The antimalarials have been commonly described for the treatment of several connective tissue diseases. Among adverse effects of antimalarials, skin hyperpigmentation has been easily overlooked for its slow onset, but it may be a marker at risk of ocular side effects. Moreover, most cases of hyperpigmentation have been reported from chloroquine, but rarely hydroxychloroquine (HCQ). We experienced two patients who showed skin pigmentation during administration of HCQ. The first case was a 53-year-old woman presented with dark brown macules on the neck and ashy-colored patches on the buttock. The second was a 75-year-old woman presented with bluish-gray patches on both shins. Before hyperpigmentation developed, each patient had been treated with HCQ 400 mg per day for two years and five months, respectively. Two years ago after skin hyperpigmentation the first patients was found to have retinal pigmentation under the fundoscopy, so that HCQ was discontinued.
Aged ; Antimalarials ; Buttocks ; Chloroquine ; Connective Tissue Diseases ; Female ; Humans ; Hydroxychloroquine ; Hyperpigmentation ; Middle Aged ; Neck ; Pigmentation ; Retinaldehyde ; Skin ; Skin Pigmentation

PURPOSE: Since the 1990s, it has been well known that orchiopexies should be performed by no later than 2 years of age. Nevertheless, studies from other countries report a substantial number of delayed orchiopexies. On the basis of an analysis of a tertiary care hospital database, we aimed to investigate the incidence of delayed orchiopexies performed in patients after 5 years of age and to understand the causes of such delays and the possible consequences. MATERIALS AND METHODS: We retrospectively analyzed the surgical database of Seoul National University Hospital between 2004 and 2012 and detected patients who underwent orchiopexy later than 5 years of age. Reasons for delayed orchiopexies were studied and the possible consequences of delayed orchiopexies were assessed with respect to surgical difficulty and testicular volume. RESULTS: We found 160 cases of delayed orchiopexies, which accounted for about 15% of all orchiopexies performed. Two major reasons for delay were related to the parents of the child: parental delay and parental request for the treatment of persistent retractile testis. Acquired cryptorchidism was found in 21 cases (13.1%), mainly associated with hypospadias. Surgical difficulty, especially owing to a short testicular cord, was encountered in 48 cases (30.2%), and a comparison with age-matched normative values showed substantially smaller testicular volume. CONCLUSIONS: Despite well-established guidelines for the optimal age of surgery, 15% of orchiopexies were not performed at a proper time. Improved propagation of an optimal age limit is necessary to reduce the rate of delayed orchiopexies considering increases in surgical difficulty and potential testicular growth retardation.
Child ; Cryptorchidism ; Female ; Humans ; Hypospadias ; Incidence ; Male ; Orchiopexy* ; Parents ; Retrospective Studies ; Seoul ; Tertiary Care Centers ; Tertiary Healthcare* ; Testis

Tracheopathia osteoplastica(TO) is a rare, clinical and pathologic benign condition of unknown cause and characterized by submucosal cartilaginous or bony projections into tracheobroncheal lumen, usually not involved posterior membranous portion of tracheobroncheal tree. We report two cases of tracheopathia osteoplastica that involved trachea and both main bronchus, diagnosed by chest CT, fiberoptic bronchoscopic biopsy.
Biopsy ; Bronchi ; Tomography, X-Ray Computed ; Trachea

OBJECTIVE: We have used diffusion tensor tractography (DTT) for the evaluation of the somatotopic organization of corticospinal tracts (CSTs) in the posterior limb of the internal capsule (PLIC) and cerebral peduncle (CP). MATERIALS AND METHODS: We imaged the brains of nine healthy right-handed subjects. We used a spin-echo echo-planar imaging (EPI) sequence with 12 diffusion-sensitized directions. DTT was calculated with an angular threshold of 35 degrees and a fractional anistropy (FA) threshold of 0.25. We determined the location of the CSTs by using two regions of interest (ROI) at expected areas of the pons and expected areas of the lateral half of the PLIC, in the left hemisphere of the brain. Fiber tracts crossing these two ROIs and the precentral gyrus (PCG) were defined as CSTs. Four new ROIs were then defined for the PCG, from the medial to lateral direction, as ROI 1 (medial) to ROI 4 (lateral). Finally, we defined each fiber tract of the CSTs between the pons and each ROI in the PCG by using two ROIs methods. RESULTS: In all subjects, the CSTs were organized along the long axis of the PLIC, and the hand fibers were located anterior to the foot fibers. The CSTs showed transverse orientation in the CP, and the hand fibers were located usually medial to the foot fibers. CONCLUSION: Corticospinal tracts are organized along the long axis of the PLIC and the horizontal direction of the CP.
Adult ; Diffusion Magnetic Resonance Imaging/*methods ; Female ; Humans ; Internal Capsule/*anatomy & histology ; Male ; Pyramidal Tracts/*anatomy & histology ; Tegmentum Mesencephali/*anatomy & histology

