A retrospective study of changes in skin cancercharacteristics over 11 years

Background@#The incidence of skin cancer, which is primarily caused by exposure to ultravioletradiation, has steadily increased in recent years. The authors of the present study sought to investigatechanges in the epidemiology of skin cancer by conducting a retrospective review of patientsdiagnosed with skin cancer who received related care at a single medical institution. @*Methods@#The present study included patients who were diagnosed with skin cancer and receivedtreatment at Gyeongsang National University Hospital from 2008 to 2018. The site andtype of skin cancer, the number of patients with skin cancer each year, the sex and sex ratio of thepatients, and changes in patients’ age at first diagnosis were examined through retrospectivechart reviews. @*Results@#The number of patients with skin cancer significantly increased, but statistically significantchanges were not found in patients’ sex, skin cancer sites, or the types of skin cancer. However,patients’ age at the first diagnosis of skin cancer showed a statistically significant decreasestarting in 2015. @*Conclusion@#In this study, the number of patients with skin cancer increased over time. However,patients’ age at first diagnosis has decreased since 2015. Therefore, younger patients should takecare to prevent skin cancer, and further research on the causes of skin cancer in younger patientsis needed.

Quality of life of patients with nasal bone fracture after closed reduction

Background@#Closed reduction is the standard treatment for nasal bone fractures, which are the most common type of facial bone fractures. We investigated the effect of closed reduction on quality of life. @*Methods@#The 15-dimensional health-related quality of life survey was administered to 120 patients who underwent closed reduction under general anesthesia for nasal bone fractures from February 2018 to December 2019, on both the day after surgery and 3 months after surgery. Three months postoperatively, the presence or absence of five nasal symptoms (nose obstruction, snoring, pain, nasal secretions, and aesthetic dissatisfaction) was also evaluated. @*Results@#The quality of life items that showed significant changes between immediately after surgery and 3 months postoperatively were breathing, sleeping, speech, excretion, and discomfort. Low scores were found at 3 months for breathing, sleeping, and distress. There were 31 patients (25.83%) with nose obstruction, 25 (20.83%) with snoring, 12 (10.00%), with pain, 11 (9.17%) with nasal secretions, and 29 (24.17%) with aesthetic dissatisfaction. @*Conclusion@#Closed reduction affected patients’ quality of life, although most aspects improved significantly after 3 months. However, it was not possible to rule out deterioration of quality of life due to complications and dissatisfaction after surgery.

Mini-Review of Studies Reporting the Repeatability and Reproducibility of Diffusion Tensor Imaging

PURPOSE: Diffusion tensor imaging (DTI) data must be analyzed by an analyzer after data processing. Hence, the analyzed data of DTI might depend on the analyzer, making it a major limitation. This paper reviewed previous DTI studies reporting the repeatability and reproducibility of data from the corticospinal tract (CST), one of the most actively researched neural tracts on this topic. MATERIALS AND METHODS: Relevant studies published between January 1990 and December 2018 were identified by searching PubMed, Google Scholar, and MEDLINE electronic databases using the following keywords: DTI, diffusion tensor tractography, reliability, repeatability, reproducibility, and CST. As a result, 15 studies were selected. RESULTS: Measurements of the CSTs using region of interest methods on 2-dimensional DTI images generally showed excellent repeatability and reproducibility of more than 0.8 but high variability (0.29 to 1.00) between studies. In contrast, measurements of the CST using the 3-dimensional DTT method not only revealed excellent repeatability and reproducibility of more than 0.9 but also low variability (repeatability, 0.88 to 1.00; reproducibility, 0.82 to 0.99) between studies. CONCLUSION: Both 2-dimensional DTI and 3-dimensional DTT methods appeared to be reliable for measuring the CST but the 3-dimensional DTT method appeared to be more reliable.

