Dermatomyositis (DM) is an idiopathic inflammatory process characterized by proximal muscle weakness and cutaneous lesions, such as the Gottron's sign, heliotrope rash, and erythematous photosensitive rash. Administration of systemic agents for the treatment of underlying systemic diseases leads to remission of the cutaneous lesions in many cases. However, cutaneous lesions may remain refractory to treatment. Pimecrolimus is a calcineurin inhibitor with combined anti-inflammatory and immunomodulatory activity. It has high affinity to the skin and low permeation potential, even in patients with acute skin inflammation and in those undergoing post-topical corticosteroid therapy. We herein report two DM patients whose cutaneous lesions were refractory to conventional treatment but showed dramatic response to topical pimecrolimus. The clinical outcomes suggest that topical pimecrolimus may be a good therapeutic alternative for the management of the cutaneous lesions of DM.
Calcineurin ; Dermatomyositis ; Exanthema ; Humans ; Inflammation ; Muscle Weakness ; Skin ; Tacrolimus

BACKGROUND AND OBJECTIVES: The patient presenting to the emergency department with the complaint of dizziness is one of the most common as well as most challenging problems confronting the emergency physician today. Dizziness is a vague symptom of disease ranging from serious to benign. The differential diagnosis and proper management of dizziness in a department of emergency medicine are the most important things. We undertook this study to evaluate the character and clinical analysis of the dizzy patients and to discuss the significance and necessity of primary care in a department of emergency medicine. MATERIALS AND METHOD: From September 1999 to October 2003, we sampled the 1,371 dizzy patients who visited the Emergency Department(ED). Of these patients, the 650 patients performed electronystagmography(ENG) and rotatory chair test were selected, except for the patients with loss of consciousness, known psychiatric disease or direct brain injury. RESULTS: The 650 patients were attributed to acute peripheral vestibulopathy in 88.5% (575 patients) of patients, benign paroxysmal positional vertigo in 9.5% (62 patients) of patients, central origin in 1.4% (9 patients) of patients, other organic origin in 0.6% (4 patients) of patients. In a retrospective analysis of patients with central origin, the symptoms estimated at central origin, for example, persistent headache, were found. CONCLUSION: The exact diagnosis and management for the dizzy patients in a department of emergency medicine require the primary physician's concern and understanding for dizziness.
Brain Injuries ; Diagnosis ; Diagnosis, Differential ; Dizziness ; Emergencies* ; Emergency Medicine* ; Emergency Service, Hospital ; Headache ; Humans ; Primary Health Care ; Retrospective Studies ; Unconsciousness ; Vertigo ; Vestibular Neuronitis

BACKGROUND: This study was performed to ascertain the usefulness of the human papillomavirus (HPV) DNA microchip test for the screening and management of women with atypical squamous cells of undetermined significance (ASC-US). METHODS: The subject group consisted of 534 patients, and all of whom were diagnosed as ASC-US according to a Papanicolaou smear, and they all underwent concomitant HPV DNA microchip test. RESULTS: The occurrence rates of overall squamous lesions and high risk lesion (cervical intraepithelial neoplasia grade 2 and grade 3, and invasive carcinoma) of the HPV-positive ASC-US patients were significantly higher than those of the HPV-negative ASC-US patients. High risk lesion was detected more frequently among the older patients and the patients with HPV 56, 33 or 70. On the follow-up HPV DNA microchip test, only 1 of 11 (9.1%) HPV type-switched women developed squamous lesion compared with 8 of 13 (61.6%) HPV type-persistent women who developed squamous lesion. CONCLUSIONS: The HPV DNA microchip test is useful for the management of ASC-US patients. HPV-positive ASC-US patients should undergo a HPV DNA microchip test periodically. If the same genotype of HPV is persistent on the follow-up test, more increased surveillance is needed.
DNA ; Female ; Follow-Up Studies ; Genotype ; Humans ; Mass Screening ; Oligonucleotide Array Sequence Analysis ; Vaginal Smears

