Various epidermal changes overlying a dermatofibroma can be induced through the proliferation of pluripotential epidermal cells by the stimulation of mesenchymal factors. The authors report a case of dermatofibroma in a 55-year-old male who had a reddish brown, asymptomatic nodule of 5 years duration on his left forearm. The biopsy specimen revealed a dermatofibroma of cellular type associated with epidermal changes: (1) acanthosis; (2) elongation of rete ridges; (3) thin interlacing epidermal strands with increased pigmentation resembling seborrheic keratosis or fibroepithelioma; (4) immature hair follicles and sebaceous lobules; (5) hair germ like buddings; (6) superficial basal cell epithelioma-like proliferations.
Biopsy ; Forearm ; Hair ; Hair Follicle ; Histiocytoma, Benign Fibrous* ; Humans ; Keratosis, Seborrheic ; Male ; Middle Aged ; Pigmentation

Complicated microphthalmos can be diagnosed when a reduction in global dimension is combined with other structural anomalies. These include corneal opacity or staphyloma, cataract, aniridia, corectopia, persistence of pupillary membrane or the tunica vasculosa lentis and hyaloid vessel, thickening or ossification of the choroid and various retinal anomalies. Complicated microphthalmos is frequently hereditary and the transmission may be either as an autosomal dominant or recessive or as a sex linked recessive trait. Four cases of bilateral complicated microphthalmos with cataract were found in a family.
Aniridia ; Cataract ; Choroid ; Corneal Opacity ; Humans ; Membranes ; Microphthalmos* ; Retinaldehyde

OBJECTIVES: This study aims to compare home care dental devices for their dental plaque removal ability. METHODS: A single blinded randomized crossover clinical study design was used to measure plaque index (Turesky Modification Quigley-Hein Plaque Index). RESULTS: All 3 groups showed a statistically significant decrease in the plaque index after usage (P<0.001). In manual tooth-brushing group, the teeth on the right dental arch showed a greater decrease in the plaque index than on the left arch (P=0.041). All appliances showed greater plaque reduction in the upper right posterior teeth than in the lower right posterior teeth (P=0.009, 0.004, 0.007). CONCLUSIONS: The results of this study support development of more effective oral hygiene appliances and emphasis on oral hygienic education.
Dental Arch ; Dental Devices, Home Care ; Dental Plaque Index ; Dental Plaque* ; Education ; Health Education ; Oral Hygiene* ; Tooth ; Vibration*

PURPOSE: Laparoscopic cholecystectomy (LC) is one of the most commonly performed surgeries in the world today. However, there is no consensus regarding whether LC can be performed in patients with acute cholecystitis while on antithrombotic therapy. The objective of our study was to describe postoperative outcomes of patients who underwent emergent LC without interruption to antithrombotic therapy. METHODS: We performed a retrospective review of patients who underwent LC for acute cholecystitis while on antithrombotic therapy from 2010 to 2015 at Soonchunhyang Universtiy Cheonan Hospital. Patients were divided into 2 groups as underwent emergent LC and elective LC. RESULTS: A total of 67 patients (emergent group, 22; elective group, 45) were included in the analysis. Elective group had significantly longer duration between the admission and operation (8 [7–10] days vs. 2 [1–3] days, P < 0.001) and longer duration of antithrombotic drugs discontinuation (7 days vs. 1 [0–3] days, P < 0.001). Emergent group had significantly more postoperative anemia (6 patients vs. 0 patient, P = 0.001) and 3 of 6 patients received packed RBC transfusion in postoperative period. However, there was no significant difference in length of postoperative stays, length of intensive care unit stays and mortality rates. CONCLUSION: Emergent LC without interruption to antithrombotic therapy was relatively safe and useful. A well-designed multicenter study is needed to confirm the safety and efficacy of LC without suspension of antithrombotic therapy and to provide a simple guideline.
Anemia ; Cholecystectomy, Laparoscopic* ; Cholecystitis, Acute ; Chungcheongnam-do ; Consensus ; Humans ; Intensive Care Units ; Mortality ; Postoperative Period ; Retrospective Studies

