Early outcomes of robotic transabdominal preperitoneal inguinal hernia repair: a retrospective single-institution study in Korea

Purpose@#Robotic hernia repair has increased in popularity since the introduction of da Vinci robots (Intuitive Surgical). However, we lack quantitative analyses of its potential benefits.Herein, we report our initial experience with robotic transabdominal preperitoneal (R-TAPP) inguinal hernia repair. @*Methods@#We retrospectively reviewed the data from patients who underwent R-TAPP inguinal hernia repair with a prosthetic mesh using the da Vinci platform. Data on patient characteristics and surgical outcomes were also collected. @*Results@#Twenty-one patients (including 20 male patients [95.2%]) with a mean age of 54.1 ±16.4 years and body mass index of 23.8 ± 1.9 kg/m2 underwent R-TAPP inguinal hernia repair. Bilateral hernia repair was performed in two patients (9.5%), and six patients (28.5%) with scrotal hernia underwent R-TAPP hernia repair. A sigmoid colon sliding hernia was present in three patients (14.3%). The mean operation and console times were 91.8 ± 20.4 minutes and 154.5 ± 26.2 minutes, and 61.4 ± 16.9 minutes and 128.0 ± 25.5 minutes for unilateral and bilateral inguinal hernia, respectively. Spermatic vessel injury was identified intraoperatively in one patient. Two minor postoperative complications, postoperative ileus, and wound seroma were reported. The mean duration of hospitalization was 3.8 ± 0.9 days. No recurrence or conversion to open surgery was required. @*Conclusion@#Our findings suggest that R-TAPP inguinal hernia repair is safe and feasible. Its cost-effectiveness, optimal procedural steps, and indications for a robotic approach require further investigation.

Irrigation Versus Suction Alone During Laparoscopic Appendectomy for Uncomplicated Acute Appendicitis

Purpose@#To compare the surgical outcomes of peritoneal irrigation versus suction alone during laparoscopic appendectomy and to identify the risk factors of surgical site infection in patients with uncomplicated acute appendicitis. @*Methods@#Data from patients with uncomplicated acute appendicitis between January 2014 and March 2016 were reviewed. We compared the irrigation and suction alone groups with regard to the following parameters: postoperative complication incidence rate, length of hospital stay, operation time, time to flatus, time to diet commencement, and duration of postoperative antibiotic. @*Results@#A total of 578 patients underwent laparoscopic appendectomy for uncomplicated acute appendicitis. Twenty-five patients were excluded from the analysis because of need for drain insertion, loss to follow-up, simultaneous surgery for another indication, presence of an appendix tumor, or pregnancy. A total of 207 patients (37.4%) had undergone irrigation, and 346 patients (62.6%) received suction alone during laparoscopic appendectomy. The preoperative fever rate was significantly higher in the irrigation group than in the suction alone group. Operative time was also significantly longer in the irrigation group than in the suction alone group (53.8 ± 18.5 minutes vs. 57.8 ± 21.4 minutes, P = 0.027). The postoperative complication rate was higher in the irrigation group than in the suction alone group (4.5% vs. 12.6%, P = 0.001). Multiple logistic regression analysis showed that irrigation and preoperative fever were risk factors for surgical site infection after laparoscopic appendectomy for uncomplicated acute appendicitis. @*Conclusion@#There is no advantage to irrigating the peritoneal cavity over suction alone during laparoscopic appendectomy for uncomplicated acute appendicitis. Irrigation may actually prolong the operative time and therefore be detrimental.

Staged partial hepatectomy versus transarterial chemoembolization for the treatment of spontaneous hepatocellular carcinoma rupture: a multicenter analysis in Korea

PURPOSE: The aim of this study was to identify the prognostic factors and compare the long-term outcomes of staged hepatectomy and transarterial chemoembolization (TACE) for patients with spontaneous rupture of hepatocellular carcinoma (HCC). METHODS: This study is a multicenter, retrospective analysis of patients with newly diagnosed ruptured HCC. To compare overall survival between staged hepatectomy group and TACE alone group, we performed propensity score-matching to adjust for significant differences in patient characteristics. To identify prognostic factors, the clinical characteristics at the time of diagnosis of tumor rupture were investigated using Cox-regression analysis. RESULTS: From 2000 to 2014, 172 consecutive patients with newly diagnosed ruptured HCC were treated in 6 Korean centers. One hundred seventeen patients with Child-Pugh class A disease were identified; of which 112 were initially treated with transcatheter arterial embolization (TAE) for hemostasis and five underwent emergency surgery for bleeder ligation. Of the 112 patients treated with TAE, 44 underwent staged hepatectomy, 61 received TACE alone, and 7 received conservative treatment after TAE. Those that underwent staged hepatectomy had significantly higher overall survival than those that underwent TACE alone before matching (P 1,200 mL, and tumor size >5 cm were associated with poor overall survival. CONCLUSION: Staged hepatectomy may offer better long-term survival than TACE alone for spontaneous rupture of HCC. Staged hepatectomy should be considered in spontaneous rupture of HCC with resectable tumor and preserved liver function.

