Onychogryphosis is a disorder of nail plate growth, which most commonly involves the toenails. It is characterized by opaque, yellow-brown thickening of the nail plate with associated marked convexity and elongation. Treatment for onychogryphosis can be conservative or operative depending on the cause and medical status of the patient. A 30-year-old male presented with onychogryphosis of the right and left toenails. Since the patient had shown recurrence after simple nail avulsion several years ago, the inverted T incision method and fusiform excision of the hypertrophic hyponychium were performed. No recurrence was observed during the 3-year follow-up period. Our results showed that nail avulsion combined with traction osteophyte removal is a suitable surgical method for treating onychogryphosis.

Purpose: We evaluated the relationship between breast pathologic complete response (BpCR) and axillary pathologic complete response (ApCR) after neoadjuvant chemotherapy (NACT) according to nodal burden at presentation. As the indications for NACT have expanded, clinicians have started clinical trials for the omission of surgery from the treatment plan in patients with excellent responses to NACT. However, the appropriate indications for axillary surgery omission after excellent NACT response remain unclear. Methods: Data were collected from patients in the Korean Breast Cancer Society Registry who underwent NACT followed by surgery between 2010 and 2020. We analyzed pathologic axillary nodal positivity after NACT according to BpCR stratified by tumor subtype in patients with cT1-3/N0-2 disease at diagnosis. Results: A total of 6,597 patients were identified. Regarding cT stage, 528 (9.5%), 3,778 (67.8%), and 1,268 (22.7%) patients had cT1, cT2, and cT3 disease, respectively. Regarding cN stage, 1,539 (27.7%), 2,976 (53.6%), and 1,036 (18.7%) patients had cN0, cN1, and cN2 disease, respectively. BpCR occurred in 21.6% (n = 1,427) of patients, while ApCR and pathologic complete response (ypCR) occurred in 59.7% (n = 3,929) and ypCR 19.4% (n = 1,285) of patients, respectively. The distribution of biologic subtypes included 2,329 (39.3%) patients with hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative disease, 1,122 (18.9%) with HR-positive/HER2-positive disease, 405 (6.8%) with HR-negative/HER2-positive disease, and 2,072 (35.0%) with triple-negative breast cancer . Among the patients with BpCR, 89.6% (1,122/1,252) had ApCR. Of those with cN0 disease, most (99.0%, 301/304) showed ApCR. Among patients with cN1-2 disease, 86.6% (821/948) had ApCR. Conclusion BpCR was highly correlated with ApCR after NACT. In patients with cN0 and BpCR, the risk of missing axillary nodal metastasis was low after NACT. Further research on axillary surgery omission in patients with cN0 disease is needed.

PURPOSE: To evaluate superiority of a night float (NF) system in comparison to a traditional night on-call (NO) system for surgical residents at a single institution in terms of efficacy, safety, and satisfaction. METHODS: A NF system was implemented from March to September 2017 and big data analysis from electronic medical records was performed for all patients admitted for surgery or contacted from the emergency room (ER). Parameters including vital signs, mortality, and morbidity rates, as well as promptness of response to ER calls, were compared against a comparable period (March to September 2016) during which a NO system was in effect. A survey was also performed for physicians and nurses who had experienced both systems. RESULTS: A total of 150,000 clinical data were analyzed. Under the NO and NF systems, a total of 3,900 and 3,726 patients were admitted for surgery. Mortality rates were similar but postoperative bleeding was significantly higher in the NO system (0.5% vs. 0.2%, P = 0.031). From the 1,462 and 1,354 patients under the NO and NF systems respectively, that required surgical consultation from the ER, the time to response was significantly shorter in the NF system (54.5 ± 70.7 minutes vs. 66.8 ± 83.8 minutes, P < 0.001). Both physicians (90.4%) and nurses (91.4%) agreed that the NF system was more beneficial. CONCLUSION: This is the first report of a NF system using big data analysis in Korea, and potential benefits of this new system were observed in both ward and ER patient management.
Electronic Health Records ; Emergency Service, Hospital ; Hemorrhage ; Humans ; Internship and Residency ; Korea ; Medical Staff ; Mortality ; Statistics as Topic ; Vital Signs