Background: Decreased heart rate variability (HRV) has been reported to be associated with cardiac autonomic dysfunction. Hypopituitarism in nonfunctioning pituitary adenoma (NFPA) is often linked to increased cardiovascular mortality. We therefore hypothesized that postoperative NFPA patients with hormone deficiency have an elevated risk of HRV alterations indicating cardiac autonomic dysfunction. Methods: A total of 22 patients with NFPA were enrolled in the study. Between 3 and 6 months after surgery, a combined pituitary function test (CPFT) was performed, and HRV was measured. The period of sleep before the CPFT was deemed the most stable period, and the hypoglycemic period that occurred during the CPFT was defined as the most unstable period. Changes in HRV parameters in stable and unstable periods were observed and compared depending on the status of hormone deficiencies. Results: In patients with adrenocorticotropic hormone (ACTH) deficiency with other pituitary hormone deficiencies, the low frequency to high frequency ratio, which represents overall autonomic function and is increased in the disease state, was higher (P=0.005). Additionally, the standard deviation of the normal-to-normal interval, which decreases in the autonomic dysfunction state, was lower (P=0.030) during the hypoglycemic period. In panhypopituitarism, the low frequency to high frequency ratio during the hypoglycemic period was increased (P=0.007). Conclusion HRV analysis during CPFT enables estimation of cardiac autonomic dysfunction in patients with NFPA who develop ACTH deficiency with other pituitary hormone deficiencies or panhypopituitarism after surgery. These patients may require a preemptive assessment of cardiovascular risk.

Background: Decreased heart rate variability (HRV) has been reported to be associated with cardiac autonomic dysfunction. Hypopituitarism in nonfunctioning pituitary adenoma (NFPA) is often linked to increased cardiovascular mortality. We therefore hypothesized that postoperative NFPA patients with hormone deficiency have an elevated risk of HRV alterations indicating cardiac autonomic dysfunction. Methods: A total of 22 patients with NFPA were enrolled in the study. Between 3 and 6 months after surgery, a combined pituitary function test (CPFT) was performed, and HRV was measured. The period of sleep before the CPFT was deemed the most stable period, and the hypoglycemic period that occurred during the CPFT was defined as the most unstable period. Changes in HRV parameters in stable and unstable periods were observed and compared depending on the status of hormone deficiencies. Results: In patients with adrenocorticotropic hormone (ACTH) deficiency with other pituitary hormone deficiencies, the low frequency to high frequency ratio, which represents overall autonomic function and is increased in the disease state, was higher (P=0.005). Additionally, the standard deviation of the normal-to-normal interval, which decreases in the autonomic dysfunction state, was lower (P=0.030) during the hypoglycemic period. In panhypopituitarism, the low frequency to high frequency ratio during the hypoglycemic period was increased (P=0.007). Conclusion HRV analysis during CPFT enables estimation of cardiac autonomic dysfunction in patients with NFPA who develop ACTH deficiency with other pituitary hormone deficiencies or panhypopituitarism after surgery. These patients may require a preemptive assessment of cardiovascular risk.

Alimentary tract duplications are uncommon congenital anomalies that usually present during the first decade of life. Complete duplication of the colon in adults is very rare and difficult to diagnose preoperatively. We report a case of a 40-year-old female with complete tubular duplication which was initially misdiagnosed as a salpingeal abscess due to colovaginal fistula.
Abscess ; Adult* ; Colon* ; Female ; Fistula* ; Humans

BACKGROUND: The use of the stapler n esophageal reconstruction after esophageal resection for benign or malignant esophageal diseases has become popular because it has less leakage at the anastomotic site and shorter operation time than manual sutures. However, the use of classic circular stapler has some complications such as stenosis and dysphagia that requires additional treatment. Such complications are closely related to the inner diameter of the anastomotic sites. In this study, the diameter of anastomotic site was compared after the use of circular stapler(EEA) and straight endoscopic stapler(endo GIA). MATERIAL AND METHOD: The patients who received esophageal reconstruction by stapler from August 1995 to September 1997 were reviewed. The patients were divided into 2 groups. One group need the circular stapler, and the other group the straight endo GIA(14 cases with endo GIA 30mm, 24 with endo GIA 45mm). After a cervical esophago-enteric anastomosis, the stricture of anastomotic site and the incidence of dysphagia were compared between the 2 groups using an esophagography and the patient's symptoms. The follow-up period was 12months in average. RESULT: In the former group in which the circular stapler was used, 2 cases of anastomotic stenosis were reported. In comparison, none were reported in the latter group. Dysphagia were reported in 8 cases of the former group, and in 3 cases of the latter group(1 case in endo GIA 30 mm, 2 cases in endo GIA 45 mm). CONCLUSION: The use of endo GIA in esophago-enteric anastomosis resulted in a wider diameter of the anastomotic site, lesser stricture, and lesser incidence of dysphagia compared to the use of former circular stapler. Therefore, it is thought to be a better method in esophageal reconstructions.
Constriction, Pathologic ; Deglutition Disorders ; Esophageal Diseases ; Follow-Up Studies ; Humans ; Incidence ; Surgical Staplers ; Sutures

