Tinea incognito (TI) is a dermatophytic infection which has lost its typical clinical appearance because of improper use of steroids or calcineurin inhibitors. The incidence of TI is increasing nowadays. We conducted retrospective review on 283 patients with TI from 25 dermatology training hospitals in Korea from 2002-2010 to investigate the demographical, clinical, and mycological characteristics of TI, and to determine the associated risk factors. More than half (59.3%) patients were previously treated by non-dermatologists or self-treated. The mean duration of TI was 15.0 +/- 25.3 months. The most common clinical manifestations were eczema-like lesion, psoriasis-like, and lupus erythematosus-like lesion. The trunk and face were frequently involved, and 91 patients (32.2%) also had coexisting fungal infections. Among 67 isolated strains, Trichophyton rubrum was the most frequently detected (73.1%). This is the largest study of TI reported to date and the first investigational report concerning TI in Korea. We suggest that doctors should consider TI when a patient has intractable eczema-like lesions accompanied by tinea pedis/unguium. Furthermore, there should be a policy change, which would make over-the-counter high-potency topical steroids less accessible in some countries, including Korea.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Demography ; Eczema/pathology ; Face/pathology ; Female ; Humans ; Lupus Erythematosus, Cutaneous/pathology ; Male ; Middle Aged ; Psoriasis/pathology ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Tinea/*diagnosis/microbiology ; Trichophyton/isolation & purification ; Young Adult

BACKGROUND: Infectious vaginitis is caused primarily by three different groups of microbial pathogens (Trichomonas vaginalis, Candida spp., and Gardnerella vaginalis). The objective of this study was to compare the Affirm VPIII assay using a DNA hybridization technique with the Papanicolaou (Pap) smear test and the Gram stain in the detection and identification of these three organisms. METHODS: A total of 300 vaginal samples were collected from women that were either symptomatic for vaginitis or asymptomatic women that were being seen for routine obstetric or gynecological care. The presence of T. vaginalis, Candida spp., and G. vaginalis was evaluated by using the Affirm VIII assay (Becton Dickinson, USA), Pap smear test, and Gram stain method, respectively. RESULTS: With the Affirm VPIII assay, 1 (0.3%) patient tested positive for T. vaginalis, 99 (33.0%) patients were positive for G. vaginalis, and 18 (6.0%) were positive for Candida spp. The detection rates of Trichomonas infection, bacterial vaginosis and candidiasis by the Pap smear test and Gram stain method were 0.7% versus 0%, 16.3% versus 35.7%, and 1.7% versus 9.7%, respectively. The differences between the detection rates of the above three organisms between the Pap smear test and the Gram stain method were statistically significant (p<0.05). CONCLUSION: The Affirm VPIII assay was more sensitive than the Pap smear test and more specific than the Gram stain method for the detection and identification of these three organisms. In addition, the results of the Affirm VPIII assay are quick to obtain and are simple and easy to interpret.
Candida ; Candidiasis ; Chimera ; DNA ; Female ; Gardnerella ; Gardnerella vaginalis ; Humans ; Trichomonas ; Trichomonas Infections ; Trichomonas vaginalis ; Vaginal Smears ; Vaginitis ; Vaginosis, Bacterial

BACKGROUND: There are limited data regarding the antifungal susceptibility of Candida albicans causing recurrent vulvovaginal candidiasis. OBJECTIVE: The aim of the present study was to evaluate the effect of azoles susceptibilities on treatment failure and recurrence of vulvovaginal candidiasis. METHODS: Species identification was performed on 84 vaginal Candida isolates collected from October 2008 to June 2010 from 404 patients with suspected vulvovaginitis. MICs of C. albicans (26 isolates) to fluconazole, itraconazole, and voriconazole were tested by broth microdilution method of the Clinical and Laboratory Standards Institute (CLSI) M27-A2. RESULTS: C. albicans was the most frequently isolated (88.1%). All isolates were susceptible to fluconazole, itraconazole, and voriconazole. Trailing growth was found in treatment success group (10.0%) and treatment failure group (33.3%). CONCLUSIONS: The results of this study suggest the possibility that trailing growth have influence on treatment failure of vulvovaginal candidiasis.
Azoles ; Candida ; Candida albicans ; Candidiasis, Vulvovaginal ; Danazol ; Fluconazole ; Humans ; Itraconazole ; Pyrimidines ; Recurrence ; Treatment Failure ; Triazoles ; Vulvovaginitis

