BACKGROUND: Preauricular sinuses represent a common congenital abnormality in children. Classically, a preauricular sinus manifests as a small opening, usually near the anterior limb of ascending helix. The difficulty in the surgical treatment of preauricular sinus is the high recurrence rate. The aim of this article is to review the outcomes of preauricular sinus and to introduce our surgical technique and its prognosis. METHODS: A single-institutional retrospective review was performed for all patients who had undergone excision of congenital periauricular sinus between October 2007 and April 2014. Medical records were reviewed for demographic information, wound complication, and recurrence rate. The sinus tract was visualized with the aid of preoperative dye instillation and intraoperative probe insertion. The skin next to the sinus opening was incised elliptically, and the tract itself was dissected medially to the end of the sinus tract and posteriorly to the cartilage of the ascending helix. RESULTS: The review identified 44 patients for a total of 57 preauricular sinus tracts. The mean age at time of operation was 16.3 years with a range from 9 months to 65 years. Unilateral preauricular sinus tract was present in 31 patients (11 right and 20 left preauricular tract), and 13 patients had bilateral sinus tract. None of the patients had experienced wound issues postoperative, and there were no recurrent sinus tract formation or infection. CONCLUSION: Using a combination of dye instillation, probe insertion, and modified dissection, we were able to achieve a recurrence free series of preauricular sinus tract excision among a heterogenous group of patients. A large patient series is necessary to replicate the results of this study.
Cartilage ; Child ; Congenital Abnormalities ; Extremities ; Follow-Up Studies ; Humans ; Medical Records ; Prognosis ; Recurrence ; Retrospective Studies ; Skin ; Wounds and Injuries

PURPOSE: Leptin is a protein encoded by the ob gene that is expressed in adipocytes. It regulates eating behavior by the action to the satiety centers in the hypothalamus. In ob/ob mouse, adipocytes can not produce leptin because of a mutation in the ob gene which results in obesity. Whereas, leptin concentrations were elevated in obese adults, and leptin levels in obese children has not been studied much until now. The purpose of this study is to evaluate leptin concentrations in obese children and to find out correlating factors with leptin. METHODS: Thirty-six obese childrens whose weight is above 97 percentile of korean weight standard and 39 children with average weight were included. Height, weight, waist to hip ratio, fat weight and lean body mass were measured. The serum levels of leptin, insulin, cholesterol and triglyceride were measured. RESULTS: Mean age was 10.8 +/- 2.5 years in obese group and 10.6 +/- 2.6 years in control group. Obesity percent was 51.6 +/- 18.8% in obese and 8.8 +/- 10.2% in control group. Body mass index (BMI) was 26.3 +/- 5.8kg/m2 in obese group and 17.3 +/- 1.9kg/m2 in control group. Leptin levels of obese group (13.7 +/- 5.4ng/ml) were significantly higher than that of the control group (3.6 +/- 3.3ng/ ml). Leptin levels showed no significant difference by gender and by pubertal development. Leptin levels significantly correlated with BMI, obesity percent, fat weight, and serum cholesterol level but showed no significant correlation with lean body mass, serum fasting insulin and triglyceride levels. CONCLUSION: Serum leptin levels of obesity group were significantly higher than that of the control group, and they were correlated with BMI, obesity percent and fat weight. Additional research is necessary to assess the mechanism of leptin resistance in obese children.
Adipocytes ; Adult ; Animals ; Body Mass Index ; Child* ; Cholesterol ; Fasting ; Feeding Behavior ; Humans ; Hypothalamus ; Insulin ; Leptin* ; Mice ; Obesity ; Triglycerides ; Waist-Hip Ratio

