BACKGROUND AND OBJECTIVES: Implantation of cardiac implantable electronic devices (CIED), including permanent pacemakers (PM), implantable cardioverter-defibrillators (ICD), and cardiac resynchronization therapy (CRT) devices, has increased significantly over the past several years. However, limited data exists regarding temporal trends of CIED implantations in Asian population. This study aimed to investigate temporal trends of CIED treatment in Korea. METHODS: Using the National Health Insurance Service database of the entire Korean adult population, temporal trends of CIED procedures between 2009 and 2016 were evaluated. Additionally, temporal changes in the prevalence of patients' comorbidities were evaluated. RESULTS: A total of 35,421 CIED procedures (new implantations: 27,771, replacements: 7,650) were performed during the study period. The mean age of new CIED recipients and the prevalence of comorbidities, including hypertension, diabetes mellitus, heart failure, stroke, and atrial fibrillation, increased substantially with time. Compared to 2009, the number of new implantations of PM, ICD, and CRT devices increased by 2.0 (1,977 to 3,910), 3.6 (230 to 822), and 4.9 (44 to 217) times in 2016, respectively. The annual new implantation rate of CIED also increased accordingly (5.1 to 9.3 for PM, 0.6 to 1.9 for ICD, and 0.1 to 0.5 for CRT devices, per 100,000 persons). CONCLUSIONS: The number of CIED implantation increased substantially from 2009 to 2016 in Korea. Also, the patients with CIED have been changed to be older and have more comorbidities. Therefore, the burden of health care cost in patients with CIED would be expected to increase in the future.
Adult ; Asian Continental Ancestry Group ; Atrial Fibrillation ; Cardiac Resynchronization Therapy ; Comorbidity ; Defibrillators, Implantable ; Diabetes Mellitus ; Epidemiology ; Health Care Costs ; Heart Failure ; Humans ; Hypertension ; Korea ; National Health Programs ; Pacemaker, Artificial ; Prevalence ; Stroke

BACKGROUND AND OBJECTIVES: Implantation of cardiac implantable electronic devices (CIED), including permanent pacemakers (PM), implantable cardioverter-defibrillators (ICD), and cardiac resynchronization therapy (CRT) devices, has increased significantly over the past several years. However, limited data exists regarding temporal trends of CIED implantations in Asian population. This study aimed to investigate temporal trends of CIED treatment in Korea. METHODS: Using the National Health Insurance Service database of the entire Korean adult population, temporal trends of CIED procedures between 2009 and 2016 were evaluated. Additionally, temporal changes in the prevalence of patients' comorbidities were evaluated. RESULTS: A total of 35,421 CIED procedures (new implantations: 27,771, replacements: 7,650) were performed during the study period. The mean age of new CIED recipients and the prevalence of comorbidities, including hypertension, diabetes mellitus, heart failure, stroke, and atrial fibrillation, increased substantially with time. Compared to 2009, the number of new implantations of PM, ICD, and CRT devices increased by 2.0 (1,977 to 3,910), 3.6 (230 to 822), and 4.9 (44 to 217) times in 2016, respectively. The annual new implantation rate of CIED also increased accordingly (5.1 to 9.3 for PM, 0.6 to 1.9 for ICD, and 0.1 to 0.5 for CRT devices, per 100,000 persons). CONCLUSIONS The number of CIED implantation increased substantially from 2009 to 2016 in Korea. Also, the patients with CIED have been changed to be older and have more comorbidities. Therefore, the burden of health care cost in patients with CIED would be expected to increase in the future.

Unilateral nevoid telangiectasia is characterized by unilateral occurrence of telangiectases assigned to certain dermatomes. Histologically, numerous thin-walled dilated vessels are seen in the upper and mid dermis without endothelial cell proliferation. Although it may be congenital or aquired, only acquired forms have been frequently reported in association with physiologic states of estrogen increase or estrogenized pathologic states, such as chronic hepatic disease in alcoholism. We report a case of congenital unilateral nevoid telangiectasia with extensive involvement of C4-T2, L1-S3 dermatomes in a 3-year-old girl.
Alcoholism ; Dermis ; Endothelial Cells ; Estrogens ; Preschool Child ; Telangiectasis

