The nevus of Ota is a benign dermal melanocytic lesion that most commonly occurs unilaterally in areas innervated by the first and second division of the trigeminal nerve. Acquired bilateral nevus of Ota-like macules(ABNOM) are located bilaterally on the forehead, temples, eyelids, cheeks, and/or nose. They usually occur in the fourth or fifth decade of life in women(rarely in men). In contrast to the nevus of Ota, ABNOM have not been observed in the mucous membranes of the oral cavity, nose, or eyes. Traditional treatments were palliative, risky electrocautery, or cryotherapy. These methods resulted in permanent pigmentary changes and/or scarring. Recently utilizing the principle of selective photothermolysis, the Q-switched Alexandrite laser has been reported to be successful in treating benign pigmentary lesions and tattoos. Our study evaluated the treatment of 127 patients with nevus of Ota and ABNOM with the Q-switched Alexandrite laser(755 nm, 100 nsec). Nevi were treated up to 7 times with 7-8 J/cm2 at a minimum of 6 weeks interval. Good therapeutic effects were gained (up to 50% improvement was seen in 89% of patients.) and our patients were very satisfied. No patients had permanent textural change or scarring. Treatment with on Alexandrite laser for nevus of Ota & ABNOM is considered to be a safe and effective method.
Cheek ; Cicatrix ; Cryotherapy ; Electrocoagulation ; Eyelids ; Forehead ; Humans ; Lasers, Solid-State* ; Mouth ; Mucous Membrane ; Nevus of Ota ; Nevus* ; Nose ; Trigeminal Nerve

A various type of hairline and height of forehead is considered as a result of genetic effect. The conventional corrective surgical operation of low hairline in forehead has been too complicated and painful to apply, and also has many disadvantages such as scar, bleeding, risks of anesthesia. Recently four classes of devices are designed to remove hair with intense light beam : Nd-Yag lasers with carbon cream, the Ruby lasers, the Alexandrite lasers, and the polychromic broad band light source of flashlamp technology. The goal of these therapeutic modality is to destroy the melanin pigment selectively in hair follicle without injuring the skin for permanent epilation. We have been used long pulse infrared Alexandrite laser for treat low hair line in 27 patients from Dec. 1997 to Dec. 1998. We experienced 3 cases of temporary hyperpigmentation and 1 case of bulla, and the most of patients were satisfied in 89%. The average lengthening of forehead was 2.2cm (median line) and 2.3cm (paramedian line). We achieved successful result without permanent hyperpigmentation or scarring
Anesthesia ; Carbon ; Cicatrix ; Forehead ; Hair Follicle ; Hair Removal ; Hair* ; Hemorrhage ; Humans ; Hyperpigmentation ; Lasers, Solid-State* ; Melanins ; Skin

The spontaneous rupture of splenic artery aneurysm during pregnancy is a rare but catastrophic event. Two thirds of all ruptures happen during the third trimester. Clinical presentation is often non-specific, with good hemodynamic compensation, followed by a rapid deterioration. Active management and operation are the most important procedures for diagnosis and therapy of the bleeding. Abdominal delivery will help to establish diagnosis and should be performed immediately. We report a case of a patient at 38 weeks of gestation suffering epigastric pain and fetal distress. At emergency cesarean delivery, an aneurysmal rupture of the splenic artery was found to be the reason for the hemoperitoneum. Spleen, aneurysm and the tail of the pancreas were removed. In spite of fatal hemorrhage, the patient survived but her fetus was dead. With a review of the literature on this topic, diagnostic aspects and treatment options are discussed.
Aneurysm* ; Cesarean Section ; Compensation and Redress ; Diagnosis ; Emergencies ; Female ; Fetal Distress ; Fetus ; Hemodynamics ; Hemoperitoneum ; Hemorrhage ; Humans ; Pancreas ; Pregnancy ; Pregnancy Trimester, Third* ; Rupture ; Rupture, Spontaneous* ; Spleen ; Splenic Artery*

We report a case of 46-year-old women who suffered from delayed transfusion hemolytic anemia due to anti-Jkb antibody after renal transplantation. The patient had been treated with hemodialysis and had a past history of multiple transfusion. On the second postoperative day, she received 2 units of packed red cell. During transfusion, she complained of mild chest tightness only, but 10 days later, anemia of unknown origin developed. Irregular antibody was found in her serum and identified as anti- Jkb antibody. Together with other serologic findings, she was diagnosed as delayed hemolytic transfusion reaction due to anti -Jkb antibody. We thought that this reaction might be the amnestic response to previous exposure during delivery or remote multiple transfusion. Our patient responded to steroid and plasmapheresis and recovered without severe hemolytic transfusion reaction. In conclusion, antibody screening tests and identification test might be considered as a routine pretransfusion test for all renal recipients for safe transfusion practices.
Anemia ; Anemia, Hemolytic ; Blood Group Incompatibility* ; Female ; Humans ; Kidney Transplantation ; Mass Screening ; Middle Aged ; Plasmapheresis ; Renal Dialysis ; Thorax ; Transplantation*

