No abstract available.
Risk Factors*

A 68-year-old male patient visited our clinic complaining of a single skin lesion on the left shoulder for 5 months. The lesion was a bluish to pigmented, bean-sized nodule. No subjective symptoms and signs accompanied it. Histologically, the tumor mass was composed tumor emboli in the vessels and moderately differentiated neoplastic glands lined by anaplastic cells. These findings were consistent with the metastatic adenocarcinoma. Abdominal sonography and CT scanning showed a mass at the tail of the pancreas. Therefore, we diagnosed this skin lesion as a metastatic adenocarcinoma originating from the pancreatic tail. We report herein a rare case of skin metastasis from pancreatic tail cancer, in which the cutaneous involvement was the first sign of the internal malignancy.
Adenocarcinoma ; Aged ; Humans ; Male ; Neoplasm Metastasis* ; Pancreas ; Pancreatic Neoplasms ; Shoulder ; Skin* ; Tail* ; Tomography, X-Ray Computed

BACKGROUND: We have already shown that a new vitamin D3 analogue, calcipotriol is a potent growth inhibitor for human keratinocytes, indicating the close relationship between the in vitro inhibitory effect of calciipotriol and its therapeutic effectiveness or psoriasis. OBJECTIVE: Our purpose was to evaluste the clinical efficscy, safety and tolerability of calcipotriol (50ug/g) ointment twice daily in the treatment of psoriasis. MEHTODS: We treated 31 patients with calcipotriol for 6 weeks. Patients were provided with a maximum of 100g of ointment per week. Efficacy, as measured by the Psoriasis Area and Severity Index(PASI), and safety were assessed at 2,4, and 6 weeks. RESULTS: Reduction of PASI was stastistically significant at all time points for treatments (p<0.01). At the completian of 6 weeks of treatment, the mean PASI reduction was 3.61. An analysis of patient overall self-assessment, at 6 weeks showed clearance or marked improvement in 61%. Some patients developed minimal irriltation of lesional or perilesional skin(6.5%). Laboratory tests did not show any significant changes, in particular there was no change in serum calcium levels. CONCLUSIONS: Calcipotriol ointment was effective as measured by the PASI and the self-assessment in patients with psoriaeis. This treatrnent was well tolerated.
Calcium ; Cholecalciferol ; Humans ; Keratinocytes ; Psoriasis* ; Self-Assessment

Purpose: A high anion gap (AG) is known to be a significant risk factor for serious acid-base imbalances and death in acute poisoning cases. The strong ion difference (SID), or strong ion gap (SIG), has recently been used to predict in-hospital mortality or acute kidney injury (AKI) in patients with systemic inflammatory response syndrome. This study presents a comprehensive acidbase analysis in order to identify the predictive value of the SIG for disease severity in severe poisoning. Methods: A cross-sectional observational study was conducted on acute poisoning patients treated in the emergency intensive care unit (ICU) between December 2015 and November 2020. Initial serum electrolytes, base deficit (BD), AG, SIG, and laboratory parameters were concurrently measured upon hospital arrival and were subsequently used along with Stewart’s approach to acid-base analysis to predict AKI development and in-hospital death. The area under the receiver operating characteristic curve (AUC) and logistic regression analysis were used as statistical tests. Results: Overall, 343 patients who were treated in the intensive care unit were enrolled. The initial levels of lactate, AG, and BD were significantly higher in the AKI group (n=62). Both effective SID [SIDe] (20.3 vs. 26.4 mEq/L, p<0.001) and SIG (20.2 vs. 16.5 mEq/L, p<0.001) were significantly higher in the AKI group; however, the AUC of serum SIDe was 0.842 (95% confidence interval [CI]=0.799-0.879). Serum SIDe had a higher predictive capacity for AKI than initial creatinine (AUC=0.796, 95% CI=0.749-0.837), BD (AUC=0.761, 95% CI=0.712-0.805), and AG (AUC=0.660, 95% CI=0.607-0.711). Multivariate logistic regression analyses revealed that diabetes, lactic acidosis, high SIG, and low SIDe were significant risk factors for in-hospital mortality. Conclusion Initial SIDe and SIG were identified as useful predictors of AKI and in-hospital mortality in intoxicated patients who were critically ill. Further research is necessary to evaluate the physiological nature of the toxicant or unmeasured anions in such patients.

