Changes in the length and area of congenital nevi involving the face and extremities after two serial excisions

Background@#The objective of this study was to determine the outcome of serial excisions of congenital nevi involving the face and extremities and to calculate changes in the area and length of the nevi. @*Methods@#Data from 18 patients with congenital nevi who underwent serial excisions from 2005 to 2017 were retrospectively reviewed. There were 12 congenital nevi involving the face and six involving the extremities. Two serial excisions were performed in all cases. The final diagnosis was confirmed by histology. Postoperative outcomes were analyzed photogrammetrically. The clinical outcomes were analyzed through ordinary scales. @*Results@#The mean age of patients and the median area, length, and width of congenital nevi on the face and extremities were 9.4 and 15.2 years, 189.8 and 487.8 mm2, 21.1 and 35.0 mm, and 13.2 and 19.6 mm, respectively. After the first operation, photogrammetric analysis showed a 64.6% reduction in the area of facial nevi and a 68.1% reduction for nevi on the extremities. The final scar length increased by 62.8% for the face and 73% for the extremities compared to before surgery. A clinical assessment demonstrated excellent results for the removal of the congenital nevi, without any deformation of the surrounding structures, and good final scar quality. @*Conclusions@#This study will contribute to the prediction of results of each stage when serial excision is required.

Changes in the length and area of congenital nevi involving the face and extremities after two serial excisions

Background@#The objective of this study was to determine the outcome of serial excisions of congenital nevi involving the face and extremities and to calculate changes in the area and length of the nevi. @*Methods@#Data from 18 patients with congenital nevi who underwent serial excisions from 2005 to 2017 were retrospectively reviewed. There were 12 congenital nevi involving the face and six involving the extremities. Two serial excisions were performed in all cases. The final diagnosis was confirmed by histology. Postoperative outcomes were analyzed photogrammetrically. The clinical outcomes were analyzed through ordinary scales. @*Results@#The mean age of patients and the median area, length, and width of congenital nevi on the face and extremities were 9.4 and 15.2 years, 189.8 and 487.8 mm2, 21.1 and 35.0 mm, and 13.2 and 19.6 mm, respectively. After the first operation, photogrammetric analysis showed a 64.6% reduction in the area of facial nevi and a 68.1% reduction for nevi on the extremities. The final scar length increased by 62.8% for the face and 73% for the extremities compared to before surgery. A clinical assessment demonstrated excellent results for the removal of the congenital nevi, without any deformation of the surrounding structures, and good final scar quality. @*Conclusions@#This study will contribute to the prediction of results of each stage when serial excision is required.

A Disintegrin and Metalloproteinase 8 as a Potential Blood Biomarker for Early Diagnosis of Gastric Cancer

PURPOSE: We aimed to evaluate the clinical significance of a disintegrin and metalloproteinase 8 (ADAM 8) as a potential blood biomarker for gastric cancer (GC). MATERIALS AND METHODS: Blood ADAM 8 was measured by ELISA. Cytokines/chemokines [interleukin-23 (IL-23), stromal cell-derived factor 1α/CXC chemokine ligand 12 (SDF-1α/CXCL12), interleukin-8 (IL-8), and soluble CD40 ligand (sCD40L)] were measured by chemiluminescent immunoassay. They were compared among five groups; normal/gastritis, high-risk, early GC (EGC), advanced GC (AGC) without distant metastasis, and AGC with distant metastasis by one-way analysis of variance in both training (n=80) and validation dataset (n=241). Clinicopathological features of GC and GC-associated cytokines were evaluated for their correlations with blood ADAM 8. To evaluate the diagnostic accuracy to predict GC, receiver operating characteristic (ROC) curve and logistic regression were used. RESULTS: Blood ADAM 8 significantly increased along GC carcinogenesis in both training (ANOVA, p<0.001) and validation dataset (p<0.001). It was significantly higher in EGC compared to high-risk (post-hoc Bonferroni, p=0.041) and normal (p<0.001). It was also higher in AGC compared with high-risk (p<0.001) and normal (p<0.001) groups. However, no significant difference was found between cancer groups. Blood ADAM 8 was correlated with N-stage (Spearman's correlation, γs=0.320, p=0.011), but not with T-stage or M-stage. Pearson's correlations showed blood ADAM 8 was closely correlated with pre-inflammatory cytokines, IL-23 (p=0.036) and SDF-1α/CXCL12 (p=0.037); however, it was not correlated with pro-angiogenic cytokine IL-8 (p=0.313), and sCD40L (p=0.702). ROC curve and logistic regression demonstrated that blood ADAM 8 showed higher diagnostic accuracy (sensitivity, 73.7%; specificity, 86.2%) than CEA (sensitivity, 23.1%; specificity, 91.4%). Combination of ADAM 8 and CEA further increased the diagnostic accuracy to predict GC (sensitivity, 81.8%; specificity, 84.0%). CONCLUSION: Blood ADAM 8 is a promising biomarker for early detection of GC.

