A Case of Retronychia on Toenail

PURPOSE: Retronychia is the embedding of the nail into proximal nail fold. Retronychia starts with disruption of the longitudinal growth of the nail. With the growth of a new nail, the old one is pushed upwards and backwards. This leads to embedding of the top nail into the ventral aspect of the proximal nail fold and results with chronic paronychia. We present a case of retronychia that was rarely reported in the literature. METHODS: A 46-year old female presented with a 3-month history of painful right first, 2nd, 3rd toenail changes. Although she was initially treated with broad spectrum antibiotics, she did not response to therapy. Later, she presented to our department because of progressively worsening pain that impaired her walking. Physical examination revealed with proximal nail fold erythema, painful swelling, yellowish nail discoloration, and distal onycholysis. Bacterial and fungus culture showed no organism. Treatment was surgical nail avulsion under local anesthesia. RESULTS: The postoperative course was uneventful. 10 months later, the patient had a normal growing nail and was free of symptoms. CONCLUSION: We report a case of retronychia on toenail. Retronychia is a proximal nail plate ingrowth into the proximal nail fold which is associated with multiple generations of nail plate misaligned beneath the proximal nail. Management consisted of simple avulsion of superimposed nail. Retronychia is suspected with a persistent paronychia, particularly in the setting of trauma. Avulsion of the top nail confirms the diagnosis and may be curative if the underlying nail appears healthy.

Surgical Treatment of Mallet Finger Deformity with Hook Plate

PURPOSE: The bony mallet finger injury is generally managed by conservative treatments. But operative treatments are needed especially when the fractures involve above 30% of articular surface, or when distal phalanx is accompanied by subluxation in the volar side. This is the reason why they often result in chronic instability, articular subluxation and cosmetic dissatisfaction. In this report, We describe new method using the hook plate as an operative treatment of mallet finger deformity. METHODS: Among 13 patients with mallet finger deformity who came from February 2006 to February 2008, six patients were included in surgical indication. Under local anesthesia, H or Y type incision was made at the DIP joint area. After the DIP joint extension, the hook plate was put on the fracture line, and one self tapping screw was used for fixation. 2 hole plate which was one of the holes in 1.5 mm diameter was cut in almost half and bended by approximately 100 degrees. RESULTS: In all six cases which were applied the hook plate, complications such as loss of reduction or nail deformity were not seen. In only one patient, hook pate was removed due to inflammatory reaction after the surgery. In 2 weeks after the operation, active motion of DIP joint was performed. The result was satisfactory not only cosmetically but also functionally. In 6 weeks after the operation, the range of motion of DIP joint was average 64 degrees. CONCLUSION: The purpose of the operative treatment for mallet finger deformity using the hook plate is to provide anatomical reduction with rigid fixation and to prevent contracture at the DIP joint. While other operations takes 6 weeks, the operation using the hook plate took only two weeks to enable active motion. Complication rate was low and the method is rather simple. Thus, the operation using the hook plate is recommended as a good alternative method for the mallet finger deformity treatment.

Characteristics of Nasal Trauma in the Implanted Nasal Prosthesis

PURPOSE: Presently, silicone rubber is chosen most frequently for nasal augmentation. However, there is a possibility of extrusion with this material. Sometimes, noses are prone to be traumatized, and then silicone rubber has a possibility of deformity or deviation resulting in trauma. We experienced cases with complications and traumatic deformities after the augmentation rhinoplasty. METHODS: A retrospective review was performed to determine the characteristics of the implanted nasal silicone prosthesis after trauma. The patients' data such as deviation of implant, shape of fracture, age and sex of the patient, time of treatment, operative methods were reviewed. From March 2001 to March 2008, this study was performed in 30 patients. The patients were 25 females and 5 males, from 24 to 60 years of age, with an average of 42. All patients had previous augmentation rhinoplasty with silicone implant. RESULTS: All of the 30 patients were confirmed as deviation of silicone and nasal bone fractures in the facial bone CT scan. The most common cause of fracture was traffic accident. The classification of nasal trauma after augmentation was done by facial bone CT. Class I: Deviation of silicone without nasal bone fracture without extrusion(12 cases, 40%), Class II: Deviation of silicone without nasal bone fracture and with extrusion(4 cases, 13%), Class III: Deviation of silicone with nasal bone fracture and without extrusion(8 cases, 27%), Class IV: Deviation of silicone with nasal bone fracture and with extrusion(3 cases, 10%), Class V: Mild deviation of silicone with nasal bone fracture(3cases, 3%). Specially, the comminuted or trapezoid nasal fracture was confirmed in 11 cases(Class III, IV). CONCLUSION: The problems of silicone implant have generally been related to foreign body reactions, rigidity of the material, encapsulation, infections, and extrusion. We experienced 11 cases of comminuted or comminuted trapezoid shaped fracture below nasal implant. So, we think this phenomenon could be used in late problem of silicone implant.