Covered Self-expandable Metallic Stent Insertion as a Rescue Procedure for Postoperative Leakage after Primary Repair of Perforated Duodenal Ulcer / 대한소화기학회지

Surgery has been the standard treatment for perforated duodenal ulcers, with mostly good results. However, the resolution of postoperative leakage after primary repair of perforated duodenal ulcer remains challenging. There are several choices for re-operation required in persistent leakage from perforated duodenal ulcers. However, many of these choices are complicated surgical procedures requiring prolonged general anesthesia that may increase the chances of morbidity and mortality. Several recent reports have demonstrated postoperative leakage after primary repair of a perforated duodenal ulcer treated with endoscopic insertion using a covered self-expandable metallic stent, with good clinical results. We report a case with postoperative leakage after primary repair of a perforated duodenal ulcer treated using a covered self-expandable metallic stent.

Quality Improvement Activities to Facilitate the Filing of Complexity Payment Claims for Patients with Malnutrition

PURPOSE: The grade of complexity in the diagnosis related group (DRG) payment system is influenced by the secondary diagnosis of specific complication and comorbidity level, in which moderate or severe malnutrition is included. This study examined an existing proportion of patients with malnutrition who were supposed to be qualified for the complexity level and devised quality improvement measures to increase the proportion of qualifying complexity payments. METHODS: The goal of the activities was to increase the rate of complexity payment claims for patients with malnutrition (%). Cases ineligible for the DRG payment system and cases with no diagnosis of malnutrition were excluded. We established a collaborative system between the nutrition support team and departments related to each improvement factor (i.e., patient care, medical records, insurance review, and medical information). RESULTS: Before implementing the activities, this study investigated the current level of complexity payment claims for malnutrition patients who were discharged within a specific period (June 1, 2015~August 31, 2015). The results showed that complexity payment claims were filed in 10.00% (2 of the 20 malnutrition cases). After the activities, the rate of complexity payment claims for the patients with malnutrition within the study period (June 1, 2016~August 31, 2016) was 46.43% (26 out of 56), showing an approximately 364% increase from the pre activity rate. This change was statistically significant according to the chi-square test on Microsoft Excel 2010 (P < 0.01). CONCLUSION: Collaborative efforts by the related departments enabled the smooth implementation of each activity. In addition, moderate or severe malnutrition was revealed to be a variable in the complexity-specific payment system. In the future, hospital-wide awareness and effort are crucial to promot the steady practice of these activities and expand their implementation.

Feasibility of single-incision laparoscopic appendectomy in a small hospital

PURPOSE: This study aimed to compare clinical outcomes for single-incision laparoscopic appendectomy (SILA) and conventional laparoscopic appendectomy (CLA) for the treatment of acute appendicitis and to assess the feasibility of performing SILA in a small hospital with limited surgical instruments and staff experience. METHODS: Retrospective record review identified 133 patients who underwent laparoscopic appendectomy from December 2013 to April 2015. Patients were categorized according to the type of appendectomy performed (SILA or CLA). Patient characteristics and surgical outcomes were compared between the 2 groups. Postoperative complication rates were compared using the Clavien-Dindo classification. Postoperative pain was assessed using a visual analog scale immediately postsurgery; at 12, 24, 36, and 48 hours postoperatively, and at 7 days postoperatively. RESULTS: Record review identified 38 patients who had undergone SILA and 95 patients who had undergone CLA. No significant differences in clinical characteristics were found between the 2 groups. There were no significant differences in operation time, time to flatus, or length of hospital stay. Overall complication rates were not significantly different between the 2 groups. No complications worse than grade IIIa occurred in the SILA group. Postoperative pain scores were not significantly different between the 2 groups at any time point. CONCLUSION: We found comparable surgical outcomes for SILA compared to CLA. Even in a small hospital with limited surgical instruments and staff experience, SILA may be a feasible and safe technique.

