Korean Woman Research Articles

Association between Muscle Loss and Urinary Incontinence in Elderly Korean Women.

BackgroundIncontinence and muscle loss are important senior health issues. Nevertheless, there are no available domestic or international studies on the association between urinary incontinence and muscle loss. The aim of this study was to investigate the association between muscle loss and urinary incontinence in elderly Korean woman.MethodsKorean women (1,313) ≥65 years of age whose complete body composition data were collected using dual X-ray absorptiometry were analyzed from the Fourth Korean National Health and Nutritional Examination Surveys. Class I and II losses of the appendicular, truncal, and total muscle mass were defined using adjustments for weight and height. Each participant's incontinence status was collected using constructed questionnaires. Multiple logistic regression was performed to examine the association between muscle loss and incontinence.ResultsOn the basis of physician-diagnosed incontinence, weight- and height-adjusted muscle loss showed no association with urinary incontinence (weight-adjusted muscle loss: class I adjusted odds ratio [aOR], 0.77; 95% confidence interval [CI], 0.34 to 1.73; class II aOR, 1.37; 95% CI, 0.59 to 3.18; height-adjusted muscle loss: class I aOR, 0.51; 95% CI, 0.18 to 1.51; class II aOR, 1.86; 95% CI, 0.22 to 15.79). Similar results were observed for truncal muscle and total muscle mass as well as self-reported urinary incontinence.ConclusionOur study found no association between urinary incontinence and appendicular, truncal, and total muscle loss in elderly Korean women.

Identification of Two Cases of Ciliopathy-Associated Diabetes and Their Mutation Analysis Using Whole Exome Sequencing.

BackgroundAlström syndrome and Bardet-Biedl syndrome are autosomal recessively inherited ciliopathies with common characteristics of obesity, diabetes, and blindness. Alström syndrome is caused by a mutation in the ALMS1 gene, and Bardet-Biedl syndrome is caused by mutations in BBS1-16 genes. Herein we report genetically confirmed cases of Alström syndrome and Bardet-Biedl syndrome in Korea using whole exome sequencing.MethodsExome capture was done using SureSelect Human All Exon Kit V4+UTRs (Agilent Technologies). HiSeq2000 system (Illumina) was used for massive parallel sequencing. Sanger sequencing was used for genotype confirmation and familial cosegregation analysis.ResultsA 21-year old Korean woman was clinically diagnosed with Alström syndrome. She had diabetes, blindness, obesity, severe insulin resistance, and hearing loss. Whole exome sequencing revealed a nonsense mutation in exon 10 of ALMS1 (c.8776C>T, p.R2926X) and a seven base-pair deletion resulting in frameshift mutation in exon 8 (c.6410_6416del, p.2137_2139del). A 24-year-old Korean man had Bardet-Biedl syndrome with diabetes, blindness, obesity, and a history of polydactyly. Whole exome sequencing revealed a nonsynonymous mutation in exon 11 of the BBS1 gene (c.1061A>G, p.E354G) and mutation at the normal splicing recognition site of exon 7 of the BBS1 gene (c.519-1G>T).ConclusionWe found novel compound heterozygous mutations of Alström syndrome and Bardet-Biedl syndrome using whole exome sequencing. The whole exome sequencing successfully identified novel genetic variants of ciliopathy-associated diabetes.

Actinic granuloma arising from the pulsed dye laser-treated skin in a patient with capillary malformation.