Schwannoma Originating from Infraorbital Nerve

Schwannomas are well-differentiated solitary benign tumors that originate from the schwann cells of the nerve sheath. They can readily occur in the head and neck regions, but the schwannoma originating from the infraorbital nerve is extremely rare and usually painless, slow-growing, and without specific symptoms. The author experienced a rare case of infraorbital schwannoma, which was completely removed through the intraoral approach. A 20-year-old woman was admitted to our hospital for a painless, solid and circular mass located on the right infraorbital region. The eyeball movement and visual field were normal. There was no globe displacement or proptosis. Preoperative computed tomography demonstrated 13x10x5 mm-sized soft tissue mass. On March 2011, the mass was removed through an intraoral approach. On histopathological examination, the gross specimen consisted of a smooth, well-encapsulated and light yellowish solid mass, measuring 12x7x5 mm. Microscopically, it presented a typical manifestation of schwannoma with Antoni A area with Verocay body, and Antoni B area on H&E stain. The result of the immunohistochemical staining was positive for the S-100 protein. The patient had hypoesthesia of the nasal septum and vestibule in the postoperative period, and this finding confirmed that the internal nasal branch of infraorbital nerve was the nerve in which the schwannoma originated. Infraorbital schwannomas are very rare and must be included in the differential diagnosis of the orbital masses inferior to the eyeball. In the case of early diagnosis, the small-sized infraorbital schwannomas can be completely removed without any scar through an intraoral approach.

Analysis and Management of Complications of Open Reduction and Medpor Insertion through Transconjunctival Incision in Blowout Fractures

PURPOSE: In accordance to an increased interest in facial appearance and the popularization of computed tomography scanning, the number of diagnosis and treatment of blowout fractures has been increased. The purpose of this article is to review pure blowout fracture surgery through transconjunctival incision focusing on complications and their management. METHODS: In this retrospective study, 583 patients, who had been treated for pure blowout fracture through transconjunctival incision from 2000 to 2009, were evaluated. Their hospital records were reviewed according to their sex, age, fracture site, preoperative presentations, time interval between trauma and surgery, and postoperative complications. RESULTS: According to postoperative follow-up results, there were early complications that included wound dehiscence and infection (0.2%), hematoma (insomuch as extraocular movement is limited) (0.7%), lacriminal duct injury (0.5%), and periorbital nerve injury (0.7%). In addition, there were late complications that lasted more than 6 months, that included persistent diplopia (1.7%), extraocular movement limitation (0.9%), enophthalmos (1.0%), periorbital sensation abnormalities (1.0%), and entropion (0.5%). CONCLUSION: We propose the following guidelines for prevention of postoperative complications: layer by layer closure; bleeding control with the epinephrine gauzes, Tachocomb, and Tisseel; conjunctival incision 2 to 3 mm away from punctum; avoidance of excessive traction; performing surgical decompression and high dose corticosteroid therapy upon confirmation of nerve injury; atraumatic dissection and insertion of Medpor Barrier implant after securing a clear view of posterior ledge; using Medpor block stacking technique and BioSorb FX screw fixation; performing a complete resection of the anterior ethmoidal nerve during medial wall dissection; and making an incision 2 to 3 mm below the tarsal plate.

Analysis and Management of Complications of Open Reduction and Medpor Insertion through Transconjunctival Incision in Blowout Fractures