Early Feeding Is Feasible after Emergency Gastrointestinal Surgery

PURPOSE: This study was undertaken to assess the feasibility of early feeding in patients that have undergone emergency gastrointestinal (GI) surgery. MATERIALS AND METHODS: The authors retrospectively reviewed 84 patients that underwent emergency bowel resection and/or anastomosis from March 2008 to December 2011. Patients with severe shock, intestinal ischemia, sustained bowel perforation, or short bowel syndrome were excluded. Patients were divided into the early (group E; n=44) or late (group L; n=40) group according to the time of feeding commencement. Early feeding was defined as enteral feeding that started within 48 hours after surgery. Early and late feeding groups were compared with respect to clinical data and surgical outcomes. RESULTS: The most common cause of operation was bowel perforation, and the small bowel was the most commonly involved site. No significant intergroup differences were found for causes, sites, or types of operation. However, length of stay (LOS) in the intensive care unit (1 day vs. 2 days, p=0.038) and LOS in the hospital after surgery were significantly greater (9 days vs. 12 days, p=0.012) in group L than group E; pulmonary complications were also significantly more common (13.6% vs. 47.5%, p=0.001) in group L than group E. CONCLUSION: After emergency GI surgery, early feeding may be feasible in patients without severe shock or bowel anastomosis instability.

Waiting Time for Deceased Donor Kidney Allocation in Korea: A Single Center Experience / 대한이식학회지

BACKGROUND: The kidney recovery rate associated with deceased donors has increased after the establishment of the Korean Network for Organ Sharing (KONOS). And the KONOS organ allocation system gives priority to candidates affiliated with a Hospital based Organ Procurement Organization (HOPO) and/or donor recovery hospital. Regardless of whether or not this organ allocation system is fair, it can make an important impact on the waiting time for an organ transplant. METHODS: A total of 157 deceased donor kidney transplantations were performed at Severance Hospital between January 2006 and April 2011. The recipients of these transplantations were retrospectively divided into five groups according to their allocation types; general allocation group (GA, n=54), HOPO priority group (HP, n=65), zero antigen mismatching group (ZM, n=23), marginal donor allocation group (MD, n=7), and the combined organ transplant allocation group (CT, n=8). The five groups were assessed in terms of their waiting time for organ allocation, cold ischemia time, and post-transplant graft outcome. RESULTS: Mean waiting time for organ allocation of the HP group (69.5+/-27.4 months) was significantly shorter than for the GA group (90.0+/-34.0 months)(P<0.05). However, the degree of HLA mismatching was not different between each group. The cold ischemia time for the HP group (301.5+/-133.9 min) was significantly shorter than all other groups, except for the ZM group. There were no differences between groups in terms of acute rejection episodes, delayed graft function events or graft survival rates. CONCLUSIONS: Our retrospective analysis of the kidney allocation pattern showed that there were disparities in distribution by priority of allocation. We should make a consensus within the Korean transplant society in order to further develop the allocation system to decease donor kidney transplantation time.

Impact of pretransplant rituximab induction on highly sensitized kidney recipients: comparison with non-rituximab group / 대한외과학회지

PURPOSE: Highly sensitized patients with a high level of panel reactive antibody (PRA) experience more episodes of antibody-mediated rejection (AMR) and poorer graft survival than non-sensitized patients. Rituximab is a well-known monoclonal anti-CD20 antibody that causes the depletion of B lymphocytes. The aim of this study was to compare a rituximab-administered and a non-administered group of highly sensitized recipients. METHODS: Forty-three kidney recipients with a PRA level of > or =50% were included. Sixteen (group R) received one dose of rituximab at 2 days prior to transplantation and 27 patients (group NR) did not. RESULTS: Patients' demographics, such as age, sex, dialysis duration, and type of immunosuppressive agent were not different in the two groups. No side effects due to rituximab administration were observed in group R. Class I PRA of group R (75.6 +/- 37.7%) was higher than that of group NR (45.7 +/- 35.8%, P = 0.013). More acute rejection episodes occurred within 1 year after transplantation in group NR but the difference between the groups was not significant (18.8% in group R vs. 29.6% in group NR, P = 0.631). However, two AMR episodes occurred only in group NR. Renal functions were not different in the two groups. In group R, CD19 and CD20 rapidly decreased 2 days after rituximab infusion. Furthermore, the administration of rituximab was not linked to acute rejection. CONCLUSION: To confirm the long-term anti-rejection and beneficial effects of rituximab, further studies should be performed with a larger cohort. In conclusion, rituximab administration 2 days prior to transplantation is both effective and safe.