BACKGROUND: Psoriasis is an immune-mediated, chronic inflammatory disease affecting multiple aspects of patients' lives. Its epidemiology varies regionally; however, nationwide epidemiologic data on psoriasis depicting profile of Korean patients has not been available to date. OBJECTIVE: To understand nationwide epidemiologic characteristics and clinical features of adult patients with psoriasis visited university hospitals in Korea. METHODS: This multicenter, non-interventional, cross-sectional study recruited 1,278 adult patients with psoriasis across 25 centers in Korea in 2013. Various clinical data including PASI, BSA, DLQI, SF-36 and PASE were collected. RESULTS: A total of 1,260 patients completed the study (male:female=1.47:1). The mean age was 47.0 years with a distribution mostly in the 50s (24.9%). Early onset (<40 years) of psoriasis accounted for 53.9% of patients. The mean disease duration was 109.2 months; mean body mass index was 23.9 kg/m²; and 12.7% of patients had a family history of psoriasis. Plaque and guttate types of psoriasis accounted for 85.8% and 8.4%, respectively. Patients with PASI ≥10 accounted for 24.9%; patients with body surface area ≥10 were 45.9%. Patients with DLQI ≥6 accounted for 78.8%. Between PASI <10 and PASI ≥10 groups, significant difference was noted in age at diagnosis, disease duration, blood pressure, waist circumference of female, and treatment experiences with phototherapy, systemic agents, and biologics. CONCLUSION: This was the first nationwide epidemiologic study of patients with psoriasis in Korea and provides an overview of the epidemiologic characteristics and clinical profiles of this patient population.
Adult ; Biological Products ; Blood Pressure ; Body Mass Index ; Body Surface Area ; Cross-Sectional Studies* ; Diagnosis ; Epidemiologic Studies ; Epidemiology ; Female ; Hospitals, University ; Humans ; Korea* ; Phototherapy ; Psoriasis* ; Waist Circumference

BACKGROUND: The development of therapies for psoriasis has led to the need for a new strategy to the treatment of patients with moderate-to-severe psoriasis. New consensus guidelines for psoriasis treatment have been developed in some countries, some of which have introduced treatment goals to determine the timing of therapeutic regimens for psoriasis. OBJECTIVE: To investigate the opinions held by Korean dermatologists who specialize in psoriasis about treatment goals, and to compare these with the European consensus. METHODS: Korean dermatologists who specialize in psoriasis were asked 11 questions about defining the treatment goals for psoriasis. The questionnaire included questions about the factors used to classify the severity of psoriasis, defining the induction and maintenance phases of psoriasis treatment, defining treatment responses during the induction phase, and defining treatment responses during the maintenance phase. RESULTS: The Korean consensus showed responses that were almost similar to the European consensus, even without using the Delphi technique, which uses repeated rounds of questions to reach a consensus. Only one response that related to psoriasis severity in the context of the quality of patients' lives differed from the European consensus. CONCLUSION: The concept of using treatment goals in the treatment of moderate-to-severe psoriasis can be applied to Korean psoriasis patients. Since a tool for assessing the quality of patients' lives is not commonly used in Korea, the development of a simple, rapidly completed, and region-specific health-related quality of life assessment tool would enable treatment goals to be used in routine clinical practice.
Consensus* ; Delphi Technique ; Humans ; Korea ; Psoriasis* ; Quality of Life ; Severity of Illness Index ; Surveys and Questionnaires