PURPOSE: Fluorouracil (5-FU) and leucovorin combination therapy have shown synergistic or additive effect against advanced colorectal cancer, but the frequency of mucositis and diarrhea is increased. Most previous studies have used high dose leucovorin (300~500 mg/m2). However, some studies of oxaliplatin and 5-FU with low-dose or high-dose leucovorin in Korea have shown similar response rates. Therefore, we studied the necessity of leucovorin and evaluated the objective tumor response rates and toxicities of a regimen of oxaliplatin and 5-FU without leucovorin every 2 weeks in metastatic colorectal cancer patients. MATERIALS AND METHODS: Twenty-four patients with metastatic colorectal cancer were enrolled between January 2002 and March 2003. Patients received 85 mg/ m2 of oxaliplatin on day 1, a bolus 5-FU 400 mg/m2 on day 1 and a continuous 5-FU infusion at 600 mg/m2/ 22 hours days 1 and 2, every 2 weeks. RESULTS: Of the 24 patients treated, 17 patients received previous 5FU with leucovorin and/or other chemotherapy. Three patients could not be evaluated. Five partial responses were observed with overall response rate of 21% (n=24). Of the previous chemotherapy group (n= 17), 4 partial responses were observed with response rate of 24%. Median overall survival was 18 months (range 4~32 months) and median progression free survival was 4 months (range 2~6 months). This regimen was well tolerated and only 1 grade 3 anemia was observed. CONCLUSION: Oxaliplatin/5-FU combination therapy without leucovorin achieved a relatively high response rate even in patients resistant to the previous 5-FU chemotherapy, and toxicity was minimal.
Anemia ; Colorectal Neoplasms* ; Diarrhea ; Disease-Free Survival ; Drug Therapy* ; Fluorouracil ; Humans ; Korea ; Leucovorin* ; Mucositis

PURPOSE: This study was designed to analyze the outcome and toxicity of thoracic radiation therapy (TRT) and chemotherapy for patients who suffer with limited-stage small-cell lung cancer (LS-SCLC). MATERIALS AND METHODS: We retrospectively studied 35 patients with LS-SCLC. TRT was administered once daily (1.8 to 2 Gy per fraction) and it was directed to the primary tumor for a total 50 to 66 Gy in 6 to 7 weeks. The patients received four cycles of etoposide plus cisplatin. TRT was begun on day 1 of the first cycle of chemotherapy in the concurrent arm and after the fourth cycle in the sequential arm. RESULTS: The median progression-free survival time was 16.5 months (95% confidence interval [CI], 9.0 to 24.1 months) for the sequential arm, and 26.3 months (95% CI, 16.6 to 35.9 months) for the concurrent arm. The 2-year progression-free survival rate was 16.0 percent for the sequential arm and 50.0 percent for the concurrent arm (p=0.0950 by log-rank test). Leukopenia was more severe and more frequent in the concurrent arm than in the sequential arm. However, severe esophagitis was infrequent in both arms. The radiotherapy was interrupted more frequently in the concurrent arm than in the sequential arm due to hematologic toxicities (p=0.001). CONCLUSION: This study suggests that concurrent TRT with etoposide plus cisplatin is more effective for the treatment of LS-SCLC than sequential TRT. However, there is a significant increase in the risk of toxicities, and radiotherapy was frequently interrupted in the concurrent arm due to hematologic toxicities.
Arm ; Chemoradiotherapy ; Cisplatin ; Disease-Free Survival ; Esophagitis ; Etoposide ; Humans ; Leukopenia ; Lung ; Lung Neoplasms ; Retrospective Studies

PURPOSE: We undertook this study to find out the recognitions of terminal cancer patients and doctors about advance directives (ADs), of how they would do in non-response medical conditions and whether ADs could be one of medical options for their dying with dignity. METHODS: One hundred thirty four cancer patients in the Hospice Unit, St. Vincent's Hospital, and 97 medical doctors in the Department of Internal Medicine, Catholic Medical Center, were asked about ADs, including Do-Not-Resuscitate (DNR), medical power of attorney, living will and medical options. RESULTS: One hundred thirty patients (97%) and 38 doctors (39.2%) were unfamiliar with ADs, however, 128 patients (95.5%), 95 doctors (97.9%) agreed with it. Seventy nine patients (59.0%) and 96 doctors (99.0%) wanted DNR rather then intensive treatments if they were in non-response medical conditions. Eighty four patients (62.7%) and 75 doctors (77.3%) were agreeable to medical power of attorney. One hundred Thirty four patients (100.0%) and 94 doctors (96.9%) did not want medical options to be in terminal conditions, and hoped to die in peace. CONCLUSION: Most of patients did not know about ADs and how to make it. However, they showed positive attitudes about it. If we advertise it properly, it is highly likely that a large number of cancer patients would make their living wills easily by ADs. Nevertheless, many legal and ethical problems have to be solved. Doctors should engage their patients in an ongoing communication about the end-of-life. Therefore, let the patients have opportunities to plan their own deaths.
Advance Directives ; Hospice Care ; Hospices ; Humans ; Internal Medicine ; Linear Energy Transfer ; Living Wills