The Safety of Early Enteral Feeding after Emergency Gastrointestinal Surgery / 대한소화기학회지

BACKGROUND/AIMS: Postoperative early feeding has many advantages, and current guidelines recommend the early diet or enteral feeding after gastrointestinal surgery. However, there are controversies in emergency situation. The aim of this study was to assess the safety of early enteral feeding in patients underwent emergency gastrointestinal (GI) surgery. METHODS: We reviewed the patients underwent emergency GI surgery by single surgeon from March 2008 to December 2010, retrospectively. The early feeding was defined when feeding was started within 72 hours after operation. RESULTS: Fifty-three patients were enrolled. Men were 31, with mean 60.6 (+/-18.5) years old age. Thirty-three patients were treated in the intensive-care unit after operation. The most common cause of operation was bowel perforation, and followed by intestinal obstruction. Segmental resection with primary anastomosis of small bowel is the most common operation. Thirty-two of them started the diet within 48 hours postoperatively. Twenty-nine patients had post-operative complications. Wound complications were the most common, and followed by the abdominal pain, and ileus. Wound complications were developed in 18 patients, and the post-feeding abdominal pain was in 7 patients. Anastomotic leakage and intraabdominal abscess were developed in 2 patients, and 1 patient required reoperation to treat the anastomotic disruption. One patient developed pneumonia and sepsis, and resolved under conservative treatment. There was no mortality in these patients. CONCLUSIONS: Early enteral feeding may be safe in cases of emergency GI surgery. However, it may require further studies to confirm the safety and feasibility of the early feeding in emergency situations.

The Risk Factors for Extrahepatic Recurrence after Curative Resection of Hepatocellular Carcinoma

PURPOSE: A few studies have been reported on extrahepatic metastasis after curative resection for hepatocellular carcinoma (HCC). We investigated the patterns of extrahepatic recurrence and we identified the risk factors for extrahepatic recurrence after curative resection for HCC. METHODS: We retrospectively reviewed 587 patients who underwent surgical resection with a curative aim from January 1998 to December 2007 in the Yonsei University Health Care System. Among the 571 patients, 291 (51.0%) patients developed recurrence. Sixty five patients initially presented with extrahaptic recurrence. The patients with extrahepatic recurrence were divided into Group A (peritoneal recurrence) and Group B (non-peritoneal extrahepatic recurrence). RESULTS: Group A had higher rates of intraoperative bleeding>1,500 ml and perioperative transfusion too. On the multivariate analysis, perioperative transfusion, satellite nodule and the tumor size were the independent risk factors for Group A. The Edmondson-Steiner grade, satellite nodule and the tumor size were the independent risk factors for Group B. The 1, 3 and 5-year overall survival rates after curative resection for the patients with extrahepatic recurence were 83.1%, 48.9% and 27.4%, respectively. The recurrence patterns and treatment modalities did not affect the overall survival after treatment for extrahepatic recurrence. CONCLUSION: A perioperative transfusion was found to be a different risk factor for peritoneal recurrence, as compared to those risk factors for non-peritoneal extrahepatic recurrence. Therefore, efforts by physicians to decrease intraoperative bleeding may prevent peritoneal recurrence after performing curative resection for HCC.

A Case of an Asymptomatic Adrenal Myelolipoma

Adrenal myelolipoma is a rare benign, non-functioning tumor that is frequently discovered incidentally. We report here on a case of a 47-year-old woman with an incidentally found adrenal tumor. She was slightly obese and had been diagnosed with diabetes. Her blood sugar level was well-controlled with oral hypoglycemic agents. All the laboratory test results were within normal limits. The abdomen CT scan revealed a well-demarcated homogenous solid mass that was 9cm in diameter, and it consisted of fat tissues. The differential diagnosis for malignant tumors was necessary, so we performed complete surgical excision. The patient recovered well without any major complications. If the diagnosis of adrenal myelolipoma is definite, then regular follow-up of this type of patient is sufficient. However, as the differential diagnosis with malignant tumors is rather difficult and as spontaneous hemorrhage can persist in the giant myelolipomas that are greater than 10cm in diameter, performing complete surgical excision is inevitable.

