Location of Ulnar Nerve Branches to the Flexor Carpi Ulnaris during Surgery for Cubital Tunnel Syndrome

Objective@#: Cubital tunnel syndrome, the most common ulnar nerve entrapment neuropathy, is usually managed by simple decompression or anterior transposition. One of the concerns in transposition is damage to the nerve branches around the elbow. In this study, the location of ulnar nerve branches to the flexor carpi ulnaris (FCU) was assessed during operations for cubital tunnel syndrome to provide information to reduce operation-related complications. @*Methods@#: A personal series (HJY) of cases operated for cubital tunnel syndrome was reviewed. Cases managed by transposition and location of branches to the FCU were selected for analysis. The function of the branches was confirmed by intraoperative nerve stimulation and the location of the branches was assessed by the distance from the center of medial epicondyle. @*Results@#: There was a total of 61 cases of cubital tunnel syndrome, among which 31 were treated by transposition. Twenty-one cases with information on the location of branches were analyzed. The average number of ulnar nerve branches around the elbow was 1.8 (0 to 3), only one case showed no branches. Most of the cases had one branch to the medial head, and one other to the lateral head of the FCU. There were two cases having branches without FCU responses (one branch in one case, three branches in another). The location of the branches to the medial head was 16.3±8.6 mm distal to the medial epicondyle (16 branches; range, 0 to 35 mm), to the lateral head was 19.5±9.5 mm distal to the medial epicondyle (19 branches; range, -5 to 30 mm). Branches without FCU responses were found from 20 mm proximal to the medial condyle to 15 mm distal to the medial epicondyle (five branches). Most of the branches to the medial head were 15 to 20 mm (50% of cases), and most to the lateral head were 15 to 25 mm (58% of cases). There were no cases of discernable weakness of the FCU after operation. @*Conclusion@#: In most cases of cubital tunnel syndrome, there are ulnar nerve branches around the elbow. Although there might be some cases with branches without FCU responses, most branches are to the FCU, and are to be saved. The operator should be watchful for branches about 15 to 25 mm distal to the medial epicondyle, where most branches come out.

Delayed Cerebral Toxoplasmosis in a Kidney Transplant Patient: a Case Report

Cerebral toxoplasmosis is often life-threatening in an immunocompromised patient due to delayed diagnosis and treatment. Several differential diagnoses could be possible only with preoperative brain images of cerebral toxoplasmosis which show multiple rim-enhancing lesions. Due to the rarity of cerebral toxoplasmosis cases in Korea, the diagnosis and treatment are often delayed. This paper concerns a male patient whose cerebral toxoplasmosis was activated 21 years post kidney transplantation. Brain open biopsy was decided to make an exact diagnosis. Cerebral toxoplasmosis was confirmed by immunohistochemistry and PCR analyses of the tissue samples. Although cerebral toxoplasmosis was under control with medication, the patient did not recover clinically and died due to sepsis and recurrent gastrointestinal bleeding.

Differences in Brain Morphology between Hydrocephalus Ex Vacuo and Idiopathic Normal Pressure Hydrocephalus

Objective@#The distinction between idiopathic normal pressure hydrocephalus (iNPH) and hydrocephalus ex vacuo caused by encephalic volume loss remains to be established. This study aims to investigate radiological parameters as clinically useful tools to discriminate iNPH from hydrocephalus ex vacuo caused by Alzheimer’s disease (AD). @*Methods@#A total of 54 patients with ventriculomegaly (iNPH, 25; hydrocephalus ex vacuo, 29) were recruited in this study. Consequently, nine radiological parameters were compared between iNPH and hydrocephalus ex vacuo using magnetic resonance imaging (MRI). @*Results@#A small callosal angle (CA), the Sylvian fissure dilatation, and absence of narrowing of superior parietal sulci discriminated the iNPH group from the hydrocephalus ex vacuo group (p<0.05). The final binary logistic regression model included narrowing of superior parietal sulci, degrees of the CA, and height of the Sylvian fissure after controlling for age and global Clinical Dementia Rating (CDR). The composite score made from these three indicators (narrowing of superior parietal sulci, degrees of the CA, and height of the Sylvian fissure) was statistically different between iNPH and hydrocephalus ex vacuo. @*Conclusion@#The narrowing of the CA, dilatation of the Sylvain fissure, and narrowing of superior parietal sulci may be used as radiological key indices and noninvasive tools for the differential diagnosis of iNPH from hydrocephalus ex vacuo.