PURPOSE: Leptin is a protein encoded by the ob gene that is expressed in adipocytes. It regulates eating behavior by the action to the satiety centers in the hypothalamus. In ob/ob mouse, adipocytes can not produce leptin because of a mutation in the ob gene which results in obesity. Whereas, leptin concentrations were elevated in obese adults, and leptin levels in obese children has not been studied much until now. The purpose of this study is to evaluate leptin concentrations in obese children and to find out correlating factors with leptin. METHODS: Thirty-six obese childrens whose weight is above 97 percentile of korean weight standard and 39 children with average weight were included. Height, weight, waist to hip ratio, fat weight and lean body mass were measured. The serum levels of leptin, insulin, cholesterol and triglyceride were measured. RESULTS: Mean age was 10.8 +/- 2.5 years in obese group and 10.6 +/- 2.6 years in control group. Obesity percent was 51.6 +/- 18.8% in obese and 8.8 +/- 10.2% in control group. Body mass index (BMI) was 26.3 +/- 5.8kg/m2 in obese group and 17.3 +/- 1.9kg/m2 in control group. Leptin levels of obese group (13.7 +/- 5.4ng/ml) were significantly higher than that of the control group (3.6 +/- 3.3ng/ ml). Leptin levels showed no significant difference by gender and by pubertal development. Leptin levels significantly correlated with BMI, obesity percent, fat weight, and serum cholesterol level but showed no significant correlation with lean body mass, serum fasting insulin and triglyceride levels. CONCLUSION: Serum leptin levels of obesity group were significantly higher than that of the control group, and they were correlated with BMI, obesity percent and fat weight. Additional research is necessary to assess the mechanism of leptin resistance in obese children.
Adipocytes ; Adult ; Animals ; Body Mass Index ; Child* ; Cholesterol ; Fasting ; Feeding Behavior ; Humans ; Hypothalamus ; Insulin ; Leptin* ; Mice ; Obesity ; Triglycerides ; Waist-Hip Ratio

PURPOSE: Recently, laparoscopy assisted gastrectomy has taken its place as one of the main strategies for managing early gastric cancer (EGC). We conducted this study to evaluate its value from the point of view of initial experience. METHODS: Between June 2007 and May 2008, 63 patients who underwent laparoscopy assisted distal gastrectomy (LADG, n=43) or open distal gastrectomy (ODG, n=20) for EGC by a single surgeon, enrolled in this retrospective, non-randomized study. The operative procedure was decided on through patients' preferences. We compared several clicopathological factors and short-term postoperative outcomes between the two groups. RESULTS: There were no significant differences in the patients' demography and pathologic results between the two groups. The operation time was more shorter (167+/-23.2 vs. 268+/-68.6 mins, P<0.0001) in the ODG group, but the time to first flatus (2.8+/-0.6 vs. 3.1+/-0.4 days, P=0.033), the time to first diet (3.0+/-0.3 vs. 3.6+/-0.6 days, P<0.0001), and the duration of hospital stay (9.1+/-1.2 vs. 11.6+/-3.1 days, P<0.0001) were significantly shorter in the LADG group. Although there were no significant differences in postoperative morbidity and mortality between the two groups, one patient died of postoperative myocardiac infarction in the LADG group (P=0.6854). Comparison between before and after learning curve; there were statistically significant differences in the number of retrieved lymph nodes (31.2+/-13.7 vs. 42.2+/-13.4, P=0.0185) and the time of operation (295+/-63.8 vs. 208+/-30.5 mins, P<0.0001). CONCLUSION: Although our results represent initial experiences, we could find some advantages in LADG compared with ODG. We suggest that application of more restrictive indication is required at an earlier time on the learning curve.
Demography ; Diet ; Flatulence ; Gastrectomy ; Humans ; Hypogonadism ; Infarction ; Laparoscopy ; Learning ; Learning Curve ; Length of Stay ; Lymph Nodes ; Mitochondrial Diseases ; Ophthalmoplegia ; Retrospective Studies ; Stomach Neoplasms ; Surgical Procedures, Operative

Spinal gabapentin and adenosine have been known to display an antinociceptive effect. We evaluated the nature of the interaction between gabapentin and adenosine in formalin-induced nociception at the spinal level. Male Sprague-Dawley rats were prepared for intrathecal catheterization. Pain was evoked by injection of formalin solution (5%, 50 microliter) into the hindpaw. After examination of the effects of gabapentin and adenosine, the resulting interaction was investigated with isobolographic and fractional analyses. Neither gabapentin nor adenosine affected motor function. Gabapentin or adenosine decreased the sum of the number of flinches during phase 2, but not during phase 1 in the formalin test. Isobolographic analysis, in phase 2, revealed an additive interaction between gabapentin and adenosine. Taken together, intrathecal gabapentin and adenosine attenuated the facilitated state and interacted additively with each other.
*Adenosine/administration & dosage/metabolism/therapeutic use ; *Amines/administration & dosage/metabolism/therapeutic use ; *Analgesics/administration & dosage/metabolism/therapeutic use ; Animals ; *Cyclohexanecarboxylic Acids/administration & Dose-Response Relationship, Drug ; Formaldehyde/*toxicity ; Injections, Spinal ; Male ; Motor Activity/physiology ; Pain Measurement ; Rats ; Rats, Sprague-Dawley ; Research Support, Non-U.S. Gov't ; *gamma-Aminobutyric Acid/administration & dosage/metabolism/therapeutic

