Background: The main cause of death in pulmonary embolism (PE) is right-heart failure due to acute pressure overload. In this sense, extracorporeal membrane oxygenation (ECMO) might be useful in maintaining hemodynamic stability and improving organ perfusion. Some previous studies have reported ECMO as a bridge to reperfusion therapy of PE. However, little is known about the patients that benefit from ECMO. Methods: Patients who underwent ECMO due to pulmonary thromboembolism at a single university-affiliated hospital between January 2010 and December 2018 were retrospectively reviewed. Results: During the study period, nine patients received ECMO in high-risk PE. The median age of the patients was 60 years (range, 22–76 years), and six (66.7%) were male. All nine patients had cardiac arrests, of which three occurred outside the hospital. All the patients received mechanical support with veno-arterial ECMO, and the median ECMO duration was 1.1 days (range, 0.2–14.0 days). ECMO with anticoagulation alone was performed in six (66.7%), and ECMO with reperfusion therapy was done in three (33.3%). The 30-day mortality rate was 77.8%. The median time taken from the first cardiac arrest to initiation of ECMO was 31 minutes (range, 30–32 minutes) in survivors (n=2) and 65 minutes (range, 33–482 minutes) in non-survivors (n=7). Conclusion High-risk PE with cardiac arrest has a high mortality rate despite aggressive management with ECMO and reperfusion therapy. Early decision to start ECMO and its rapid initiation might help save those with cardiac arrest in high-risk PE.

Drug-induced immune hemolytic anemia is a rare disease that occurs in 1 in 1 million individuals of the general population. Rifampin-induced immune hemolytic anemia is caused by drug-dependent antibodies and this can be treated without complication by drug cessation. Herein, we present a case of rifampin-induced immune hemolytic anemia in a patient with primary Sjogren's syndrome (pSS) which occurred during treatment of pulmonary tuberculosis. At admission, the patient's laboratory tests revealed hemolytic anemia and positive direct antiglobulin test result. Since the incidence of autoimmune hemolytic anemia (AIHA) in pSS is reported to be 3 percent, which is higher than that of the general population, differential diagnosis between AIHA and rifampin-induced immune hemolytic anemia was required for planning future anti-tuberculous treatment. We identified rifampin-dependent antibody by drug-induced immune complex test and diagnosed rifampin-induced immune hemolytic anemia. Based on this experience, if rifampin administration is considered in patients with systemic autoimmune disease such as pSS, which has a high incidence of AIHA, we suggest evaluating the presence and the cause of hemolytic anemia at baseline by testing serum lactate dehydrogenase, haptoglobin, and direct and indirect antiglobulin tests before drug administration to promptly identify the cause of hemolysis if hemolytic anemia develops.

Basal cell carcinoma (BCC) is the most common malignant tumor of the skin and usually seen on hair-bearing skin that is frequently exposed to the sun, especially on the face. Polypoid BCC, which is thought to be a new variant, is distinguished from other histologic types by having a stalk and by restriction of the tumor aggregation to the pedunculated zone. We report a case of polypoid BCC in a 73-year old man who had a skin-colored pedunculated papule in the perianal area mimicking soft fibroma.
Carcinoma, Basal Cell ; Fibroma ; Skin ; Solar System

PURPOSE: We evaluated the usefulness of intracranial stent implantation for treating patients with atherosclerotic stenosis and with recurrent, ischemic, neurological symptoms despite having undergone medical therapy. MATERIALS AND METHODS: Between March 2004 and April 2010, we attempted intracranial, stent-assisted angioplasty in 77 patients with 85 lesions (anterior circulation 73 cases, posterior circulation 12 cases) and who had ischemic neurological symptoms with more than 50% major cerebral artery stenosis. We analyzed the results regarding the technical success rate, complication rate, and restenosis rate during the mean 29.4 month follow-up period. RESULTS: Intracranial stent implantation was successfully performed in 74 cases (87.1%). In nine cases among the 11, failed cases, stent implantation failure was due to the tortuosity of the target vessel. One patient experienced middle cerebral artery rupture during the procedure, and we embolized the vessel using a microcoil. Five patients developed cerebral infarction in three weeks after the procedure, three of whom improved using conservative management, although the other, two patients expired. The mean number of residual stenoses decreased from 72.3% to 14.7%. Three patients demonstrated significant in-stent restenosis, i.e. more than 50%, during the follow-up period. CONCLUSION: As stent-assisted angioplasty in intracranial, atherosclerotic stenosis is effective and relatively safe, it can be considered as an alternative treatment for patients with recurrent, ischemic, neurologic symptoms despite having undergone medical therapy.
Angioplasty ; Cerebral Arteries ; Cerebral Infarction ; Constriction, Pathologic ; Follow-Up Studies ; Glycosaminoglycans ; Humans ; Intracranial Arteriosclerosis ; Middle Cerebral Artery ; Neurologic Manifestations ; Rupture ; Stents

