Erythema nodosum is a reactive dermatosis that occurs in response to various stimuli, such as bacterial, fungal and viral infections, drugs and malignancies. Lesions of erythema nodosum usually appear symmetrically on the extensor aspects of the legs with occasional involvement of the thighs or forearms. Unilateral or plantar involvement uncommonly occurs. A 26-year-old man presented with bilateral, painful, multiple, confluent, erythematous, firm nodules confined to the both plantar skin for 7 days. Histopathologic examination revealed fibrosis of and a lymphohistiocytic infiltrate within the septae of fat lobules, consistent with erythema nodosum. We, herein, report an unusual case of plantar erythema nodosum, which was successfully treated with nonsteroidal antiinflammatory drugs for 2 weeks.
Adult ; Erythema Nodosum* ; Erythema* ; Fibrosis ; Forearm ; Humans ; Leg ; Skin ; Skin Diseases ; Thigh

BACKGROUND AND OBJECTIVES: In the Ultrafiltration versus Intravenous Diuretics for Patients Hospitalized for Acute Decompensated Heart Failure trial, ultrafiltration (UF) removed volume more effectively than usual care (UC). Hypothetically, UF may be superior to UC due to increased sodium (Na) removal and less neurohormonal activation. We compared UF and UC in a randomized pilot trial of target weight guided therapy for acute decompensated heart failure (ADHF). SUBJECTS AND METHODS: Sixteen patients with ADHF were enrolled and target weights established prospectively, prior to randomization to UC or UF. UF patients did not receive diuretics and UC patients were all treated with a continuous furosemide drip. All urine and ultrafiltrate were collected and Na concentrations measured. RESULTS: Similar volumes were removed in UC and UF groups (110105 mL and 107415 mL, respectively) and the UF group also produced 45325 mL of urine. Na concentration was 138+/-6 meq/L in the ultrafiltrate, 85+/-73 meq/L in the UC group's urine, and 26+/-23 meq/L in the UF group's urine. Given the relevant associated volumes, total meq of the Na removed was similar (1168 in UC vs. 1216 in UF). The UF group produced isotonic ultrafiltrate and a higher volume of dilute urine than anticipated. CONCLUSION: In a randomized pilot study of target weight guided therapy with UC or UF for ADHF, there were no differences in total volumes or Na removed, and lengths of hospital stays were similar. Isotonic fluid loss by UF was accompanied by the production of very dilute urine.
Diuretics ; Furosemide ; Heart Failure* ; Humans ; Length of Stay ; Pilot Projects* ; Prospective Studies ; Random Allocation ; Sodium* ; Ultrafiltration* ; Weights and Measures

Acrometastasis is rare and accounts for 0.1% of all metastasis. Renal cell carcinoma accounts for only 10% of this infrequent site. It is usually the late manifestation of a disseminated tumor, but may also be the primary manifestation of an occult cancer. Clinically, it may mimic benign tumors or nonneoplastic osteoarthritic conditions, thus resulting in misdiagnosis and improper treatment. We reported a case of acrometastasis in a renal cell carcinoma in a 76-year-old man who had been diagnosed with a progressed renal cell carcinoma with metastasis of the lung and brain.
Aged ; Brain ; Carcinoma, Renal Cell* ; Diagnostic Errors ; Humans ; Lung ; Neoplasm Metastasis

We report a case of intradermal nevus in a 43-year-old female patient, who presented with a tender, solitary papule on the periungual area, which seemed to be a periungual fibroma. The skin biopsy revealed the upper dermis and lower dermis containing nests and cords of nevus cells without junctional activity. It was totally removed by excisional biopsy.
Adult ; Biopsy ; Dermis ; Female ; Fibroma* ; Humans ; Nevus ; Nevus, Intradermal* ; Skin