Objective: This study aimed to determine whether there are regional differences in the blood-brain barrier (BBB) permeability of cognitively normal elderly participants and to identify factors influencing BBB permeability with a clinically feasible, 10-minute dynamic contrast-enhanced (DCE) MRI protocol. Materials and Methods: This IRB-approved prospective study recruited 35 cognitively normal adults (26 women; mean age, 64.5 ± 5.6 years) who underwent DCE T1-weighted imaging. Permeability maps (Ktrans) were coregistered with masks to calculate the mean regional values. The paired t test and Friedman test were used to compare Ktrans between different regions. The relationships between Ktrans and the factors of age, sex, education, cognition score, vascular risk burden, vascular factors on imaging, and medial temporal lobar atrophy were assessed using Pearson correlation and the Spearman rank test. Results: The mean permeability rates of the right and left hippocampi, as assessed with automatic segmentation, were 0.529 ± 0.472 and 0.585 ± 0.515 (Ktrans, x 10-3 min-1 ), respectively. Concerning the deep gray matter, the Ktrans of the thalamus was significantly greater than those of the putamen and hippocampus (p = 0.007, p = 0.041). Regarding the white matter, the Ktrans value of the occipital white matter was significantly greater than those of the frontal, cingulate, and temporal white matter (p < 0.0001, p = 0.0007, p = 0.0002). The variations in Ktrans across brain regions were not related to age, cognitive score, vascular risk burden, vascular risk factors on imaging, or medial temporal lobar atrophy in the study group. Conclusion Our study demonstrated regional differences in BBB permeability (Ktrans) in cognitively normal elderly adults using a clinically acceptable 10-minutes DCE imaging protocol. The regional differences suggest that the integrity of the BBB varies across the brains of cognitively normal elderly adults. We recommend considering regional differences in Ktrans values when evaluating BBB permeability in patients with neurodegenerative diseases.

Objective: This study aimed to determine whether there are regional differences in the blood-brain barrier (BBB) permeability of cognitively normal elderly participants and to identify factors influencing BBB permeability with a clinically feasible, 10-minute dynamic contrast-enhanced (DCE) MRI protocol. Materials and Methods: This IRB-approved prospective study recruited 35 cognitively normal adults (26 women; mean age, 64.5 ± 5.6 years) who underwent DCE T1-weighted imaging. Permeability maps (Ktrans) were coregistered with masks to calculate the mean regional values. The paired t test and Friedman test were used to compare Ktrans between different regions. The relationships between Ktrans and the factors of age, sex, education, cognition score, vascular risk burden, vascular factors on imaging, and medial temporal lobar atrophy were assessed using Pearson correlation and the Spearman rank test. Results: The mean permeability rates of the right and left hippocampi, as assessed with automatic segmentation, were 0.529 ± 0.472 and 0.585 ± 0.515 (Ktrans, x 10-3 min-1 ), respectively. Concerning the deep gray matter, the Ktrans of the thalamus was significantly greater than those of the putamen and hippocampus (p = 0.007, p = 0.041). Regarding the white matter, the Ktrans value of the occipital white matter was significantly greater than those of the frontal, cingulate, and temporal white matter (p < 0.0001, p = 0.0007, p = 0.0002). The variations in Ktrans across brain regions were not related to age, cognitive score, vascular risk burden, vascular risk factors on imaging, or medial temporal lobar atrophy in the study group. Conclusion Our study demonstrated regional differences in BBB permeability (Ktrans) in cognitively normal elderly adults using a clinically acceptable 10-minutes DCE imaging protocol. The regional differences suggest that the integrity of the BBB varies across the brains of cognitively normal elderly adults. We recommend considering regional differences in Ktrans values when evaluating BBB permeability in patients with neurodegenerative diseases.