Retrorectal or presacral tumors are rare, with incidences of approximately 0.01%. Generally, these tumors have no specific symptoms and are likely to be found incidentally on CT or MRI scans. Most of them are benign masses, but malignant masses are reported on occasion. The modality of treatment is a resection in cases of a benign mass, but chemotherapy or radiation therapy can be done in cases of malignancy. Like our case, a matured cystic teratoma in the retrorectal area is very rare. In addition, no laparoscopic resection of a retrorecal teratoma was reported until 2008. Thus, we report the case of a 31-yr-old female patient who underwent a total laparoscopic excision for a matured cystic teratoma in the retrorectal space.
Female ; Humans ; Incidence ; Laparoscopy ; Magnetic Resonance Imaging ; Teratoma

OBJECTIVE: To evaluate the relationship between gestational age, tubal ultrasonographic diameter, and serum beta-hCG levels and different stages of trophoblastic infiltration of the tubal wall in tubal pregnancy. METHODS: The 45 cases of fallopian tube containing tubal pregnancy were reviewed. Gestational age, diameter of the tubal mass, and beta-hCG level on the day of surgery were calculated by transvaginal sonography and immunoassay respectively. The tubal pregnancy was classified according to the depth of trophoblastic infiltration: trophoblast limited to the tubal mucosa (stage I), extension to the tubal muscularis (stage II), or complete tubal wall infiltration up to the serosa discontinued by trophoblastic cells (stage III). RESULTS: 14 patients (31.1%) had stage I tubal infiltration, 10 patients (22.2%) had stage II infiltration, 21 patients (46.7%) had stage III infiltration. There was no relationship between gestational age, tubal diameter and stage, but there was a predictable correlation between beta-hCG and the depth of trophoblastic invasion. The median beta-hCG level was 1,332.1 mIU/mL (range, 215-2,995 mIU/mL) for patients with stage I infiltration, 9,548.0 mIU/mL (range, 569-43,989 mIU/mL) for stage II infiltration, and 23,087.9 mIU/mL (range, 1,373-98,000 mIU/mL) for stage III infiltration. Cut off level of beta-hCG for each stage were 1,996.5 mIU/mL (stage I vs II, III) and 5,665 mIU/mL (stage I, II vs III) respectively. CONCLUSION: These findings may explain why beta-hCG is a important predicting factor for invasion of trophoblast in tubal pregnancy.
Chorionic Gonadotropin* ; Fallopian Tubes ; Female ; Gestational Age ; Humans* ; Immunoassay ; Mucous Membrane ; Pregnancy ; Pregnancy, Tubal* ; Serous Membrane ; Trophoblasts*

OBJECTIVE: The purpose of this study is to introduce and evaluate new anti-incontinence surgical procedure, Distal Urethral Polypropylene Sling (DUPS) for stress urinary incontinence in Korea. METHODS: DUPS were performed on 12 patients with stress urinary incontinence at Kangbuk Samsung Hospital from Feb. 2005 to May 2005. Patients were evaluated preoperatively with history, physical examination, standardized symptom questionnaire, voiding diary, post-void residual urine and urodynamics. We reviewed medical records and clinical characteristics and evaluated the efficacy of the sling procedure, retrospectively. RESULTS: The mean age was 48.08+/-9.3 years. The average operative time was 29.00+/-15.8 minutes for the sling procedure. The average hemoglobin change is 1.57+/-1.14 g/dL. The mean hospital stay day is 3.74+/-0.88 days. Concomitant procedures were performed including rectocele repair (n=5), LAVH with rectocele repair (n=2), LAVH (n=1), VTH with cystocele and rectocele repair (n=1). There was no intraoperative complications or major postoperative complications. The cure rate (patients' satisfaction) was 94.7%. CONCLUSION: DUPS is a new, inexpensive, safe and simple alternative treatment for patients with stress urinary incontinence.
Cystocele ; Humans ; Intraoperative Complications ; Korea* ; Length of Stay ; Medical Records ; Operative Time ; Physical Examination ; Polypropylenes* ; Postoperative Complications ; Surveys and Questionnaire ; Rectocele ; Retrospective Studies ; Urethra ; Urinary Incontinence* ; Urodynamics

