The most common cause of chronic cutaneous sinus tract in the face and neck is chronically draining dental infection. The diagnosis is easily confirmed by dental examination and dental roentgenogram of the involved area, but this disease is frequently misdiagnosed and incorrectly treated in dermatologic department. We report four cases of cutaneous sinus tract of dental origin. First patient had a painful nodule with chronically draining pus and a dimple on the left cheek. Second patient had a dimple with draining bloody fluid on the right chin. Third patient had a pea-sized papule with draining serous fluid on the left chin. Fourth patient had a fluctuant erythematous plaque with draining pus and a dimple on the left buccal area. In all four patients radiologic examination of the maxillary and mandibular regions demonstrated radioluency at the apex of tooth consistent with periapical abscess.
Cheek ; Chin ; Diagnosis ; Humans ; Neck ; Periapical Abscess ; Suppuration ; Tooth

We herein report a case of transient acrodermatitis enteropathica in a 3-month-old, breast-fed, full-term infant. The patient was presented with a 2-month history of diarrhea and crusted erythema- tous patches on the periorificial area. Similar lesions were seen in his siblings. His serum zinc level and the zinc level in his mother's breast milk were markedly reduced. Diarrhea and skin lesions disappeared promptly with oral zinc supplementation and did not recur when zinc was discontinued after three weeks. Our case indicates that even full-term infants, who feed excl-usively on mothers milk, run a risk of developing zinc deficiency, if the concentration of zinc in the breast milk is very low.
Acrodermatitis* ; Diarrhea ; Humans ; Infant* ; Milk ; Milk, Human ; Mothers ; Siblings ; Skin ; Zinc

Purpura is discoloration of the skin and mucous membranes due to extravasation of red blood cells and may be due to a variety of factors, but it is sometimes difficult to identify the exact cause. Some forms of purpura can frighten the patient and puzzle the physician. Mask phenomenon is an unusual purpura of the relatively loose tissues of the face and neck occuring after prolonged coughing, vigorous vomiting, valsalva's maneuver, parturition, or any other exertion that raises intrathoracic or abdominal pressure. This occurs with acute onset and fades within twenty-four to seventy-two hours spontaneously. A work-up for a coagulation or platelet defect is usually not required. We herein describe five cases of mask phenomenon(unusual facial purpura).
Blood Platelets ; Cough ; Erythrocytes ; Humans ; Masks* ; Mucous Membrane ; Neck ; Parturition ; Purpura* ; Skin ; Valsalva Maneuver ; Vomiting

Purpura is discoloration of the skin and mucous membranes due to extravasation of red blood cells and may be due to a variety of factors, but it is sometimes difficult to identify the exact cause. Some forms of purpura can frighten the patient and puzzle the physician. Mask phenomenon is an unusual purpura of the relatively loose tissues of the face and neck occuring after prolonged coughing, vigorous vomiting, valsalva's maneuver, parturition, or any other exertion that raises intrathoracic or abdominal pressure. This occurs with acute onset and fades within twenty-four to seventy-two hours spontaneously. A work-up for a coagulation or platelet defect is usually not required. We herein describe five cases of mask phenomenon(unusual facial purpura).
Blood Platelets ; Cough ; Erythrocytes ; Humans ; Masks* ; Mucous Membrane ; Neck ; Parturition ; Purpura* ; Skin ; Valsalva Maneuver ; Vomiting

Total hip replacement for adults with severe acetabular dysplasia presents a difficult problem because deficient bone stock and soft tissue contractures usually prevent sitting at the normal anatomic level. The rationales of high hip center are due to high failure rate of bulk structural weight bearing graft, good short-term result of hemispherical cementless acetabular component in revision surgery, high hip center but not lateral which does not adversely affect the biomechanics of the hip, and intimate apposition with viable host bone. We represented the short-term results of 21 total hip replacements with proximal placement of the acetabular cup than the anatomical position that is normally used. The mean duration of follow up was 18 months(range, 12-58 months) and the mean age of the patient was fifty-one years(range, thirty to sixty-seven years). Most of these hips had a major deficiency or defect of the acetabular bone stock. They had an aver- age Harris hip score of 47 points preoperatively and 90 points postoperatively. Roentgenographic measurements showed that the mean change in the height of the center of the hip postoperatively was only +6.6 millimeters and the mean change of horizontal location of them was 10 millimeters medial to the preoperative position. Postoperative complications included calcar fracture(1 case), trochanteric bursitis(1 case), postop- erative dislocation(1 case) and one case of radiological loosening of the acetabular component. The center of the hip in THR is not a crucial parameter with regard to the long-term stability of acetabular component, so our recommendation is to place the acetabular component at a more proximal but not lateral position if strong bone stock is available. But future studies of high hip center need to address femoral component longevity.
Acetabulum ; Adult ; Arthroplasty, Replacement, Hip ; Contracture ; Femur ; Follow-Up Studies ; Hip Joint ; Hip ; Humans ; Longevity ; Osteoarthritis ; Postoperative Complications ; Transplants ; Weight-Bearing

