Congenital melanocytic nevus is a hamartoma derived from the neural crest that is present at birth. Regression following surgical excision with an apparent halo phenomenon through suture lines has never been reported. A nine-year-old boy presented with a solitary symmetric, oval-shaped, blackish pigmented patch on his right forearm.He reported increasing size of the lesion with no other subjective symptoms. Histological examination of the first excisional biopsy revealed congenital melanocytic nevus, and serial excisions were planned. Interestingly, at the second visit at 18 months after the first biopsy, the size of the congenital melanocytic nevus was reduced with a peripheral whitish halo. Linear regression through suture lines and a peripheral halo was observed after the second and third serial excisions. The mechanism of the halo phenomenon remains elusive but is suggested theorized to be caused by destruction of melanocytes by immune responses of autoantibodies or cytotoxic T cells.

Congenital melanocytic nevus is a hamartoma derived from the neural crest that is present at birth. Regression following surgical excision with an apparent halo phenomenon through suture lines has never been reported. A nine-year-old boy presented with a solitary symmetric, oval-shaped, blackish pigmented patch on his right forearm.He reported increasing size of the lesion with no other subjective symptoms. Histological examination of the first excisional biopsy revealed congenital melanocytic nevus, and serial excisions were planned. Interestingly, at the second visit at 18 months after the first biopsy, the size of the congenital melanocytic nevus was reduced with a peripheral whitish halo. Linear regression through suture lines and a peripheral halo was observed after the second and third serial excisions. The mechanism of the halo phenomenon remains elusive but is suggested theorized to be caused by destruction of melanocytes by immune responses of autoantibodies or cytotoxic T cells.

Background: Isotretinoin is a gold standard treatment for moderate to severe acne vulgaris but is associated with cheilitis. Though moisturizing agents or petrolatum have been suggested, uncomfortable isotretinoin-induced cheilitis can disrupt treatment of acne patients. Topical tacrolimus has been used in atopic dermatitis with good safety and efficacy; however, there is no study of application of topical tacrolimus in cheilitis induced by isotretinoin. Objective: In this study, we aimed to describe the efficacy of topical tacrolimus 0.1% ointment on cheilitis associated with isotretinoin therapy using isotretinoin cheilitis grading scale (ICGS), investigator global assessment (IGA), and patient global assessment (PGA). We also observed the side effects of topical tacrolimus ointment. Methods: Fifty acne vulgaris patients with isotretinoin-induced cheilitis were randomly allocated to either topical tacrolimus or petrolatum treatment using permuted-block randomization. Patients were followed-up at 4 and 8 weeks, at which cheilitis lesions were photographed and evaluated with ICGS, IGA, and PGA. Results: Compared to petrolatum group, tacrolimus group had greater responses to treatment as measured by mean values of ICGS, IGA, PGA at follow-up visits. Also, the ICGS decrease was larger in the tacrolimus group compared with the petrolatum group even according to isotretinoin dose. Conclusion Topical tacrolimus ointment had superior efficacy in treating cheilitis induced by isotretinoin compared to petrolatum. Erythema, fissures, scales, and commissures all showed better response to tacrolimus ointment. Topical tacrolimus ointment can be administered as an effective strategy in treatment of cheilitis as a complication of isotretinoin therapy and can improve compliance of acne patients.

