What Is the Optimal Energy Density of 1,470 nm Diode Laser in the Treatment of the Varicose Veins?

PURPOSE: This study was done to determine the suitable level of energy for the elimination of saphenous veins. METHODS: A randomized comparative study was done to determine the optimal linear endovenous energy density (LEED) for EVLT of incompetent great saphenous veins. Between October 2009 and September 2010, in 268 (173 women, 95 men) patients with a mean age of 43.1 (range 20~80) were treated, using a 1,470 nm diode laser at 10 watts in continuous mode. Patients were randomized to undergo EVLT with 100 J/cm (Group A) or 80 J/cm (Group B), respectively. They were evaluated clinically and by duplex at 1, 3, and 6 months and 1 year. RESULTS: There was no significant difference concerning gender, age, C of CEAP or diameter of the treated veins. Successful occlusion rates of the GSV, defined as the absence of flow on color doppler imaging, were 92% in Group A and 91% in Group B. There was no deep vein thrombosis, superficial burns or thrombophlebitis. In group A, visual analog scale was 3.7.6, which was higher than group B (2.3.2). The area of ecchymosis was 37.5% in group A, but 12.5% in group B. CONCLUSION: There was no significant difference between 80 J/cm group and 100 J/cm group in terms of occlusion rate within 1 year. Long-term results will be required to determine the optimal level of energy.

Expert Opinion on Death Investigation Center for Medicine Related Death / 대한법의학회지

To check expert opinion about the investigation system of medicine-related death, model for "Death Investigation Center" was suggested and related questionnaire were requested. Between 15 December 2009 and 5 April 2010, we sent e-mails of the questionnaire which asked the opinion for the new postmortem investigation system. We sent the questionnaire to 3,289 lawyers and 4,523 doctors (total 7812), and received 100 replies out of the total. All the lawyers and doctors interviewed knew the importance of the postmortem investigation system. Most of them (87%) agreed to the introduction of the new postmortem investigation system. Some of them thought that protector's agreement was necessary for the postmortem investigation (21%), and more doctors were likely to participate with legal protocol (23%). If the postmortem investigation could not be performed due to the protector's disagreement, another specialized medical investigation should be needed to figure out the cause of death (85%). The new postmortem investigation system should be performed by the specific institution, and supported by the government (44%). In many expert's opinion, nonmedical experts such as lawyers and priests should be included for the institution of investigation for objectivity and neutrality (72%). This sample study finds that the postmortem investigation performed by specialized institution is necessary to determine the cause of death in the hospital. For the operation of the system, neutrality and the operating core would be the most important.

Review of Korean Disability Evaluation Systems and Suggestions for the Improvement Direction / 대한법의학회지

In case of accident, appropriate payment for the injured is important in the point of justice or even for the early social rehabilitation of the injured. To evaluate the exact status of the injured is the prerequisite for this. The physical status is converted to social or legal status using impairment or disability evaluation system. For this many different systems are used in Korea right now, that are several legislations such as 'Nation Compensation Law', or popular McBride and AMA(American Medical Association) guidelines. These guidelines are not similar in main idea or in detail items. Furthermore as these are from another country, these could not reflect our national status. Several national legislations are also far from appropriateness. There are many cases that showed different evaluation results depending on what guidelines are adopted. To overcome this irrational situation, many trials have been made to establish Korean guideline for the disability evaluation by different groups of specialists using different concepts. In this study the irrational status that showed different rating results depending on different guideline adopted were showed through several case works. With thorough review of the related materials, the pros and cons of the major systems in Korea were pointed out. Guideline suggested recently in Korea by different groups were also reviewed thoroughly. To know the points that must be considered in making new guideline, many specialists and business mans who are actively participating in compensation related works were questioned on the major topics. With the introduction of major concept in compensation medicine, author tried to present the plausible way for the improvement of our system. Author believe that this results would be helpful in making direction for the Korean guideline for the disability evaluation and contribute in settling down the social or legal dispute around the disability evaluation around us.