BACKGROUND: Selection of reconstruction route in esophageal cancer surgery is based on the patient's status, characteristics of tumor, surgeon's preference and experience. Of the various routes, it has been documented that subcutaneous or substernal route may prolong operation time and may be vulnerable to postoperative respiratory complications. This study was designed to evaluate whether the selection of reconstruction route affects the surgical outcomes. MATERIAL AND METHOD: Of 131 patients who have undergone resection and reconstruction for esophageal cancer, posterior mediastinal route(Group I, n=34), substernal route (Group II, n=31), and subcutaneous route(Group III, n=21) were retrospectively reviewed in 86 patients. Results of early operations and morbidities were compared between the groups. RESULT: There was a male prevalence(79 of males vs. 7 of females). There were 81 squamous cell cancers and 5 adenocarcinomas. There were no differences between groups in weight, height, age, cancer staging and location, and in the preoperative anesthetic risk evaluation and pulmonary function test(p=NS). Postoperative mechanical ventilation time was longer in Group I(20.6 hours) than in Group II(7.8 hours) or III(3.4 hours)(p=0.005). Duration of stay in the intensive care unit was prolonged in Group III(6.4 days) compared to Group I (3.9 days) or II(3.1 days)(p=0.043). No differences were noted in the duration of hospital stay between the groups(p=NS). Blood transfusion was needed in 30 out of 34 patients in Group I compared to 14/31 in Group II or 15/21 in Group III(p=0.001). The mean amount of transfusion for each patient was also higher in Group I(3,833 mL) than in Group II(1535 mL) or Group III(1419 mL)(p=0.04), but there was no difference in the inreoperation due to bleeding. Ea ly mortality rate was substantially higher in Group I(17.6%) but the differences between the groups were insignificant(p=NS). Although sepsis was a more prevalent cause of death in Group I, it was not related to anastomotic leak. Other morbidities did not differ between the groups(p=NS). CONCLUSION: In above results show that the reconstruction route does not affect the outcome of esophageal cancer surgery. We believe that the selection of reconstruction route can be based on the surgeon's preference and experience.
Adenocarcinoma ; Anastomotic Leak ; Blood Transfusion ; Cause of Death ; Esophageal Neoplasms* ; Esophagectomy* ; Hemorrhage ; Humans ; Intensive Care Units ; Length of Stay ; Male ; Mortality ; Neoplasm Staging ; Neoplasms, Squamous Cell ; Respiration, Artificial ; Retrospective Studies ; Sepsis

BACKGROUND/AIMS: The conventional treatment of patients with common bile duct (CBD) stones was to insert a T-tube via the duct after stone removal. But since the placement of T-tubes resulted in a lot of complications, a few alternative methods have been suggested lately, such as primary closure or intraductal drainage etc. Deciding whether to perform primary closure or to insert a stent or a T-tube is usually based on objective findings such as inspection, palpation or intraoperative cholangiogram. We made a study using the intraoperative biliary manometry as an objective indicator in decision making among the procedures. METHODS: The study was based on 23 patients (10 male, 13 female) who underwent common bile duct exploration for stone removal from March 2002 to May 2003. The basal pressure and frequency of phasic contraction of the Sphincter of Oddi were measured intraoperatively by manometry RESULTS: Primary closure after CBD exploration was performed in 15 cases, intraductal drainage in the remaining 8 cases. No complication such as bile leakage or postoperative obstructive jaundice was observed. CONCLUSION: The intraoperative biliary manometry is a simple and useful tool that can be used as an indicator in deciding whether to perform a drainage procedure after common bile duct stone removal.
Bile ; Common Bile Duct* ; Decision Making ; Drainage ; Humans ; Jaundice, Obstructive ; Male ; Manometry* ; Palpation ; Sphincter of Oddi ; Stents