Background: Eosinophilic cellulitis, also known as Wells’ syndrome, is an uncommon skin disease characterized by recurrent pruritic polymorphous plaques or nodules. There is limited knowledge in the Korean literature regarding the clinical characteristics and course of eosinophilic cellulitis. Objective: To investigate the clinical and histological features of eosinophilic cellulitis in Korean patients. Methods: In this case series study, we retrospectively reviewed the electronic medical records of patients diagnosed with eosinophilic cellulitis at our institutions from 2004 to 2022. We also analyzed the literature published in dermatology and internal medicine journals in Korea. Results: A total of 17 patients were included in this study (age, 39.4±21.8 years; 12 male [70.6%]), with an average disease duration of 4.4 months. We identified six clinical variants, with the typical plaque type being the most common (33.3%), followed by the papulonodular type (22.2%). Eosinophilia was observed in 78.6% of patients, and a flame figure, which is a typical histopathological feature of eosinophilic cellulitis, was observed in 52.9% of patients. Systemic and topical steroids and antihistamines were used as first-line treatment with generally favorable results (82.4%), followed by antibiotics (35.3%), cyclosporine (23.5%), and topical calcineurin inhibitors (23.5%).The recurrence rate during the mean follow-up period of 21.8 months was 29.4%. Conclusion Eosinophilic cellulitis can present with various clinical manifestations, and flame figures do not appear in all cases; therefore, clinical and histological correlations are critical for accurate diagnosis of patients with eosinophilic cellulitis.

Background: To date, there has been no practical guidelines for the prescription of antiepileptic drugs (AEDs) in brain tumor patients in Korea. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, had begun preparing guidelines for AED usage in brain tumors since 2019. Methods: The Working Group was composed of 27 multidisciplinary medical experts in Korea.References were identified through searches of PubMed, MEDLINE, EMBASE, and Cochrane CENTRAL using specific and sensitive keywords as well as combinations of the keywords. Results: The core contents are as follows. Prophylactic AED administration is not recommended in newly diagnosed brain tumor patients without previous seizure history. When AEDs are administered during peri/postoperative period, it may be tapered off according to the following recommendations. In seizure-naïve patients with no postoperative seizure, it is recommended to stop or reduce AED 1 week after surgery. In seizure-naïve patients with one early postoperative seizure (<1 week after surgery), it is advisable to maintain AED for at least 3 months before tapering. In seizure-naïve patients with ≥2 postoperative seizures or in patients with preoperative seizure history, it is recommended to maintain AEDs for more than 1 year. The possibility of drug interactions should be considered when selecting AEDs in brain tumor patients. Driving can be allowed in brain tumor patients when proven to be seizure-free for more than 1 year. Conclusion The KSNO suggests prescribing AEDs in patients with brain tumor based on the current guideline. This guideline will contribute to spreading evidence-based prescription of AEDs in brain tumor patients in Korea.

Background: There have been no guidelines for the management of adult patients with diffuse midline glioma (DMG), H3K27M-mutant in Korea since the 2016 revised WHO classification newly defined this disease entity. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, had begun preparing guidelines for DMG since 2019. Methods: The Working Group was composed of 27 multidisciplinary medical experts in Korea.References were identified through searches of PubMed, MEDLINE, EMBASE, and Cochrane CENTRAL using specific and sensitive keywords as well as combinations of keywords. As ‘diffuse midline glioma’ was recently defined, and there was no international guideline, trials and guidelines of ‘diffuse intrinsic pontine glioma’ or ‘brain stem glioma’ were thoroughly reviewed first. Results: The core contents are as follows. The DMG can be diagnosed when all of the following three criteria are satisfied: the presence of the H3K27M mutation, midline location, and infiltrating feature. Without identification of H3K27M mutation by diagnostic biopsy, DMG cannot be diagnosed. For the primary treatment, maximal safe resection should be considered for tumors when feasible. Radiotherapy is the primary option for tumors in case the total resection is not possible. A total dose of 54 Gy to 60 Gy with conventional fractionation prescribed at 1-2 cm plus gross tumor volume is recommended. Although no chemotherapy has proven to be effective in DMG, concurrent chemoradiotherapy (± maintenance chemotherapy) with temozolomide following WHO grade IV glioblastoma’s protocol is recommended. Conclusion The detection of H3K27M mutation is the most important diagnostic criteria for DMG. Combination of surgery (if amenable to surgery), radiotherapy, and chemotherapy based on comprehensive multidisciplinary discussion can be considered as the treatment options for DMG.

