Xanthelasma palpebrum is the most common type of xanthoma that develops mainly on the inner epicanthus of upper eyelids with symmetrical distribution. The lesion tends to be permanent, progressive and cosmetically disfiguring. The recommended treatment has been surgical excision, local treatment with chemicals, and carbon dioxide laser. All of the mentioned treatment have some disadvantages including scarring, pigmentary change and need for local anesthesia. We describe the treatment of xanthelasma palpebrum with the pulsed dye laser which coagulates the hyperpermeable vessels so that the lipid leakage could be blocked and prevent recurrence and further progression.
Anesthesia, Local ; Cicatrix ; Eyelids ; Lasers, Dye* ; Lasers, Gas ; Recurrence ; Xanthomatosis

Norovirus (NV) has caused large outbreaks of gastroenteritis in schools. Studies of NV epidemiology in schools related to NV outbreaks have been frequently reported. However, reports of that in schools without outbreaks are not found. Presently, NV molecular epidemiology surveillance was carried out in asymptomatic food handlers working at nonoutbreak elementary schools in Incheon, Korea, in March, April and December, 2009. NV prevalence was examined by real-time reverse transcription-PCR (RT-PCR) and the positive products were re-evaluated by conventional RT-PCR for sequencing. Fecal samples (n = 776) were collected from 776 food handlers in 60 schools. NV was detected in 26 of them (3.4%). Of these, 17 (65%) were positive for NV GII and 10 (38%) were positive for NV GI. Of the 26 samples, 19 were positive by conventional RT-PCR. Sequencing of these 19 strains revealed GII/4 (n = 5), GI/6 (n = 3), GI/14 (n = 2), GII/8 (n = 2), GI/2 (n = 2), GI/10 (n = 1), GII/1 (n = 1), GII/3 (n = 1), GII/7 (n = 1), and GII/16 (n = 1). In this survey, the food handler population unrelated to NV outbreaks was found to normally contain asymptomatic carriers of NV. The excretion of NV from asymptomatic food handlers should be an infection source of NV outbreaks.
Adult ; Caliciviridae Infections/*epidemiology/genetics ; Feces/virology ; Female ; Food Handling ; Gastroenteritis/*epidemiology/genetics ; Genotype ; Humans ; Male ; Middle Aged ; Norovirus/genetics/*isolation & purification ; Prevalence ; RNA, Viral/analysis ; Republic of Korea ; Reverse Transcriptase Polymerase Chain Reaction ; Schools ; Sequence Analysis, RNA

A case of primary carcinoid tumor of the liver with striking central fibrous scar in a 61-year-old male is reported. Tumor cells contained electron dense secretory granules with an average diameter 150~200 nm which demonstrated positive immunohistochemical reaction for neuron-specific enolase, synaptophysin and chromogranin. The stellate central scar was observed in various hepatic tumors including focal nodular hyperplasia, fibrolamellar carcinoma, or sclerosing hepatocellular carcinoma, but have not been reported in carcinoid tumor.
Carcinoid Tumor* ; Carcinoma, Hepatocellular ; Cicatrix ; Focal Nodular Hyperplasia ; Humans ; Liver ; Male ; Middle Aged ; Phosphopyruvate Hydratase ; Secretory Vesicles ; Strikes, Employee ; Synaptophysin

Venous thrombosis and thromboembolism appear to occur more often in patient with inflammatory bowel disease (IBD). The cause of thrombotic complications in IBD is generally considered to be associated with hypercoagulable conditions. Its prevalence rate ranges from 1% to 8% in clinical studies and rises to 39% in autopsy, but the renal vein thrombosis is very rare complication in ulcerative colitis patient. A 24-year-old man presented with intermittent abdominal pain and hematochezia for 6 months and recently developed pitting edema for few weeks. He was diagnosed as severe ulcerative colitis involving whole colon combined with thrombosis in both renal veins by colonoscopy and computed tomography scan of abdomen. We used steroid for the treatment of ulcerative colitis and both intravenous lower molecular weight heparin and warfarin for renal vein thrombosis. His symptoms were improved after treatment and maintained with mesalazine and warfarin. Follow-up abdominal CT scan showed complete resolution of both renal vein thrombosis. Currently he has been followed up for 2 years with oral mesalazine.
Anticoagulants/therapeutic use ; Colitis, Ulcerative/complications/*diagnosis/pathology ; Colonoscopy ; Heparin/therapeutic use ; Humans ; Male ; Protein S/metabolism ; *Renal Veins ; Tomography, X-Ray Computed ; Venous Thrombosis/complications/*diagnosis/radiography ; Warfarin/therapeutic use ; Young Adult

