The Use of Medical Devices for Medical Skin Care and the Legal Issues / 대한피부과학회지

BACKGROUND: Medical skin care is essential for the treatment of skin diseases all over the world. Medical skin care is also part of medical practice and this must be differentiated from the simple skin care that is given for normal healthy skin. OBJECTIVE: We wanted to discuss medical skin care and the related medical devices and legal issues. METHODS: We reviewed the related laws and regulations, we consulted experts and associations and we analyzed the result of the survey. RESULTS: Legally, medical skin care and simple skin care are well classified. However, many illegal procedures are still performed by non-medical personnel and many adverse effects have been reported as a result. Furthermore, there are no legal restrictions for the performer based on the grade of each medical skin care procedure. CONCLUSION: For the best results and safe procedures, medical skin care must be performed by approved medical equipment under the supervision of a physician or medical personnel. Continuous control and guidance by the government is strongly needed.

Shift of the Brain during Functional Neurosurgery

OBJECTIVE: The study investigates the extent of brain shift and its effect on the accuracy of the stereotaxic procedure. METHODS: Thirty-five patients underwent 40stereotactic procedures between June 2002 and March 2004. There were 26 males, mean age 59years old. There were 34procedures for Parkinson's disease, 2 for essential tremor, 3 for cerebral palsy, 1 for dystonia. Patients were divided in four groups based on postoperative pneumocephalus: under 5cc (9 procedures), between 5~10cc (13procedures), between 10~15cc (11procedures) and more than 15cc (7procedures). The coordinates of the anterior commissure(AC), posterior commissure(PC), and target were defined in pre-and intraoperative magnetic resonance image scans and the amount of air volume was measured with @Target (BrainLab, Heimstetten, Germany). RESULTS: The mean AC-PC was 26.5mm for patients with less than 5cc, 26.9mm for 5~10cc, 25.8mm for 10~15cc and 26.2mm for more than 15cc. The length of AC-PC line and coordinates of AC, PC was also not statistically different, Euclidean distance as well as delta x, delta y, delta z of AC, PC, and target were also not statistically different among the groups (p<0.1). There was a variance in target of 0.7~7.6mm, Euclidean distance of 2.5mm, related to electrophysiology but not to brain-shift. CONCLUSION: The amount of air accumulated in the intracranial space and compressing the cortical surface has no effect on the localization of subcortical stereotactic target and landmarks.

Removal of a T1-2 Neurilemmoma by Lateral Parascapular Extrapleural Approach

The authors report a case of T1-2 neurilemmoma removed by lateral parascapular extrapleural approach. A 28-year-old man was presented with smooth, well-marginated radiopaque mass in left superior mediastinum on plain chest X-ray. Magnetic resonance imaging revealed a sharply marginated isosignal lesion in the left thoracic inlet on T1 weighted image and strong enhancement on T1 enhanced image. A 15cm length hockey stick skin incision was made from C7 to T9 level. A 2x3cm sized orange colored soft tissue mass was detected over the pleura. The intercostal nerve, subclavian artery, and internal carotid artery were adherent with mass. After gentle dissection, the tumor was removed from nerve bundle. Pathologic examination of tumor revealed a neurilemmoma. The patient was discharged 3 weeks after operation without neurologic deficit.