BACKGROUND: Recent studies have demonstrated the benefits of off-pump coronary bypass grafting over the on-pump technique in patients with chronic kidney disease (CKD). To further reduce the risk of acute kidney injury and the need for renal replacement therapy, even in patients undergoing off-pump coronary artery bypass grafting, we adopted protocol-based perioperative management for patients with CKD. METHODS: From December 2012 to March 2015, 265 patients underwent isolated off-pump coronary artery bypass grafting. To analyze renal function in a stable condition, we excluded 12 dialysis-dependent end stage renal failure and 10 emergency or urgent cases. Among the remaining 243 patients, 208 patients had normal kidney function (normal group), and 35 patients had CKD (CKD group). Minimizing contrast exposure, ensuring adequate hydration, using strict drug dosage adjustment, and optimizing hemodynamic status were key elements of the protocol for the CKD group. RESULTS: The risk of acute kidney injury was about ×3 higher in the CKD group than in the normal group (p=0.01). Estimated glomerular filtration rates and serum creatinine levels deteriorated until the third postoperative day in the CKD group. However, by adopting protocol-based perioperative management, this transient renal dysfunction recovered to preoperative levels by the fifth postoperative day without requiring renal replacement therapy in all cases. CONCLUSION: Off-pump coronary bypass surgery combined with this protocol-based perioperative management strategy in patients with non-dialysis-dependent CKD could mostly be performed without renal replacement therapy.
Acute Kidney Injury ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump* ; Creatinine ; Emergencies ; Glomerular Filtration Rate ; Hemodynamics ; Humans ; Kidney ; Perioperative Care ; Renal Insufficiency ; Renal Insufficiency, Chronic* ; Renal Replacement Therapy ; Transplants*

Hypertriglyceridemia is a rare cause of acute pancreatitis. However, the relationship between gestational pancreatitis and hypertriglyceridemia is well known. We report here on a case of gestational pancreatitis due to hypertriglyceridemia in a 29 years old pregnant woman who was at 20 weeks gestation and suffered from epigastric pain and rebound tenderness. Lowering the elevated triglyceride level via heparin and insulin infusion therapy wasn't effective and the abdominal pain was unresponsive to analgesics. Plasma exchange was performed at day 3 in order to rapidly decrease the triglyceride and for the safety of the patient and her fetus. We report here that hypertriglyceridemia induced high risk gestational pancreatitis and this was treated by plasma exchange, and we briefly review the relevant literature.
Abdominal Pain ; Analgesics ; Female ; Fetus ; Heparin ; Humans ; Hypertriglyceridemia ; Insulin ; Pancreatitis ; Plasma ; Plasma Exchange ; Pregnancy ; Pregnant Women

Loeys-Dietz syndrome (LDS) is an autosomal dominant connective tissue disorder that is characterized by aggressive arterial and aortic disease, often involving the formation of aortic aneurysms. We describe the cases of two children with LDS who were diagnosed with aortic root aneurysms and successfully treated by valve-sparing aortic root replacement (VSRR) with a Valsalva graft. VSRR is a safe and suitable operation for children that avoids prosthetic valve replacement.
Aneurysm ; Aorta ; Aortic Aneurysm ; Aortic Diseases ; Child* ; Connective Tissue ; Humans ; Loeys-Dietz Syndrome* ; Transplants