Dear Editor: Actinic granuloma is a rare inflammatory skin disorder that presents in chronically sun-damaged skin with flesh-colored to erythematous papules that coalesce to form centrifugally enlarging annular patterns1. However, its pathogenesis remains to be elusive. It is thought that ultraviolet radiation, heat, viral diseases or other unknown factors transform the antigenicity of elastic fibers and induce cellular immune reactions1,2. A 49-year-old Korean woman had reddish patches on the right side of her face from birth. She was diagnosed with capillary malformation about 20 years ago. She has treated the skin lesion with a pulsed dye laser (PDL) and fractional laser >10 times with 7 years. However, her skin lesion has not completely disappeared. On examination, the reddish patch had an uneven surface and firm texture (Fig. 1). These changes in the skin occurred 2 years ago. Histopathologically, there were some telangiectatic vessels and granulomatous inflammation in the superficial and mid-dermis (Fig. 2A). The dermis showed histiocytes with numerous giant cells, and some of them contained elastotic material, which was consistent with actinic granuloma (Fig. 2B, C). Because of previous repeated laser therapy, we presumed that these granulomatous reactions resulted from the laser therapy-induced actinic and/or heat damage. First, she was treated with oral methylprednisolone (8 mg; Methylon; Kunwha, Seoul, Korea) for 4 months and topical desonide (0.05%; Desowen Lotion; Galderma Pharma SA, Lausanne, Switzerland) for 1 year. However, this treatment resulted in no response. Then she was treated with oral isotretinoin (10 mg; Roaccutane; Roche, Basel, Switzerland) for 4 months, but she also had a minimal response. Fig. 1 (A) Ill-demarcated reddish patch with an (B) uneven surface and firm texture on the right side of the face (white arrow: the biopsy site). Fig. 2 (A) Some telangiectatic vessels and granulomatous inflammation in the superficial and mid-dermis (H&E, ×40). (B) The granuloma is comprised of numerous giant cells (H&E, ×200). (C) Some giant cells are contained in the ... Actinic granuloma typically affects exposed, weather-beaten skin in patients who are at least aged >30 years. Predilection sites are the neck, face, chest, and arms. O'Brien3 considered actinic granuloma to be a phenomenon of repair within damaged connective tissue. A biopsy specimen shows three distinct zones in the dermis. At the periphery within normal skin, actinic elastosis is prominent. The annulus shows a histiocytic and giant cell inflammatory reaction in the papillary and mid-dermal region. The giant cells may contain intracytoplasmic degenerated elastic fibers, or they may surround the foci of elastosis. A center, relatively elastin-free zone is present within the annulus3,4. The differential diagnosis includes granuloma annulare and necrobiosis lipoidica. The absence of dermal mucin and the presence of larger, more numerous giant cells help to distinguish actinic granuloma from granuloma annulare. The presence of elastophagocytosis, degenerated collagen, and sclerosis aid in distinguishing actinic granuloma from necrobiosis lipoidica. The treatment of actinic granuloma has been disappointing. Most reports have cited poor response to topical steroids with a single report of a response to isotretinoin5. In our current report, the patient was previously treated with PDL and fractional laser therapy >10 times. She was a housewife living in an urban area. We thought that the actinic granuloma resulted from the repeated laser therapy-induced heat and/or actinic damage. And, the damage may have destroyed the elastic fiber, which triggers an inflammatory response that causes granulomas. We describe an unusual case of actinic granuloma arising from the laser therapy treated skin.

Cyclosporine-Induced Posterior Reversible Encephalopathy Syndrome in a Patient with Pemphigus Vulgaris.

Dear Editor: Cyclosporine is an immunosuppressive drug originally isolated from Tolypocladium inflatum in 19701. Here, we report a case of cyclosporine-induced posterior reversible encephalopathy syndrome (PRES) in a patient with pemphigus vulgaris. A 41-year-old Korean woman who had no underlying disease except pemphigus vulgaris was admitted to the emergency room owing to a sudden onset of severe headache, nausea, vomiting, and vision loss. A few minutes after admission, she presented with generalized tonic-clonic convulsive movement and became confused. Transient hypertension (160/100 mmHg) accompanied the episode. Laboratory tests showed leukocytosis (17.9×109/L) with neutrophilia (92.2%); cerebrospinal fluid was normal. Multiple ill-defined high-signal enhanced lesions were visible in the cortex and subcortical white matter of the bilateral parieto-occipital lesion on a T2-weighted brain magnetic resonance imaging (MRI) (Fig. 1A). Six months earlier, the patient presented with highly crusted vegetating lesions on her lower lip (Fig. 2A) as well as several flaccid blisters and scaly crusted erosions on her trunk (Fig. 2B). Histopathological examination showed suprabasal acantholysis (Fig. 2C), and a direct immunofluorescence study on the perilesional dorsal skin showed intercellular epidermal IgG deposition (Fig. 2D). Therefore, she was diagnosed with pemphigus vulgaris. Initially, the patient received prednisolone 100 mg/day for 2 weeks and tapered for 4 months; this was followed by cyclosporine 200 mg/day (4 mg/kg) for 2 months. We considered acute hypertension and cyclosporine administration as possible causes of the convulsive encephalopathy. Cyclosporine was discontinued immediately, and conservative therapy was administered. The patient showed a complete clinical recovery in 6 weeks, and signal enhancement also decreased on follow-up brain MRI (Fig. 1B). Cyclosporine is rarely reported to cause PRES; its association with cyclosporine was first described by Adams et al.2 in 1987. PRES is characterized by clinical symptoms including headache, mental confusion, vomiting, visual disturbance, and multiple generalized tonic-clonic seizures; it is associated with characteristic radiological abnormalities in the posterior area of the cerebral white matter3. In addition to immunosuppressive or cytotoxic drugs, reported causes of PRES also include acute hypertension, infection, autoimmune disease, eclampsia, and pre-eclampsia3. Although the pathophysiology of PRES remains unclear, several mechanisms have been proposed. Cyclosporine has a direct toxic effect on vascular endothelial cells, causing them to release endothelin, prostacyclin, and thromboxane; these may cause microthrombi and also damage the blood-brain barrier3. Many PRES cases have been reported in organ and bone marrow transplant recipients receiving high-dose cyclosporine4. However, in the present case, the patient had been taking low-dose cyclosporine 4 mg·kg-1·day-1 and had no associated risk factors for neurotoxicity. We finally diagnosed the patient with PRES because of her favorable response to cyclosporine discontinuation and the ultimately near-full reversal of encephalopathy. Thus, the possibility of PRES in patients taking even low-dose cyclosporine who present with neurologic symptoms should be emphasized. Physicians should rapidly diagnose this disease and withdraw the causative drug(s), because delayed diagnosis could lead to permanent sequelae. Fig. 1 (A) Axial T2-weighted magnetic resonance imaging (MRI) showing an area of high signal intensity in the bilateral white matter of the posterior parieto-occipital area. (B) Six weeks later, axial T2-weighted MRI showing significant improvement after cyclosporine ... Fig. 2 (A) Highly crusted vegetating lesions on the lower lip. (B) Several flaccid blisters and scaly crusted erosions are distributed on her trunk. (C) Separation of the epidermis above the basal layer and scattered acantholytic cells (H&E, ×200). ...

