Hyperkeratosis of the nipple and areola is a rare skin disordr characterized clinically by thickening and discoloration of the skin of the areola and/or nipple and pathoiog cally by papillomaosis or acanthosis-nigricans like changes. We report a case of hyperkeratosis of the nipple and areola occuring in a woman with no underlying endocrinopathy and no other additional hyperkeratotic conditions. Ttie iresent case seems to be the nevoid form by the Levy-Franckel classification. Treatment with topical medications including steroids and keratolytic agents produced no improvement. Therefore we recommeneded surgical excision because the paient was greatly disturbed by the appearance of the lesions. Surgical excision and full thickness skin graft were performed sucessfully.
Classification ; Female ; Humans ; Keratolytic Agents ; Nipples* ; Skin* ; Steroids ; Transplants*

Renal cell carcinoma has been recognized for several years as a relatively common cause of paraneoplastic syndromes. Fever, polycythemia, hypercalcemia, amyloidosis, abnormal liver function, Cushing's syndrome and neuropathy have been ostm frequently reported in association with renal cell carcinoma, but leukemoid reactions have been reported only rarely with this tumor. Recently we experienced a leukemoid reaction in a 64-year old female patient who presented with an advanced case of renal cell carcinoma. According to the literature the mortality is 100% with leukemoid reactions in renal cell carcinoma, and indeed this patient expired. We therefore, consider this reaction as a late manifestation of a bizzare presentation of renal cell carcinoma.
Amyloidosis ; Carcinoma, Renal Cell* ; Cushing Syndrome ; Female ; Fever ; Humans ; Hypercalcemia ; Leukemoid Reaction* ; Liver ; Middle Aged ; Mortality ; Paraneoplastic Syndromes ; Polycythemia

Although ventricular pacing alone initially had deemed adequate for most clinical situations, some patients did not do well after ventricular pacing was initiated, and developed various symptoms attributed to this mode of pacing. The pacemaker syndrome is complex of clinical signs and symptoms related to the adverse hemodynamic and electrophysiologic consequences of ventricular pacing in the absence of other causes. Neurologic symptoms or those congestive heart failure predominated. We recently experienced a case of pacemaker syndrome in a 44-year-old female who had suffered sick sinus syndrome and was implanted with dual chamber pacing system being programmed to VVI pacing. She complained of chest discomfort, dyspnea, and near-fainting in a day after being programmed to VVI. Blood pressure was decreased to 9/60mmHg. Electrocardiography showed toPwave onT wave, representing retrograde ventriculoatrial conduction. The symptoms and signs were disappeared immediately after the pacing system was programmed to DDD pacing.
Adult ; Blood Pressure ; Dichlorodiphenyldichloroethane ; Dyspnea ; Electrocardiography ; Female ; Heart Failure ; Hemodynamics ; Humans ; Neurologic Manifestations ; Sick Sinus Syndrome ; Thorax

PURPOSE: To assess the safety and long term effectiveness of polyurethane-covered retrievable expandable nitinol stents in the treatment of benign and malignant tracheobronchial strictures. MATERIALS AND METHODS: Under fluoroscopic guidance, the stents were placed in 32 patients with dyspnea whose strictures were malignant in 15 cases and benign in 17. A stent was removed when complications occurred,or -electively- 2-6 months after placement in patients with benign strictures. The range of follow-up period was 1 -98 weeks (median, 47; range, 50) weeks. RESULTS: Stent placement was well tolerated in 30 patients. After placement, all 32 showed immediate symptom improvement and in none were complications such as ingrowth of a tumor or granulation tissue observed during the follow up period. Stent migration occurred in six patients. In one of six and four of five patients from whom, respectively, stents had been electively removed two and six months after placement, tracheo-bronchial restenosis did not occur during follow up. Second stents were placed in six patients in whom dyspnea recurred due to restenosis after elective stent removal. In two of these six, stents were removed six months after placement and dyspnea did not recur during follow up. CONCLUSION: The use of covered retrievable tracheobronchial stents is safe and feasible in the conservative treatment of patients with malignant tracheobronchial strictures as well as for selected patients with benign strictures.
Constriction, Pathologic* ; Dyspnea ; Follow-Up Studies* ; Granulation Tissue ; Humans ; Stents*

Benign paroxysmal positional vertigo (BPPV) is a commonly presenting problem at the emergency department. Three types have been recognized based on the pathogenesis of BPPV. The first is posterior-canal canalolithiasis, the second is horizontal-canal canalolithiasis, and the last is horizontal-canal cupulolithiasis. With the first two types of BPPV, an otolith-repositioning manuever can be performed quickly at the bedside with rapid results, often providing much satisfaction to both patient and physician. However, in the case of horizontal-canal cupulolithiasis, no established repositioning maneuver existed until recently. In 2000, Jo et al. developed a new repositioning maneuver and reported excellent results. We report a case of BPPV horizontal-canal cupulolithiasis that immediately responded to the maneuver of Jo et al. and strongly recommend use of this repositioning maneuver at the emergency department.
Emergency Service, Hospital ; Humans ; Semicircular Canals* ; Vertigo