BACKGROUND: At present, there are many instruments to diagnose anxiety and depression. However, most of the instruments have a number of questions. Therefore, we have many difficulties in applying them to the primary care. The purpose of this study was to measure the reliability and the validity of a Korean-translated Goldberg s short screening scale for anxiety and depression, which were developed for screening of anxiety and depression in primary care. METHODS: 178 asymtomatic subjects and 58 patients(anxiety 15, depression 43) aged from 18 to 64 years old were selected. The patients were diagnosed by psychiatrist according to DSM-IV criteria. This study was performed for 3 months, from May to August 1996. The reliability of this instrument was measured by internal consistency reliability. The validity of this instrument was measured by three methods. The first method was the comparison of the score between the patients and the control group. The second method was to measure the relationships of this instrument with the other instruments such as Self-rating Depression Scale and State-Trait Anxiety Inventory. The last method was to measure the relationship of this instrument with Comprehensive Global Assessment. In addition, we calculated the sensituvity and specificity at the cut off values. RESULTS: The Cronbach's a value was 0.736 for the anxiety and 0.749 for the depression. Goldberg anxiety scale was significantly associated with state in STAI(r=0.279, P<0.001), and trait in STAI(r=0.125, P=0.041). However, Goldberg depression scale was not sigficantly associated with SDS. Goldberg anxiety scale as well as Goldberg depression scale were significantly associated with CGA(r=0.433, P=0.001; r=0.695, P=0.001). The seore of Goldberg anxiety scale was significantly higher in the anxious patients than in the control group(P=0.047). The score of Goldberg depression scale was significantly higher in the depressive patients than in the control group(P<0.001). For anxiety scale of Goldberg scale, the sensitivity and the specificity was 60% and 68% at score 3. For depression scale of Goldberg scale, the sensitivity and the specificity was 80% and 68% at score 2. CONCLUSIONS: We concluded that the value of Cronbach's a in Goldberg scale was 0.736 for anxiety and 0.749 for depression. For the validity, the scores of Goldberg scale were higher in patient group than in asymptomatic group. However, the relationships of Goldberg scale with other screening instruments were variable. So further study for the validity of Goldberg scale is requested.
Anxiety* ; Depression* ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Mass Screening* ; Middle Aged ; Primary Health Care ; Psychiatry ; Sensitivity and Specificity

A case of mucinous cystadenocarcinoma arising from a mature cystic teratoma in the right ovary of a 37-year-old woman is reported. Malignant transformation of a mature teratoma is a rare event and the commonest malignant neoplasm to develop is squamous cell carcinoma.(83%) Adenocarcinoma occurs with less frequency.(6.8%) The patient was treated by staging operation followed by adjuvant chemotherapy. After six courses of combination chemotherapy, oncological investigations, including chest X-ray, abdominopelvic CT scan and tumor markers, all revealed no evidence of recurrence.
Adenocarcinoma ; Adult ; Chemotherapy, Adjuvant ; Cystadenocarcinoma, Mucinous* ; Drug Therapy, Combination ; Female ; Humans ; Mucins* ; Ovary* ; Recurrence ; Teratoma* ; Thorax ; Tomography, X-Ray Computed ; Biomarkers, Tumor

Keratoacanthoma is a rapidly growing cutaneous tumor with a histopathologic pattern often suggestive of a squamous cell carcinoma (SCC). It may be viewed as an aborted malignancy which only rarely progresses into an aggressive SCC. It is most likely arising from hair follicle that has the tendency of spontaneous resolution. The diagnosis of keratoacanthoma is based on clinical, histopathologic features and biologic behavior. A 75-year-old woman presented with a 1-month history of a rapidly enlarging exophytic tumor on the lower lip. A biopsy was performed leading to a diagnosis of keratoacanthoma. We report a case of keratoacanthoma on the lower lip, because the mucosal area is an unexpected location.
Aged ; Biopsy ; Carcinoma, Squamous Cell ; Diagnosis ; Female ; Hair Follicle ; Humans ; Keratoacanthoma* ; Lip*