Rosacea is a common chronic cutaneous disorder that primarily occurs on the convex surfaces of the central face and is often characterized by exacerbations and remissions. A case of a 52-yr-old woman visited our clinic in February 2008 complaining typical features of rosacea including multiple pinhead to rice-sized erythematous papules. We applied various conventional treatments including topical benzoyl peroxide and metronidazole as well as oral metronidazole, isotretinoin, and doxycycline. The lesions were not controlled but were rather aggravated by complications from these treatments. Therefore, we prescribed oral azithromycin, which has anti-inflammatory effects and reduces reactive oxygen species. Ten weeks after the administration of oral azithromycin, 500 mg per day for 2 weeks, the lesions had mostly disappeared and no specific side effects related to the azithromycin were noted. Oral azithromycin dosing 500 mg/day for 2 weeks is effective for treatment of intractable rosacea.
Administration, Oral ; Azithromycin/administration & dosage/pharmacology/*therapeutic use ; Erythema/diagnosis/drug therapy ; Female ; Humans ; Middle Aged ; Reactive Oxygen Species ; Rosacea/diagnosis/*drug therapy ; Skin Diseases/drug therapy

Congenital carpal coalition is an uncommon anomaly that results from an incomplete joint cavitation of the primitive carpus. Congenital carpal coalition between the capitate and hamate is generally believed to be asymptomatic and, thus, is usually discovered on radiographs taken for unrelated reasons. We report two cases of congenital carpal coalition (capitate-hamate) associated with pain of the wrist.
Carpal Bones ; Joints ; Wrist

Hemophagocytic syndrome is a rare complication of a systemic infection that can have a fatal outcome. The skin manifestations can present as erythematous patches or nodules, purpura, ulcers, or edema. But the histopathologic features solely consist of infiltration of benign histiocytes and hemophagocytosis. We report a case of a 67 year-old male patient diagnosed with hemophagocytic syndrome caused by Pseudomonas aeruginosa infection.
Aged ; Edema ; Fatal Outcome ; Histiocytes ; Humans ; Lymphohistiocytosis, Hemophagocytic* ; Male ; Pseudomonas aeruginosa* ; Pseudomonas* ; Purpura ; Skin Manifestations ; Ulcer

Verapamil overdose results in cardiac arrhythmia including the complete A-V block, and hypotension due to decreased peripheral resistance and decreased myocardial contractility. However, sustained-release verapamil overdose frequently has atypical presentations, such as delayed and prolonged course of toxic signs and symptoms. Although several cases of sustained-release verapamil overdose have been reported worldwidely, the specific treatment modalities and prognostic indicators for verapamil overdose have not been well-defined. Recently, we experienced a case of sustained-release verapamil overdose in 30-year-old female. 10 hours after verapamil ingestion she presented in severe bradycardia and hypotensive shock state. Initial EKG showed the complete AV block and her systolic blood pressure was below 60 mmHg. Temporary cardiac pacemaker was performed and she was treated with activated charcoal, glucagon, amrinone, and several sympathomimetics, and 48 hours after admission, she was fully recovered.
Adult ; Amrinone ; Arrhythmias, Cardiac ; Atrioventricular Block ; Blood Pressure ; Bradycardia ; Charcoal ; Eating ; Electrocardiography ; Female ; Glucagon ; Humans ; Hypotension ; Shock ; Sympathomimetics ; Vascular Resistance ; Verapamil*

BACKGROUND: Cilostazol leads to inhibition of platelet aggregation and to vasodilatation. It is widely used for the secondary prevention of cerebral infarction. However, headache is a well-known adverse effect of cilostazol, and these headaches may be caused by the vasodilation of the cerebral artery. The goal of our study was to assess the frequency and severity of headaches following cilostazol treatment and to evaluate factors related to the development of these headaches. METHODS: Seventy patients with cerebral infarction were included in this study. We measured the carotid intima media thickness (IMT), the distensibility of the carotid artery (CAD), the brachial ankle index (ABI), and the brachial ankle pulse wave velocity (PWV) in order to quantify the degree of atherosclerosis and arterial stiffness. Patients were then given 100 mg of cilostazol in tablet form twice daily. For three days, we evaluated headache incidence and severity using a verbal rating scale (0-10). RESULTS: Twenty three (32.9%) patients reported headache during cilostazol medication and 7 patients had severe headache. Women were more likely to develop headaches than men (p=0.03). In addition, the mean IMT was lower in subjects with cilostazol-induced headache than in the headache-free subjects (0.8+/-0.1 vs 1.01+/-0.2 mm, p=0.001), while CAD was higher in these subjects (0.3+/-0.1 vs 0.25+/-0.1, p=0.03). There was no difference in PWV and ABI. CONCLUSIONS: Lower carotid IMT, increased CAD, and female gender may be associated with the development of cilostazol-induced headache in patients with cerebral inafarction, but not the systemic arterial stiffness.
Animals ; Ankle ; Atherosclerosis ; Carotid Arteries ; Carotid Intima-Media Thickness ; Cerebral Arteries ; Cerebral Infarction ; Female ; Headache ; Humans ; Incidence ; Male ; Platelet Aggregation ; Pulse Wave Analysis ; Secondary Prevention ; Tetrazoles ; Vascular Stiffness ; Vasodilation