Background: To date, there has been no practical guidelines for the prescription of antiepileptic drugs (AEDs) in brain tumor patients in Korea. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, had begun preparing guidelines for AED usage in brain tumors since 2019. Methods: The Working Group was composed of 27 multidisciplinary medical experts in Korea.References were identified through searches of PubMed, MEDLINE, EMBASE, and Cochrane CENTRAL using specific and sensitive keywords as well as combinations of the keywords. Results: The core contents are as follows. Prophylactic AED administration is not recommended in newly diagnosed brain tumor patients without previous seizure history. When AEDs are administered during peri/postoperative period, it may be tapered off according to the following recommendations. In seizure-naïve patients with no postoperative seizure, it is recommended to stop or reduce AED 1 week after surgery. In seizure-naïve patients with one early postoperative seizure (<1 week after surgery), it is advisable to maintain AED for at least 3 months before tapering. In seizure-naïve patients with ≥2 postoperative seizures or in patients with preoperative seizure history, it is recommended to maintain AEDs for more than 1 year. The possibility of drug interactions should be considered when selecting AEDs in brain tumor patients. Driving can be allowed in brain tumor patients when proven to be seizure-free for more than 1 year. Conclusion The KSNO suggests prescribing AEDs in patients with brain tumor based on the current guideline. This guideline will contribute to spreading evidence-based prescription of AEDs in brain tumor patients in Korea.

Background: There have been no guidelines for the management of adult patients with diffuse midline glioma (DMG), H3K27M-mutant in Korea since the 2016 revised WHO classification newly defined this disease entity. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, had begun preparing guidelines for DMG since 2019. Methods: The Working Group was composed of 27 multidisciplinary medical experts in Korea.References were identified through searches of PubMed, MEDLINE, EMBASE, and Cochrane CENTRAL using specific and sensitive keywords as well as combinations of keywords. As ‘diffuse midline glioma’ was recently defined, and there was no international guideline, trials and guidelines of ‘diffuse intrinsic pontine glioma’ or ‘brain stem glioma’ were thoroughly reviewed first. Results: The core contents are as follows. The DMG can be diagnosed when all of the following three criteria are satisfied: the presence of the H3K27M mutation, midline location, and infiltrating feature. Without identification of H3K27M mutation by diagnostic biopsy, DMG cannot be diagnosed. For the primary treatment, maximal safe resection should be considered for tumors when feasible. Radiotherapy is the primary option for tumors in case the total resection is not possible. A total dose of 54 Gy to 60 Gy with conventional fractionation prescribed at 1-2 cm plus gross tumor volume is recommended. Although no chemotherapy has proven to be effective in DMG, concurrent chemoradiotherapy (± maintenance chemotherapy) with temozolomide following WHO grade IV glioblastoma’s protocol is recommended. Conclusion The detection of H3K27M mutation is the most important diagnostic criteria for DMG. Combination of surgery (if amenable to surgery), radiotherapy, and chemotherapy based on comprehensive multidisciplinary discussion can be considered as the treatment options for DMG.

Purpose: We aimed to evaluate shoulder muscle activities during shoulder external rotation exercises using an elastic band with the arm at the side or at 90° of abduction in static and dynamic body positions. Methods: In 2017, a total of 19 right-handed male subjects were included in this study. Surface electromyography signals were recorded from the anterior deltoid, middle deltoid, upper trapezius, lower trapezius, serratus anterior, and infraspinatus muscles. The subjects underwent maximal voluntary isometric contraction testing of each muscle in the W position or 90/90 position. Subjects performed the exercise in the sitting, static squat, static rotational squat, dynamic squat to standing (DSS), and dynamic squat to standing and trunk rotation (DSSR) positions. Results: The main finding of this study was that shoulder external rotation exercises in the DSSR position were effective in reducing shoulder muscle activities except in the serratus anterior compared with static rotational squat position. Conclusion DSSR enabled effective control of scapular motion with less shoulder muscle activation. Therefore, the kinetic chain exercises incorporated with lower extremity, hip, or trunk would be beneficial for shoulder muscle exercises, which is required for patients with weak periscapular muscles, in whom the lower trapezius activities were found to be frequently decreased.

The supramalleolar osteotomy is a joint-preserving surgical procedure. It is a very good treatment option for the asymmetric varus ankle and medial compartment osteoarthritis. The primary objective of the procedure is to shift medial concentration of stress toward the lateral intact articular cartilage to redistribute the joint loads during ambulation. Several studies have shown that deformities of the ankle result in uneven load distribution in the ankle joint, which eventually leads to articular cartilage degeneration. Since the lateral articular cartilage is intact, joint-sacrificing procedures such as total ankle replacement or ankle arthrodesis are not the most appropriate treatment choices for medial compartment arthritis. Results of supramalleolar osteotomies are very promising in terms of functional outcome and pain relief. In younger patients with medial compartment varus ankle osteoarthritis or even with a normal tibial anterior surface angle, supramalleolar osteotomies can be performed to realign the ankle to promote regeneration of the asymmetrically damaged cartilage. In this review article, we will discuss the indications, complications, surgical techniques, and outcomes of the supramalleolar osteotomy reported in the current literature.

