OBJECTIVE: The purpose of this study was to report our preliminary experience with endovascular treatment (EVT) for life-threatening bleeding from branches of the external carotid artery (ECA) in patients with traumatic maxillofacial fractures. MATERIALS AND METHODS: A total of 12 patients seen between March 2010 and December 2014 were included in this study. All subjects met the following criteria: 1) presence of maxillofacial fracture; 2) continuous blood loss from oronasal bleeding; and 3) EVT to stop bleeding. Various clinical factors were recorded for each patient and the correlations between those factors and clinical outcome (Glasgow Outcome Scale, GOS) were evaluated. RESULTS: Four patients were injured in traffic accidents, five in falls, and three by assaults. Mean initial Glasgow Coma Scale (GCS) was 6.9 ± 2.1 and the lowest hemoglobin measured was mean 6.3 ± 0.9 g/dL. GOS at discharge was 4 in five patients, 3 in three patients, and 1 (death) in four patients. GOS on follow-up (mean 13.7 months) was 5 in two patients, 4 in three patients, and 3 in three patients. Initial GCS (p = 0.016), lowest systolic blood pressure (p = 0.011), and lowest body temperature (p = 0.012) showed a significant positive correlation with good clinical outcomes. The number of units of red blood cells transfused (p = 0.030), the number of units of fresh frozen plasma transfused (p = 0.013), and the time from arrival to groin puncture (p < 0.001) showed significant negative correlation with good clinical outcomes. CONCLUSION: It might be suggested that rapid transition to EVT could be preferable to struggling with other rescue strategies to stop life-threatening bleeding from branches of the ECA in patients with traumatic maxillofacial fractures.
Accidental Falls ; Accidents, Traffic ; Blood Pressure ; Body Temperature ; Carotid Artery, External* ; Endovascular Procedures ; Erythrocytes ; Facial Bones ; Follow-Up Studies ; Glasgow Coma Scale ; Groin ; Hemorrhage* ; Humans ; Maxillary Artery ; Maxillary Fractures ; Plasma ; Punctures

OBJECTIVE: The purpose of this study was to report our preliminary experience with endovascular treatment (EVT) for life-threatening bleeding from branches of the external carotid artery (ECA) in patients with traumatic maxillofacial fractures. MATERIALS AND METHODS: A total of 12 patients seen between March 2010 and December 2014 were included in this study. All subjects met the following criteria: 1) presence of maxillofacial fracture; 2) continuous blood loss from oronasal bleeding; and 3) EVT to stop bleeding. Various clinical factors were recorded for each patient and the correlations between those factors and clinical outcome (Glasgow Outcome Scale, GOS) were evaluated. RESULTS: Four patients were injured in traffic accidents, five in falls, and three by assaults. Mean initial Glasgow Coma Scale (GCS) was 6.9 ± 2.1 and the lowest hemoglobin measured was mean 6.3 ± 0.9 g/dL. GOS at discharge was 4 in five patients, 3 in three patients, and 1 (death) in four patients. GOS on follow-up (mean 13.7 months) was 5 in two patients, 4 in three patients, and 3 in three patients. Initial GCS (p = 0.016), lowest systolic blood pressure (p = 0.011), and lowest body temperature (p = 0.012) showed a significant positive correlation with good clinical outcomes. The number of units of red blood cells transfused (p = 0.030), the number of units of fresh frozen plasma transfused (p = 0.013), and the time from arrival to groin puncture (p < 0.001) showed significant negative correlation with good clinical outcomes. CONCLUSION: It might be suggested that rapid transition to EVT could be preferable to struggling with other rescue strategies to stop life-threatening bleeding from branches of the ECA in patients with traumatic maxillofacial fractures.
Accidental Falls ; Accidents, Traffic ; Blood Pressure ; Body Temperature ; Carotid Artery, External* ; Endovascular Procedures ; Erythrocytes ; Facial Bones ; Follow-Up Studies ; Glasgow Coma Scale ; Groin ; Hemorrhage* ; Humans ; Maxillary Artery ; Maxillary Fractures ; Plasma ; Punctures

