Retrospective study about the postoperative stability of zygomaticomaxillary complex fracture / 대한악안면성형재건외과학회지

Background@#The aim of this study is to evaluate the postoperative stability of zygomaticomaxillary complex (ZMC) fractures according to the number of fixation sites and to investigate the direction of postoperative displacement of the unfixed part of the fractured segment. @*Methods@#This study was retrospectively performed on 38 patients who were treated by open reduction and internal fixation of ZMC fractures and were taken postoperative computed tomography (CT) between February 2012 and July 2019. The patients were classified into 3 groups: 1-point fixation, 2-point fixation, 3-point fixation according to the number of fixations. The postoperative displacement of the fractured segment was evaluated by the superimposition between postoperative CT and follow-up CT, and the postoperative stability according to the fixation sites was investigated through the amount of postoperative displacement. In addition, it was investigated in which direction the location of the fractured segment was changed in the unfixed fractured segment according to the fixation sites. @*Results@#The amount of postoperative displacement of the fractured segment was 0.75 ± 1.18 mm on average. In the postoperative displacement of the distal area according to the number of fixation of the fracture, there was no statistically significant difference in the amount of displacement of the fracture (p = 0.574). As for the direction of the change in the location of the fractured segment, 12 patients among 38 patients with the change in the location of the fractured segment were investigated, and the displacement in the medial direction (n = 11, 91.67%) was the most common in all three fixation methods. @*Conclusion@#In patients with a ZMC fracture who were treated by open reduction and internal fixation, the number of fixations did not make the difference in the postoperative displacement of the fracture. In addition, the fractured segment mainly changes in the medial direction after surgery, and this fact can be used as a reference for the reduction direction during surgery for the stable prognosis.

A Case of Eccrine Poroma on the Subungual Area / 대한피부과학회지

No abstract available.

Effectiveness of Sodium Picosulfate/Magnesium Citrate (PICO) for Colonoscopy Preparation

PURPOSE: Bowel preparation with sodium phosphate was recently prohibited by the U.S. Food and Drug Administration. Polyethylene glycol (PEG) is safe and effective; however, it is difficult to drink. To identify an easy bowel preparation method for colonoscopy, we evaluated three different bowel preparation regimens regarding their efficacy and patient satisfaction. METHODS: In this randomized, comparative study, 892 patients who visited a secondary referral hospital for a colonoscopy between November 2012 and February 2013 were enrolled. Three regimens were evaluated: three packets of sodium picosulfate/magnesium citrate (PICO, group A), two packets of PICO with 1 L of PEG (PICO + PEG 1 L, group B), and two packets of PICO with 2 L of PEG (PICO + PEG 2 L, group C). A questionnaire survey regarding the patients' preference for the bowel preparation regimen and satisfaction was conducted before the colonoscopies. The quality of bowel cleansing was scored by the colonoscopists who used the Aronchick scoring scale and the Ottawa scale. RESULTS: The patients' satisfaction rate regarding the regimens were 72% in group A, 64% in group B, and 45.9% in group C. Nausea and abdominal bloating caused by the regimens were more frequent in group C than in group A or group B (P < 0.01). Group C showed the lowest preference rate compared to the other groups (P < 0.01). Group C showed better right colon cleansing efficacy than group A or group B. CONCLUSION: Group A exhibited a better result than group B or group C in patient satisfaction and preference. In the cleansing quality, no difference was noted between groups A and C.

The Reverse Nasolabial Flap with a Cartilage Graft for the Repair of a Full-Thickness Alar Defect: A Single-Stage Procedure

A 65-year-old woman with a deeply infiltrating basal cell carcinoma in the right ala underwent full-thickness excision of most of the ala, including the alar rim, crease, and the adjacent cheek, leaving a 'through-and-through' defect. Reconstruction was performed by using the reverse nasolabial flap and a cartilage graft across the alar defect, harvested from the concha, to prevent nostril collapse and to maintain the alar shape. The reverse or turnover nasolabial flap is a variant of the conventional nasolabial flap; however, it may be more suited for the repair of a full-thickness, lateral alar defect. The reverse nasolabial flap functions both as an inner liner and an outer cover and the repair is performed as a single-stage procedure. Furthermore, this flap can provide both excellent function and excellent cosmetic outcome.

