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.

Background: Merkel cell carcinoma is an uncommon primary cutaneous neuroendocrine cancer. It is a highly aggressive cancer with high rates of local recurrence and nodal metastasis. While there are some case reports on Korean patients with Merkel cell carcinoma, there has been no comparison study between Western patients and Korean patients regarding its clinical features. Objective: This study aimed to identify the clinical features of Merkel cell carcinoma in Korean patients and compare them with those seen in Western studies. Methods: We retrospectively reviewed the medical records of patients who were diagnosed with Merkel cell carcinoma between January 1995 and May 2019. Clinical features were compared with those seen in Western studies. Results: Thirty-one patients were enrolled in the analysis. The mean age of onset was 67.6 years, and there were more female patients (1:1.58). The head and neck was the most common primary site (38.7%, 12/31). Patients treated by surgical methods alone were the most common (58.1%, 18/31). Twelve patients (38.7%) had recurrence, and seven patients (22.6%) died of Merkel cell carcinoma. Patients younger than 70 years were more frequent in Korea than in Western countries (Fishers exact test, p＜0.05). In addition, patients with distant metastasis were less frequent in Korea than in Western countries (Fishers exact test, p＜0.05). Conclusion Compared with Western studies, there were no differences between demographic and clinical features, except that older patients and patients with distant metastasis were less frequent in Korea.

PURPOSE: Vascular calcification (VC) scores on simple plain radiographic films are known to be associated with coronary artery disease (CAD) and mortality. The present study was designed to demonstrate a correlation between VC scores of the hands and pelvis, and feet and lateral lumbar spine on plain radiographs. In addition, we analyzed the usefulness of checking all the plain radiographs for assessment of pre-existing CAD. METHODS: We recruited 61 hemodialysis (HD) patients from OO Dialysis Center. We checked the plain radiographic films of the feet, hands, pelvis, and lateral lumbar spine and evaluated VC scores with previously reported methods. We defined CAD based on myocardial scans, echocardiography, or coronary angiography. RESULTS: Positive associations were found between the VC scores of the feet, VC scores of the hands and pelvis, scores of abdominal aortic calcifications (AACs), and CAD. Approximately 30% of patients who had CAD could be missed based on a single VC scoring method. Patients who showed any one finding among the AAC scores >5, VC scores of the pelvis and hands >3 or arterial media calcifications of the feet on plain radiographs had a high sensitivity (93.8%) and a high negative predictive value (96.3%) for the presence of CAD. CONCLUSION: Each VC score was highly inter-correlated. All three VC scoring methods on plain radiographic films are useful screening tests for the presence of CAD in HD patients.
Coronary Artery Disease ; Coronary Vessels ; Dialysis ; Echocardiography ; Foot ; Hand ; Humans ; Mass Screening ; Pelvis ; Renal Dialysis ; Research Design ; Spine ; Tunica Media ; Vascular Calcification ; X-Ray Film

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in end- stage renal disease (ESRD) patients. The early diagnosis and treatment of CVD could improve survival in dialysis patients. The plasma level of B-type Natriuretic Peptide (BNP) correlates with the severity of LV dysfunction and increases following myocardial ischemia. We investigated the ability of BNP as a predictor of CVD in new ESRD patients whose volume overload status were not corrected. METHODS: CVD was defined as an LV ejection fraction <45% or a positive myocardial SPECT. We measured plasma levels of BNP in 79 new ESRD patients requiring hemodialysis (HD) and investigated the relationships between BNP levels and echocardiography and myocardial SPECT. RESULTS: Median concentrations of BNP were higher in 16 patients with heart failure than those in 63 patients without heart failure (1, 748.5 vs. 127.0 pg/mL, p<0.001) and higher in 12 patients with positive myocardial SPECT than those in 67 patients with negative SPECT (1, 160.5 vs. 129.0 pg/mL, p< 0.001). BNP levels were higher in 23 patients with CVD than those in 56 patients without CVD (1, 234.0 vs. 119.0 pg/mL, p<0.001). There was an inverse correlation between BNP and LV ejection fraction (r=-0.65, p<0.001). The present study demonstrated a significant 34.9% increment of cardiac mortality by the every increase of 100 pg/mL of BNP. The negative predictive value of BNP for excluding CVD was 89.3% (cut-off value, 500 pg/mL). CONCLUSION: Our findings suggest that BNP could be an effective screening test for the evaluation of the presence of CVD in ESRD patients starting maintenance HD.
Cardiovascular Diseases* ; Dialysis ; Early Diagnosis ; Echocardiography ; Heart Failure ; Humans ; Kidney Failure, Chronic* ; Mass Screening ; Mortality ; Myocardial Ischemia ; Natriuretic Peptide, Brain* ; Plasma ; Renal Dialysis* ; Tomography, Emission-Computed, Single-Photon

