Herpes zoster involving noncontiguous dual dermatomes is very rare in both immunocompetent and immunocompromised persons. This unique presentation has been referred to as zoster duplex unilateralis or bilateralis, depending whether one or both halves of the body are involved. A 22-year-old woman, who had been treated for acute leukemia, congestive heart failure and chronic disseminated candidiasis, was referred to our department for painful papulovesicular eruptions on the right side of the anterior chest and upper back for 2 days, and the left buttock for 1 day. Tzanck smear revealed multinucleated giant cells with intranuclear inclusion bodies. We report a rare case of zoster duplex bilateralis.
Buttocks ; Candidiasis ; Female ; Giant Cells ; Heart Failure ; Herpes Zoster* ; Humans ; Intranuclear Inclusion Bodies ; Leukemia ; Thorax ; Young Adult

BACKGROUND: A novel technique for the repair of tears of the upper subscapularis tendon—intraarticular knotless fixation—has been introduced recently. The purpose of this study was to evaluate the clinical and structural outcomes of arthroscopic intraarticular knotless fixation for the treatment of upper subscapularis tendon tears. METHODS: We retrospectively analyzed the clinical and radiological outcomes of 27 patients who underwent arthroscopic intraarticular knotless fixation for upper subscapularis tendon tears. Finally, a total of 10 patients who could participate in at least a 6 month follow-up of magnetic resonance imaging evaluation and in a least 1-year follow-up on an outpatient basis were enrolled in our study. The mean age at the time of operation was 60.7 years, and the mean duration of follow-up was 14.7 months. Two patients had concomitant tears of the supraspinatus tendon and 8 patients had concomitant tears of the supraspinatus and the infraspinatus tendons. RESULTS: The clinical and radiological outcomes improved after the patients had undertaken arthroscopic intraarticular knotless fixation. The mean visual analogue scale score for pain during motion improved from 6.7 preoperatively to 1.4 at the final follow-up (p<0.001). The mean Constant score improved from 59.3 preoperatively to 79.6 at the final follow-up, and the mean the University of California at Los Angeles score, from 21.7 to 30.2, respectively (p<0.001 and p<0.001). The upper subscapularis tendon tear was healed in every patient except one (90%), for the patient had suffered from a postoperative trauma that resulted in a retear. CONCLUSIONS: We found that arthroscopic intraarticular knotless fixation gives good clinical and structural outcomes for the repair of upper subscapularis tendon tears. Arthroscopic intraarticular knotless fixation provided such a reliable and efficient restoration of the subscapularis tendon footprint that we anticipate it will become a widely-used procedure for upper subscapularis tendon tears.
Arthroscopy ; California ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Outpatients ; Retrospective Studies ; Shoulder ; Tears* ; Tendons* ; Treatment Outcome

BACKGROUND: Cases of patients presenting side effects after illegal therapeutic attempts by non-medical personnel have been increasing and the patterns of attempts and related side effects become complicated. OBJECTIVE: To analyze the causes and characteristics of illegal therapeutic attempts and its' side effects performed by non-medical personnel. METHODS: Between April 1, 2008 and April 30, 2008, a total of 120 case reports of patients who developed side effects after illegal therapeutic attempts by non-medical personnel were collected from the members of the Korean dermatological association and analyzed. RESULTS: Clinical diagnoses, suggested to have before receiving illegal therapeutic attempts, revealed that 44 (36.6%) patients presented various pigmentary disorders, such as acquired melanocytic nevi and melasma, 22 (18.3%) wanted to have tattooing for permanent make up, skin aging in 16 (13.3%) cases, and acne in 10 (8.3%). Illegal therapeutic attempts performed included tattooing for permanent make up in 22 (18.3%) cases, peelings 19 (15.8%), laser therapies 18 (15.0%), and filler injection 12 (10.0%). The various clinical diagnoses of the patients with side effects were suggested, such as contact dermatitis in 34 (25.6%) cases, scarring in 33 (24.8%), post-inflammatory hyperpigmentation 20 (15.0%), secondary infection 19 (14.3%), and acne or acneiform eruption 9 (6.8%). CONCLUSION: In this report, we demonstrated patterns of illegal therapeutic attempts by non-medical personnel and its' side effects. We suggest that more effort should be followed by dermatologists to inform patients the risks of the illegal therapeutic attempts by non-medical personnel and to increase public health awareness.
Acne Vulgaris ; Acneiform Eruptions ; Cicatrix ; Coinfection ; Cosmetics ; Dermatitis, Contact ; Humans ; Hyperpigmentation ; Laser Therapy ; Melanosis ; Nevus, Pigmented ; Public Health ; Skin Aging ; Tattooing

