BACKGROUND AND OBJECTIVES: We aimed to analyze the morphologic features of the nose in the human embryo from 4th to 8th developmental weeks according to the Carnegie stage. MATERIALS AND METHOD: A total of 27 cases of embryos, ranging from Carnegie stage of 13 to 23, were analyzed. The external morphology was observed with a stereomicroscope, photographed and analyzed. The histologic features were observed with a light microscope in the horizontally-transected specimens stained with hematoxylin-eosin staining. RESULTS: The nasal placode was observed at the stage 13, and it became flat or even concave at the stage 14. At the stage 15, the nasal pit was formed. At the stage 16, the nasal sac and nasal fin were observed. At the stage 17, the oronasal membrane was formed by thinning of the nasal fin. At the stage 18, the primitive choana was established by rupture of the oronasal membrane. At the stage 19, the lateral palatine process projected vertically below the level of the tongue. The cartilaginous nasal capsule was formed at the stage 20. At the stage 21, the olfactory area was localized to the upper portion of the lateral nasal wall and the nasal septum. At the stage 22, the lateral palatine process developed in a somewhat horizontal orientation. At the stage 23, the premaxilla and primitive choana were formed. CONCLUSION: The development of the nose is most active from the Carnegie stage of 13 to 19, which corresponds to the end of the 4th embryonic week to the end of the 7th week. Thus, this period is considered to be the most important period in human nasal embryonic development.
Embryonic Development ; Embryonic Structures* ; Female ; Humans* ; Membranes ; Nasal Septum ; Nose* ; Pregnancy ; Rupture ; Tongue

Cerebral gigantism(Sotos syndrome) is a growth disorder that consists of large size at birth, rapid early growth rate with accompanying advanced bone age, acromegalic features, and developmental delay. Clumsiness in the absence of other abnormal neurologic findings is common. The cause is unknown. We report here a case of 238/12-year-old Sotos syndrome with final adult height above 97 percentile, abnormal brain MRI findings(large ventricles, prominent trigone, prominent occipital horn & thining of corpus callosum), clumsiness, and some behavioral problems.
Adult ; Animals ; Brain ; Growth Disorders ; Horns ; Humans ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Parturition ; Sotos Syndrome

OBJECTIVE: The intracranial pathologies after head trauma should be usually progressed. It is clearly visualized in the non-invasive brain CT. The invasive monitor such as intracranial pressure (ICP) monitoring may be accompanied with the complications. This study aims whether the patients with severe head injury could be managed with serial CT scans. METHODS: The medical records of 113 patients with severe head injury in the prospectively enrolled trauma bank were retrospectively analyzed. After the emergency care, all the patients were admitted to the intensive care unit for the aggressive medical managements. Repeat brain CT scans were routinely taken at 6 hours and 48 hours after the trauma. ICP monitoring was restrictively applied for the uncertain intracranial pressure based on the CT. The surgical intervention and the mortality rate were analyzed. RESULTS: Immediate surgical intervention after the initial CT scan was done in 47 patients. Among the initially non-surgical patients, 59 patients were managed with the serial CT scans and 7 with the ICP monitoring. Surgical interventions underwent eventually for 10 patients in the initially non-surgical patients; 1 in the ICP monitoring and 9 in the serial CT. The mortality rate was 23.7% in the serial brain CT and 28.6% in the ICP monitoring. There was no statistical difference between two groups in the aspect of mortality (p=0.33). CONCLUSION: Serial CT scans in time could be a good way to monitor the intracranial progression in the severe head injury and reduce the implantation of an invasive ICP probe.
Brain* ; Craniocerebral Trauma* ; Emergency Medical Services ; Humans ; Intensive Care Units ; Intracranial Pressure* ; Medical Records ; Mortality ; Pathology ; Prospective Studies ; Retrospective Studies ; Tomography, X-Ray Computed*

Setleis syndrome, also known as the focal facial dermal dysplasia type 3, is characterized by atrophic scar-like lesions in both the temporal regions and other facial abnormalities. The syndrome is associated with a mutation in the TWIST2 gene and is inherited as an autosomal recessive pattern. Here, we describe a case of an 18-year-old woman and her 10-year-old brother with bitemporal depressed patches. The lesions were observed at birth, but they were replaced by atrophic patches after several months. No abnormalities in growth or development were observed. Histopathologic findings showed atrophy of the epidermis and loss of appendages, such as hair follicles and adnexal glands, in the atrophic patches compared to that of the adjacent normal skin.

Primary small cell cancer of the duodenum is very rare. Only six cases have been reported previously. The patient of this case report was a twenty-year-old male who suffered from frequent nausea and vomiting being accompanied by weight loss. The poorly differentiated neuroendocrine cancer was initially diagnosed by endoscopic biopsy and the patient underwent pancreaticoduodenectomy. The diagnosis was refined as primary small-cell neuroendocrine cancer of which the histological appearance was identical to pulmonary and extrapulmonary small-cell carcinoma. The neuroendocrine differentiation was demonstrated by the positive immunoreactions for neuron-specific enolase. This case emphasizes the need to include the duodenum as a possible primary site when metastatic small cell neuroendocrine carcinoma is seen in the absence of apparent pulmonary disease.
Biopsy ; Carcinoma, Neuroendocrine ; Diagnosis ; Duodenal Neoplasms* ; Duodenum ; Humans ; Lung Diseases ; Male ; Nausea ; Pancreaticoduodenectomy ; Phosphopyruvate Hydratase ; Vomiting ; Weight Loss

