Stimulator of interferon gene (STING)-associated vasculopathy with onset in infancy (SAVI) is an extremely rare autoinflammatory disease. We present the case of a female Korean patient with early-onset interstitial lung disease who was initially suspected to have systemic lupus erythematosus (SLE) but was ultimately diagnosed with SAVI. The patient exhibited signs of interstitial lung disease and cutaneous manifestations before the age of 1 year and continued to have recurrent fever accompanied by pulmonary infiltrates. Based on positive findings for antibodies associated with SLE, such as antinuclear antibodies and anti-double-stranded DNA, the pulmonary involvement was considered a manifestation of SLE. Another significant symptom was recurrent skin ulceration, which led to partial spontaneous amputation of most of the toes due to inflammation. Given the early onset of interstitial lung disease, severe skin ulcers, and symptoms resembling SLE, autoinflammatory syndrome, especially SAVI was suspected.Following confirmation by genetic testing at age 29 years, the patient was started on tofacitinib, a Janus kinase inhibitor. Despite the prolonged use of multiple immunosuppressive therapies, the patient’s lung condition continued to worsen, ultimately requiring lung transplantation. This observational report highlights the importance of considering SAVI as a potential diagnosis when manifestations of interstitial lung disease are observed during infancy. Early proactive treatment is crucial for lung involvement, as this can have long-term effects on patient’s prognosis.

Background: Purse-string suture is a simple technique to reduce wound size and to achieve complete or partial closure of skin defects. Objective: To classify situations in which purse-string sutures can be utilized and to assess the long-term size reduction and cosmetic outcome of the final scar. Methods: Patients (93 from Severance hospital and 12 from Gangnam Severance hospital) in whom purse-string sutures were used between January 2015 and December 2019 were retrospectively reviewed. Wound site, final reconstruction method, repair duration, final wound size, and Vancouver scar scale were assessed. Results: A total of 105 patients were reviewed. Lesions were located on the trunk (48 [45.7%]), limbs (32 [30.5%]), and face (25 [23.8%]). Mean ratio of wound length/primary defect length was 0.79±0.30. Multilayered purse-string suture showed the shortest duration from excision to final repair (p<0.001) and most effectively minimized the scar size (scar to defect size ratio 0.67±0.23, p=0.002). The average Vancouver scar scale measured at the latest followup visit at least 6 months postoperatively was 1.62, and the risk of hypertrophic scarring was 8.6%. There was no significant difference in the Vancouver scar scale and the risk of hypertrophic scarring between the different surgical method groups. Conclusion Purse-string sutures can be utilized in many stages of reconstruction to effectively reduce scar size without compromising the final cosmetic outcome.

Background: This study investigates the influence factors of medical service variations using medical charge and the length of stay (LOS) for urinary incontinence surgery and uterine polypectomy. Methods: The National Health Insurance claims data and Medical Resource Report by the Health Insurance Review & Assessment Service in 2016 were used. Frequency analysis, one-way analysis of variance, and Bonferroni post-hoc tests were executed for each surgery. A multilevel analysis was executed to assess the factors to the medical charge and LOS for each surgery in patient, doctor, and hospital level. Results: Fifty-two point eight percent of urinary incontinence surgery and 87.1% of uterine polypectomy were distributed in general and tertiary hospitals. Among three levels, the patient level variation was 61.5% or 77.2% in medical charge and 93.9% or 96.3% in LOS, respectively. The doctor level variation was 29.6% or 22.6% in medical charge and 0.6% or 0.0% in LOS, respectively. The institution level variation was 8.9% or 0.2% in medical charge and 5.5% or 3.7% in LOS, respectively. Number of other disease and organizational type were main factors that affected the charge and LOS for urinary incontinence surgery and uterine polypectomy. Conclusion Medical service variations of the urinary incontinence surgery and uterine polypectomy were the largest for the patient level, followed by doctor level for the medical charge, and the institution level for the LOS.

Yonsei Dermatology celebrated its centennial in 2017, marking 100 years since Kung Sun Oh established the first Department of Dermatology and Urology in Korea in 1917. Following the footsteps of Kung Sun Oh, a pioneer of Korean dermatology, its members united and worked to provide the best medical service and achieve academic milestones in dermatology. Over the past hundred years, Yonsei Dermatology has played a pivotal role in the advancement of medical science and academia in Korea. The main activities of the department include medical care, education, and dermatologic research. Its research activities have encompassed a wide spectrum of dermatologic manifestations from skin immunology and pathology to introduction of newly developed treatment technologies. As Kung Sun Oh was the first Korean professor of dermatology at Severance Medical School and a passionate educator, we continue to serve his will by nurturing medical students and dermatology specialists to serve as global medical leaders. The Kung Sun Oh Memorial Lecture, first hosted in 1977, was the beginning of mutual international academic exchange in the field of dermatology in Korea. The memorial lecture has played a major role in advancing the academic status of Korean dermatological science by inviting distinguished dermatologists from around the world as guest lecturers. Yonsei Dermatology has played a key role in the history of modern medicine and dermatology in Korea over the last 100 years and continues to make an impact.
Allergy and Immunology ; Dermatology* ; Education ; History, Modern 1601- ; Humans ; Korea* ; Pathology ; Schools, Medical ; Skin ; Solar System ; Specialization ; Students, Medical ; Urology

