We present a case of malignant melanoma arising in a longstanding melanocytic nevus on the palm. Histological examination showed mature nevoid cell nests in the dermis underlying atypical melanocytic lesion. Along the dermoepidermal junction spindle-shaped atypical melanocytes with dermal invasion are observed as well as pagetoid spreading of cells with clear cytoplasm or of spindle cells upward the epidermis. Subtypes of this case is difficult to conclude, because this case shares both histopathologic characteristics of superficial spreading melanoma and those of acral lentiginous melanoma.
Cytoplasm ; Dermis ; Epidermis ; Melanocytes ; Melanoma* ; Nevus, Pigmented*

The clinical characteristics of primary cutaneous CD30-positive large cell lymphoma are solitary or localized skin lesions, frequent relapses, spontaneous regression and a favorable prognosis. These relapses and spontaneous regressions occur frequently in borderline cases between CD30-positive large cell lymphoma and lymphomatoid papulosis. Regression and relapse, which occurs in both cutaneous CD30 positive large cell lymphoma and lymphomatoid papulosis, dose not help distinguish one from the other. We report two cases diagnosed as clinically and histologically primary cutaneous CD30-positive large cell lymphoma, recurred respectively on the same anatomic site and on the different anatomic site.
Lymphoma* ; Lymphomatoid Papulosis ; Prognosis ; Recurrence ; Skin

Neonatal lupus erytematosus is characterized by cutaneous findings showing the morphology of subacute cutaneous lupus erythematosus, congenital heart block, and anti-Ro/SSA and/or anti-La/SSB autoantibodies which result from the transplacental passage of maternal autoantibodies. We report two cases of a 25-day-old female infant and a 30-day-old male infant who presented with characteristic clinical features of cutaneous neonatal lupus erythematosus but without evidence of congenital heart block. The serological studies in both infants revealed the presence of anti-SSA/Ro antibodies and antinuclear antibodies. We diagnosed their mothers as systemic lupus erythematosus with the clinical and laboratory findings.
Antibodies ; Antibodies, Antinuclear ; Autoantibodies ; Female ; Heart Block ; Humans ; Infant ; Lupus Erythematosus, Cutaneous ; Lupus Erythematosus, Systemic ; Male ; Mothers

BACKGROUND: For the long-term management of chronic dermatitis such as atopic dermatitis or xerotic eczema, it is important for a clinician to choose a medication that has the least side effects. OBJECTIVE: We planned to evaluate the anti-inflammatory effect of a moisturizer containing green-tea extracts compared with 1% hydrocortisone lotion. METHODS: The anti-inflammatory effects of 1% hydrocortisone lotion and a moisturizer containing green-tea extracts were evaluated in the inflammation of skin induced by ultraviolet B(UVB) irradiation and sodium lauryl sulfate(SLS) irritation. Twice a day application of topical agents for reducing artificially induced local inflammation was done. Mexameter and chromameter were used for the evaluation of erythema. RESULTS: UVB induced erythema continued to increase regardless of applying topical agents. In contrast, SLS-induced erythema slowly decreased with time duration. Furthermore, increasing pattern of erythema was irregular after UVB irradiation. These results suggest that SLS-induced erythema was more reliable for evaluation of anti-inflammatory effects of topical agent. In addition, we found that a moisturizer containing green tea extracts showed nearly the same effect as or even more effective than 1% hydrocortisone lotion. CONCLUSION: A moisturizer containing green tea extracts would be effective for improving dry skin and also for the treatment of atopic dermatitis or xerotic eczema.
Dermatitis ; Dermatitis, Atopic ; Eczema ; Erythema ; Hydrocortisone ; Inflammation ; Skin ; Sodium ; Tea

A 22-year-old man underwent an operation for posterolateral fusion of the lumbar spine at L3-5. He was ventilated via a tracheostomy site in a prone position for 210 minutes. Ventilator function and eyeballs were checked periodically. After changing his position to supine for the wake-up test, it was noticed that his tongue was self-inflicted and looked to be cut unless immediate decompression was applied. After several manual attempts to open the mouth failed, anesthesia depth was deepened with thiopental sodium and neuromuscular blocker to decompress and reposition the tongue into the intraoral cavity. Minimal teeth marks and scarring remained after seven months without any complications.
Anesthesia ; Bites and Stings ; Bites, Human ; Cicatrix ; Decompression ; Humans ; Mouth ; Neuromuscular Blockade ; Prone Position ; Spine ; Thiopental ; Tongue ; Tooth ; Tracheostomy ; Ventilators, Mechanical ; Young Adult

A mixture of local anesthetic and epinephrine provides hemostasis for ear microsurgery. However, epinephrine has adverse cardiovascular effects, such as arrhythmia, pulmonary edema, and even cardiac arrest. We have experienced catecholamine-induced cardiovascular crisis, with severe hypertension, tachycardia, and acute pulmonary edema, after subcutaneous infiltration with a 2% lidocaine and 1:200,000 epinephrine solution. The patient recovered without any apparent sequelae after intensive care, including diuretics, steroids, and nitroglycerin for the hypertension and pulmonary edema, and a vasopressor for the subsequent hypotension.
Arrhythmias, Cardiac ; Diuretics ; Ear ; Epinephrine ; Heart Arrest ; Hemostasis ; Humans ; Hypertension ; Hypotension ; Critical Care ; Lidocaine ; Microsurgery ; Nitroglycerin ; Pulmonary Edema ; Steroids ; Tachycardia