BACKGROUND: The study was designed to provide a comprehensive comparison of the nerve conduction velocities(NCVs) and current perception thresholds(CPTs) in evaluating the clinical severity of diabetic neuropathy. METHODS: The seventy-eight individuals(mean age : 43.5 years, M:F = 40:38) with diabetes neuropathy of varying degrees of severity were selected after exclusion of any other potential causes of peripheral neuropathies or radiculopathies. Detailed, scored neurological symptoms(symptom score . 0-10) and physical examination(physical score : 0-48), emphasizing sensory assessment, were performed in all subjects. In addition, NCVs of motor and sensory nerves, CPTs at 5, 250, 2000Hz of the upper and lower extremities were determined. Non-parametric correlation analysis(Spearman rho) was performed as a measure of association of symptoms and physical score with the various electrodiagnostic variables. RESULTS: Correlations between physical scores(PS) and symptom scores(55) and NCVs were significant. In most parameters, but their values of coefficients were relatively weak(rho = 0.12-0.41), particularly for the correlations of symptom scores with the motor NCVs. But, correlations of the 55 and PS with CPTs were higher than with NCVs[rho(ss): 0.25-0.38, rho(PS) : 0.32-0.60]. The correlations between PS and subgroups of CPTs were significant, but those between SS, PS and NCV were insignificant. Among the 3 types of frequencies, CPTs at 5Hz was the most effective discriminator in the lowest physical and symptom scores. CONCLUSIONS: CPT measurements were more effective as discriminators of both symptomatic and physical status than NCV measurements. So, the supplementary use of CPT testing may improve the quantitative assessment of this condition.
Diabetic Neuropathies* ; Lower Extremity ; Neural Conduction ; Peripheral Nervous System Diseases ; Radiculopathy

Background/Aims: There is no clear consensus on the relative ranking of interventional and radiation techniques with indications similar to those of radiofrequency ablation (RFA) for the treatment of early hepatocellular carcinoma (HCC). We used a network meta-analysis to compare the efficacy of non-surgical treatments for early HCC. Methods: We searched databases for randomized trials assessing the efficacy of loco-regional treatments for HCCs ≤5 cm with no extrahepatic spread or portal invasion. The primary outcome was the pooled hazard ratio (HR) for overall survival (OS), and secondary outcomes included overall and local progression-free survival (PFS). A frequentist network meta-analysis was performed, and the relative ranking of therapies was assessed with P-scores. Results: Nineteen studies comparing 11 different strategies in 2,793 patients were included. Chemoembolization plus RFA improved OS better than RFA alone (HR 0.52, 95% confidence interval [CI] 0.33–0.82; P-score=0.951). Cryoablation, microwave ablation, laser ablation, and proton beam therapy had similar effects on OS compared with RFA. For overall PFS, but not local PFS, only chemoembolization plus RFA performed significantly better than RFA (HR 0.61, 95% CI 0.42–0.88; P-score=0.964). Injection of percutaneous ethanol or acetic acid was significantly less effective than RFA for all measured outcomes, while no differences in progression outcomes were identified for other therapies included in the network. Conclusions Our results suggest that chemoembolization combined with RFA is the best option for local treatment of early HCC. Cases with potential contraindications for RFA may benefit from a tailored approach using thermal or radiation modalities.