The effect of contamination on bonding of orthodontic brackets with a self-etching primer/adhesive / 대한치과교정학회지

The purpose of this study was to investigate the influence of water, saliva, and blood contamination on the bonding strenght of metal brackets with a self-etching primer/adhesive to enamel. Ninety-six extracted human teeth were divided into four groups. The brackets were bonded to enamel with a self- etching primer (3M/Unitek Dental Products, Monorovia, California) according to one of four protocols. The teeth were bonded in a dry condition (group D) or in contamination with distilled water (group W), artificial saliva (group S), or fresh human blood (group B). Shear bond strengths were tested using an Instron Universal testing machine. After debonding, bracket and tooth surfaces were examined with a stereomicroscope. In each group, four samples were selected and examined with a Scanning electron microscope of the prepared enamel surface and resin-enamel interface. The results obtained were summarized as follows: Shear bond strength in group D (15.22 +/- 2.86 MPa) and W (16.20 +/- 3.85 MPa) were higher than in group B (12.56 +/- 2.94 MPa) (p 0.05). There was a tendency to have less residual adhesive remaining on the enamel surfaces of group B than group D. The SEM morphology of group D and W showed a more roughened etching pattern than group S and B. Water or saliva contamination on bonding of orthodontic brackets with Transbond plus self etching primer had almost no influence on bond strength. In this study, the blood contaminated group showed the lowest bond strength, but it was above the clinically acceptable bond strength (5.9-7.8 MPa, Reynold, 1975). The results of this study suggest that acceptable clinical bond strengths can be obtained in wet conditions when self-etching adhesives are used.

Comparison of bracket bond strength in various directions of force / 대한치과교정학회지

The purpose of this study was to evaluate the bond strength of orthodontic brackets bonded to metal bar with chemically cured adhesive (Ortho-one, Bisco Co, USA) in various types and directions of force application. Three types of metal bracket with different bracket base configurations; Micro-Loc base(Tomy Co, Japan), Chessboard base(Daesung Co, Korea), Non-etched Foil-Mesh base(Dentaurum, Germany); were used in this study. Peel, shear, tensile bond strengths were measured by universal testing machine and compared each other. The peel force directions applied were 0degrees, 15degrees, 30degrees, 45degrees, 60degrees, 75degrees, 90degrees. And then, in consideration of the different surface area of the bracket bases, the bond strength per unit area were calculated and compared. The results obtained were summarized as follows : 1. The bond strengths according to the types and the directions of the forces were greatest at the shear forces in all three bracket base configuration groups(p < 0.01). 2. As the peel force direction grew higher in degree, peel bond strength decreased. The patterns of peel bond strength change according to force direction was similar in all three bracket base configurations. The minimum bond strength was 60 degree-peel bond strengths in all three bracket base configurations. 3. In Micro-Loc base group, minimum peel bond strength(60PBS) was in 29% level of shear bond strength and 52% level of tensile bond strength. In Chessboard base group, 60PBS was in 34% level of shear bond strength and 61% level of tensile bond strength. In Non-etched Foil-Mesh base group, 60PBS was in 34% level of shear bond strength and 55% level of tensile bond strength. 4. The bond strengths per unit area were lowest in Non-etched Foil-Mesh base group and highest in Chessboard base group(p < 0.05). However, there were no differences in shear bond strength, tensile bond strength, 75PBS and 90PBS per unit area between Micro-Loc and Chessboard base groups.

Eperimental study on the effects of ovariectomy and estrogen on the bone pattern of mandible in rats / 대한치과교정학회지

The purpose of this study was to evaluate the changes of cancellous and cortical bone and the effect of estrogen in ovariectomized rats. Fifty female rats, 250gm in body weight, were divided into three groups : ovariectomized group(OVE), ovariectomized and estrogen-injected group(OVE-EST), and sham operated and estrogen-injected group(EST), Bilateral ovariectomy was performed at the onset of the experiment. In OVE-EST group and EST group, estrogen was injected 50microgram/kg B.W. every other days from 3 weeks after surgery to sacrifice Each five rats were sacrificed after 5, 6, 7 weeks. One side of mandibular body was radiographed with a soft x-ray apparatus (Hitex Co., Ltd., Japan). Thereafter the obtained microradiographs were used for the morphometric analysis using a Image analyzer. The morphometric analysis was performed for parameters such as total bone area, cortex bone area and medullary one area. The other side of the mandibular bone was decalcified and embedded in paraffin as using a general method. The specimens were sectioned and stained with Mallory`s anilline blue and observed light microscopically. The results were as follows. 1. In all groups, the proportion of cortex to total bone area was not significantly different. 2. In ovarietomized(OVE) group, the proportion of marrow cavity to medullary bone area increased significantly from 5 to 7 weeks(p<0.05). In ovariectomized and estrogen-injected (OVE-EST) group, it decreased significantly at 7 weeks, and in estrogen-injected(EST) group, it decreased significantly from 6 week(p<0.05). 3. Microradiogram and histopathologic findings revealed that marrow cavity was enlarged and osteoclasts were observed around irregular bone surface in OVE group. In OVE-EST group, the size of marrow cavity at 7 weeks was similar to that of control group, as dense trabecular bone increased from 5 to 7 weeks, marrow cavity decreased.