Auricular Composite Chondrocutaneous Grafts in the Repair of Nasal Alar Rim Defects

No abstract available.

Efficacy of Radiation Therapy Following Keloidectomy on the Recurrence / 대한피부과학회지

BACKGROUND: The treatment of keloids is unsatisfactory and even a challenge to many dermatologists or dermatosurgeons. Simple excision of a keloid alone is associated with a high recurrence rate. Thus, surgical treatment should be combined with various adjuvant therapies. OBJECTIVE: The aim of this study was to evaluate the efficacy of postoperative radiation therapy on the recurrence of keloids. METHODS: Between March 2007 and May 2012, 24 patients with keloids (n=56) in various anatomical sites were treated with our protocol consisting of total or subtotal keloidectomy followed by immediate irradiation of 12~18 Gy in 3 fractions over 3 days with pre- and postoperative intralesional steroid injection as an adjuvant therapy. After a year to a year and a half, treatment was terminated at that point. RESULTS: When treated keloids were classified according to the degree of flattening, the outcomes were excellent in 48.2% (27/56) of the patients, good in 32.1% (18/56), fair in 14.3% (8/56), and poor in 5.3% (3/56). This treatment protocol showed almost excellent outcomes in earlobe, earhelix, retroauricular region and abdomen. Although the sites with high stretch tension such as chest and shoulder showed above good outcomes (72%, 18/25), they also showed three poor results. The most common complication was postinflammatory hyperpigmentation while the most serious one was full-thickness skin necrosis, which was recovered by skin graft later. CONCLUSION: Radiation therapy is an effective and safe therapy for the prevention of recurrence of keloids following keloidectomy.

Surgical Treatment of Lip Hypertrophy Secondary to Port-wine Stain / 대한피부과학회지

BACKGROUND: Port-wine stain (PWS) is a congenital capillary malformations characterized by ectasia of capillaries and venules. These vascular channels progress gradually to hyperplasia of soft and hard tissues, manifested as hypertrophy of involved structures. Especially, when these lesions involve the lip, macrocheilia may develop with time. Usually vascular-specific laser treatment is used for PWS, however with no favorable effect with soft-tissue hypertrophy. Therefore, surgical treatment may be necessary in such cases. OBJECTIVE: The subjects were 9 patients who had PWS with lip hypertrophy, who were aged from 9 to 65 years. METHODS: The patients underwent cheiloplasty which include making an incision horizontally on a labial mucosa of the lip, and dissection of hypertrophied soft tissue in the front and back of the orbicularis oris muscle. RESULTS: Of the 9 patients, only 2 had postoperative complication such as mild chewing of the labial mucosa. After a minor revision surgery, these symptoms disappeared. Good to excellent results were achieved in all patients during the final postoperative cosmetic evaluation. CONCLUSION: Surgical correction is appropriate for treatment of three-dimensional tissue deformity such as lip hypertrophy with good cosmetic results and minimal complications.

Optimal positive end-expiratory pressure during robot-assisted laparoscopic radical prostatectomy / 대한마취과학회지

BACKGROUND: Increased intra-abdominal pressure during laparoscopic surgery causes cephalad displacement of the diaphragm, resulting in the formation of atelectasis, which can be overcome by positive end-expiratory pressure (PEEP). The aim of this prospective study was to investigate the level of optimal PEEP to maintain adequate arterial oxygenation and hemodynamics during robot-assisted laparoscopic radical prostatectomy (RLRP). METHODS: One hundred patients undergoing RLRP were randomly allocated to one of five groups (n = 20) (0, 3, 5, 7 and 10 cmH2O of PEEP). Hemodynamic variables and respiratory parameters were measured at baseline with the patient in the supine position; at 30 min, 1, 2, 3 and 4 h during CO2 insufflation with the patient in the post-Trendelenburg position; and after deflation in the supine position with increasing PEEP. RESULTS: The PaO2 levels and alveolar-arterial difference in oxygen tension (AaDO2) were improved in patients with PEEPs compared with patients in whom PEEP was not used. The application of PEEP (10 cmH2O) resulted in higher PaO2 levels compared to those with lower PEEP levels, but excessive peak airway pressure (PAP) was sometimes observed. The application of a PEEP of 7 cmH2O resulted in similar PaO2 levels without causing excessive PAP. There was a significant difference in central venous pressure between the groups, but there were no significant differences in heart rate, mean arterial pressure or minute ventilation between the groups. CONCLUSIONS: A PEEP of 7 cmH2O is associated with the greater improvement of PaO2 and AaDO2 without causing excessive PAP during RLRP.