Although congenital syphilis can be prevented with prenatal screening, the disease remains problematic. Currently, there are no cases that describe hematuria and pneumonia related to congenital syphilis. We report a case of congenital syphilis that involved nephrotic syndrome and pneumonia alba in a 22-day-old male infant whose mother did not receive adequate prenatal care. The congenital syphilis diagnosis was confirmed with a serologic test and the patient recovered with penicillin treatment. Clinical findings may be subtle in neonates and delayed recognition occurs frequently, thus complete prenatal screening is critical for congenital syphilis prevention. Immediate serologic testing should be performed to obtain a differential diagnosis if an infant is delivered by a mother that has not received appropriate prenatal examinations.
Diagnosis ; Diagnosis, Differential ; Exanthema* ; Hematuria* ; Humans ; Infant ; Infant, Newborn ; Male ; Mothers ; Nephrotic Syndrome ; Penicillins ; Pneumonia* ; Prenatal Care ; Prenatal Diagnosis ; Serologic Tests ; Syphilis, Congenital*

BACKGROUND AND PURPOSE: The goal of this study was to estimate the efficacy and safety of the rivastigmine transdermal patch in patients with probable Alzheimer's disease (AD) who cannot tolerate or do not respond to oral cholinesterase inhibitors (ChEIs). METHODS: A 24-week, prospective, open-label, single-arm, multicenter study was conducted from June 2009 to June 2010 in patients with probable AD. The enrolled patients had either a poor response or a decline in global function after treatment with oral ChEIs, or they were not able to tolerate treatment with oral ChEIs due to adverse events such as nausea or vomiting. A poor response was defined as a decrease of at least 2 points on the Korean version of the Mini-Mental State Examination (K-MMSE) within the previous 6 months (the decline in global function was determined by the investigator or caregiver). The efficacy of treatment was assessed using a follow-up Clinical Global Impression of Change (CGIC) assessment and K-MMSE conducted after 24 weeks, and safety was measured by the occurrence of adverse events and patient disposition. RESULTS: In total, 164 patients aged 74.7+/-7.52 years (mean+/-SD) and with 5.12+/-3.64 years of education were included. The study was completed by 70% of the patients (n=116), with 12.2% discontinuing due to adverse events. The most frequently reported adverse events (11%) were skin lesions, such as erythema or itching, followed by gastrointestinal problems (1.2%). Either an improvement or no decline in CGIC scores was reported for 82% of the patients. CONCLUSIONS: The immediate switching of patients from an oral ChEI to the rivastigmine transdermal patch without a washout period was safe and well tolerated by the probable-AD patients in this study.
Aged ; Alzheimer Disease ; Cholinesterase Inhibitors ; Cholinesterases ; Erythema ; Follow-Up Studies ; Humans ; Nausea ; Phenylcarbamates ; Prospective Studies ; Pruritus ; Research Personnel ; Skin ; Transdermal Patch ; Vomiting ; Rivastigmine

BACKGROUND: This study was intended to look into the characteristics and problems when FACES III are used as tools to evaluate family function of adolescents. METHODS: From May to June 1996, self-reported questionnaires for FACES III were conducted on 2,430 middle school and high school students (males:1,190, females:1,240) in Seoul and Yangpyung, Kyunggi-Do. There were eight schools (four middle schools, four high schools) in Seoul and two schools (one middle school, one high school) in Yangpyung, Kyunggi-Do in this study. Also, educational level of parents, occupational status of parents, family types (extended/nuclear), number of family member and numbers of siblings were assessed. RESULTS: The mean values of adaptability were significantly higher in Seoul students, in females, and in nuclear families. The mean values were higher in single sibling than two or more and in parents with higher education. The mean values of cohesion were significantly higher in Seoul students, in middle school students and in family members of 5 and under. The mean values were higher in those without a sibling and in those with above college education. In stepwise regression analysis, educational level of parents, gender, area, occupational status of mother and grade were associated significantly with the mean values of adaptability and educational level of parents, grade and numbers of siblings were significantly associated with the mean values of cohesion. CONCLUSIONS: We consider that there are problems in deciding the cut-off point and in the questionnaires of survey when the FACES III is used as a tool for evaluating family function of adolescents. Trials of combining other tools of family function or consideration of lower concepts are needed in other to be applicable to the individual conversation and the clinical surroundings.
Adolescent* ; Education ; Employment ; Female ; Gyeonggi-do ; Humans ; Mothers ; Nuclear Family ; Parents ; Seoul ; Siblings ; Surveys and Questionnaires