BACKGROUND: Ota's nevus, characterized by the presence of melanocytes in the dermis, has been familiar among dermatologists, but the etiology, the pathophysiology, the clinical and histological classification are not entirely clear. To understand and elucidate them, more clinical studies and researches are necessary. OBJECT: The aim of this study was to document the clinical and histopathological features of Ota's nevus. METHODS: We examined 299 patients with Ota's nevus who visited the dermatology clinic in Korea from February 1993 to August 2003. Among them, 188 patients were biopsied. All the specimens were stained with hematoxylin and eosin. We examined the age & sex distribution, age of onset, seasonal variation, associated skin diseases, aggravating factors and color. We clinically classified Ota's nevus into 4 types according to Tanino's classification and histologically into 5 types based on the pattern of pigmentation. RESULTS: 1. The ratio of male and female was 1: 3. 2. The peak age of onset was at birth (28.4%) and puberty (24.8%). 3. Seasonal variation was observed with distinct aggravation in the summer (60%). 4. The associated diseases were 9 cases of persistent mongolian spot, 6 cases of nevus flameus, 4 cases of blue nevus, 3 cases of vitiligo, 3 cases of nevus of Ito, 2 cases of atopic dermatitis, 2 cases of psoriasis, 2 cases of cafe au late macules and 2 cases of contact dermatitis. 5. The aggravating factors were sunlight (35.8%), emotional stress (21.0%), menstruation (12.6%), cold exposure (9.5%), pregnancy (9.5%), fatigue (9.5%) and chemical agents (2.1%). 6. The color of lesions were blue black (36.8%), brown (34.8%), dark brown (16.1%) and slate (11.0%). 7. All cases were classified according to Tanino's METHODS: type Ia (23.1%), type Ib (20.1%), type II (26.7%), type III (9.4%), type IV (20.7%). 8. The histological subtypes of Ota's nevus were classified as: the superficial type (35.6%); the middermis type (5.9%), the superficial-middermis type (18.6%); the mid-lower dermis type (2.7%); the diffuse type was composed of the superficial dominant type (19.7%), the middermis dominant type (4.8%), the dispersed (true diffuse) type (12.2%) and the deep dominant type (0.5%). 9. In the relation between histological types and the color of the lesion: the superficial type had 31 cases of brown color, 15 cases of blue black color, 11 cases of dark brown color and 9 cases of slate color; the middermis type had 6 cases of blue black color and 2 cases of dark brown color, query number of cases of slate color; the superficial-middermis type had 12 cases of blue black color, 10 cases of dark brown color, 7 cases of brown color and 6 cases of slate color: the mid-lower dermis type had 3 cases of blue black color; for the diffuse type, the superficial dominant type had 13 cases of brown color, query number of cases of blue black color and 7 cases of dark brown color; the mid-dermis dominant type had 4 cases of brown color, query number of cases of dark brown color, the dispersed type had 14 cases of blue black color and 5 cases of brown color; the deep dominant type had 1 case of blue black color. CONCLUSION: The histological reclassification of Ota's nevus may be very useful in making a therapeutic prognosis of the disease.
Adolescent ; Age of Onset ; Classification ; Dermatitis, Atopic ; Dermatitis, Contact ; Dermatology ; Dermis ; Eosine Yellowish-(YS) ; Fatigue ; Female ; Hematoxylin ; Humans ; Korea ; Male ; Melanocytes ; Menstruation ; Mongolian Spot ; Nevus ; Nevus of Ota* ; Nevus, Blue ; Parturition ; Pigmentation ; Pregnancy ; Prognosis ; Psoriasis ; Puberty ; Seasons ; Sex Distribution ; Skin Diseases ; Stress, Psychological ; Sunlight ; Vitiligo

