PURPOSE: To report a case of multiple eyelid trichilemmomas associated with Cowden syndrome. CASE SUMMARY: A 27-year-old woman presented with multiple upper and lower eyelid skin masses that developed over several years. The masses were as large as whitish millet, and were around the upper and lower eyelid margin and the face. The patient had previously undergone subtotal thyroidectomy for a thyroid mass and a mass excision for extremity hemangioma. Excisional biopsy was performed for the diagnosis, and trichilemmoma was diagnosed based on histopathologic examination. Consequently, multiple trichilemmoma associated with Cowden syndrome was diagnosed, and breast evaluations for existence of further masses were recommended. On breast examinations, intraductal papilloma and fibroadenoma were detected. CONCLUSIONS: The trichilemmoma was a hair-follicle benign tumor that also appeared on the skin around the eyelid. If multiple trichilemmoma is diagnosed, an association with Cowden syndrome should be considered as well as presence of masses in other organs.
Biopsy ; Breast ; Extremities ; Eyelids ; Female ; Fibroadenoma ; Hamartoma Syndrome, Multiple ; Hemangioma ; Humans ; Panicum ; Papilloma, Intraductal ; Skin ; Thyroid Gland ; Thyroidectomy

BACKGROUND/AIMS: This stuy evaluated the role of a second-look endoscopy after gastric endoscopic submucosal dissection in patients without signs of bleeding. METHODS: Between March 2011 and March 2012, 407 patients with gastric neoplasms who underwent endoscopic submucosal dissection for 445 lesions were retrospectively reviewed. After the patients had undergone endoscopic submucosal dissection, they were allocated to two groups (with or without second-look endoscopy) according to the following endoscopy. The postoperative bleeding risk of the lesions was not considered when allocating the patients. RESULTS: The delayed postoperative bleeding rates did not differ between the two groups (with vs without second-look endoscopy, 3.0% vs 2.1%; p=0.546). However, a tumor in the upper-third of the stomach (odds ratio [OR], 5.353; 95% confidence interval [CI], 1.075 to 26.650) and specimen size greater than 40 mm (OR, 4.794; 95% CI, 1.307 to 17.588) were both independent risk factors for delayed postoperative bleeding. Additionally, second-look endoscopy was not related to reduced delayed postoperative bleeding. However, delayed postoperative bleeding in the patients who did not undergo a second-look endoscopy occurred significantly earlier than that in patients who underwent a second-look endoscopy (4.5 and 14.0 days, respectively, p=0.022). CONCLUSIONS: A routine second-look endoscopy after gastric endoscopic submucosal dissection is not necessary for all patients.
Female ; Gastrectomy/*adverse effects ; Gastric Mucosa/surgery ; *Gastroscopy ; Humans ; Male ; Middle Aged ; Postoperative Hemorrhage/diagnosis/etiology/*prevention & control ; Retrospective Studies ; Risk Factors ; Second-Look Surgery ; Stomach/pathology/surgery ; Stomach Neoplasms/pathology/surgery ; Time Factors

PURPOSE: The insertion site of K-wire for skeletal traction is proximal part of tibia or distal part of femur. However, people prefer proximal tibia over distal femur due to lower risk of infection rate when change to interlocking IM nailing is needed. We evaluated the infection rate of interlocking IM nailing. MATERIALS AND METHODS: Fourty-seven patients were included in this study who underwent interlocking IM nailing due to femur shaft fracture. Traction was applied at the distal femur in 19 cases and proximal tibia in 10 cases before interlocking IM nailing. No skeletal traction was applied to the remaining 18 cases. Thirty-eight patients were male and 9 were female. The average age at the time of surgery was 36.7 years old (range, 15~17 years). The average traction period was 9.5 days (range, 3~33 days) and the average followed-up period was 17.2 months. RESULTS: In the distal femoral traction group, 8 cases of superficial pin tract infection developed, but no case of deep infection such as osteomyelitis occurred. In the proximal tibia traction group, 2 cases of superficial pin tract infection developed, but no case of deep infection occurred. In the group that received no skeletal traction before interlocking IM nailing, no case of infection developed. CONCLUSION: In femur shaft fracture, the distal femoral skeletal traction followed by interlocking IM nailing of femur, compared to proximal tibia skeletal traction, did not increase the risk of deep infection such as osteomyelitis.
Female ; Femur* ; Fracture Fixation, Intramedullary* ; Humans ; Incidence* ; Male ; Osteomyelitis ; Tibia ; Traction*