Alveolar soft part sarcoma (ASPS) is a rare malignant soft tissue tumor of uncertain origin, and it has a strong propensity for metastasis to the lungs, bones and brain. We report upon an unusual case of ASPS, presenting as multiple lung nodules with no other detectable primary site, in a 44-year-old man. A fine needle aspiration of the nodules yielded scattered, discohesive cells, each containing an eccentrically displaced nucleus and prominent nucleolus, on a granular background. Tumor cells with numerous bared nuclei, and occasional sheets of epithelioid cells were also found. Under the cytological diagnosis of an unclassified epithelioid malignant tumor, resection of the lung nodules was performed. The histologic findings were consistent with ASPS, showing positive TFE3-nuclear immunoreactivity. There is limited literature concerning cytological findings associated with pulmonary ASPS: especially in cases where the primary site is unknown. Here, we present a cytological review of pulmonary ASPS, investigating the significance of TFE3 staining in the diagnosis of ASPS.
Adult ; Biopsy, Fine-Needle ; Brain ; Epithelioid Cells ; Humans ; Lung ; Neoplasm Metastasis ; Sarcoma, Alveolar Soft Part ; Viperidae

OBJECTIVES: Magnetic resonance imaging (MRI)-guided high intensity focused ultrasound surgery (MRgFUS) is a newly emerging non-invasive technique for the treatment of uterine fibroids. The purpose of this study is to review the clinical impact of MRgFUS. METHODS: This study examined 157 patients. The high intensity focused ultrasound (HIFU) utilized in this study was Philips Achieva 1.5 Tesla MR (Philips Healthcare, Best, the Netherlands) and Sonalleve HIFU system. The patients were followed in post-operative Month 1, Month 3, and Month 6 to investigate any change. Then, these were further classified according to the use of uterine stimulant (oxytocin) in parallel, Funaki Type of uterine fibroid, HIFU intensity, and non-perfused volume (NPV) ratio. RESULTS: When the uterine stimulant was utilized, the HIFU intensity was measured at significantly lower levels, compared with the group not using uterine stimulant, and treatment duration was significantly. The NPV ratio was found significantly higher in the group using uterine stimulant. Concerning the correlation between Funaki Type of uterine fibroid and average sonication power, it was found that the closer to Type I, the lower the sonication power, the shorter the treatment duration, and the higher the NPV ratio significantly. CONCLUSIONS: In this study, it was found that the lower the Funaki Types of uterine fibroids, and the higher the NPV ratio immediately after the operation, the larger the uterine fibroid volume decrease and SSS change were. Also, if uterine stimulant was used in parallel in treatment, treatment duration and HIFU intensity could become shorter and lower.
Delivery of Health Care ; High-Intensity Focused Ultrasound Ablation ; Humans ; Leiomyoma* ; Magnetic Resonance Imaging ; Myoma ; Oxytocin ; Sonication ; Ultrasonography*

Lung cancer is a malignant tumor that is often fatal. Vaginal metastasis of pulmonary adenocarcinoma is very rare. To the best of our knowledge, this is the second such report worldwide and the first one from Korea. A 67-year-old woman presented with cough, excessive sputum and dyspnea that she had sufferd with for the past one year and she had a palpable lesion in the vagina. Chest CT showed diffuse bronchial wall thickening involving the left main bronchus, the left upper lobar bronchus and the lingular divisional bronchus of the left upper lobe. There were multiple, various sized nodules in both lungs, of which the largest one measured about 1.0 cm in diameter. Both lung and vaginal biopsies were performed and the masses were diagnosed as adenocarcinoma. Immunohistochemically, the tumor cells were positive for cytokeratin 7 and TTF-1, but they were negative for cytokeratin 20. We present this case of primary lung adenocarcinoma metastasis to the vagina.
Adenocarcinoma ; Aged ; Biopsy ; Bronchi ; Cough ; Dyspnea ; Female ; Humans ; Keratin-20 ; Keratin-7 ; Korea ; Lung ; Lung Neoplasms ; Neoplasm Metastasis ; Sputum ; Thorax ; Vagina

Congenital thoracic malformations such as intra- and extra-pulmonary sequestration, cystic adenomatoid malformation, congenital pulmonary airway malformation, malinosculation, bronchogenic cyst, reduplication cyst, and foregut cyst are frequently detected on routine prenatal ultrasound. There are some controversies about treatment for postnatally persistent pulmonary sequestration. Some authors recommend expectant long term follow up but most authors advocate elective surgical excision because of complication such as respiratory distress, infection, intrathoracic bleeding, haemoptysis, cardiac failure, and potential risk of malignancy. We experienced 2 cases of prenatally diagnosed extrapulmonary sequestration which were located in the subdiaphragmatic retroperitoneum. Resections were performed at 2 months and 4 months of age using intraabdominal approach. There were no complications. In conclusion, if the prenatally diagnosed extrapulmonary sequestration remained postnatally, early operation might reduce morbidity related to extrapulmonary sequestration and parental anxiety without any postoperative complication.
Anxiety ; Bronchogenic Cyst ; Bronchopulmonary Sequestration ; Follow-Up Studies ; Heart Failure ; Hemorrhage ; Humans ; Parents