Immediate regraft of the remnant skin on the donor site in split-thickness skin grafting

BACKGROUND: Skin defects of head and neck need reconstruction using various local flaps. In some cases, surgeons should consider skin graft for large skin defect. It is important to heal skin graft and donor sites. The authors investigated wound healing mechanisms at the donor sites with split-thick-ness skin graft (STSG). In this study, the authors compared two types of immediate regraft including sheets and islands for the donor site after facial skin graft using remnant skin. METHODS: The author reviewed 10 patients who underwent STSG, from March 2015 to May 2017, for skin defects in the craniofacial area. The donor site was immediately covered with the two types using remnant skin after harvesting skin onto the recipient site. Depending on the size of the remnant skin, we conducted regraft with the single sheet (n= 5) and island types (n= 5). RESULTS: On postoperative day 1 and 3 months, the scar formation was evaluated using the Patient and Observer Scar Assessment Scale (POSAS) and Vancouver Scar Scale (VSS). Total POSAS and VSS scores for the island type were lower than in single sheet group after 3 months postoperatively. There was significant difference in specific categories of POSAS and VSS. CONCLUSION: This study showed a reduction in scar formation following immediate regrafting of the remnant skin at the donor site after STSG surgery. Particularly, the island type is useful for clinical application to facilitate healing of donor sites with STSG.

The clinical usefulness of closed reduction of nasal bone using only a periosteal elevator with a rubber band

BACKGROUND: Closed reduction of nasal fracture with various instrument is performed to treat nasal fracture. Depending on the type of nasal fracture and the situation in which it is being operated, the surgeon will determine the surgical tool. The objective of this study was to investigate whether a periosteal elevator (PE) was a proper device to perform closed reduction for patients with simple nasal fractures. METHODS: From March 2018 to December 2018, 50 cases of simple nasal bone fracture underwent closed reduction performed by a single surgeon. These patients were divided into two groups randomly: nasal bone reduction was performed using only PE (freer) and nasal bone reduction was performed using Walsham, Asch forcep, and Boies elevator (non-freer, non-PE). RESULTS: The paranasal sinus computed tomography was performed on patients before and after operation to carry out an accurate measurement of reduction distance at the same level. According to the results, the interaction between instruments and fracture types had a significant influence on reduction distance (p = 0.021). To be specific, reduction distance was significantly (p= 0.004) increased by 2.157 mm when PE was used to treat patients with partial displacement compared to that when non-PEs were used. CONCLUSION: Closed reduction using PE and other elevator is generally an effective treatment for nasal fracture. In partial-displacement type of simple nasal fracture, closed reduction using PE can have considerable success in comparison with using classic instruments.

Reconstruction of nasal ala and tip following skin cancer resection

BACKGROUND: Defects of the nasal ala and tip have a complex three-dimensional structure that makes them challenging to reconstruct. Many reconstructive options have been described for nasal ala and tip defects, ranging from primary closure to local flaps and skin grafts. However, it is difficult to determine which method will yield the best cosmetic results in each individual case. Thus, the purpose of this study was to determine which surgical procedures for reconstructing defects of the nasal ala and tip have better cosmetic results.METHODS: From 2008 to 2018, 111 patients underwent surgery to reconstruct skin defects after resection of skin cancer in the nasal ala or tip. Their charts were reviewed to obtain data on age, sex, surgical location, size of the defect, surgical method, and cosmetic results using a visual analog scale (VAS).RESULTS: For nasal ala reconstruction, the most commonly used surgical technique was the nasolabial flap (n= 42). This method also had the highest VAS score (7/10). The most commonly selected surgical method for nasal tip reconstruction was the bilobed flap (n= 13), and bilobed flaps and primary closure had the highest VAS score (7/10).CONCLUSION: Nasolabial flaps showed excellent cosmetic results for the reconstruction of nasal ala defects, while primary closure and bilobed flaps yielded excellent cosmetic results for the reconstruction of nasal tip defects.

Injury of the Lower Ascending Reticular Activating System by Subfalcine Herniation in a Patient With a Cerebral Infarct

No abstract available.