A Case of Eccrine Porocarcinoma on Back

PURPOSE: Eccrine porocarcinoma is a very rare, potentially fatal tumor which arises from the intraepidermal portion of the eccrine sweat ductal apparatus. It does not have a characteristic clinical feature but does have a high incidence of metastasis. It may be developed de novo or in a preexisting benign eccrine poroma. It usually affects older people and is located most commonly on lower extremities. We report a rare case of eccrine porocarcinoma which developed on the back without metastasis. METHODS: The patient was a 94-year-old woman who showed a painful, ulcerated, dark brown colored polypoid 3.5x3.0cm sized mass on the back for 3 years. We totally excised the lesion including normal tissue. RESULTS: After wide excision of the lesion, pathologist reported an eccrine porocarcinoma. Histopathologic findings reveal that the classic type of eccrine gland carcinoma, eccrine porocarcinoma. Immunocytochemical studies showed a positive reactivity to anti-EMA antibody and anti-CEA antibody. CONCLUSION: Authors experienced a rare case of primary eccrine porocarcinoma on the back. Because of the propensity to develop local recurrence, wide excision of the primary tumor with histologic confirmation of negative margins represents the only curative treatment regimen for eccrine porocarcinoma.

Initial Experience with Large Jostent in the Treatment of Pulmonary Artery Stenosis with Congenital Heart Disease: Comparison of Clinical Results with Palmaz Stent

PURPOSE: The aim of this study was to assess the efficacy of Jostent (peripheral, large; JS) in the treatment of pulmonary artery stenosis with congenital heart disease (CHD) and report our initial experience with JS. METHODS: Seventy four large-sized stents in 70 patients with CHD were implanted from June 1996 to July 2004. Thirty eight Palmaz stent (large; PS) in 36 patients (PS group) and 36 JS in 34 patients (JS group) were used. Immediate and follow-up results were compared. RESULTS: All stent placements were successful except 1 procedure with long PS (P308) due to acute angle of passage to the lesion. In both groups, stenosis diameters increased (PS group; 4.1+/-1.3 to 10.3+/-2.0 mm, JS group; 4.2+/-1.9 to 9.9+/-2.9 mm), pressure gradients decreased (PS group; 23.7+/-13.9 to 2.6+/-4.5 mmHg, JS group; 23.8+/-20.8 to 2.6+/-4.5 mmHg) and perfusions to the affected lung improved significantly (PS group; 20.2+/-9.7 to 38.5+/-9.7%, JS group; 16.6+/-8.5 to 36.4+/-10.2%). Redilatation of the implanted stents were feasible and effective except 3 stents in PS group and 1 stent in JS group. There was no significant stenosis or thrombus formation caused by the protruded stents, but failure to get access into the stent for redilatation due to protruded stent orifice was occurred in 1 patient. No significant stent recoil or distortion was observed. CONCLUSION: The efficacy and safety of JS in the treatment of pulmonary artery stenosis with CHD is comparable with those of PS. The smooth tip design and flexibility of JS enhances feasibility of the procedure.

Esthesioneuroblastoma Treated by Craniofacial Resection: Case Report

The authors report a case of esthesioneuroblastoma with intracranial extension treated by craniofacial resection. The tumor was resected by transbasal approach and repaired the dural defect using pericranial flap. The defect of floor of anterior cranial fossa was repaired with splitted calvarium and pericranial flap. Otorhinolaryngologist removed the residual tumor mass located at paranasal sinuses using lateral rhinotomy. Using cranifacial resection, the authors could remove the mass completely. The patient was referred to hemato-oncologist for chemotherapy.