BACKGROUND: Atracurium, a nondepolarizing muscle relaxant, is eliminated by Hofmann elimination and not affected by pseudocholinesterase(pChe). Many reports show fall in pChe activity during pregnancy and our measurement failed to prove it. However, the authors found previously the infusion rate of mivacurium, which is metabolized by pChe, to achieve surgical relaxation is decreased. So, we compared the difference in the infusion rate of atracurium between full-term pregnant and nonpregnant women. METHODS: Muscle relaxation of full-term pregnant women(C group, n=10) and nonpregnant women (Non-C group, n=10) was maintained by continuous infusion of atracurium to keep 1st response of TOF at 5 1%. After discontinuance of infusion, recovery index was measured without reversals using the accelerograph. RESULTS: There was no significant difference in infusion rate of atracurium to maintain 1st twitch response of TOF at 5 1% and recovery index between two groups. There was little correlation between the total infusion time and infusion rate, or between the total infusion time and recovery index. CONCLUSION: The atracurium infusion rate in parturients to maintain muscle relaxation was not different from that in non-parturients. For Cesarean section, the usual infusion rate of atracurium is recommended to achieve the adequate surgical relaxation.
Atracurium* ; Cesarean Section* ; Female ; Humans ; Muscle Relaxation ; Obstetrics ; Pregnancy ; Relaxation

Marchiafava-Bignami disease(MBD), characterized by the primary degeneration of the corpus callosum, is a rare complication of chronic alcoholism. Recently, a few cases of MBD with reversible neuro-imaging abnormalities were reported. A 58-year-old, chronic alcoholic man was admitted with mental change, dysarthria, and a seizure attack. A T2-weighted Brain magnetic resonance imaging demonstrated high signal intensities in the body and splenium of the corpus callosum, multiple white matter, and cortical gray matter. Treatment with a multiple vitamin complex resulted in a near complete recovery of neurological manifestation. A brain MRI obtained four weeks after admission revealed a dramatic resolution of previous imaging abnormalities. We report a case of Marchiafava-Bignami disease with reversible neuro-imaging abnormalities.
Alcoholics ; Alcoholism ; Brain* ; Corpus Callosum ; Dysarthria ; Humans ; Magnetic Resonance Imaging* ; Marchiafava-Bignami Disease* ; Middle Aged ; Neurologic Manifestations ; Seizures ; Vitamins

OBJECTIVE: To analyze the clinical data and surgical results from symptomatic chronic subdural hematoma (CSDH) patients who underwent burr-hole drainage (BHD) at the maximal thickness area and twist-drill craniostomy (TDC) at the precoronal point. METHODS: We analyzed data from 65 symptomatic CSDH patients who underwent TDC at the pre-coronal point or BHD at the maximal thickness area. For TDC, we defined the pre-coronal point to be 1 cm anterior to the coronal suture at the level of the superior temporal line. TDC was performed in patients with CSDH that extended beyond the coronal suture, as confirmed by preoperative CT scans. Medical records, radiological findings, and clinical performance were reviewed and analyzed. RESULTS: Of the 65 CSDH patients, 13/17 (76.4%) with BHD and 42/48 (87.5%) with TDC showed improved clinical performance and radiological findings after surgery. Catheter failure was seen in 1/48 (2.4%) cases of TDC. Five patients (29.4%) in the BHD group and four patients (8.33%) in the TDC group underwent reoperations due to remaining hematomas, and they improved with a second operation, BHD or TDC. CONCLUSION: Both BHD at the maximal thickness area and TDC at the pre-coronal point are safe and effective drainage methods for symptomatic CSDHs with reasonable indications.
Catheters ; Drainage* ; Hematoma ; Hematoma, Subdural, Chronic* ; Humans ; Medical Records ; Sutures ; Tomography, X-Ray Computed

To find out the different cognition of the members of medical school about the importance of graduate outcomes such as 'clinical performance, communication, supporting patients, professionalism, problem solving and research, self-development', a survey applied with self-report method was conducted with 110 faculties, 132 students (71 premedical 2nd graders and 61 medical 2nd graders), and 30 parents about graduate outcomes and sub-outcome competences. Parents usually thought highly of the importance of graduate outcomes, while medical second graders comparatively regarded them as less important. Among graduate outcomes, 'clinical performance' was definitely considered the most important and was followed by 'communication'. As for 'self-development', parents and premedical 2nd graders regarded it as important, while faculty and medical 2nd graders had lower awareness about its importance. As to the suboutcome competences, faculty generally had lower awareness about their importance compared to students and parents.
Cognition ; Humans ; Methods ; Parents* ; Problem Solving ; Professionalism ; Schools, Medical*

Ureteral fistula is a serious complication of abdomino-pelvic surgeries, often resulting in poor outcomes owing to lack of proper treatment. We report the case of a 49-year-old woman who underwent placement of a silicone-covered ureteral occlusion stent in her right ureter for the management of ureteral leakage after pelvic surgery. A ureterogram obtained 18 months following the stent placement confirmed that there was no stent migration or additional urine leakage. We propose that the silicone-covered ureteral occlusion stent is practical, fast, and safe for the management of ureteral leakage.
Female ; Fistula ; Humans ; Middle Aged ; Stents* ; Therapeutic Occlusion ; Ureter* ; Urinary Diversion ; Urinary Fistula