PURPOSE: To examine community integration and contributing factors in people with aphasia (PWA) following stroke and to investigate the relationship between community integration and quality of life (QOL). MATERIALS AND METHODS: Thirty PWA and 42 age-and education-matched control subjects were involved. Main variables were as follows: socioeconomic status, mobility, and activity of daily living (ADL) (Modified Barthel Index), language function [Frenchay Aphasia Screening Test (FAST)], depression [Geriatric Depression Scale (GDS)], Community Integration Questionnaire (CIQ) and Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39). Differences between aphasia and control groups and factors affecting community integration and QOL were analyzed. RESULTS: Home and social integration and productive activity were significantly decreased in the aphasia group compared to the control group; 8.5 and 18.3 points in total CIQ score, respectively. Amount of time spent outside the home and frequency of social contact were also significantly reduced in the aphasia group. Total mean score on the SAQOL-39 was 2.75+/-0.80 points and was significantly correlated with economic status, gait performance, ADL, depressive mood, and social domain score on the CIQ. Depression score measured by GDS was the single most important factor for the prediction of QOL, but the FAST score was significantly correlated only with the communication domain of the SAQOL-39. CONCLUSION: Community activities of PWA were very limited, and depression was highly associated with decreased community integration and QOL. Enhancing social participation and reducing emotional distress should be emphasized for rehabilitation of PWA.
Activities of Daily Living ; Adult ; Aged ; Aphasia/etiology/*psychology/rehabilitation ; Case-Control Studies ; Community Integration/*psychology ; Depression/psychology ; Female ; Humans ; *Interpersonal Relations ; Male ; Middle Aged ; Psychiatric Status Rating Scales ; *Quality of Life ; Residence Characteristics ; Sickness Impact Profile ; Social Behavior ; Socioeconomic Factors ; Stroke/complications/psychology/*rehabilitation ; Surveys and Questionnaires

PURPOSE: This study was conducted to examine the relationship between the prevalence of burnout and its related factors in medical students in Korea. METHODS: All available medical students in the metropolitan city of Daejeon, Korea, were asked to answer self-administered questionnaires from July 1 to July 26 in 2013. A total of 534 medical students participated. The Maslach Burnout Inventory-Student Survey (MBI-SS) and structured questionnaires on related factors were used. Confirmatory factor analysis and Cronbach's alpha were used to verify the applicability of the MBI-SS to medical students in Korea. We also performed chi-square test and logistic regression analysis to identify the factors that were associated with burnout. RESULTS: The MBI-SS was reliable and valid in measuring burnout in Korean medical students. Our confirmatory factor analysis approved and explained the appropriateness of the model fit. The prevalence of burnout among medical students was 26.4% (n=141). Such rates were higher in students who were female, experienced greater levels of depression, had poor academic performance, feared dropping out, and were stressed by the poor quality of the class facilities. CONCLUSION: The MBI-SS is a valid instrument to measure academic burnout in Korean medical students. Further studies should be performed, because improvements in the mental health of medical students will benefit these doctors-to-be and their future patients.
Burnout, Professional/*epidemiology ; Factor Analysis, Statistical ; Female ; Humans ; Logistic Models ; Male ; Prevalence ; Psychometrics/*methods ; Reproducibility of Results ; Republic of Korea/epidemiology ; Risk Factors ; Stress, Psychological/*epidemiology ; Students, Medical/*psychology ; Surveys and Questionnaires/*standards

