Wernicke's encephalopathy is a reversible but potentially critical disease caused by thiamine deficiency. Most patients complain of symptoms such as ophthalmoplegia, ataxia and confusion. Heavy alcohol drinking is commonly associated with the disease, but other clinical conditions also can provoke it. In pregnant women, hyperemesis gravidarum can lead to the depletion of body thiamine due to poor oral intake and a high metabolic demand. We report a case of Wernicke's encephalopathy following hyperemesis gravidarum in a 36-year-old female at 20 weeks of pregnancy, who visited our hospital because of shock with vaginal bleeding. This case suggests that although the initial presentation may include atypical symptoms (e.g., shock or bleeding), Wernicke's encephalopathy should be considered, and thiamine replacement should be performed in pregnant women with neurologic symptoms and poor oral intake.
Acute Kidney Injury ; Adult ; Alcohol Drinking ; Ataxia ; Female ; Humans ; Hyperemesis Gravidarum* ; Neurologic Manifestations ; Ophthalmoplegia ; Pregnancy ; Pregnant Women ; Shock ; Thiamine ; Thiamine Deficiency ; Uterine Hemorrhage ; Wernicke Encephalopathy*

Isolated collagenoma usually occurs on the plantar area and is frequently associated with Proteus syndrome. A few reports have described isolated collagenoma on extra-plantar areas such as palm, scalp, face, thigh and finger. Herein, we report a case of isolated collagenoma on the periungual area, which was confused with digital mucous cyst. A 26-year-old man visited our clinic with an asymptomatic, 0.8x0.7 cm-sized, firm, skin-colored nodule on the periungual area of the left fourth finger. The distal nail of the nodule showed a longitudinal groove. Histopathologic findings from periungual nodule showed thickened collagen bundles packing reticular dermis.
Adult ; Collagen ; Dermis ; Fingers ; Humans ; Nails ; Proteus Syndrome ; Scalp ; Thigh

No abstract available.
Eosinophils* ; Mouth Mucosa* ; Ulcer*

No abstract available.
Granuloma* ; Syphilis, Cutaneous*

No abstract available.
Eosinophilia ; Eosinophils ; Folliculitis ; Skin Diseases, Vesiculobullous ; Tacrolimus

A giant thrombosed extracranial internal carotid artery aneurysm (ECCA) is extremely rare and its treatment is challenging. Despite the advance of endovascular technique, open surgery is still considered a first-line treatment in giant thrombosed ECCA. We describe a case of giant thrombosed ECCA which was successfully treated by aneurysmectomy and graft interposition with the technical details.

Objective: Kummell's disease (KD) is a form of delayed vertebral compression fracture. However, its incidence and predictors remain unclear. We investigated the incidence rate and predictors of KD in patients with benign vertebral compression fractures. Methods: We retrospectively analyzed 437 consecutive patients with benign vertebral compression fractures admitted to XXX between 2015 and 2018. The inclusion criterion was patients with newly diagnosed KD at ≥20 years of age. The control subjects had acute benign vertebral compression fractures. Univariate and multivariate regression analyses were performed to evaluate the predictors of KD. Results: In total, 39 patients (8.9%) were newly diagnosed with KD, with an average age of 77.3 years. In older patients (≥70 years), the incidence was 12.8%. The incidence rate was highest in patients in their 70s. Most cases of KD (69.2%) occurred in the thoracolumbar region. Multivariate regression analysis showed that age ≥70 years (odds ratio [OR], 3.24; 95% confidence interval [CI], 1.05–9.97; p=0.041) and a history of ischemic stroke (OR, 2.92; 95% CI, 1.26–6.74; p=0.012) were independently associated with KD. Conclusion KD appears to be relatively common, especially in older people (≥70 years). Older age and a history of ischemic stroke may be independent predictors of KD. This study also indicated that ischemic factors may play a more important role than mechanical factors in the development of KD from vertebral compression fractures.