Seborrheic keratoses (SK) are very common benign tumor arising in epidermis. Few malignant transformation of SK were reported. Inflammation, ulceration or atypical nature is the evidence of malignant transformation. Some melanoma can mimic SK. So, all SK need confirm histopathologic diagnosis. We reported a case of recurrent seborrheic keratosis with satellite lesions on the left groin in a linear pattern in a 46-year-old man.
Diagnosis ; Epidermis ; Groin* ; Humans ; Inflammation ; Keratosis, Seborrheic* ; Melanoma ; Middle Aged ; Ulcer

Cognitive impairment is a result of dementia of diverse causes, such as cholinergic dysfunction and Alzheimer's disease (AD). Houttuynia cordata Thunb. (Saururaceae) has long been used as a traditional herbal medicine. It has biological activities including protective effects against amyloid beta (Abeta) toxicity, via regulation of calcium homeostasis, in rat hippocampal cells. To extend previous reports, we investigated the effects of water extracts of H. cordata herb (HCW) on tauopathies, also involving calcium influx. We then confirmed the effects of HCW in improving memory impairment and neuronal damage in mice with Abeta-induced neurotoxicity. We also investigated the effects of HCW against scopolamine-induced cholinergic dysfunction in mice. In primary neuronal cells, HCW inhibited the phosphorylation of tau by regulating p25/p35 expression in Abeta-induced neurotoxicity. In mice with Abeta-induced neurotoxicity, HCW improved cognitive impairment, as assessed with behavioral tasks, such as novel object recognition, Y-maze, and passive avoidance tasks. HCW also inhibited the degeneration of neurons in the CA3 region of the hippocampus in Abeta-induced neurotoxicity. Moreover, HCW, which had an IC50 value of 79.7 microg/ml for acetylcholinesterase inhibition, ameliorated scopolamine-induced cognitive impairment significantly in Y-maze and passive avoidance tasks. These results indicate that HCW improved cognitive impairment, due to cholinergic dysfunction, with inhibitory effects against tauopathies and cholinergic antagonists, suggesting that HCW may be an interesting candidate to investigate for the treatment of AD.
Acetylcholinesterase ; Alzheimer Disease ; Amyloid ; Animals ; Calcium ; Cholinergic Antagonists ; Dementia ; Herbal Medicine ; Hippocampus ; Homeostasis ; Houttuynia* ; Inhibitory Concentration 50 ; Memory ; Mice ; Neurons ; Phosphorylation ; Rats ; Tauopathies ; Water

Onychomycosis is the invasion of the healthy nail plate by species of dermatophytes, as well as a variety of non-dermatophytes (yeasts and moulds) which may cause nail infection, particularly after tissue damage by trauma or disease. Candida albicans and C. parapilosis are the most commonly isolated yeasts from abnormal toenails. The patient was a 20-year-old woman who presented with a thickened and crumbly nail plate of the right second finger for 4 months. Initially, a tiny yellowish macule appeared under the nail plate, which gradually involved the entire nail plate, resulting in complete deformity of the nail. She was diagnosed with diabetes mellitus 4 months ago and her blood sugar level was controlled with subcutaneous insulin injections. Direct microscopic examination of the scrapings prepared with potassium hydroxide revealed fungal elements. Repeated cultures on Sabouraud dextrose agar showed cream to white colored, semi-glossy, flat colonies, which were findings consistent with C. albicans. Complete extraction of the involved nail with meticulous curettage of the nail bed was made. She has been taking 150 mg of oral fluconazole weekly since August 2003 and showed substantial improvement.
Agar ; Arthrodermataceae ; Blood Glucose ; Candida albicans* ; Candida* ; Congenital Abnormalities ; Curettage ; Diabetes Mellitus* ; Female ; Fingers ; Fluconazole ; Glucose ; Humans ; Insulin ; Nails ; Onychomycosis* ; Potassium ; Yeasts ; Young Adult

