We report a case of Buerger's disease manifested by a scrotal mass, in view of its rarity. A tender bean sized mass was palpated in the left scrotum of a 34 year-old male heavy smoker, who had a history of right pain two years ago which subsided spontaneously. The left testis with the paratesticular tissue was excised. Vessels of the spermatic cord and epididymis showed microscopic changes of Buerger's disease. The involved arteries and veins revealed a predominantly subacute pattern with granulomatous inflammation and Langhans' type giant cells within the thrombi.
Male ; Humans

Many methods of correcting secondary cleft lip nose deformity have been introduced, but a single best method that can be uniformly adjusted for all cases does not exist. Since it is difficult to make the nostril of the cleft side symmetric with that of normal side, the authors tried to formulate the basis for correction of unilateral secondary cleft lip nose deformity according to the varying amounts of deformed nostril. We then adopted 4 different methods of correcting the soft tissue and nostril deformity in 63 patients from 1996 to 1998 and surveyed the results. Our principles were as follows: 1) Alar rim incision was done in cases of different-shaped cleft-side nostrils with nearly the same measured area in comparison to the normal side. 2) When deformity of the alar-columellar web was severe, we performed modified Z-plasty. 3) When the nostril of the cleft-side nostril was smaller than the normal side with slight asymmetry, reverse W-plasty was done. 4) We adopted a reverse-U incision when there was a discrepancy in height with moderate asymmetry compared with the normal nostril. After dissection, repositioning of alar cartilage was done by same method in each case. A nasal stent was kept in position for at least 6 months postoperatively in almost all cases. After follow-up of 6 to 24 months, we concluded that our choice was correct in selecting the optimal operative method, considering the characteristics of deformity of the cleft side nostril in an effort to make it symmetric with that of the normal side.
Cartilage ; Cleft Lip* ; Congenital Abnormalities* ; Follow-Up Studies ; Humans ; Nose* ; Stents

The search for the ideal augmentation material of facial soft tissues has been an ongoing effort for many years. Injectable soft tissue substitutes provide an affordable, non-surgical alternative for correcting contour defects in facial skin. A safe and effective material for this purpose should respect certain characteristics that it should be biocompatible, non-antigenic, nonpyrogenic, noninflammatory, noninflammatoy, nontoxic, easy to use, stable after injection, non-migratory, long-lasting but reabsorbable, natural looking and not too expensive. Although many biomaterials are currently on the market, none meets all the above criteria. The recent development of hyaluronic acid gels(Restylane ) for dermal implantation is therefore particularly interesting in treating the aging face. Restylane is produced in cultures of Equine streptococci by fermentation in presence of sugar, the hyaluronic acid chains are then chemically stabilized through permanent epoxidic cross-links that the manufacturer reports to alter only about 1% of the hyaluronan molecular network. The resulting viscoelastic transparnet gel, suitable for intradermal infection, has a concentration of 20 mg/ml, is delivered in disposable syringes (0.7 ml) ready for use, using a 30 gauge needles. The twenty-one patients in thirty area were treated with facial intradermal implantation of hyaluronic acid gel for augmentation therapy of wrinkles and folds for recoutouring. The results were evaluated in all patients by subjective judgment by the physician and the patients. This study provides a clinical evaluation of safety and efficacy of a cross-linked stabilized non-animal hyaluronic acid gel to determine its characteristics, advantages, disadvantages, and side-effects in Korean. We concluded that Restylane implantation was soft, easy to use and long lasting effective materials in augmentation therapy of soft tissue of face.
Aging ; Biocompatible Materials ; Fermentation ; Humans ; Hyaluronic Acid ; Judgment ; Needles ; Skin ; Syringes