A 4-month-old boy diagnosed with acute myocarditis was treated with extracorporeal membrane oxygenation (ECMO). Follow-up echocardiography eight hours after ECMO revealed intracardiac thrombosis involving all four heart chambers. Because of the high risk of systemic embolization due to a pedunculated thrombus of the aortic valve, we performed an emergency thrombectomy. After the operation, the patient had a minor neurologic sequela of left upper arm hypertonia, which had almost disappeared at the last outpatient clinic two months later. He was diagnosed with a major mutation in MTHFR (methylenetetrahydrofolate reductase), which is related to thrombosis.
Ambulatory Care Facilities ; Aortic Valve ; Arm ; Echocardiography ; Emergencies ; Extracorporeal Membrane Oxygenation ; Follow-Up Studies ; Heart ; Humans ; Infant ; Male ; Methylenetetrahydrofolate Reductase (NADPH2) ; Myocarditis ; Oxygen* ; Thrombectomy ; Thrombosis*

OBJECTIVE: To translate the English version of the London Chest Activity of Daily Living scale (LCADL) into a Korean version and to determine the reliability and validity of the Korean version in patients with chronic obstructive pulmonary disease (COPD). METHODS: The English version of LCADL was translated into Korean and back-translated into English. Subsequently, the back-translated version was reviewed and compared with the original, and thus the final K-LCADL was obtained. To evaluate the validation of the K-LCADL, patients simultaneously completed a pulmonary function test, a 6-Minute Walk Test (6MWT), and questionnaires, including the modified Medical Research Council (mMRC) dyspnea scale, the Korean version of the St. George's Respiratory Questionnaire (K-SGRQ), the Korean version of the COPD Assessment Test (K-CAT), and the Korean version of the EuroQoL-5 Dimensions (K-EQ-5D). To assess test-retest reliability, the K-LCADL was again administered to the same patients within 2 weeks from initial assessment. RESULTS: A total of 94 patients participated in the present study. The total K-LCADL score was positively correlated with the K-SGRQ (r=0.802, p < 0.001), the mMRC dyspnea scale (r=0.603, p < 0.001), and the K-CAT score (r=0.714, p < 0.001), and negatively correlated with the K-EQ-5D (r=−0.764, p < 0.001), 6MWT (r=−0.635, p < 0.001), forced expiratory volume in one second 1 (r=−0.416, p=0.002), and forced vital capacity (r=−0.397, p=0.023). Intraclass correlation coefficient of the K-LCADL was 0.951 (p < 0.001). CONCLUSION: The K-LCADL is a reliable and valid questionnaire for evaluating limitation of activities of daily living in patients with COPD.
Activities of Daily Living ; Dyspnea ; Forced Expiratory Volume ; Humans ; Pulmonary Disease, Chronic Obstructive* ; Reproducibility of Results ; Respiratory Function Tests ; Thorax* ; Vital Capacity

BACKGROUND/AIMS: Tenofovir disoproxil fumarate (TDF) is potentially nephrotoxic in chronic hepatitis B patients. Hepatocellular carcinoma (HCC) patients treated using transarterial chemoembolization (TACE) are at an increased risk of renal injury. The aim of this study was to determine whether TDF is associated with more renal adverse events than entecavir (ETV) in HCC patients treated with TACE. METHODS: In this retrospective single-center study, we selected 53 HCC patients who were treated with TDF from January 2012 to July 2013 and had their first TACE procedure in the same period. These patients were matched by age and sex to patients treated with ETV. RESULTS: There were no significant differences in baseline characteristics, including HCC factors, and nephrotoxic drug use, between the two groups. The median follow-up period was 17.0 and 20.0 months for the TDF and ETV groups, respectively. There was no difference during the follow-up period between the TDF and ETV groups in the increase in creatinine over 0.5 mg/dL (17.0% and 17.0%, P=1.00, respectively) and the decrease in eGFR over 25% (43.4% and 41.5%, P=0.84, respectively). Multivariate analysis revealed that Child-Pugh class over B (hazard ratio [HR], 7.30; 95% confidence interval [CI] 2.79–19.10; P<0.01) was associated with increase in creatinine, and Child-Pugh class over B (HR, 82.74; 95% CI 12.31–555.83; P<0.01) and Barcelona-Clinic Liver Cancer stage over B (HR, 14.93; 95% CI 1.60–139.51; P=0.02) were associated with decrease in eGFR. CONCLUSIONS: TDF has comparable safety to that of ETV for HCC patients undergoing TACE.
Antiviral Agents ; Carcinoma, Hepatocellular ; Creatinine ; Follow-Up Studies ; Hepatitis B, Chronic ; Humans ; Kidney Diseases ; Liver Neoplasms ; Multivariate Analysis ; Retrospective Studies ; Tenofovir

