A new balloon dissector, a modification of a Foley catheter, was devised and it can be used either as a dissector or a tissue expander. Since most operating time was spent in balloon manipulation (inflation/deflation), the duct for saline injection was made to be wider than the Foley catheter. As a result, the balloon could be inflated faster than before. In order to reduce the scar at the donor site, harvest of the sural nerve using endoscopic technique is currently applied, but utilization of this method is technically difficult and requires a long operating time. For these reasons, new our method of using a balloon dissector was devised. The balloon dissector can also be used for immediate intraoperative tissue expansion for the reconstruction of small skin defects without distortion. We have found that the advantages of using the new balloon dissector include a reduction in operating time, preservation of the perforating vessels, and primary closure with less tension. In addition, this simple and inexpensive instrument is cost-beneficial to patients.
Catheters ; Cicatrix ; Humans ; Skin ; Sural Nerve ; Tissue Donors ; Tissue Expansion ; Tissue Expansion Devices

Granular cell tumors were originally described in 1926 by Abrikossoff as myoblastic myomas. They usually occur as solitary tumors but can be multiple in about 10% of cases. They have a predilection for the skin, subcutaneous tissue and tongue, but also occur in many other organs. We report a case of solitary granular cell tumor on the palm. This is a very unusual location of this disease which merits consideration.
Granular Cell Tumor* ; Myoblasts ; Myoma ; Skin ; Subcutaneous Tissue ; Tongue

Malignant hyperthermia is defined as a potentially fatal hypermetabolic syndrome characterized by hyperpyrexia, skeletal muscle rigidity, tachycardia, respiratory and metabolic acidosis, cyanosis etx. There is no simple noninvasive test to identify the susceptible individuals. A history of hyperpyrexia and/or muscle rigidity during previous general or a family history of such a condition provides the anesthesiologist with valuable information. Avoidance of potent inhalational anesthetic agents and other triggering agenta, and the selective use of regional anesthesia with either a local anesthetic agent or neuroleptic anesthesia, are the usual acceptable guidelines in the anesthetic management of susceptible individuals. Dentrolene sodium has been shown to be effective in the prevention and treatment of malignant hyperthermia in malignant hyperthermia susceptible swine. We gave Dantrolene sodium orally as a part of the prophylaxia for malignant hyperthermia in a 34yearts-old woman who underwent an emergency bilateral salpingectomy and who had a family history of malignant hyperthermia. We report on this patient with a family history of hyperthermia and reviewed the literature concerning malignant hyperthermia.
Acidosis ; Anesthesia ; Anesthesia, Conduction ; Anesthetics ; Cyanosis ; Dantrolene ; Emergencies ; Female ; Fever ; Humans ; Malignant Hyperthermia* ; Muscle Rigidity ; Muscle, Skeletal ; Salpingectomy ; Sodium ; Swine ; Tachycardia

Purpose: Female sexual dysfunction is defined as a disorder of sexual desire, arousal, or orgasm, and/or sexual pain, resulting in personal distress that impacts on the quality of life and interpersonal relationships. It is a compilation of problems that has both biological and psychosocial components and is multifactorial in its etiology. In this study, the female sexual dysfunction in overactive bladder (OAB) patients was evaluated. Materials and Methods: The subjects included 63 female who visited our health care center for health medical examinations without voiding symptoms (control group) and 37 female patients with OAB. All patients were asked to complete the Brief index of sexual functioning for women (BISF-W), which had been translated into Korean. The Beck depression inventory (BDI) and State-Trait anxiety inventory (STAI) were also used to assess the relationship between the sexual dysfunction and anxiety or depression. The results were analyzed statistically by ANCOVA using age as a covariant. Results: The mean ages in the OAB and control groups were 35.47+/-6.76 and 42.70+/-9.68 years, respectively. The mean scores of desire in the OAB and control groups were 3.92+/-3.09 and 8.92+/-4.99, for arousal were 6.78+/-3.85 and 11.06+/-5.60, frequency of sexual activity 3.92+/-5.24 and 8.53+/-4.52, receptivity/initiation 10.08+/-3.71 and 11.47+/-4.91, orgasm 13.19+/-6.97 and 19.72+/-7.36, relationship satisfaction 7.12+/-1.68 and 7.11+/-1.88 and physical problems affecting sexual function 12.14+/-6.17, 11.83+/-5.05, respectively. The OAB group shows decreased sexual desire, arousal, frequency of sexual activity and orgasm compared to the control group (p<0.05). However, there were no differences in anxiety or depression between the two groups and there was no sexual dysfunction due to anxiety or depression in either group. Conclusions: Female sexual dysfunction was more common in OAB patients than the controls. OAB is one of the important factor affecting female sexual dysfunction. Consideration should be given with regard to female sexual dysfunction in patients with OAB.
Anxiety ; Arousal ; Delivery of Health Care ; Depression ; Female* ; Humans ; Orgasm ; Quality of Life ; Sexual Behavior ; Sexuality ; Urinary Bladder ; Urinary Bladder, Overactive*