Hair takes a great role in featuring man's appearance and absence of hair can causes troubles in physical and psychological aspects. Many efforts have been made to treat male pattern baldness, including medical therapy and surgical correction, but there is not a definite and eternal method of treatment. Even though the diagnosis of male pattern baldness can be made with its characteristic clinical manifestations, histopathological study must be done for definite diagnosis. Author obtained biopsy material from the frontal progressive baldness area and the occipital non-baldness area with punch biopsy in 20 patients who were diagnosed to be Type II and III male pattern baldness according to the Norwood classification. A comparative study was done in the basis of histopathology using serial vertical section of the biopsy materia with the aid of light microscope and the results are as follows : 1. The average number of total hair in the frontal area was on third than that of occipital area and the number of anagen hair was less in the frontal area. The number of telogen hair in the frontal area was seven times more than that of occipital area. 2. The thickness of epidermis and dermis in the frontal area was thinner than that of occipital area. 3. The infiltration of inflammatory cells in the periadnexal field like blood vessels, hair follicles, sebaceous glands, eccrine glands was more prominent in the frontal area than in the occipatal area. 4. Perifollicular fibrosis and hypertrophy of arrector pilli muscle were more remarkable in the frontal area compared with that of occipital area. 5. There was no difference between the frontal and occipiral area in the number of lobules of sebaceous glands.
Alopecia* ; Biopsy ; Blood Vessels ; Classification ; Dermis ; Diagnosis ; Eccrine Glands ; Epidermis ; Fibrosis ; Hair ; Hair Follicle ; Humans ; Hypertrophy ; Male* ; Sebaceous Glands

PURPOSE: The objective of this study is to investige the clinical features, natural histories, and results of medical and surgical treatment of NMD in patients who were diagnosed during childhood. METHODS: We performed a retrospective analysis of medical records of 57 patients with NMD who were newly diagnosed by MRI or pathologically in epilepsy children since March 1993 to June 2000. RESULTS: These 57 patients with NMD consisted of 26 with cortical dysplasia, 9 with lissencephaly, 7 with polymicrogyria, 6 with schizencephaly, 4 with hemimegalencephaly, 3 with heterotopias, and 2 with double cortex. Clinically, 94.7% of these patients showed seizures, 33.3% with developmental delay, 21.1% mental retardation, 15.8% cerebral palsy, and 7.0% attention deficit hyperactivity disorder. Their response to antiepileptic drugs was good to 31 patients (75.6%), moderate to 3 (7.3%), and poor to 7 (17.1%). Twelve patients were completely seizure-free after receiving medication for at least 15 months. Seventeen patients tolerated with monotherapy with antiepileptic drugs. Fourteen patients underwent surgical resection. The results of operation were highly correlated with the complete removal of epileptic focus. Six patients who underwent complete resection were seizure-free after operation. On the other hand, Eight patients who had incomplete resection of the epileptic focus showed poor outcome. CONCLUSION: Most of previous reports suggested that NMD is associated with refractory to medical treatments, and early surgical operation has been recommended. Our study demonstrates remarkably good responses of NMD patients with medical treatment only.
Anticonvulsants ; Attention Deficit Disorder with Hyperactivity ; Cerebral Palsy ; Child* ; Epilepsy ; Hand ; Humans ; Intellectual Disability ; Lissencephaly ; Magnetic Resonance Imaging ; Malformations of Cortical Development ; Medical Records ; Neuronal Migration Disorders* ; Neurons* ; Retrospective Studies ; Seizures

