Delayed Pneumothorax after Thoracic Paravertebral Block / 대한정형외과학회잡지

This paper reports a case of a patient aged 63 years who developed a delayed pneumothorax after thoracic paravertebral block (TPVB). TPVB is a non-invasive procedure that is known to be relatively safe. A 63-year-old female was admitted with back pain. TPVB T9–10 left was then performed. Two days after the procedure, she complained of dyspnea in the emergency room. X-ray showed a pneumothorax in her left side with partial left lung collapse. The pneumothorax was managed by surgical intervention, and an intercostal tube was inserted. The post-procedural X-ray showed a fully expanded lung. A chest tube was taken out after 72 hours. A delayed pneumothorax can occur after TPVB. Therefore, careful observation is required after this procedure.

Usefulness of V-Y Advancement Flap for Defects after Skin Tumor Excision

BACKGROUND: After skin tumor excision on the face, extremities, or trunk, the choice of treatment for a skin defect is highly variable. Many surgeons prefer to use a local flap rather than a skin graft or free flap for small- or moderately-sized circular defects. We have used unilateral or bilateral V-Y advancement flaps, especially on the face. Here we evaluated the functional and aesthetic results of this technique. METHODS: All of the patients were pathologically diagnosed with squamous cell carcinoma (SCC), basal cell carcinoma (BCC), or malignant melanoma or premalignant lesion (Bowen's disease). Thirty-two patients underwent V-Y advancement flap repair (11 unilateral and 21 bilateral) from January 2007 to June 2011. We analyzed the patients' age and satisfaction, and location and size of defect. The patients were followed up for 6 months or more. RESULTS: There were 22 women and 10 men. The ages ranged from 47 to 93 years with a mean age of 66 years. The causes were SCC in 15 cases, BCC in 13 cases, malignant melanoma in 1 case, Bowen's disease in 2 cases, and another cause in 1 case. The tumor locations were the face in 28 patients, and the scalp, upper limb, and flank each in one patient. All of the flaps survived and the aesthetic results were good. Postoperative recovery was usually rapid, and no complication or tumor recurrence was observed. CONCLUSIONS: The V-Y advancement flap is often used not only for facial circular defects but also for defects of the trunk and extremities. Its advantages are less scarring and superior aesthetic results as compared with other local flap methods, because of less scarification of adjacent tissue and because it is an easy surgical technique.

Sebaceous Carcinoma Arising from the Nevus Sebaceous

No abstract available.

A Case of Pancreatic Pseudocyst Presenting as Duodenal Bleeding / 대한내과학회지

Pancreatic pseudocysts occur following acute pancreatitis, chronic pancreatitis or secondary to pancreatic trauma. Most pancreatic pseudocysts are located in or around the pancreas, but they can be found in all the potential spaces around viscera in and outside of the abdominal cavity. The complications of pancreatic pseudocyst are infection, rupture, obstruction, fistula, or hemorrhage. Hemorrhage is a rare but frequently fatal complication of pancreatic pseudocysts. We report a case of pancreatic pseudocyst presented as bleeding of duodenum, which was misidentified for duodenal submucosal tumor bleeding.

The Effects of Neuromuscular Electrical Stimulation on Swallowing Function in Healthy Older Adults

OBJECTIVE: To evaluate the effects of neuromuscular electrical stimulation on the swallowing function in healthy older adults without clinical dysphagia. METHOD: The subjects were 18 healthy older adults aged >70 years and 10 young adults aged <30 years without symptoms or a history of dysphagia. Both groups were evaluated by the functional dysphagia scale (FDS) and pharyngeal transit time (PTT), using a videofluoroscopic swallowing study with semisolid material. Only the healthy older adults group received neuromuscular electrical stimulation (NMES) on suprahyoid and infrahyoid muscles, 60 min/day, 5 days/wk, for 2 weeks. The healthy older adults group was then re-evaluated by FDS and PTT. RESULTS: The average PTT in young adults was lower than in healthy older adults. FDS of the oral phase was larger in the older adults than in the young adults. After NMES for 2 weeks in older adults, there was a significant improvement in the averages for PTT and FDS. CONCLUSION: The results of this study showed that healthy older adults without clinical dysphagia had decreased swallowing function when they were compared with young adults. After NMES, the swallowing function, evaluated by FDS and PTT, was improved in healthy older adults.