Breast Cancer Screening in Korean Woman with Dense Breast Tissue

Breast Cancer Screening in Korean Woman with Dense Breast Tissue

Acquired Dermal Melanocytosis of the Dorsum in a Middle-Aged Asian Woman.

Dear Editor: Here, we describe a case of acquired dermal melanocytosis involving the dorsum in an Asian woman. A 45-year-old Korean woman presented with a 3-year history of a relatively well-demarcated, pale, blue-grayish, asymptomatic round patch on her interscapular back area (Fig. 1). Hypertrichosis was not observed within the lesion. Physical examination revealed no other similar lesions elsewhere. The patient denied any history of preceding inflammatory changes, trauma, bruises, tattoos, or metal contact on her back. She also denied taking heavy metals or any medicines that may result in hyperpigmentation and had no family history of similar skin lesions. Histopathologic examination revealed multiple spindle-shaped brown pigment-containing cells scattered among collagen fibers in the dermis (Fig. 2A, B). Immunohistochemical staining demonstrated these cells were positive for S100 protein (Fig. 2C) and negative for HMB-45 (data not shown). In addition, the brown pigment stained positive with Fontana-Masson stain, which is indicative of melanin (Fig. 2D), but not with Perls Prussian blue stain for hemosiderin (data not shown). Furthermore, immunohistochemistry revealed CD68-positive cells scattered in the dermis (Fig. 2E). Therefore, the patient was diagnosed with acquired dermal melanocytosis of the back, but no treatment was administered in accordance with the patient's wishes. Fig. 1 A relatively well-demarcated pale blue-grayish round patch on the interscapular area. Fig. 2 Histopathologic examinations and immunohistochemistry. (A, B) Multiple spindle-shaped brown pigment-containing cells scattered among collagen fibers in the dermis (HE A: ×100, B: ×200). (C) Immunohistochemical staining showed ... Dermal melanocytosis is defined by the presence of melanin-containing dendritic melanocytes in the dermis and can be differentiated on the basis of lesion onset and location1. Congenital forms of dermal melanocytosis include Mongolian spot, nevus of Ota, and nevus of Ito. Acquired forms of dermal melanocytosis include nevus of Hori and nevus of Sun, which involve the bilateral and unilateral malar areas, respectively. Acquired dermal melanocytosis located in areas besides the face is very rare; previously reported non-facial sites include the extremities and back1,2. Some of these reported cases were associated with malignancies including melanoma, physical trauma, oral estrogen, and eczema2. Although the pathogenesis of acquired dermal melanocytosis is unclear, one possibility is that dermal melanocytes may pre-exist in an immature state; they subsequently become activated by various stimuli including ultraviolet exposure, sex hormones, and inflammation3,4. This is supported by the observation that dermal melanocytes are also found in the normal-appearing skin neighboring the lesions of acquired dermal melanocytosis5. Nevertheless, the origin of the pre-existing dermal immature melanocytes is not fully understood. They may descend from the basal layer of the epidermis, migrate from hair bulbs, or improperly migrate during the embryonic period4. Acquired dermal melanocytosis does not usually fade; the pigment persists in contrast with Mongolian spots. This persistence may be associated with the extracellular sheath encircling dermal melanocytes, which has been observed in ultrastructural studies4. The extracellular sheaths of Mongolian spots usually fade over time, whereas those of nevus of Ota gradually thicken over time. Extracellular sheaths are also observed in acquired dermal melanocytosis and presumably play a role in protecting dermal melanocytes4. In conclusion, we report a case of acquired dermal melanocytosis with an unusual location that has not been described previously.