PURPOSE: In accordance to an increased interest in facial appearance and the popularization of computed tomography scanning, the number of diagnosis and treatment of blowout fractures has been increased. The purpose of this article is to review pure blowout fracture surgery through transconjunctival incision focusing on complications and their management. METHODS: In this retrospective study, 583 patients, who had been treated for pure blowout fracture through transconjunctival incision from 2000 to 2009, were evaluated. Their hospital records were reviewed according to their sex, age, fracture site, preoperative presentations, time interval between trauma and surgery, and postoperative complications. RESULTS: According to postoperative follow-up results, there were early complications that included wound dehiscence and infection (0.2%), hematoma (insomuch as extraocular movement is limited) (0.7%), lacriminal duct injury (0.5%), and periorbital nerve injury (0.7%). In addition, there were late complications that lasted more than 6 months, that included persistent diplopia (1.7%), extraocular movement limitation (0.9%), enophthalmos (1.0%), periorbital sensation abnormalities (1.0%), and entropion (0.5%). CONCLUSION: We propose the following guidelines for prevention of postoperative complications: layer by layer closure; bleeding control with the epinephrine gauzes, Tachocomb, and Tisseel; conjunctival incision 2 to 3 mm away from punctum; avoidance of excessive traction; performing surgical decompression and high dose corticosteroid therapy upon confirmation of nerve injury; atraumatic dissection and insertion of Medpor Barrier implant after securing a clear view of posterior ledge; using Medpor block stacking technique and BioSorb FX screw fixation; performing a complete resection of the anterior ethmoidal nerve during medial wall dissection; and making an incision 2 to 3 mm below the tarsal plate.

Enlarged Lipogranuloma after Closed Reduction of Nasal Bone Fracture: A Case Report

PURPOSE: Lipogranuloma is the reaction of adipose tissue to various oils, paraffin, and other hydrocarbons injected into subcutaneous tissue for cosmetic or other reasons. The authors experienced a case of sclerosing lipogranuloma on the nasal dorsum. METHODS: A 42-year-old female, without a history of the injection of any foreign materials, was admitted on our hospital for a painless, irregular, and firm mass located on her nasal dorsum with step-off deformity. It was considered that the mass had developed after augmentation rhinoplasty. The size of mass had been increased after closed reduction of nasal bone fracture. On April 2011, under general anesthesia, the mass was removed by open rhinoplasty technique. In addition, a pathologic examination was performed. After the mass extirpation, dermofat graft was performed for the correction of depression deformity. RESULTS: The histopathological findings demonstrated a Swiss cheese pattern with variably-sized vacuoles, which corresponded to lipid removed with tissue processing, and variable foreign body giant cell reaction, fat necrosis, and hyalinized fibrous tissue. The pathologic diagnosis is lipogranuloma replacing nasalis muscle. It has been considered that sclerosing lipogranuloma is caused by nerve injury during augmentation rhinoplasty and the ointment used after the closed reduction of nasal bone fracture, which infiltrated through the injured mucosa. CONCLUSION: During the treatment of rhinoplasty or nasal bone fracture, the nerve injury or the ointment use can lead to lipogranuloma. Therefore, careful dissection for avoidance of the nerve injury and limited use of ointment seems to be helpful in decreasing incidence of lipogranuloma.

Enlarged Lipogranuloma after Closed Reduction of Nasal Bone Fracture: A Case Report

PURPOSE: Lipogranuloma is the reaction of adipose tissue to various oils, paraffin, and other hydrocarbons injected into subcutaneous tissue for cosmetic or other reasons. The authors experienced a case of sclerosing lipogranuloma on the nasal dorsum. METHODS: A 42-year-old female, without a history of the injection of any foreign materials, was admitted on our hospital for a painless, irregular, and firm mass located on her nasal dorsum with step-off deformity. It was considered that the mass had developed after augmentation rhinoplasty. The size of mass had been increased after closed reduction of nasal bone fracture. On April 2011, under general anesthesia, the mass was removed by open rhinoplasty technique. In addition, a pathologic examination was performed. After the mass extirpation, dermofat graft was performed for the correction of depression deformity. RESULTS: The histopathological findings demonstrated a Swiss cheese pattern with variably-sized vacuoles, which corresponded to lipid removed with tissue processing, and variable foreign body giant cell reaction, fat necrosis, and hyalinized fibrous tissue. The pathologic diagnosis is lipogranuloma replacing nasalis muscle. It has been considered that sclerosing lipogranuloma is caused by nerve injury during augmentation rhinoplasty and the ointment used after the closed reduction of nasal bone fracture, which infiltrated through the injured mucosa. CONCLUSION: During the treatment of rhinoplasty or nasal bone fracture, the nerve injury or the ointment use can lead to lipogranuloma. Therefore, careful dissection for avoidance of the nerve injury and limited use of ointment seems to be helpful in decreasing incidence of lipogranuloma.