OBJECTIVE: In 2002, the Korean Society for Affective Disorders developed the guidelines for the treatment of major depressive disorder (MDD), and revised it in 2006 and 2012. The third revision of these guidelines was undertaken to reflect advances in the field. METHODS: Using a 44-item questionnaire, an expert consensus was obtained on pharmacological treatment strategies for MDD 1) without or 2) with psychotic features, 3) depression subtypes, 4) maintenance, 5) special populations, 6) the choice of an antidepressant (AD) regarding safety and adverse effects, and 7) non-pharmacological biological therapies. Recommended first, second, and third-line strategies were derived statistically. RESULTS: AD monotherapy is recommended as the first-line strategy for non-psychotic depression in adults, children/adolescents, elderly adults, patient with persistent depressive disorder, and pregnant women or patients with postpartum depression or premenstrual dysphoric disorder. The combination of AD and atypical antipsychotics (AAP) was recommended for psychotic depression in adult, child/adolescent, postpartum depression, and mixed features or anxious distress. Most experts recommended stopping the ongoing initial AD and AAP after a certain period in patients with one or two depressive episodes. As an MDD treatment modality, 92% of experts are considering electroconvulsive therapy and 46.8% are applying it clinically, while 86% of experts are considering repetitive transcranial magnetic stimulation but only 31.6% are applying it clinically. CONCLUSION: The pharmacological treatment strategy in 2017 is similar to that of Korean Medication Algorithm for Depressive Disorder 2012. The preference of AAPs was more increased.
Adult ; Aged ; Antipsychotic Agents ; Biological Therapy ; Consensus ; Depression ; Depression, Postpartum ; Depressive Disorder ; Depressive Disorder, Major ; Drug Therapy ; Electroconvulsive Therapy ; Female ; Humans ; Mood Disorders ; Pregnant Women ; Premenstrual Dysphoric Disorder ; Transcranial Magnetic Stimulation

In this review, we compared recommendations from the Korean Medication Algorithm Project for Depressive Disorder 2017 (KMAP-DD 2017) to other global treatment guidelines for depression. Six global treatment guidelines were reviewed; among the six, 4 were evidence-based guidelines, 1 was an expert consensus-based guideline, and 1 was an amalgamation of both evidence and expert consensus-based recommendations. The recommendations in the KMAP-DD 2017 were generally similar to those in other global treatment guidelines, although there were some differences between the guidelines. The KMAP-DD 2017 appeared to reflect current changes in the psychopharmacology of depression quite well, like other recently published evidence-based guidelines. As an expert consensus-based guideline, the KMAP-DD 2017 had some limitations. However, considering there are situations in which clinical evidence cannot be drawn from planned clinical trials, the KMAP-DD 2017 may be helpful for Korean psychiatrists making decisions in the clinical settings by complementing previously published evidence-based guidelines.
Complement System Proteins ; Depression ; Depressive Disorder* ; Psychiatry ; Psychopharmacology

BACKGROUND: Melasma is a common acquired hyperpigmentation disorder that predominantly affects the face. It frequently occurs in women with darker skin types and severely impacts quality of life. OBJECTIVE: To characterize the clinicoepidemiological features and triggering or aggravating factors of melasma in Korean patients. METHODS: This cross-sectional study was conducted at the dermatology clinics of five university hospitals in Korea. Between January 2011 and August 2012, 411 patients with melasma completed a questionnaire about the clinical and aggravating factors associated with their melasma. RESULTS: The study population consisted of 400 women and 11 men aged 22~73 years (mean age, 42.8±9.92 years). Triggering or aggravating factors were sun exposure (68.4%), pregnancy (27.0%), and emotional stress (24.8%). Interestingly, 61.1% of patients complained of sensitive/inflammatory features such as erythema, itching, and a stinging sensation. Dryness was the most common aggravating factor, followed by erythema/redness and itching/stinging. Concomitant pigmentary disorders included post-inflammatory hyperpigmentation in 15.1% of patients, followed by pigmented contact dermatitis, and acquired bilateral nevus of Ota-like macules. CONCLUSION: It is well known that sun exposure and hormonal changes are the most common triggers of melasma; however, sensitive/inflammatory features may aggravate melasma in East Asian patients. Therefore, these individual and racial differences should be considered in the prevention and treatment of melasma.
Asian Continental Ancestry Group ; Bites and Stings ; Cross-Sectional Studies ; Dermatitis, Contact ; Dermatology ; Erythema ; Female ; Hospitals, University* ; Humans ; Hyperpigmentation ; Korea ; Male ; Melanosis* ; Nevus ; Pregnancy ; Pruritus ; Quality of Life ; Sensation ; Skin ; Solar System ; Stress, Psychological

