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

No abstract available.
Risk Factors*

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.

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*

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

Hypertrophic lupus erythematosus is a clinical variant of chronic cutaneous lupus erythematosus (CCLE). It is critical to differentiate hypertrophic lupus erythematosus from CCLE because of treatment and prognosis. We report a case of hypertrophic lupus erythematosus with CCLE occured on arms. Combination therapy with acitretin and intralesional corticosteroid injection resulted in control of previously refractory skin lesion.
Acitretin ; Arm ; Lupus Erythematosus, Cutaneous ; Prognosis ; Skin

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

No abstract available.
Female ; Fibromatosis, Aggressive ; Mammaplasty ; Silicones

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