BACKGROUND: Botulinum toxin type A is being widely used for the treatment of facial wrinkles affected by facial expression muscles. Due to the sudden and exponential surge in popularity of its use for facial wrinkles, there are scanty reports of facial wrinkles treated with botulinum toxin type A especially in Asians. OBJECTIVE: This study was performed to investigate the clinical features of facial wrinkles affected by facial expression muscles and the effects of botulinum toxin A on the treatment of wrinkles. METHODS: Medical records of 61 patients with facial wrinkles treated with botulinum toxin type A were reviewed. Demographic profiles of the patients, the age of onset of facial wrinkle, the distributions of facial wrinkles, treatment dose of botulinum toxin type A, side effects, and follow up data were analyzed. RESULTS: Female patients were predominant(93.4%) than male patients(6.6%). The mean age of the patients was 41.3 years. Crow's feet were the most frequently treated site of facial wrinkles. Average number of treated sites were 2.38. Side effect profiles were similar as previous reports in Cauca sians. The number of patients who took the regular retreatment was less than expected. CONCLUSION: The clinical profiles of wrinkle patients in Koreans treated with botulinum toxin A were assessed. We think it is one of the effective treatment modalities for antiwrinkling.
Age of Onset ; Asian Continental Ancestry Group ; Botulinum Toxins ; Botulinum Toxins, Type A ; Facial Expression* ; Female ; Follow-Up Studies ; Foot ; Humans ; Male ; Medical Records ; Muscles* ; Retreatment

PURPOSE: The purpose of this study was to determine the effect-site concentration (Ce) of remifentanil in 50% of patients (EC50) and 95% of patients (EC95) for smooth laryngeal mask airway (LMA) removal in adults under propofol and remifentanil anesthesia. MATERIALS AND METHODS: Twenty-five patients of ASA physical status I-II and ages 18-60 years who were to undergo minor gynecological or orthopedic surgery were assessed in this study. Anesthesia was induced and maintained with propofol and remifentanil target-controlled infusion (TCI). Remifentanil was maintained at a predetermined Ce during the emergence period. The modified Dixon's up-and-down method was used to determine the remifentanil concentration, starting from 1.0 ng/mL (step size of 0.2 ng/mL). Successful removal of the LMA was regarded as absence of coughing/gagging, clenched teeth, gross purposeful movements, breath holding, laryngospasm, or desaturation to SpO2<90%. RESULTS: The mean+/-SD Ce of remifentanil for smooth LMA removal after propofol anesthesia was 0.83+/-0.16 ng/mL. Using isotonic regression with a bootstrapping approach, the estimated EC50 and EC95 of remifentanil Ce were 0.91 ng/mL [95% confidence interval (CI), 0.77-1.07 ng/mL] and 1.35 ng/mL (95% CI, 1.16-1.38 ng/mL), respectively. CONCLUSION: Our results showed that remifentanil TCI at an established Ce is a reliable technique for achieving safe and smooth emergence without coughing, laryngospasm, or other airway reflexes.
Adolescent ; Adult ; Analgesics, Opioid/*administration & dosage ; Anesthetics, Inhalation/*administration & dosage ; Cough/prevention & control ; Device Removal ; Dose-Response Relationship, Drug ; Female ; Gynecologic Surgical Procedures ; Humans ; *Laryngeal Masks ; Male ; Middle Aged ; Orthopedic Procedures ; Piperidines/*administration & dosage ; Propofol/*administration & dosage ; Treatment Outcome ; Young Adult

BACKGROUND: Remifentanil sometimes elicits cough during induction of anesthesia, as with the use of other fentanyl congeners. We designed this study to investigate the incidence of remifentanil-induced cough (RIC) in children and to evaluate the effect of injection speed on RIC. METHODS: One hundred twenty ASA physical status I-II patients, aged 3-12 yr, undergoing general anesthesia were enrolled in the study. Patients were randomly assigned to one of the three groups. Patients in Group R30 received remifentanil 1.5 microg/kg at a constant rate over 30 s. Patients in Group R45 received remifentanil 1.5 microg/kg over 45 s, and patients in Group R60 received remifentanil 1.5 microg/kg over 60 s, respectively. Episodes of cough were recorded and graded as mild (1-2), moderate (3-4), or severe (5 or more). Mean arterial pressure (MAP), heart rate (HR), and SpO2 were recorded on arrival in the operating room (baseline) and 1 min after remifentanil infusion. RESULTS: The incidence of RIC was 33.3% in Group R30 (13 of 39 patients), 17.9% in Group R45 (7 of 39 patients), and 5.0% in Group R60 (2 of 40 patients). Patients in Group R60 had a significantly lower incidence of RIC than those in Group R30 (P = 0.001). The MAP, HR, and SpO2 values were not significantly different between groups. CONCLUSIONS: When intravenous remifentanil 1.5 microg/kg was administered in pediatric patients, the incidence of RIC decreased from 33 to 5% by increasing the injection time from 30 to 60 s. Remifentanil should be administered slowly over 60 s in children to suppress cough during anesthesia induction.
Anesthesia ; Anesthesia, General ; Arterial Pressure ; Child* ; Cough* ; Fentanyl ; Heart Rate ; Humans ; Incidence ; Operating Rooms

Epiglottic cyst are relatively uncommon and account for about five percent of benign laryngeal lesions. The most common location is the epiglottis. We experienced two cases of congenital epiglottic cysts, one in an infant who showed dyspnea at birth and was incubated and the other in a 1-month-old infant with increasing stridor during the first month of life. In both cases, each cysts were completely removed under suspension laryngoscopy under general anesthesia with satisfactory results. We reviewed the clinical characteristics, diagnostic modalities, treatments, and prognosis of the epiglottic cyst.
Anesthesia, General ; Dyspnea ; Epiglottis ; Humans ; Infant ; Infant, Newborn ; Laryngoscopy ; Parturition ; Prognosis ; Respiratory Sounds