Central Pain Due to Traumatic Axonal Injury of the Spinothalamic Tract in Patients with Mild Traumatic Brain Injury

Central pain, a neuropathic pain caused by an injury or dysfunction of the central nervous system, is a common, annoying sequela of mild traumatic brain injury (mTBI). Clarification of the pathogenetic mechanism of central pain is mandatory for precise diagnosis, proper management, and prognosis prediction. The introduction of diffusion tensor imaging allowed assessment of the association of the central pain and injury of the spinothalamic tract (STT), and traumatic axonal injury (TAI) in mTBI. In this review, 6 diffusion tensor tractography studies on central pain due to TAI of the STT in patients with mTBI are reviewed. The diagnostic approach for TAI of the STT in individual patients with mTBI is discussed, centering around the methods that these studies employed to demonstrate TAI of the STT.

A Comparison of International Guidelines for Pediatric Asthma Pharmacotherapy

OBJECTIVE: International institutes such as Global institute for Asthma(GINA), KAAACI(Republic of Korea), NHLBI(USA), BTS(UK) and JSA(Japan) have published guidelines for asthma treatment. The aim of this study was to compare the representatives' international guidelines of pharmacotherapy for pediatric asthma. METHODS: The recommendations related to pharmacotherapy for pediatric asthma were extracted from the latest representatives' international guidelines, and comprehensive comparisons were conducted. RESULTS: Major comparison outcomes between international guidelines were evaluated as follows: classification system on severity and pediatric age group, recommendation for inhaled corticosteroid dose, recommendation for pediatric age group of theophylline in mild asthma, and recommendation for pediatric age group of tiotropium in severe asthma. Clinical trials emphasized the adverse effects of theophylline, whereas tiotropium demonstrated beneficial actions for pediatric asthma. Therefore, theophylline was recommended for older patients with persistent asthma, and tiotropium was considered to be suitable for younger patients with severe asthma according to GINA guidelines. CONCLUSION: These findings address the requirement to harmonize international guidelines of pharmacotherapy in pediatric asthma. In addition, the findings suggest that KAAACI needs to update its pharmacotherapy guidelines of theophylline, tiotropium and other medicines recently approved.

Multivariate Analysis of the Prognostic Significance of Resection Weight after Transurethral Resection of Bladder Tumor for Non-Muscle-Invasive Bladder Cancer

PURPOSE: Tumor size and multiplicity are known to be important prognostic factors in non-muscle-invasive bladder cancer (NMIBC). However, evaluation of accurate tumor size is subjective and difficult. Furthermore, there are limitations to the objectification of tumor volume in the case of multiple lesions. In this study, we investigated the relation between resection weight after transurethral resection of bladder tumor (TURBT) and the prognosis of NMIBC. MATERIALS AND METHODS: This was a retrospective analysis of 406 patients diagnosed with pTa or pT1 bladder tumors after TURBT between September 1999 and May 2010. The patient's age, sex, underlying diseases, cancer stage, grade, multiplicity, tumor size, lymphovascular invasion, and resection weight were analyzed in relation to cancer progression and recurrence. The resection weight was weighted after formaldehyde fixation. RESULTS: The mean follow-up time was 76.9 months (range, 12 to 167 months) in 406 patients diagnosed as having NMIBC. Mean resection weight was 4.5 g (range, 0.1 to 35.0 g). The cancer recurred in 99 patients (24.4%), and disease progression was noted in 30 patients (7.4%). Resection weight was categorized as greater than or less than 2 g by use of receiver operator characteristic curves. Cancer grade (p=0.022) and multiplicity (p=0.043) were significantly related to cancer recurrence in the analysis with Cox's multivariate proportional hazard model. Cancer grade (p=0.001) and resection weight (p=0.018) were related to disease progression. CONCLUSIONS: Resection weight after TURBT was significantly related to progression of NMIBC. Resection weight was an independent factor of progression. Further management should be considered if the resection weight exceeds 2 g.

