No abstract available.
Dermatitis*

Tuberous sclerosis complex (TSC) is a neurocutaneous disorder with variable manifestations. The diagnosis is based on clinical criteria, and is divided into definite, probable, and possible TSC. If patients present with mild symptoms, clinicians may hesitate to perform further evaluations because of the high economic burden. A 16-year-old male presented with multiple skin-colored papules on the lower back and buttock. The histopathologic findings were compatible with connective tissue nevi (CTN). No other findings were observed with the exception of one hypomelanotic macule on the left shin. As the patient's parents wished to confirm the diagnosis, genetic testing was performed, and a TSC1 gene mutation was detected. With this genetic result, further evaluations were performed without hesitation. Genetic testing is a sensitive and specific modality for the diagnosis of TSC. We report a case of TSC presenting with CTN only, in which genetic testing was very useful to confirm the diagnosis and to determine the appropriateness of further high-cost studies.
Adolescent ; Buttocks ; Connective Tissue* ; Diagnosis ; Genetic Testing* ; Humans ; Male ; Neurocutaneous Syndromes ; Nevus* ; Parents ; Tuberous Sclerosis*

PURPOSE: The aim of our study was to investigate gender differences in factors related to prehospital delay and identify whether the knowledge of acute myocardial infarction symptoms affects this delay in Korean patients with ST-elevation myocardial infarction (STEMI). MATERIALS AND METHODS: A total of 350 patients (286 men, 64 women) with confirmed STEMI were interviewed to investigate socio-demographics, history of disease, symptom onset time, and factors that contributed to delayed decision time in seeking treatment and hospital arrival time from symptom onset. Factors associated with prehospital delay were examined separately by gender using univariate and multivariate analyses. RESULTS: Female patients had higher proportions of ≥60-minute decision time and ≥120-minute arrival time compared to male patients (33.9% vs. 23.1%, 60.9% vs. 52.1%, respectively). However, the difference was not statistically significant (p=0.093 and 0.214, respectively). Previous cardiovascular disease (CVD) was associated with increased decision time in men, whereas, in women, lower educational status caused a greater delay in decision time. Factors associated with hospital arrival time excluding delayed decision time were referral from another hospital, previous CVD, and percutaneous coronary intervention in men, and referral from another hospital in women. CONCLUSION: Gender differences exist in factors related to prehospital delay. Therefore, public education to reduce prehospital delay should be conducted according to gender with a focus on the pertinent factors.
Acute Coronary Syndrome ; Cardiovascular Diseases ; Education ; Educational Status ; Female ; Humans ; Male ; Multivariate Analysis ; Myocardial Infarction* ; Percutaneous Coronary Intervention ; Referral and Consultation ; Sex Characteristics ; Time Out, Healthcare

Ischemic stroke caused by spontaneous thrombosis of posterior inferior cerebellar artery (PICA) aneurysm has been rarely reported. A 52-year-old man presented with sudden headache, dizziness, and gait disturbance. Diffusion-weighted MRI showed acute infarction in left PICA territory. A saccular aneurysm with internal thrombus at the distal PICA was detected by CT angiography and conventional angiography. The thrombus resolved spontaneously at 2 months after stroke onset with aspirin medication. At that time, endovascular coiling was underwent successfully to prevent aneurysmal rupture.
Aneurysm* ; Angiography ; Arteries* ; Aspirin ; Cerebral Infarction ; Dizziness ; Gait ; Headache ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Middle Aged ; Pica ; Rupture ; Stroke ; Thrombosis*

The concept of mosaicism has been used to explain different cutaneous patterns, such as the lines of Blaschko, the checkerboard pattern, the phylloid pattern, and a patchy pattern. Many mosaic patterns are caused by loss of heterozygosity, the genetic mechanism by which a heterozygous somatic cell becomes either homozygous or hemizygous. A particular form of loss of heterozygosity is twin spotting, which give rise to two contrary homozygous daughter cells. The concept of twin spotting has been used for some of these human phenotypes, which are characterized by the co-occurrence of two different nevi, including nevus vascularis mixtus. Nevus vascularis mixtus is a rare vascular malformation characterized by the coexistence of a nevus anemicus and a nevus telangiectaticus, and can be associated with extra-cutaneous anomalies, such as cerebral malformations. Herein, we report a 6-year-old girl with paired cutaneous vascular nevi telangiectaticus, anemicus, and nevus vascularis mixtus, that were distributed on the left side of her chest and left arm, without other systemic and neurologic anomalies.
Arm ; Child ; Female ; Humans ; Loss of Heterozygosity ; Metrorrhagia ; Mosaicism ; Nevus* ; Nuclear Family ; Phenotype ; Thorax ; Twins ; Vascular Malformations

Notalgia paresthetica (NP) is a chronic localized itch, affecting mainly the inter-scapular area particularly between the T2-T6 dermatomes. Occasionally it has a more widespread distribution and involves the shoulders, back, and upper chest. There are no specific cutaneous signs, apart from those attributed to scratching and rubbing. Various etiologies have been reported, but the cause of NP is not established. The current hypothesis regarding its etiology postulates that a neuropathic itch develops due to nerve entrapment of the posterior rami of spinal nerve arising at T2-T6. Another recent documented case showed an increase in the number of intradermal nerves by neural immunochistochemistry staining of S-100 protein, protein gene product 9.5 (PGP 9.5). Herein, we experienced an uncommon case of NP of the back and tried to clarify pathogenesis by using quantitative sensory testing, such as neurometer and Von-Frey filaments. Also, we performed neural immunochemistry to confirm an increase in nerve fibers at the site of the lesion.
Immunochemistry ; Nerve Compression Syndromes ; Nerve Fibers ; Pregabalin* ; S100 Proteins ; Shoulder ; Spinal Nerves ; Thorax