Spontaneous Regression of Merkel Cell Carcinoma / 대한피부과학회지

Merkel cell carcinoma is a malignant neuroendocrine tumor with a high rate of recurrence and metastasis. However, approximately 23 cases of spontaneous regression have been reported. We report a case of Merkel cell carcinoma which showed spontaneous regression. The patient was an 84-year-old male with a large red-colored, hemispheric tumor on the left inner thigh which had been presented for a year. We planned to perform surgery, but the tumor suddenly started to regress spontaneously. The size of the tumor decreased, the surface was flattened, and the color changed from red to brown. The lesion finally appeared as a brownish flat plaque. Excision of the regressed tumor was performed; immunohistopathological analysis showed CD3+ T cells infiltrating around the regressed merkel cell carcinoma.

Papular Elastorrhexis in Down's Syndrome / 대한피부과학회지

No abstract available.

The effect of hand dominance on neuromuscular monitoring at the adductor pollicis muscle / 대한마취과학회지

BACKGROUND: Neuromuscular blockade of the adductor pollicis muscle may be influenced by hand dominance resulting in conflicting results of several studies. The current study examined whether hand dominance could influence the measurements of neuromuscular blockade with acceleromyography at the adductor pollicis. METHODS: The acceleromyographic responses from 0.6 mg/kg of rocuronium were monitored supramaximally in both hands in 31 patients after induction of anesthesia. Onset, maximum effect, and offset of rocuronium were measured and compared in both hands. The train-of-four (TOF) ratios to 0.9 were recorded in all patients. RESULTS: In total, 27 patients were right-handed and 4 patients were left-handed. The mean supramaximal threshold or initial TOF ratio was not different between dominant and nondominant hands. No statistically significant differences were found between 716 paired TOF ratios in both hands. A correlation was seen between the dominant and nondominant hand (Nondominant = 0.931.Dominant + 1.714, R = 0.929). The analysis by the Bland-Altman plot showed an excellent agreement with a bias of 1.6% and limits of agreement of -21.2 to 24.5%. CONCLUSIONS: Dominant and nondominant hands can be used interchangeably for neuromuscular monitoring at the adductor pollicis.

Hemodynamic parameters during robotic radical prostatectomy in elderly patients with increased cardiac risk

BACKGROUND: We studied the hemodynamic changes associated with steep Trendelenburg position and prolonged pneumoperitoneum during robot-assisted laparoscopic prostatectomy in elderly patients with cardiac diseases. METHODS: Hemodynamic variables were measured at baseline supine position, at 30 min, 1, 2, 3 and 4 h during CO2 insufflation in post-Trendelenburg position, and after deflation in the supine position. RESULTS: In comparison with normal subjects, the cardiac index and systemic vascular resistance index of patients with cardiac diseases were significantly affected by the Trendelenburg position and pneumoperitoneum (P < 0.001). However, other variables of heart rate, mean arterial pressure and central venous pressure were not differed between the groups. CONCLUSIONS: We conclude that attention should be paid to maintain adequate hemodynamic status during prolonged pneumoperitoneum in the Trendelenburg position, and which is unfeasible in patients with severe heart failure and unstable angina.

Scleromyxedema with Monoclonal Gammopathy / 대한피부과학회지

Scleromyxedema is a rare disorder characterized by generalized papular and sclerodermoid eruption, increased fibroblast proliferation, mucin deposition, and monoclonal gammopathy in the absence of thyroid disease. It is a generalized subtype of lichen myxedematosus. A paraproteinemia, typically an IgG lambda, is observed in more than 80% of patients with scleromyxedema. Here, we report a 38-year-old woman with a 1-year history of a progressively spreading of eruption of small papules on the entire body, including the face, neck, arms, legs, and trunk. Laboratory tests were within normal limits, except lambda light chain monoclonal gammopathy. We administered oral retinoid and topical steroid with slight clinical improvement. To our knowledge, this is the first reported case of scleromyxedema in Korea.