Chronic spontaneous urticaria (CSU) is a complex idiopathic disease of the skin with various cellular infiltrations. Although mast cells are key effector cells in the pathogenesis of CSU, CD4+ T helper 2 cells also have particular roles in the development and maintenance of CSU. Periostin is known as a downstream molecule of interleukin (IL)-4 and IL-13, key cytokines of type 2 immune responses. In this study, we examined periostin and IL-13 levels in the sera of patients with CSU (n=84) and healthy normal controls (NCs, n=43). Periostin levels were significantly lower in the CSU group than in NCs (71.4±21.8 vs 85.1±22.4 ng/mL, P=0.04). Periostin levels were also lower in the severe CSU group than those in mild CSU (59.7±18.0 vs 73.4±22.0 ng/mL, P=0.04). However, IL-13 levels were significantly higher in patients with CSU than in NCs (508.5±51.2 vs 200.7±13.3 pg/mL, P=0.001). In conclusion, periostin and IL-13 may be independently related to the pathogenesis of CSU.
Cytokines ; Humans ; Interleukin-13* ; Interleukins ; Mast Cells ; Skin ; Urticaria*

In general, coronary steal is defined as a fall in blood flow toward a certain vascular region in favor of another area during arteriolar vasodilatation. The coronary artery fistulae is an unusual abnormality in the general population, but is the most common abnormality of the coronary arteries that are ED: Either the ARTERIES ARE hemodynamically significant, or the ABNORMALITY IS hemodynamically significant. Hemodynamically significant. We experienced a 58-year-old male patient with intermittent chest pain at rest. Coronary angiography showed coronary artery fistulae on the LCX and RCA and retrograde flow from the LAD to LCX. Retrograde flow caused coronary artery steal syndrome on LAD territory. A stress/rest MIBI myocardial scan showed reversible ischemia on the LAD territory. He underwent an operation for the coronary artery fistulae, and has since been doing well without chest pain.
Arteries* ; Arteriovenous Fistula* ; Chest Pain ; Coronary Angiography ; Coronary Vessels ; Fistula ; Humans ; Ischemia ; Male ; Middle Aged ; Vasodilation

Orlistat(Xenical(R), Roche) is considered a safe and effective drug to treat obesity by reduced absorption of 30% digested fat. To date, no serious adverse effects affecting the liver have been published except a case of subacute hepatic failure leading to liver transplantation in a young women with moderate obesity treated with orlistat. We report a case of acute cholestatic hepatitis in a young woman with moderate obesity treated with orlistat: a 33-year-old female admitted for the evaluation of jaundice. Abdominal ultrasonography, ERCP, routine chemistry, viral markers, and a fine needle biopsy of liver were performed. Microscopic findings of the liver biopsy specimen were compatible with acute cholestatic hepatitis. After steroid therapy, liver function was improved.
Acute Disease ; Adult ; Anti-Obesity Agents/*adverse effects ; Cholestasis/*chemically induced/diagnosis ; English Abstract ; Female ; Hepatitis, Toxic/*diagnosis/etiology ; Human ; Lactones/*adverse effects ; Lipase/antagonists & inhibitors

PURPOSE: This study was designed to compare Transilluminated Powered Phlebectomy (TIPP) with conventional surgical treatment (high ligation of the greater saphenous vein and above knee stripping with varicosectomy). METHODS: 428 cases of varicose veins, managed surgically at our hospital, were reviewed. A retrospective review of clinical records, between November 2000 an March 2003, was performed. The patients were divided into one of two groups: TIPP or a conventional operation. All the patients had at least a C2 CEAP disease. RESULTS: The demographics, hospital stays and operating times for the two groups were similar. However, a TIPP was associated with significantly fewer incisions (4.4+/-1.5 vs 8.2+/-3.9; P<0.001) and recurrence (n=14, 6% vs n=24, 12%; P=0.003). The incidence of a postoperative hematoma developing was more common with TIPP (n=20, 9% vs n=1, 0.5%; P=0.023). The problem of a hematoma formation in TIPP was solved by the insertion of a small closed suction drain. Skin perforation and wrinkling, and dermatosclerosis, were only complicated in the TIPP. The mean pain scores (out of 10) for the TIPP and conventional operation groups, at 2 and 7 days and 4 weeks, were 4.8, 1.4 and zero, and 4.8, 2.8 and zero, respectively. The cosmetic satisfaction score was higher in the TIPP group (8.7 vs 5.7; P<0.001). CONCLUSION: With respect to pain, cosmetic satisfaction and residual varicose, the outcomes in the TIPP group were significantly better than those in the conventional operation group.
Demography ; Hematoma ; Humans ; Incidence ; Knee ; Length of Stay ; Ligation ; Lower Extremity* ; Recurrence ; Retrospective Studies ; Saphenous Vein ; Scleroderma, Localized ; Skin ; Suction ; Varicose Veins*