Multivariate Analysis of the Prognostic Significance of Resection Weight after Transurethral Resection of Bladder Tumor for Non-Muscle-Invasive Bladder Cancer

PURPOSE: Tumor size and multiplicity are known to be important prognostic factors in non-muscle-invasive bladder cancer (NMIBC). However, evaluation of accurate tumor size is subjective and difficult. Furthermore, there are limitations to the objectification of tumor volume in the case of multiple lesions. In this study, we investigated the relation between resection weight after transurethral resection of bladder tumor (TURBT) and the prognosis of NMIBC. MATERIALS AND METHODS: This was a retrospective analysis of 406 patients diagnosed with pTa or pT1 bladder tumors after TURBT between September 1999 and May 2010. The patient's age, sex, underlying diseases, cancer stage, grade, multiplicity, tumor size, lymphovascular invasion, and resection weight were analyzed in relation to cancer progression and recurrence. The resection weight was weighted after formaldehyde fixation. RESULTS: The mean follow-up time was 76.9 months (range, 12 to 167 months) in 406 patients diagnosed as having NMIBC. Mean resection weight was 4.5 g (range, 0.1 to 35.0 g). The cancer recurred in 99 patients (24.4%), and disease progression was noted in 30 patients (7.4%). Resection weight was categorized as greater than or less than 2 g by use of receiver operator characteristic curves. Cancer grade (p=0.022) and multiplicity (p=0.043) were significantly related to cancer recurrence in the analysis with Cox's multivariate proportional hazard model. Cancer grade (p=0.001) and resection weight (p=0.018) were related to disease progression. CONCLUSIONS: Resection weight after TURBT was significantly related to progression of NMIBC. Resection weight was an independent factor of progression. Further management should be considered if the resection weight exceeds 2 g.

Association of Visceral Fat and Risk Factors for Metabolic Syndrome in Children and Adolescents

PURPOSE: Visceral fat (VF) is closely associated with many metabolic risk factors and is also known to be a strong predictive factor for severe metabolic complications in adults. But there are only a few studies concerning the association of VF and risk factors for metabolic syndrome (MS) in children and adolescents. In our study, we emphasized the association of VF [measured by VF computed tomography (VFCT)] and risk factors for metabolic syndrome in children and adolescents. MATERIALS AND METHODS: The subjects were outpatients aged 6 to 18 years who underwent VFCT in the family medicine of The Catholic University of Korea from January 2005 to August 2009. There were 82 patients in total (42 children, 40 adolescents). Height, weight, blood pressure (BP), blood tests, body composition analysis and VF were measured. The three groups were also classified by metabolic score. RESULTS: In children, only high density lipoprotein cholesterol (HDL-C) showed a statistically significant difference, while in adolescents, triglyceride, HDL-C, BP, body mass index (BMI), waist circumference (WC) and VFA showed statistically significant differences. In terms of VFA, fasting glucose, BP, BMI, basal metabolic rate (BMR) and WC showed statistically significant differences. BMI showed a statistically significant difference in terms of BP, BMR, WC, VFA and HDL-C. CONCLUSION: There is a need to acknowledge the statistically significant associations of VF and risk factors for MS in children and adolescents. Screening tests for BP, cholesterol, fasting glucose and WC should be given in clinics for children and adolescents so that MS can be detected and its risk factors treated early.