Adult onset dyschomatosis universalis.

Dear Editor: Dyschromatosis universalis hereditaria (DUH) is a rare hereditary skin disorder that is characterized by a mixture of small and irregularly sized hyperpigmented and hypopigmented macules of a mottled or reticulated pattern. The usual onset age of DUH is 6 years1. The common pattern of inheritance is generally autosomal dominant; however, rarely, a few cases show a sporadic pattern. Some authors named this form as dyschromatosis universalis (DU) instead of DUH2. We report a case of DU in a 29-year-old female patient with no family history and a late onset of the disease. A 29-year-old Korean woman presented with asymptomatic multiple pinhead to rice sized mottled hypopigmented macules with diffuse hyperpigmented patches on the abdomen and left upper arm (Fig. 1A). The hyperpigmented lesions, which had been noted 1 year previously, started initially on the abdomen and gradually spread to the left upper arm. She has no history of systemic disease or any previous cutaneous disease. She also denied any family history of skin discoloration or similar skin lesions. Fig. 1 (A) Multiple pinhead to rice sized mottled hypopigmented macules with diffuse hyperpigmented patches. (B) A closer view. (C) A biopsy specimen taken from a hyperpigmented lesion on the abdomen showed increased abundant melanin pigments in the epidermis ... A biopsy specimen taken from the hyperpigmented lesion on the abdomen showed increased abundant melanin pigments in the epidermis, with normal number and distribution of melanocytes on hematoxylin-eosin, Fontana Masson, and MART-1 stainning (Fig. 1B). In contrast, the histopathologic finding of a hypopigmented macule suggested a reduced amount of melanin pigments in the lesion area (Fig. 1C). On the basis of these findings, the diagnosis was concluded to be DU. We recommended treatment with Q-switched Nd:YAG laser for the hyperpigmented lesions; however, she refused the therapy. She has been followed without any changes. Rycroft et al.3 reported a case with no family history, but was associated with short stature and high tone deafness. In addition, Shono amd Toda4 reported a case with no family history and associated with photosensitivity and a neurosensory hearing defect. Also, Kim et al.2 reported a case that occurred in the patient at age 20 years, with a sporadic pattern and with no comorbid conditions. Some authors suggest that DU is a more appropriate name for the sporadic cases rather than DUH2. DU should be differentiated from other conditions showing both hyperpigmentation and hypopigmentation, such as generalized Dowling-Degos disease, xeroderma pigmentosum, dyskeratosis congenita and chronic radiodermatitis. DU generally does not involve a family history and present only dyschromatosis without systemic disorder. Various therapeutic trials, such as psoralen and ultraviolet A irradiation, thin split-thickness skin autograft, and Q-switched ruby laser have been tried to treat these lesions; however, there is no definitely effective treatment for both hyperpigmented and hypopigmented lesions. Recently, Kim et al.5 reported that they successfully treated the hyperpigmented lesions of DUH with a Q-switched Nd:YAG laser. Only a few cases of DU have been reported worldwide, and we could find only three cases in the Korean literature (Table 1)2,3,4. Particularly, adult-onset DU like our case is very unusual. Thus, we here report a case of DU occurring in a 29-year-old female patient with no family history. Table 1 Reported cases of dyschromatosis universalis in global literatures (including Korea)

Mycobacterium marinum Infection on the Face Diagnosed by Polymerase Chain Reaction Amplification and Direct Sequencing.