BACKGROUND: Spinal anesthesia for urologic surgery in elderly patients is preferred. The addition of opioids to local anesthetics reduces the side effects of spinal anesthesia. This study examined the effects of intrathecal fentanyl 10microgram and 20microgram when administered with hyperbaric 0.5% bupivacaine to elderly patients undergoing urologic surgery. METHODS: Forty-five elderly patients undergoing urologic surgery were randomized into the following three groups: group 1, bupivacaine 7.5 mg; group 2, bupivacaine 5 mg + fentanyl 10microgram; and group 3, bupivacanie 5 mg + fentanyl 20microgram. The total volume of intrathecally injected was adjusted to 1.5 ml with sterile normal saline. Spinal anesthesia was administered with a 25 G Quincke needle at the L3-4 or L4-5 interspace in the lateral position. The neural block was assessed using a pinprick test and the Bromage scale. RESULTS: There were no significant differences in the onset time of the T10 sensory block, peak level of the sensory block, and onset time of the peak level. The duration of the sensory block was significantly shorter in group 2 than in group 1 (P = 0.017). The duration of the motor block was longer in group 1 than in groups 2 and 3 (P = 0.016, P = 0.04). Pruritus was observed more often in group 3 (37.5%) and shivering was more common in group 1 (P = 0.005). CONCLUSIONS: The addition of fentanyl 10microgram and 20microgram to bupivacaine 5 mg provides adequate anesthesia for elderly patients undergoing urologic surgery with fewer side effects, and fentanyl 10microgram is recommended as outpatient anesthesia.
Aged ; Analgesics, Opioid ; Anesthesia ; Anesthesia, Spinal ; Anesthetics, Local ; Bupivacaine ; Fentanyl ; Humans ; Needles ; Outpatients ; Pruritus ; Shivering

BACKGROUND/AIMS: Despite great progress, antiviral treatment for chronic hepatitis C in patients with prior hepatocellular carcinoma (HCC) has been rarely investigated. We evaluated the efficacy and safety of antiviral therapy following treatment for hepatitis C-related HCC. METHODS: Thirteen patients (age 34 to 60 years) who were treated with peginterferon plus ribavirin after treatment for HCC were reviewed. RESULTS: There were 6 patients with genotype 1 and 7 patients with genotype 2. All patients showed advanced fibrosis (> or =F3) but belonged to the Child-Pugh class A. Treatment was stopped in 2 patients because of recurrent HCC and in 1 patient due to a lack of early virologic response. Seven patients achieved sustained virologic response and three patients relapsed. The sustained virologic response rate was 54% overall, 17% in genotype 1, and 86% in genotype 2. No significant adverse events were reported. CONCLUSIONS: Antiviral therapy should not be excluded in patients who were previously treated with HCC with genotype 2 chronic hepatitis C, in which an efficacious antiviral treatment for chronic hepatitis C was feasible. Additional study is needed to prove the validity of antiviral therapy in patients with genotype 1 hepatitis C-related HCC.
Carcinoma, Hepatocellular ; Fibrosis ; Genotype ; Hepatitis ; Hepatitis C, Chronic ; Humans ; Ribavirin