Background: and Purpose: The expression of the 18-kDA mitochondrial translocator protein (TSPO) in the brain is an attractive target to study neuroinflammation. However, the binding properties of TSPO ligands are reportedly dependent on genetic polymorphism of the TSPO gene (rs6971). The objective of this study is to investigate the rs6971 gene polymorphism in the Korean population. Methods: We performed genetic testing on 109 subjects including patients with mild cognitive impairment, Alzheimer’s disease (AD) dementia, non-AD dementia, and cognitively unimpaired participants. Magnetic resonance imaging scans and detailed neuropsychological tests were also performed, and 29 participants underwent 18 F-DPA714 PET scans. Exon 4 of the TSPO gene containing the polymorphism rs6971 (Ala or Thr at position 147) was polymerase chain reaction amplified and sequenced using the Sanger method. The identified rs6971 genotype codes (C/C, C/T, or T/T) of the TSPO protein generated high-, mixed-, or lowaffinity binding phenotypes (HABs, MABs, and LABs), respectively. Results: We found that 96.3% of the study subjects were HAB (105 out of 109 subjects), and 3.7% of the subjects were MAB (4 out of 109 subjects). 18 F-DPA-714 PET scans showed nonspecific binding to the thalamus and brainstem, and increased tracer uptake throughout the cortex in cognitively impaired patients. The participant with the MAB polymorphism had a higher DPA714 signal throughout the cortex. Conclusions The majority of Koreans are HAB (approx. 96%). Therefore, the polymorphism of the rs6971 gene would have a smaller impact on the availability of second-generation TSPO PET tracers.

Purpose: This study aimed to identify and compare the risk factors of depression among middle-class Korean workers. Methods: A cross sectional study was designed for secondary data analysis. From the 8th Korean Medical Panel Survey (2008~2013), a total of 3,056 data was drawn and analyzed. With SPSS version 24, a developmental stage comparison, with the stage being young adults (20~39), middle-aged adults (40~64), and older adults (65+) were conducted. Frequency, percentage, x 2 test and logistic regression analysis were statistical tools used to analyze the data. Results: In all developmental groups, experience of frustration was found to be a common risk factor of depression. Stress from excessive task, peer-compared subjective health status, and self-perceived social class were risk factors of depression in the young adults and the middle-aged adults. Anxiety for the future significantly influenced depression in the middle-aged adults and older adults. Conclusion Experience of frustration was a major risk factor of depression among Korean middle-class workers. Interventions to reduce depression need to be developed focusing on the specific risk factors by developmental stages such as experience of frustration, stress from task burden, poor peer-compared subjective health status and anxiety for the future.

Objective: : Exploring protein requirements for critically ill patients has become prominent. On the other hand, considering the significant impact of coma therapy and targeted temperature management (TTM) on the brain as well as systemic metabolisms, protein requirements may plausibly be changed by treatment application. However, there is currently no research on protein requirements following the application of these treatments. Therefore, the aim of this study is to elucidate changes in patients’ protein requirements during the application of TTM and coma therapy. Methods: : This study is a retrospective analysis of prospectively collected data from March 2019 to May 2022. Among the patients admitted to the intensive care unit, those receiving coma therapy and TTM were included. The patient’s treatment period was divided into two phases (phase 1, application and maintenance of coma therapy and TTM; phase 2, tapering and cessation of treatment). In assessing protein requirements, the urine urea nitrogen (UUN) method was employed to estimate the nitrogen balance, offering insight into protein utilization within the body. The patient’s protein requirement for each phase was defined as the amount of protein required to achieve a nitrogen balance within ±5, based on the 24-hour collection of UUN. Changes in protein requirements between phases were analyzed. Results: : Out of 195 patients, 107 patients with a total of 214 UUN values were included. The mean protein requirement for the entire treatment period was 1.84±0.62 g/kg/day, which is higher than the generally recommended protein supply of 1.2 g/kg/day. As the treatment was tapered, there was a statistically significant increase in the protein requirement from 1.49±0.42 to 2.18±0.60 in phase 2 (p<0.001). Conclusion : Our study revealed a total average protein requirement of 1.84±0.62 g during the treatment period, which falls within the upper range of the preexisting guidelines. Nevertheless, a notable deviation emerged when analyzing the treatment application period separately. Hence, it is recommended to incorporate considerations for the type and timing of treatment, extending beyond the current guideline, which solely accounts for the severity by disease.