Basaloid follicular hamartoma(BFH) is a rare, benign adnexal tumor with a wide clinical appearance spectrum. A characteristic finding is multifocal islands in the papillary dermis and branching cords of basaloid epithelial cells in continuity at various sites with the basal layer of the epidermis and the hair follicles. We present a case of basaloid follicular hamartoma combined with basal cell epithelioma that developed on the tip of the nose in a 75-year-old man. To our knowledge, this is the first case report of basaloid follicular hamartoma combined with basal cell epithelioma in the Korean literature.
Aged ; Carcinoma, Basal Cell* ; Dermis ; Epidermis ; Epithelial Cells ; Hair Follicle ; Hamartoma* ; Humans ; Islands ; Nose

No abstract available.
Humans ; Organophosphate Poisoning* ; Respiratory Insufficiency*

We identified the early and late prognostic factors of acute myocardial infarction, and evaluated the clinical differences and the prognosis between Q-wave myocardial infarction and non-Q wave myocardial infarction. Total 146 patients who were managed from Jan 1987 to Aug. 1989 at hallym University hospital were evaluated. According to the presence or absence of Q wave on electrocardiogram, the patients were divided into two groups : a Q wave myocardial infarction group(QMI) and a non-Q wave myocardial infarction group (NQMI). Among 146 patients 109 patients(74.7%) had QMI and 37 patients(25.3%) had NQNI. The mean age, male to female ratio and serum cholesterol level were similar in both groups. But peak level of CPK was significantly higher in the QMI group than that in the NQMI group(P<0.01). Left ventricular end-systolic dimension and ratio of left ventricular dimension to wall thickness in the QMI group were significantly higher than that in the NQMI group(P<0.01). There were no significant differences between two groups in the incidences of mortality, postinfarction angina and re-infarction. During the in-hospital period female gender, old age(more than 60 years), Killip class at admission, early reinfarction and a history of hypertension were significant prognostic factors. main causes of death during the in-hospital period were ventricular tachyarrthymia, heart failure and cardiogenic shock. The incidences of mortality, heart failure and post-infarction angina during a mean follow-up period of 14 months (6~30months) were same in the two groups. The late prognostic factors were old age(more than 60 years), Killip class at admission, heart failure occured during follow-up period(P<0.001) and a history of diabetes mellitus(P<0.05). The patients with late postinfarction angina had more dilated left ventricular end-systolic demension(P<0.05) and lower fractional shortening(P<0.01) than those of patients without late postinfraction angina. There were no significant difference in long term survival rate between QMI group and NQMI group. Further prospective study should be performed to clarify the short and long term prognosis in patients with acute myocardial infarction treated by reperfusion.
Cause of Death ; Cholesterol ; Electrocardiography ; Female ; Follow-Up Studies ; Heart Failure ; Humans ; Hypertension ; Incidence ; Male ; Mortality ; Myocardial Infarction* ; Prognosis ; Reperfusion ; Shock, Cardiogenic ; Survival Rate

PURPOSE: We report a case of a scleral perforation during inferior rectus recession in congenital fibrosis of extraocular muscles and the management of this perforation with a scleral patch graft. CASE SUMMARY: A 20-month-old female with bilateral ptosis, absence of elevation and a chin-up position was diagnosed with congenital fibrosis of extraocular muscles. Because severe esotropia in the downward gaze was observed, we first performed esotropia surgery. After 1 year, she underwent a bilateral ptosis correction. We decided to perform bilateral inferior rectus recession due to an abnormal head posture and the absence of elevation. Because the inferior rectus muscles were extremely tight and adhered to the sclera, hooking and isolating these muscles during surgery was difficult. After muscle suture placement, a portion of the sclera that contacted the left inferior rectus was chipped off as this muscle was disinserted with blunt Westcott scissors. A scleral perforation was observed, thus, we placed a scleral patch graft using the donor sclera and finished the bilateral inferior rectus recession. No abnormal findings for the vitreous or retina were detected. At 8 months after surgery, the patient exhibited exotropia of 12 prism diopters in her primary gaze. Her abnormal head posture nearly disappeared. CONCLUSIONS: Careful isolation and disinsertion of the muscle from the globe is necessary in the treatment of patients who are expected to exhibit severe adhesions between the muscle and sclera, such as patients with congenital fibrosis of extraocular muscles.
Esotropia ; Exotropia ; Female ; Fibrosis* ; Head ; Humans ; Infant ; Muscles* ; Posture ; Retina ; Sclera ; Sutures ; Tissue Donors ; Transplants

