No abstract available.
Neurothekeoma* ; Scalp*

No abstract available.
Fever ; Humans ; Still's Disease, Adult-Onset* ; Urticaria*

No abstract available.
Chlorpromazine* ; Hyperpigmentation ; Pigmentation*

No abstract available.
Danazol* ; Panniculitis*

No abstract available.
Child* ; Humans ; Nevus, Spindle Cell*

Lichen nitidus(LN) is an uncommon chronic inflammatory disease of shiny, flat-topped, flesh-colored uniform papules most commonly located on the penis, forearms and wrists, lower abdomen, and thighs. LN almost has localized distribution, but in rare cases, it may become generalized. In Korea, three cases of generalized LN were reported. We report here three cases of generalized lichen nitidus in 31-year-old man, 8-year-old boy, and 6-year-old girl who had generalized numerous pinhead-sized, erythematous to flesh-colored, shiny papules. Microscopically, they had typical appearance of LN.
Abdomen ; Adult ; Child ; Female ; Forearm ; Humans ; Korea ; Lichen Nitidus* ; Lichens* ; Male ; Penis ; Thigh ; Wrist

Recent clinical trials have demonstrated the values of cardiac computed tomography (CT) in the initial evaluation of stable chest pain which led to drastic changes in the National Institute for Health and Care Excellence (NICE) guidelines in 2016. According to the updated NICE guidelines, cardiac CT should be performed as the initial cardiac testing in stable chest pain regardless of pre-test probability (PTP) of coronary artery disease (CAD). As a result, cardiac CT is now considered as a validated gatekeeper for assessing stable chest pain, which precedes all the functional studies including nuclear myocardial perfusion imaging (MPI). Nuclear MPI, in contrast, has been assigned as one of the second-line studies, which is inevitably dependent on the results of cardiac CT. However, nuclear MPI has genuine values in the diagnosis, treatment decision, and prognostic stratification of stable chest pain, which cannot be replaced by cardiac CT. In this review, the updated NICE guidelines and related cardiac CT trials will be critically reviewed from the view of nuclear physicians and the exceptional values of nuclear MPI will be described along with the future perspectives.

Recent clinical trials have demonstrated the values of cardiac computed tomography (CT) in the initial evaluation of stable chest pain which led to drastic changes in the National Institute for Health and Care Excellence (NICE) guidelines in 2016. According to the updated NICE guidelines, cardiac CT should be performed as the initial cardiac testing in stable chest pain regardless of pre-test probability (PTP) of coronary artery disease (CAD). As a result, cardiac CT is now considered as a validated gatekeeper for assessing stable chest pain, which precedes all the functional studies including nuclear myocardial perfusion imaging (MPI). Nuclear MPI, in contrast, has been assigned as one of the second-line studies, which is inevitably dependent on the results of cardiac CT. However, nuclear MPI has genuine values in the diagnosis, treatment decision, and prognostic stratification of stable chest pain, which cannot be replaced by cardiac CT. In this review, the updated NICE guidelines and related cardiac CT trials will be critically reviewed from the view of nuclear physicians and the exceptional values of nuclear MPI will be described along with the future perspectives.
Cardiology ; Chest Pain ; Coronary Artery Disease ; Diagnosis ; Myocardial Perfusion Imaging ; Thorax