BACKGROUND: It has been reported that nail psoriasis is common in psoriatic arthritis (PsA) patients, however, studies on the prevalence of PsA with nail psoriasis and the relationship between the severity of the diseases has not previously been reported in Korea. OBJECTIVE: The aim of this study was to investigate nail psoriasis and its relation to psoriasis and PsA. METHODS: After researching past medical records, 48 patients with nail psoriasis and 247 patients without nail psoriasis were enrolled in this study. Nail psoriasis was classified according to the morphologic types of nails and severity was evaluated using the modified nail psoriasis severity score index (mNAPSI). We assessed the severity of psoriasis and PsA by psoriasis area and severity index (PASI), and swollen and tender joint counts (STJC), respectively. Finally, we analyzed the relationship between mNAPSI, PASI, and STJC. RESULTS: Nail involvement was observed in 48 (16.3%) of 295 patients. Prevalence of PsA was higher in nail psoriasis (31.3%) than in uncomplicated psoriasis (9.3%, p<0.001). mNAPSI showed a positive correlation with STJC (p=0.002, Pearson correlation=0.427), but not with PASI (p=0.094, Pearson correlation=0.202). CONCLUSION: The results show that PsA is more common and severe in psoriatic patients with nail involvement than in uncomplicated psoriasis. Clinicians should be alert to nail involvement in psoriatic patients, as it could be related to the disease course and prognosis of PsA.
Arthritis, Psoriatic* ; Humans ; Joints ; Korea ; Medical Records ; Prevalence ; Prognosis ; Psoriasis*

Botulinum toxin type A is widely used for functional improvement of muscles and aesthetic plastic surgery. It paralyzes the injected muscle by inhibiting acetylcholine release from synapses of neuromuscular junctions. We herein report a case of progressive respiratory distress after botulinum toxin injection at both the gastrocnemius and soleus muscles. The patient also showed ptosis, dysphonia, dysphagia, and general weakness. Vocal cord dysfunction was observed by laryngoscopy. Other neurologic examination findings, including those of the physical examination, brain MRI, and Jolly's test, were normal. To our knowledge, this is the first report of botulinum toxin injection associated with dyspnea (MRC dyspnea scale, grade 3) in Korea.
Acetylcholine ; Botulinum Toxins ; Botulinum Toxins, Type A ; Brain ; Deglutition Disorders ; Dysphonia ; Dyspnea ; Humans ; Korea ; Laryngoscopy ; Muscles ; Neurologic Examination ; Neuromuscular Junction ; Physical Examination ; Surgery, Plastic ; Synapses ; Vocal Cords

PURPOSE: We describe a 54-year-old woman with systemic lupus erythematosus (SLE) who suddenly presented with chorea and had positive antiphospholipid antibodies. F-18 FDG PET showed abnormally increased glucose metabolism in bilateral putamen and primary motor cotex. Tc-99m ECD SPECT also showed abnormally increased regional cerebral blood flow in bilateral putamen. She was treated with corticosteroid and aspirin after which the symptoms improved. Four months later, follow up F-18 FDG PET showed improvement with resolution of hypermetabolism in bilateral putamen. This case suggests that striatal hypermetabolism is associated with chorea in SLE.
Antibodies, Antiphospholipid ; Aspirin ; Chorea* ; Female ; Follow-Up Studies ; Glucose ; Humans ; Lupus Erythematosus, Systemic* ; Metabolism ; Middle Aged ; Putamen ; Tomography, Emission-Computed, Single-Photon

BACKGROUND/AIMS: Adefovir (ADV) is the preferred drug for treating lamivudine (LAM)-resistant hepatitis B. However, not all patients who face virologic breakthrough during LAM treatment respond to ADV. The aim of this study was to determine the factors associated with efficacy of ADV in LAM-resistant hepatitis B patients. METHODS: The medical records of 231 patients who received ADV due to LAM-resistance were reviewed. Efficacy was assessed by the initial virologic response (IVR), defined as hepatitis B virus (HBV) DNA not being undetectable by real-time PCR at 6 months of ADV treatment. RESULTS: Seventy patients (30%) achieved IVR. While 'add-on' modality, hepatitis B e antigen (HBeAg) negativity, and low baseline HBV DNA levels were associated with IVR in univariate analysis, multivariate analysis revealed HBeAg status and the DNA level to be the significant factors. The probability of IVR achievement increased sharply per each log10 copies/mL decrement in the baseline viral load, which was 133 times in patients who had HBV DNA <10(5) copies/mL compared with those who had > or =10(8) copies/mL. CONCLUSIONS: Factors associated with the IVR were HBeAg negativity and a low baseline viral load. Therefore, when virologic breakthrough with genotypic resistance emerges during LAM therapy, ADV treatment should be considered immediately before further increases in viral load. Additional long-term follow-up data are warranted.
Achievement ; Adenine ; DNA ; Drug Resistance, Viral ; Follow-Up Studies ; Hepatitis B ; Hepatitis B e Antigens ; Hepatitis B virus ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Humans ; Lamivudine ; Lipopolysaccharides ; Medical Records ; Multivariate Analysis ; Organophosphonates ; Real-Time Polymerase Chain Reaction ; Viral Load