Many approaches are being used for exposure of the anterior cranial base regions, ranging from extracranial to intracranial, such as transsphenoidal approach. This intracranial approach, developed in the beginning of the twentieth century, has recently become one of the most commonly used approaches after many incremental improvements. This thesis aims at examining the development of the approach and those who contributed to this procedure. The author also contemplate problems which may occur in the historical analysis. From the nineteenth century, advances have been made in anesthesiology, sterilization, cerebral localization and knowledge of anatomical and physiologic aspects of the skull base. The development of new knowledge and technique has helped to overcome obstacles, making surgery of the skull base through extracranial approach both technically feasible and therapeutically effective. To avoid serious postoperative complications after the extracranial approach, transsphenoidal approach had been developed in the beginning of the twentieth century. Transsphenoidal approach had been widely used right after its introduction. But it had not been used popularly since late 1920s in the United States. In early 1960s, this technique, spread from Europe, has regained popularity and become one of the most widely-used approaches. In the history of the transsphenoidal approach, it has been thought that the effort of Harvey Cushing and Oskar Hirsch, the endeavor of Cushing's scholars, several new attempts of otolaryngologists played an important role. However, comparing to great appreciation of neurosurgeons, especially Harvey Cushing on their significant contribution to the further development of this technique, the role of other pioneering doctors have been underestimated in previous historical studies on the transsphenoidal approach. It was because dynamical relationships among several specialties had influence on the historical analysis. This cases shows that historical analysis is influenced not only by past figures but also by current situations.
English Abstract ; History of Medicine, 19th Cent. ; History of Medicine, 20th Cent. ; History of Medicine, 21st Cent. ; Neurosurgery/*history ; Skull Base/*surgery ; Surgery/*history

Exenteraion in early infancy by a tumor and radiotherapy caused the contracted eye socket and Orbital hypoplasia. This result is because of the abscence of the conjunctival fornix and in severe contraction of orbital fat and developmental bone abnormalities. The authors corrected a contracted eye socket and orbital hypoplasia simultaneously, secondary to previous surgery and radiotherapy. A one-stage surgical reconstruction was undertaken using a radial osteocutaneous flap, which were transfered for eye socket reconstruction and orbital hypoplasia. Adipofascia and fragment of radius inserted as an hypoplastic orbit rim susbtitute to enlarge the orbital region. We report that we have experienced a case of eye socket reconstruction with a radial forearm osteocutaneous free flap.
Forearm* ; Free Tissue Flaps* ; Orbit* ; Radiotherapy ; Radius

PURPOSE: Paragonimiasis is infectious disease occurred by Paragonimus Westermani, which invades into human body as a final host. Habitual eating the freshwater crab or crawfish unboiled is one of the reason of infection. Paragonimiasis raged in 1970s in Korea, Japan, China and other Asian countries but the incidence decreased rapidly. Once people eat infected second host, parasite penetrates the duodenal wall and migrates to the lung. During this migration period, the parasite can migrate to other organ, such as brain, spinal cord, liver and subcutaneous tissue, but the cases are rarely reported. The objective of our study is to present our experience of the ectopic migration of parasite to the subcutaneous tissue of the abdomen, which was easily treated with excision and Praziquantel medication. METHODS: A 59-year-old woman who likes eating unboiled freshwater crab was diagnosed as Paragonimiasis 15 months ago. Her symptoms were fever and cough, and she was treated with Praziquantel medication. 3 months after discharge, she visited our hospital with left pleuritic chest pain, cough with fever, and palpable mass formation on left lower quadrant of the abdomen. Wedge resection of the left lung and Praziquantel medication was maintained for a week. Nevertheless, fever persisted after the treatment. The patient received total excision of the abdominal soft tissue mass, and the fever was relieved. RESULTS: Pathologic findings of the mass showed multiple cyst and abscess formation with crystal structure which is suspicious parts of the parasite or calcified egg shells. Uncontrolled fever was relieved after the operation, and there was no evidence of recurrent Paragonimiasis and ectopic migration for 1 year follow up period. CONCLUSION: Ectopic migration of Paragonimus is rare, but multiple organ can be involved. Patient with Paragominiasis who was refractory in fever control after Praziquantel medication or surgical evaluation of the lung should be considered as ectopic migration of the Paragonimiasis.
Abdomen ; Abscess ; Animals ; Asian Continental Ancestry Group ; Brain ; Chest Pain ; China ; Communicable Diseases ; Cough ; Eating ; Egg Shell ; Female ; Fever ; Follow-Up Studies ; Fresh Water ; Human Body ; Humans ; Incidence ; Japan ; Korea ; Liver ; Lung ; Middle Aged ; Paragonimiasis ; Paragonimus ; Paragonimus westermani ; Parasites ; Praziquantel ; Rage ; Spinal Cord ; Subcutaneous Tissue