BACKGROUND AND PURPOSE: Although thrombolytic strategies with streptokinase(STK) and tissue-type plasminogen activator(t-PA) in the treatment of acute myocardial infarction(AMI) have been studied in large-scale clinical trials in the western countries, such large-scale studies with urokinase(UK) are scanty. Even though UK is most commonly used thrombolytic agent for the treatment of AMI in Korea, there is no consensus on the dosage and the way of administration of UK in patients with AMI. Accordingly, a prospective clinical study was performed to evaluate the effects of thrombolytic strategies of intravenous double bolus method and standard double-infusion method with different dosage of UK in the treatment of AMI. SUBJECTS AND METHODS: Ninety there patients with AMI(male 75, female 18, age 57.5+/-10.8 years) were studied. The patients were divided into 3 groups according to dosage of UK and method of administration. Group I : 19 patients who received 1.5 million U of UK IV bolus, followed by 1.5 million U IV infusion for an hour(High Dose Group). Group II : 34 patients received 20,000U/kg body weight of UK IV bolus, followed by 20,000U/kg IV infusion for an hour(Double Dose Group). Group III : 40 patients received 1.5 million U of UK IV bolus and followed by 20,000U/kg IV bolus in 30 minutes with total dose of no more than 3 million U(Double Bolus Group). Coronary angiography(CAG) and left ventriculography(LVG) were performed 90 minutes after the administration of UK and post-AMI 7-10 days to investigate the patency of infarct-related artery(IRA) and LV function. Patency of IRA was graded according to the extent of flow of IRA. TIMI grade 0-1 was regarded as occluded, and grade 2-3 flow as patent. LV ejection fraction(EF) by echocardiography was measured on day 1, day 7-10 and 1 month after AMI. Indirect clinical parameters of thrombolysis were evaluated and were compared with CAG findings. RESULTS: 1) The 90 minutes IRA patency in Group III(Double bolus ; 79.0%) was higher than that in Group 1, but showed no statistically significant difference(High dose ; 61.5%, p=0.790). The 90 minutes IRA patency in Group III showed borderline significance with Group II(Double dose ; 57.1%, p=0.057). TIMI flow III in Group III(60.6%) was significantly higher than that in Group II(53.6%, p=0.0468) but showed no statistically significant difference with Group I(61.5%, p=0.158). 2) The EF by LVG were 49.1% in Group I, 41.7% in Group II and 49.2% in Group III. The difference in EF between Group I and Group III vs Group II was significant(p=0.008 in Group I, p=0.014 in Group III vs Group II). 3) Fatal bleeding complications(1 intracranial hemorrhage and 1 gastric ulcer bleeding) developed in Group II (Double dose). 4) Pain to door time, pain to needle time and door to needle time tended to be shorter in open(TIMI flow II-III) IRA group than in closed IRA group. 5) Initial EF were similar between open IRA group and closed IRA group(46.1% and 42.1% ; p=NS). The EF of open IRA group measured by LVG on initail coronary angiography(41.8% in closed IRA vs 48.0%, in open IRA, p=0.03) and by 2D-Echo on 7-10 day(41.7% in closed IRA vs 51.0% in open IRA, p=0.004) were better than those of closed IRA group. 6) Indirect clinical indices of reperfusion such as mean CPK peak, time to CPK peak significantly lower in open IRA group than in closed IRA group. 7) Fatal bleeding complications(1 intacranial hemorrhage and 1 gastric ulcer bleeding) developed in closed IRA group. CONCLUSION: The findings we observed in this trial showed that earlier initiation and more rapid infusion of UK were associated with more increased 90min patency of infarct-related artery and more improved LV function without any obviously increased bleeding complications or other serious life-threatening complications than conventional UK therapy. Specifically, double bolus IV injection of UK(1.5 million U bolus followed by 20,000 U/Kg bolus in 30min)was more effective method of thrombolysis than conventional method for achieving optimal reperfusion in AMI patients. Also, IRA patency at 90 minutes after the initiation of thrombolysis was important in preserving global LV function in early recovery phase of AMI. Further trials may be needed to determine more effective thrombolysis with UK in AMI.
Arteries ; Body Weight ; Consensus ; Echocardiography ; Female ; Hemorrhage ; Humans ; Intracranial Hemorrhages ; Korea ; Myocardial Infarction* ; Needles ; Plasminogen ; Prospective Studies ; Reperfusion ; Stomach Ulcer ; Urokinase-Type Plasminogen Activator*

PURPOSE: Discharge against medical advice (DAMA) carries a risk of increased mortality and readmissions in the emergency department (ED). The aim of the current study was to examine characteristics of suicidal attempters with acute poisoning who were discharged against psychiatric medical advice and other clinical department admission as acute intervention. METHODS: We retrospectively selected a consecutive series of suicidal attempters with acute poisoning who were admitted to the emergency department between 2011 and 2012. Sex, age, admission time, psychiatric DAMA, impressions by the Psychiatrist-in-charge, and psychiatry follow-up after discharge were reviewed in the medical records. DAMA was defined as an unplanned discharge for which the psychiatrist-in-charge documented in the medical record that the patient or one's legally authorized representatives decided to refuse hospitalization against the psychiatrist's medical advice including closed ward admission. RESULTS: A total of 883 patients who had attempted suicide who visited the emergency department were included. Of these, 155 patients were suicidal attempters with acute poisoning for ED ward admission. Among these patients, the rate of psychiatric DAMA was 66.5% (n=103). Psychiatric impressions were 1) adjustment disorder 51.5% (n=53), 2) major depressive disorder 28.2% (29%). The rate of DAMA was higher in the adjustment disorder group than in the major depressive disorder group (82.8% vs 58.7%, p <0.001). The rate of follow-up after hospital discharge to the psychiatric outpatient department was 26.5% (n=27). CONCLUSION: Admission to the emergency department may improve psychiatric outpatient department referral in suicidal attempters with acute poisoning. In addition, customized plans according to psychiatric diagnosis will be considered for effective acute intervention and continuous psychiatric referral.
Adjustment Disorders ; Depressive Disorder, Major ; Emergencies* ; Emergency Service, Hospital* ; Follow-Up Studies ; Hospitalization ; Humans ; Medical Records ; Mental Disorders ; Mortality ; Outpatients ; Patient Discharge ; Poisoning* ; Referral and Consultation ; Retrospective Studies ; Suicide ; Suicide, Attempted ; Treatment Refusal