Acute generalized exanthematous pustulosis is clinically characterized by fever, pruritus and an acute pustular eruption. It can be described as having an abrupt onset and then spontaneous resolution occurs shortly after the start of symptoms, and there is usually only a single episode. Most cases have been triggered by the ingestion of drugs. Diltiazem hydrochloride is a calcium channel blocker that is commonly used for treating hypertension and angina. This drug was found to be the responsible agent in our current patient. There have been 9 such case reports in the English medical literature, yet this is the first such report in the Korean medical literature. We present the case of a 51-year-old male who experienced an acute generalized exanthematous pustulosis due to diltiazem hydrochloride and we review the relevant literature.
Acute Generalized Exanthematous Pustulosis ; Calcium Channels ; Diltiazem ; Eating ; Fever ; Humans ; Hypertension ; Male ; Middle Aged ; Pruritus

BACKGROUND: Several studies have shown an increase in skin cancers on the left side of the face. But such studies have not been conducted in Korean patients. OBJECTIVE: In this study, we analyzed the prevalence of left or right sided skin cancers in head and neck areas. METHODS: We retrospectively included 384 head and neck skin cancers (Basal cell carcinoma, Squamous cell carcinoma, Bowen disease, Malignant melanoma) diagnosed at our center from January 1995 to February 2011. Location, age, and sex were recorded and analyzed. RESULTS: All types of skin cancers occurred more on the left (54.17%) than on the right (45.83%) (p=0.051), with no stronger trend in men. CONCLUSION: There are more skin cancers on the left than the right side in Korean patients. But further study is needed because of the small patient population studied.
Bowen's Disease ; Carcinoma, Squamous Cell ; Head ; Humans ; Neck ; Prevalence ; Retrospective Studies ; Skin ; Skin Neoplasms

BACKGROUND: Few clinical studies are available on childhood and adolescent psoriasis in Korea. OBJECTIVE: The purpose of this study was to analyze clinical features of childhood and adolescent psoriasis in a referral center in Korea. METHODS: We performed retrospective medical record-based analyses for 255 psoriasis patients younger than 16 years of age at the time of diagnosis at our center from March 2001 to July 2010. Age, sex, onset age, familial history, site of involvement, type of psoriasis, nail involvement, initial PASI score, and treatment modality were analyzed. RESULTS: There was no sexual predominance; mean age of onset was 8.85 years; 17.25% of patients had a familial history. Upper extremities, lower extremities, trunk, scalp and face were the most commonly involved sites in sequence. Guttate psoriasis (58.90%) was the most common type of psoriasis. Nail involvement was observed in 11.11% of patients. The mean initial PASI score at the time of diagnosis was 7.9. The most common treatment was topical steroids and topical vitamin D in combination. CONCLUSION: Childhood and adolescent psoriasis is not an uncommon disease. A larger scale epidemiological study is needed.
Adolescent ; Age of Onset ; Epidemiologic Studies ; Humans ; Lower Extremity ; Nails ; Psoriasis ; Referral and Consultation ; Retrospective Studies ; Scalp ; Steroids ; Upper Extremity ; Vitamin D

Acute generalized exanthematous pustulosis (AGEP) is manifested by rapid development of many sterile, nonfollicular pustules on a background of edematous erythema. More than 90 percent of AGEP are induced by medication, mostly antibiotics. Drug patch test can be helpful in the diagnosis of AGEP. This paper reports the first case of celecoxib-induced AGEP confirmed by patch test in Korean literature.
Acute Generalized Exanthematous Pustulosis ; Anti-Bacterial Agents ; Erythema ; Patch Tests ; Pyrazoles ; Sulfonamides ; Celecoxib

Dermatofibroma (DF) is usually confined to the dermis and the overlying epidermis is usually hyperplastic. Although DF with deep subcutaneous extension is commonly encountered, purely subcutaneous DF is uncommon. In this review, we describe a case of a 41-year-old male patient who presented with a painless, subcutaneous, hard papule on the left thigh. After the skin had been incised the lesion was totally removed, and histopathology revealed a subcutaneous dermatofibroma.
Adult ; Dermis ; Epidermis ; Histiocytoma, Benign Fibrous ; Humans ; Male ; Skin ; Thigh

Lichen sclerosus et atrophicus (LSA) is an inflammatory disease that primarily causes anogenital lesion in middle aged women. We present here a case of facial LSA with an asymptomatic, well-demarcated, whitish to bluish, atrophic patch in a linear pattern on the forehead of a 48-year-old woman. This case showed an atypical clinical presentation and it mimicked en coup de sabre, but the histopathologic results confirmed the diagnosis of LSA.
Female ; Forehead ; Humans ; Lichen Sclerosus et Atrophicus ; Lichens ; Middle Aged ; Scleroderma, Localized