A Case of Huge Pedunculated Hepatocellular Carcinoma Mimicking a Gastrointestinal Stromal Tumor / 대한내과학회지

Pedunculated hepatocellular carcinoma (P-HCC) can be defined as a carcinoma protruding from the liver with or without a pedicle. Cases of P-HCC showing extrahepatic growth are very rare. P-HCC constitutes 0.2-4.2% of all HCC cases in Japan and Taiwan, but few cases in Korea have been reported. A 67-year-old female patient was admitted to our hospital with a 6-month history of epigastric discomfort. Examination identified an abdominal mass in the left upper quadrant, and abdominal computed tomography revealed a huge mass adjacent to the fundus of the stomach. We diagnosed this mass as a gastrointestinal stromal tumor because of its size and site. However, postoperative histopathological findings showed that the mass was HCC. Here, we report this case and review the relevant medical literature.

A Case of Huge Pedunculated Hepatocellular Carcinoma Mimicking a Gastrointestinal Stromal Tumor / 대한내과학회지

Pedunculated hepatocellular carcinoma (P-HCC) can be defined as a carcinoma protruding from the liver with or without a pedicle. Cases of P-HCC showing extrahepatic growth are very rare. P-HCC constitutes 0.2-4.2% of all HCC cases in Japan and Taiwan, but few cases in Korea have been reported. A 67-year-old female patient was admitted to our hospital with a 6-month history of epigastric discomfort. Examination identified an abdominal mass in the left upper quadrant, and abdominal computed tomography revealed a huge mass adjacent to the fundus of the stomach. We diagnosed this mass as a gastrointestinal stromal tumor because of its size and site. However, postoperative histopathological findings showed that the mass was HCC. Here, we report this case and review the relevant medical literature.

A Case of Cutaneous Sarcoidosis Associated with Pegylated Interferon Alpha-2a and Ribavirin Therapy / 대한내과학회지

Pegylated interferon plus ribavirin is the standard treatment regimen in chronic hepatitis C. The main adverse events of pegylated interferon plus ribavirin combination therapy are bone marrow depression, alopecia, insomnia, and influenza-like symptoms. However, there are few reports of cutaneous sarcoidosis occurring during pegylated interferon alpha-2a and ribavirin therapy. Here, we report a case of cutaneous sarcoidosis induced by pegylated interferon alpha-2a and ribavirin during the treatment for chronic hepatitis C. The patient's sarcoidosis improved spontaneously after the treatment.

Recent Trend of the Reduction Mammaplasty and comparing with Vertical Reduction Method and Inverted T-scar Method

PURPOSE: The goal of reduction mammaplasty is breast with natural cone shape, minimizing scars, well-placed and sensate nipple-areolar area and maintaining breast physiology. In order to satisfy that goal, variable reduction mammaplasty methods are performed, however, two methods such as vertical reduction method and inverted T-scar method are currently most used. We compared indications and advantages of the two methods and set up useful guidlines. METHODS: For 15 years from 1995 to 2010, we experienced 84 patients(162 breasts). We performed vertical reduction method as Lejour's superior pedicle technique(45 patients) and inverted T-scar method as Goldwyn's inferior dermal flap technique(39 patients). We evaluated the result of the operation comparing patient's age, amount of resected tissue, complications and post-operative scars of the two methods. RESULTS: The mean age was 36 years and the vertical reduction group was 3 years younger than inverted T-scar group. The mean breast tissue resection amount per one breast, inverted T-scar group(712 gm) was lagger than vertical reduction group(395 gm). CONCLUSION: There is no ideal method for reduction mammaplasty until now. However, we suggest that guide line, the vertical reduction method is effective for minimal and moderate macromastia in young and middle aged women and inverted T-scar method is appropriate for severe macromastia with ptosis in elderly women. Recently, all procedures tried shorter and smaller scar on the vertical line as small I, J or L shape scar, and inframammary fold as short inverted T-scar.

