Accurate diagnosis and management of a femoral vascular injury is important as it is a life-threatening injury with high morbidity and mortality. This is the case of a 75-year-old man admitted to the emergency room with trauma to the right groin due to a horse fall. Computed tomography showed active bleeding of the femoral artery without pelvic or femoral fracture. We inserted a stent-graft, but hypotension persisted. Exploration of the groin was completed, and the bleeding from the external iliac vein was identified and repaired. In conclusion, vascular injury is rare in groin trauma without associated fracture, however, arterial and venous injury should not be completely ruled out. Endovascular therapy is worth recommending as a quicker and safer management than surgery in patients with active bleeding in the femoral artery. However, the possibility of combined injury of the femoral vein should be suspected in case of ongoing hemodynamic instability.

BACKGROUND: Superficial dermatomycoses are fungal infections of the skin, hair, or nails and are most commonly caused by dermatophytes. Superficial dermatomycoses are very common diseases in the field of dermatology; however, their prevalence and clinical characteristics vary with geographical areas and populations. Moreover, pathogenic species change constantly over time. OBJECTIVE: This multicenter study aimed to investigate the epidemiologic and clinical findings of tinea corporis, tinea faciale, and tinea capitis in Korea during 2016-2017. In addition, we sought to identify the pathogenic organism causing these three different types of fungal infections. METHODS: Total 453 patients from the dermatology clinics of 13 tertiary hospitals in Korea were enrolled in this study. Information regarding demographic characteristics, comorbidities, occupation, family history of superficial dermatomycoses, suspected routes of infection, and treatment was collected. Fungal cultures and molecular analyses were performed for patients with tinea corporis, tinea faciale, and tinea capitis. RESULTS: Of the 453 patients, 275 were men and 178 were women. With respect to past history, 214 patients (53.4%) had at least one comorbidity. Tinea corporis (27.3%) was the most common form of superficial dermatomycosis, followed by tinea pedis (23.2%) and tinea unguium (16.6%). Overall, the fungal culture positivity was 77.8% (126/162). Trichophyton rubrum was the most common causative organism for tinea corporis (66.7%, 68/80) and tinea faciale (43.8%, 14/23), while Microsporum canis was the most common causative organism for tinea capitis (36.7%, 11/23). CONCLUSION Trichophyton rubrum was consistently the most common causative organism of superficial dermatomycoses, except for tinea capitis in Korea.

We assessed the success rate of empirical antifungal therapy with itraconazole and evaluated risk factors for predicting the failure of empirical antifungal therapy. A multicenter, prospective, observational study was performed in patients with hematological malignancies who had neutropenic fever and received empirical antifungal therapy with itraconazole at 22 centers. A total of 391 patients who had abnormal findings on chest imaging tests (31.0%) or a positive result of enzyme immunoassay for serum galactomannan (17.6%) showed a 56.5% overall success rate. Positive galactomannan tests before the initiation of the empirical antifungal therapy (P=0.026, hazard ratio [HR], 2.28; 95% confidence interval [CI], 1.10-4.69) and abnormal findings on the chest imaging tests before initiation of the empirical antifungal therapy (P=0.022, HR, 2.03; 95% CI, 1.11-3.71) were significantly associated with poor outcomes for the empirical antifungal therapy. Eight patients (2.0%) had premature discontinuation of itraconazole therapy due to toxicity. It is suggested that positive galactomannan tests and abnormal findings on the chest imaging tests at the time of initiation of the empirical antifungal therapy are risk factors for predicting the failure of the empirical antifungal therapy with itraconazole. (Clinical Trial Registration on National Cancer Institute website, NCT01060462)
14-alpha Demethylase Inhibitors/adverse effects/therapeutic use ; Adolescent ; Adult ; Aged ; Antifungal Agents/adverse effects/*therapeutic use ; Aspergillosis/complications/*drug therapy ; Candidiasis/complications/*drug therapy ; Coccidioidomycosis/complications/drug therapy ; Febrile Neutropenia/complications/drug therapy ; Female ; Hematologic Neoplasms/complications/drug therapy/*microbiology ; Humans ; Itraconazole/adverse effects/*therapeutic use ; Male ; Mannans/blood ; Middle Aged ; Prospective Studies ; Treatment Outcome ; Young Adult

