Scleredema is a rare scleradematosis of unknown cause involving the face, neck, upper portion of the trunk, and proximal upper extremities. The clinical features of the disease are nonpitting indurated edema or stiffness of the neck, which may be sudden or insidious in onset. Diabetes mellitus and its complications have been frequently described to be associated with this disease. We present a case of scleredema developed on the nape, upper portion of the back and shoulder in 60-year-old man who had been suffered from diabetes mellitus for the past ten years.
Diabetes Mellitus ; Edema ; Humans ; Middle Aged ; Neck ; Scleredema Adultorum* ; Shoulder ; Upper Extremity

No abstract available.

No abstract available.
Intervertebral Disc* ; Prevalence* ; Spine*

We experienced a case of 16-year-old female with verruciform xanthoma transformed from lesions of epidermal nevus syndrome. The biopsy specimen of yellowish brown to red verrucous papule on the right buttock showed 1) uniform and verrucous acanthosis without cytological atypia, 2) parakeratosis and hyperkeratosis,3) variable foci of superficial necrosis with crusting and microabscess in the granular layer, 4) rete ridge elongation and papillomatosis, 5) characteristic foam cells located within the papillary dermis, but not below the rete ridges. Our case was diagnosed verruciform xanthoma by histopathologic finding which occured as a secondary development in lesions of epidermal nevus syndrome.
Adolescent ; Biopsy ; Buttocks ; Dermis ; Female ; Foam Cells ; Humans ; Necrosis ; Nevus ; Papilloma ; Parakeratosis ; Xanthomatosis*

No abstract available.
Hospitals, General* ; Humans

PURPOSE: Because of the volume of elective sterilizations performed in the world during the past decade, the vasectomy was a popular method for male sterilization in Korea and this, in turn, had been followed by an increase in the number of patient requiring vasectomy reversal with the high rate of subsequent divorce and remarriage. Recently, many authors have reported high success rates of vasovasostomy using microsurgical techniques and we performed modified two layer vasovasostomy with intravasal silicone tube to increase postoperative patency and pregnacy rate. METHODS: Microscopic vasovasostomy was performed in 9 patients at our department using modified two layer vasovasostomy with silicone tube insertion. Their ages ranged from 28 to 44 with an average of 35.78+/-1.36 years. Standard Guibor silicone tube, consisting of two 17.7cm, 0.064cm diameter, malleable, stainless steel probes connected by 29cm of silicone tubing wedged onto disposable probes, were used in all cases. RESULTS: Success rates were 88.8% for patency and pregnancy 44.4% for pregnancy in modified two layer vasovasostomy with silicone tube insertion. The patency rates were higher in cases of long postoperative day and in cases of short duration of vasectomy and vasovasostomy. CONCLUSION: We used a modified method to correspond the patency and pregnancy rate in microscopical modified two layer vasovasostomy using the intravasal silicone tube permanently. This method brings normal patency in microsurgical vasovasostomy because the silicone tube prevent obstruction of anastomosed site of the vas permanently.
Divorce ; Humans ; Korea ; Marriage ; Microsurgery ; Pregnancy ; Pregnancy Rate ; Silicones ; Stainless Steel ; Sterilization, Reproductive ; Vasectomy ; Vasovasostomy

PURPOSE: Many causes for triggering or locking of the fingers have been discussed in other literatures. The most common one is known stenosing tenosynovitis, which causes, a mismatch between the volume of the flexor tendon sheath and its contents. However, repeated trauma to the hand is uncommon cause of trigger finger. Therefore, we present a case of a rare condition of stenosing tenosynovitis which developed from a repeated relatively weak superficial flexor tendon injury. METHODS: The patient was a 62-year-old woman who showed a painless, fixed and round mass on her right hand with no particular cause. Active and passive range of motion of the metacarpophalangeal joint of long finger was limited in flexion and extension. Ultrasonographic finding showed injured flexor digitorum superficialis tendon had fibrillar architecture with swelling between hyperechoic synovial membrane and hypoechoic surrounding area. Surgical exploration revealed that a bunched portion of the flexor digitorum superficialis and A1 pulley cause triggering during operation after adhesiolysis of scar tissue. RESULTS: After releasing the A1 pulley, the range of motion of the metacarpophalangeal joint of long finger showed no limitation and histological examination of the subcutaneous tissue revealed fibrous fatty degeneration. In this case, releasing the A1 pulley with adhesiolysis of the subcutaneous scar tissue was successful and we obtained good functional outcome. CONCLUSION: We examined a patient in whom a repetitive impact forces to the palm caused longitudinal tear of the flexor tendon, leading to trigger finger. We experienced a rare case of stenosing tenosynovitis and trigger finger caused after close injury to flexor digitorum superficialis and its degenerative changes that caused mass like effect. To the best of authors' knowledge, our case of close injury to the flexor digitorum superficialis and unique morphologic change before rupture of tendon is rarely to be reported.
Cicatrix ; Female ; Fingers ; Hand ; Humans ; Metacarpophalangeal Joint ; Middle Aged ; Range of Motion, Articular ; Rupture ; Subcutaneous Tissue ; Synovial Membrane ; Tendon Entrapment ; Tendon Injuries ; Tendons