SIADH closely related to a non-functioning pituitary adenoma: case report / 대한내과학회지

We present a case of severe hyponatremia in a 64-year-old man who had a pituitary tumor. He had nausea and recurrent vomiting with a severe headache, and was admitted to Chungnam National University Hospital for further evaluation. On physical examination, he was alert, and had bitemporal hemianopsia. There was no indication of dehydration or edema. Laboratory data showed a serum sodium level of 126 mEq/L, plasma osmolality of 259 mOsm/kg, and urinary osmolality of 544 mOsm/kg. The plasma argipressin level was 2.88 pg/mL, despite marked hyposmolality. Otherwise, pituitary function was normal. Brain magnetic resonance imaging showed a pituitary macroadenoma measuring 25x16x13 mm and no visible normal pituitary stalk or gland in the sella turcica. After the adenomectomy, the serum sodium level maintained normal without treatment. Histology showed the presence of a pituitary adenoma. These findings indicate that a non-functioning pituitary tumor may cause the exaggerated secretion of argipressin, resulting in inappropriate antidiuretic hormone syndrome.

The Relationship between the BRAF Mutations in Thyroid Papillary Carcinomas and the Prognostic Factors / 대한내분비학회지

BACKGROUND: Thyroid cancers account for about 1% of all human malignancies, with papillary thyroid carcinomas being the most common istotype. Several investigators have recently identified the most common BRAF mutation, the T1796A transversion mutation, in 29~69% of papillary thyroid cancers. The BRAF mutation has been demonstrated as a novel prognostic biomarker for the prediction of poor clinicopathological outcomes, such as increased incidence of extrathyroid invasion and distant metastasis of the tumor. In this study, we investigated the prevalence of the BRAF mutation of thyroid tissues obtained by a thyroidectomy, and its correlation with the clinicopathological outcomes. METHODS: We studied 36 thyroid tissues obtained from 24 women and 12 men by thyroidectomies, including 30 papillary carcinomas, 3 follicular carcinomas, 1 medullary carcinoma and 2 nodular hyperplasia. The mutation was sought in all specimens using DNA sequencing. RESULTS: We studied the BRAF exon 15 T1796A in these 36 thyroid tissues. The mean age at surgery was 46.6, ranging from 18 to 72 years, with a median tumor size of 2.79, ranging from 1.5 to 4.5cm. At the time of diagnosis, 27 of the 34 patients presented with some kind of extrathyroidal invasion of the tumor, and 16 had lymph node metastases. 16, 2 and 16 patients were in stages I, II and III, respectively. There was no distant metastasis. A missense mutation was found at T1796A in exon 15 in 21 of the 30 papillary carcinomas(70%). The other thyroid diseases, including the 3 follicular carcinomas, 1 medullary carcinoma and 2 nodular hyperplasia show no exon 15 T1759A transversion mutation. No statistically significant association was found between the BRAF mutations and clinicopathological characteristics of papillary carcinomas. CONCLUSION: The BRAF mutation is a important genetic alteration, with a high prevalence in papillary thyroid carcinomas. However, there was no significant association between the BRAF mutation and any of the clinicopathological factors. Further, large scale studies will be needed to evaluate the correlation between the BRAF mutation and the clinicopathological factors

The Relationship between the BRAF Mutations in Thyroid Papillary Carcinomas and the Prognostic Factors / 대한내분비학회지