Bisphosphonate is used widely for osteoporosis management. On the other hand, some studies have reported that prolonged use of bisphosphonate without a proper resting period can cause insufficiency fracture and, in rare cases, fractures on the femur neck. This paper reports a case of an elderly patient who suffered bilateral femur neck insufficiency fractures induced by non-stopped long-term bisphosphonate therapy. The patient complained of pain in her buttocks at the first visit. During the admission period, inguinal area pain newly developed. Both a femur neck insufficiency fracture was observed on the hip radiographic image. Hip pinning and postoperative parathyroid hormone treatment were performed. The patient was discharged without specific complications and reported improvement in symptoms on the last follow-up. Several authors have reported one-sided femoral neck insufficiency fractures due to bisphosphonate use, but the present case is uncommon in that it occurred simultaneously in both femur necks. In addition, in the case of bilateral femur fractures, the walking ability after surgery is lower than that of one-sided fracture cases, so active rehabilitation is necessary.

Purpose: Total hip arthroplasty (THA) using dual mobility components (DMC) is a reasonable surgical option for displaced femoral neck fractures in elderly patients, resulting in lower dislocation rates and improved stability. The purpose of this study was to investigate the clinical outcomes and risk factors responsible for mortality in elderly patients who were diagnosed with a displaced femoral neck fracture and had undergone DMC-THA. Materials and Methods: Out of 147 cases of THA from December 2018 to June 2020, a total of 79 cases were enrolled in this study, with the following characteristics: (1) Garden stage III or IV, (2) over 75 years of age, and (3) over 1 year of follow-up. All the patients received DMC-THA surgery using the anterolateral approach. Results: The mean follow-up period was 15.0±8.43 months and a total of one dislocation case was observed. The mortality rate was 17.7% (14/79), and it was especially higher in patients with a past medical history of malignancy (odds ratio [OR]=7.18, p=0.03) or a cognitive disorder such as dementia (OR=5.48, p=0.03). Preoperative low initial hemoglobin levels (OR=0.65, p=0.04) and low UCLA (Uni-versity of California at Los Angeles) score (OR=0.47, p=0.02) were also associated with mortality. Conclusion When considering THA as a treatment approach in elderly patients with a displaced femoral neck fracture, a high mortality rate is expected in patients with low preoperative hemoglobin levels or a history of malignancy or cognitive disorders. Hence, thorough monitoring and management should be undertaken before and after surgery.

Treatment of rotator cuff tears by open subacromial decompression has known successful in decreasing pain and restoring function in patients who have failed nonoperative treatment. But, open rotator cuff repair may result in significant deficits in strength and active motion by deltoid separation from the acromion. Deltoid detachment may be avoided by repair using mini-open technique. Arthroscopic subacromial decompression and the rotator cuff repair revel satisfactory results. Subacromial decompression involves decompression of the coracoacromial arch including routine release or resection of the coracoacromial ligament. Recent ligament-cutting studies have confirmed the role of the coracoacromial ligament as a static restraint to superior humeral head displacement. Complete resection of the coracoacromial ligament may be avoided through minimized arthroscopic acromioplasty. We evaluated all 11 patients with rotator cuff tears who underwent arthroscopic minimized subacromial decompression and rotator cuff repairs using mini-open technique. Their average age was 53 years (26 to 64 years); and the average follow-up was 13 months. Preoperatively, all patients complained pain and weakness. Follow-up using modified Hospital for Special Surgery shoulder score showed good to excellent results in 10 cases and poor results in 1 case an average 13 months postoperatively. We found that arthroscopic minimized subacromial decompression and repair using mini-open technique are safe, effective procedure for addressing cuff tears of a wide range of sizes.
Acromion ; Decompression ; Follow-Up Studies ; Humans ; Humeral Head ; Ligaments ; Rotator Cuff* ; Shoulder

The bladder is involved in 1% to 3% of all hernia cases. We report a case of a large paraperitoneal bladder hernia (BH) in a 59-year-old man who had a palpable scrotal mass. Several techniques and approaches have been described for managing BHs. We performed a laparoscopic partial cystectomy and herniorrhaphy. This is the first case report on the repair of a large BH by use of a laparoscopic technique in Korea.
Cystectomy ; Hernia ; Hernia, Inguinal ; Herniorrhaphy ; Korea ; Laparoscopy ; Urinary Bladder

