Familial benign pemphigus is a skin disease with recurrent blistering lesions, mainly in the neck and intertriginous areas. The course of the disease is characterized by spontaneous exacerbations and remissions. The many remedies for this disorder include topical and systemic glucocorticosteroids, and antibacterial and antimycotic agents. However, these therapies usually do not prolong the remission periods. Surgical treatments, such as skin graft, have been more successful. Laser treatment has reported to be effective in recurrent familial benign chronic phemphigus. Here we report a case of familial benign chronic phemphigus that was treated with carbin dioxide laser.
Blister ; Carbon Dioxide* ; Carbon* ; Lasers, Gas* ; Neck ; Pemphigus ; Pemphigus, Benign Familial* ; Skin ; Skin Diseases ; Transplants

Familial benign pemphigus is a skin disease with recurrent blistering lesions, mainly in the neck and intertriginous areas. The course of the disease is characterized by spontaneous exacerbations and remissions. The many remedies for this disorder include topical and systemic glucocorticosteroids, and antibacterial and antimycotic agents. However, these therapies usually do not prolong the remission periods. Surgical treatments, such as skin graft, have been more successful. Laser treatment has reported to be effective in recurrent familial benign chronic phemphigus. Here we report a case of familial benign chronic phemphigus that was treated with carbin dioxide laser.
Blister ; Carbon Dioxide* ; Carbon* ; Lasers, Gas* ; Neck ; Pemphigus ; Pemphigus, Benign Familial* ; Skin ; Skin Diseases ; Transplants

PURPOSE: The objective of this study was to evaluate the correlation between patterns of focal epileptiform discharge (ED) and brain lesions diagnosed by MRI in children with focal epilepsy. METHODS: We retrospectively reviewed routine scalp EEGs, medical records, and results from brain MRIs in 149 children who had been diagnosed as epilepsy with focal epileptiform discharges in our hospital between 2008 and 2010. We classified the patterns of focal ED into spikes, sharp waves, and polyspikes. EEGs with homogenous patterns of ED were termed single-form ED and those with heterogenous patterns of ED were termed multi-form ED. We evaluated the relationship between the specific patterns of focal ED and brain lesions in pediatric epilepsy. RESULTS: Fifty-six of 149 (37.6%) patients had brain lesions on brain MRI. 67.8% (101/149) patients exhibited single-form ED and 32.2% (48/149) patients revealed multi-form ED. Thirty of 48 patients (62.5%) with multi-form ED showed brain lesions, which was higher than those for patients with single-form ED (25.7%, 26/101) (P <0.001). 27.5% (41/149) patients had and 25/41 (61.0%) also had brain lesion, which was higher than those for patients without polyspikes (28.7%, 31/108) (P <0.001). 19 of 82 patients (23.2%) with single-form ED with spikes only had brain lesion on brain MRI, which was significantly lower than those of remaining patients (55.2%, 37/67) (P <0.001). CONCLUSION: We suggest that a heterogenous pattern of ED or polyspikes lead to a higher incidence of brain lesions in children with focal epilepsy.
Brain ; Child ; Electroencephalography ; Epilepsies, Partial ; Epilepsy ; Humans ; Incidence ; Medical Records ; Retrospective Studies ; Scalp

Kaposi's sarcoma is a neoplasm of multifocal origin which manifests primarily as vascular nodules in the skin and other organs. We report a case of classic Kaposi's sarcoma in a 79-year-old man who had asymptomatic dark-brown macules, papules and nodules on his Rt. lower extremities. The biopsy specimen showed typical histopathologic features of Kaposi's sarcoma including dilated, bizarre-shaped vessels, endothelial cell proliferation, and spindle cell formation with vascular slits throughout the dermis. Many of the spindle-shaped cells associated with the proliferating vessels in Kaposi's sarcoma lesion expressed factor VIII-related antigen. Initially he was treated with 4,000 rads of radiation(200 rad per day for 20 successive days), and after two months 2,500 rads of radiation(500 rad per day for 5 successive days). Three months after radiotherapy, skin lesions were healed leaving hyperpigmentation.
Aged ; Biopsy ; Dermis ; Endothelial Cells ; Humans ; Hyperpigmentation ; Lower Extremity ; Radiotherapy* ; Sarcoma, Kaposi* ; Skin ; von Willebrand Factor