Congenital earlobe deformity and the presence of the cleft at a site of the earlobe seems to be rare. It is important to well-formed, symmetrically positioned ears as a sign of esthetically pleasing, harmonious facial features. So the patients with cleft earlobe require operative repairs. The surgical techniques for congenital earlobe clefts employed vary from simple closure, Z-plasty, L-plasty, two flap method, triangular flap method, and so on. Among them, Passow-Claus described the classic L-plasty method. We designed the modified method that the L-flap direction faced laterally opposed to that of classic L-plasty and propose to term this method `reverse L-plasty`. Kitayama classified the congenital earlobe cleft into four groups according to the shape of cleft, as longitudinal, transverse, triplelobe or mixed, and defective type. We experienced four cases of congenital earlobe cleft. One patient was a defective type and the others were triplelobe types. There`s no complication in patients. We could obtain the advantages of smooth contour of free border, lack of groove or notching due to scar contracture, and possible in moderate defective type without additional method after long term follow-up. This technique breaks the vertical component of scar contracture, resulting in a smooth lobular border. So we believe that this reverse L-plasty technique offers a better cosmetic result in the repair of the cleft earlobe.
Cicatrix ; Congenital Abnormalities ; Contracture ; Ear ; Follow-Up Studies ; Humans

PURPOSE: Granulocyte-colony stimulating factor(G-CSF) and granulocyte macrophage-colony stimulating factor(GM-CSF) are principal cytokines in granulopoiesis and their physiologic effects are mediated through binding to specific cell surface receptors. Although it is known that the level of serum G-CSF and GM-CSF, and presentation of the receptors are increased in infectious diseases, there have been no studies to find the correlation between the granulopoiesis and leukocytosis. This study was designed to measure G-CSF and GM-CSF in leukocytosis and in control and to demonstrate the possible pathogenesis of granulopoiesis in leukocytosis using quantitative analysis of G- CSF, GM-CSF and their CSFr. METHODS: The plasma levels of G-CSF, GM-CSF of 13 children without leukocytosis and 14 children with leukocytosis were measured. Counts of cell surface G-CSFr and GM-CSFr were measured by combining anti G-CSFr and anti GM-CSFr monoclonal antibodies to their respective receptors by using quantitative flow cytometric assay. RESULTS: There was no significant difference betweeen the plasma concentration of G-CSF and GM-CSF in acute leukocytosis and in the control group. However, levels of G-CSFr in acute leukocytosis decreased significantly compared to the control(P=0.012) and the levels of GM-CSFr in both groups revealed no significant difference. CONCLUSION: Increase in the number of leukocyte in leukocytosis was mediated by increasing the number of neutrophil, and increased plasma concentration of G-CSF may be the cause of neutrophilia. But GM-CSF did not have any influence on leukocytosis.
Antibodies, Monoclonal ; Child* ; Communicable Diseases ; Cytokines ; Granulocyte Colony-Stimulating Factor* ; Granulocyte-Macrophage Colony-Stimulating Factor* ; Granulocytes* ; Humans ; Leukocytes ; Leukocytosis* ; Neutrophils ; Plasma* ; Receptors, Cell Surface ; Receptors, Granulocyte Colony-Stimulating Factor ; Receptors, Granulocyte-Macrophage Colony-Stimulating Factor

Primary cutaneous anaplastic large cell lymphoma (ALCL) is composed of large cells with anaplastic, pleomorphic cytomorphology and the expression of the CD30 antigen by the majority (more than 75%) of tumor cells. Recently some variants of ALCL with extensive inflammatory cell infiltration have been reported. A 34-year-old male presented with multiple tumors over the arm, groin, and legs. The tumors of the right groin showed ulceration and purulent discharge. The biopsy specimens revealed extensive infiltrate of large atypical lymphoid cells with mixed inflammatory cells consisting of numerous eosinophils and neutrophils. Immunohistochemical staining was positive for CD3, CD4, and CD30. TCR-gamma gene rearrangement was detected. There was no evidence of extracutaneous involvement. We report a case of primary cutaneous ALCL, associated with marked inflammatory cell infiltration. Diagnosis in such cases is challenging because the large atypical lymphoid cells may be easily obscured by the massive infiltrate of eosinophils and neutrophils.
Adult ; Antigens, CD30 ; Arm ; Biopsy ; Eosinophils ; Gene Rearrangement ; Groin ; Humans ; Leg ; Lymphocytes ; Lymphoma, Primary Cutaneous Anaplastic Large Cell ; Male ; Neutrophils ; Ulcer