Effect of Carboxymethylcellulose with Low and High Degree of Substitution on Wound Healing

PURPOSE: Wound healing is a dynamic and complex process of tissue repair that involves a number of cellular and molecular events, which is characterized by intercalating degradation and re-assembly of connective tissue and epidermal layer. Carboxymethyl cellulose (CMC) is one of the most common hydrofiber dressing. This material have a various degree of substitution. Our goal was to test the efficacy of Carboxymethyl cellulose with low and high degree of substitution on wound healing. METHODS: Four round (diameter 2 cm) wounds were made bilaterally on the dorsum of the all rat's trunk and were divided into four groups of dressing material: Group A with gauze dressing as a negative control group, Group B with high gel (DS=0.3), Group C with Aquacel(R) (ConvaTec, US) as a positive control group, Group D with low gel (DS= 0.15). We compared each group with gross findings by means of percentage of wound contraction, percentage of wound epithelization, and percentage of total wound healed area by tracing the remained wound area on each time periods. RESULTS: Group B and C show statistically higher percentage of wound contraction and higher percentage of wound healed than the other groups until 14th day after wound formation. Group D shows higher percentage of wound epithelization rate in early days, but it was reversed that Group B and C show statistically higher percentage of wound epithelization on 21st day after wound formation. Histologically, Group B and C show less inflammatory cell infiltration, faster and more prominent angiogenesis. On the 21st day after wound formation, collagen fibers was more regularly and densely arranged on Group B and C than the other groups. CONCLUSION: This study suggest Carboxymethylcellulose with high degree of substitution induces stable reepithelization and collagen synthesis in the wound healing process and have optimal effective results and is expected as more application of a various property of Carboxymethylcellulose for treatment of wound healing.

Telecanthus Associated with Blepharoptosis

PURPOSE: Blepharoptosis is often associated with telecanthus and the presence of epicanthal fold in telecanthus is one of unique features in Asian eyelids. The purpose of this article is to define telecanthus and pseudotelecanthus, and to determine optimal surgical procedure depending on classification of telecanthus. METHODS: Among 187 patients with blepharoptosis who had the advancement procedure of the Muller's muscle-levator aponeurosis composite flap for ptosis, 55 patients underwent Flowers' split V-W plasty concomitantly with shortening the medial canthal tendon for correction of telecanthus from September 2003 to January 2011. Among them, 52 patients were followed up for 16 months. We newly defined telecanthus because Mustarde ratio is inaccurate to measure in certain cases and then made a definition of pseudotelecanthus. Besides, we also classified telecanthus into mild, moderate and severe types based on its severity. RESULTS: Telecanthus is defined when the ICD (inner canthal distance) is greater than 110% of normal ICD. Pseudotelecanthus is a telecanthus like a wide skin bridge formed between the eyes because of the epicanthal fold in the normal ICD. Flowers' split V-W plasty combined with shortening medial canthal tendon was very effective in mild and moderate telecanthus with almost invisible scar and no recurrence occurring. In severe types, however, it showed high incidence (28%) of incomplete correction of telecanthus. CONCLUSION: New definition of telecanthus can be easily applied to any case and we think the classification of telecanthus is useful to select an appropriate operative procedure. Split V-W plasty with shortening of medial canthal tendon is a very effective procedure in mild and moderate telecanthus. Besides, it is also effective in improving the treatment outcomes of ptosis in cases of blepharoptosis associated with telecanthus.

Treatment of Postburn Facial Hyperpigmentation with Vitamin C Iontophoresis

PURPOSE: Many facial burn patients suffer from hyperpigmentation and its treatment has been challenging. Vitamin C(ascorbic acid) has important physiologic effects on skin, including inhibition of melanogenesis, promotion of collagen biosynthesis, prevention of free radical formation, and acceleration on wound healing. The purpose of this study is to evaluate the effectiveness of Vitamin C iontophoresis for the treatment of postburn hyperpigmentation. METHODS: The authors performed a retrospective analysis of 93 patients who were admitted for the treatment of facial burn from February 2008 through February 2010. Among them, 51 patients were treated with Vitamin C iontophoresis to control postburn hyperpigmentation and 42 patients were not. Experimental group was chosen 20 of 51 patients who had been treated with Vitamin C iontophoresis and had normal facial skin on the comparable contralateral aesthetic unit. Control group was chosen 20 of 42 patients who were not treated with Vitamin C iontophoresis and had also contralateral normal aesthetic unit. The resulting color of 20 patients who were treated with Vitamin C iontophoresis was compared with the color of the contralateral normal facial skin using a digital scale color analysis. Results were analyzed with Wilcoxon signed rank test. RESULTS: The analysis revealed significant improvement of hyperpigmentation in the experimental group compared to control group. The difference of intial value and the value in 6 months showed significant change. Mean(Delta(initial)-Delta(6month)) of experimental group was 11.61 and control group was 7.23. Thus, the difference between the experimental group and the control group was 4.38. Therefore, Vitamin C iontophoresis revealed significant improvement of hyperpigmentation in the experimental group compared with control group. CONCLUSION: Vitamin C iontophoresis is an effective treatment modality for postburn hyperpigmentation.