Arteriovenous malformations (AVMs) are rare congenital anomalies characterized by direct communication between arteries and veins that bypass the capillary bed. AVMs may not manifest clinically until late infancy or childhood. In particular, facial AVMs can cause urgent life-threatening dental events. A 5-year-old girl without a medical history visited the hospital because of spontaneous gingival bleeding around the posterior gingival area of the lower left 2nd primary molar.
Angiography through the femoral approach under general anesthesia was performed for differential diagnosis and therapeutic option. The blood flow was effectively reduced after arterial embolization alone, and there was no evidence of recurrence at the 5-month follow-up.
The present study reports that embolization of the affected vessels can be a more effective and safe method than surgical resection for the treatment of AVM during the growth period.

Anaphylactic transfusion reactions are rare complications of blood transfusions. Anhaptoglobinemia, a condition that has high incidence in Asia, can cause allergic transfusion reactions or anaphylaxis in severe cases. A 50-yr-old Korean woman was diagnosed with relapsed acute promyelocytic leukemia. She developed thrombocytopenia during chemotherapy and an anaphylactic transfusion reaction on the 4th and 5th platelet transfusions immediately after the transfusion of the platelet concentrates was initiated. Blood analysis showed no detectable serum haptoglobin. We examined her genetic phenotype and detected anhaptoglobinemia, which occurs because of an allelic deletion in the Hp gene cluster. The presence of an antibody against haptoglobin was detected by performing ELISA. To prevent anaphylactic reactions, apheresis platelets were transfused after washing. Consequently, anaphylactic transfusion reactions did not develop. Here, we report the first case of anhaptoglobinemia causing anaphylactic transfusion reaction in Korea.
Alleles ; Anaphylaxis/*etiology ; Antineoplastic Agents/therapeutic use ; Female ; Gene Deletion ; Haptoglobins/*genetics/immunology ; Humans ; Isoantibodies/immunology ; Leukemia, Promyelocytic, Acute/complications/*diagnosis/drug therapy ; Middle Aged ; Phenotype ; Platelet Transfusion/*adverse effects ; Recurrence ; Republic of Korea ; Thrombocytopenia/complications/diagnosis

PURPOSE: We investigated the outcome and the prognostic factors of patients with locally advanced esophageal cancer who were treated with concurrent chemo-radiotherapy. Materials and METHODS: Two hundred forty six patients with esophageal cancer that were treated by radiotherapy between January 1994 and July 2007. Of these, 78 patients who received radiotherapy of > or =45 Gy with concurrent chemotherapy were retrospectively enrolled in this study. We included patients stages IIA, IIB, III, IVA, and IVB with supraclavicular metastasis in the middle/lower esophageal cancer or celiac node metastasis in cervical or upper/middle thoracic esophageal cancer. The median radiation dose was 54 Gy and the combination chemotherapy with 5-FU and cisplatin (FP chemotherapy) was given concurrently with radiotherapy in most patients (88%). RESULTS: The follow-up period ranged from 2 to 117 months (median 14 months). The treatment response of the 54 patients could be evaluated by computerized tomography or endoscopy. A complete response (CR) was observed in 17 patients, whereas a partial response was observed in 18 patients. In patients with a CR, the median recurrence time was 20 months and the first relapse sites constituted a locoregional failure in 3 patients and a distant failure in 7 patients. The 1-, 2-, and 5-year overall survival (OS) rates were 58.9%, 21.7%, and 12.2%, respectively. The median survival period was 14 months. A univariate analysis indicated that the treatment response and cycles of FP chemotherapy were significant prognostic factors for OS. Daily or weekly administration of cisplatin as a radiosensitizer showed a better treatment response than FP chemotherapy. CONCLUSION: This study has shown that results of concurrent chemo-radiotherapy in patients with locally advanced esophageal cancer is comparable to those of other studies. Daily or weekly cisplatin administration may be considered as an alternative treatment in patients that are medically unfit for FP chemotherapy.
Cisplatin ; Drug Therapy, Combination ; Endoscopy ; Esophageal Neoplasms ; Fluorouracil ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies