Primary splenic tumors are rare and mainly found incidentally on radiologic studies. Among them, sclerosing angiomatoid nodular transformation (SANT) of the spleen is a new entity defined as a benign pathologic lesion. Most SANTs have no clinical symptoms and are occasionally accompanied by other splenic diseases such as malignancies. So, the exact diagnosis of the nature of the splenic tumor is mandatory for further treatment. But, preoperative diagnosis is not easy since it is difficult to obtain the tissue from the spleen for pathological study. Recently, laparoscopic splenectomy has become the more standard procedure for the spleen for diagnosis and treatment. Here, we report a rare case of SANT diagnosed following laparoscopic splenectomy.
Spleen ; Splenectomy ; Splenic Diseases

Munchausen syndrome by proxy (MSBP) is a rare form of mental disorder and is known as a particular type of child abuse. MSBP has been described since 1977 as a severe form of abuse with illness falsification or the intentional harming by guardians, mostly mothers. The perpetrator of MSBP may inflict damage to the child directly or indirectly through medical procedures. The perpetrator’s alleged motive is to satisfy her psychological needs, and she has a history of mental illness, mostly, factitious disorder, personality disorder, and somatic disorder. The pathology is not well known; as such, it is difficult for medical personnel to detect it early. In addition, it is hard to be handled effectively by the police and child welfare agencies because of the scarcity of evidence. Therefore, the authors attempt to examine the essential information from early detection and child abuse prevention by analyzing its clinical characteristics and the perpetrator’s characteristics, including alerting signs of MSBP. For this purpose, we focus on the role of nursing staff to detect this unusual cause of child abuse.

Background: Cyclosporine (CsA), an immunosuppressant that specifically regulates T-lymphocytes, has long been used in dermatology practice. However, nephrotoxicity, a well-known adverse effect associated with high-dose (≥5 mg/kg/d) and long-term administration (≥2 years) has limited the use of CsA. Objective: We investigated the association between the cumulative dose of CsA and renal dysfunction, as well as the long-term effects of low-dose CsA on renal function in patients who presented with dermatological conditions. Methods: The study included 697 patients who received CsA at an outpatient dermatology clinic between January 2015 and May 2019. Logistic regression analysis was performed to determine the association between the cumulative dose of CsA and renal dysfunction. Results: Compared with patients who received the lowest cumulative dose (˂7,000 mg), those who received the highest cumulative dose of CsA (≥30,600 mg) showed a 64% higher risk of renal dysfunction; however, the difference was not statistically significant (odds ratio 1.64, 95% confidence interval 0.39∼6.84). Conclusion Among patients who receive a low-dose CsA regimen, those who are treated with cumulative doses higher than the critical value may be predisposed to renal dysfunction, whereas those treated with a cumulative dose lower than the critical value are unlikely to develop nephrotoxicity.

Background: Cyclosporine (CsA), an immunosuppressant that specifically regulates T-lymphocytes, has long been used in dermatology practice. However, nephrotoxicity, a well-known adverse effect associated with high-dose (≥5 mg/kg/d) and long-term administration (≥2 years) has limited the use of CsA. Objective: We investigated the association between the cumulative dose of CsA and renal dysfunction, as well as the long-term effects of low-dose CsA on renal function in patients who presented with dermatological conditions. Methods: The study included 697 patients who received CsA at an outpatient dermatology clinic between January 2015 and May 2019. Logistic regression analysis was performed to determine the association between the cumulative dose of CsA and renal dysfunction. Results: Compared with patients who received the lowest cumulative dose (˂7,000 mg), those who received the highest cumulative dose of CsA (≥30,600 mg) showed a 64% higher risk of renal dysfunction; however, the difference was not statistically significant (odds ratio 1.64, 95% confidence interval 0.39∼6.84). Conclusion Among patients who receive a low-dose CsA regimen, those who are treated with cumulative doses higher than the critical value may be predisposed to renal dysfunction, whereas those treated with a cumulative dose lower than the critical value are unlikely to develop nephrotoxicity.

OBJECTIVES: Stress is considered a causal factor in many diseases, allergic disease being one of them. The prevalence of allergic disease is increasing in Korea, but the relationship between allergic symptoms and stress is not empirically well known. We aimed to evaluate the relationship between allergy-related symptoms and stress in children and adolescents. METHODS: We investigated 698 children and adolescents living in Gwangyang Bay, Korea, using a multi-stage cluster sampling method. Using the International Study of Asthma and Allergies in Childhood and the Psychosocial Well-being Index, these subjects were surveyed on allergy-related symptoms and psychosocial stressors in their lives, respectively. We used a multivariate logistic analysis for odds ratios for the complaint rate of allergic symptoms, after adjusting for age, gender, household income, body mass index, and residence. RESULTS: After adjustments, lifetime rhinitis (odds ratio [OR], 1.024), rhinoconjunctivitis (OR, 1.090), diagnosis of itchy eczema (OR, 1.040), treatment of itchy eczema (OR, 1.049), 12-month allergic conjunctivitis (OR, 1.026), diagnosis of allergic conjunctivitis (OR, 1.031), and treatment of allergic conjunctivitis (OR, 1.034) were found to be significantly associated with stress. CONCLUSIONS: Our results support the notion that there is a relationship between stress and allergic symptoms in children and adolescents. Further research into any causal relationship between stress and allergies, as well as preventative public health plans for decreasing stress in children and adolescents are needed.
Adolescent ; Child ; Cluster Analysis ; Conjunctivitis, Allergic/diagnosis/psychology/therapy ; Cross-Sectional Studies ; Eczema/diagnosis/psychology/therapy ; Female ; Humans ; Hypersensitivity/diagnosis/epidemiology/*psychology ; Interviews as Topic ; Logistic Models ; Male ; Questionnaires ; Republic of Korea ; Rhinitis/diagnosis/psychology ; *Stress, Psychological

BACKGROUND: The sniffing position is recommended for conventional laryngeal mask airway (LMA) insertion. However, there has been a high success rate of LMA insertion with the head in the neutral position. The effect of a difficult airway on the ease of LMA insertion is not clear. In this study, we compared the ease of LMA ProSeal(TM) (PLMA) insertion and the fiberoptic scoring according to the head position and the presence of a difficult airway. METHODS: After obtaining informed consent from the subjects, we enrolled 144 adult patients (age range: 18-65) with an ASA physical status 1 or 2. After evaluation of the airway, all the patients were grouped into the EA (easy airway) group (n = 68) and the DA (difficult airway) group (n = 76). According to the head position, each group was divided into the EA-SE (extension) group (n = 35), the EA-SN (sniffing) group (n = 33), the DA-SE group (n = 39) and the DA-SN group (n = 37). The success rate and insertion time at the first attempt were evaluated. The position of the PLMA was fiberoptically scored from the mask aperture of the airway tube in the original head position. After the head position was changed to the sniffing and neutral positions in the SE and SN group, respectively, the position of PLMA was re-evaluated fiberoptically. RESULTS: The success rate and insertion time at the first attempt and the fiberoptic score showed no significant difference among the groups. After head position was changed, there were no significant changes in the fiberopitc scores. CONCLUSIONS: A difficult airway and the head position had no influence on the ease of PLMA insertion and the fiberopic score. Therefore, the head position can be selected according to the individual patient's situation.
Adult ; Head ; Humans ; Informed Consent ; Laryngeal Masks ; Masks

BACKGROUND: The clinical symptoms of facial and truncal acne differ. Skin surface acidity (pH), which is affected by sebum secretions, reflects the different clinical characteristics of the face and trunk. However, no studies have been conducted on truncal sebum production and skin pH. OBJECTIVE: We evaluated the differences and relationship between pH values of the face and trunk. We also evaluated the relationship between pH and the quantity of sebum produced in the trunk. METHODS: A total of 35 female patients clinically diagnosed with truncal acne were included. We measured pH on the face and truncal area using the Skin-pH-Meter PH 905®. We measured truncal sebum secretions using the Sebumeter SM 815®. Statistical analysis was performed to evaluate the correlations and differences between pH and sebum. RESULTS: Facial pH was significantly higher than chest and back pH values. The correlation between pH on the trunk and the face was significant. We used linear regression equations to estimate truncal pH using only measured pH from the chin. There was no significant relationship between truncal sebum secretion and pH. CONCLUSION: This was the first study that evaluated the differences and correlations between facial and truncal pH. We found that facial pH can predict truncal pH. In addition, we conclude that differences in pH and sebum secretion between the face and trunk are one of the reasons for differences in acne symptom at those sites.
Acne Vulgaris ; Chin ; Female ; Humans ; Hydrogen-Ion Concentration* ; Linear Models ; Sebum ; Skin ; Thorax

BACKGROUND: The clinical symptoms of facial and truncal acne differ. Skin surface acidity (pH), which is affected by sebum secretions, reflects the different clinical characteristics of the face and trunk. However, no studies have been conducted on truncal sebum production and skin pH. OBJECTIVE: We evaluated the differences and relationship between pH values of the face and trunk. We also evaluated the relationship between pH and the quantity of sebum produced in the trunk. METHODS: A total of 35 female patients clinically diagnosed with truncal acne were included. We measured pH on the face and truncal area using the Skin-pH-Meter PH 905®. We measured truncal sebum secretions using the Sebumeter SM 815®. Statistical analysis was performed to evaluate the correlations and differences between pH and sebum. RESULTS: Facial pH was significantly higher than chest and back pH values. The correlation between pH on the trunk and the face was significant. We used linear regression equations to estimate truncal pH using only measured pH from the chin. There was no significant relationship between truncal sebum secretion and pH. CONCLUSION: This was the first study that evaluated the differences and correlations between facial and truncal pH. We found that facial pH can predict truncal pH. In addition, we conclude that differences in pH and sebum secretion between the face and trunk are one of the reasons for differences in acne symptom at those sites.
Acne Vulgaris ; Chin ; Female ; Humans ; Hydrogen-Ion Concentration* ; Linear Models ; Sebum ; Skin ; Thorax

BACKGROUND: The assessment of the severity of psoriasis is often subjective because of the lack of quantitative laboratory diagnostic tools. Histopathological examination is the most commonly performed procedure for psoriasis diagnosis; however, it is usually descriptive. Thus, there is currently no quantitative method of determining psoriasis severity. The clinical types of psoriasis are correlated with the severity of the disease, and a lesional severity index, such as the psoriasis severity index (PSI), could be used as a quantitative tool for assessing gross severity. OBJECTIVE: To correlate the histopathological findings of psoriasis with the PSI. METHODS: Psoriatic lesions in 98 patients were evaluated. The lesions were classified into the guttate, papular, small plaque, and large plaque types according to morphology, and were scored according to the PSI. Ten common histopathological features of psoriasis were evaluated for correlation with gross severity. RESULTS: The clinical types of psoriasis showed significant correlations with the histopathological severity. However, the PSI score showed no correlation with histopathological severity. CONCLUSION: In the future, subjective gross assessment should be modified by using objective measuring devices with detailed scales, in order to correlate the findings with the histological severity.
Adult ; Classification ; Diagnosis ; Evidence-Based Practice ; Humans ; Pathology ; Psoriasis* ; Weights and Measures

Background: Nail psoriasis is a common clinically significant symptom of psoriasis. However, few studies have focused on the characteristics and course of toenail psoriasis. Objective: To investigate the treatment response of toenail psoriasis during a 52-week period of ustekinumab use. Methods: Patients were evaluated using the Nail Psoriasis Severity Index (NAPSI) at every injection visit. NAPSI score changes throughout the treatment were analyzed. The treatment response in each toenail and each NAPSI characteristic was also analyzed. Results: A total of 22 patients with chronic plaque psoriasis with concomitant toenail psoriasis were examined. Several characteristics such as ridging or onychomycosis that mimic psoriasis or hinder the evaluation were identified. NAPSI significantly improved during the treatment (p＜0.05). The big and second toes were significantly improved after 52 weeks of ustekinumab treatment (p＜0.05). Pitting and oil-drop discoloration were the only two characteristics that showed significant changes post-treatment (p＜0.05). Conclusion Ustekinumab proved to be efficacious in treating toenail psoriasis.Because of the factors that hinder the NAPSI scoring, only NAPSI scores of the first and second toes can be used.