Modified Orbitozygomatic Approach for Resecting a Parasellar Tumor in a Single Institution

Background@#Modified orbitozygomatic craniotomy is characterized by simplicity and wide exposure. The purpose of the present study was to describe a modified orbitozygomatic approach without resecting the zygomatic arch for large parasellar tumor surgeries. @*Methods@#Between April 2016 and December 2019, seven patients with parasellar tumor underwent surgiest with a modified orbitozygomatic approach. Surgical procedures, clinical outcomes, and complications were analyzed. @*Results@#This study included 3 meningiomas, 2 pituitary adenomas, 1 chondrosarcoma, and 1 schwannoma. Modified orbitozygomatic craniotomy provides a wider surgical freedom in the opticocarotid and prechiasmatic cistern than frontotemporal craniotomy without orbitotomy, Total, subtotal, and partial resections were achieved for 3, 2, and 2 patients, respectively. Reasons for partial resections were tight adhesion to the carotid artery and encasing of the carotid artery. Permanent morbidities developed in one patient with 3rd nerve palsy and one patient with hemiparesis. @*Conclusion@#Modified orbitozygomatic approach can provide the shortest access to the interpeduncular cistern with a minimum brain retraction. Surgeons who experience surgical challenge during the conventional approach for parasellar tumor resection are recommended to learn the modified orbitozygomatic approach.

How Well Can Matrix of Ferritin and Neutrophil to Lymphocyte Ratio Predict Metabolic Syndromein Korean Adults?

Background@#Previous studies have shown that elevated ferritin level and neutrophil to lymphocyte ratio (NLR) are risk factors of chronic low-gradeinflammation and contribute to the onset and progression of cardiovascular disease. In addition, metabolic syndrome has a similar relevance; thus,in this study, we aimed to determine how well metabolic syndrome could be predicted by measuring ferritin level and NLR. @*Methods@#From January 2016 to September 2018, 1,815 adults who underwent medical interviews, physical measurements, and blood tests at amedical examination center of a university hospital in Seoul were evaluated. Data were analyzed using the Spearman correlation analysis, anaverage comparison using analysis of variance, and a t test. The prevalence of metabolic syndrome was determined according to ferritin level andNLR. @*Results@#We found a significant correlation between the components of metabolic syndrome and ferritin level, but not NLR. The NLRs were divided intoquartiles for comparison with the mean values of the components of metabolic syndrome, but the results were not significant. A significantdifference was found only in ferritin level when we compared the mean values of ferritin level and NLR according to the presence or absence of ametabolic syndrome diagnosis. When ferritin level and NLR were considered simultaneously, the prevalence of metabolic syndrome tended tochange only when the ferritin level changed. @*Conclusion@#In healthy Korean adults, ferritin level, but not NLR, could be used as a predictor of metabolic syndrome.

Application of Relative Fat Mass Equation in Korean Adults

Background@#Body mass index (BMI) has limitations in determining body fat percentage and body fat distribution, and causes misclassification of body fat-defined obesity. As high body fat percentage is associated with mortality, an accurate assessment of body fat percentage is considered clinically important. Recently, Woolcott and Bergman reported a relative fat mass (RFM) equation which calculated the body fat percentage using the height and waist circumferences. However, as RFM has been studied only in European-, Mexican-, and African-Americans, an assessment in Asians was needed. Therefore, we aimed to evaluate the applicability of RFM in Korean adults. @*Methods@#This study included 7,733 adults who visited a Sanggye Paik Hospital Health Promotion Center from May 1, 2016 to November 12, 2018. BMI and RFM were calculated by measuring height, weight, and waist circumference. The total body fat (TBF) percentage was measured by bioelectrical impedance analysis. We compared the BMI, RFM, and TBF percentage to assess the applicability of RFM in Korean adults. @*Results@#RFM had a statistically significant correlation with TBF percentage in both male and female (male: β=0.808, R2=0.653, female: β=0.766, R2=0.587, P<0.001). In the Bland-Altman plot, RFM showed good agreement with the TBF percentage within the 95% confidence interval. @*Conclusion@#The RFM equation can be used to predict TBF percentage in Korean adults.