BACKGROUND: Mohs micrographic surgery (MMS) is a precise method of treating skin cancer. There have been many studies about the advantages and disadvantages of MMS. However, no study has yet been carried out regarding the length of surgery. OBJECTIVE: The purpose of this study was to report our experience with MMS for the treatment of skin cancers and to analyze the operative time of MMS. METHODS: We analyzed 50 cases of skin cancers treated by MMS at the Dermatosurgery Clinic in Pusan National University Hospital between April 2009 and November 2009. RESULTS: The minimum and maximum operative times of MMS were 88 and 356 minutes, respectively, and the mean operative time was 171.4 minutes. The mean number of stages was 1.7 (range, 1~4). The mean operative time per stage was 93.9, 62.9, 57.2, and 53 minutes for the 1st, 2nd, 3rd, and 4th stages, respectively. The time percentages for a pathologic consult to the Department of Pathology per stage was 42%, 50%, 52%, and 57% for the 1st, 2nd, 3rd, and 4th stages, respectively; therefore, the consultation to the Department of Pathology occupied a high percentage of the operative time. The mean operative time of repair for surgical defects was 44.4 minutes. LIMITATIONS: The results of this study are based on the experience of a single surgical team in a single institution. CONCLUSION: The results of our study reveal that MMS is a time-consuming operation. Further studies are required to shorten the operation time of MMS.
Mohs Surgery ; Operative Time ; Skin Neoplasms

Locating a corticotropin-releasing hormone (CRH)- or adrenocorticotropic hormone (ACTH)-secreting tumor is challenging. A 69-year-old woman admitted to our hospital for generalized edema was diagnosed with ectopic Cushing's syndrome. We attempted to find an ectopic tumor and could establish no ectopic focus except a retropharyngeal mass in the neck. We diagnosed the retropharyngeal mass as thyroid papillary carcinoma and examined whether the thyroid papillary carcinoma was the ectopic focus. No relationship between thyroid papillary carcinoma and ectopic Cushing's syndrome has been established. We failed to find another ectopic focus, except for the increased uptake of the retropharyngeal mass on fluorodeoxyglucose positron emission tomography (FDG-PET). Ectopic Cushing's syndrome combined with thyroid papillary carcinoma is very rare, so we report this case along with reviews of related literatures.
Adrenocorticotropic Hormone ; Aged ; Carcinoma ; Carcinoma, Papillary ; Corticotropin-Releasing Hormone ; Cushing Syndrome ; Edema ; Female ; Humans ; Neck ; Positron-Emission Tomography ; Thyroid Gland ; Thyroid Neoplasms

Addison's disease, or primary adrenal insufficiency, results from progressive destruction of the adrenal glands. The common causes of Addison's disease are idiopathic autoimmune atrophy and tuberculosis of the adrenals glands. Adrenal insufficiency caused gradual adrenal destruction is characterized by an insidious onset of fatigability, weakness, anorexia, nausea, weight loss, and cutaneous manifestations, such as hyperpigmentation of the skin, especially in sun-exposed areas, palmar creases, frictional areas, recent scars, and oral mucosa, and longitudinal pigmented bands in the nails. After diagnosing Addison's disease, determining the underlying adrenal abnormality is important for the appropriate treatment of the disease. To date, there have been no reports regarding the cause of Addison's disease confirmed in the Korean dermatologic literature. We report here a case of Addison's disease secondary to adrenal tuberculosis confirmed by a tuberculosis-polymerase chain reaction (TB-PCR).
Addison Disease ; Adrenal Glands ; Adrenal Insufficiency ; Anorexia ; Atrophy ; Cicatrix ; Friction ; Hyperpigmentation ; Mouth Mucosa ; Nails ; Nausea ; Polymerase Chain Reaction ; Skin ; Tuberculosis ; Weight Loss