Calbindin-D9k (CaBP-9k) is a cytosolic calcium-binding protein expressed in tissues in the intestine, uterus, placenta, kidney, pituitary gland and bone. Its exact function is unknown, but it is considered to regulate intracytoplasmic concentration and transport of free ions (Ca2+). CaBP-9k protein is involved in intestinal calcium absorption in the intestine and in the regulation of myometrial activity by intracellular calcium in the uterus. Renal CaBP-9k protein is expressed at the site of calcium re-absorption in the kidney and expressed in distal convoluted tubules, where it is thought to facilitate calcium re-absorption. Expression of the CaBP-9k gene has been explored in most mammalians except in a canine model. Presently, we elucidated the expression of CaBP-9k mRNA and protein in the duodenum, kidney and uterus in a canine model involving two adult (2.5-year-old) female beagles. To collect tissues, the dogs were euthanized and then the abdominal cavity was exposed by midline incision. The proximal duodenum, cortex of kidney and uterine horn were collected. Expression of CaBP-9k mRNA was confirmed by reverse transcription-polymerase chain reaction (RT-PCR) and real-time PCR. CaBP-9k protein expression and localization were ascertained by Western blot analysis and immunohistochemistry, respectively. CaBP-9k mRNA was detected in the duodenum, but not in the kidney and uterus. Its protein was expressed only in the enterocytes of the duodenum. Taken together, the results indicate that CaBP-9k mRNA and protein are highly expressed in the enterocytes of the duodenum of a canine model, consistent with findings in other mammalian species.
Animals ; Blotting, Western/veterinary ; Calcium-Binding Protein, Vitamin D-Dependent/*biosynthesis/genetics ; Dogs/*physiology ; Duodenum/*physiology ; Female ; Immunohistochemistry/veterinary ; Kidney/*physiology ; RNA, Messenger/biosynthesis/genetics ; Reverse Transcriptase Polymerase Chain Reaction/veterinary ; Transcription, Genetic ; Uterus/*physiology

PURPOSE: Ganglioneuromas are well-differentiated tumors derived from neuroectodermal neural crest cells. Although these tumors can occur anywhere along the sympathetic chain from the base of the skull to the pelvic cavity, they usually develop in the posterior mediastinum and retroperitoneum these tumors are rarely found in the cervical region. METHODS: We report the case of a 16-year-old male patient with neurofibromatosis type 1 who was admitted because of a palpable mass centrally located on the left side of the neck. A preoperative contrast-enhanced neck computed tomography image showed a low-density homogeneous mass on the parapharyngeal space along with marked displacement of the trachea and carotid vessels. Round and soft masses were also detected on both axillae. RESULTS: The patient subsequently underwent complete excision of the neck mass via the transcervical approach. The mass was smooth and well encapsulated between the sternocleidomastoid muscle and the trachea. Further, the mass appeared to arise from the cervical sympathetic chain, which was preserved during surgery. Both the axillary masses were also excised. The histopathological findings were ganglioneuroma for the neck mass and neurofibroma for both the axillary masses. CONCLUSION: Cervical ganglioneuromas are rare tumors that present as enlarging parapharyngeal cervical masses in the oropharynx or neck. To our knowledge, a case of cervical ganglioneuroma associated with neurofibromatosis type 1 has never been reported. In patients with neurofibromatosis, multiple tumors may develop, and therefore periodic clinical and radiological follow-up is recommended. Further, repeated imaging analysis should be performed if the presence of another tumor is suspected.
Adolescent ; Axilla ; Displacement (Psychology) ; Follow-Up Studies ; Ganglioneuroma ; Humans ; Male ; Mediastinum ; Muscles ; Neck ; Neural Crest ; Neural Plate ; Neurofibroma ; Neurofibromatoses ; Neurofibromatosis 1 ; Oropharynx ; Skull ; Trachea

BACKGROUND AND PURPOSE: Mutations of the skeletal muscle sodium channel gene SCN4A, which is located on chromosome 17q23-25, are associated with various neuromuscular disorders that are labeled collectively as skeletal muscle sodium channelopathy. These disorders include hyperkalemic periodic paralysis (HYPP), hypokalemic periodic paralysis, paramyotonia congenita (PMC), potassium-aggravated myotonia, and congenital myasthenic syndrome. This study analyzed the clinical and mutational spectra of skeletal muscle sodium channelopathy in Korean subjects. METHODS: Six unrelated Korean patients with periodic paralysis or nondystrophic myotonia associated with SCN4A mutations were included in the study. For the mutational analysis of SCN4A, we performed a full sequence analysis of the gene using the patients' DNA. We also analyzed the patients' clinical history, physical findings, laboratory tests, and responses to treatment. RESULTS: We identified four different mutations (one of which was novel) in all of the patients examined. The novel heterozygous missense mutation, p.R225W, was found in one patient with mild nonpainful myotonia. Our patients exhibited various clinical phenotypes: pure myotonia in four, and PMC in one, and HYPP in one. The four patients with pure myotonia were initially diagnosed as having myotonia congenita (MC), but a previous analysis revealed no CLCN1 mutation. CONCLUSIONS: Clinical differentiating between sodium-channel myotonia (SCM) and MC is not easy, and it is suggested that a mutational analysis of both SCN4A and CLCN1 is essential for the differential diagnosis of SCM and MC.
Channelopathies ; Diagnosis, Differential ; DNA ; Humans ; Hypokalemic Periodic Paralysis ; Muscle, Skeletal ; Mutation, Missense ; Myasthenic Syndromes, Congenital ; Myotonia ; Myotonia Congenita ; Myotonic Disorders ; Paralyses, Familial Periodic ; Paralysis ; Paralysis, Hyperkalemic Periodic ; Sequence Analysis ; Sodium ; Sodium Channels