BACKGROUND: It has become clear that inflammation is an important process in the pathogenesis of atherosclerosis. Cyclooxygenase (COX)-2 inhibitors, such as rofecoxib or celecoxib, are new nonsteroidal anti-inflammatory drugs. Some reports that COX-2 inhibitors decreased inflammatory markers in animals and humans. In this study, we evaluated the effects of celecoxib on the level of high-sensitivity C-reactive protein (hs-CRP), D-dimer, von Willebrand factor (vWF) and troponin-T in continuous ambulatory peritoneal dialysis (CAPD) patients. METHODS: From June 2002 to December 2002, 46 CAPD patients with hs-CRP equal or greater than 0.25 mg/dL were included in this prospective study. The 46 patients were randomized to the treatment group who took 200 mg of celecoxib daily for 4 weeks or to the control group who did not take the medication. Of the 46 patients, 43 patients completed this study. RESULTS: Baseline values of all the parameters were not significantly different between the two group. In the control group (N=22), the levels of hs- CRP, albumin, D-dimer, vWF and troponin-T did not change. In the treatment group (N=21), administration of celecoxib for 4 weeks significantly reduced hs-CRP from 0.77 (range 0.25-7.08) to 0.39 mg/dL (range 0.11-5.22, p<0.05). The level of albumin, D- dimer, vWF and troponin-T levels were not affected by the administration of celecoxib.0.CONCIUSION: Our preliminary short-term study shows that celecoxib decreased hs-CRP and not changed the level of vWF, D-dimer and torponin-T in CAPD patients. We suggest that celecoxib has an anti-inflammatory effect in usual dosage in CAPD patients.
Animals ; Atherosclerosis ; C-Reactive Protein* ; Cyclooxygenase 2 Inhibitors ; Humans ; Inflammation ; Peritoneal Dialysis, Continuous Ambulatory* ; Prospective Studies ; Prostaglandin-Endoperoxide Synthases ; Troponin T* ; von Willebrand Factor* ; Celecoxib

BACKGROUND: It has become clear that inflammation is an important process in the pathogenesis of atherosclerosis. Cyclooxygenase (COX)-2 inhibitors, such as rofecoxib or celecoxib, are new nonsteroidal anti-inflammatory drugs. Some reports that COX-2 inhibitors decreased inflammatory markers in animals and humans. In this study, we evaluated the effects of celecoxib on the level of high-sensitivity C-reactive protein (hs-CRP), D-dimer, von Willebrand factor (vWF) and troponin-T in continuous ambulatory peritoneal dialysis (CAPD) patients. METHODS: From June 2002 to December 2002, 46 CAPD patients with hs-CRP equal or greater than 0.25 mg/dL were included in this prospective study. The 46 patients were randomized to the treatment group who took 200 mg of celecoxib daily for 4 weeks or to the control group who did not take the medication. Of the 46 patients, 43 patients completed this study. RESULTS: Baseline values of all the parameters were not significantly different between the two group. In the control group (N=22), the levels of hs- CRP, albumin, D-dimer, vWF and troponin-T did not change. In the treatment group (N=21), administration of celecoxib for 4 weeks significantly reduced hs-CRP from 0.77 (range 0.25-7.08) to 0.39 mg/dL (range 0.11-5.22, p<0.05). The level of albumin, D- dimer, vWF and troponin-T levels were not affected by the administration of celecoxib.0.CONCIUSION: Our preliminary short-term study shows that celecoxib decreased hs-CRP and not changed the level of vWF, D-dimer and torponin-T in CAPD patients. We suggest that celecoxib has an anti-inflammatory effect in usual dosage in CAPD patients.
Animals ; Atherosclerosis ; C-Reactive Protein* ; Cyclooxygenase 2 Inhibitors ; Humans ; Inflammation ; Peritoneal Dialysis, Continuous Ambulatory* ; Prospective Studies ; Prostaglandin-Endoperoxide Synthases ; Troponin T* ; von Willebrand Factor* ; Celecoxib