BACKGROUND: The diagnostic methods of atherosclerosis before the development of clinical diseases(such as angina pectoris, myocardial infarction, cerebral infarction or peripheral vascular disease) are rather limited. The Russian doctors made the observations through the autopsy studies that there is a good correlation between the degree of atherosclersis or the cholesterol content of the aorta and the cholesterol content of the skin. We tried to investigate whether there is a significant degree of differences in the cholesterol content of the skin between the patietns with atherosclerotic disease(disease group), the patients who have not developed the clinical atheroscleric disease but have risk factors for atherosclerosis(risk group), and the normal control patients(normal group). METHODS: The skin choleterol was extracted from the palm of the hands by the closed contact with the chemicals. RESULTS: 1) The skin cholesterol was 2.77+/-1.08/microg/cm2in the disease group, 2.47+/-1.13microg/cm2in the risk group, and 1.84+/-0.60microg/cm2in the control group, The difference between the disease group and the normal group was significant(p<0.001), but the difference between the disease group and the risk group was not significant. 2) When the skin cholesterol of 2.1microg/cm2was used as a criterion. its sensitivity and specificity to predict either the disease gorup or the risk group was 66.1% and 70.8%. 3) In addition to the skin cholesterol of 2.1microg/cm2or more, if we add a criteria of cholesterol >220mg/dl, or TC/HDL-C ratio >4:1, or Apo B/A ratio >0.9, these separated the normal group from either the disease group or risk group much beter. 4) There was no significant correlation between the skin cholesterol and blood cholesterol. Also there were not any significant correlations between the skin cholesterol and the LDL cholesterol, TC/HDL-C ratio or Apo B/A ratio. CONCLUSION: On the basis of the above mentioned observations made by the Russian doctors and the present data showing significantly higher skin cholesterol level in the disease and risk group compared with normal control group, and little significant correlation between the skin cholesterol and the blood cholesterol level, it is likely that the skin cholesterol can be considered as an independent risk index for the atherosclerotic disease. Measuring the skin cholesterol by extraction of cholesterol from the palms of the hands may help predicting the presence or the risks of the atherosclerotic diseases.
Angina Pectoris ; Aorta ; Atherosclerosis* ; Autopsy ; Cerebral Infarction ; Cholesterol* ; Cholesterol, LDL ; Hand ; Humans ; Myocardial Infarction ; Risk Factors ; Sensitivity and Specificity ; Skin*

PURPOSE: To compare the clinical characteristics and laboratory finding between adenoviral and group A streptococcal (GAS) pharyngitis. METHODS: A retrospective review of medical records was performed in the patients with adenovirus infection among those who were admitted for febrile respiratory disease from January 2011 to July 2013 and GAS pharyngitis among those who visited for symptoms of scarlet fever from August 2006 to July 2013. RESULTS: 179 patients (AV1 group) were diagnosed with adenoviral pharyngitis and 37 (AV2 group) of these patients had adenovirus single infection. 26 patients (GAS group) were diagnosed with scarlet fever. Adenoviral infection (AV2 group) developed in younger patients compared to GAS group (2.8+/-2.1 years vs. 5.4+/-1.8 years, P=0.000). Total durations of fever and admission were longer in AV2 (6.3+/-2.6 days vs. 3.3+/-1.9 days, P=0.000; 4.1+/-1.2 days vs. 1.9+/-1.8 days, P=0.000, respectively). WBC counts were higher in AV2 (11,449+/-5,680 cells/mm2 vs. 6,722+/-6,941 cells/mm2, P=0.000). CRP was not significantly different between AV2 and GAS group (3.8+/-3.2 mg/dL vs. 5.2+/-5.1 mg/dL, P=0.368). No difference was found between two groups in the percentage of antibiotics use (91.9% vs. 100%, P=0.261). CONCLUSION: Clinical characteristics and measures of inflammation in the laboratory findings were similar between adenoviral and GAS pharyngitis group. It is necessary to conduct the test for respiratory virus and bacteria in early stage to differentiate in the pharyngitis patients with leukocytosis and elevation of CRP level.
Adenoviridae ; Adenoviridae Infections ; Anti-Bacterial Agents ; Bacteria ; Child* ; Fever ; Humans ; Inflammation ; Leukocytosis ; Medical Records ; Pharyngitis* ; Retrospective Studies ; Scarlet Fever