A comparison of the accuracy of ulnar versus median nerve stimulation for neuromuscular monitoring / 대한마취과학회지

BACKGROUND: Inexperienced anesthesiologists are frequently unclear as to whether to stimulate the ulnar or median nerve to monitor the adductor pollicis. The primary purpose of this study was to determine whether monitoring the adductor pollicis by positioning the stimulating electrodes over the median nerve is an acceptable alternative to applying electrodes over the ulnar nerve. METHODS: In 20 patients anesthetized with propofol and remifentanil, one pair of stimulating electrodes was positioned over the ulnar nerve. A second pair was placed over the median nerve on the other hand. The acceleromyographic response was monitored on both hands. Rocuronium 0.6 mg/kg was administered. Single twitch (ST) and train-of-four (TOF) stimulations were applied alternatively to both sites. RESULTS: None of the patients showed a twitch response at either site after injection of rocuronium. There were no differences in the mean supramaximal threshold, mean initial TOF ratio, or mean initial ST ratio between the two sites. Bland-Altman analysis revealed a bias (limit of agreement) in the TOF and ST ratios over the median nerve of 7% (+/- 31%) and 26% (+/- 73%), respectively, as compared with the ulnar nerve. The median nerve TOF ratio was overestimated by 16.2%, as compared with that of the ulnar nerve value, and the median nerve ST ratio was overestimated by 72.9%, as compared to that of the ulnar nerve. CONCLUSIONS: The ulnar and median nerves cannot be used interchangeably for accurate neuromuscular monitoring.

Lymphoepithelioma-like Carcinoma of the Upper Eyelid / 대한피부과학회지

Lymphoepithelioma-like carcinoma is a neoplasm at extranasal sites with striking histological similarity to lymphoepithelioma arising in the nasopharynx. The tumor is composed of islands of pleomorphic cells with a lymphocytic infiltrate. The head and neck are the principal locations for this tumor, which occurs in the skin. Differential diagnoses include squamous cell carcinoma, Merkel cell tumor, lymphoma, cutaneous lymphadenoma, malignant melanoma, and metastatic lymphoepithelioma. Here, we report a case of lymphoepithelioma-like carcinoma of the skin in a 78 year-old male who had a firm nodule on the right upper eyelid. He was treated with wide excision and local flap coverage. The patient had been disease-free for more than 1 year.

Multiple, Giant Soft Fibromas in the Labium Majus / 대한피부과학회지

Soft fibromas are benign fibrous tissue tumors of the dermis. In general, they appear as small, soft, pedunculated or sessile tumors and they are mostly located on the axillae, lateral neck and inguinal region. Although large sized soft fibromas may occur in the groin or upper thighs, and especially in patients with diabetes, they rarely exceed 2 cm in size. We report herein a case of multiple giant soft fibromas, including an unusually huge, giant lesion in the labium majus of a healthy, middle-aged woman, and such fibromas on the labium majus are very rare.

The Usefulness of FDG-PET/CT for the Prediction of Regional Lymph Node Metastases in Colorectal Cancer

PURPOSE: Proper preoperative staging is important in planning optimal therapy for individual patients and improving outcome. There is no ideal imaging methods for accurate colorectal cancer staging. The purpose of our study was to determine the usefulness of fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT) for the status of regional lymph node metastasis in colorectal cancer. METHODS: Two hundred forty six surgically resected colorectal cancers were retrospectively reviewed from Jan 2007 to Jul 2009. All patients underwent abdominal CT and FDG-PET/CT preoperatively. RESULTS: There were 129 males (52.4%) and the mean age was 62 (range: 25~88 years). Tumor location was the colon in 148 (59.7%) patients, and the rectum in 98 (40.3%) patients. Pathological stages were I: 43 (17.5%), II: 78 (31.7%), III: 81 (32.9%), IV: 44 (17.9%). Regional lymph node metastasis by pathological examination was 118 (48%) patients. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of regional lymph node staging were 66.4%, 66.7%, 64.8%, 68.3%, and 67%, respectively, with the FDG-PET/CT, and 57.1%, 71.3%, 64.8%, 64.3%, and 65%, respectively, with whole abdominal CT. The difference in the accuracy of nodal staging between the two modalities was not significant. CONCLUSION: The diagnostic accuracy of FDG-PET/CT for the assessment of regional lymph node metastasis in colorectal cancer was relatively low, and similar to that of abdominal CT. Therefore, further study will be needed to determine the clinical usefulness of preoperative FDG-PET/CT in colorectal cancer.