Atrophoderma of Pasini and Pierini is a form of dermal atrophy that manifests as either single or multiple, sharply demarcated, hyperpigmented, non-indurated patches. These patches are marked by a slight depression of the skin, with an abrupt edge (i.e., the "cliff-drop" borders), usually located on the backs of adolescents or young adults. The pathophysiology of the disease is unknown, but some authors have suggested a role of Borrelia burgdorferi infection. A 35-year-old woman visited our department because of asymptomatic, hypopigmented, depressed patches on her chest and back lasting for three months. Laboratory evaluations were normal, except for positive serum antibodies to Borrelia burgdorferi. Histologic examination revealed a significantly decreased thickness of the dermis. The patient underwent treatment with oral doxycycline 200 mg/day for six weeks, after which the depth of depression was improved. Herein, we report a case of atrophoderma of Pasini and Pierini, associated with Borrelia burgdorferi infection, successfully treated with oral doxycycline.
Adolescent ; Adult ; Antibodies ; Atrophy ; Borrelia ; Borrelia burgdorferi ; Depression ; Dermis ; Doxycycline ; Female ; Humans ; Skin ; Thorax ; Young Adult

Periodic alternating nystagmus (PAN) is characterized by horizontal nystagmus that reverses direction periodically. PAN can occur in both congenital and acquired conditions. We report a 58-year old man with peripheral vertigo and hearing impairment showing PAN in darkness.
Darkness ; Hearing Loss ; Meniere Disease ; Nystagmus, Pathologic ; Vertigo

A prominent crista terminalis is a normal anatomic variant which consist of thick muscular bridge within the right atrium. However, it could be often misdiagnosed with an abnormal mass on the transthoracic echocardiography. The case report presented here, describe the findings of transthoracic echocardiography that suggested a right atrial mass in patients with pulmonary embolism. However, subsequent transesophageal echocardiography and cardiac computed tomography/magnetic resonance imaging differentiated a true right atrial mass from a prominent crista terminalis.
Echocardiography ; Echocardiography, Transesophageal ; Heart Atria ; Humans ; Pulmonary Embolism

BACKGROUND AND OBJECTIVES: The aims of this study were to compare the lipid distributions and risk factors in an angiographically normal coronary artery group to those of microvascular and coronary artery diseased groups of Koreans, and to find the effects of the variable risk factors on the serum lipid levels according to the coronary atherosclerosis status. SUBJECTS AND METHODS: A total of 1,198 patients (563 males and 635 females), having undergone a coronary angiography (CAG) using Judkins method, were included. According to their coronary angiographic findings, they were divided into normal CAG (n=568), microvascular disease (n=230) and coronary atherosclerosis (n=400) groups. RESULTS: The mean value of the total cholesterol in the patients with normal coronary artery was 175 mg/dl, which progressively increased to 182 mg/dl and 198 mg/dl in the patients with microvascular disease and coronary atherosclerosis, respectively. The frequencies of the risk factors for coronary atherosclerosis also progressively increased in the patients with microvascular disease and coronary atherosclerosis. The mean values of the serum total cholesterol, LDL-cholesterol and lipoprotein(a), progressively increased from the patients with normal angiographic findings to those with microvascular disease and coronary atherosclerosis, and the results were statistically significant. The results for the patients with microvascular disease were in between those of the patients with normal angiographic findings and those with coronary atherosclerosis. CONCLUSION: The correlation between coronary atherosclerosis and the serum cholesterol levels has, until now, been studied epidemiologically, and this is the first study to angiographically elucidate the positive relationship between coronary artery disease and the serum cholesterol levels. Our data showed lower ranges of lipid distributions compared to those of the ATP III guideline.
Adenosine Triphosphate ; Cholesterol ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels ; Humans ; Lipoprotein(a) ; Male ; Risk Factors* ; Triglycerides

BACKGROUND: Differential diagnosis of thyroid nodule is important in deciding treatment modality and fine needle aspiration is a good method to do so. But, sometimes, it has limitation in use because of inadequate test material and difficulty in interpreting it. Among the study of oncogene and tumor suppresor gene on the origin of thyroid tumor, expression of Fra-1, one of AP-1 system, is increased in thyroid neoplasm. So there is a possibility that it would be used as a method for differential diagnosis of thyroid nodule. We tried to know whether presence or absence of Fra-1 expression can be used as a diagnostic method in differential diagnosis of thyroid nodule using immuno- histochemical(IHC) staining method. METHODS: In 4 types of thyroid tumor that was confirmed by histologic diagnosis after operation(30 cases of papillary cancer, 10 cases of follicular cancer, 16 cases of follicular adenoma, 18 cases of adenomatous goiter), IHC staining method was performed to evaluate the expression of Fra-1. RESULTS: In papillary and follicular thyroid cancer, the expression of Fra-1 was stronger than benign thyroid tumor, but there was no difference in Fra-1 expression between two types of carcinoma. Weak expression of Fra-1 was observed in all cases of follicular adenoma, and it was also weakly expressed in 6 out 18 cases of adenomatous goiter. CONCLUSION: The expression of Fra-1 was stronger in thyroid cancer than in benign thyroid adenoma, but it was impossible to differentiate thyroid cancer from benign thyroid adenoma by the presence or absence of Fra-1 expression using IHC staining method.
Adenoma ; Biopsy, Fine-Needle ; Diagnosis ; Diagnosis, Differential ; Goiter ; Immunohistochemistry ; Oncogenes ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroid Nodule ; Transcription Factor AP-1