Henoch-Schonlein purpura is a systemic leukocytoclastic vasculitis involving small vessels. The diagnostic criteria is defined as a typical skin rash of which pathologic examination shows leukocytoclastic vasculitis, accompanied by any two of these major manifestations of the disease, namely gastrointestinal tract, kidney, joint involvement. In elder patient, Henoch-Schonlein purpura shows more serious gastrointestinal tract involvement. There are some reports of brain involvement of Henoch-Schonlein purpura. A 69-year-old man was admitted to department of neurosurgery, because of loss of consciousness. Brain CT showed acute cerebellar hemorrhage with rapid resolution by conservative treatment. Diffuse purpuric eruptions on both low legs were developed after 7 days of hospitalization. He was refered to our department due to epigastric pain and bloody diarrhea. There were multiple longitudinal ulcers with hemorrhage on the stomach and the sigmoid colon of which biopsy showed leukocytoclastic vasculitis. Microscopic hematuria and proteinuria were also noted. He had a fatal course due to recurrent colonic bleeding and poor medical condition. We report an unusual case of cerebellar and gastrointestinal involvement of Henoch-Schonlein purpura in elderly patient.
Aged ; Biopsy ; Brain ; Colon ; Colon, Sigmoid ; Diarrhea ; Exanthema ; Gastrointestinal Tract ; Hematuria ; Hemorrhage* ; Hospitalization ; Humans ; Joints ; Kidney ; Leg ; Neurosurgery ; Proteinuria ; Purpura, Schoenlein-Henoch* ; Stomach ; Ulcer ; Unconsciousness ; Vasculitis

BACKGROUND: This study compared the bronchodilator efficacy and safety of tiotropium inhalation capsules (18microgram once daily) with a ipratropium metered dose inhaler (2 puffs of 20microgram q.i.d.) in patients with chronic obstructive pulmonary disease (COPD). METHOD: After the initial screening assessment and a two-week run-in period, patients received either tiotropium 18microgram once daily or ipratropium 40microgram four times daily over a period of 4 weeks in a double blind, double dummy, parallel group study. The outcome measures were the lung function, the daily records of the peak expiratory flow rate (PEFR), the patients' questionnaire, and the use of concomitant salbutamol. The forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC) were measured 5 minutes before inhalation, and 0.5, 1, 2 and 3 hours after inhaling the study drug on days 0, 14 and 28. RESULT: In 16 centers, 134 patients with a mean (SD) age of 66 (7) years and a predicted FEV1 of 42 (12)% were analyzed. The trough FEV1 response was significantly higher in the tiotropium group than in the ipratropium group after a four-week treatment period. The weekly mean morning PEFR of the tiotropium group was consistently higher than that of the ipratropium group during the 4-week treatment period with differences ranging from 12.52 to 13.88 l/min, which were statistically significant. Tiotropium was well tolerated by the COPD patients during the 4-week treatment period and had a similar safety profile to ipratropium. CONCLUSION: This study shows that tiotropium administrated once daily has a superior bronchodilator effect with a similar safety profile in treating COPD patients compared with ipratropium, inhaled four times daily.
Adult* ; Albuterol ; Bronchodilator Agents ; Capsules ; Forced Expiratory Volume ; Humans ; Inhalation ; Ipratropium* ; Lung ; Mass Screening ; Metered Dose Inhalers ; Outcome Assessment (Health Care) ; Peak Expiratory Flow Rate ; Pulmonary Disease, Chronic Obstructive* ; Surveys and Questionnaires ; Vital Capacity ; Tiotropium Bromide