Effects of Health Insurance Coverage for Vasovasostomy / 대한남성과학회지

PURPOSE: In early 1980s, vasectomy was performed in more than 10 thousand men of reproductive age annually without cost as a South Korean government policy of birth control, but because the policy has been converted to encouraging childbirth since July 2004, vasovasostomy is now covered by national health insurance. We investigated the effect of national health insurance coverage of vasovasostomy. MATERIALS AND METHODS: From August 1997 to June 2009, a total of 117 patients who underwent vasovasostomy were enrolled in this study. We divided the patients into two groups. The 63 patients undergoing the procedure before national health insurance coverage were included in group A, and the other 54 patients, who underwent the procedure after insurance coverage began, were classified into group B. The two groups were compared according to age, spouse's age, time since vasectomy, number of children at the time of vasectomy, occupation, educational attainment, religion, and the reason for vasovasostomy. RESULTS: The average number of cases of vasovasostomy was almost 3 times higher after insurance coverage was introduced, at 2.3 cases per month. The average spouse's age was significantly higher in group B than group A (35.2+/-4.8 vs. 32.2+/-3.5, p=0.012). Time since vasectomy was shorter in group B than group A (5.7+/-4.7 years vs. 8.9+/-5.0 years, p=0.001). Number of children at the time of vasectomy showed no significant difference between group A and group B, at 1.7+/-0.7 and 1.6+/-0.8 respectively. Cross tabulation analysis of occupation, educational status, religion, and the reason for vasovasostomy showed no significant difference. The patency rate was significantly higher in group A than group B (87.3% vs. 90.7%, p=0.012), but there was no significant difference in pregnancy rate. CONCLUSIONS: A significant increase was seen in patency rate, but not in pregnancy rate, after insurance coverage. However, further follow up will show us that a rise in the patency rate promises positive effects on the rise of pregnancy rate. We suggest that insurance coverage for vasovasostomy has encouraged an increase in births.

Pyogenic Sacroiliitis with Psoas Abscess: A case report

Pyogenic sacroiliitis is a rare infection that may accompany psoas muscle abscess with vague clinical presentation, which present a diagnostic challenge requiring a high index of suspicion. We report a 48-year-old male, diagnosed pyogenic sacroiliitis with psoas abscess caused by Streptococcus intermedius and Sphingomonas paucimobilis. Magnetic resonance imaging showed multiloculated rim-enhancing lesion in right psoas muscle and joint effusion with osteomyelitis around sacroiliac joint. Intravenous antibiotics were administered after ultrasonographically guided abscess aspiration. Surgical drainage was done and his fever and symptom gradually subsided.

Usefulness of Electronic Pressure Algometer in Evaluation of Pressure Pain Threshold in Normal Korean Adults

OBJECTIVE: To examine pressure pain threshold (PPT) on several skeletal muscles in upper extremity, trunk, and lower extremity by using electronic pressure algometer and to evaluate it's interrater reliability, reproducibility, difference between gender and dominance, correlation with body mass index, and comparison among each muscles. METHOD: Forty healthy adults (male 27, female 13) were examined by two raters and reexamined in the same order after a rest of 10 minute. PPT at the splenius capitis, upper trapezius, infraspinatus, lumbar paraspinal muscle, extensor carpi radialis, vastus medialis, and gluteus medius muscles of both side was measured by medical electronic algometer. Rate of force application was approximately 2 lb/sec. Body mass index (BMI) was estimated from the individual's body weight by the square of their height. RESULTS: There were no statistical differences of PPTs at all muscles between two raters, between two test with time interval, and between dominant and nondominant side, respectively. PPT in man was higher than female at all muscles. There was significant correlation between BMI and PPT at lumbar paraspinal muscle, vastus medialis, and gluteus medius only in male. PPT was highest at lumbar paraspinal muscle and lowest at splenius capitis. CONCLUSION: Electronic pressure algometer is a reliable tool for evaluation of PPT which has high interrater reliability and high reproducibility and is not affected by dominance and location of muscles. Therefore, it is a useful clinical tool to compare PPT before and after treatment and to study the mechanism of musculoskeletal pain research program.

The Relationship between Waist Circumference/Height Ratio and Risk Factors of Cardiovascular Disease in Obese Females