Drug Hypersensitivity Syndrome Associated Dapsone / 대한피부과학회지

No abstract available.

A Case of Nevus Comedonicus Syndrome / 대한피부과학회지

No abstract available.

A Case of Neurofollicular Hamartoma / 대한피부과학회지

Neurofollicular hamartoma is an unusual, previously described neoplasm characterized by a stroma composed of proliferation of spindle cells and hyperplastic pilosebaceous units. The stroma has light microscopic and immunohistochemical features consistent with neuroid differentiation showing positive S-100 antigen. Lesions are almost invariably located on the face with strong predilection for the nose or nasolabial fold. A 35-year-old man presented with a solitary, skin-colored, dome-shaped papule that had been present on his right temple area for a few years. Clinical differential diagnosis included basal cell carcinoma, angiofibroma and intradermal nevus. Clinically, the lesion presents as a small, skin-colored, dome-shaped firm papule, 3 to 7 mm in diameter. Although clinical aspects of the lesion are not diagnostic, the histological features are very typical. Herein, we report a rare case of neurofollicular hamartoma on the right temple area.

Induction of Melanogenesis by Rapamycin in Human MNT-1 Melanoma Cells

BACKGROUND: Melanogenesis is one of the characteristic parameters of differentiation in melanocytes and melanoma cells. Specific inhibitors of phosphatidylinositol 3-kinase (PI3K), such as wortmannin and LY294002, stimulate melanin production in mouse and in human melanoma cells, suggesting that PI3K and mammalian target of rapamycin (mTOR) might be involved in the regulation of melanogenesis. OBJECTIVE: The involvement of the mTOR pathway in regulating melanogenesis was examined using human MNT-1 melanoma cells, and the effects of the potent inhibitor of mTOR, rapamycin, in the presence or absence of alpha-melanocyte-stimulating hormone (alpha-MSH) were evaluated. METHODS: In cells treated with rapamycin, cell viability, melanin content, and tyrosinase (TYR) activity were measured and compared with untreated controls. Protein levels of TYR, tyrosinase-related protein (TYRP)-1, TYRP-2, and microphthalmia-associated transcription factor (MITF) were also analyzed by Western blot. RESULTS: In rapamycin-treated cells, the melanin content increased concomitantly with an elevation in TYR activity, which plays a major role in melanogenesis. There was also an up-regulation of TYR, TYRP-1, and MITF proteins. Combined treatment with rapamycin or wortmannin and alpha-MSH increased melanogenesis more strongly than alpha-MSH alone. CONCLUSION: Rapamycin-induced melanin formation may be mediated through the up-regulation of TYR protein and activity. Furthermore, rapamycin and wortmannin, inhibitors of mTOR and PI3K, respectively, have co-stimulatory effects with alpha-MSH in enhancing melanogenesis in melanocyte cells.

Mycosis Fungoides Palmaris et Plantaris in Children / 대한피부과학회지

Mycosis fungoides palmaris et plantaris (MFPP) is a rare form of mycosis fungoides that is confined to the palms and soles. The clinical manifestation of MFPP is often confused with inflammatory palmoplantar dermatoses. Mycosis fungoides is usually considered as a disease of middle age, but it is rarely developed at any age. A 10-year-old girl was referred to us with a 2-year history of recalcitrant palmoplantar dermatoses. Other clinics had treated her for more than 2 years, but all medical treatments turned out to have had no effect, despite her young age. She had not had any atopic dermatitis or allergic contact dermatitis. Histopathologic findings showed inflammatory cell infiltration and lymphocytic epidermotrophism. Monoclonal TCR-rearrangement was positive, so we diagnosed her as having MFPP. We tried to treat her with topical PUVA therapy and she improved within 3 months. Herein, we report on a case of mycosis fungoides Palmaris et plantaris in a 10-year-old girl that was treated successfully with topical PUVA.