Necrotizing Fasciitis of the Chest Wall Complicating Acupuncture

A 20-year-old man developed necrotizing fasciitis of the left chest wall complicating acupuncture. Necrotizing fasciitis is a highly morbid soft tissue infection that rarely involves the upper torso. In the past, there has been few report on necrotizing fasciitis complicating acupunture in the English literature (based on a MEDLINE search covering 1966 to 2005). We present this extremely unusual case of a patient after taking acupuncture who survived severe necrotizing fasciitis of the chest wall following wide debridement of the necrotic tissue and broad-spectrum antibiotic therapy.

Association of carotid atherosclerosis and obesity in type 2 diabetic patients / 대한내과학회지

BACKGROUND: Diabetes mellitus is a major independent risk factor for atherosclerosis. In recent years non-invasive high resolution B-mode ultrasound methods have been developed to measure the intima-media thickness (IMT) of the carotid artery as an indicator for early atherosclerosis. It is known that obesity plays a role in the development of type 2 diabetes and cardiovascular disease, and it has also been reported that not only the amount but also the distribution of body fat is important. This study investigated the relationship between obesity and the development of carotid atherosclerosis in type 2 diabetic patients. METHODS: Carotid IMT was measured by ultrasound B-mode imaging in 144 patients with type 2 diabetes mellitus. All subjects underwent assessment for the degree and distribution of obesity, the presence of coronary artery disease risk factors, and the presence of diabetic complications. RESULTS: Carotid IMT was increased in the abdominal obese group defined by waist circumference. However, there was no significant difference in carotid IMT between the non-obese group and obese group as defined by body mass index, waist to hip ratio, and total body fat percent measured by bioelectrical impedance analysis. There were positive correlations between carotid IMT and age, duration of diabetes, systolic blood pressure, and waist circumference. Multiple linear regression analysis revealed the variable that interacted independently with carotid IMT was age in type 2 diabetic patients. Carotid IMT was significantly increased in type 2 diabetic patients with macrovascular complications and microvascular complications. CONCLUSIONS: This study suggested that abdominal obesity rather than general obesity was associated with carotid atherosclerosis reflected by increment of carotid IMT in type 2 diabetic subjects.

A Case Of Adrenal Ganglioneuroma Secreting Catecholamines / 대한내과학회지

Ganglioneuromas is a rare benign neoplasm that originates from the sympathetic ganglia and the adrenal medulla. It belongs to the group of neurogenic tumors, which also include ganglioneuroblastoma and neuroblastoma. Most of them are asymptomatic and diagnosed by chance, rarely because of their hormonal activity or metaiodobenzylguanidine (MIBG) uptake. We here report a case of adrenal ganglioneuroma secreting catecholamine. A 22-year old male presented with incidentally detected calcifications in the left upper quadrant of the abdomen. Abdominal CT and MRI revealed an about 8-cm adrenal mass with eggshell and punctuate calcifications. Increased urinary catecholamine metabolites and MIBG uptake in the tumor leaded to the preoperative diagnosis of adrenal pheochromocytoma. His blood pressure was normal and the typical symptoms of catecholamine excess were not observed during the admission period. Surgical resection and histologic examination of the tumor confirmed the diagnosis of ganglioneuroma originating from the left adrenal gland. Characteristic radiologic and histologic findings are presented with review of the literature.

A Case of Tracheal Adenoid Cystic Carcinoma Presenting with Diffuse Goiter / 대한내분비학회지

A goiter is among the most common presenting symptoms of patients with thyroid diseases and is usually caused by intrinsic thyroid problems. While direct invasion of the trachea by aggressive thyroid tumors is a well-known phenomenon, the reverse situation, that is, a primary tracheal neoplasm invading by direct extension into the thyroid gland, presenting with a goiter is very rare. Here, a case of a tracheal adenoid cystic carcinoma(ACC), presenting with a diffuse goiter, is reported. A 47-year-old woman presented with slowly growing anterior neck swelling. A physical examination showed a diffuse firm goiter. The patient was euthyroiditic, and serum negative for thyroid autoantibodies. Thyroid ultrasonography and neck CT revealed a doughnut-shaped mass, encircling the trachea and displacing the thyroid anteriorly. Ultrasonography-guided fine needle aspiration(FNA) was compatible with an ACC, and a subsequent surgical resection confirmed the diagnosis. Although the occurrence of a tracheal ACC invading the thyroid is rare, this case highlights the need to be aware of unusual lesions arising in the region of the thyroid. This knowledge will help in making the correct cytological diagnosis when these lesions are sampled by FNA