Pulmonary blastoma is a rare lung tumor resembling fetal lung tissue. Pathologically the tumor can be classified to 2 groups, well-differentiated fetal adenocarcinoma(WDFA) and biphasic blastoma. WDFA has more favorable prognosis with fewer metastasis at initial presentation and fewer recurrence after treatment. We experienced a case of pulmonary blastoma in 32-year-old female patient. The patient was referred to our hospital because of abnormal mass shadow in right middle lobe. The diagnosis of pulmonary blastoma(WDFA type, Stage I T2NOMO) was confirmed after right middle lobectomy. We followed up 22 months without an evidence of recurrence.
Adult ; Diagnosis ; Female ; Humans ; Lung ; Neoplasm Metastasis ; Prognosis ; Pulmonary Blastoma* ; Recurrence

A 64-year-old male patient presented with hand numbness and gait disturbance. He had undergone cervical artificial disc replacement (C-ADR) at another hospital nine years earlier. Magnetic resonance imaging (MRI) revealed a protruded disc at the surgical level compressing the spinal cord. The implant and protruded disc were removed. Fusion was then performed. This case report highlights the importance of long-term follow-up of patients who have undergone C-ADR, and the need to be aware of the potential for late complications.In addition, it is important to ensure as complete a disk removal as possible during C-ADR.

BACKGROUND: A correct estimate of the tracheal tube insertion depth can prevent complications, including endobronchial intubation and vocal cord trauma. We evaluated a new topographical method for endotracheal tube positioning relative to the carina, using a well-known prior topographical method for comparison. METHODS: One hundred adult (male 50, female 50) patients were studied. The comparison topographic length (in cm) was measured by adding the distance between the right mouth corner and the right mandibular angle to the distance between the right mandibular angle and the center of the sternal manubrium. The new endotracheal tube insertion depth (in cm) was determined by adding the distance between the right mouth corner and the vocal cords, measured with the endotracheal tube itself, to the distance between the thyroid prominence and the manubriosternal joint, and then subtracting 4 cm. After intubation, the endotracheal tube was positioned properly at the right mouth corner and the endotracheal tube tip was evaluated using a fiberoptic bronchoscope at the carina. RESULTS: The distances from the tip of the endotracheal tube to the carina were not significantly different between the methods in the same gender. However, our method allowed endotracheal tube tip placement between 3 cm and 5 cm, above the carina more frequently than the prior method in males. CONCLUSIONS: The new topographical method can be used as a guide to positioning the endotracheal tubes.
Adult ; Bronchoscopes ; Female ; Humans ; Intubation ; Joints ; Manubrium ; Mouth ; Thyroid Gland ; Vocal Cords

PURPOSE: To compare the clinical outcomes of ultrasound-guided percutaneous repair (USPR) and open repair in a ruptured Achilles tendon. MATERIALS AND METHODS: The outcomes of 12 patients with USPR (group A) and 18 patients with open repair (group B) from January 2015 to February 2017 were analyzed retrospectively. The postoperative clinical evaluations were performed using the Arner-Lindholm scale, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Achilles tendon total rupture score (ATRS), and visual analogue scale for the overall satisfaction and cosmetic satisfaction with the scar, and the starting time of single heel raises. The complications were also evaluated. RESULTS: The Arner-Lindholm scale, AOFAS ankle-hindfoot score, ATRS, starting time of single heel raises were similar in both groups (all p>0.05). Group A showed a significantly higher overall patient's satisfaction and cosmetic satisfaction in than group B (all p < 0.05). Two cases of Achilles tendon elongation were encountered in group A, and 1 case of re-rupture with deep infection and 1 case of superficial infection were experienced in group B. CONCLUSION: USPR showed good clinical outcomes and high satisfaction as well as a low rate of complications, such as sural nerve injury. Therefore, USPR can be considered as an effective surgical treatment option for Achilles tendon ruptures.
Achilles Tendon* ; Ankle ; Cicatrix ; Foot ; Heel ; Humans ; Orthopedics ; Retrospective Studies ; Rupture ; Sural Nerve ; Ultrasonography

Obstruction of the fluid spaces of the cochlea was previously thought to contraindicate cochlear implantation due to difficulties of electrodes insertion and questions about potential benefits. However, the concept of implantation of ossified cochlea and its subsequent acceptance have progressed rapidly. A 62-year-old man complained of both hearing loss after meningitis and temporal bone CT scan showed partial obliteration of cochlea bilaterally. We fully inserted 22 active electrodes via scala vestibuli without difficulty. The purpose of this study is to determine the safety and efficacy of scala vestibuli electrode insertion in partially ossified cochlea.
Cochlea ; Cochlear Implantation ; Cochlear Implants ; Electrodes ; Hearing Loss ; Humans ; Meningitis ; Middle Aged ; Scala Vestibuli ; Temporal Bone