Background: Isotretinoin is a gold standard treatment for moderate to severe acne vulgaris but is associated with cheilitis. Though moisturizing agents or petrolatum have been suggested, uncomfortable isotretinoin-induced cheilitis can disrupt treatment of acne patients. Topical tacrolimus has been used in atopic dermatitis with good safety and efficacy; however, there is no study of application of topical tacrolimus in cheilitis induced by isotretinoin. Objective: In this study, we aimed to describe the efficacy of topical tacrolimus 0.1% ointment on cheilitis associated with isotretinoin therapy using isotretinoin cheilitis grading scale (ICGS), investigator global assessment (IGA), and patient global assessment (PGA). We also observed the side effects of topical tacrolimus ointment. Methods: Fifty acne vulgaris patients with isotretinoin-induced cheilitis were randomly allocated to either topical tacrolimus or petrolatum treatment using permuted-block randomization. Patients were followed-up at 4 and 8 weeks, at which cheilitis lesions were photographed and evaluated with ICGS, IGA, and PGA. Results: Compared to petrolatum group, tacrolimus group had greater responses to treatment as measured by mean values of ICGS, IGA, PGA at follow-up visits. Also, the ICGS decrease was larger in the tacrolimus group compared with the petrolatum group even according to isotretinoin dose. Conclusion Topical tacrolimus ointment had superior efficacy in treating cheilitis induced by isotretinoin compared to petrolatum. Erythema, fissures, scales, and commissures all showed better response to tacrolimus ointment. Topical tacrolimus ointment can be administered as an effective strategy in treatment of cheilitis as a complication of isotretinoin therapy and can improve compliance of acne patients.

OBJECTIVE: To investigate phasic changes during filling cystometry that most accurately represent detrusor properties, regardless of other factors affecting detrusor contractility. METHODS: Seventy-eight patients (59 males, 19 females; mean age, 48.2 years) with spinal cord injuries were enrolled. Urodynamic studies were performed using a normal saline filling rate of 24 mL/min. We calculated bladder compliance values of the detrusor muscle in each of three filling phase intervals, which divided the filling cystometrogram into three phases referable to the cystometric capacity or maximum cystometric capacity. The three phases were sequentially delineated by reference to the pressure-volume curve reflecting bladder filling. RESULTS: Bladder compliance during the first and second phases of filling cystometry was significantly correlated with overall bladder compliance in overactive detrusors. The highest coefficient of determination (r2=0.329) was obtained during the first phase of the pressure-volume curve. Bladder compliance during all three phases was significantly correlated with overall bladder compliance of filling cystometry in underactive detrusors. However, the coefficient of determination was greatest (r2=0.529) during the first phase of filling cystometry. CONCLUSION: Phasic bladder compliance during the early filling phase (first filling phase) was the most representative assessment of overall bladder compliance during filling cystometry. Careful determination of early phase filling is important when seeking to acquire reliable urodynamic data on neurogenic bladders.
Compliance* ; Female ; Humans ; Male ; Spinal Cord Injuries ; Urinary Bladder* ; Urinary Bladder, Neurogenic* ; Urinary Bladder, Overactive ; Urodynamics

An ultrasonic device for medical skin care is used to gently exfoliate the skin of dead skin cells and impurities. Ultrasound waves help loosen and remove oil, dirt and cellular debris from pores. Ponophoresis or sonophoresis is the use of ultrasound to increase percutaneous absorption of drugs, serums, lotions, creams and masques to a depth where it is more effective and beneficial. For improved results and safer procedures, we need to know the contraindications and adverse effects of ultrasonic treatments. Therefore, we summarized and reviewed the issue of safety including contraindications, cautions, and adverse events.
Skin ; Skin Absorption ; Skin Care ; Ultrasonics

Ultrasound is over 20 khz, which represents the upper frequency limit of human hearing. Acoustic vibrations are generated when piezoelectric materials on the thin disc-shaped transducers expand and contract. Although low frequency ultrasound devices have been used widely in the dermatologic area for a long time, the mechanism and side effects have been overlooked. A low-frequency ultrasound device has many benefits on the cosmetic dermatology area by thermal effect, vibration effect, and increase of transdermal delivery of lipophilic drugs or cosmetics. However, there have been reports of dermatitis, dyspnea, dizziness, and burns after treatment with ultrasound. Therefore, the use of this device should be under a doctor's supervision.
Acoustics ; Burns ; Contracts ; Cosmetics ; Dermatitis ; Dermatology ; Dizziness ; Dyspnea ; Hearing ; Humans ; Organization and Administration ; Transducers ; Ultrasonics ; Vibration