We report a case of epidermolysis bullosa simplex, Dowling-Meara type (EBS-DM), which was associated with congenital pyloric atresia (PA) and various urologic abnormalities, a diagnosis confirmed by immunofluorescence mapping and electron microscopic findings. Immunofluorescent mapping showed the serum from a patient with bullous pemphigoid faintly binding to the floor of the blister, and monoclonal antibodies against type IV and VII collagens were also stained on the floor of the blister. Electron microscopy showed epidermolytic cleavage and prominent clumping of tonofilaments in the basal and suprabasal keratinocytes. An abdominal radiograph and barium swallow showed a complete obstruction at the pyloric channel level. The widespread bullae healed without any scar formation and the bullae formation was localized on the extremities after 3 months of age without any specific treatment. Multiple urologic abnormalities such as bilateral hydronephrosis, hydroureter and a distended bladder with trabeculation were observed at 12 months of age. Currently, with the patient at 4 years of age, bullae still appear on the hands and feet and nail shedding can be observed. The patient's father, a paternal uncle and a paternal aunt had had similar bullous eruptions in infancy, all of which had improved spontaneously by the age of one.
Case Report ; Collagen/metabolism ; Epidermolysis Bullosa Simplex/pathology ; Epidermolysis Bullosa Simplex/metabolism ; Epidermolysis Bullosa Simplex/complications* ; Human ; Infant, Newborn ; Male ; Pylorus*/radiography ; Stomach Diseases/radiography ; Stomach Diseases/complications* ; Urologic Diseases/congenital* ; Urologic Diseases/complications*

Clinical lymphadenopathies are subjected to fine needle aspiration cytology(FNAC) for diagnosing not only benign lesions but also malignant ones, as the first diagnostic procedure. While the diagnostic reliability in metastatic carcinoma is high, it is difficult to differentiate malignant lymphoma from reactive conditions. We evaluated the diagnostic reliability of FNAC in lymphadenopathy, and discuss the diagnostic limitation and its place in clinical practice in this study. Over 8 years from January 1988, FNAC of 1,216 lymphadenopathies were analyzed and among them 170 cases were compared with histopathology. The results are as follows. 1. Of all the cases, 890 cases(73.2%) were diagnosed cytologically as benign, 312 cases(25.7%) as malignant, and 14 cases(1.1%) as unsatisfactory material. Reactive hyperplasia was diagnosed in 585 cases(65.7%) of the benign lesions, and among the malignant diseases, metastatic carcinoma was diagnosed in 248 cases(79.5%), and malignant lymphoma in 62 cases(19.9%). 2. The overall diagnostic accuracy was 89.2%, and no false positive case and 9 false negative results were observed among 170 cases which were proven by histopathology. Six cases of sampling error of false negative diagnoses included 3 of metastatic carcinomas and 3 of malignant lymphomas. The causes were difference between aspiration and biopsy site, poor fixation, or scanty cellularity with bloody smear. All 3 cases of misinterpretation error were malignant lymphomas, one of mixed type on biopsy which was diagnosed as reactive hyperplasia cytologically. In summary, FNAC technique is thought to be useful in the initial diagnosis of lymphadenopathies as well as in the follow-up of patients with known malignancy. Although the results of malignant lymphoma was less accurate than other malignant lesions, the application of strict cytologic criteria or lymphoid marker studies of aspiration material will reduce the false negative rate.
Biopsy ; Biopsy, Fine-Needle* ; Diagnosis ; Follow-Up Studies ; Humans ; Hyperplasia ; Lymph Nodes ; Lymphatic Diseases* ; Lymphoma ; Selection Bias

The squamous cell carcinoma is the most common cancer of lower lip. Although various treatment methods have been introduced, surgical resection and reconstruction is considered to be the most important medical remedy. We surveyed 11 patients who received the surgery for squamous cell carcinoma on lower lip from January 1992 to December 1997. The survey included the size and location of tumor mass, the presence of lymph node metastasis for a preoperative evaluation, the aesthetic and the performance of lower lip after the operation, the recurrence rate, the complication and the mortality rate. In resectioning tunmor mass, the surgery has to completely remove the mass and meanwhile has to minimize the loss of normal tissues. Also in reconstruction of lower lip, it has to resemble, aesthetically and functionally, the normal lower lip as well. To achieve such s, the pre-excisional frozen biopsy was performed to determine the surgical margins and various reconstructive methods were tried according to the location and size of the defect remained in the lower lip. In the most of clinical cases, appropriate vermillion and nasolabial sulcus were fashioned and they functioned normally in both speech and mastication. As for complications, each case of drooling and macrostomia were reported, There was no mortality from lower lip carcinoma and its recurrence. Due to determination of the safe surgical margin by pre-excisional frozen biopsy and reconstruction by appropriate procedure according to the location and the size of defect, the survey indicates minimized postoperative complications, no recurrence and no mortality as well as aesthetically and functionally adequate lower lip
Biopsy ; Carcinoma, Squamous Cell* ; Humans ; Lip* ; Lymph Nodes ; Macrostomia ; Mastication ; Mortality ; Neoplasm Metastasis ; Postoperative Complications ; Recurrence ; Sialorrhea