PURPOSE: To compare the MR imaging findings of experimentally induced pyogenic arthritis of rabbit knees with the corresponding histopathologic findings. MATERIALS AND METHODS: Infection was induced in 20 rabbit knees by direct intra-articular injection of Staphylococcus aureus. The animals were divided into four groups of five rabbits each, and spin-echo sagittal T1-and T2-weighted images were obtained 3 days, 1 week, 2 weeks, and 4 weeks, respectively, after staphylococcal inoculation. MR-pathologic correlation was performed, with emphasis on intra-and extra-articular soft tissue lesion characteristics. Soft tissue lesion signal intensity (SI) was classified as low, iso, or high on the basis of that of muscle, and high SI was further subdivided into three categories. RESULTS: At T2-weighted imaging, all soft tissue lesions showed high SI. Pathologic examination revealed the presence of inflammatory cell infiltration (n=2), abscess (n=1), granulation tissue (n=3), fibrosis (n=11), edema (n=4), congestion (n=9), and joint fluid (n=11). Except for the abscess, these lesions were irregular in shape and had variable SI (grade 1-3) and at T2WI could not, therefore, be differentiated. In nine kness, extraarticular soft-tissue lesions were demonstrated at T2WI and correlated with infectious soft tissue lesions such as inflammatory cell infiltration, abscess, granulation tissues and fibrosis; and non-infectious reactive soft tissue changes such as edema and congestion. CONCLUSION: In pyogenic arthritis, the MR imaging features of soft tissue lesions varied and were nonspecific, depending on the histopathologic abnormalities observed. Our results indicate that in assessing the extent of pyogenic arthritis with MR imaging, caution is required.
Abscess ; Animals ; Arthritis* ; Arthritis, Infectious ; Edema ; Estrogens, Conjugated (USP) ; Fibrosis ; Granulation Tissue ; Injections, Intra-Articular ; Joints ; Knee* ; Magnetic Resonance Imaging* ; Pathology* ; Rabbits ; Staphylococcus aureus

PURPOSE: This study was performed to review the clinical presentation, diagnostic methods, treatments and prognosis of children with vascular rings. METHOD: We reviewed the medical records of 7 patients with vascular ring who were admitted in Samsung medical center between 1996 and 2000 retrospectively. RESULT: Pulmonary artery sling was noted in 4 cases. Two cases had double aortic arch, and 1 case had right aortic arch with left ligamentum arteriosus and aberrant left subclavian artery. The mean age at onset of symptoms was 3.2 months(from birth to 11 months). The mean age at diagnosis was 7.0 months(from 6 weeks to 15 months). Presenting symptoms and signs were respiratory difficulty, stridor, chest retraction, coughing, grunting, wheezing, sputum, cyanosis, choking, dysphagia, and poor feeding. All patients with pulmonary artery sling had tacheobronchial and/or pulmonary anomalies and cardiac defects were associated in two of them. Surgical repair was done successfully for the patients with double aortic arch or right aortic arch, but three deaths occurred to the patients with pulmonary artery sling combined with bronchial anomaly. CONCLUSION: Vascular ring should be considered especially for infants with respiratory distress or chronic respiratory symptoms. Associated anomalies are likely to affect the prognosis in these patients.
Airway Obstruction* ; Aorta, Thoracic ; Child ; Cough ; Cyanosis ; Deglutition Disorders ; Diagnosis ; Humans ; Infant ; Medical Records ; Parturition ; Prognosis ; Pulmonary Artery ; Respiratory Sounds ; Retrospective Studies ; Sputum ; Subclavian Artery ; Thorax