Relationship between Expression of Thy- midylate Synthase mRNA and Resistance of Colon and Gastric Cancer Cells to 5-FU

PURPOSE: Thymidylate synthase (TS) is an important target for chemotherapeutic drugs such as 5-fluorouracil (5-FU). Overexpression of TS has been linked to chemotherapy resistance, but their relationship was not completely understood. We compared the expression level of TS with resistance of colon and gastric cancer cell lines to 5-FU. METHODS: Expression of TS mRNA was determined by RT-PCR assay in 9 colon and 10 gastric cancer cell lines. Cytotoxicity of 5-FU was determined by MTT assay. Apoptosis was determined using propidium iodide staining by flow cytometry. RESULTS: All cancer cell lines tested showed differential levels of TS mRNA expression. Colon cancer cell Colo320 (the highest expression of TS) was more resistant to 5-FU than SNU-C1 (the lowest expression of TS) was. Flow cytometry also showed that 5-FU induced apoptosis less in Colo320 than SNU-C1. But in gastric cancer cells SNU-1 (the highest expression of TS) was not resistant to 5-FU than SNU-16 (the lowest expression of TS) was. CONCLUSIONS: The high level of expression of TS was correlated with resistance of colon cancer cells to 5-FU, but not in gastric cancer cells. Thus, TS may be differently involved in the resistance of gastric and colon cancer cells to 5-FU, which may depend on the origin of cancer cells and status of apoptosis related genes.

Development of Upgraded Cortical Impact Model(Part I: Mechanics)

OBJECTIVE: Head trauma model is important and essential to development of new therapeutic modality. We present a upgraded head trauma model for experimental animals. METHODS: Using pneumatic cylinder, solenoid valve, linear variable differential transformer(LVDT) and load cell, we developed "Chung-Ang University Hospital Model 1.0(CAUH-1)" based on controlled cortical impact model. RESULTS: Changing pressure, impact velocity could be controlled up to 4m/sec. Using solenoid valve, we could control dwell time precisely. Real time impact force could be measured with load cell. CONCLUSION: Controlling dwell time, impact velocity, depth of deformation, this model would reproduce variable degrees of head injury. This model is so precise and versatile that it would be useful in diverse animal experimental researches.

Angiographically Occult Arteriovenous Malformation Mimicking Brain Tumor: Case Report

The authors report a case of angiographycally occult intracranial vascular malformation. The patient had huge calcified mass at left frontoparietal area. The preoperative diagnosis was a slowly growing benign tumor. The mass was very hard and so vascular malformation was not suspected even during the operation. Pathologic report revealed arteriovenous malformation.

Development of Upgraded Cortical Impact Model (Part II: Functional outcome)

OBJECTIVE: With the technical support from department of mechanical engineering, Korea Advanced Institute of Science and Technology(KAIST), we began to develop a better head trauma model named "Chung-Ang University Hospital Model 1.0(CAUH-1)" in March 2001 and completed it August 2001. In addition, we conduct functional tests(postural reflex, balance beam test, rotarod test, and etc) to verify this model. METHODS: Twelve four hours after moderate head injury(air tank pressure : 125psi, impact velocity: 1.34m/sec, depth of deformation : 2.5mm, dwell time : 84.5msec), we conducted various functional tests. Then, we compared the results with those of sham group. RESULTS: Using this device, we revive neurobehavioral changes(decreased reflexes, hemiparesis, decreased vestibulo-motor function) occuring after human head trauma. CONCLUSION: In our opinion, this is a very useful experimental head trauma model and will be helpful to many head trauma researchers.

Two Cases of Neonatal Arrhythmia Observed by Fetal Echocardiography / 대한주산의학회잡지

M-mode, pulsed Doppler and Doppler color flow mapping, in addition to two-dimensional echocardiography, have greatly improved imaging of the fetal heart through identification of abnormal cardiac anatomy and rhythm in utero. The early detection of cardiac disturbance in utero permits alteration in obstetric management such as delivery in a high-risk center for optimal neonatal care and/or decision in optimal delivery time. We report two cases of the neonatal arrhy-thmia which were observed by fetal echocardiography. In the first case, female baby showed neonatal arrhythmias including tachycardia and brady-cardia until 3 days after birth, and then turned to bradyarrhythmia due to non-conducted atrial bigeminy. These events lead us to review the fetal echocardiographs of the patient carefully. Premature atrial contractions were observed in her fetal echocardiography. At 2 months after birth, the patient's electrocardiogram showed normal sinus rhythm. Severe neonatal bradycardia of the second case was due to congenital complete heart block, identified clearly by electrocardiogram after birth. This case also showed complete heart block in her fetal echocardiography. After insertion of the temporary pacemaker, cardiomegaly was improved. Both the neonate and the mother had positive anti-SSA/Ro autoantibody. But any other symptoms and signs of neonatal lupus did not appear in the neonate. Patient's mother also did not show any symptoms and signs of systemic lupus erythematosus. Since the prognosis depends upon the cause of bradyarrhythmia in fetus and neonates, differential diagnosis is important in obstetric management and optimal neonatal treatment.