Fluconazole Induced Fixed Drug Eruption

We report on a rare case of fluconazole induced fixed drug eruption in a 62-year old female patient. She was referred to our department for multiple erythematous itchy maculopatches on the face, neck, both upper arms, and trunk area, which had occurred over the previous 6 months. Her attending physician prescribed fluconazole for treatment of onychomycosis. Patch test and oral provocation were performed. The patch test showed a negative result; however, the result for oral provocation was positive, confirming this as a rare case of fluconazole induced fixed drug eruption. To the best of our knowledge, this is the first reported case in Korean dermatologic literature.

Treatment of Oral Lichen Sclerosus with 1% Pimecrolimus Cream

Lichen sclerosus is a chronic inflammatory mucocutaneous disorder predominately affecting prepubertal girls and postmenopausal women. Isolated lichen sclerosus affecting the oral mucosa is exceedingly rare, and only 13 patients with biopsy-proved isolated oral disease have been reported in the literature. We report on a 7-year-old Korean girl with a well-demarcated 1.2x1.2 cm atrophic white plaque with an erythematous border and focal telangiectasia on the left vermillion lip, extending to the labial mucosa. No other cutaneous surfaces, including genitalia, were involved. An incisional biopsy of the plaque on the lip revealed a patchy lichenoid infiltrate of lymphocytes associated with sclerosis of the papillary dermis and a thinned epidermis consistent with a diagnosis of linear orofacial lichen sclerosus. Treatment with a short course of 1% pimecrolimus cream effectively prevented the progression of this lesion.

A Case of Atypical Granuloma Annulare Involving Both Ears

We report a rare case of granuloma annulare (GA), affecting both ear antihelixes, in a 28-year old male patient that presented with a 1-year history of non-tender, firm, skin-colored, 1~5 mm papules on both ear antihelixes. There was no history of trauma. An excisional biopsy specimen taken from one of the lesions of the right ear revealed infiltration of histiocytes and lymphocytes around a zone of collagen alteration in the dermis. Based on the clinical and pathological findings, the patient was diagnosed with a rare case of bilateral GA of both antihelixes; this is the first report in the Korean dermatology literature.

Relation between ERCC1 Expression in Sputum and Survival after Cisplatin-Based Chemotherapy in Patients with Non-Small Cell Lung Cancer / 결핵및호흡기질환

BACKGROUND: Excision repair cross complementing gene 1 (ERCC1) not only has a protective role against carcinogens, but plays an important role in cisplatin-resistance via the repair of cisplatin-DNA adducts. This study investigated the association between the ERCC1 expression levels in sputum and survival after cisplatin-based chemotherapy in patients with inoperable non-small cell lung cancer (NSCLC). METHODS: Using the sputum collected from 67 inoperable (stage IIIa-IV) NSCLC patients treated with either taxanes (33 cases) or gemcitabine (34 cases) plus cisplatin, the relative expression levels of ERCC1 and the expression of the tumor specific antigen, MAGE, were examined by the quantitative RT-PCR and RT-PCR, respectively. The response and survival were compared with the relative level of ERCC1 or MAGE expression and the treatment modality. RESULTS: In the sputum, ERCC1 and MAGE was detected in 74.6% and 40.2% of patients, respectively. Using the median ERCC1 level, the patients were classified as having high or low ERCC1 expression. The median overall survival (MST) was significantly longer in patients with a high ERCC1 expression level than those with a low expression level (84 weeks vs. 44 weeks respectively, P=0.017). In the taxene-based treatment group, the MST was longer than the gemcitabine group (79 weeks vs. 47 weeks, respectively, P=0.03). The levels of ERCC1 were significantly higher in patients who were MAGE-positive (P=0.003). In the MAGE-negative patients, the MST was longer in the high ERCC1 group (103 weeks vs. 43 weeks, P=0.008), but not in the MAGE-positive patients (62 weeks vs. 44 weeks, P=0.348). CONCLUSION: ERCC1 expression in the sputum can be a prognostic factor for survival after chemotherapy in patients with inoperable NSCLC.