Abdominal aortic aneurysm (AAA) can be defined as an abnormal, progressive dilatation of the abdominal aorta, carrying a substantial risk for fatal aneurysmal rupture. Endovascular aneurysmal repair (EVAR) for AAA is a minimally invasive endovascular procedure that involves the placement of a bifurcated or tubular stent-graft over the AAA to exclude the aneurysm from arterial circulation. In contrast to open surgical repair, EVAR only requires a stab incision, shorter procedure time, and early recovery. Although EVAR seems to be an attractive solution with many advantages for AAA repair, there are detailed requirements and many important aspects should be understood before the procedure. In this comprehensive review, fundamental information regarding AAA and EVAR is presented.
Aneurysm ; Aorta, Abdominal ; Aortic Aneurysm, Abdominal ; Dilatation ; Endovascular Procedures ; Rupture

Purpose: To analyze the success and complication rates and factors associated with technical failure of the ultrasound (US)-guided percutaneous thrombin injection of femoral artery pseudoaneurysms caused by vascular access. Materials and Methods: Records of 30 patients with post-catheterization femoral artery pseudoaneurysms who had been treated with US-guided percutaneous thrombin injections in the department of radiology between March 2009 and June 2019 were retrospectively analyzed.The lesion was diagnosed based on US or contrast-enhanced CT. The characteristics of the patients and their lesions were analyzed. Results: The mean patient age was 67.8 years. The mean diameter of the pseudoaneurysmal sac was 20.88 mm (5–40 mm). Twenty patients (66.6%) obtained complete thrombosis after the primary injection, while 10 patients (33.3%) obtained partial thrombosis. The number of patients with a low platelet count (< 130 k/µL) was significantly higher in the partial thrombosis group than in the complete thrombosis group (p = 0.02). No substantial procedure-related complications were found in any patient. Conclusion The US-guided percutaneous thrombin injection is considered an initial treatment option for pseudoaneurysms caused by vascular access because of its safety and efficacy.

Purpose: To analyze the success and complication rates and factors associated with technical failure of the ultrasound (US)-guided percutaneous thrombin injection of femoral artery pseudoaneurysms caused by vascular access. Materials and Methods: Records of 30 patients with post-catheterization femoral artery pseudoaneurysms who had been treated with US-guided percutaneous thrombin injections in the department of radiology between March 2009 and June 2019 were retrospectively analyzed.The lesion was diagnosed based on US or contrast-enhanced CT. The characteristics of the patients and their lesions were analyzed. Results: The mean patient age was 67.8 years. The mean diameter of the pseudoaneurysmal sac was 20.88 mm (5–40 mm). Twenty patients (66.6%) obtained complete thrombosis after the primary injection, while 10 patients (33.3%) obtained partial thrombosis. The number of patients with a low platelet count (< 130 k/µL) was significantly higher in the partial thrombosis group than in the complete thrombosis group (p = 0.02). No substantial procedure-related complications were found in any patient. Conclusion The US-guided percutaneous thrombin injection is considered an initial treatment option for pseudoaneurysms caused by vascular access because of its safety and efficacy.