Two Cases of Cerebral Arteriovenous Malformations Treated by Embolization: Case Report

Embolization of intracranial arteriovenous malformations has been mainly used for palliation of symptom, for preoperative management, or for patients who have large sized AVM planned for radiosurgery. But, it can be used as a sole, effective treatment modality in some selected cases. However, there have been many controversies about its completeness. Over the past 10 years, the authors experienced two cases of patients who have suffered from a recurrences of AVMs after embolization. The authors reviewed the literatures concerning about the recurrence of AVM after embolization and postulated the causes for recurrences of our two cases. In our opinions, complete embolic obliteration of cerebral AVM is impossible in most cases and embolization must not be used as a sole treatment modality of cerebral AVM.

Factors Affecting Development and Recovery of Symptomatic Vasoapasm in Patients with Ruptured Intracranial Aneurysm(s)

To determine the factors affecting development and recovery of symptomatic vasospasm, the author analyzed the results of patients with ruptured intracranial aneurysms treated by nimodipine and prophylactic "triple-H" therapy. From January 1991 to December 1995, 199 patients underwent surgery for ruptured intracerebral aneurysms. Combined hypervolemic hemodilution was initiated at the time of admission. Induced hypertension was added immediately after surgery(aneurysmal neck clipping). All patients received nimodipine intravenously or orally until the 14th day of SAH. Sixty patients underwent surgery on Day 0 through 2 after attackes of subarachnoid hemorrhage(Group A), 105 patients on Day 3 through 14(Group B), and 34 patients after Day 14(Group C). Of 199 patients, 76(38%) patients suffered from symptomatic vasospasm. Symptomatic vasospasm occurred in 34% of Group A patients, 33% of Group B patients, and 5% of Group C patients. Symtomatic vasospasm occurred more frequently in the older age group, the Fisher group 3, and Hunt & Hess grades 3, 4 and 5 groups. Of 76 patients who suffered from symptomatic vasospasm, 47(62%) patients recovered completely. The author analyzed the relationship between recovery rate and sex, age, Hunt & Hess grade and Fisher group among these 76 patients. Recovery rates between these groups were not significantly different. Based on this experience, the author believes that Hunt-Hess grade, Fisher group, and age are important factors affecting symptomatic vasospasm development.

Trapped Fourth Ventricle: Case Report

Trapped fourth ventricle is a rare clinical entity. It presents as a posterior fossa mass lesion. A case of trapped fourth ventricle which developed after surgery of cystic neurocysticercosis located at the cerebellopontine angle is presented. The authors reviewed the literatures of the trapped fourth ventricle and discussed the pathogenesis as well as the management of this rare clinical entity.

Transcatheter Closure of Secundum Atrial Septal Defect with "Buttoned" Device

No abstract available.

Morphological Classification of Left Superior Vena Cava and Analysis of Associated Cardiac Anomalies

The persistent left superior vena cava (LSVC) is not rare cardiovascular developmental anomaly occurring both in association with congenital heart disease and as an isolated anomaly of no hemodynamic importance. We have studied 73 cases of the LSCV out of 1,060 cases of congenital heart disease catheterized at Yonsei Cardiovascular Center. We conducted the study with a view point of position of the heart and abdominal organs and segmental analysis of the underlying congenital heart disease. We also analysed the associated extracardiac vascular anomalies. The following results were obtained: 1) The incidence of this anomaly among congenital heart disease was 6.9% and 41 cases(56.2%) had cyanosis. 2) We observed 20 cases(27.3%) with the malposition of the heart and 17 cases(23.3%) with malposition of the abdominal organs. The ventricular loops revealed D-loop in 60 cases, L-loop in 7 cases and in the remaining 6 cases, it was uncertain. 3) With a view point of type of LSVC by Lucas & Krabill, type A was in 50 cases(68.5%), type D in 14 cases(19.2%), type B in 5 cases(6.8%) and type C in 4 cases(5.5%). 4) Associated cardiovascular anomalies were as follows: ventricular septal defect; 42 cases(57.5%), atrial septal defect; 33 cases(45.2%), patent ductus arteriosus; 27 cases(36.9%), and tetralogy of Fallot; 18 cases(24.7%). In conclusion, LSVC usually has no hemodynamic importance, but this cardiac anomaly is frequently combined with complex intracardiac anomalies. Therefore, it is important to making accurate diagnosis and successful management for preventing the risk of it.