BACKGROUND: Thyroid cancers account for about 1% of all human malignancies, with papillary thyroid carcinomas being the most common istotype. Several investigators have recently identified the most common BRAF mutation, the T1796A transversion mutation, in 29~69% of papillary thyroid cancers. The BRAF mutation has been demonstrated as a novel prognostic biomarker for the prediction of poor clinicopathological outcomes, such as increased incidence of extrathyroid invasion and distant metastasis of the tumor. In this study, we investigated the prevalence of the BRAF mutation of thyroid tissues obtained by a thyroidectomy, and its correlation with the clinicopathological outcomes. METHODS: We studied 36 thyroid tissues obtained from 24 women and 12 men by thyroidectomies, including 30 papillary carcinomas, 3 follicular carcinomas, 1 medullary carcinoma and 2 nodular hyperplasia. The mutation was sought in all specimens using DNA sequencing. RESULTS: We studied the BRAF exon 15 T1796A in these 36 thyroid tissues. The mean age at surgery was 46.6, ranging from 18 to 72 years, with a median tumor size of 2.79, ranging from 1.5 to 4.5cm. At the time of diagnosis, 27 of the 34 patients presented with some kind of extrathyroidal invasion of the tumor, and 16 had lymph node metastases. 16, 2 and 16 patients were in stages I, II and III, respectively. There was no distant metastasis. A missense mutation was found at T1796A in exon 15 in 21 of the 30 papillary carcinomas(70%). The other thyroid diseases, including the 3 follicular carcinomas, 1 medullary carcinoma and 2 nodular hyperplasia show no exon 15 T1759A transversion mutation. No statistically significant association was found between the BRAF mutations and clinicopathological characteristics of papillary carcinomas. CONCLUSION: The BRAF mutation is a important genetic alteration, with a high prevalence in papillary thyroid carcinomas. However, there was no significant association between the BRAF mutation and any of the clinicopathological factors. Further, large scale studies will be needed to evaluate the correlation between the BRAF mutation and the clinicopathological factors

The Adequacy of Ultrasound-Guided Fine Needle Aspiration in Thyroid Nodules / 대한내분비학회지

BACKGROUND: Fine needle aspiration(FNA) is an accurate and safe method for the diagnosis of thyroid nodules. One of the limitations of FNA is the variable rate of unsatisfactory specimens, especially in small sized, deep seated or complex cystic nodules. To overcome this problem, ultrasound-guided FNA(US-FNA) has been widely used. In this study, the adequacy of cytologic specimens by US-FNA was compared with that of conventional palpation-guided FNA(P-FNA). METHODS: The medical records of all patients who were engaged in FNA due to thyroid nodules at Chungnam National University Hospital from January 2003 to July 2004 were retrospectively examined. The US-FNA and P-FNA were performed in 114 and 185 patients, respectively. RESULTS: Comparison of the adequacy of the two techniques in providing sufficient material for the cytologic diagnosis showed that specimens in 24(13.0%) and 6(5.3%) patients collected by P-FNA and US-FNA, respectively, were unsatisfactory(P=0.031). A total of 23 patients underwent thyroid surgery due to strong suspicion of malignancy at cytologic finding and/or on clinical judgement. Seventeen patients belonged to the P-FNA group and 6 patients to the US-FNA group. In the P-FNA group, a histologic diagnosis revealed two false-negative cytologic findings, but no false-negative findings were found in the US-FNA group. CONCLUSION: Compared with P-FNA, US-FNA may reduce the possibility of unsatisfactory cytologic specimens and the rate of false-negative diagnosis, and may improve the diagnostic accuracy in investigating thyroid nodules