PURPOSE: The aim of this study is to investigate the effect of different experience level and different light source on shade selection ability comparing prosthodontist group and dental student group under 4,000 K and 5,500 K light. MATERIALS AND METHODS: After color difference of Vitapan 3D-master shade guides was measured, 3 sets of 5 shade tabs were selected with similar value but have different chroma (set a, b, c). Also 3 sets of 5 shade tabs were selected with similar chroma but have different values (set d, e, f). Under 4,000 K and 5,500 K light sources, ten prosthodontists and ten dental students were allowed to match in one set of 5 tabs the same shade tab with the tab which was originally selected in the other set of 5 tabs. Color differences of original tab and matched tab were measured by spectrophotometer and the shade selection ability was evaluated with those data. Evaluation of color difference value was performed in regard to different light conditions and different level of experience, followed by t-test with 95% confidence interval. RESULTS: Color difference values under 4,000 K and 5,500 K light source were 1.62 +/- 2.0, and 1.33 +/- 1.7 respectively. In addition, color difference values of prosthodontist group and dental student group were 1.34 +/- 1.7, and 1.61 +/- 2.0 respectively. Difference of shade selection ability was not found under either different light sources (P=.398), or different experience level (P=.221). CONCLUSION: Level of experience did not affect on the shade selection ability when prosthodontists and dental students matched the shades with the same shade tab under the same light source.
Ceramics ; Dental Porcelain ; Humans ; Light ; Prosthesis Coloring ; Spectrophotometry ; Students, Dental

The treatment of pathological scars, such as keloids and hypertrophic scars, can be challenging for dermatologists. The first-line treatment is intralesional corticosteroid injection, especially when patients complain of pain or discomfort. Laser treatment can also be used in patients with keloids and hypertrophic scars. However, even after multiple sessions of intralesional corticosteroid injections and laser treatment, desirable outcomes may not be achieved, and recurrence is common. Recent studies on the efficacy of intralesional bleomycin injection (BLMILI) in treating keloids and hypertrophic scars have suggested that a significant improvement is observed after BLMILI. However, there is limited research on the effectiveness of BLMILI for patients who do not respond to other treatments, such as intralesional corticosteroid injection or laser treatment. Here, we report four cases of BLMILI in keloids and hypertrophic scars that were unresponsive to previous intralesional corticosteroid injection and/or laser treatment.

PURPOSE: The purpose of this study was to report the authors’ experience with external ventricular drainage (EVD) before endovascular treatment (EVT) in patients with acute aneurysmal subarachnoid hemorrhage (aSAH) and to investigate its relation to hemorrhagic complications. MATERIALS AND METHODS: Between March 2010 and December 2017, a total of 122 patients were recruited who had an aSAH, underwent EVT to secure the ruptured aneurysm, and had EVD performed within 72 hours of rupture. The pre-embo EVD group (n=67) comprised patients who underwent EVD before EVT, and the post-embo EVD group (n=55) comprised those who underwent EVD after EVT. RESULTS: Overall, EVD-related hemorrhage occurred in 18 patients (14.8%): six (8.9%) in the pre-embo EVD group and 12 (21.8%) in the post-embo EVD group (P=0.065). No rebleeding occurred between EVD and EVT in the pre-embo EVD group. Clinical outcomes at discharge did not differ significantly between groups (P=0.384). At discharge, the final modified Rankin Scale score in patients who experienced pre-embo rebleeding was better in the pre-embo EVD group than in the post-embo EVD group (P=0.041). Current use of an antiplatelet agent or anticoagulant on admission (odds ratio [OR], 2.928; 95% confidence interval [CI], 1.234–7.439; P=0.042) and stent use (OR, 2.430; 95% CI, 1.524–7.613; P=0.047) remained independent risk factors for EVD-related hemorrhagic complications. CONCLUSION: EVD before EVT in patients with aSAH in acute period did not increase the rate of rebleeding as well as EVD-related hemorrhagic complications. Thus, performing EVD before EVT may be beneficial by normalizing increased intracranial pressure. Especially in patients with rebleeding before the ruptured aneurysm is secured, pre-embo EVD may improve clinical outcomes at discharge.
Aneurysm ; Aneurysm, Ruptured ; Drainage ; Hemorrhage ; Humans ; Hydrocephalus ; Intracranial Aneurysm ; Intracranial Pressure ; Risk Factors ; Rupture ; Stents ; Subarachnoid Hemorrhage