To explore the anti-allergic and anti-inflammatory effects of extracts of Petasites genus, we studied the effects of s-petasin, a major sesquiterpene from Petasites formosanus (a butterbur species) on asthma and peritonitis models. In an ovalbumin-induced mouse asthma model, s-petasin significantly inhibited the accumulations of eosinophils, macrophages, and lymphocytes in bronchoalveolar fluids. S-petasin inhibited the antigen-induced degranulation of beta-hexosamidase but did not inhibit intracellular Ca2+ increase in RBL-2H3 mast cells. S-petasin inhibited the LPS induction of iNOS at the RNA and protein levels in mouse peritoneal macrophages. Furthermore, s-petasin inhibited the production of NO (the product of iNOS) in a concentration-dependent manner in the macrophages. Furthermore, in an LPS-induced mouse model of peritonitis, s-petasin significantly inhibited the accumulation of polymorpho nuclear and mononuclear leukocytes in peritoneal cavity. This study shows that s-petasin in Petasites genus has therapeutic effects on allergic and inflammatory diseases, such as, asthma and peritonitis through degranulation inhibition in mast cells, suppression of iNOS induction and production of NO in macrophages, and suppression of inflammatory cell accumulation.
Animals ; Asthma* ; Eosinophils ; Leukocytes, Mononuclear ; Lymphocytes ; Macrophages ; Macrophages, Peritoneal ; Mast Cells ; Mice ; Peritoneal Cavity ; Peritonitis* ; Petasites ; RNA

OBJECTIVE: This study was performed to analyze the clinical variables associated with occurrence of delirium tremens (DT) in inpatients with alcohol dependence initially admitted with diseases unrelated to alcohol. METHODS: This study included 132 inpatients seeking treatment for medical problem with acute alcohol withdrawal. The cases were divided into two groups : with DT group (n=44), without DT group (n=88). We compared the epidemiologic data, alcohol withdrawal symptoms and serum analysis data between two groups. We used the logistic regression to predict risk factors for DT. RESULTS: The DT group had more severe alcohol withdrawal symptoms, more amount of drinking alcohol, more number of drinking per month, higher blood urea nitrogen (BUN), creatinine, amylase, C-reactive protein and lower serum total protein than the without-DT group. According to the result of a logistic regression, occurrence of DT showed correlation with the following factors : sweating, hallucination, agitation, amount of alcohol consumption, number of drinking per month. CONCLUSION: Our study suggests development of DT was correlated with severe alcohol withdrawal symptoms, high BUN, creatinine and low total serum protein. Therefore, during assessment of alcohol dependent patients, clinicians should keep these parameters in mind in order to prevent DT.
Alcohol Drinking ; Alcohol Withdrawal Delirium* ; Alcoholism* ; Amylases ; Blood Urea Nitrogen ; C-Reactive Protein ; Creatinine ; Dihydroergotamine ; Drinking ; Hallucinations ; Humans ; Inpatients ; Logistic Models ; Risk Factors ; Substance Withdrawal Syndrome* ; Sweat ; Sweating

BACKGROUND: Fms-like tyrosine kinase 3 internal tandem duplication (FLT3 ITD) mutation is related to poor prognosis in normal-karyotype acute myeloid leukemia (AML). However, the prognostic significance of the mutation at relapse has not been adequately investigated. We investigated the prognostic significance of the FLT3 ITD mutation at relapse in normal-karyotype AML patients. METHODS: We analyzed 69 normal-karyotype AML patients, in whom paired bone marrow samples taken at initial diagnosis and subsequent relapse were analyzed for the FLT3 ITD mutation at the Asan Medical Center between 1995 and 2009. RESULTS: Forty patients showed a persistent wild-type genotype, 11 showed the FLT3 ITD mutation at diagnosis and relapse, and 9 lost and another 9 acquired the mutation at relapse. The mutation status at relapse affected the overall survival (OS), with the mutation group showing shorter OS and survival after relapse than the wild-type group did (P<0.001 and P<0.001, respectively), despite having received more frequent stem cell transplantation after relapse than the wild-type group did. However, no difference was detected in the OS and survival after relapse with regard to the mutation status at diagnosis. CONCLUSION: The patients with FLT3 ITD mutation at relapse showed poorer prognoses than those without the mutation. However, mutation status at diagnosis did not affect the outcome. These results suggest that, in normal-karyotype AML patients with relapse, the prognostic significance of FLT3 ITD mutation at relapse is greater than that of the mutation status at diagnosis.
Bone Marrow ; fms-Like Tyrosine Kinase 3 ; Genotype ; Humans ; Leukemia, Myeloid, Acute ; Prognosis ; Recurrence ; Stem Cell Transplantation