BACKGROUND: Primary hyperoxaluria (PH), a rare inborn error of glyoxylate meta bolism causing overproduction of oxalate, is classified into three genetic subgroups: type 1–3 (PH1–PH3) caused by AGXT, GRHPR , and HOGA1 gene mutations, respectively. We performed a retrospective case series study of Korean pediatric patients with PH.METHODS: In total, 11 unrelated pediatric patients were recruited and their phenotypes and genotypes were analyzed by a retrospective review of their medical records.RESULTS: Mutational analyses revealed biallelic AGXT mutations (PH1) in nine patients and a single heterozygous GRHPR and HOGA1 mutation in one patient each. The c.33dupC was the most common AGXT mutation with an allelic frequency of 44%. The median age of onset was 3 months (range, 2 months-3 years), and eight patients with PH1 presented with end stage renal disease (ESRD). Patients with two truncating mutations showed an earlier age of onset and more frequent retinal involvement than patients with one truncating mutation. Among eight PH1 patients presenting with ESRD, five patients were treated with intensive dialysis followed by liver transplantation (n=5) with/without subsequent kidney transplantation (n=3).CONCLUSION: Most patients presented with severe infantile forms of PH. Patients with two truncating mutations displayed more severe phenotypes than those of patients with one truncating mutation. Sequential liver and kidney transplantation was adopted for PH1 patients presenting with ESRD. A larger nation-wide multicenter study is needed to confirm the genotype-phenotype correlations and outcomes of organ transplantation.
Age of Onset ; Dialysis ; Genetic Association Studies ; Genotype ; Humans ; Hydrogen-Ion Concentration ; Hyperoxaluria, Primary ; Kidney Failure, Chronic ; Kidney Transplantation ; Liver ; Liver Transplantation ; Medical Records ; Organ Transplantation ; Phenotype ; Retinaldehyde ; Retrospective Studies ; Transplants

OBJECTIVE: So far, there is no study answering the question of which type of surgical technique is practically the most useful in the treatment of adult patients with ischemic type moyamoya disease (MMD). We evaluated the efficacy of single barrel superficial temporal artery (STA)-middle cerebral artery (MCA) bypass in the treatment of adult patients with ischemic type MMD by retrospectively collecting clinical and radiological data. MATERIALS AND METHODS: A retrospective review identified 31 adult patients who underwent 43 single barrel STA-MCA bypass procedures performed for treatment of ischemic-type MMD between 2006 and 2014. The male to female ratio was 17:14 and the mean age was 41 years (range, 21-65 years). Peri-operative complications, angiographic and clinical outcomes were analyzed retrospectively. RESULTS: The permanent neurological morbidity and mortality rates were 2.3% and 0%, respectively. During the observation period of a mean of 35 months (range, 12-73 months), 29 patients (93.5%) had no further cerebrovascular events and transient ischemic attack occurred in two patients (6.5%), resulting in an annual stroke risk of 2.2%. Follow-up computed tomography perfusion (CTP) (mean, 18.4 months after surgery) documented improved cerebral hemodynamics in the revascularized hemispheres (p < 0.001). Post-operative patency was clearly verified in 38 bypasses (88.4%) of 43 bypasses on follow-up imaging (mean, 16.5 months). CONCLUSION: Our results suggest that single barrel STA-MCA bypass with wide dural opening is safe and durable method of cerebral revascularization in adult patients with ischemic type MMD and can be considered as a potential treatment option for adult patients with ischemic type MMD.
Adult* ; Cerebral Arteries* ; Cerebral Revascularization ; Female ; Follow-Up Studies ; Hemodynamics ; Humans ; Ischemia ; Ischemic Attack, Transient ; Male ; Methods ; Mortality ; Moyamoya Disease* ; Perfusion ; Retrospective Studies ; Stroke ; Temporal Arteries

Refractory angina pectoris is defined as angina refractory to optimal medical treatment and standard coronary revascularization procedures. Despite recent therapeutic advances, patients with refractory angina pectoris are not adequately treated. Spinal cord stimulation is a minimally invasive and reversible technique which utilizes electrical neuromodulation by means of an electrode implanted in the epidural space. It has been reported to be an effective and safe treatment for refractory angina pectoris. We report a case of spinal cord stimulation which has effectively relieved chest pain due to coronary artery disease in a 40-year-old man. This is the first report of spinal cord stimulation for treatment of refractory angina pectoris in South Korea.
Adult ; Angina Pectoris ; Chest Pain ; Coronary Artery Disease ; Electrodes ; Epidural Space ; Humans ; Republic of Korea ; Spinal Cord ; Spinal Cord Stimulation