Differences in Brain Morphology between Hydrocephalus Ex Vacuo and Idiopathic Normal Pressure Hydrocephalus

Objective@#The distinction between idiopathic normal pressure hydrocephalus (iNPH) and hydrocephalus ex vacuo caused by encephalic volume loss remains to be established. This study aims to investigate radiological parameters as clinically useful tools to discriminate iNPH from hydrocephalus ex vacuo caused by Alzheimer’s disease (AD). @*Methods@#A total of 54 patients with ventriculomegaly (iNPH, 25; hydrocephalus ex vacuo, 29) were recruited in this study. Consequently, nine radiological parameters were compared between iNPH and hydrocephalus ex vacuo using magnetic resonance imaging (MRI). @*Results@#A small callosal angle (CA), the Sylvian fissure dilatation, and absence of narrowing of superior parietal sulci discriminated the iNPH group from the hydrocephalus ex vacuo group (p<0.05). The final binary logistic regression model included narrowing of superior parietal sulci, degrees of the CA, and height of the Sylvian fissure after controlling for age and global Clinical Dementia Rating (CDR). The composite score made from these three indicators (narrowing of superior parietal sulci, degrees of the CA, and height of the Sylvian fissure) was statistically different between iNPH and hydrocephalus ex vacuo. @*Conclusion@#The narrowing of the CA, dilatation of the Sylvain fissure, and narrowing of superior parietal sulci may be used as radiological key indices and noninvasive tools for the differential diagnosis of iNPH from hydrocephalus ex vacuo.

Improvement of Health Indicators after Participating in Health Promotion Program of General Hospital Staff: A Pilot Study

BACKGROUND@#An 8-week health program is achieved for health providers in a general hospital in Seoul to verify whether health parameters are enhanced by improving life habits. We want to examine the effect of this program with measuring health parameters and exercise ability. This study is performed as a pilot study, and the goal is to introduce the outcome of health program with experimental methods.@*METHODS@#Participants of this research consist of 42 health providers who were overweight, and they enrolled an 8-week health program in 2015. They took a class about improving eating habits and recorded daily diet. Moreover, they implemented exercise program with encouraging active participation by rewarding members who attended the program frequently.@*RESULTS@#The result is analyzed with 31 participants who finished the program. There are 4 men whose physical indices correspond with the criteria of metabolic syndrome. Otherwise, 27 women have physical indices below the criteria. The result indicates that physical indices would not reveal meaningful changes. However, basal fitness comprised of flexibility, sit-up, and back muscle strength implies meaningful improvement.@*CONCLUSIONS@#Even though there were some problems to revise in exercise intervention, it was accomplished systematically while nutrition intervention was not controlled strictly. In addition, factors including inspiring the enrollment of men and extending the period of program should be considered to improve the next program. The final goal of the health promoting hospital is to improve the health of health providers by sustaining this program with developing exercise and nutrition intervention in detail.

Improvement of Health Indicators after Participating in Health Promotion Program of General Hospital Staff: A Pilot Study

BACKGROUND: An 8-week health program is achieved for health providers in a general hospital in Seoul to verify whether health parameters are enhanced by improving life habits. We want to examine the effect of this program with measuring health parameters and exercise ability. This study is performed as a pilot study, and the goal is to introduce the outcome of health program with experimental methods. METHODS: Participants of this research consist of 42 health providers who were overweight, and they enrolled an 8-week health program in 2015. They took a class about improving eating habits and recorded daily diet. Moreover, they implemented exercise program with encouraging active participation by rewarding members who attended the program frequently. RESULTS: The result is analyzed with 31 participants who finished the program. There are 4 men whose physical indices correspond with the criteria of metabolic syndrome. Otherwise, 27 women have physical indices below the criteria. The result indicates that physical indices would not reveal meaningful changes. However, basal fitness comprised of flexibility, sit-up, and back muscle strength implies meaningful improvement. CONCLUSIONS: Even though there were some problems to revise in exercise intervention, it was accomplished systematically while nutrition intervention was not controlled strictly. In addition, factors including inspiring the enrollment of men and extending the period of program should be considered to improve the next program. The final goal of the health promoting hospital is to improve the health of health providers by sustaining this program with developing exercise and nutrition intervention in detail.