The silver nanocrystalline is widely used for biological field because of its biocompatibility and anti-microbial effect. The objective of this study was to evaluate the therapeutic efficacy of the silver nanocrystalline ointment on the temporomandibular joint (TMJ) capsulitis. Total 39 patients were included in this study and all patients were received single topical application of the silver nanocrystalline ointment (group A, n=30) or placebo ointment (group B, n=19). Measured variables were maximum mouth opening (MMO), visual analog scale (VAS) for pain, and VAS for function. In results, we could not assess any therapeutic efficacy of single application in the chronic TMJ capsulitis (p>0.05). However, the single application of silver nanocrystalline ointment showed significant improvement in MMO and VAS for pain compared to placebo effect in the acute TMJ capsulitis (p<0.05). We could not find any complications related to ointment application in both groups. In conclusion, the single application of silver nanocrystalline ointment was effective in improving patient's symptom in acute TMJ capsulitis without any noticing complications.
Humans ; Mouth ; Placebo Effect ; Silver* ; Temporomandibular Joint* ; Visual Analog Scale

Disseminated and recurrent infundibulo-folliculitis is an infrequent entity of unknown etiology that was first described in 1968, by Hitch and Lund. Most patient reports have been on young black male adults. It is rarely reported in Asian, and there has been only 1 case reported in the Korean medical literature in the year 1984. The syndrome has been characterized as tiny uniform, skin-colored papules similar to 'goose-bumps' of skin. These papules predominantly involve the trunk and proximal extremities, and are usually accompanied by mild pruritus. In this report, we presented a 33-year-old man with a 10-year history of generalized skin-colored, follicular papules on the chest and back with intermittent pruritus. The clinical initial differential diagnosis included keratosis pilaris, lichen spinulosus, lichen nitidus, folliculitis, and disseminated and recurrent infundibulo-folliculitis. A histopathologic examination showed predominant mononuclear cell infiltration around the infundibular portion of hair follicles, follicular spongiosis and lack of hyperkeratosis. Herein, we reported a rare case of disseminated and recurrent infundibulo-folliculitis with typical clinical and histopathological findings in a 33-year-old Korean man.
Abnormalities, Multiple ; Adult ; Asian Continental Ancestry Group ; Darier Disease ; Diagnosis, Differential ; Extremities ; Eyebrows ; Folliculitis ; Hair Follicle ; Humans ; Keratosis ; Lichen Nitidus ; Lichens ; Male ; Pruritus ; Skin ; Thorax

Purpose: Recent clinical trials have reported response rates < 50% among patients treated with programmed death-1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitors for microsatellite instability‒high (MSI-H) colorectal cancer (CRC), and factors predicting treatment response have not been fully identified. This study aimed to identify potential biomarkers of PD-1/PD-L1 inhibitor treatment response among patients with MSI-H CRC. Materials and Methods: MSI-H CRC patients enrolled in three clinical trials of PD-1/PD-L1 blockade at Asan Medical Center (Seoul, Republic of Korea) were screened and classified into two groups according to treatment response. Their histopathologic features and expression of 730 immune-related genes from the NanoString platform were evaluated, and a machine learning–based classification model was built to predict treatment response among MSI-H CRCs patients. Results: A total of 27 patients (15 responders, 12 non-responders) were included. A high degree of lymphocyticeutrophilic infiltration and an expansile tumor border were associated with treatment response and prolonged progression-free survival (PFS), while mucinous/signet-ring cell carcinoma was associated with a lack of treatment response and short PFS. Gene expression profiles revealed that the interferon-γ response pathway was enriched in the responder group. Of the top eight differentially expressed immune-related genes, PRAME had the highest fold change in the responder group. Higher expression of PRAME was independently associated with better PFS along with histologic subtypes in the multivariate analysis. The classification model using these genes showed good performance for predicting treatment response. Conclusion We identified histologic and immune-related gene expression characteristics associated with treatment response in MSI-H CRC, which may contribute to optimal patient stratification.