Partial unilateral lentiginosis (PUL) is an unusual pigmentary disorder that's characterized by multiple lentigines in a unilateral distribution. The lesions often have a segmental pattern with a sharp demarcation at the midline. This is sometimes combined with other disorders such as neurofibromatosis or cafe-au-lait macules (CALMs). The presence of multiple CALMs in the same distribution as the lentigines on a PUL patient makes it difficult to differentiate PUL from segmental neurofibromatosis. We present here a 25-year-old woman with an unusual combination of several caf?-au-lait macules and scattered numerous lentigines involving the left side of the abdomen, flank and back.
Abdomen ; Adult ; Female ; Humans ; Lentigo ; Neurofibromatoses

The skin lesion of herpes zoster is classically limited to single dermatomal area, and most cases of multidermatomal herpes zoster have contiguous skin lesions. Noncontigous multidermatomal herpes zoster is very rare in both immunocompetent and immunocompromised persons. The phenomenon of zoster occurring in two noncontiguous dermatomes has been referred to as zoster duplex unilateralis or bilateralis. We report a case of herpes zoster multiplex in five disparate dermatomes in a 71-year-old woman with non-Hodgkin's lymphoma.
Aged ; Female ; Herpes Zoster ; Humans ; Lymphoma, Non-Hodgkin ; Skin

Symptomatic pacing lead-associated thrombosis is very uncommon occurring in 0.5-3.5% of pacemaker implants. Especially thrombisis-induced total occlusion occures almost in late stage over several months to years but acute thrombosis occurring several days after venous pacing has not been reported. In this case, We performed upper limb venography in the patient who presented edema and pain of neck, left upper limb and headache as well as intermittent cough occurring in bending forward. A venogram confirmed acute thrombus completely occluding the left brachiocephalic vein and the patient received intravenous heparin and was maintained on warfarin. Repeated veno- graphy after treatment for 30 days revealed persistent thrombus with total occlusion which not be improved signi- ficantly copmpared to previous venogram and collateral veins diverting the blood to the contralateral side and into the superior vena cava was developed. The patient's symptoms resolved almost and that is likely to be due to the development of collateral venous channels.
Brachiocephalic Veins* ; Cough ; Edema ; Headache ; Heparin ; Humans ; Neck ; Phlebography ; Thrombosis* ; Upper Extremity ; Veins ; Vena Cava, Superior ; Warfarin

Bullous pemphigoid (BP) is a chronic autoimmune subepidermal blistering disease that usually occurs in the elderly. Two types of clinical variants exist. The generalized form typically involves the lower abdomen, groin, thighs and inner arms. The localized forms of BP include (1) mucous membrane pemphigoid or cicatrical pemphigoid, (2) localized scarring pemphigoid or Brunsting-Perry pemphigoid, and (3) localized nonscarring pemphigoid. We report here on a case of localized nonscarring pemphigoid on the face of a 71-years-old man.
Abdomen ; Aged ; Arm ; Blister ; Cicatrix ; Groin ; Humans ; Mucous Membrane ; Pemphigoid, Bullous ; Thigh