Delayed Trochlear Nerve Palsy Following Traumatic Subarachnoid Hemorrhage: Usefulness of High-Resolution Three Dimensional Magnetic Resonance Imaging and Unusual Course of the Nerve / 대한신경손상학회지

Cranial nerve palsies are relatively common after trauma, but trochlear nerve palsy is relatively uncommon. Although traumatic trochlear nerve palsy is easy to diagnose clinically because of extraocular movement disturbances, radiologic evaluations of this condition are difficult to perform because of the nerve's small size. Here, we report the case of a patient with delayed traumatic trochlear nerve palsy associated with a traumatic subarachnoid hemorrhage (SAH) and the related radiological findings, as obtained with high-resolution three-dimensional (3D) magnetic resonance imaging (MRI). A 63-year-old woman was brought to the emergency room after a minor head trauma. Neurologic examinations did not reveal any focal neurologic deficits. Brain computed tomography showed a traumatic SAH at the left ambient cistern. The patient complained of vertical diplopia at 3 days post-trauma. Ophthalmologic evaluations revealed trochlear nerve palsy on the left side. High-resolution 3D MRI, performed 20 days post-trauma, revealed continuity of the trochlear nerve and its abutted course by the posterior cerebral artery branch at the brain stem. Chemical irritation due to the SAH and the abutting nerve course were considered causative factors. The trochlear nerve palsy completely resolved during follow-up. This case shows the usefulness of high-resolution 3D MRI for evaluating trochlear nerve palsy.

The Conical-Shaped, Staged Laser Ablation Technique in the Removal of a Medium Sized Intradermal Nevus

No abstract available.

Towards a better healthcare system in Korea: 5 suggestions from young doctors

Residents who are currently in the process of completing graduate medical education (GME) will eventually become independently practicing professionals; therefore, the quality of GME is of enormous importance for our society. To improve the quality of GME in Korea, we, as young doctors, suggest that the government support funding for GME; make all possible efforts to ensure reasonable and sustainable working conditions for residents; implement adequate maternity plans; prohibit all kinds of unauthorized medical practice by other healthcare providers; and prevent all kinds of workplace violence toward residents. These measures to improve the quality of GME will surely benefit patient safety and the overall quality of healthcare in the future.

Survey on Perspectives and Treatment Status Regarding Skin Laser Treatment / 대한피부과학회지

BACKGROUND: Skin laser treatment has improved significantly and has become an effective treatment approach for many skin diseases while also having applications for beauty treatments. However, since skin laser transfers energy directly to the skin, the misuse of such treatment may result in permanent damage to skin tissues. OBJECTIVE: This survey of Korean adults, conducted to obtain their perspectives on and their treatment experience with skin laser treatment, will be used to determine the current status of skin laser treatment and to identify necessary changes to ensure proper and safe conduct of skin laser treatment. METHODS: From April 5th to April 12th, 2016, a survey was conducted to obtain information regarding the perspectives and the treatment experience of adults aged 20~59 years. RESULTS: Approximately 50% of the participants had experience with skin laser treatment, and among these, 24.7% had not received treatment at a dermatology clinic. Compared to treatment at a dermatology clinic, the danger of side effects was 1.7 times higher at a non-dermatology clinic, 2 times higher at a skin care shop, and 5.3 times higher at an Oriental medical clinic. Among patients who received skin laser treatment, 16.1% experienced side effects, and among these, 1 out of 4 patients visited a non-dermatologist for treatment of these side effects. CONCLUSION: The results of the survey showed that in order for the public to receive safe and effective skin laser treatment based on professional diagnosis, there is a definitive need to provide correct information to the public and to implement changes to ensure proper understanding of skin laser treatment among this population.