Poly-D,L-lactic acid (PDLLA) is widely used in facial rejuvenation as a collagen stimulator, with a lower risk of granuloma formation compared to poly-L-lactic acid (PLLA). However, granulomas may still occur. In this case, a 58-year-old woman developed firm, non-tender, bilateral infraorbital granulomas 2 months after her third PDLLA injection for infraorbital hollowing. The lesions were unresponsive to intralesional trichloroacetic acid (TCA) and intense pulsed light therapy, necessitating surgical removal. Histopathological analysis confirmed foreign-body granulomas caused by the PDLLA filler. This case highlights the need for caution when injecting PDLLA into thin-skinned areas like the infraorbital region, where granulomas can be more visible due to limited tissue volume. Although PDLLA fillers are generally safe, granuloma formation remains a potential complication. Early diagnosis and treatment with non-surgical methods, such as intralesional TCA, should be prioritized. If these methods fail, surgical excision, aimed at preserving as much normal tissue as possible, may be necessary for optimal outcomes.

Rheumatoid arthritis is a long lasting autoimmune disorder that primarily affects joints, and patients with rheumatoid arthritis are predisposed to development of chronic skin ulcers. In addition, skin ulcers with rheumatoid arthritis tend to persist despite treatment because of sustained inflammation and poor healing capacity. Treatment of skin ulcers involves medications, wound coating agents, and surgical procedures including skin grafting, however, wound dressing or skin grafts are generally excluded because of excessive cost and time and poor intake rate. The dorsal metacarpal artery perforator (DMAP) flap, a vascular island flap for coverage of soft tissue defects on the fingers, provides promising results including matched quality and color. We experienced a case of DMAP flap for reconstruction of a rheumatoid ulcer, and a DMAP flap may be considered as a good faithful option for treatment of patients with rheumatoid ulcer.
Arteries* ; Arthritis, Rheumatoid ; Bandages ; Fingers ; Humans ; Inflammation ; Joints ; Perforator Flap* ; Skin ; Skin Transplantation ; Skin Ulcer ; Transplants ; Ulcer* ; Wounds and Injuries

A pressure sore, such as quadriplegia, is developed in patients who have been idle in bed for a long time, particularly in the spinal cord. The treatment is particularly difficult in cases of multiple recurrent sores, osteomyelitis with pathologic fractures, other underlying conditions such as diabetes mellitus, immuno-suppression, or radiotherapy. Over the last 20 years, the development and popularization of rectus abdominis flap have significantly increased for reconstruction of a wide variety of difficult clinical problems. From March 2000 to Dec 2001, 6 neurologically impaired patients underwent reconstruction of chronic pressure sores utilizing an inferiorly based rectus abdominis musculocutaneous flap. Postoperative follow-up ranged from 6 to 15 months. The average thickness of rectus abdominis muscle in quadriplegic patient is less than half of that in healthy patient. In most cases, mild venous congestions are developed, but these were resolved by medical treatment. All wounds have healed without any significant complications such as flap loss, infection, hernia, and sepsis. In conclusion, rectus abdominis muscle for these reconstructions provides a simple, reliable solution to often difficult reconstructive problem. We recommended this highly viable, versatile and reliable flap as one to be considered in planning the reconstruction of the quadriplegia patient with pressure sores when other local and regional flaps are unavailable.
Diabetes Mellitus ; Estrogens, Conjugated (USP) ; Follow-Up Studies ; Fractures, Spontaneous ; Hernia ; Humans ; Myocutaneous Flap ; Osteomyelitis ; Pressure Ulcer* ; Quadriplegia* ; Radiotherapy ; Rectus Abdominis* ; Sepsis ; Spinal Cord ; Wounds and Injuries