Portal flow steal occasionally persists even after the liver transplantation, which may reduce the portal flow and thus threaten the patients' outcome. Therefore, pre- and peri-operative detection of portal steal phenomenon requiring radiological or surgical interruption is essential for the liver transplantation candidates as well as for the recipients.
Adult ; Hepatitis B, Chronic/complications ; Humans ; Liver Cirrhosis/etiology/*therapy ; *Liver Transplantation ; Male ; Mesenteric Veins/*ultrasonography

We performed hand-assisted laparoscopic surgery for a 67-year-old male with a 5.6 cm sized abdominal aortic aneurysm. To the best of our knowledge, this is the first report in Korea. After an initial hand dissection of the abdominal aorta under laparoscopy, we performed proximal anastomosis and distal abdominal aorta suture ligation through a 6 cm abdominal incision. Distal anastomosis was done at the bilateral common femoral arteries. He resumed his oral intake 6 hours after the surgery and discharged at the 4th postoperative day.
Aged ; Aorta, Abdominal ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal ; Femoral Artery ; Hand ; Hand-Assisted Laparoscopy ; Humans ; Korea ; Laparoscopy ; Ligation ; Male ; Sutures

Although the obstruction of the right colon is usually handled by primary anastomosis following resection, fear of the increased incidence of septic complication, especially anastomotic leakage with sepsis has turned surgeons away from doing anastomosis in the face of acute obstruction of the left colon. However, from recent reports, enough experiences have been accumulated to show that primary anastomosis is associated with minimum morbidity and mortality in the acute obstruction of the left colon. We experienced 54 cases of colon cancer obstruction at Holy Family Hospital from January 1988 to December 1997. Twenty six cases of them were right colon cancers, 24 cases were left colon cancers and 4 cases were rectal cancers. We reviewed these three groups for evaluation of the safety of one-stage resection and anastomosis of left colon cancer obstruction. The postoperative complication rate was 18% in right colon obstruction versus 38% in left colon obstruction. The most common complication was wound infection(43%). In using of primary resection and anastomosis, complication of right colon revealed 15% and left colon was 29%. But in a method of primary resection and anastomosis with decompression, complication of right colon was 17% and left colon was 13%. Especially on the left colon, primary resection and anastomosis with decompression revealed lower complication(13%) than that without decompression(67%). The mortality of colon cancer obstruction was 2% but this was a patient who had a poor general condition and took a primary resection and anastomosis without decompression. In cases of left colon cancer obstruction primary resection and anastomosis with decompression of left colon cancer obstruction can be a safe operation method with low morbidity and mortality.
Anastomotic Leak ; Colon* ; Colonic Neoplasms* ; Decompression ; Humans ; Incidence ; Mortality ; Postoperative Complications ; Rectal Neoplasms ; Sepsis ; Wounds and Injuries

BACKGROUND: A management protocol for hepatitis C virus (HCV) after liver transplantation (LT) has not been established in Korea. We therefore investigated HCV transplant protocols and post-transplant results from liver transplant centers in Korea. METHODS: The HCV protocol and medical data of individual cases from eight major liver transplant centers were compiled and analyzed. RESULTS: A post-transplant protocol biopsy was performed in only three centers. In these centers, HCV treatment was considered when pathological abnormalities were confirmed on the protocol biopsy (irrespective of liver function). In the other five centers, biopsies were performed when biochemical parameters were aggravated. Only two out of the eight centers performed preemptive or prophylactic therapy. A total of 5,663 adult LTs were performed between 2000 and 2010. HCV-related liver disease was responsible for 277 LTs (4.9%). Pre-transplant data were not available in many patients, including HCV genotype and serum HCV RNA level. Tacrolimus was more frequently used for initial maintenance immunosuppression than cyclosporine A (61.7% vs. 36.8%). Post-transplant HCV treatment was performed in 135 patients (48.7%). Sixty-seven recipients (24.2%) died during follow-up after LT and 11 HCV-related graft loss (4.0%) developed. The cumulative patient survival rate was 74.7% at 5 years and 67.9% at 10 years after LT. CONCLUSIONS: The HCV management protocol after LT varied markedly between the eight Korean transplant centers and a standard protocol did not exist. A nationwide multicenter study is required to investigate the most effective treatment for HCV after LT, with the goal of establishing the most effective standard protocol.
Adult ; Biopsy ; Cyclosporine ; Follow-Up Studies ; Genotype ; Hepacivirus ; Hepatitis ; Hepatitis C ; Humans ; Immunosuppression ; Korea ; Liver ; Liver Diseases ; Liver Transplantation ; RNA ; Survival Rate ; Tacrolimus ; Transplants

Major peripheral arterial graft infection is a potentially devastating complication of vascular surgery, associated with significant mortality and high amputation rates. Autologous saphenous veins are considered optimal arterial conduits for lower extremity revascularization in infected fields, but they are often unavailable or unsuitable in these patients. This study describes two patients with major peripheral graft infection, but without available autologous veins, who underwent graft excision and cryopreserved cadaveric arterial allograft reconstruction. Although long-term graft durability is unclear because of gradual deterioration and degeneration, these findings suggest that cadaveric allografts may be good options for patients with major peripheral graft infection.
Allografts* ; Amputation ; Blood Vessel Prosthesis ; Cadaver* ; Humans ; Lower Extremity ; Mortality ; Saphenous Vein ; Tissue Preservation ; Transplants* ; Veins