BACKGROUND: Carotid intima-media thickness (IMT) or the presence of carotid plaque has been reported to be related to coronary artery disease (CAD). We evaluated the relationship of the parameters of carotid ultrasonography (US) with the severity of the CAD. METHODS: From November, 2005 to November, 2006, the patients who underwent both coronary angiography and carotid US were enrolled in our study. The severity of CAD was defined by the number of diseased major coronary arteries with a percent diameter stenosis over 50. Four groups including Group 0, which has normal coronary arteries, were compared. The average and maximal IMT and the presence of plaque were used as the parameters of carotid US. RESULTS: The total number of patients was 90. Men had a greater severity of CAD (p=0.001). The average carotid IMTs were increased with the severity of CAD (Group 0, 0.67+/-0.11 mm; Group 1, 0.66+/-0.13 mm; Group 2, 0.68+/-0.08 mm; Group 3, 0.78+/-0.10 mm; p=0.001). The maximal carotid IMTs were also increased (Group 0, 0.88+/-0.16 mm; Group 1, 0.85+/-0.20 mm; Group 2, 0.89+/-0.13 mm; Group 3, 1.06+/-0.17 mm; p=0.000). Carotid plaques were also more frequently present with the increased severity of CAD (p=0.004). CONCLUSIONS: Increased carotid IMT and the presence of carotid plaque were related to the severity of CAD. Carotid ultrasonography is useful for evaluating the severity of CAD.
Carotid Intima-Media Thickness ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Humans ; Male ; Ultrasonography*

The use of nonsteroidal antiinflammatory drugs (NSAIDs) can be complicated by severe forms of renal dysfunction. These include fluid and electrolyte abnormalities, acute renal insufficiency due to alteration in renal hemodynamics, or interstitial nephritis and proteinuria secondary to glomerular pathology, which has the histologic characteristics of minimal change glomerulopathy (MCG). While NSAID-induced nephrotic syndrome characteristically consists of MCG with interstitial nephritis, which is the most common clinical manifestation, it rarely consists of MCG without interstitial nephritis, which has been reported in a handful of patients who took fenoprofen, ibuprofen, sulindac, diclofenac, or zomepirac. We experienced a 66-year-old female patient who presented with low serum albumin, proteinuria and generalized edema and received Geworin for about 2 year before developing symptoms. She histologically had MCG without interstitial nephritis and achieved a complete remission thirty-fifth days after discontinuing the drug. A cause-and-effect relationship of this disease to Geworin administration is strongly suggested by the resolution of the proteinuria after the drug was stopped and by no evidence of any impairment in renal function after twenty eight months of follow-up.
Acute Kidney Injury ; Aged ; Analgesics* ; Anti-Inflammatory Agents ; Antipyrine ; Diclofenac ; Edema ; Female ; Fenoprofen ; Follow-Up Studies ; Hand ; Hemodynamics ; Humans ; Ibuprofen ; Nephritis ; Nephritis, Interstitial* ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Pathology ; Proteinuria ; Serum Albumin ; Sulindac

OBJECTIVE: We aimed to investigate the diagnostic accuracy of cardiac computed tomography (CT) for the detection of mitral valve (MV) prolapse in mitral regurgitation (MR) with surgical findings as the standard reference, and to assess the predictability of MV replacement based on morphologic CT findings. MATERIALS AND METHODS: A total of 156 patients who had undergone preoperative cardiac CT and subsequently received MV surgery due to severe MR were retrospectively enrolled. Non-repairable MV was defined when at least one of the following conditions was met: 1) anterior leaflet prolapse, 2) bi-leaflet prolapse, or 3) valve morphology (leaflet thickening, calcification, or mitral annular calcification [MAC]). Diagnostic performance of CT for the detection of the prolapsed segment was assessed with surgical findings as the standard reference. Logistic regression analysis was performed to evaluate the value of CT findings to predict actual valve replacement. RESULTS: During surgery, MV prolapse was identified in 72.1%. The sensitivity, specificity, and diagnostic accuracy for the detection of MV prolapse were 99.1%, 81.4%, and 94.2%, respectively, per patient. One-hundred eighteen patients (75.6%) underwent MV repair and the remaining 38 patients received MV replacement. Bi-leaflet prolapse and valve morphology were independent predictors of valve replacement after adjusting for clinical variables (adjusted odds ratio, [OR] 8.63 for bi-leaflet prolapse; OR, 4.14 for leaflet thickening; and OR, 5.37 for leaflet calcium score > 5.6; p < 0.05). CONCLUSION: Cardiac CT can have high diagnostic performance for detecting the prolapsed segment of the MV and predictability of valve replacement before surgery. Bi-leaflet prolapse and valve morphology, such as leaflet thickening, or calcification or MAC, are the most important predictors of valve replacement.
Calcium ; Humans ; Logistic Models ; Mitral Valve Insufficiency ; Mitral Valve Prolapse ; Mitral Valve ; Odds Ratio ; Prolapse ; Retrospective Studies ; Sensitivity and Specificity