PURPOSE: To describe the characteristics and incidence of neurologic complications related to the novel influenza A (H1N1) virus. METHODS: We reviewed the medical records of 752 children and adolescence (< or = 18 years of age) who had been diagnosed as novel influenza A (H1N1) infection through positive results of influenza A (H1N1) RT-PCR and hospitalized or visited the outpatient clinic and emergency department of Pusan National University Hospital from July 2009 to January 2011. RESULTS: We identified 15 patients who had experienced a neurologic symptom with a mean age of 8.8 years. There were 10 (66.7%) males and five (33.3%) females. Nine patients (60.0%) presented with seizures, two (13.3%) with decreased mentality, two (13.3%) with visual hallucination, and one (6.7%) with vertigo. The mean duration from onset of respiratory illness to the beginning of neurologic symptoms was 2 days (range: 0-4 days). Three patients (patient 2, 7, and 13) (20.0%) had abnormal results on cerebrospinal fluid analysis; however, novel influenza A (H1N1) was not detected. Further, one patient (6.7%) had abnormal MRI. Antiviral therapy (oseltamivir) was administered to fourteen patients (93%) and all patients recovered fully and had no neurologic sequelae. CONCLUSION: Novel influenza A (H1N1) was a cause of neurologic symptoms during the outbreak. Pediatricians should consider influenza virus infection in the differential diagnosis for children with neurologic symptoms during an epidemic of influenza.
Adolescent ; Ambulatory Care Facilities ; Child ; Diagnosis, Differential ; Emergencies ; Female ; Hallucinations ; Humans ; Incidence ; Influenza, Human ; Male ; Medical Records ; Neurologic Manifestations ; Orthomyxoviridae ; Seizures ; Vertigo ; Viruses

Necrotizing fasciitis caused by Vibrio vulnificus can rapidly progress to septic shock and death. Hence, early surgical debridement of the involved tissue is vital. However, this can be a challenging task due to the coagulopathy and unstable conditions often associated with these patients. Herein, we present a patient with necrotizing fasciitis caused by V. vulnificus who received extracorporeal membrane oxygenation (ECMO) support for refractory hypotension. After initiating ECMO, his vital signs stabilized, and lactate, C-reactive protein, and procalcitonin levels continued to decrease. He underwent several rounds of surgical debridement and vacuum-assisted drainage on both lower legs. On ECMO day 15, he was successfully weaned off the device and his condition was uneventful for several days. However, on the 24th day of intensive care unit (ICU), he was again placed on ECMO due to clinical deterioration. On ICU day 32, he underwent bilateral below-knee amputations due to delayed wound healing. Unfortunately, he subsequently developed multi-organ failure and died. Nonetheless, this case is instructive regarding the potential use of ECMO. We suggest that ECMO could provide the necessary time for sepsis patients to undergo aggressive medical and surgical interventions.
Amputation ; C-Reactive Protein ; Debridement ; Drainage ; Extracorporeal Membrane Oxygenation* ; Fasciitis ; Fasciitis, Necrotizing ; Humans ; Hypotension ; Intensive Care Units ; Lactic Acid ; Leg ; Sepsis* ; Shock, Septic ; Vibrio vulnificus* ; Vibrio* ; Vital Signs ; Wound Healing

BACKGROUND: There have been many studies on hand-arm vibration syndrome (HAVS) for almost a century. The Stockholm Workshop scale has been accepted as a useful tool in diagnosing HAVS. Although they are not standard tests for diagnosis, cold provocation test and plethysmography of the fingers are commonly used as objective measurements to confirm the vascular component of HAVS. However, there are only a handful of case reports and studies worldwide on Raynaud's phenomenon in the toes. We report the case of a patient with HAVS who developed Raynaud's phenomenon in the toes after the vibration exposure had ceased. To our knowledge, this is the first report of this entity in Korea. CASE REPORT: A 58-year-old male, who had been diagnosed with HAVS in 2003, first noticed white toes in the summer of 2006 after immersing his feet in cold water. He had been working as a rock drill operator since 1976 for almost 30 years and had symptoms on his fingers since 1992. He underwent the cold provocation test, photoplethysmography, Nerve conduction velocity, and basic laboratory tests to rule out other causes of secondary Raynaud's phenomenon. To describe the severity of his feet, it could be classified as vascular stage 2 and sensorineural stage 1 if we were to apply the Stockholm Workshop scale. CONCLUSIONS: The patient showed vibration-induced white toes, and we would like to share the results of objective findings related to his condition. When diagnosing HAVS, symptoms of the feet should be assessed by the occupational and environmental medicine physicians. Further studies are needed to standardize test methods to diagnose "vibration-induced white toes."
Cold Temperature ; Environmental Medicine ; Fingers ; Foot ; Hand ; Hand-Arm Vibration Syndrome ; Humans ; Male ; Mandrillus ; Middle Aged ; Neural Conduction ; Photoplethysmography ; Plethysmography ; Toes ; Vibration ; Water