A Case of Tracheal Adenoid Cystic Carcinoma Presenting with Diffuse Goiter / 대한내분비학회지

A goiter is among the most common presenting symptoms of patients with thyroid diseases and is usually caused by intrinsic thyroid problems. While direct invasion of the trachea by aggressive thyroid tumors is a well-known phenomenon, the reverse situation, that is, a primary tracheal neoplasm invading by direct extension into the thyroid gland, presenting with a goiter is very rare. Here, a case of a tracheal adenoid cystic carcinoma(ACC), presenting with a diffuse goiter, is reported. A 47-year-old woman presented with slowly growing anterior neck swelling. A physical examination showed a diffuse firm goiter. The patient was euthyroiditic, and serum negative for thyroid autoantibodies. Thyroid ultrasonography and neck CT revealed a doughnut-shaped mass, encircling the trachea and displacing the thyroid anteriorly. Ultrasonography-guided fine needle aspiration(FNA) was compatible with an ACC, and a subsequent surgical resection confirmed the diagnosis. Although the occurrence of a tracheal ACC invading the thyroid is rare, this case highlights the need to be aware of unusual lesions arising in the region of the thyroid. This knowledge will help in making the correct cytological diagnosis when these lesions are sampled by FNA

Mesocolic Hemangioma

Herein, is presented the case of mesocolic hemangioma that developed in a 20-year-old man with abdominal discomfort of 2 months duration. The physical examination showed an abdominal mass, with normal laboratory findings. An abdominal CT showed a large, heterogeneous mass, with a lobulated margin, extending from the transverse colon to the head of the pancreas. During the operation, the mass was found to have engulfed the midcolic artery and vein. The patient underwent a wide excision of the mass, with segmental resection of the transverse colon. The histopathology was that of a typical cavernous hemangioma involving the mesentery of the transverse colon. It is uncommon for a hemangioma to occur along the transverse mesocolon. We report this unusual case of a mesocolic hemangioma, which was removed by an operation.

Pregnancy-Associated Breast Cancer

PURPOSE: Women pregnant or lactating at the time of breast cancer diagnosis exhibit a significantly more advanced stage disease at the time of diagnosis than non-pregnant women. The goal of this study was to identify pregnancy-associated breast cancer, and to compare the clinicopathologic characteristics and disease-free survival rates with those of non-pregnancy associated breast cancer. METHODS: The medical records of women pregnant or within 1 year postpartum at the time of breast cancer diagnosis and those of non-pregnant women with breast cancer between 1981 and 1999, were analyzed. Fourteen women with pregnancy-associated breast cancer (group I) were compared to 155 non-pregnant women with breast cancer (group II) of comparable ages, and to 1201 women with breast cancer age of 36 or older (group III). RESULTS: No significant differences were found in regards to dominant histologic types, hormone receptor statuses or histologic grade among those three groups. The delay in diagnosis of group I averaged 5.2 months longer than that of group II (P or =5 cm) tumors, and a greater portion had advanced staged (stage> or =III) cancer than group II (P<0.025). Stage by stage, there was no significant statistical difference in disease-free survival rates between group I and group II. The younger patients (group I, group II) had lower disease-free survival rates than older patients (group III) (P<0.05). CONCLUSION: No specific pathologic characteristics were found in pregnancy associated breast cancer. The delay in diagnosis and young age at diagnosis may be the primary reasons for the relatively advanced stages seen in breast cancer associated with pregnancy.