Disseminated superficial porokeratosis (DSP) is an autosomal dominant specific disorder of keratinization. Clinically, the lesions show a sharply demarcated and hyperkeratotic plaque with central atrophy, with a predilection for the extensor surface of the extremities. Unusual cases of DSP accompanied by severe pruritus have been reported as "eruptive pruritic papular porokeratosis" or "inflammatory DSP." Histopathologically, inflammatory DSP is characterized by the presence of cornoid lamella with a dense infiltration of lymphocytes in the perivascular area of the upper dermis. Here we report a case of inflammatory DSP in an 80-year-old man with choledocholithiasis.
Aged, 80 and over ; Atrophy ; Choledocholithiasis ; Dermis ; Extremities ; Humans ; Keratins ; Lymphocytes ; Porokeratosis ; Pruritus

Nevus comedonicus is an uncommon skin disorder that clinically appears as linear groups of open comedones. A 6-year-old female patient presented with a nevus comedonicus accompanied by an epidermal nevus in her genital area. The histopathologic finding showed an atrophic, cystically dilated hair follicle containing abundant keratinous debris. She was treated with oral antibiotics. We report here on an unusual case of nevus comedonicus that occurred in the genital area.
Anti-Bacterial Agents ; Child ; Female ; Hair Follicle ; Humans ; Keratins ; Nevus ; Skin

No abstract available.
Bacillus ; Exanthema ; Immunotherapy ; Pityriasis

Background: Diffuse alveolar hemorrhage (DAH) is a potentially life-threatening condition that can occur due to a variety of disorders. Hence, rapid diagnosis and prompt initiation of appropriate treatment are imperative.Case: A 55-year-old woman with a deep neck infection underwent emergent tonsillectomy. General anesthesia and surgery proceeded uneventfully. Upon transfer to the post-anesthesia care unit, ongoing respiratory distress and occasional expectoration of blood-tinged sputum were noted. Lung ultrasonography (LUS) revealed multiple B-profiles and irregular pleural lines with subpleural consolidations. Emergent bronchoscopy with bronchoalveolar lavage was diagnostic of DAH. She underwent a comprehensive evaluation for rheumatologic and infectious etiologies of DAH, all of which yielded negative results. The patient was managed with steroids and conservative treatment. Conclusions The integration of LUS with clinical information allows for more rapid differentiation of acute respiratory failure causes. Therefore, anesthesiologists’ awareness and utilization of LUS findings of DAH can significantly contribute to appropriate management.

Vandetanib is a once-daily oral anticancer drug that selectively inhibits key signaling pathways in cancer by targeting vascular endothelial growth factor receptors, epidermal growth factor receptors tyrosine kinase, and rearranged during transfection-dependent tumor cell proliferation and survival. The most frequently reported adverse events attributed to vandetanib include diarrhea, elevated aminotransferase, asymptomatic corrected QT interval prolongation, and hypertension. Though a number of randomized, doubleblind studies, including cutaneous adverse events attributed to vandetanib, have been reported along with these general symptoms, no case of Stevens-Johnson syndrome (SJS) has been reported. This paper demonstrates a case of SJS induced by vandetanib.
Carcinoma, Non-Small-Cell Lung ; Cell Proliferation ; Diarrhea ; Hypertension ; Piperidines ; Protein-Tyrosine Kinases ; Quinazolines ; Receptor, Epidermal Growth Factor ; Receptors, Vascular Endothelial Growth Factor ; Stevens-Johnson Syndrome

Masseter muscle rigidity (MMR), known as the ‘jaw of steel’, sometimes makes laryngoscope unusable due to the stiffness of the jaw. MMR during general anesthesia was previously considered as an early episode of malignant hyperthermia (MH). Generally, MMR occurs in the pediatric patients after induction with succinylcholine and volatile agents. However, MMR following the administration of non-depolarizing muscle relaxants is uncommon, although described in some reports. We report a case of 62-year-old male patient which developed MMR following intravenous administration of rocuronium during induction of anesthesia. Our patient was not found to be vulnerable to MH. Although fiberoptic nasotracheal intubation had been successfully performed in our case, an unanticipated difficult airway due to MMR can be experienced at any time. Therefore, we should be aware that, although rare, MMR can occur after using non-depolarizing muscle relaxant. Additionally, in case of any incident of MMR, anesthesiologists need to recognize the management of a difficult airway and to maintain adequate oxygenation in a variety of methods according to a difficult airway algorithm.