Mycoplasma pneumoniae (M. pneumoniae) is one of the most common causes of respiratory tract infections in pediatric and adult populations worldwide. M. pneumoniae is also associated with extrapulmonary complications, such as mucocutaneous eruptions. In dermatologic disorders, M. pneumoniae infection is known to be associated with erythema multiforme and Stevens-Johnson syndrome in children and young adults. Recently, several cases with M. pneumoniae-associated mucositis, which lacks typical target lesions, have been reported. The term Mycoplasma-induced rash and mucositis was suggested as a revised version of the term, Mycoplasma pneumoniae-associated mucocutaneous disease, which previously included erythema multiforme and Stevens-Johnsons syndrome. This revision helps to distinguish Mycoplasma-induced rash and mucositis, which has a distinct morphology, mild disease course, and potentially important clinical implications regarding treatment. Herein, we report a patient with Mycoplasma-induced rash and mucositis.
Adult ; Child ; Erythema Multiforme ; Exanthema* ; Humans ; Mucositis* ; Mycoplasma pneumoniae ; Mycoplasma* ; Pneumonia ; Pneumonia, Mycoplasma ; Respiratory Tract Infections ; Stevens-Johnson Syndrome ; Young Adult

Palonosetron is a 5-hydroxytryptamine-3 (5-HT-3) receptor antagonist used for preventing postoperative nausea and vomiting. Compared with ondansetron and granisetron, it is a better drug because of prolonged action and minimal side effects. Some adverse effects of palonosetron have been reported. In this report, we describe a 37-year-old male who developed severe hypersensitivity reactions to palonosetron during surgery for kidney donation. His medical history was unremarkable, except for inguinal hernia with herniorrhaphy 8 years ago. The surgery was uneventful until 2 hours 20 minutes. After palonosetron injection, his blood pressure dropped to 80/50 mm Hg, and facial edema, rash, conjunctival swelling, and wheezing developed. The patient was resuscitated by administration of ephedrine, hydrocortisone, and peniramine. Following the surgery, the patient was monitored for 3 days, and there were no subsequent anaphylactic reactions or other complications. The skin test on postoperative day 54 was positive for hypersensitivity to palonosetron. Although palonosetron is known for its safety, other hypersensitivity events have been reported. Ondansetron is another widely used 5-HT-3 antagonist, which has been reported to cause anaphylaxis. Therefore, clinicians should be aware of the possibility of patients experiencing severe adverse reactions to palonosetron.
Adult ; Anaphylaxis* ; Anesthesia, General* ; Blood Pressure ; Drug Hypersensitivity ; Edema ; Ephedrine ; Exanthema ; Granisetron ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Hydrocortisone ; Hypersensitivity ; Kidney ; Male ; Ondansetron ; Postoperative Nausea and Vomiting ; Respiratory Sounds ; Skin Tests

Many kinds of degenerative, psychiatric, and cerebrovascular diseases can mimic behavioral variant frontotemporal dementia. We present a 73-year-old woman who presented with apathy, inappropriate social behavior, and persecutory delusion. A neuropsychological examination revealed frontal/executive dysfunction with relative sparing of episodic memory. Magnetic resonance imaging and F-18 fluorodeoxyglucose positron-emission tomography produced normal findings. However, magnetic resonance angiography revealed severe right internal carotid stenosis. After carotid stenting, her behavioral symptoms disappeared and did not recur during an 18-month follow-up.
Aged ; Apathy ; Behavioral Symptoms ; Carotid Artery, Internal* ; Carotid Stenosis* ; Cerebrovascular Disorders ; Delusions ; Female ; Follow-Up Studies ; Frontotemporal Dementia* ; Humans ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Memory, Episodic ; Positron-Emission Tomography ; Social Behavior ; Stents

BACKGROUND: The purpose of this study was to assess the effect of our new video-assisted asthma education program on patients' knowledge regarding asthma and asthma control. METHODS: Adult asthmatics who were diagnosed by primary care physicians and followed for at least 1 year were educated via smart devices and pamphlets. The education sessions were carried out three times at 2-week intervals. Each education period lasted at most 5 minutes. The effectiveness was then evaluated using questionnaires and an asthma control test (ACT). RESULTS: The study enrolled 144 patients (mean age, 56.7±16.7 years). Half of the patients had not been taught how to use their inhalers. After participating in the education program, the participants' understanding of asthma improved significantly across all six items of a questionnaire assessing their general knowledge of asthma. The proportion of patients who made errors while manipulating their inhalers was reduced to less than 10%. The ACT score increased from 16.6±4.6 to 20.0±3.9 (p<0.001). The number of asthmatics whose ACT score was at least 20 increased from 45 (33.3%) to 93 (65.3%) (p<0.001). The magnitude of improvement in the ACT score did not differ between patients who received an education session at least three times within 1 year and those who had not. The majority of patients agreed to the need for an education program (95.8%) and showed a willingness to pay an additional cost for the education (81.9%). CONCLUSION: This study indicated that our newly developed education program would become an effective component of asthma management in primary care clinics.
Adult ; Asthma* ; Education* ; Humans ; Nebulizers and Vaporizers ; Pamphlets ; Physicians, Primary Care ; Primary Health Care*