An 8-year-old male was admitted because of dysphagia and substernal pain suffered while eating followed by postprandial vomiting for 2 years. He was always hungry due to postprandial vomiting and willing to eat again just after vomiting. After this meals, he used to jump up and down to shake off the substernal discomfort. A narrowing of the gastroesophageal junction was noted by esophagogram. Manometry revealed high Lower esophageal sphincter (LES) pressure (51.6mmHg), incomplete LES relaxation during swallowing, loss of esophageal peristalsis and a positive pressure of the esophageal body compared to intragastric pressure. After the 1st balloon dilatation, symptoms were much improved even though LES pressure still remained high (37.2mmHg). About 2 months after the 1st balloon dilatation, symptoms relapsed and we managed him with a 2nd balloon dilatation. Symptoms were more improved than after the 1st dilatation and LES pressure normalized as well. Since the 2nd dilatation, symptoms have not recurred for 3 years. We present an 8-year-old boy with achalasia successfully managed by the use balloon dilatation.
Child ; Deglutition ; Deglutition Disorders ; Dilatation* ; Eating ; Esophageal Achalasia* ; Esophageal Sphincter, Lower ; Esophagogastric Junction ; Humans ; Male ; Manometry ; Meals ; Peristalsis ; Relaxation ; Vomiting

PURPOSE: The purpose of this study was to investigate the use of an AED by 119 rescuers in prehospital cardiac arrest. METHODS: 132 patients who experienced prehospital cardiac arrest and was defibrillated by 119 rescuers using AED from January 2003 to December 2004 were included in this study. They were reviewed retrospectively based on 119 rescue service records and ECG. We analyzed patients' general characteristics, types of ECG rhythm, time intervals from EMS activation to arrival and from EMS activation to the first defibrillation, numbers of defibrillation, and return of spontaneous circulation (ROSC). RESULTS: The mean age was 57.33+/-17.84 years with 92 males and 40 females. 68 patients showed shockable rhythms (coarse ventricular fibrillation 41, fine ventricular fibrillation 24, pulseless ventricular tachycardia 3) and 39 patients showed unshockable rhythms (pulseless electrical activity 19 , asystole 18, normal sinus rhythm 2) as an initial rhythm at EMS arrival. Unshockable rhythms were changed to shockable rhythms after cardiopulmonary resuscitation. 25 patients had no ECG rhythms on 119 rescue service records. In the patients with shockable rhythms initially (68 patients), 18 patients experienced ROSC, whereas only 1 patients experienced ROSC in the patients with unshockable rhythms initially (39 patients). The patients with shockable rhythms initially had higher ROSC rates than the patients with unshockable rhythms initially (26.1% vs 2.6%, p=0.001) and received less defibrillation than the patients with unshockable rhythms initially (1.37+/-0.60 vs 2.49+/-1.87, p=0.016). There were no significant differences in the time intervals from EMS activation to arrival (5.74+/-2.13 minutes vs 7.12+/-4.33 minutes, p=0.529) and from EMS activation to the first defibrillation (14.20+/-7.97 minutes vs 13.75+/-7.30 minutes, p=0.542) between ROSC group & non-ROSC group. There was no significant difference in ROSC between male and female (13% vs 17.5%, p=0.164). CONCLUSION: The patients with shockable rhythms initially had higher ROSC rates than the patients with unshockable rhythms initially (26.1% vs 2.6%, p=0.001) and received less defibrillation than the patients with unshockable rhythms initially (1.37+/-0.60 vs 2.49+/-1.87, p=0.016).
Cardiopulmonary Resuscitation ; Defibrillators ; Electric Countershock ; Electrocardiography ; Female ; Heart Arrest ; Humans ; Male ; Retrospective Studies ; Tachycardia, Ventricular ; Ventricular Fibrillation