PURPOSE: A vascular clipping system (VCS) has been introduced for clinical use. This study was developed to compare the VCS with prolene for anastomosis of arteriovenous fistula (AVF) in hemodialysis access surgery. METHODS: 127 consecutive patients requring autologous AVF for hemodialysis and divided into two treatment groups (VCS:Prolene) by their anastomosis methods. Anastomoses were constructed with the VCS in 44 patients and with hand-swen prolene suturing in 83 patients. Among them 35 clipped and 71 sutured were able to follow up survery and the patency rates were analysed by log-rank test. RESULTS: In the VCS cases, end to side AV anastomosis was applied and mean diameter of artery and vein was 1.7 mm, and vein was able to extend to 2.9 mm averagely. The average size of anastomosis length was 7.8 mm. Operation time was 51 (40~120) minutes and the average anastomosis time was 6.5 (3~15) minutes. The average use of clip was 12. In the prolene cases, 28 cases of end to side anastomosis were measured for diameter and the average diameter was 1.7 mm in artery and 1.9 mm in vein, and the average extension of vein was 2.8 mm. Operation time was 76.5 (40~160) minutes and the average anastomosis time was 10~15 minutes. In 55 cases of side to side anastomosis, the average size of anastomosis length was 19.2 mm. There was no other complication after operation except for each one case of received hematoma remove. In the survey cases (VCS : prolene - 35 :71), early failures were 3 :8 cases (8.6 :11.3%), late failures 5 :16 cases (14.3 :22.5%) as the result of 11.3 :12.0 months in average observation. The causes were 3 :5 cases in functional failure, 5 :17 cases in thrombosis and stricture, the other causes were 2 cases in prolene. The cumulative secondary patency rate was 88.3 :65.9% (31 :47 cases). There was higher patency in VCS, but there was no significant difference in the primary and second patency rates in log-rank analysis. CONCLUSION: VCS clip could be able to shorten the clamping time of blood vessel by reducing anastomosis time. Although there was no statistically significant difference between the VCS clips and prolene sutures, the AVF formation with VCS reduced failure rate and improved patency rate.
Arteries ; Arteriovenous Fistula* ; Blood Vessels ; Constriction ; Constriction, Pathologic ; Follow-Up Studies ; Hematoma ; Humans ; Polypropylenes ; Renal Dialysis* ; Sutures ; Thrombosis ; Veins

OBJECTIVE: The authors report a retrospective analysis of the clinical effect of dorsal root entry zone (DREZ) lesioning for neuropathic intractable pain. METHODS: Fourteen patients who underwent dorsal root entry zone lesioning for various types of pain between September 1995 and August 2001 were evaluated retrospectively. Eleven male and three female patients whose ages ranging from 35 to 70 were studied. According to causes of intractable pain, patients were divided into paraplegic pain(7 patients), peripheral nerve injury pain(3), cancer pain(3), phantom limb pain(1) and root avulsion pain(1). Other preoperative pain managements showed no benificial effects. The changes in painful symtoms were closely observed during follow up period. The mean follow period after operation was 32.4 months. RESULTS: Postoperatively, the decrease in level of pain was classified into four groups : excellent, good, fair, poor. Excellent represented no pain without medication : Good, pain tolerable with non-opiate medicine ; Fair, pain tolerable with opiate medicine ; Poor, pain sustained. After operation, three patients were in excellent group, eight in good, one in fair, and two in poor. Twelve patients were in medically tolerable pain group accounting for 85.7%. There were no serious operation releated side effects. CONCLUSION: DREZ lesioning, in our series, provided substantial pain relief and this may be considered an option in management of these types of intractable neuropathic pain.
Female ; Follow-Up Studies ; Humans ; Male ; Neuralgia ; Pain Management ; Pain, Intractable* ; Peripheral Nerve Injuries ; Phantom Limb ; Retrospective Studies ; Spinal Nerve Roots*

Glufosinate ammonium is the active ingredient in broad-spectrum contact herbicides such as BASTA(R) that inhibits the activity of glutamine synthetase, which is necessary for the production of the amino acid glutamine and for ammonia detoxification. Complications of glufosinate ammonium intoxication include gastrointestinal symptoms, loss of consciousness, convulsions, memory impairment, respiratory failure, and cardiovascular instability. We report herein a case of encephalopathy and reversible signal changes in the splenium of the corpus callosum, the bilateral corticospinal tracts, the hippocampi, and the cerebellar peduncles as seen in diffusion-weighted magnetic resonance imaging and fluid-attenuated inversion recovery images following BASTA(R) intoxication.
Ammonia ; Ammonium Compounds* ; Corpus Callosum ; Glutamate-Ammonia Ligase ; Glutamine ; Herbicides ; Magnetic Resonance Imaging ; Memory ; Pyramidal Tracts ; Respiratory Insufficiency ; Seizures ; Unconsciousness