PURPOSE: The lower eyelid serves important roles in tear distribution and drainage. The purpose of this study was to measure the tear meniscus height (TMH) with anterior segment optical coherence tomography after lower blepharoplasty. METHODS: A total of 52 eyes from 26 patients treated between July 2012 and June 2015 were included in the study. A transcutaneous or transconjunctival approach was performed, depending on whether (1) the supportive lower lid orbicularis oculi muscle was tightened, (2) the middle lamella was elongated, (3) minimal fat was removed or transpositioned, and (4) lateral canthal support was established. Marginal reflex distance 2 and marginal nose distance were analyzed with Image J software. TMH was measured with anterior segment optical coherence tomography. A paired t-test and Wilcoxon signed-rank test were used for statistical comparisons. RESULTS: Marginal reflex distance 2 decreased and marginal nose distance increased with both surgical techniques. TMH decreased from 337.3 ± 117.9 to 289.3 ± 69.1 µm (p = 0.024) in patients who had transcutaneous lower blepharoplasty, but increased from 186.5 ± 35.5 to 274.8 ± 58.3 µm (p = 0.000) in patients who had transconjunctival lower blepharoplasty. Medial and lateral TMHs decreased significantly from 228.8 ± 80.7 to 152.7 ± 42.1 µm (p = 0.008) in patients with transcutaneous lower blepharoplasty. TMH was significantly restored after lower blepharoplasty with either approach. CONCLUSIONS: Enhancing the lower eyelid position combined with orbicularis muscle tightening and lateral canthal support can normalize the TMH following lower eyelid blepharoplasty.
Blepharoplasty* ; Drainage ; Eyelids ; Humans ; Nose ; Reflex ; Tears* ; Tomography, Optical Coherence*

Objective: This study evaluated the clinical usefulness of mean platelet volume (MPV) for predicting functional outcomes in subarachnoid hemorrhage (SAH) patients. Methods: This is a retrospective analysis of patients who were diagnosed with SAH in the emergency room. Based on their modified Rankin Scale (mRS) score, patients were divided into two groups: 0-2 (good outcome) and 3-6 (poor outcome). Univariable and multivariable analyses were performed to investigate whether MPV, along with other multiple factors, was associated with poor prognosis. Receiver operating characteristic (ROC) curve analysis was performed to determine the value of MPV as a predicting factor of neurological prognosis. Compared to other factors, Hunt Hess grade (HHG) and modified Fisher grade (mFG) considerably influenced the outcomes in both groups (Model 1; model including all factors). Hence, a new model (Model 2) was constructed, comprising multiple factors excluding these two factors. Results: A total of 143 patients were included in this study. Although MPV was different between the two groups, it was not a significant factor in Model 1 in the multivariable analysis. In Model 2, MPV (odds ration [OR], 1.71; 95% confidence interval [CI], 1.05-2.8), age (OR, 1.06; 95% CI, 1.03-1.1), and surgical treatment (OR, 0.37; 95% CI, 0.15-0.87) were significant factors related to poor outcomes. Area under the curve (AUC) of Model 1 was 0.93, 0.85 in HHG; 0.78 in Model 2, 0.65 in mFG, and 0.62 in MPV. Conclusion Although MPV differed significantly between the good and poor outcome groups, it is insufficient to predict poor outcomes in SAH patients as an independent biomarker.

Gastritis cystica polyposa (GCP) is a rare lesion characterized by hyperplastic and cystic dilatation of the gastric mucosal glands infiltrating into the underlying submucosa. In most cases, it develops in patients who have undergone a gastroenterectomy, but can occasionally be found in an unoperated stomach. GCP may present as a submucosal tumor or polyp, and rarely as a giant gastric mucosal fold. We experienced a case of GCP that presented as a hyperplastic polyp, and it was unrelated to any gastric surgery. Upper endoscopy revealed the presence of a subpedunculated polyp in the posterior wall of the antrum. The lesion was successfully removed by endoscopic mucosal resection and diagnosed as a GCP.
Dilatation ; Endoscopy ; Gastritis ; Humans ; Polyps ; Stomach