Elastofibroma is a rare disease which presents as a slowly-growing, solid, ill-defined fibroelastic mass occuring almost exclusively in elderly women and arising mainly from the connective tissue between the lower part of the scapula and chest wall. Of the 270 cases of elastofibroma which have been reported, 170 cases had developed in Japanese patients. Despite the fact that there have been only two case reports in Korea, there might be a higher prevalence of elastofibroma in Korea than expected because of geographical similarity. We experienced a case of elastofibroma occurring in a 56-year-old man. To our knowledge, this is the first case report of elastofibroma in Korean dermatologic of literature.
Aged ; Asian Continental Ancestry Group ; Connective Tissue ; Female ; Humans ; Korea ; Middle Aged ; Prevalence ; Rare Diseases ; Scapula ; Thoracic Wall

The changes of electroencephalogram(EEG) in patients with dementia of Alzheimer's type are most commonly studied by analyzing power or magnitude in traditionally defined frequency bands. However because of the absence of an identified metric which quantifies the complex amount of information, there are many limitations in using such a linear method. According to the chaos theory, irregular signals of EEG can be also resulted from low dimensional deterministic chaos. Chaotic nonlinear dynamics in the EEG can be studied by calculating the largest Lyapunov exponent(L1). The authors have analyzed EEG epochs from three patients with dementia of Alzheimer's type and three matched control subjects. The largest L1 is calculated from EEG epochs consisting of 16.384 data points per channel in 15 channels. The results showed that patients with dementia of Alzheimer's type had significantly lower L1 than non-demented controls on 8 channels. Topographic analysis showed that the L1 were significantly lower in patients with Alzheimer's disease on all the frontal, temporal, central, and occipital head regions. These results show that brains of patients with dementia of Alzheimer's type have a decreased chaotic quality of electrophysiological behavior. We conclude that the nonlinear analysis such as calculating the L1 can be a promising tool for detecting relative changes in the complexity of brain dynamics.
Alzheimer Disease ; Brain ; Dementia* ; Electroencephalography* ; Head ; Humans ; Nonlinear Dynamics*

Purpose: To compare the level of agreement between the Goldmann applanation tonometer (GAT), iCare IC200 rebound tonometer (IRT), and noncontact tonometer (NCT) in patients who underwent Descemet membrane stripping endothelial keratoplasty (DSEK), and to identify factors contributing to variations in intraocular pressure (IOP) measurements among the three tonometers. Methods: We retrospectively analyzed the medical records of 41 patients who underwent DSEK. IOP was measured using NCT, IRT, and GAT, in this order. We evaluated the level of agreement among IOP measurements using the three tonometers, and analyzed whether clinical factors affected the results. Results: We analyzed 49 eyes of 41 patients (average age: 62.0 years). The IOP values measured by IRT and NCT were lower than those measured by GAT, although the difference was not significant (p = 0.098 and p = 0.320, respectively). A Bland-Altman plot showed greater agreement between IOP measurements obtained by IRT and GAT than those obtained by NCT and GAT. In multivariate regression analysis, the IOP measured by GAT (β = 0.215, p = 0.022), corneal curvature (β = -1.692, p = 0.037), and postoperative duration (β = 0.042, p = 0.018) affected the difference in IOPs measured by GAT and IRT. The IOP measured by GAT (β = 0.301, p = 0.013) and corneal curvature (β = -2.670, p = 0.010) affected the difference in IOP measurements obtained by GAT and NCT. Conclusions In DSEK eyes, IRT showed good agreement and high correlation with GAT, suggesting that it is useful for IOP measurement. However, the IOP measured by GAT, corneal curvature, and postoperative duration should be considered when measuring IOP with an IRT.

Purpose: To report a case of orbital infarction syndrome in a patient with hemophagocytic lymphohistiocytosis (HLH).Case summary: A 70-year-old woman with diabetes mellitus and hypertension was referred to the Department of Ophthalmology for sudden-onset left upper eyelid ptosis after being diagnosed with HLH. After 3 days, the best corrected visual acuity in the right eye was 0.8, while there was no light perception in the left eye. In the left eye, the ocular motility examination showed limitations in all fields of gaze. On fundus examination, optic disc pallor, retinal hemorrhage, and narrowed retinal arteries were observed in the left eye. Fluorescein angiography showed no blood flow in the retinal arteries and veins in the left eye. On neck computed tomography angiography, the left distal internal carotid artery was narrowed. Orbit computed tomography showed exophthalmos and extraocular muscle hypertrophy in the left eye. Orbit magnetic resonance imaging confirmed optic nerve edema, enhancement of the optic nerve sheath, and high signal intensity of the intraocular fat in the left eye. Slit-lamp examination revealed ischemia of the anterior segment and ischemic necrosis of the eyelid in the left eye. The patient was diagnosed with orbital infarction syndrome. Conclusions Several factors may lead to ischemia of the orbital tissues in patients with HLH, including coagulopathy, an increased incidence of blood clots, and inflammation in the orbit. It is necessary to consider the possibility of orbital infarction syndrome when HLH patients present with visual loss, ocular movement limitations, and anterior segment ischemia.