BACKGROUND: In this study we estimated the prevalence of cardiovascular (CV) risk factors according to waist-to- height ratio (W/Ht ratio) in adult obese women to ensure the importance of abdominal obesity and determined the usefulness of W/Ht ratio as a index of abdominal obesity in adult obese women. METHODS: The study subjects were 190 adult obese women who visited an obesity clinic from August, 2001 to January, 2003. They were divided into 4 groups: Group 1; BMI or =0.6, Group 3; BMI> or =30, W/Ht or =30, W/Ht> or =0.6. In each group, we compared the prevalence and odds ratio for CV risk factors. RESULTS: In obese group, the prevalence of high blood glucose (P<0.01), hypertriglyceridemia (P<0.01) were significantly higher in group 2 than group 1. In high obese group, the prevalence of systolic hypertension (P<0.01), high blood glucose (P<0.01), hypercholesterolemia (P<0.01), hypertriglyceridemia (P<0.05), and high LDL-cholesterol were significantly higher in group 4 than group 3. When odds ratio for each group with reference to group 1 were compared after adjusting for age, high blood glucose (4.48), and hypertriglyceridemia (6.10) in group 2, and systolic hypertension (2.69), high blood glucose (3.02), and hypertriglyceridemia (4.00) in group 4 were significantly higher. CONCLUSION: The prevalence of CV risk factors were likely to be increased in higher W/Ht group independently to BMI. W/Ht ratio can be a simple, useful index for abdominal obesity and its related risk factors not only in adult males but also in adult obese women.

A clinical study of endometriosis / 대한산부인과학회잡지

No abstract available.

Hypotensive Effect of Diltiazem Hydrochloride(Herben(R)) in Essential Hypertension: A Clinical Study

The hypotensive effect of diltiazem hydrochloride(Herben(R)) was investigated with 32 cases of essential hypertension. Diltiazem, 90-180mg per day, was administer ed in divided doses to each of the subjects for 6 week and the blood pressure lowering effect was assessed, as remarkably effective when the lowering of blood pressure was, 20mmHg or more of systolic pressure and 10mmHg or more of diastolic pressure; as satisfactorily effective when 20mmH or more of systolic pressure or 10mmHg or more of diastolic pressure was lowered; as fairly effective when 10-19mmHg of systolic pressure and 5-9mmHg of diastolic pressure. 1. With above mentioned criteria, diltiazem was remarkably, satisfactorily and fairly effective in 11(37%), 13(43%) and 1(3%) of 30 patients, respectively, while the drug was ineffective in 5(17%). 2. Diltiazem was effective in lowering of both systolic and diastolic blood pressure, and was effective as a sole agent of as an agent of combination therapy. 3. With diltiazem treatment, the depressed ST segment was conversed to isoelectric line in all of 10 cases which showed ST depression before diltiazem treatment and the elevated ST segment was conversed to isoelectric line in 1 of 2 cases. all of 4 cases with flat T wave and 10 of 12 cases with inverted T wave showed conversion to upright T waves after diltiazem treatment. 4. Undesirable side effects was observed in 2 cases out of 32 cases(6%); 1 case of erythema multiforme-like skin eruption and 1 case of the clinical aggravation of congestive heart failure, in whom the diltiazem administration was discontinued.

Hemodynamic Effect of Prazosin in Congestive Heart Failure

The hemodynamic effects of Prazosin were evaluated in 31 cases with congestive heart failure (mitral stenosis; 15 cases, mitral insufficiency; 7 cases, hypertensive heart disease;4 cases, congestive cardiomyopathy; 5 cases) by means of echocardiographic method. Before and 90 min. after the administration of prazosin(3mg p.o.), M-mode echocardiograms of left ventricle were recorded, from which end-diastolic and end-systolic dimensions of left ventricle and left ventricular ejection time were measured. Hemodynamic parameters of left ventricular performance, i.e., mean veloity of circumferential fiber shortening, fractional fiber shortening, ejection fraction, stroke volume, and cardiac output were calculated from the measurements. Left ventricular end-diastolic and end-systolic dimensions were decreased significantly after prazosin administration and left ventricular performance was significantly increased after prazosin administration, whereas stroke volume was not. Total systemic peripheral resistance and mean arterial pressure showed no significant changes. All cases, except one of the patients showed marked symptomatic relief after prazosin administration evaluated by NYHA functional classification. There was no considerable untoward effect in the patients of congestive heart failure to whom the prazosin was administered.