Masseter muscle rigidity (MMR), known as the ‘jaw of steel’, sometimes makes laryngoscope unusable due to the stiffness of the jaw. MMR during general anesthesia was previously considered as an early episode of malignant hyperthermia (MH). Generally, MMR occurs in the pediatric patients after induction with succinylcholine and volatile agents. However, MMR following the administration of non-depolarizing muscle relaxants is uncommon, although described in some reports. We report a case of 62-year-old male patient which developed MMR following intravenous administration of rocuronium during induction of anesthesia. Our patient was not found to be vulnerable to MH. Although fiberoptic nasotracheal intubation had been successfully performed in our case, an unanticipated difficult airway due to MMR can be experienced at any time. Therefore, we should be aware that, although rare, MMR can occur after using non-depolarizing muscle relaxant. Additionally, in case of any incident of MMR, anesthesiologists need to recognize the management of a difficult airway and to maintain adequate oxygenation in a variety of methods according to a difficult airway algorithm.

The Selectatec mounting system was devised to provide easy and quick on-site fitting of various vaporizers for the anesthetic machine. However, a quick changing system for the vaporizer can also damage the O-ring due to friction between the vaporizer and the Selectatec back bar. We herein report a case of an unexpected anesthetic gas leakage from a damaged O-ring on the Selectatec back bar, which resulted from exchanging the vaporizers between two operations. In cases using the Datex Ohmeda machine, it is not easy to detect leakages from the vaporizers because of the location of the check valve near to the fresh gas outlet. This complicates the use of the positive pressure leakage test to detect a low pressure system leakage on the Selectatec back bar. We recommend the preanesthetic negative pressure or low-flow leakage test to detect a low pressure leakage when exchanging vaporizers on the Selectatec system.
Friction ; Intraoperative Awareness ; Nebulizers and Vaporizers ; Ventilators, Mechanical

Background/Aims: Vascular disease is an established risk factor for stroke in patients with atrial fibrillation (AF), which is included in CHA2DS2-VASc score. However, the role of carotid atherosclerosis remains to be determined. Methods: Three hundred-ten patients with AF who underwent carotid sonography were enrolled. Results: During a median follow-up of 31 months, 18 events (5.8%) of stroke were identified. Patients with stroke had higher carotid intima-media thickness (CIMT) (1.16 ± 0.33 mm vs. 0.98 ± 0.25 mm, p = 0.017). CIMT was significantly increased according to the CHA2DS2-VASc score (p < 0.001) and it was correlated with left ventricular mass index and early diastolic mitral annular velocity (e’), a ratio of early transmitral flow velocity to e’ (E/e’) and pulmonary artery systolic pressure (all p < 0.05). Cox regression using multivariate models showed that carotid plaque was associated with the risk of stroke (hazard ratio, 3.748; 95% confidence interval [CI], 1.107 to 12.688; p = 0.034). C-statistics increased from 0.648 (95% CI, 0.538 to 0.757) to 0.716 (95% CI, 0.628 to 0.804) in the CHA2DS2-VASc score model after the addition of CIMT and carotid plaque as a vascular component (p = 0.013). Conclusions Increased CIMT and presence of carotid plaque are associated with a high risk of ischemic stroke, and CIMT is related to myocardial remodeling and diastolic dysfunction, suggesting that carotid atherosclerosis can improve risk prediction of stroke in patients with AF, when included under vascular disease in the CHA2DS2-VASc scoring system.

Background/Aims: Chest pain in patients with obstructive coronary artery disease (OCAD) is affected by several social factors. The gender-based differences in chest pain among Koreans have yet to be investigated. Methods: The study consecutively enrolled 1,549 patients (male/female, 514/1,035; 61 ± 11 years old) with suspected angina. The predictive factors for OCAD based on gender were evaluated. Results: Men experienced more squeezing type pain on the left side of chest, while women demonstrated more dull quality pain in the retrosternal and epigastric area. After adjustment for risk factors, pain in the retrosternal area (odds ratio [OR], 1.491; 95% confidence interval [CI], 1.178 to 1.887) and aggravation by exercise (OR, 2.235; 95% CI, 1.745 to 2.861) were positively associated with OCAD. In men, shorter duration (OR, 1.581; 95% CI, 1.086 to 2.303) and dyspnea (OR, 1.610; 95% CI, 1.040 to 2.490) increased the probability for OCAD, while left-sided chest pain suggested a low probability for OCAD (OR, 0.590; 95% CI, 0.388 to 0.897). In women, aggravation by emotional stress (OR, 0.348; 95% CI, 0.162 to 0.746) and dizziness (OR, 0.457; 95% CI, 0.246 to 0.849) decreased the probability for OCAD. Conclusions This is the first study to focus on gender differences in chest pain among Koreans with angina. Symptoms with high probability for OCAD were different between sexes. Our findings suggest that patient’s medical history in pretest assessment for OCAD should be individualized considering gender.