The levonorgestrel-releasing intrauterine system (LNG-IUS) is used for contraception and treatment of heavy menstrual bleeding as well as endometrial hyperplasia and early endometrial carcinoma. A 48-year-old woman visited an Internal Medicine outpatient clinic due to significantly elevated CA-125 and CA-19-9 levels in a routine health examination. She had been using LNG-IUS for 3 years. Before LNG-IUS insertion, she suffered from heavy menstrual bleeding and severe dysmenorrhea. Her endometrial sampling and ultrasonographic imaging showed no evidence of endometrial carcinoma at the time of LNS-IUS insertion. After insertion, she complained of neither abnormal uterine bleeding nor dysmenorrhea. She received a routine health checkup every year and showed results within normal range until last year. To rule out pancreatic cancer due to significantly elevated CA-19-9 levels, her physician performed positron emission tomography-computed tomography, which demonstrated increased FDG uptake in the endometrial cavity. We obtained endometrial biopsy and found endometrial carcinoma in her uterus and performed radical hysterectomy with bilteral pelvic lymphadectomy. Permanent pathology confirmed endometrial carcinoma with lymph node metastasis. She received concurrent chemoradiation therapy. We emphasize the necessity of regular follow-ups with ultrasonography and assessment of serum tumor markers for the early detection of endometrial carcinoma, although rare, in women using LNG-IUS, including those without abnormal uterine bleeding.
Ambulatory Care Facilities ; Biopsy ; Biomarkers, Tumor ; Contraception ; Dysmenorrhea ; Electrons ; Endometrial Hyperplasia ; Endometrial Neoplasms* ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Hysterectomy ; Internal Medicine ; Lymph Nodes ; Middle Aged ; Neoplasm Metastasis ; Pancreatic Neoplasms ; Pathology ; Reference Values ; Ultrasonography ; Uterine Hemorrhage ; Uterus

Actinic keratoses (AK) are premalignant lesions, which can develop into invasive squamous cell carcinoma(SSC). Therapies for AK include cryotherapy, curettage, topical 5-fluorouracil, laser therapy and so forth. All therapies currently prescribed can be painful and may result in scarring and changes in skin pigmentation. A potential new treatment modality for AK is the imiquimod (Aldara(R)), which can be applied by patients themselves. We reported a case of AK which was very extensive on the scalp of the old man, who was treated with topical imiquimod.
Actins* ; Cicatrix ; Cryotherapy ; Curettage ; Fluorouracil ; Humans ; Keratosis, Actinic* ; Laser Therapy ; Scalp ; Skin Pigmentation

OBJECTIVES: Delirium of hospitalized patients is common and it is significantly associated with increased mortality rate. Misdiagnosis rates of delirium are reported in a range of 36.7 to 63% in clinical setting. We aimed to identify the clinical features and symptomatic characteristics associated with misdiagnosis of delirium. METHODS: Subjects were 256 inpatients who were referred for psychiatric consultation and diagnosed with delirium by a psychiatrist at a university hospital between January 1 and June 30, 2012. Clinical data were obtained with retrospective chart review. Patients were divided into misdiagnosed group and correct diagnosed group, after reviewing the reason which were described in the consultation request form. RESULTS: Sixty nine(27%) subjects of the 256 patients were referred for other reasons(mood, substance, anxiety, dementia etc.) than "delirium/confusion" by clinician(misdiagnosed group). In misdiagnosed group, use of antipsychotics was more common. There were no differences between the two groups in age, gender, and department of referring clinician. Fluctuation score of DRS-R-98 was higher in the correct diagnosed group. CONCLUSIONS: In this study, the risk of misdiagnosis was higher when the patients have taken antipsychotics or less symptom fluctuation. Careful clinical attention is needed for diagnosis for delirium in these patients.
Antipsychotic Agents ; Anxiety ; Delirium* ; Dementia ; Diagnosis ; Diagnostic Errors ; Humans ; Inpatients ; Mortality ; Psychiatry ; Retrospective Studies