Dear Editor: A 56 years old Korean woman presented with asymptomatic multiple rice-sized erythematous papules on left cheek (Fig. 1A). The scaly papules were noted 2 months ago. She had no history of trauma or exposure to fish. She had been learning to swim for 3 months. Culture examination of the smear for bacteria and fungus revealed no growth. The nested polymerase chain reaction (PCR) for Mycobacterium tuberculosis showed negative results. A biopsy specimen taken from the lesion showed granulomatous inflammation with granulation tissue in the deep dermis. The granulomatous infiltration was composed of multiple histiocytes, mononuclear cells, and giant cells (Fig. 2A). Acid-fast bacilli (AFB) staining produced negative findings (Fig. 2B). Hence, the diagnosis was as nonspecific inflammation of the face, and the patient was treated with triamcinolone injection, three times for 6 weeks. After the injection, the lesions improved overall; however, a solitary lesion showed pus formation. Thus, in addition, mycobacterial culture including the pus was performed, which showed growth of yellow pigment-producing Mycobacterium at 32℃ to 33℃ in mycobacterium growth indicator tube (Fig. 2C). Zeihl-Neelsen staining of culture materials showed innumerable AFB (Fig. 2D), and the or ganism was identified as Mycobacterium. Hence, PCR-reverse blot hybridization assay was performed to identify atypical mycobacterial species, which were confirmed as M. marinum or M. ulcerans. Fig. 1 (A) Multiple, erythematous, various sized, scaly papules on the left cheek. (B) After 4 months, the lesions improved with postinflammatory hyperpigmentation and atrophic scar. Fig. 2 (A) Granulomatous infiltration in the deep dermis was composed of multiple histiocytes, mononuclear cells, and giant cells (H&E, ×200). (B) Negative findings (acid-fast bacillus, ×100). (C) Growth of yellow pigment producing mycobacterium ... Furthermore, PCR amplification and direct sequencing of 16SrRNA, tuf, rpoB, hsp65 genes were performed for the rapid and accurate identification of the organism. In 16SrRNA and tuf gene analysis, both M. marium and M. ulcerans showed >99% homology; thus, it was not possible to differentiate between the two species. Finally, in the rpoB and hsp65 gene analysis, M. marium showed homology of 100% and 86%, respectively, whereas M. ulcerans showed homology of 99% and 85%, respectively. On the basis of this result, the organism was identified as M. marium and the patient was treated with 200 mg minocycline and 500 mg clarithromycin for 2 months. After the treatment, the lesions improved, showing postinflammatory hyperpigmentation (Fig. 1B). M. marium is a nontuberculous photochromogenic mycobacterium1. The optimal temperature for its growth is 30℃ to 32℃, and it rarely grows at 37℃. Thus, M. marium infection rarely occurs on the face and most commonly affects the cooler extremities2. Thus far, only seven cases of infection on the face have been reported worldwide3. The conventional microbiological methods used for M. marium diagnosis are slow and solely rely on phenotypic characteristics. As delayed diagnosis is the main cause of adverse effects, rapid and accurate molecular diagnosis methods are necessary. Rapid detection of mycobacteria by using conventional broad-range PCR has previously been described in the literature4. Nowadays, M. marinum infection due to the use of pools rarely occurs because of chlorination disinfection of pool water. Thus, we report a rare and interesting case of M. marium infection showing an unusual location in a patient with a history of exposure to pool water. Hence, clinicians should consider the possibility of M. marium infection even if the history and location are atypical.

A Case of Influenza Associated Fulminant Myocarditis Successfully Treated with Intravenous Peramivir.

We report the case of a patient with fulminant myocarditis caused by influenza A virus, who presented with acute-onset heart failure and cardiogenic shock and was treated successfully with single dose of intravenous peramivir and with pharmacologic hemodynamic support. A 45-year-old Korean woman presented to our emergency department (ED) with shortness of breath and an episode of seizure that developed abruptly 5 hours before she arrived in the ED. She had a history of recurrent epileptic seizure 25 years ago, but denied other specific medical illnesses. In the ED, she was hypoxemic (arterial partial pressure of oxygen, 59.8 mmHg on room air) and chest radiography revealed bilateral alveolar infiltrates. A rapid antigen test for influenza A virus was positive, and she was administered a single dose of peramivir (300 mg) intravenously. Five hours later, the patient's dyspnea had worsened and she was hypotensive (blood pressure, 86/53 mmHg), requiring norepinephrine infusion. Further evaluation disclosed an increased cardiac troponin I level of 1.36 ng/mL and a depressed left ventricular ejection fraction of 30%. Under the diagnosis of influenza A-associated myocarditis and cardiogenic shock, she was managed with continuous critical care in the intensive care unit. On day 3, the patient's dyspnea began to resolve and her ventricular function returned to normal. Real-time polymerase chain reaction assays for influenza viruses in serial nasopharyngeal aspirates were positive for influenza A (hH3N2) with a threshold cycle value of 27.39 on day 2, but these became negative by day 4. The patient recovered and was discharged on day 9 after admission. In conclusion, this case indicates that intravenous peramivir might be an effective antiviral agent for the treatment of severe influenza A virus infection.