No abstract available.
Athletes* ; Echocardiography* ; Humans

This review of upper cervical spine injuries includes 51 patients admitted to Korea University Hospital, Seoul during the period 1 Jan. 1990 to 31 Dec. 1994. The incidence of upper cervical injury was 13.6% in the 375 spine injury cases and 31.7% in the 161 cervical spine injuries. The most common type of injury was odontoid fracture, ie. 16 cases or 31.3%. The male-to-female ratio was 2.6:1 and the 4th decade showed peak incidence. 33 cases(64.7%) of the injuries were caused by traffic accidents. The chief complaints on admission were neck pain with limited range of motion in 39 cases(76.5%), motor weakness in 3 cases(5.9%), and sensory disturbance in 2 cases(3.9%). Operative treatment was performed in 23 patients resulted in neurologic improvement in 22 Cases(95.7%) and 28 patients were managed by conservative treatment with 25 cases(89.3%) of neurologic improvement. Mortality rate of the upper cervical spine injury was 3.9%. The above represents our experience with 51 patients suffering from upper cervical injuries. Management and follow-up guidelines are also reviewed.
Accidents, Traffic ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Mortality ; Neck Pain ; Range of Motion, Articular ; Seoul ; Spine*

PURPOSE: This study aimed to evaluate the clinical significance of Ki-67 and p53 expressions in patients with pancreatic head cancer. METHODS: Between May 2008 and April 2013, immunohistochemical staining for Ki-67 and p53 was performed in 34 patients with pancreatic head cancer (ductal adenocarcinoma). All 34 patients underwent pancreaticoduodenectomy at Chonnam National University Hwasun Hospital, Hwasun, Korea. Clinical and histopathological characteristics were analyzed, relative to p53 expression. RESULTS: Thirty (88.2%) and twenty-one (61.7%) of the 34 pancreatic head cancers exhibited positive expression of Ki-67 and p53, respectively. Patients expressing Ki-67 and p53 experienced more frequent tumor recurrences within 1 year after surgical resection (P = 0.003 and P = 0.030, respectively). However, no correlation was detected between Ki-67 and p53 expression. Ki-67 expression was correlated with pathological grade, lymph node metasatsis, and clinical stage (P < 0.05). Importantly, Ki-67 was the independent predictive factor for postoperative recurrence within 1 year in both univariable and multivariable analyses (odds ratio, 27.219; 95% confidence interval, 1.403-528.135; P = 0.029). CONCLUSION: The expression of Ki-67 and p53 are significantly related to early postoperative recurrence within 1 year after surgical resection in pancreatic head cancer. Especially, Ki-67 was the independent predictive factor for postoperative recurrence within 1 year. Therefore, immunohistochemical staining for Ki-67 and p53 may be applied as a predictive marker for early postoperative recurrence in pancreatic head cancer.
Carcinoma, Pancreatic Ductal ; Head ; Head and Neck Neoplasms* ; Humans ; Immunohistochemistry ; Jeollanam-do ; Ki-67 Antigen ; Korea ; Lymph Nodes ; Pancreaticoduodenectomy ; Recurrence* ; Risk Factors ; Tumor Suppressor Protein p53

PURPOSE: To evaluate the usefulness of preoperative or postoperative lymphoscintigraphy for the identification of lymphatic drainage and sentinel lymph node in patients with eyeball and ocular adnexal malignant tumors. METHODS: Lymphoscintigraphy was performed preoperatively or postoperatively in 5 patients with biopsy proven primary eyeball or ocular adnexal malignant tumors. Patients underwent lymphoscintigraphy with 500 micro Ci of technetium-99m antimony trisulfide colloid in a volume of 0.1 ml. We injected intradermally either the outer 1/3 of the upper or lower lid, or the inner 1/3 of the upper or lower lid. Images were taken by Gamma camera and we checked lymphatic drainage and sentinel lymph nodes. RESULTS: Two patients with conjunctival malignant melanoma showed normal lymphatic drainage, but the other two patients had lymphatic drainage to the parotid and submandibular chain, and sentinel lymph nodes were noted as the parotid lymph node and the submandibular lymph node. The patients with sebaceous gland carcinoma injected in the outer 1/3 of the upper lid had submandibular lymphatic chain and the sentinel lymph node proved to be the submandibular lymph node. CONCLUSIONS: Lymphoscintigraphy demonstrated the lymphatic drainage system and successfully identified the sentinel lymph nodes. This should prove to be very helpful to evaluate metastasis of the eyeball and ocular adnexal malignant tumors by selective lymph node biopsy and to decide the degree of surgery.
Antimony ; Biopsy ; Colloids ; Drainage ; Gamma Cameras ; Humans ; Lymph Nodes ; Lymphoscintigraphy* ; Melanoma ; Neoplasm Metastasis ; Sebaceous Glands