Distraction Osteogenesis for Early Correction of Sagittal Craniosynostosis

Sagittal synostosis with related functional aspects of elevated ICP, hydrocephalus, mental retardation and visual abnormalities, or with multiple suture synostosis, surgical correction is imperative. But, craniofacial surgery may impose a threat to an infant or small child. The blood volume in these patients is small and a minor hemorrhage may induce proportionately greater blood loss, resulting in a greater stress to the patient's system. Mortality resulting from craniofacial surgery is uncommon, mostly from operative hemorrhage and infections. Releasing the stenosis and reshaping the cranial vault is the primary operative goal. Authors sought to minimize surgical stress on the child and attain control of cranial vault reshaping by gradual distraction osteogenesis in treating children with sagittal suture synostosis. Three sagittal synostosis patients, aged from 11 months to 3 years old were treated. One of the patients had multiple suture synostosis. Patient follow-up ranged from 3 months to 3 years. Biparietal bone flap was elevated and external distraction devices were inserted. Distraction rate varied from 0.5 to 1mm/day, without a latency period. After a consolidation period of 2-3weeks, the devices were removed. Functional aspects of ICP and mental retardation subsided post surgery. Radiological follow-up showed cessation of enhancement of bone deposition at the frontal and occipital sutures. Excellent aesthetic results were accounted for in all three of the patients. Application of distraction osteogenesis in correcting sagittal craniosynostosis is very effective; surgical stress on the patients is minimal and controlled cranial vault reshaping is possible.

Deflation of Saline Filled Breast Implant by Scar Tissue Contracture

Saline filled breast implants have been used for augmentation mammoplasty for cosmetic purposes as well as for breast reconstruction following mastectomy for cancer. Despite the immense benefit they provide, their usage is associated with some complications. Most of these complication are related to the surgery and be reduced by good surgical management. The major late complications associated with their use are adverse capsular contracture, buckling of implant/rippling of the skin, and deflation. We experienced gradual implant deflation after augmentation mammoplasty using saline filled implant. The cause was diaphragm valve opening by contracted scar captured between implant valve and seat.

Delivery Alar Sculpturing Technique Through a Marginal Incision

No abstract available.

Nasal Deformity after Rhinoplastry using AlloDerm

No abstract available.

A Case of Bartter's Syndrome in an Adult / 대한신장학회잡지

Bartter's syndrome is characterized by hypokalemia and secondary hyperaldosteronism without edema or hypertension. Its pathogenesis is obscure and the characteristic renal potassium wastage is difficult to treat. We experienced a case of Bartter's syndrome in 47 year-old diabetic female. She had felt dizziness, muscle weakness and cramping for about two years. During diagnostic evaluation, hypokalemic metabolic alkalosis and hyperreninemic hyperaldosteronism were discovered. The patient denied ingestions of laxatives, diuretics, licorice and she had no nausea, vomiting, diarrhea or edema. She had normal blood pressure. The patient improved with potassium supplements and spironolactone therapy along with oral hypoglycemic agent. So we report this case with the review of literature.

A Case of Subsequent Papillary Carcinoma of the Thyroid gland and Hashimoto's Thyroiditis / 대한내분비학회지

The association of thyroid carcinoma and Hashimotos thyroiditis in same thyroid gland is controversial. Incidence of carcinoma who has Hashimotos thyroiditis has been reported from 0.5 to 22.5 per cent by Crile and by Hirabayashi et al. The reason that there are such great diffarences in the reported incidences of carcinoma in Hashimotos disease is the result of the way the material is reported. The carcinomas of the thyroid which occur in association with Hashirnotos thyroiditis are predominently papillary tumors of lower grade malignancy. Thyroid carcinoma need not be feared in patimts with Hashimotos thymiditis, if one examines the ghmd catefully. When patients with Hashimotos disease are treated with thyroxine, there is little or no tendency for Hashimotos disease propess to clinieally detectable carcinoma of the thymid, and the microcarcinoma does not appear. In this case, single thyroid nodule was detected in Hashiimotos disease patient who was treated with thyroxine. There was no significant volume change of thyroid nodule despite of TSH suppression therapy during six months. Therefore we perforrned FNABC twice, the results were highly suspicious thyroid malignancy and subtotoal thyroidectomy was performed. The final pathologic result was microscopic papillary carcinoma with background Hashlmotos thyroiditis. In conclusion, we experienced a case of subsequent microscopic papillary carcinoma of the thyroid in patient with Hashimotos thyroiditis who was TSH suppression therapy with thyroxine.