Pelvic actinomycosis with abundant ascites, pleural effusion, and lymphadenopathy diagnosed with endometrial biopsy and treated with medication only

ObjectivePelvic actinomycosis almost always presents as a “dry” type, and pelvic actinomycosis with ascites is extremely rare. We present an unusual case of pelvic actinomycosis with ascites, pleural effusion, and lymphadenopathy. Because of these atypical clinical features, a malignant process such as ovarian cancer or peritoneal carcinomatosis was suspected, but an endometrial biopsy revealed pelvic actinomycosis, which was treated without surgical intervention. Case reportA 50-year-old Korean woman presented to our clinic with a 3-month history of abdominal pain and weight loss. An abdominopelvic computed tomography scan demonstrated ascites, pleural effusion, bilateral adnexal tubular structures, several enlarged lymph nodes in the paraaortic area, and diffuse peritoneal infiltration. Ultrasonography showed fluid collections measuring 2.7 cm in the cul-de-sac, 2.42 cm in the right paracolic gutter, and 3.13 cm in the left paracolic gutter. Endometrial/endocervical specimens showed marked chronic inflammation with sulfur granules, with a colony of filamentous organisms consistent with Actinomyces infection. The patient underwent antibiotic treatment for 6 months and recovered without complications or adverse events in the 13 months of follow up. ConclusionPelvic actinomycosis should always be considered in patients with a pelvic mass and peritoneal infiltration, especially in the presence of intrauterine device use, despite the fact that abundant ascites, pleural effusion, and lymphadenopathy almost never accompany pelvic actinomycosis. Endometrial/endocervical biopsy may yield a diagnosis without an invasive procedure and should be performed. Because of the excellent response to penicillin, medical treatment alone is an effective method to eradicate pelvic actinomycosis without the need for surgical intervention.

Novel germline SDHD mutation in a patient with recurrent familial carotid body tumor and concomitant pheochromocytoma

Recent advances in genetics revealed that 25% to 30% of head and neck paragangliomas (PGLs) are inherited tumors associated with germline mutation, mainly in the succinate dehydrogenase (SDH) gene. DNA was isolated from whole blood and polymerase chain reaction (PCR) products were sequenced with an ABI3730 × 1 Genetic Analyzer. A 30-year-old Korean woman underwent resection of a carotid PGL. Fourteen years later, she was readmitted for a cervical mass. (18) F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT revealed a hot spot in the adrenal gland, besides the carotid mass. Surgical pathology confirmed recurrence of the carotid PGL and a concomitant pheochromocytoma. Genetic analysis revealed SDHD c.119del T (p.I40TfsX46) mutation. One daughter has been identified as a carrier. We found a novel SDHD mutation from a Korean family that shows similar clinical features to those in other SDHD mutations, mostly from Western countries. Further studies are needed to determine whether similar genotype-phenotype correlations exist in the Asian patients with familial PGLs.

간호사의 다문화 여성 출산간호 경험

Purpose: This study was conducted in order to investigate the experiences of nurses in health care of women with multi-cultural background. The structure of these experiences was identified in a social-cultural context. Methods: Data were collected by means of in-depth interviews using tape-recordings from 16 participants who were providing childbirth care for culturally different women. A phenomenological method proposed by Colaizzi was used to guide the process of data analysis. Results: A total of 138 significant statements were extracted from the data resulting in nine themes and five theme clusters. Theme clusters that emerged from the data were: more in-depth cultural difference, difficulty in providing care in multi-cultured, sticking to care in our own way, not being ready to nurse, and accepting culturally different woman, such as a Korean woman. Conclusion: The findings suggest that systematic educational programs for enhancement of cultural competency and its support systems should be developed for Korean nurses. Useful materials on Korean childbirth care should also be provided to women giving birth.