OBJECTIVE: To evaluate the indications, advantages and complications of laparoscopically assisted vaginal hysterectomy (LAVH), retrospectively. METHODS: From Mar. 2003 to Feb. 2004, clinical trials of LAVH (n=154) were performed in the Department of Obstetrics and Gynecology, Kangbuk Samsung Medical Center, School of Medicine, University of Sungkyunkwan, Seoul, Korea. Medical records of patients who underwent LAVH were reviewed. The results were evaluated according to characteristics of patients, history of previous abdominal surgery, preoperative surgical indications, postoperative diagnosis, mean operation times, weight of uterus, change of hemoglobin, hospital stay, associated diseases, concomitant procedures and complications. RESULTS: The mean age was 46.09 +/- 6.67 years. The mean parity was 2.08 +/- 0.94. Tubal ligation, vaginal bleeding, leiomyoma was the most common previous abdominal surgery, preoperative surgical indication, and postoperative diagnosis, respectively. The mean operation time was 130.66 +/- 67.68 minutes. The mean uterine weight was 259.27 +/- 123.48 gm. The mean hemoglobin change was 1.61 +/- 1.12 g/dL. The mean hospital stay was 3.44 +/- 1.83 days. The complication rate was 3.2% (5 cases); bladder injury (3 cases) being the most common complication. CONCLUSION: LAVH appears to be beneficial in many aspects. The further development of laparoscopic instruments and skills will reduce limitations and complications of LAVH and will hopefully allow the utilization of this technique to expand to include other clinical indications and concomitant procedures.
Diagnosis ; Female ; Gynecology ; Humans ; Hysterectomy, Vaginal* ; Korea ; Leiomyoma ; Length of Stay ; Medical Records ; Obstetrics ; Parity ; Retrospective Studies ; Seoul ; Sterilization, Tubal ; Urinary Bladder ; Uterine Hemorrhage ; Uterus

OBJECTIVE: This study was designed to assess the effect of extracorporeal magnetic innervation (ExMI) therapy for urinary incontinence and sexual function. METHODS: Fifty female patients with urinary incontinence were prospectively studied. Their mean age was 47.2 years, and the mean duration of symptoms was 6.7 years. All they had a history of previous vaginal delivery and mixed urinary incontinence symptoms. Evaluation before treatment included urine analysis and culture for excluding urinary infection, physical examination including neurologic and gynecologic evaluation for structural abnormality, vaginal pressure measurement with perineometer and quality of life survey with questionnaire. For the treatment, the patients were seated fully clothed in a Neocontrol chair with a magnetic field therapy. Treatment sessions were for 20 minutes, twices a week for the average 8 weeks. At one week after ExMI therapy, vaginal pressure measurement and quality of life survey (including questions of patient and patient's husband for satisfaction degree of their sexual life) were repeated. The comparison of incontinence symptoms, qulity of life (including sexual life) and vaginal pressure measurement before and after ExMI therapy were assessed. RESULTS: The results were as follows 1) The mean of urge incontinence symptoms score was increased 3.06 to 4.60 after ExMI (P<0.05). 2) The mean of stress incontinence symptoms score was increased 3.08 to 4.57 after ExMI (P<0.05). 3) The mean of quality of life (QoL) score was increased 3.36 to 4.77 after ExMI (P<0.05). 4) The mean of quality of sexual life (QoSL) score was increased 3.70 to 4.92 after ExMI (P<0.05). 5) The mean of vaginal pressure and duration of pelvic floor muscle contraction after ExMI were increased with startistical significance. CONCLUSION: Our results suggested that ExMI therapy might be effective for not only urinary incontinence but also improvement of sexual function.
Female ; Humans ; Magnetic Field Therapy ; Muscle Contraction ; Pelvic Floor ; Physical Examination ; Prospective Studies ; Quality of Life ; Surveys and Questionnaire ; Spouses ; Urinary Incontinence* ; Urinary Incontinence, Urge