OBJECTIVE: This study examined the differences in psychiatric comorbidities and behavioral aspects in accordance with the severity of Internet addiction in male adolescents. METHODS: One hundred and twenty-five adolescents from four middle and high schools in Seoul were enrolled in this study. The subjects were divided into non-addict, abuse, and dependence groups according to a diagnostic interview by psychiatrists. The psychiatric comorbidities and behavioral aspects of subjects were evaluated through psychiatric clinical interviews based on the Diagnostic and Statistical Manual of Mental Disorders (4th edition), the Children's Depression Inventory, the State-Trait Anxiety Inventory, the Internet Addiction Test, and a self-reported questionnaire about behavioral aspects. RESULTS: The psychiatric comorbidity distributions were significantly different in the abuse and dependence groups, particularly in terms of attention-deficit hyperactivity disorder and mood disorder items. The Children's Depression Inventory, the State-Trait Anxiety Inventory, and the Internet Addiction Test scores were also significantly different among the three groups. There were significant differences in 10 of the 20 items of the Internet Addiction Test between the non-addict, abuse, and dependence groups. There were significant differences in seven items between the non-addict and abuse groups, but no differences between subjects in the abuse and dependence groups. Significant differences were observed in three items between the abuse and dependence groups, but there were no significant differences between the non-addict and abuse groups. In terms of behavioral aspects, scores for abusive, sexual, and decreased social interest behaviors were highest in the dependence group, and lowest in the non-addict group. However, the behavioral aspects of decreased interpersonal relationships did not show this difference between groups. CONCLUSION: This study suggests that there are differences in psychiatric comorbidities and behavioral aspects between adolescent males with characteristics of Internet abuse and Internet dependence.
Adolescent* ; Anxiety ; Comorbidity* ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Internet* ; Male ; Mood Disorders ; Psychiatry ; Surveys and Questionnaires ; Seoul

OBJECTIVES: Internet gaming disorder (IGD) is known to be related to stress and the serotonin-transporter-linked polymorphic region (5-HTTLPR) that is known to be associated with stress and has been studied to affect various psychiatric illness outbreaks. We tried to examine the relationship between stress, 5-HTTLPR and IGD. METHODS: A total of 59 participants with IGD, diagnosed according to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria and 67 normal controls (NC) were enrolled. The IGD group and the NC were compared using chisquare test and independent sample t-test, and logistic regression analysis was used to examine the relationship between stress, the 5-HTTLPR, and IGD. RESULTS: The mean scores for anxiety, impulsivity and stress were significantly higher in the IGD group than in the NC. In addition, there was a significant association between stress and IGD [odds ratio (OR) = 1.172, 95% confidence interval (CI) = 1.008–1.362]. CONCLUSIONS: This study showed that stress would affect IGD. Therefore, the evaluation and management of stress should be included in the diagnosis and treatment of IGD.
Adult* ; Anxiety ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Disease Outbreaks ; Humans ; Immunoglobulin D ; Impulsive Behavior ; Internet* ; Logistic Models

Glial cell line-derived neurotrophic factor (GDNF) has been reported to be involved in negatively regulating the effects of addictive disorders. The objective of this study was to investigate alterations in the levels of GDNF in patients with Internet gaming disorder (IGD) and to assess the relationship between GDNF levels and the severity of IGD indices. Nineteen male patients with IGD and 19 sexmatched control subjects were evaluated for alteration of plasma GDNF levels and for relationship between GDNF levels and clinical characteristics of Internet gaming, including the Young's Internet Addiction Test (Y-IAT). The GDNF levels were found to be significantly low in patients with IGD (103.2±62.0 pg/mL) compared with the levels of controls (245.2±101.6 pg/mL, p<0.001). GDNF levels were negatively correlated with Y-IAT scores (Spearman's rho=-0.645, p=<0.001) and this negative correlation remained even after controlling for multiple variables (r=-0.370, p=0.048). These findings support the assumed role of GDNF in the regulation of IGD.
Case-Control Studies ; Glial Cell Line-Derived Neurotrophic Factor ; Humans ; Immunoglobulin D ; Internet ; Male ; Neuroglia ; Pilot Projects ; Plasma