Vacillating images of Shin Saimdang: the invention of a historical heroine in colonial Korea

Shin Saimdang (1504–1551) is a nationally renowned historical figure who is generally considered an iconic traditional Korean woman; that is, “a wise mother and good wife” (hyeonmoyangcheo). Yet simultaneously, she is the most controversial woman in Korean history. In 2009, she became the first female figure to appear on a Korean banknote. Shin Saimdang is a truly complex symbol that has been (re)constructed as both a “tradition” and a figure in “the realm of memory” throughout the twentieth century in Korea. This paper examines the early phase of the discovery and interpretation of Shin Saimdang in the modern scene that began in the Enlightenment period and ended in the Japanese colonial period. In particular, the author highlights how frameworks and strategies to interpret Shin Saimdang vacillated according to nationalistic and colonial strategies. The author also explains how the concept of “good wife and wise mother” (ryousaikenbo in Japanese), which was imported from Japan, was hybridized and transformed into a complex ideal for Korean women that emphasized the “wise mother” over the “good wife.”

Intra-tumoral Metastatic Double Primary Carcinoma: Synchronous Metastatic Tumor in Lung from Breast and Thyroid Carcinoma.

Cases of phenotypic heterogeneity of cells within tumors have recently been reported. Here, we report on a patient with characteristic intra-tumor double primary metastases in the lung. This patient was a 40-year-old Korean woman who had been diagnosed with breast cancer (T1N0M0, estrogen receptor/progesterone receptor/HER2 +/+/+) and papillary thyroid cancer three years prior and underwent a complete surgical resection followed by appropriate adjuvant treatment with radiation, hormone, and radioactive iodine. She was recently admitted for newly developed pulmonary nodules. Metastasectomy through video-assisted thoracoscopic surgery revealed recurrent double primary cancer with two different components (metastatic ductal carcinomas from the breast and metastatic papillary carcinomas from the thyroid gland) in each pulmonary nodule in the right upper lobe and right middle lobe. To the best of our knowledge, this is the first report of simultaneous recurrent double metastasis in one organ from different primary origins.

The use of everolimus to target carcinogenic pathways in a patient with renal cell carcinoma and tuberous sclerosis complex: a case report.

IntroductionAn increased understanding of the genetic pathways involved in renal cell carcinoma has resulted in the development of various drugs that target relevant signaling cascades for the specific treatment of this disease. However, no validated predictive markers have been identified to guide the decision whether patients should receive vascular endothelial growth factor–targeted therapy or mammalian target of rapamycin–targeted therapy. We present what is, to the best of our knowledge, the first case of renal cell carcinoma in a patient with tuberous sclerosis complex who was successfully treated with everolimus.Case presentationThe patient was a 49-year-old Korean woman with tuberous sclerosis complex and recurrent renal cell carcinoma. The patient was treated with the tyrosine kinase inhibitor sunitinib followed by the mammalian target of rapamycin inhibitor everolimus. This treatment resulted in a prolonged response and significant clinical benefit. Notably, everolimus ameliorated the symptoms related not only to renal cell carcinoma but also to tuberous sclerosis complex.ConclusionThis case provides a rationale for the use of everolimus as first-line treatment for this specific patient population in order to target the correct pathway involved in carcinogenesis.

Recurred Sparganosis 1 Year after Surgical Removal of a Sparganum in a Korean Woman

Sparganosis, an infection due to the plerocercoid of Spirometra erinacei, are found worldwide but the majority of cases occur in East Asia including Korea. This report is on a recurred case of sparganosis in the subcutaneous tissue of the right lower leg 1 year after a surgical removal of a worm from a similar region. At admission, ultrasonography (USG) of the lesion strongly suggested sparganosis, and a worm was successfully removed which turned out to be a sparganum with scolex. Since sparganum has a variable life span, and may develop into a life-threatening severe case, a patient once diagnosed as sparganosis should be properly followed-up for a certain period of time. Although imaging modalities were useful for the diagnosis of sparganosis as seen in this case, serological test such as ELISA should also be accompanied so as to support the preoperative diagnosis.

Renoportal anastomosis for dual-graft living donor liver transplantation using an artificial graft and a left renal vein-connected inferior vena cava cuff

Renoportal anastomosis for dual-graft living donor liver transplantation using an artificial graft and a left renal vein-connected inferior vena cava cuff

Sarcoidosis Mimicking Metastatic Breast Cancer in Korean Woman with Breast Cancer

Sarcoidosis Mimicking Metastatic Breast Cancer in Korean Woman with Breast Cancer

Completeness of pedigree and family cancer history for ovarian cancer patients.