No abstract available.
Porokeratosis*

Background: Various treatments exist for addressing volume loss in atrophic scars. Although laser therapy has gained traction in treating atrophic scars, it is associated with side effects, such as post-inflammatory hyperpigmentation or erythema. Additionally, not all types of atrophic scars respond optimally to laser therapy, even after multiple sessions. Objective: This study aimed to evaluate the efficacy and safety of punch elevation for atrophic scars that yielded unsatisfactory outcomes after repeated laser treatment sessions. Methods: Seven patients with atrophic scars on their facial area underwent punch elevation, concurrently supplemented by fractional CO2 laser application to the scar margins. Improvement in volume restoration of atrophic scars was assessed via investigator evaluation and 3-dimensional (3D) image analysis. Results: After 1 month, median volume (interquartile range) of depression improved from 4.39 mm3 (2.23∼9.90 mm3 ) to 1.97 mm3 (1.46∼7.50 mm3 ), indicating a statistically significant difference post-punch elevation (p=0.018). No serious adverse events were reported during follow-up. Conclusion The efficacy of the punch elevation was objectively evaluated. Punch elevation is a safe and effective therapeutic avenue for atrophic scars that exhibit resistance to laser or alternative interventions.

Aggressive digital papillary adenoma (ADPA) is a rare tumor of the sweat glands. They usually present as solitary masses, with or without pain, and are most commonly observed in the fingers. A 19-year-old man presented with a solitary, protruding lesion on the right big toe that had enlarged 6 months previously. The biopsy specimen revealed a well-marginated mass with papillary projections and tubular structures. On foot magnetic resonance imaging, there was no invasion, and chest radiography showed no metastasis. Based on these findings, the tumor was diagnosed as ADPA, and wide excision was performed. Herein, we report a rare sweat gland tumor on the toe that was diagnosed as an ADPA.

Onychogryphosis is a disorder of nail plate growth, which most commonly involves the toenails. It is characterized by opaque, yellow-brown thickening of the nail plate with associated marked convexity and elongation. Treatment for onychogryphosis can be conservative or operative depending on the cause and medical status of the patient. A 30-year-old male presented with onychogryphosis of the right and left toenails. Since the patient had shown recurrence after simple nail avulsion several years ago, the inverted T incision method and fusiform excision of the hypertrophic hyponychium were performed. No recurrence was observed during the 3-year follow-up period. Our results showed that nail avulsion combined with traction osteophyte removal is a suitable surgical method for treating onychogryphosis.

Background: and Purpose: Moyamoya disease (MMD) is a rare form of intracranial stenoocclusive disease that can be associated with intracranial aneurysms. We evaluated the clinical features and outcomes of MMD-associated aneurysms while focusing on their locations. Methods: Between January 1998 and December 2018 there were 1,302 adult and pediatric patients diagnosed as MMD at a single institution. These patients included 38 with 44 MMD-associated aneurysms. The MMD-associated aneurysms were classified into two groups based on their locations: major-artery aneurysms and non-major-artery aneurysms. The clinical and radiological data for patients with MMD-associated aneurysms were reviewed retrospectively. Results: The 44 MMD-associated aneurysms comprised 28 in major arteries and 16 in nonmajor arteries. All of the major-artery aneurysms were initially unruptured lesions, and follow-up angiography showed that 23 (82.1%) had an improved or stable status and 5 (17.9%) had a worse status. The non-major-artery aneurysms comprised 10 ruptured and 6 unruptured lesions, and follow-up angiography showed that 11 (68.8%) had improved or were stable and 5 (31.2%) had worsened. At the latest follow-up, there were four cases of unfavorable outcome: two initial hemorrhagic insults, one treatment-related morbidity, and one repeatedhemorrhage case. Conclusions MMD-associated aneurysms occurred in 3.3% of the MMD cohort in this study, of which 63.6% were major-artery aneurysms and 36.4% were non-major-artery aneurysms. The major-artery group included 17.9% that became angiographically worse, while 31.2% were growing or hemorrhaging in the non-major-artery group.