Subclinical Peripheral Neuropathy in Patients with Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: Symptomatic neuropathy is uncommon in rheumatoid arthritis (RA) but, compression neuropathy and vascular neuropathy were reported in longstanding RA. To investigate the occurrence of electrophysiologically evident peripheral nerve involvement in RA patients without a clinical manifestation of peripheral nerve involvement, we studied nerve conduction velocity study (NCV) in RA patients without symptomatic neuropathy. Twenty-five RA patients were evaluated neurological examination and by NCV. We compared clinical parameters between electrophysiologic positive group and negative group. There was no patient who had neurologic symptoms or signs of peripheral involvement. Eleven patients (44%) of all exhibited NCV findings consistent with distal symmetrical sensorimotor polyneuropathy, 5 patients (20%) had entrapment neuropathy, 2 patients (8%) showed distal symmetrical sensory polyneuropathy, 1 patient (4%) had digital neuropathy, and 6 patients (24%) had normal NCV. CONCLUSION: Patients with RA may have electrophysiologic peripheral nerve damage, even in the absence of clinical evidence of peripheral nerve involvement. There was no correlation with any clinical parameters. The inclusion of electrophysiologic examination of the RA patients is recommended in routine diagnostic procedures.

The Allergenicity of the Storage Mites(Tyrophagus Putrescentiae and Acarus Siro) in Patients with Allergic Rhinitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Storage mites, Tyrophagus putrescentiae (TP) and Acarus siro (AS), known as the major causative allergens to people who deal with stored foods and grains, may occur more frequently in house dust than expected. During the recent 6 months, positive reactions to TP and AS were observed as frequently as those to Dermatophagoides pteronyssinus (DP) in patients with allergic rhinitis in Pusan. The purpose of this study was to identify allergenic components within TP and AS, and evaluate the cross reactivity with DP. MATERIALS AND METHODS: Using extracts of DP, TP and AS, prepared after dialysis and lyophilization, allergenic components were identified using SDS-PAGE and western blotting. Cross reactivity among them were evaluated by inhibition tests using pharmacia CAP system. RESULTS: The protein components of DP, TP and AS, showed different patterns in SDS-PAGE. Molecular weight of major IgE binding components of TP were 17 kD, 25 kD and 67 kD, and those of AS were 18 kD, 19 kD, 25 kD and 27 kD. TP- or AS-specific IgE was partially inhibited by DP extract; however, DP-specific IgE was not significantly inhibited either by TP or AS extract. Significant inhibition were noted between TP and AS. CONCLUSION: TP and AS may share common allergens with DP. However, sensitization to TP or AS was also suspected in some cases. The percentage of Acaridae family in Pusan was 12% of total mites. Therefore, storage mites should be considered as causative allergens and included in allergy test battery.

Differential Findings of Color M-mode Doppler Echocardiography according to the In-hospital Congestive Heart Failure Following Actue Myocardial Infarction

BACKGROUND: Abnormalities of the left ventricular diastolic function can be classified by pulsed Doppler echocardiography, but sometimes it may be difficult to differentiate normal diastolic function from pseudonormalization. Heart failure caused by increased left ventricular filling pressure is rather associated with pseudonormalization or restrictive pattern than normal pattem or relaxation abnormality. We investigated the usefulness of color M-mode Doppler echocardiographic indexes in differentiating normal relaxation from pseudonormalization after acute myocardial infarction. METHOD: Echocardiographic examination including color M-mode Doppler was performed in 44 patients with acute myocardial infarction between 10 and 14 days after attack. 34 patients without in-hospital congestive heart failure(CHF) were assigned as group I, and 10 patients with in-hospital CHF as group II. Flow propagation slope(FPS), time difference(TD) between the occurrence of peak flow velocity in the apical region and at the mitral tip, and normalized time difference(nTD) by mitral and apical distance were measured with color M-mode Doppler echocardiography. RESULTS: FPS was lower in group II(group I, 42.0+/-20.6cm/sec vs group II, 27.8+/-8.0cm/ sec , p=0.065). Both groups had similar TD and nTD. FPS was compared in patients with E/ A ratio of mitral inflow greater than 1(22 patients of group I and 7 patients of group II). Patients with E/A) 1 in group II had significantly lower FPS(group I, 52.1+/-17.5cm/sec vs group II, 31.0+/-7.4cm/sec ; p(0.01). CONCLUSION: FPS was significantly decreased after acute myocardial infarction in patients with in-hospital CHF compared with patients without in-hospital CHF, even when E/A ratio of mitral inflow was greater than 1. Therefore, FPS was an useful index in differentiating normal relaxation from pseudonormalization.