BACKGROUND: More than 70% of morbidity and mortality of diabetes mellitus is due to macrovascular complications. These complications may be associated with defect of endothelium-dependent vascular relaxation. There have been suggestions that this defect might be due to direct toxicities of oxygen-free radical. So in this study ascorbic acid was used as a dietary supplement in streptozotocin induced diabetic rats to correct this defect. MATERIAL AND METHOD: Sixty male Sprague-Dawley rats were used in this study. They were divided into control and experimental groups. Streptozotocin was injected to the 33 rats of experimental group and then divided into two the other receiving subgroups; one receiving ascorbic acid supplement(1 g/l in drinking water); and nosupplements. At 6, 9 and 12 weeks, abdominal aortic rings were obtained to make tissue preparations for evaluation of vascular smooth muscle contractility. RESULT: While control group showed good response to acetylcholine induced relaxation, diabetic group showed decreased relaxation regardless of ascorbic acid supplement at the experiments 6 weeks after streptozotocin treatment. This abnormal endothelium-dependent vascular relaxation was markedly reversed at 9 and 12 weeks into the diabetic group with ascorbic acid supplement. There were no differences in sodium nitroprusside induced relaxation responses between control and experimental groups; also, norepinephrine induced contractile responses did not show any remarkable effects. CONCLUSION: These results strongly suggest that the endothelial cells have defects in diabetic rats. Dietary supplement of ascorbic acid can reverse the defects of diabetic endothelial cells through its antioxidant effects and it may further protect against vascular disease in diabetic patients.
Acetylcholine ; Animals ; Antioxidants ; Ascorbic Acid* ; Diabetes Mellitus ; Dietary Supplements ; Drinking ; Endothelial Cells ; Humans ; Male ; Mortality ; Muscle, Smooth, Vascular ; Nitroprusside ; Norepinephrine ; Rats* ; Rats, Sprague-Dawley ; Relaxation ; Streptozocin ; Vascular Diseases

Congenital macrostomia is a result of defective union between the mandibular and maxillary processes and it is a rare deformity seen in every 100 to 300 facial clefts. Ohnizuka1`classified macrostomia into two groups as congenital and posttraumatic. We experienced two cases of acquired macrostomia due to NOMA sequelae(58/F:Lt & 51/F:Rt) and one case of congenital macrostomia (3 months/M:Rt). Many plastic surgeons have developed surgical procedures for repair of this congenital macrostomia. Among them, McCarthy6,11 described the classic commissuroplasty. We could repaired 1 case of congenital macrostomia and two cases of acquired macrostomia due to NOMA sequelae using modified technique of McCarthy,s classic commissuroplasty. McCarthy described new oral commissure 2-3mm laterally for prevention of postoperative contraction, orbicularis oris muscle transposition to restore labial function and a z- plasty cutaneous closure. But some author raise an objection to new oral commissure 2-3mm laterally, and they made new oral commissure at same distance of opposite side normal commissure. And so, we designed the new oral commissure moved 1mm laterally comparing to original commissuroplasty in a congenital case for the prevention of displacement. In cases of acquired macrostomia due to NOMA sequelae, we reconstructed new oral commissure like congenital case, moved 1mm laterally. Orbicularis oris muscle transposition could not be possible because of destruction of muscle, adhesion and atrophy. And so we dissected muscle and just sutured side by side. Acquired macrostomia following NOMA sequelae manifsted facial deformity variably, and reconstruction of the facial deformity is difficult by using simple approach. Other variable reconstructive procedures were needed with commissuroplasty as like Washio flap, rotation advancement flap, bone graft and free radial forarm flap, etc. Postoperative results were relatively good. We propose that macrostomia due to NOMA sequelae must add to Ohnizuka classification of acquired macrostomia.
Atrophy ; Classification ; Congenital Abnormalities ; Macrostomia* ; Noma ; Transplants