Facial Pseudocyst Caused by Hyaluronic Acid Filler Injection: A Case Report / 대한피부과학회지

Administration of a hyaluronic acid (HA) filler injection is a common aesthetic procedure widely used for facial soft-tissue augmentation. Owing to their low immunogenicity, hyaluronic acid fillers have rarely been linked with serious long-term adverse effects. Although generally safe, reports of adverse events linked to hyaluronic acid filler injection are increasing following its extensive usage globally. We describe the case of a 33-year-old woman who presented with multiple facial nodules at sites of filler injection. To the best of our knowledge, this is the first reported case of facial pseudocyst related to monophasic hyaluronic acid filler injection, in Korea.

Facial Pseudocyst Caused by Hyaluronic Acid Filler Injection: A Case Report / 대한피부과학회지

Administration of a hyaluronic acid (HA) filler injection is a common aesthetic procedure widely used for facial soft-tissue augmentation. Owing to their low immunogenicity, hyaluronic acid fillers have rarely been linked with serious long-term adverse effects. Although generally safe, reports of adverse events linked to hyaluronic acid filler injection are increasing following its extensive usage globally. We describe the case of a 33-year-old woman who presented with multiple facial nodules at sites of filler injection. To the best of our knowledge, this is the first reported case of facial pseudocyst related to monophasic hyaluronic acid filler injection, in Korea.

Graduate and postgraduate medical ethics education

This article provides an overview of medical ethics education for practicing doctors in Korea, focusing on its aims, objectives, content, pedagogical methods, educators, and key issues and challenges for future development. Education on medical ethics for practicing doctors in Korea started relatively recently on a small scale, based on the initiative of a few specialty boards. Currently, no formal aims and objectives for medical ethics education for practicing doctors have been proposed, and no formalized curricula have been developed by any specialty boards or by the Korean Medical Association. In the educational programs that currently exist, lectures are the predominant teaching method, and only a few educators who are doctors specializing in medical ethics deliver all those lectures. Thus, there are many issues and challenges in the Korean medical environment that must be thoroughly investigated and overcome. Nevertheless, medical ethics is an integral part of the medical profession and should be taught at all levels of training, including undergraduate, graduate, and postgraduate.

Graduate and postgraduate medical ethics education

This article provides an overview of medical ethics education for practicing doctors in Korea, focusing on its aims, objectives, content, pedagogical methods, educators, and key issues and challenges for future development. Education on medical ethics for practicing doctors in Korea started relatively recently on a small scale, based on the initiative of a few specialty boards. Currently, no formal aims and objectives for medical ethics education for practicing doctors have been proposed, and no formalized curricula have been developed by any specialty boards or by the Korean Medical Association. In the educational programs that currently exist, lectures are the predominant teaching method, and only a few educators who are doctors specializing in medical ethics deliver all those lectures. Thus, there are many issues and challenges in the Korean medical environment that must be thoroughly investigated and overcome. Nevertheless, medical ethics is an integral part of the medical profession and should be taught at all levels of training, including undergraduate, graduate, and postgraduate.

Failed First Craniotomy and Tumor Removal of Parasagittal Meningioma with Severe Peritumoral Brain Edema

Parasagittal meningioma often presents as peritumoral brain edema (PTBE). The risk of edema increases when the tumor occludes the superior sagittal sinus (SSS). Although PTBE may be expected based on the patient’s symptoms or radiologic findings, extensive brain swelling and extracranial herniation during elective surgery are rare. Herniation during surgery could lead to irreversible neurological damage and even brain rupture. We report a case of a failed routine craniotomy for a parasagittal meningioma with complete occlusion of the posterior third of the SSS in a 30-year-old male patient. The patient developed extensive brain swelling and extracranial herniation during surgery.