Langerhans Cell Histiocytosis That Improved with Oral Isotretinoin Therapy / 대한피부과학회지

Langerhans cell histiocytosis (LCH) is a reactive disease in which abnormal Langerhans cells accumulate in various body sites. We report here on a 51-year-old male patient with LCH that was classified as single-system disease (restricted LCH). The skin lesions were a small, deep ulcer in the right inguinal area and multiple erythematous papules scattered on the lower abdomen, and the patient had these lesions for 1 year. The histopathologic examination revealed a dense histiocytic infiltration in the dermis, and most of the cells showed the characteristics of "LCH" cells. The immunohistochemistry for S-100 protein and CD1a complex all showed positive results. The patient was much improved after surgical excision of the inguinal ulcer and administering oral isotretinoin (20 mg daily) for 8 months, and there was no recurrence. We think retinoid is an effective treatment option for LCH, especially for single system disease.

Diagnostic Usefulness of Routinely Performed Preoperative Chest Computed Tomography for Colorectal Cancer

PURPOSE: The most common site of metastases in colorectal cancer (CRC) is the liver, and the second common site is the lung (10-20%). Preoperative staging for CRC is very important. The aim of this study was to assess the usefulness of chest computed tomography (CT) for preoperative staging in CRC. METHODS: From January 2006 to December 2007, a total of 597 patients with colorectal cancer underwent surgery at our hospital. One hundred fifty of those patients had received chest CT preoperatively. We analyzed the chest radiologic findings from chest x-ray (CXR), abdominal CT, and chest CT. RESULTS: The detection rate of abnormal lung findings was higher in chest CT than in the other chest radiologic findings (chest PA: 10 [6.6%]; abdominal CT: 19 [12.7%]; chest CT: 48 [32.0%]). On the chest CT, 19 of the 150 (12.7%) patients that had received a chest CT preoperatively were initially suspected of having malignant lesions. Besides two primary lung malignancies (solitary nodules), metastatic lesions were revealed in 5 (3.3%), 11 (7.3%), and 17 (11.3%) patients on CXR, abdominal CT, and chest CT, respectively. Eleven (64.7%) of the patients having metastatic chest CT lesions were also identified on lower lung fields by abdominal CT. Seven also had other metastatic foci (liver and paraaortic LN). Initially, stage IV was identified in 37 (24.7%) and 40 (26.7%) patients in abdominal CT and chest CT, respectively. After one year, 11 of the 150 (7.3%) patients who had received a chest CT had been diagnosed with pulmonary metastasis. CONCLUSION: Chest computed tomography is the most sensitive method for the diagnosis of pulmonary metastases. However, if the interpretations of abdominal CT and individualized diagnostic methods are accurate, the demand for unnecessary preoperative work-up may be reduced.

Morphological Features of Metastatic Gastrointestinal Stromal Tumors after Gleevec Treatment: Two Cases Report

We report two patients with metastatic gastrointestinal stromal tumors (GISTs) with a focus on the morphological features related to Gleevec treatment. In case 1, a 50-year-old woman presented with a 1.8 cm metastatic GIST in the liver after resection of a gastric GIST. Majority of the metastatic tumor showed fibrosis and hyalinization after 8 weeks of Gleevec treatment. CD117-positive cells were present in approximately 1% of the overall tumor. In case 2, a 2 cm and 14 cm metastatic liver masses were found in a 54-year-old man who had a rectal GIST. After 4 weeks of Gleevec treatment, metastatic tumors showed a decrease in size on CT scan. The metastatic tumors showed a decrease in number of tumor cells. The hemorrhage, cystic changes, necrosis, and fibrosis made up approximately 90% of the tumor. The morphological features related to Gleevec treatment are important for correct diagnosis and evaluation of tumor response and prognosis.