Reconstruction of total nasal defect is limited in methods, but in cases of partial nasal defect, various methods can be adapted according to the size, shape and location. The authors tried to summarize the relationship between the etiology, location, size of partial nasal defect and reconstructive methods. The authors experienced 27 patients of partial nasal defect for the recent 3 years, male patients were 13 and female patients were 14 among them. The age of the patients ranged from 27 to 78. Malignant skin tumor was the most common among the causes of the defect: 16 cases of basal cell carcinoma, 4 cases of squamous cell carcinoma. The locations of the defect can be summarized as 8 cases of nasal alar area, 8 cases of nasal tip area, 6 cases of nasal side wall and 5 cases of nasal dorsum. As reconstructive methods, the authors used median forehead flap in 7 cases, dorsal nasal flap in 6 cases, full thickness skin graft in 5 cases, bilobed local flap in 3 cases, nasolabial flap in 3 cases, and other local flap in 3 cases. Skin graft is an easy method for the shallow defect, but its major disadvantage is color mismatch with adjacent skin. In cases of flap surgery, though it often causes deformity in contour, appropriate reconstruction was possible with through preoperative evaluation. According to our survey, local flap such as bilobed flap was enough for the defect of small size, and in cases moderate to large sized defect, nasolabial flap was appropriate for defect in nasal tip area, dorsal nasal flap was good for the defect in nasal dorsum and median forehead flap was useful for the defect in nasal side wall. The authors presents our comparative results of the 27 cases of partial nasal defect for the recent 3 years with the hope of being contributed in choosing the reconsfructive methods in the future.
Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Congenital Abnormalities ; Female ; Forehead ; Hope ; Humans ; Male ; Nose* ; Skin ; Transplants

BACKGROUND: Bispectral index (BIS) is a useful tool to assess depth of anesthesia. Recently, spectral entropy has been promoted as a monitor of anesthetic depth in adult, but its characteristics in children remains poorly defined. This study was to compare BIS and entropy indices during sevoflurane anesthesia in children. METHODS: Forty children (aged 1-12 yr) scheduled for ENT surgery, were included. Anesthesia was induced with 5.0% sevoflurane in O2 6 L/min. Tracheal intubation was performed with rocuronium 0.6 mg/kg. Heart rate, blood pressure, end-tidal sevoflurane concentration (Etsev), BIS, response entropy (RE) and state entropy (SE) were measured every 5 minutes. The correlation between BIS and entropy index and Etsev was calculated, RESULTS: The BIS, SE and RE values decreased with induction and increased with recovery. The BIS, RE, and SE values were inversely proportionally related to the Etsev. The RE and SE values were closely correlated with the BIS values (respectively r = 0.948 and r = 0.946, P< 0.001). CONCLUSIONS: We demonstrated a close correlation of SE and RE with Etsev and with BIS during sevoflurane anesthesia in children. State entropy and RE seem to be useful electroencephalographic measures of sevoflurane drug effect in children.
Adult ; Androstanols ; Anesthesia ; Blood Pressure ; Child ; Entropy ; Heart Rate ; Humans ; Intubation ; Methyl Ethers ; Organothiophosphorus Compounds