OBJECTIVES: This study was performed to estimate the prevalence and possible risk factors of the metabolic syndrome in steel-mill workers, and to evaluate the relation between gamma-glutamyltransferase (gamma-GTP) and the metabolic syndrome. METHODS: The study subjects comprised 1,604 male steel-mill workers. The indices of metabolic syndrome, such as BMI, triglyceride, HDL-cholesterol, blood pressure, fasting glucose, and gamma-GTP were analyzed in each subject. We collected information about demographic characteristics, behavioral patterns, such as alcohol drinking, smoking, and exercise, and family medical history through a self-administered questionnaire. Statistical analysis was done by using the chi-square test, Mantel-Haenszel trend test and logistic regression model. RESULTS: The crude and age-adjusted prevalences of the metabolic syndrome were 21.3% and 15.5%, respectively, in the steel-mill workers. Age (OR: 1.063, 95% CI: 1.033-1.094), alcohol drinking (OR: 1.657, 95% CI: 1.175-2.337) and smoking (OR: 1.359, 95% CI: 1.017-1.816) were risk factors for the metabolic syndrome. Meanwhile, shift work showed a significant relation with hypertension (OR: 1.329, 95% CI: 1.038-1.700), but not with other metabolic syndrome components. However, tenure, exercise and family medical history were not significant factors for the metabolic syndrome in this study. The risk ratio of the metabolic syndrome (OR: 3.345, 95 % CI: 2.534-4.416) and its components, such as obesity, hypertriglyceridemia, hypertension and hyperglycemia, were higher in the high gamma-GTP group (> or =63 IU/ liter) than in the controls (<63 IU/liter). CONCLUSIONS: These results confirm the need for health education to control the metabolic syndrome by improving behavioral patterns, such as alcohol drinking and smoking, in factory workers. In addition, it is suggested that gamma-GTP might be a useful candidate in screening for the metabolic syndrome.
Alcohol Drinking ; Blood Pressure ; Fasting ; gamma-Glutamyltransferase ; Glucose ; Health Education ; Humans ; Hyperglycemia ; Hypertension ; Hypertriglyceridemia ; Logistic Models ; Male ; Mass Screening ; Obesity ; Odds Ratio ; Prevalence ; Questionnaires ; Risk Factors* ; Smoke ; Smoking ; Triglycerides

Deep vein thrombosis (DVT) is a common disease. However, May-Thurner syndrome, which is the cause of DVT, is an uncommon processes in which there is an impaired venous return due to compression of the left iliac vein by the overlying right common artery. This condition results in a left iliofemoral deep thrombosis and severe leg edema. It is, therefore, called iliac compression syndrome. Catheter-directed thrombolytic therapy of acute extensive iliofemoral DVT and balloon angioplasty with venous stenting are recommended. Two cases with history of left leg swelling are diagnosed as May-Thurner syndrome, which was demonstrated by venography. We successfully treated the patients with thrombolysis, balloon angioplasty, and stent insertion at the site of common iliac vein compression. Therefore, we report the cases with overall review of the literature.
Angioplasty, Balloon ; Arteries ; Edema ; Humans ; Iliac Vein ; Leg ; May-Thurner Syndrome* ; Phlebography ; Stents* ; Thrombolytic Therapy ; Thrombosis ; Venous Thrombosis

BACKGROUND: To avoid the risks associated with transfusion of homologous blood products, artificial colloid solutions represent an alternative for intra-operative blood loss replacement. However, synthetic colloids have been implicated as a cause of coagulopathy when administered in large quantities. We investigated the effect of Hydroxyethyl starch (HES) on blood coagulation in vitro under thromboelastography (TEG). METHODS: Whole blood was withdrawn from fifteen volunteers undergoing peripheral surgery who had no history of coagulation defect. Whole blood was diluted with HES to 25, 50 and 75 vol% concentrations, and the changes in coagulation status were analysed using TEG and were compared with those of an undiluted control specimen obtained concurrently from the same patients. RESULTS: Hemodilution with HES solution at 50 vol% concentration decreased the MA and alpha angle values (P < 0.05), but the R and K values remained unchanged. In case of profound hemodilution at a 75 vol% concentration, the values of MA and alpha angle were severely decreased (P < 0.05) and the values of R and K were severely increased (P < 0.05). CONCLUSIONS:There were many reports that moderate hemodilution with crystalloids increased coagulability, but hemodilutions up to 50 vol% concentration with HES solution did not significantly change blood coagulability. Significant hypocoagulability occurred at a 75 vol% hemodilution with HES.
Blood Coagulation ; Colloids ; Hemodilution ; Humans ; Starch* ; Thrombelastography* ; Volunteers