We aimed to compare the recommendations of the Korean Medication Algorithm Project for Depressive Disorder 2012 (KMAP-DD 2012) with other recently published treatment guidelines for depressive disorder. We reviewed a total of five recently published global treatment guidelines and compared each treatment recommendation of the KMAP-DD 2012 with those in other guidelines. For initial treatment recommendations, there were no significant major differences across guidelines. However, in the case of nonresponse or incomplete response to initial treatment, the second recommended treatment step varied across guidelines. For maintenance therapy, medication dose and duration differed among treatment guidelines. Further, there were several discrepancies in the recommendations for each subtype of depressive disorder across guidelines. For treatment in special populations, there were no significant differences in overall recommendations. This comparison identifies that, by and large, the treatment recommendations of the KMAP-DD 2012 are similar to those of other treatment guidelines and reflect current changes in prescription pattern for depression based on accumulated research data. Further studies will be needed to address several issues identified in our review.
Depression ; Depressive Disorder* ; Drug Therapy ; Prescriptions

BACKGROUND/AIMS: It is unknown whether pulmonary rehabilitation (PR) is an effective intervention to manage coal-worker pneumoconiosis (CWP). We evaluated the efficacy and safety of an individualized PR program in 53 patients with CWP hospitalized in two medical institutions. METHODS: The PR program consisted of upper and lower extremity exercises to improve exercise endurance and skeletal musculoskeletal strength. All subjects performed treadmill and ergometer exercise with steady loading weights three times/week for 12 weeks. The following tests were performed before and after the study to investigate the efficacy of the PR program: modified Borg scale, pulmonary function test, mid-thigh circumference, maximum muscular strength, 6-min walk distance (6MWD), and the St. George's Respiratory Questionnaire (SGRQ), Korean version. RESULTS: Forty patients (75.5%) completed their PR programs. They improved significantly on the modified Borg scale, mid-thigh circumference, maximum muscular strength, 6MWD (all p < 0.000), and SGRQ (p = 0.007); however, no significant improvement was observed on the pulmonary function test. A significant improvement in dyspnea (p = 0.004) and 6MWD (p = 0.002) was observed in 12 patients with forced expiratory volume in 1 sec < 60%. The PR program with smoking cessation resulted in significantly more improvement on the 6MWD (p < 0.0001) and the SGRQ score (p = 0.002), as compared to those of patients who did not quit smoking. CONCLUSIONS: Our results show that an individualized 12-week PR program improves exercise capacity and quality of life for patients with CWP.
Dyspnea ; Exercise ; Exercise Therapy ; Forced Expiratory Volume ; Humans ; Lower Extremity ; Pneumoconiosis* ; Quality of Life ; Surveys and Questionnaires ; Rehabilitation* ; Respiratory Function Tests ; Smoke ; Smoking ; Smoking Cessation ; Weights and Measures

OBJECTIVE: Since the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was developed in 2002, the third revision of KMAP-BP was performed in 2014 in order to reflect the recent rapid development and research of bipolar disorder and psychopharmacology. METHODS: According to methodology of previous versions, KMAP-BP 2014 was revised using the same questionnaire consisting of 14 questions. Sixty-four experts of the review committee completed the survey. The executive committee analyzed the results and discussed the final production of algorithm considering scientific evidence. RESULTS: The first-line pharmacotherapeutic strategy for acute bipolar depressive episode with moderate, non-psychotic severe and psychotic severe episode was mood stabilizer combined with atypical antipsychotic (AAP) or AAP with lamotrigine. Compared to KMAP-BP 2010, preference of AAP has been increased in the treatment of bipolar depressive episode in KMAP-BP 2014. Among AAPs, olanzapine, quetiapine and aripiprazole were preferred. When considering the efficacy and safety simultaneously, (es)citalopram, bupropion, and sertraline were recommended among antidepressants for bipolar depression. CONCLUSION: Compared with the previous version, we found that more aggressive pharmacological strategies as an initial treatment were preferred, although various strategies were recommended as same as previous studies. Increased preference of AAP was prominent in KMAP-BP 2014. We expect this algorithm may be helpful in the treatment of bipolar disorder, depressive episode.
Advisory Committees ; Antidepressive Agents ; Bipolar Disorder* ; Bupropion ; Drug Therapy ; Psychopharmacology ; Surveys and Questionnaires ; Sertraline ; Aripiprazole ; Quetiapine Fumarate