No abstract available.
Hyperlipidemias ; Skin Diseases

Background and Objectives: A mobile application (app)-based electrocardiogram (ECG) consultation system (InterMD Co., Ltd., Seoul, Korea) using the collective intelligence (CI) and the availability of large-scale digitized ECG data would extend the utility of ECGs beyond their current limitations, while at the same time preserving interpretability that remains critical to medical decision-making. Methods: We developed a new mobile app-based ECG consultation system by CI for general practitioners. We compared the responses of ECG reading between the mobile app-based CI system and the conventional system in a tertiary referring hospital. Results: We analyzed 376 consecutive ECGs between December 2017 and May 2019. Of these, 159 ECGs (42.3%) were interpreted by CI through the mobile app-based ECG consultation system and 217 ECGs (57.7%) were analyzed by cardiologists in the conventional systems based on electronic medical record data in a tertiary hospital. All ECG readings were confirmed by an electrophysiologist (EP). The time to an initial response by the CI system was faster than that of the conventional system (6.6 hours vs. 35.8 hours, p<0.0001). The number of responses of each ECG in CI system outnumbered those of the conventional system in the tertiary hospital (3.1 vs. 1.2, p<0.0001). The consensus of the ECG readings with EP was similar in both systems (98.6% vs. 100%, p=0.158). Conclusions The mobile app-based ECG consultation system by CI is as reliable method as the conventional referral system. It would expand the app of the 12-lead ECG with the collaboration of physicians in clinics and hospitals without time and space constraints.

Background and Objectives: A mobile application (app)-based electrocardiogram (ECG) consultation system (InterMD Co., Ltd., Seoul, Korea) using the collective intelligence (CI) and the availability of large-scale digitized ECG data would extend the utility of ECGs beyond their current limitations, while at the same time preserving interpretability that remains critical to medical decision-making. Methods: We developed a new mobile app-based ECG consultation system by CI for general practitioners. We compared the responses of ECG reading between the mobile app-based CI system and the conventional system in a tertiary referring hospital. Results: We analyzed 376 consecutive ECGs between December 2017 and May 2019. Of these, 159 ECGs (42.3%) were interpreted by CI through the mobile app-based ECG consultation system and 217 ECGs (57.7%) were analyzed by cardiologists in the conventional systems based on electronic medical record data in a tertiary hospital. All ECG readings were confirmed by an electrophysiologist (EP). The time to an initial response by the CI system was faster than that of the conventional system (6.6 hours vs. 35.8 hours, p<0.0001). The number of responses of each ECG in CI system outnumbered those of the conventional system in the tertiary hospital (3.1 vs. 1.2, p<0.0001). The consensus of the ECG readings with EP was similar in both systems (98.6% vs. 100%, p=0.158). Conclusions The mobile app-based ECG consultation system by CI is as reliable method as the conventional referral system. It would expand the app of the 12-lead ECG with the collaboration of physicians in clinics and hospitals without time and space constraints.

Pigmented Spitz nevus is a benign melanocytic skin lesion with distinct clinical features and it is frequently found on the extremities. However, it rarely occurs on acral area of the body, and such a case has not yet been fully documented. We present a case of acral pigmented Spitz nevus occurring on the foot, and this mimicked acral lentiginous malignant melanoma. Clinicians should be well aware of this entity and its possible clinical presentations. Since acral pigmented Spitz nevus is benign in nature, making the correct diagnosis is important to avoid unnecessary mutilating or excessive surgery.
Extremities ; Foot ; Melanoma ; Nevus, Epithelioid and Spindle Cell ; Skin

Central serous chorioretinopathy (CSCR) is an idiopathic disorder characterized by serous detachment of the macula and retinal pigment epithelial (RPE) detachment. Its etiology and pathophysiology are still unknown. However, CSCR can arise secondary to chronic treatment with steroids. We present two cases in which CSCR developed in patients on oral steroid therapy and resolved after treatment was stopped. We also offer a review of the literature.
Central Serous Chorioretinopathy ; Glomerulonephritis ; Humans ; Retinaldehyde ; Steroids

Necrobiotic xanthogranuloma (NXG), is a rare multisystem disease that manifests as cutaneous inflammatory lesions, and is commonly associated with lymphoproliferative disease. Diffuse normolipemic plane xanthoma (NX), is also a rare, acquired disease that is often associated with systemic diseases such as lymphoproliferative disease. Both of these diseases have been reported to be associated with monoclonal gammopathy (MG). However, there are few cases in which these diseases co-exist. A 78-year-old female, who had a known case of NX on the neck and axillary area, presented with an asymptomatic erythematous plaque on her left supraclavicular area. Histopathological examination showed lymphoid aggregates, necrobiotic areas, and granulomatous inflammation in the dermis. Numerous foreignbody and Touton type giant cells were noticed. Serum protein immunoelectrophoresis showed an IgG kappa type MG. Lipid profile of the patient was normal. Bone marrow examination showed plasma cell myeloma. Based on these histologic and laboratory results, we diagnosed this lesion as NXG coexisting with NX and multiple myeloma. She was started on treatment with bortezomib and melphalan for multiple myeloma, and high-dose systemic corticosteroid and triamcinolone intralesional injection for the skin lesion. After 3 months of treatment, the NXG skin lesion and MG improved.

Typically, sporotrichosis follows an environmental transmission route via traumatic inoculation of contaminated plant or soil matter. Although familial occurrences of sporotrichosis are rare, human-to-human transmission is even rarer. Herein, we report two cases, a father and son, with sporotrichosis caused by Sporothrix (S.) globosa. A 33-year-old male who otherwise appeared healthy presented with a tender, erythematous, ulcerative crusted plaque on the left ala nasi and upper lip. A skin biopsy and mycological study revealed fixed cutaneous sporotrichosis. The patient irregularly received oral itraconazole with a relapsing course. Approximately a year later, his 3-year-old son developed a single plaque on the left leg. When the father carried his son on his shoulder, there was direct contact between the two lesions. Fungal culture results from the father and son's lesions confirmed S. globosa with ribosomal DNA ITS sequencing. In both patients, oral terbinafine exhibited better results than oral itraconazole. These cases are an excellent example of human-to-human transmission of sporotrichosis.