PURPOSE: The aim of this study was to clarify the clinicopathological differences between T1N1M0 and T2N0M0, particularly the survival rates, and the role of chemotherapy in the stage Ib gastric cancer. METHODS: From January 1992 to December 1999, 118 cases were confirmed as having stage Ib gastric cancer in the Korea University Medical Center. Among them 31 patients were classified as being T1N1M0 and the other 87 cases were T2N0M0. The clinicopathological features and the prognosis were evaluated retrospectively. RESULTS: The overall 5-year survival rate of the stage Ib gastric cancer patients was 94%. Overall 5-year survival rates in T1N1M0 and T2N0M0 were 100% and 91%, respectively. Though T1N1M0 group showed better prognosis, there was no significant difference between two groups (P=0.14). D1, D2, and D2+alpha resections were performed in 28 cases (23.7%), 81 (68.6%), and 9 (7.6%), respectively, and there was no difference in the survival rate (P>0.05). The 5-year survival rates were analyzed according to whether or not they had received chemotherapy. There was a 98% 5-year survival rate with those who had chemotherapy and a 90% 5-year survival rate with those who had not had chemotherapy, but there was no significant difference between them (P=0.18). In the T2N0M0 group, the 5 year survival rates of patients with or without chemotherapy were 97% and 86%, respectively, but there was no significant difference (P=0.16). CONCLUSION: Though T1N1M0 group showed a better prognosis than the T2N0M0 group, there was no significant difference between the two groups (P=0.14). There was no significant survival difference between D1, D2, or D2+alpha procedures. It appears that post operative intravenous chemotherapy does not affect the prognosis of stage Ib gastric cancer, and the role of the chemotherapy in patients with T2N0M0 diseases is minimal.
Academic Medical Centers ; Drug Therapy ; Humans ; Korea ; Prognosis ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate

OBJECTIVE: A multistep process of gene alterations is required for tumor formation. p53 gene mutation is the most frequent and K-ras gene mutation places second in the gene abnormalities of non-small cell lung cancer (NSCLC). The effect by the mutations of the p53 and ras genes on clinical manifestation is still highly controversial. Little is known about the interaction between them in NSCLC. The present study was designed to investigate the effect by the mutations of the p53 tumor suppressor gene and K-ras oncogene on clinical manifestation, and the interaction between the mutations of two genes in the Korean NSCLC. METHODS: Fifty-eight patients were enrolled in this study who had been diagnosed as having NSCLC from stageI to stage III. They all had been alive for more than one month without any complication after curative resection. The paraffin-embedded lung tissues after resection were used to investigate the p53 expression by immunohistochemical staining, the mutations of the p53 and K-ras genes by polymerase chain reactionsingle strand conformation polymorphism (PCR-SSCP) and nucleotide sequencing. RESULTS: p53 protein was overexpressed in 25.9% by immunohistochemical staining. Overexpression was significantly more frequent in epidermoid carcinoma (p=0.01634). But there was no significant difference between the overexpression group and the negative expression group according to stage and survival. By PCR-SSCP analysis, the mobility shift of the p53 gene was found in 29.1%. There was no significant difference between the groups with and without mobility shift according to cell type, stage and survival. By nucleotide sequencing, p53 gene mutation was 37.9%. The locations of mutation were dispersed among numerous codons and the modes of mutation were also diverse. There was also no significant difference between the groups with and without mutation according to cell type, stage and survival. K-ras gene mutation was 24.1% and only in codon 12 by nucleotide sequencing. Although there was no significant difference between the groups with and without mutation according to cell type or stage, K-ras gene mutation carried a significantly worse prognosis in NSCLC (overall survival p=0.0391, disease-free survival p=0.0318). When the patients were divided into 4 groups according to p53 gene mutation and K-ras gene mutation, there was also no significant difference among any group according to cell type or stage. The prognosis became worse if K-ras gene mutation accompanied (overall survival p=0.0021, disease- free survival p=0.0166). Only the stage (p=0.0313) and K-ras gene mutation (p=0.0457) were significant prognostic factors by Cox regression test. An analysis in stage III showed the significantly shorter survival period in the patients with K-ras gene mutation. K-ras gene mutation, therefore, was confirmed as the independently significant prognostic factor separately from stage. CONCLUSION: p53 gene mutation had no clinical or prognostic significance because of scattered locations and diverse modes of mutation in contrast to K-ras gene mutation, which had a significantly negative effect on the prognosis of NSCLC. p53 and K-ras gene mutations were apparently independent genetic alterations which played different roles in the clinical manifestation and prognosis of NSCLC.
Carcinoma, Non-Small-Cell Lung* ; Carcinoma, Squamous Cell ; Codon ; Disease-Free Survival ; Genes, p53 ; Genes, ras* ; Genes, Tumor Suppressor* ; Humans ; Lung ; Prognosis