Analysis of the Factors That Influence on the Effect of Prostaglandin E1(PGE1)in Infants with Ductus-Dependent Cyanotic Congenital Heart Disease

BACKGROUND: The prostaglandin E1(PGE1) is a well known protent dilator of arteriosus. Maintaining of the patency of ductus arteriosus is crucial for the survival of patients suffering from ductus-dependent cyanotic congenital heart disease. We aimed to analyse the efficacy and the influencing factors upon PGE1 in patients suffering from this disease. METHODS: Between May 1991 and April 1993, 26 neonates and infants with ductus- dependent cyanotic congenital heart disease received on intravenous infusion of PGE1 in the Division of Pediatric Cardiology. Yonsei Cardiovascular Center. The result was a dramatic improvement in systemic arterial oxygen tension and oxygen saturation during infusion of PGE1with a dependency on the infusion of PGE1. We evaluated the arterial blood gas analysis both at the immediate pre-infusion stage and 2 hours after infusion. We aimed to analyse the factors which may influence the intravenous of PGE1to infant suffers of ducts-dependent cyanotic congenital heart disease, such as pulmonary atresia(n=14), severe pulmonary stenosis(n=7) or complete transposition of the great arteries(n=5). RESULTS: 1) There was a significant increase in PaO2 and Oxygen saturation 2 hours after the infusion of PGE1. This appeared to be unrelated to the different forms of the disease when compared with the pre-infusion values. 2) The infants' responsiveness of the ductus arteriosus appeared to be age related with significant differences emerging between the 2 group(p<.05). In infants younger than 9 hours old, the differences in PaO2 changes between pre-infusion and post-infusion of PGE1 were 16.3+/-3.7mmHg compared to just 10.4+/-0.4mmHg in infants older than 96 hours. 3) No significant difference emerged between an increase in PaO2or oxygen saturation relating to the shape of ductus arteriosus ; or the level of PaO2prior to the infusion. 4) The side effects of PGE1were as follows ; fever(84.6%),loose stool(61.5%), apnea(30.8%) and hypotension(15.4%), etc.. CONCLUSION: PGE1provides excellent medical palliation for infants suffering from ductus-dependent cyanotic congenital heart disease until the pulmonary arteries are large enough for a modified Blalock-Taussig shunt ; or until corrective surgery is possible.

Echocardiographic Evaluation of the Changes of the Interventricular Septal Morphology in Postoperative Tetralogy of Fallot Patients

The hemodynamic feature of the tetralogy of Fallot (TOF) is best characterized by equality of left and right ventricular peak systolic pressure. The interventricular septum is flattened and thickened. Even after the right ventricular pressure is normalized in the postoperative period, the morphological abnormality continues for some time We have analyzed the morphological changes of the IVS echocardiographically after total correction and tried to correlate them with the prognosis of the patients. Forty five patients underwent total correction of TOF between May 1991 and July 1992.The IVS morphology was assessed with 2-D echocardiography before and after surgery. The control group consisted of 15 normal subjects(8 with functional cardiac murmur and 7 with non-cardiac diseases).We also evaluated the influence of the residual pulmonary regurgitation(PR) or pulmonic stenosis (PS) upon sequential changes in the end-systolic configuration and the thickness of the IVS. The following results were obtained. 1) Four months after total correction the IVS thickness and configuration at end-systole of the study patients were normalized, and they were not significantly different compared to those of the control group. 2) The postoperative residual PR of mild to moderate degree did not influence the course of morphological normalization. On the other hand, the postoperative residual PS greater than moderate degree hindered the normalization process. And the morphological abnormalities in the patients with the residual PS lasted longer than in the patients with the residual PR. 3) It would be necessary to perform cardiac catheterization in order to evaluate and to take care of the residual hemodynamic abnormalities if the IVS morphology remains to be abnormal even after one year after total correction.

A comparison of treatment between needle aspiration and incision in the patient with peritonsillar abscess / 대한이비인후과학회지

No abstract available.

Tricuspid atresia: a re-evaluation and classification

Morphological evaluations accounting the associated anomalies were performed in the 60 cases of tricuspid atresia, diagnosed at Division of Pediatric Cardiology. The following results were obtained. 1) Twenty one out of the 6 cases had transposition of the great vessels, among which 8 cases were in complete A-transposition. 2) Seven cases were associated with pulmonany atresia, in 1 case, aorta arise from morphological right ventricle and in 6 case, aorta from morphological left ventricle. Pulmonary stenosis or pulmonary outflow obstruction was found in 52 cases except the rest 8 cases. 3) Four cases were associated with double outlet right ventricle and double outlet left ventricle in 1 case. In conclusion, for the classification of tricuspid atresia on the clinical basis, every possible interrelation of great vessels should be put into full consideration and pulmonary atresia, with very few exceptions, be separated as and isolated item due to the impracticability to verify the origin of pulmonary arteries.