Nerve Injuries after the Operations of Orbital Blow-out Fracture

PURPOSE: In accordance with the increasing number of accidents caused by various reasons and recently developed fine diagnostic skills, the incidence of orbital blow-out fracture cases is increasing. As it causes complications, such as diplopia and enophthalmos, surgical reduction is commonly required. This article reports a retrospective series of 5 blow-out fracture cases that had unusual nerve injuries after reduction operations. We represents the clinical experiences about treatment process and follow-up. METHODS: From January 2000 to August 2009, we treated total 705 blow-out fracture patients. Among them, there were 5 patients(0.71%) who suffered from postoperative neurologic complications. In all patients, the surgery was performed with open reduction with insertion of Medpor(R). Clinical symptoms and signs were a little different from each other. RESULTS: In case 1, the diagnosis was oculomotor nerve palsy. The diagnosis of the case 2 was superior orbital fissure syndrome, case 3 was abducens nerve palsy, and case 4 was idiopathic supraorbital nerve injury. The last case 5 was diagnosed as optic neuropathy. Most of the causes were extended fracture, especially accompanied with medial and inferomedial orbital blow-out fracture. Extensive dissection and eyeball swelling, and over-retraction by assistants were also one of the causes. Immediately, we performed reexploration procedure to remove hematomas, decompress and check the incarceration. After that, we checked VEP(visual evoked potential), visual field test, electromyogram. With ophthalmologic test and follow-up CT, we can rule out the orbital apex syndrome. We gave Salon(R)(methylprednisolone, Hanlim pharmaceuticals) 500 mg twice a day for 3 days and let them bed rest. After that, we were tapering the high dose steroid with Methylon(R)(methylprednisolon 4 mg, Kunwha pharmaceuticals) 20 mg three times a day. Usually, it takes 1.2 months to recover from the nerve injury. CONCLUSION: According to the extent of nerve injury after the surgery of orbital blow-out fracture, the clinical symptoms were different. The most important point is to decide quickly whether the optic nerve injury occurred or not. Therefore, it is necess is to diagnose the nerve injury immediately, perform reexploration for decompression and use corticosteroid adequately. In other words, the early diagnosis and treatment is most important.

A Study on Health Hazards of Cold Exposed Workers / 대한산업의학회지

In order to evaluate the status of cold exposure and its health hazards of workers at cold storage workplaces and to provide basic data for effective health care, the author measured core temperature and also observed clinical symptoms and signs, past and present history, and general health examination data on 99 cold exposed workers for exposure group and 96 non-exposed workers for control group working at 2 food refrigerating companies in Pusan area from January 6, 1998 to February 24, 1998. The results were as follows : 1. There was statistically significant difference in water intake between the exposure and control group and increased urine volume, urine frequency in exposure group without statistically significant difference. 2. Past and present illness in exposure group were hypertension (18.2%), hepatopathy(8. 1%). gastro-intestinal disease(7. 1%). arthritis (4.0%), intervertebral disc herniation(4.0%). and so on, and hypertension, arthritis was statistically significant difference compared to control group. 3. Symptoms inexposure group were. fatigue(89.9%), headache (64.6%), drowsy(63.6%), neck stiffness(59.6%), excessive food intake (59.6%). general weakness(58.6%), hunger(58. 6%), numbness(54. 5%), and so on, and there was statistically significant difference between the exposure and control group except fatigue, drowsy. 4. As results of clinical test abnormality rate of the systolic, diastolic blood pressure and electrocardiogram were significantly higher in exposed group that control. 5. Core temperature in exposure group was statistically significantly lower than control group and the highest statistically significant inverse correlation with the working hours and working frequency of daily mean cold storage. As above results, the author suggested that the further studies should be conducted to evaluate the health status of workers about chronic health effects in cold workplaces and to establish effective health care methods for them.