We report a case of isolated primary medullary hemorrhage with a review of the literature to analyze the clinical presentation and radiological character. A 46-year-old man with chronic alcoholism developed tegmental medullary syndrome secondary to spontaneous hemorrhages in the medulla oblongata. Magnetic resonance imaging study was carried out on the third day after the second event, which showed two distinct isolated hematomas in the medulla oblongata. Digital subtraction angiography was normal. The cause of hemorrhage was presumed to be cryptic vascular malformation. The primary medullary hemorrhage usually presents with a characteristic syndrome of sudden onset vertigo with neurological signs that correspond to various combination of medial and lateral medullary involvement. Usually, the prognosis is good only with conservative treatment.
Alcoholism ; Angiography, Digital Subtraction ; Hematoma ; Hemorrhage* ; Humans ; Magnetic Resonance Imaging ; Medulla Oblongata ; Middle Aged ; Prognosis ; Vascular Malformations ; Vertigo

OBJECTIVE: Cognitive behavioral therapy (CBT) is regarded as one of the most effective intervention for obsessive-compulsive disorder (OCD). However, many patients remain untreated or inadequately treated due to time or geographical constraints. The purpose of this study was to develop an internet-based CBT (ICBT) for OCD, and to examine its efficacy in the Korean clinical setting. METHODS: The ICBT program ('COT') was developed from the same OCD manual in the standard CBT intervention. Twenty-seven participants of the total 42 patients completed all training sessions of the ICBT and the remainder (n=15) were classified as non-completers. Self-report measures of OCD, depression, anxiety, and work/social functioning, in addition to a neurocognitive test battery, were administered by face-to-face before and after treatment. RESULTS: The participants showed significant improvements in OCD and depressive symptoms, and in work/social functioning after ICBT completion. The presence of combined medication had no significant impact on treatment effect. The non-completers displayed more severe depressive and anxiety symptoms, and ICBT responders were younger and performed better in the Wisconsin Card Sorting Test. CONCLUSION: ICBT was found to be as effective for patients with moderate OC symptoms and little treatment experience. Considering the high accessibility and convenience of ICBT, it could be a helpful first treatment step for OCD patients when face-to-face treatment is unavailable. In the future a randomized controlled study will be necessary for verification and generalization of these results.
Anxiety ; Cognitive Therapy* ; Depression ; Generalization (Psychology) ; Humans ; Internet ; Korea* ; Obsessive-Compulsive Disorder* ; Treatment Outcome ; Wisconsin

Inverted nipples have shortened lactiferous ducts and less fibrous and collagenous muscular tissue and less connective tissue present, thus giving less bulk and less tissue for nipple projection. Until now, many authors suggested various methods of correction of inverted nipple, but it shows that perfect method does not exist. From July 2008 to December 2010, 41 nipples in 21 patients were treated. 20 patients had bilateral inverted nipples. Under the local anesthesia with sedation, the nipple was everted. A small incision was made on both lateral side at the nipple-areola junction. After nipple traction, the lactiferous ducts and surrounding connective tissues were divided by sharp dissection only through vertical direction. Upper and lower purse-string sutures using Nylon 4-0 were performed for the maintenance of corrected nipple. The small incision was closed by the simple suture. The operation time averaged 15minutes for each nipple. The mean follow-up period was 6 months. There were no complications associated with surgery, such as recurrence, infection, hematoma, nipple necrosis and sensory loss. We applied modified purse-string sutures to mild and moderate inverted nipple patients, and acquired good results. So we report our experience with a review of literature.
Anesthesia, Local ; Breast Diseases ; Collagen ; Connective Tissue ; Follow-Up Studies ; Hematoma ; Humans ; Necrosis ; Nipples ; Nylons ; Recurrence ; Suture Techniques ; Sutures ; Traction