Ischemic colitis represents most common form of gastrointestinal ischemia, usually developed in elderly or debilitated patient with a variety of underlying medical problems. The presumed etiologies are numerous. It usually presents as an acute abdominal illness with bloody diarrhea. Subacute ischemic colitis in healthy adults develops spontaneously in the absence of major vasculature occlusion, and the original insult precipitating the ischemic event usually cannot be established. Diagnosis is based on the clinical symptom, barium study, colonoscopic and histopathologic findings. Therapy and outcome are depen-dent on the severity of disease. It usually requires only medical management and is asso-ciated a good prognosis. We report a case of subacute ischemic colitis in healthy adults developed after severe watery diarrhea with literatures.
Adult ; Aged ; Barium ; Colitis, Ischemic* ; Colon ; Diagnosis ; Diarrhea* ; Humans ; Ischemia ; Prognosis

PURPOSE: We evaluated the usefulness of two-stage revision knee arthroplasty for treatment of infected total knee arthroplasty(TKA). MATERIALS AND METHODS: We retrospectively reviewed 13 cases treated by two-stage reimplantation among the 18 infected TKA cases from February 1993 to March 2003, which had been followed up for more than two years. We analyzed the results of treatment, knee society score before and after the two stage reimplantation, recurrence of infection, and other complications. RESULTS: The mean period between the time of primary TKA and that of diagnosis of deep infection was 1.7 years. The mean period from removal of infected primary prosthesis to the second stage reimplantation was 7.2 weeks. The mean range of motion increased from 60.3 degrees to 95.7 degrees after operation. The mean Knee Society Score increased from 50.2 points to 83.4 points. Infection recurred in two cases but immediately subsided by intravenous antibiotics therapy. One case with patella fracture was treated by total patellectomy. CONCLUSION: This procedure using antibiotics-impregnated cement spacer and complete debridement of necrotic tissues can control infection and improve functional results. The result of two-stage revision for deep infected total knee arthroplasty was satisfactory in view of eradication of infection and functional restoration of the knee.
Anti-Bacterial Agents ; Arthroplasty* ; Debridement ; Diagnosis ; Knee Joint ; Knee* ; Patella ; Prostheses and Implants ; Range of Motion, Articular ; Recurrence ; Replantation* ; Retrospective Studies

A growing body of evidence supports that Internet gaming disorder (IGD) is considered as ‘behavioral addiction’ with neurobiological alterations. We have reviewed previous research into the clinical and neurobiological features of IGD, and suggest a flowchart for the comprehensive evaluation of IGD. Several self-rating screening tests based on Diagnostic and Statistical Manual of Mental Disorder, 5th edition (DSM-5) IGD criteria were developed. IGD is often comorbid with depressive disorder, social anxiety disorder, attention deficit/hyperactivity disorder (ADHD), and smartphone addiction. Individuals with IGD are prone to act impulsively and make risky decisions, especially in response to game-related cues. Functional neuroimaging results have shown altered functional activities in prefrontal cortex, cingulate cortex, superior temporal gyrus and nucleus accumbens (NAc). Structural neuroimaging demonstrated gray matter volume changes in prefrontal cortex and NAc, while showing white matter integrity disruption in thalamus and posterior cingulate cortex. There are few evidences on the attribution of specific genes to IGD. To evaluate IGD comprehensively, self-rating scales based on DSM-5 are useful, but a diagnostic interview by a clinician is more helpful to assess functional impairments of IGD. Presence of psychiatric comorbidities such as depressive disorder, social anxiety disorder, ADHD, and smartphone addiction should be evaluated. Neurocognitive tests that assess impulsivity, decision-making under risk, and cue-reactivity are helpful when planning individualized IGD treatment.
Anxiety Disorders ; Comorbidity ; Cues ; Depressive Disorder ; Functional Neuroimaging ; Gray Matter ; Gyrus Cinguli ; Immunoglobulin D ; Impulsive Behavior ; Internet* ; Mass Screening ; Mental Disorders ; Neuroimaging ; Nucleus Accumbens ; Prefrontal Cortex ; Smartphone ; Software Design ; Temporal Lobe ; Thalamus ; Weights and Measures ; White Matter