Plexiform neurofibromas are among the most pathognomonic features of neurofibromatosis type 1 (NF1). Although characteristically benign, plexiform neurofibroma can cause pain, disfigurement and functional changes, and more importantly, it may turn malignant. We present here the case of a 3-year-old boy with progressive hemifacial hypertrophy that was colocalized with light brown-colored macules. The biopsy specimen showed that the bundles of nerve fibers were arranged in a concentric manner with myxoid changes. On the evaluation of the pigmented lesion, only the basal melanin pigments were increased in the epidermis without any melanin-laden pigmented cells in the dermis. We have demonstrated that neurofbroma needs to be considered in the differential diagnosis of hemifacial hypertrophy since this is likely to have implications for the further management of these patients. The absence of other findings does not exclude NF1 as the underlying disease since many NF1 patients have not yet developed cafe-au-lait macules or freckles in early childhood.
Biopsy ; Dermis ; Diagnosis, Differential ; Epidermis ; Humans ; Hypertrophy ; Light ; Melanins ; Melanosis ; Nerve Fibers ; Neurofibroma, Plexiform ; Neurofibromatosis 1 ; Preschool Child

Pheochromocytoma is a catecholamine-producing tumor characterized by hypertension, headache, tachycardia, excessive diaphoresis, and angina pectoris. The thunderclap headache is so named because the pain strikes suddenly and severely. Although the symptoms of bladder pheochromocytoma are rather evident, the diagnosis of this rare neuroendocrine tumor can be missed. This study reports the case of a woman diagnosed with bladder pheochromocytoma who experienced thunderclap headache triggered by urination and angina pectoris as an initial manifestation. This case study suggests that thunderclap headache and angina pectoris occurring concurrently with sudden blood pressure elevation during or immediately after urination are important diagnostic clues of bladder pheochromocytoma.
Angina Pectoris* ; Blood Pressure ; Diagnosis ; Female ; Headache ; Headache Disorders, Primary* ; Humans ; Hypertension ; Neuroendocrine Tumors ; Pheochromocytoma* ; Strikes, Employee ; Tachycardia ; Urinary Bladder* ; Urination*

Frontal fibrosing alopecia is considered to be a clinical variant of lichen planopilaris. This condition is characterized by progressive frontal hairline recession associated with scarring. Frontal fibrosing alopecia has become an increasingly recognized distinct clinical entity in recent years. We report a typical case of frontal fibrosing alopecia and review the pertinent literature.
Alopecia* ; Cicatrix ; Lichens

PURPOSE: To evaluate the usefulness of quantitative analysis of the facial nerve using contrast-enhanced three-dimensional (CE 3D) fluid-attenuated inversion recovery-volume isotopic turbo spin echo acquisition (FLAIR-VISTA) for the diagnosis of Bell's palsy in pediatric patients. MATERIALS AND METHODS: Twelve patients (24 nerves) with unilateral acute facial nerve palsy underwent MRI from March 2014 through March 2015. The unaffected sides were included as a control group. First, for quantitative analysis, the signal intensity (SI) and relative SI (RSI) for canalicular, labyrinthine, geniculate ganglion, tympanic, and mastoid segments of the facial nerve on CE 3D FLAIR images were measured using regions of interest (ROI). Second, CE 3D FLAIR and CE T1-SE images were analyzed to compare their diagnostic performance by visual assessment (VA). The sensitivity, specificity, and accuracy of RSI measurement and VA were compared. RESULTS: The absolute SI of canalicular and mastoid segments and the sum of the five mean SI (total SI) were higher in the palsy group than in the control group, but with no significant differences. The RSI of the canalicular segment and the total SI were significantly correlated with the symptomatic side (P = 0.028 and 0.015). In 11/12 (91.6%) patients, the RSI of total SI resulted in accurate detection of the affected side. The sensitivity, specificity, and accuracy for detecting Bell's palsy were higher with RSI measurement than with VA of CE 3D FLAIR images, while those with VA of CE T1-SE images were higher than those with VA of CE 3D FLAIR images. CONCLUSION: Quantitative analysis of the facial nerve using CE 3D FLAIR imaging can be useful for increasing the diagnostic performance in children with Bell's palsy when difficult to diagnose using VA alone. With regard to VA, the diagnostic performance of CE T1-SE imaging is superior to that of CE 3D FLAIR imaging in children. Further studies including larger populations are necessary.
Bell Palsy* ; Child ; Diagnosis ; Facial Nerve* ; Geniculate Ganglion ; Humans ; Magnetic Resonance Imaging ; Mastoid ; Paralysis ; Sensitivity and Specificity