Clinical Study on Blowout Fractures of the Inferior and Medial Orbital Walls / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A blowout fracture is the outward fracture of orbital wall that occurs at the inferior wall or medial wall as intraocular pressure, caused by the impact of trauma, increases rapidly. The importance of diagnosis and treatment for blowout fractures have increased as heavy industrialization, high speed transportation and violent accidents have increased recently. We caaried out a retrospective study of blowout fracture according to different incidences, treatment methods and their results. MATERIALS AND METHOD: A retrospective review was performed on 154 cases of blowout fracture. They were diagnosed with 5mm facial CT, and treated in our department from March, 1989 to March, 1998. RESULTS: Severnty-four patients (48%) had medial fractures, 49 patients (32%) had inferior fractures and 31 patients (20%) had medial and inferior fractures. The cases of inferior fractures were treated with the reduction of fractured area with autologous bone harvested from the anterior wall of maxillary sinus, titanium mesh, and silastic sheet. Medial fractures were treated with endoscopic intranasal reduction with silastic sheet. CONCLUSION: In this study, medial fractures comprised 68%, demonstrating more incidence than inferior fractures. Anterior wall of maxillary sinus was very useful in reduction of inferior wall fracture. We operated on 92 patients of the 154 cases of inferior and medial blowout fractures, and had successful results.

Arthroscopic Synovectomy on Knee Joint

The results of arthroscopic synovectomy of the knee joints were reviewd in 23 joints of 21 patients hetween May 1992 and June 1996. The results were as follows: 1. Pain, tenderness, swelling, ROM of synovitis syrnpknns were much nsiproved postoperatively. 2. The degrees of articular cartilage damage were closely related to posto-perative functional recovery. 3. Preoperative and postoperative ESR changes were not ditferent signihcantly, 4. Recurrence rate was 17%, 4 cases. Of them, 2 cases were rheumatoid arthritis, 1 case was pigmented villonodular synovitis, I case was nonspecipic synovitis 5. Complicatior of arthrosc:opic synovectomy was nol found. We concluded that arthroscopic synovectoiny was very useful method of early diagnosis and treatment of synovial memhrane diseases.

The Results of Treatment of Multilevel Spinal Stenosis: Comparison of the results on the numbers of decompressed segments and types of bone graft / 대한척추외과학회지

STUDY DESIGN: Ninty eight patients with multilevel spinal stenosis who were treated with posterior decompression and instrumented posterolateral fusion were reviewed retrospectively. All patients were divided two groups by pathologic level and surgery level. One is complete level decompression group (whole pathologic levels were decompressed) and the other is limited level decompression group (less than pathologic levels were decompressed). SUMMARY OF BACKGROUND DATA: Many patients with spinal stenosis haute multilevel pathology, which is very difficult problem to make surgical strategy for determination of decompression level. METHOD: Patients were reviewed using combination of clinical records, follow-up examinations and radiographs. Posterior decompression and instrumented posterolateral fusion were performed in all patients using pedicle screw fixation (TSRH 49 cases, Diapason 37 cases, CCD 12 cases) and either autogenous bone graft alone or autograft with allograft. The average follow-up period was 19.7 months. RESULTS: In the clinical results by the criteria of Kirkalldy-Willis, there was no difference between complete level decompression group and limited level decompression group. By the bone graft mothorts, fusion rate was no difference between autograft alone group and autograft with allograft group, but fusion periods were more shorter in autograft alone group than in autograft with allograft group(P>0.05). CONCLUSION: In multilevel spinal stenosis, the segments that associated with neurologic symptoms or seyeie stenosis on radiograph must be decompressed but the segments that not associated with neurologic symptoms and mild stenosis on radiograph do not need preventive decompression.