ObjectiveTo investigate the completeness of pedigree and of number of pedigree analysis to know the acceptable familial history in Korean women with ovarian cancer.MethodsInterview was conducted in 50 ovarian cancer patients for obtaining familial history three times over the 6 weeks. The completeness of pedigree is estimated in terms of familial history of disease (cancer), health status (health living, disease and death), and onset age of disease and death.ResultsThe completion of pedigree was 79.3, 85.1, and 85.6% at the 1st, 2nd, and 3rd time of interview and the time for pedigree analysis was 34.3, 10.8, and 3.1 minutes, respectively. The factors limiting pedigree analysis were as follows: out of contact with their relatives (38%), no living ancestors who know the family history (34%), dispersed family member because of the Korean War (16%), unknown cause of death (12%), reluctance to ask medical history of relatives (10%), and concealing their ovarian cancer (10%). The percentage of cancers revealed in 1st (2%) and 2nd degree (8%) relatives were increasing through surveys, especially colorectal cancer related with Lynch syndrome (4%).ConclusionAnalysis of pedigree at least two times is acceptable in Korean woman with ovarian cancer from the first study. The completion of pedigree is increasing, while time to take family history is decreasing during three time survey.

Toxic Epidermal Necrolysis in a Patient with HLA-B*5901 Haplotype Caused by Topical and Oral Carbonic Anhydrase Inhibitors.

Dear Editor: Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are severe life-threatening mucocutaneous diseases that involve different extents of epidermal detachment and severity1. Carbonic anhydrase inhibitors (CAIs) are used to decrease intraocular pressure (IOP) in glaucoma2 and may rarely induce TEN/SJS. Moreover, strong genetic associations between human leukocyte antigen (HLA)-B*5901HLA alleles and methazolamide-induced TEN/SJS have been discovered in Koreans3. Herein, we report a case of TEN in a Korean woman with HLA-B* 5901 haplotype, who had taken methazolamide for 1 day and instilled brinzolamide for 10 days. An otherwise healthy 33-year-old Korean woman presented with pruritic, multiple, coalescent, erythematous patches with vesicles on the face and trunk involving erosive oral mucosa (Fig. 1A). Twenty days prior, she visited an ophthalmic clinic complaining of blurred vision after taking phendimetrazine, an anorectic agent, for 2 days. Her IOP was elevated and was treated with methazolamide, brinzolamide 1%/timolol 0.5%, brimonidine 0.15%, and prednisolone 1% eye drops for 1 day. Nevertheless, her IOP remained elevated, and both eyes were treated with argon laser iridotomy. Brinzolamide 1%/timolol 0.5% and brimonidine 0.15% eye drops were administrated for an additional 9 days. Two days after stopping the eye drops, she noted pruritic erythematous macules on the face. Her cutaneous lesions were aggravated and expanded distally with conjunctival and oral mucosal involvements over several days. She had no history of drug allergies, including sulfonamide antibiotics. Personal and family histories were unremarkable. Routine laboratory test results were normal. HLA typing showed B*5901 and B*5204. She was initially treated with dexamethasone 10 mg daily for 2 days, but epidermal necrolysis worsened and became confluent (Fig. 1B, C). Intravenous immunoglobulin (3.5 g/day) was infused for 4 days. Her skin lesions gradually improved within 3 weeks. Fig. 1 (A) Coalescent erythematous macules, papules, and patches with vesicles on the face. (B) Widespread sheet-like epidermolytic detachment on the dorsum. (C) Histopathologic findings show subepidermal bullae, diffuse epidermal necrosis, and mild upper dermal ... In the present case, topical timolol and brimonidine were administrated for 10 days. However, there has been no report of timolol- or brimonidine-associated TEN/SJS. Moreover, neither timolol nor brimonidine appears to cause TEN/SJS, because the relative risk of timolol or brimonidine for TEN/SJS is much lower than that of CAIs. Therefore, CAIs appear to have induced TEN in this patient. Twelve days before the first cutaneous manifestations, she took methazolamide for 1 day while simultaneously instilling brinzolamide for 10 days. Therefore, it is reasonable to postulate that 2 types of CAIs contributed to the induction of TEN in this patient, because either topical or oral CAIs can induce TEN/SJS4. The first methazolamide administrated appears to have played a role in initial phase of sensitization, whereas continual brinzolamide administration appears to have played crucial roles in maturation and/or the initial phase. TEN/SJS encompass idiopathic hypersensitivity reactions to specific drugs and usually occur in people with a genetic predisposition1. A strong and unique genetic association between HLA alleles and drug-induced TEN/SJS has been discovered. In Koreans, HLA-B*5901 is strongly associated with methazolamide-induced TEN/SJS3. The gene frequency of HLA-B*5901 allele in the Korean population is reported to be 2.06%5 and HLA-B*5901 allele was detected in this patient. In summary, both topical and oral CAIs should be administrated cautiously in Koreans.