with OPN. According to our indications for laparoscopic RFA, laparoscopic RFA is an effective minimally invasive therapy for the treatment of small renal masses, yielding oncologic outcomes and renal function equivalent to those of OPN.
Catheter Ablation ; Creatine ; Follow-Up Studies ; Humans ; Kidney Neoplasms ; Length of Stay ; Nephrectomy ; Operative Time

OBJECTIVES: To identify changes in relationships with superiors or colleagues at work and family members and social networks at home, based on occupational stress and psychological characteristics in during the process of restructuring some plants undergoing a long-term labor dispute. METHODS: This study invested 213 workers involved in a long-term labor dispute using the KOSS (Korean Occupational Stress Scale) and the MMPI-2 (Minnesota Multiphasic Personality Inventory) and questionnaires. The KOSS and MMPI-2 scores in accordance with aggressiveness of trade union activity and changes in human relationships were compared. In addition, the odds ratio of whether there were differences in health behavior (perception of health status, smoking, alcohol abuse, medical treatment) and the absenteeism rate was calculated by logistic regression analysis. RESULTS: For members of the aggressiveness of trade union activity group, the rate at which the relationship between superiors or colleagues deteriorated was high, as was the total KOSS score, occupational system and lack of reward score of KOSS subclass. The depression subclass score of MMPI-2 was generally high, while the score of hypochondriasis, hysteria, psychopathic deviate, hypomania was high, and social introversion was low in the active group. In cases in which there were high score of psychopathic deviate, hypomania and paranoia, there were also signs of negative health behavior. CONCLUSIONS: Occupational stress caused by a long-term labor dispute, accompanied with depression can result in an aggressive, hostile and vulnerable personalities and have a negative impact on health behavior.
Absenteeism ; Alcoholism ; Depression ; Dissent and Disputes ; Health Behavior ; Humans ; Hypochondriasis ; Hysteria ; Introversion (Psychology) ; Labor Unions ; Logistic Models ; Odds Ratio ; Paranoid Disorders ; Questionnaires ; Reward ; Smoke ; Smoking

PURPOSE: N-acetylcysteine (NAC) is a potent antioxidant, and a free radical scavenger. We investigated the possible effects of NAC after ischemia/reperfusion (I/R) of rat bladder. MATERIALS AND METHODS: I/R injury was induced by abdominal aorta clamping and ischemia for 60minutes, followed by 120minutes reperfusion. Twenty rats were divided into four groups: sham operation + saline group (S+S), sham operation + NAC group (S+NAC), I/R + saline group (I/R+S), I/R + NAC group (I/R+NAC). Blood levels of reactive oxygen species (ROS) were determined using the free oxygen radical tests (FORT). Superoxide generation was measured based on lucigenin-enhanced chemiluminescence. The level of malondialdehyde (MDA) was analyzed in order to measure lipid peroxidation. RESULTS: In I/R+S group, the isometric contractile responses to carbachol were significant lower than other groups and were reversed by the pretreatment with NAC. The level of FORT and MDA showed a marked increase in I/R+S group compared with S+S group. NADPH-stimulated superoxide production was also significantly increased. I/R+NAC decreased these parameters compared with I/R+S group. CONCLUSION: Our results suggest that treatment with NAC reversed the low contractile responses of rat bladder and prevented oxidative stress following I/R.
Acetylcysteine ; Animals ; Aorta, Abdominal ; Carbachol ; Constriction ; Ischemia ; Lipid Peroxidation ; Luminescence ; Malondialdehyde ; Oxidative Stress ; Oxygen ; Panax* ; Rats* ; Reactive Oxygen Species ; Reperfusion ; Superoxides ; Urinary Bladder*

PURPOSE: Arteriovenous fistula is one of high flow vascular malformations. Recently, arteriovenous fistula has been regarded as one of the type of arteriovenous malformations. The patients were diagnosed as arteriovenous malformation Schobinger clinical stage II. Even though arteriovenous fistula rarely occurs on head and neck, treatment of that is difficult due to frequent recurrence. In treating the arteriovenous fistula, chemical embolization, surgical excision and other treatment modalities were used, but the results were not satisfactory. The authors experienced three cases of arteriovenous fistula and treated them with surgical excision. METHODS: In cases, warmth, enlargement, pulsation, thrill, and bruit were found. For the accurate evaluation before the operation, angiography and MRI were checked in advance. Incision was made on the site of pulsation. The artery and vein connected to the arteriovenous fistula were dissected widely, individually ligated, and divided. And then the entire mass was totally removed. RESULTS: All surgical sites were healed well without complications and there was no evidence of recurrence in all cases up to for 2 years of follow-up examination. CONCLUSION: The arteriovenous fistula on face is a very rare disease and has difficulties in treatment. The authors experienced three cases of arteriovenous fistula with complete surgical removal and no recurrence was found in all cases.
Angiography ; Arteries ; Arteriovenous Fistula* ; Arteriovenous Malformations ; Follow-Up Studies ; Head ; Humans ; Magnetic Resonance Imaging ; Neck ; Rare Diseases ; Recurrence ; Vascular Malformations ; Veins

PURPOSE: Malignant melanoma is a fatal tumor arising in the melanocytic systems of the skin. The incidence of malignant melanoma, formerly considered a rare tumor in Korea, is observed to increase. The aim of this study is to analyze the clinical and histopathological pattern of malignant melanoma in one institute. METHODS: Thirty patients with ages ranging from 33 to 80 years, diagnosed as malignant melanoma at our skin tumor department, were enrolled in a retrospective study over a 6 year period(2000. 9-2006. 7). The analyzed data included age, sex, location, duration before diagnosis, clinical type, level of invasion, and stage. RESULTS: The cases were identified and analyzed by clinical and histopathologic study. The male to female ratio was 1:1.7. Lower extremities(especially, feet) were favored sites. The majority of cases were acral lentiginous melanoma(40%), followed by nodular melanoma (36.7%), superficial spreading melanoma(20%) in this study. Clark level IV was predominant in histopathologic study. There was merely narrow gap among each stage by AJCC. CONCLUSION: The clinicopathological characteristic of melanoma in our patients is quite different with that in the West. In this retrospective study, primary lesions of the foot were predominant with melanoma, and a high percentage of these were classified pathologically as acral lentiginous melanomas. Patients had a more advanced stage of disease at first presentation and a more deeply invasive primary lesion than Western patients. These suggest that malignant melanoma has a worse prognosis in our patients than in the West. So, further organized prospective studies are needed to approach the prudent and accurate diagnosis and management of melanoma in Korea.
Diagnosis ; Female ; Foot ; Humans ; Incidence ; Korea ; Male ; Melanoma* ; Prognosis ; Retrospective Studies ; Skin