STUDY DESIGN: This is a retrospective study that was done according to clinical and radiological evaluation. PURPOSE: We analyzed the clinical and radiological outcomes of minimally invasive transforaminal lumbar interbody single level fusion. OVERVIEW OF LITERATURE: Minimally invasive transforaminal lumbar interbody fusion is effective surgical method for treating degenerative lumbar disease. METHODS: The study was conducted on 56 patients who were available for longer than 2 years (range, 24 to 45 months) follow-up after undergoing minimally invasive transforminal lumbar interbody single level fusion. Clinical evaluation was performed by the analysis of the visual analogue scale (VAS) score and the Oswestry Disability Index (ODI) and the Kirkaldy-Willis score. For the radiological evaluation, the disc space height, the segmental lumbar lordotic angle and the whole lumbar lordotic angle were analyzed. At the final follow-up after operation, the fusion rate was analyzed according to Bridwell's anterior fusion grade. RESULTS: For the evaluation of clinical outcomes, the VAS score was reduced from an average of 6.7 prior to surgery to an average of 1.8 at the final follow-up. The ODI was decreased from an average of 36.5 prior to surgery to an average of 12.8 at the final follow-up. In regard to the clinical outcomes evaluated by the Kirkaldy-Willis score, better than good results were obtained in 52 cases (92.9%). For the radiological evaluation, the disc space height (p = 0.002), and the whole lumbar lordotic angle (p = 0.001) were increased at the final follow-up. At the final follow-up, regarding the interbody fusion, radiological union was obtained in 54 cases (95.4%). CONCLUSIONS: We think that if surgeons become familiar with the surgical techniques, this is a useful method for minimally invasive spinal surgery.
Follow-Up Studies ; Humans ; Retrospective Studies

PURPOSE: Synuclein has been identified as an important neuroprotein for developing pathologic deposits in Alzheimer's and Parkinson's disease patients. gamma-synuclein is also known as a breast cancer-specific gene 1 thats's not found in normal breast tissues but it has been reported to be overexpressed in breast cancer, ovarian cancer and other tumors. To evaluate the availability of gamma-synuclein expression as a prognostic factor for infiltrative breast cancer, we analyzed its correlation with the clinical parameters and the HER-2/neu gene expression. METHODS: Two hundred fiffty samples of breast cancer tissues embedded in paraffin and that were obtained from the infiltrative breast cancer patients who were operated in our institution from January 1995 to December 2000 were analyzed with employing the tissue microarray technique. The expression of gamma-synuclein was studied with immunohistochemistry and with using gamma-synulcein antibodies. One hundred thirty one cases that showed favorable staining were selected and studied retrospectively. RESULTS: Fiffty five% (71/131) of the patients showed gamma-synuclein overexpression. The histopathological findings that significantly correlated with gamma-synuclein overexpression were the number of metastatic lymph nodes (p<0.01) and the cancer stage (p<0.01). Using the same tissue mircoarray, the HER-2/neu gene expression and gamma-synuclein expression also showed statistically significant correlation (p=0.04). CONCLUSION: gamma-synuclein overexpression showed significant correaltion with lymph node metastasis and cancer stage. It also showed significant relevance with the HER-2/neu gene expression, and that is already known to be a prognostic factor for breast cancer. Therefore gamma-synuclein may be a useful prognostic factor for infiltrative breast cancer and further studies on the its correlation with survival, local recurrence, and distant metastasis should be conducted
Antibodies ; Breast Neoplasms* ; Breast* ; gamma-Synuclein* ; Gene Expression ; Humans ; Immunohistochemistry ; Lymph Nodes ; Neoplasm Metastasis ; Ovarian Neoplasms ; Paraffin ; Parkinson Disease ; Recurrence ; Retrospective Studies ; Synucleins

No abstract available.
Bile Ducts, Extrahepatic* ; Neuroendocrine Tumors*