Expression of Epidermal c-Kit+ of Vitiligo Lesions Is Related to Responses to Excimer Laser

BACKGROUND: The survival and growth of melanocytes are controlled by the binding of stem cell factor to its cell surface receptor c-kit+ (CD117). We have observed that c-kit+ melanocytes existed in some lesions of vitiligo, while Melan A+ cells were absent. OBJECTIVE: To verify possible relation between c-kit+ expression and treatment response in non-segmental vitiligo lesions. METHODS: Skin biopsies were done from the center of the 47 lesions from the 47 patients with non-segmental vitiligo. Expression of c-kit+ and Melan A, and amounts of melanin in the epidermis were assessed in each lesion, and treatment responses to excimer laser were evaluated. RESULTS: Thirty-five of the 47 lesions (74.5%) had c-kit+ phenotypes. There was significant difference of c-kit staining value between good responders in 3 months of excimer laser treatment (average of 24 sessions) and the others. CONCLUSION: c-Kit expression in vitiliginous epidermis may be related to better treatment responses to excimer laser.

Successful Treatment of Tattoos with a Picosecond 755-nm Alexandrite Laser in Asian Skin

No abstract available.

Successful Treatment of Tattoos with a Picosecond 755-nm Alexandrite Laser in Asian Skin

No abstract available.

Penetration and Splitting of Optic Nerve by Tuberculum Sellae Meningioma

Preservation of the optic nerves is an important issue in the resection of tuberculum sellae meningiomas. We report the case of a patient whose optic nerve was penetrated by a tuberculum sellae meningioma. During surgery, a bulging tumor was found to penetrate the right optic nerve. The tumor was gross totally removed, including tumors bulging through the optic nerve. Two trunks of the split optic nerve were preserved. The penetrated shape of the optic nerve may lead to misjudgment and its damage. Divided trunks of optic nerves are difficult to recognize and may be confused for the tumor capsule, because they may be thinned and seem to contain tumors. In addition, a single trunk may be confused for the whole nerve; thus, the other trunk may be easily damaged if not dissected cautiously. Treatment strategy according to the remnant visual acuity was suggested.

Usefulness of Fracture Risk Assessment Tool Using Lumbar Bone Mineral Density in Prediction of Osteoporotic Vertebral Fracture

OBJECTIVE: To investigate the value of lumbar bone mineral density (BMD) in fracture risk assessment (FRAX) tool. METHODS: One hundred and ten patients aged over 60 years were enrolled and divided into 2 groups as non-osteoporotic vertebral fracture (OVF) and OVF groups. The 10-year-risk of major osteoporotic vertebral fracture of each group was calculated by FRAX tool with femoral and lumbar spine BMDs to compare the usefulness of lumbar spine BMD in prediction of OVF. The blood level of osteocalcin and C-terminal telopeptide (CTX) as markers of activities of osteoblast and osteoclast, respectively were analyzed using the institutional database. RESULTS: In the OVF group, the ratio of patients with previous fracture history or use of glucocorticoid was higher than those in non-OVF group (p=0.000 and 0.030, respectively). The levels of T-score of femur neck and lumbar spine in OVF group were significantly lower than those in non-OVF group (p=0.001 and 0.000, respectively). The risk of OVF in FRAX using femur BMD in non-OVF and OVF groups was 6.7+/-6.13 and 11.4+/-10.06, respectively (p=0.007). The risk of using lumbar BMD in the 2 groups was 6.9+/-8.91 and 15.1+/-15.08, respectively (p=0.002). The areas under the receiver operator characteristic curve in the FRAX risk with lumbar and femur neck BMD were 0.726 and 0.684, respectively. The comparison of osteocalcin and CTX was not significant (p=0.162 and 0.369, respectively). CONCLUSION: In our study, the 10-year risk of major osteoporotic fracture in the OVF group of our study was lower than the recommended threshold of intervention for osteoporosis. Hence, a lower threshold for the treatment of osteoporosis may be set for the Korean population to prevent OVF. In the prediction of symptomatic OVF, FRAX tool using lumbar spine BMD may be more useful than that using femur neck BMD.