Objective: Despite the increasingly widespread adoption of unilateral biportal endoscopic (UBE) decompressive laminectomy for lumbar spinal stenosis, the learning curve for surgeons new to endoscopic techniques remains a significant barrier. This study aimed to quantify this learning curve and identify strategies to expedite proficiency, focusing on reducing operative times and complications. Methods: The cumulative summation test was used to evaluate the learning curves for both the operative time and the degree of intraoperative dural tear occurrence. Moreover, clinical outcomes and postoperative complications were compared between the cranial and caudal approaches, depending on the direction of ligamentum flavum removal. Results: In total, 54 patients were included, with 22 in the cranial group and 32 in the caudal group. The operative time was notably shorter in the caudal group (cranial group, 110.86±32.63 minutes; caudal group, 79.56±24.21 minutes; p<0.01), and the complication rate was considerably lower (cranial group, 40%; caudal group, 15%; p=0.04). Twenty-six patients and 29 patients were needed to overcome the learning curves for operative time and intraoperative dural tear occurrence, respectively. Conclusion Although UBE surgery has a short learning curve, a considerable number of cases (26 and 29, respectively) were needed to achieve competency in terms of operative time and intraoperative dural tear occurrence. We highlight the caudal-to-cranial direction of ligamentum flavum dissection and removal as a way to decrease the number of dural tears and shorten the operative time.

Background: Acanthosis nigricans is characterized by a velvety thickening of the epidermis accompanied by different degrees of hyperpigmentation, and known to be linked to obesity and insulin resistance. Objective: We aimed to analyze obesity-related factors in acanthosis nigricans patients and to evaluate the correlations between acanthosis nigricans and various factors. Methods: From January 2004 to February 2015, 27 acanthosis nigricans patients participated in this study. Blood samples were collected from a control group of seven overweight people and from the seven acanthosis nigricans patients, and they were analyzed for different obesity-related factors. Skin samples were collected from the 23 acanthosis nigricans patients and from 11 patients with epidermal nevi, and immunohistochemistry was performed to detect the presence of adiponectin receptor 1, adiponectin receptor 2, and the leptin receptor. Results: The median serum leptin level in the acanthosis nigricans patients (13 ng/mL) was significantly higher than that in the overweight control individuals (8.9 ng/mL) (p=0.021). The acanthosis nigricans patients had significantly higher levels of insulin-like growth factor-1 in their serum samples (p=0.017). The immunohistochemical analysis determined that the skin from the acanthosis nigricans patients stained significantly more intensely for the leptin receptor compared with that seen in the skin from the patients with epidermal nevi (p=0.002). Conclusion In conclusion, this study’s findings suggest that the levels of leptin and insulin-like growth factor-1 in the serum, and the expression of the leptin receptor in the skin are elevated with acanthosis nigricans.

No abstract available.
Dermatitis, Atopic ; Stem Cells

Azathioprine is an immunosuppressive drug that has been widely used in dermatology for the treatment of immunobullous diseases. Myelosuppression is the most important side effect and requires close observation of the complete blood cell count. The clinical findings of myelosuppression include general weakness, poor oral intake, nausea, dyspnea, and pallor. It can occur within several weeks to years after initial azathioprine treatment; thus, a weekly full blood count for the first 4 weeks, followed by reduced frequency of monitoring to a minimum of once every 3 months is recommended. If the myelosuppression is not treated properly, it can lead to fever, secondary infection, sepsis, and even death. Herein, we present three educational cases for dermatologists to order to underline the risk of myelosuppression during azathioprine treatment.
Azathioprine* ; Blood Cell Count ; Coinfection ; Dermatology ; Dyspnea ; Fever ; Nausea ; Pallor ; Sepsis

BACKGROUND: Staphylococcal scalded skin syndrome (SSSS) is a blistering disease of superficial skin mediated by Staphylococcus aureus (S. aureus) exfoliative toxin. Generally, SSSS affects mainly infants and children younger than 5 years and has a good prognosis. However, an increasing number of cases of methicillin-resistant S. aureus (MRSA) have been reported recently. OBJECTIVE: The purposes of this study were to evaluate the clinical features and course, to investigate the microbiological manifestations, and to perform antimicrobial susceptibility testing of SSSS among Korean children. METHODS: From March 2003 to July 2016, a total of 141 children were included in this study. The patients were divided into two different groups according to time of onset of their disease: before or after September 2011. We retrospectively reviewed medical records, microbiological results, bacterial detection sites, and antimicrobial susceptibility tests of all participating children. The results of comparison between the two groups were evaluated using the chi-square test. RESULTS: S. aureus infections were identified in all patients. Among all cultured S. aureus specimens, 63.1% (89/141) showed methicillin resistance. Beginning in September 2011, MRSA infection showed a significantly higher prevalence than that previously demonstrated (71.7% vs. 38.8%; p=0.0010). Moreover, MRSA infections were detected on the skin and neck and in the nose (each detected on 61, 41, and 18 occasions, respectively) with overlap observed in many cases. CONCLUSION: In conclusion, since the prevalence of MRSA infection has been gradually increasing in recent years, careful consideration is needed in the selection of antibiotics covering MRSA.
Anti-Bacterial Agents ; Blister ; Child ; Humans ; Infant ; Medical Records ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Neck ; Nose ; Prevalence ; Prognosis ; Retrospective Studies ; Skin ; Staphylococcal Scalded Skin Syndrome* ; Staphylococcus aureus

No abstract available.
Dermatofibrosarcoma* ; Mohs Surgery*

No abstract available.
Molluscum Contagiosum*

Subcorneal pustular dermatosis is a pustular eruption that shows subcorneal pustules containing polymorphonuclear leukocytes and chronic progression. It most commonly affects the trunk, inguinal region, and axilla of middle-aged women, and the pustules are distributed bilaterally. Cultures of the pustules consistently do not reveal bacterial growth. Subcorneal pustular dermatosis rarely happens, and no specific etiology and pathogenesis are known. Thus, we present this case to provide dermatologists with information on its adequate diagnosis and treatment and to inform them of the risk of subcorneal pustular dermatosis in kidney dialysis patients who use darbepoetin-α.
Axilla ; Diagnosis ; Dialysis ; Female ; Humans ; Kidney ; Neutrophils ; Renal Dialysis* ; Skin Diseases, Vesiculobullous*

No abstract available.
Anemia, Aplastic* ; Child* ; Granulocyte Colony-Stimulating Factor* ; Granulocytes* ; Humans ; Sweet Syndrome*

No abstract available.
Benzalkonium Compounds* ; Dermatitis, Contact*