Changes of Various Epidermal Enzymatic Activities of Diabetic patients / 대한피부과학회지

BACKGROUND: In our previous report, we observed the increaseed epidermal glucose concentrations and decreased hexokinase actiuities of diabetic patients which were ciimpared to those of normal individuals. And we considered that, there were some derrangement of lipid metabolism and glycolysis of diabetic epidermis. OBJECTIVES: This study wns planed to prove the above possible changes of lipid metabolism and glycolysis of diabetic epidermis. METHODS: The epidermal enzymatic activties of glucose-6-phophate dehydrogenase(G6PDH), phosphofructokinase(PFK), 1-glycerophosphate dehydrogenase(GOPDH) and b-hydroxybutyryl CoA dehydrogenase(HBDH) were assayed in the skin samples obtained friom diabetic patients and normal individuals by the fluorometric: method. RESULTS: Teh epidermal PFK activities of diabetic patients were decreased(3.49+1.35(mmole/hr/kg dry weight)) compared to that of normal individuals(5.00+0.56(mmcle/hr/kg dry weight))(p<0.05). The epidermal HBDH activities of diabetic patients were decreised(0.28+0.10(mole/hr/kg dry weight)) compared to that of normal individuals(0.49+0.20(mole/hr/kg dry weight)(p<0.01). The mean epidermal G6PDH activity of diabetic patients was decreasec. compased to that of normal individuals, but there was no statisical significance. The mean epidermal 3OPDH activittes of diabetic patients and normal individual; showed no significant difference. CONCLUSION: We consider that the decreased epidermal HBDH actiities of diabetic patients can decrease keton body formatiori, and the abnormal glycolysis can exist in the diabetic epidermis because the decreased enzymatic activities of diabetic epidermal PFK may decrease the velocity of glycolysis.

Overlap Syndrome: A case showing severe CNS involvement / 대한피부과학회지

We describe a patient with overlap syndrome in whom systemic lupus erythematosus and scleroderma were combined. The patient expired due to severe central nervous system involvernent and pneumonia. Pertinent neuropsychiatric signs of the patient included generalied seizure, impairment of recent, memory, dysarthria, mental deterioration, Balints syndrome, right sided hemiparesis and right sided central type facial weakness. Hrain MRI and cerebral angiogram slowed cerebral vasculopathy. We suggest that a long-term follow-up is necessary for the confirmation of ciagnosis of a connective tissue disease, because the evolution, transition and overlapping features among the group of connective tissue diseases may commonly occur over time.

A case of Cutaneous focal mucinosis in the vaginal mucosa / 대한피부과학회지

A solitary, asymptomatic lesion, clinically resembling a transpare it cyst, has been present for 4 months in the vaginal mucosa of a 43-year-old healthy woman. An xcisional biopsy revealed the lesion to be a focal accumulatition of hyaluronic acid replacing the collagen fibers and fibroblastic proliferation in the dermis consistant with cutaneous focal mucinosis. During the follow-up period for 3 months, no recurrence was observed.

A case of Cutaneous focal mucinosis in the vaginal mucosa / 대한피부과학회지

A solitary, asymptomatic lesion, clinically resembling a transpare it cyst, has been present for 4 months in the vaginal mucosa of a 43-year-old healthy woman. An xcisional biopsy revealed the lesion to be a focal accumulatition of hyaluronic acid replacing the collagen fibers and fibroblastic proliferation in the dermis consistant with cutaneous focal mucinosis. During the follow-up period for 3 months, no recurrence was observed.

Multiple basal cell carcinoma associated with keratoacanthoma

We report a case of multiple basal cell carcinoma associated with keratoacanthoma. A 65-year-old Korean female had suffered from multiple, variable-sized papules and nodules on the face for 20 years previous to treatment. She had no history of arsenic intake, irradiation, herb medication, or hereditable or preexisting dermatoses. Histopathologically, the tumors revealed typical findings of solid and adenoid types of basal cell carcinoma and keratoacanthoma.