PURPOSE: We compared the sequential characteristic MR findings with histopathologic findings in experimentally induced osteomyelitis of rabbits tibiae . MATERIALS AND METHODS: We induced osteomyelitis in the left tibiae of 25 rabbits by direct inoculation of E. coli. Right tibiae of the same rabbits were directly punctured with sterile needle, which were used as control groups. Spin-echo sagittal T1- and T2-weighted images(T1WI & T2WI) and gadolinium-enhanced T1-weighted sagittal images of both tibiae were obtained at 3 days, 5 days, 1 week, 2 weeks, and 4 weeks following inoculation of pathogen. MR-pathologic correlation study was done with emphasis on changes of the morphology and the MR signal intensity(SI) of marrow abscess. RESULTS: Well-defined abscesses were seen on MR 3 -5 days after pathogen inoculation and they all showed low SI on both T1 & T2WI and no enhancement. MR imaging of abscess wall, which became visible at 3 days as high SI on T1WI, gradually changed to low SI on T1WI and high SI on T2WI with diffuse enhancement according to the time sequence (17% after 3 days; 40% after 5 days; 46% after 1 week; 56% after 2 weeks; 60% after 4 weeks). The peripheral portion of the abscess, which was seen in some cases (48% after 3 days; 40% after 4 weeks), showed iso-intensity to muscle on T1WI and ill-defined high SI on T2WI with mild Gd-enhancement. Pathologically the abscesses and their walls were composed of cell debris and granulation tissue with infiltration of inflammatory cells. Fibroblasts and acute inflammatory cells in the abscess wall, which were most prominent at 3 and 5 days relatively, decreased gradually along with the development of abscess. Inner layer of the abscess wall was composed of chronic inflammatory cells, which appeared after 2 weeks of inoculation. The granulation tissue and inner chronic inflammatory cell layer became more organized feature after 4 weeks. The peripheral portion of the abscess revealed as granulation tissue. In the control group, necrosis or inflammatory cell infiltration was absent and the lesion decreased in size to remain only focal fatty change of bone marrow after 4 weeks. CONCLUSION: Central abscess composed of cell debris showed low SI on both T1 & T2WI without enhancement. Granulation tissue of the abscess wall showed more organized feature forming inner layer of chronic inflammatory cells along with the progression of osteomyelitis. Abscess showed hyperintensity on T1WI in the early stage, but changed to hypointensity on T1WI, hyperintensity on T2WI in later stage.
Abscess ; Animals ; Bone Marrow ; Fibroblasts ; Granulation Tissue ; Magnetic Resonance Imaging* ; Necrosis ; Needles ; Osteomyelitis* ; Rabbits* ; Statistics as Topic ; Tibia

PURPOSE: We compared the sequential characteristic MR findings with histopathologic findings in experimentally induced osteomyelitis of rabbits tibiae . MATERIALS AND METHODS: We induced osteomyelitis in the left tibiae of 25 rabbits by direct inoculation of E. coli. Right tibiae of the same rabbits were directly punctured with sterile needle, which were used as control groups. Spin-echo sagittal T1- and T2-weighted images(T1WI & T2WI) and gadolinium-enhanced T1-weighted sagittal images of both tibiae were obtained at 3 days, 5 days, 1 week, 2 weeks, and 4 weeks following inoculation of pathogen. MR-pathologic correlation study was done with emphasis on changes of the morphology and the MR signal intensity(SI) of marrow abscess. RESULTS: Well-defined abscesses were seen on MR 3 -5 days after pathogen inoculation and they all showed low SI on both T1 & T2WI and no enhancement. MR imaging of abscess wall, which became visible at 3 days as high SI on T1WI, gradually changed to low SI on T1WI and high SI on T2WI with diffuse enhancement according to the time sequence (17% after 3 days; 40% after 5 days; 46% after 1 week; 56% after 2 weeks; 60% after 4 weeks). The peripheral portion of the abscess, which was seen in some cases (48% after 3 days; 40% after 4 weeks), showed iso-intensity to muscle on T1WI and ill-defined high SI on T2WI with mild Gd-enhancement. Pathologically the abscesses and their walls were composed of cell debris and granulation tissue with infiltration of inflammatory cells. Fibroblasts and acute inflammatory cells in the abscess wall, which were most prominent at 3 and 5 days relatively, decreased gradually along with the development of abscess. Inner layer of the abscess wall was composed of chronic inflammatory cells, which appeared after 2 weeks of inoculation. The granulation tissue and inner chronic inflammatory cell layer became more organized feature after 4 weeks. The peripheral portion of the abscess revealed as granulation tissue. In the control group, necrosis or inflammatory cell infiltration was absent and the lesion decreased in size to remain only focal fatty change of bone marrow after 4 weeks. CONCLUSION: Central abscess composed of cell debris showed low SI on both T1 & T2WI without enhancement. Granulation tissue of the abscess wall showed more organized feature forming inner layer of chronic inflammatory cells along with the progression of osteomyelitis. Abscess showed hyperintensity on T1WI in the early stage, but changed to hypointensity on T1WI, hyperintensity on T2WI in later stage.
Abscess ; Animals ; Bone Marrow ; Fibroblasts ; Granulation Tissue ; Magnetic Resonance Imaging* ; Necrosis ; Needles ; Osteomyelitis* ; Rabbits* ; Statistics as Topic ; Tibia