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/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

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

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

Epidermal nevus syndrome is defined as the association of epidermal nevi with abnormalities of the other organ systems, and is regarded as one of the neurocutaneous syndromes. However, till now, epiderrnal nevus syndromi has not been reported with either Morning glory syndrome or intestinal pseudoobstruction. We experienced a case of a 7-year old rnale who had had multiple epidermal nevi on the scalp and forehead and solitary larg cafeau lait spot on his chest since birth. He had histories of failure to thrive and mental retardation, but no seizures. He also had histories of frequent diarrhea and abdominal distension. Physical examination showed abnormalities of the skin, teeth, and Morning glory syndrome of both oplic discs. Colon study, small bowel series and biopsy showed intestinal pseudoobstruction. Skeletal survey revealed a difference between the left upper extremity and the right one.
Biopsy ; Child ; Colon ; Diarrhea ; Failure to Thrive ; Forehead ; Humans ; Intellectual Disability ; Intestinal Pseudo-Obstruction* ; Neurocutaneous Syndromes ; Nevus* ; Parturition ; Physical Examination ; Scalp ; Seizures ; Skin ; Thorax ; Tooth ; Upper Extremity

Spinach (Spinacia oleracea) is a widely consumed vegetable, but rarely causes allergic reactions. Spinach contains plenty of histamine derivatives, so it is sometimes difficult to distinguish food allergy from pharmacologic effect of histamine itself in susceptible individuals. Latex exhibits strong cross reactivity with proteins from different fruits, vegetables, and grains, which is called as latex fruit syndrome. A 27 year old female visited emergency room with hives, facial swelling, dyspnea and palpitation immediately after meal. She had been suffering from latex allergy and had experienced an episode of anaphylaxis after eating eggplant 5 months earlier. Skin prick test with spinach extract was positive. Specific IgE to spinach antigens was detected by ELISA. ELISA inhibition test revealed that there is cross reactivity between latex and spinach. Two IgE binding components were detected between 22kD and 36kD, and another two between 16kD and 22kD on IgE-immunoblot analysis.
Adult ; Anaphylaxis ; Edible Grain ; Dyspnea ; Eating ; Emergency Service, Hospital ; Enzyme-Linked Immunosorbent Assay ; Female ; Food Hypersensitivity ; Fruit* ; Histamine ; Humans ; Hypersensitivity ; Immunoglobulin E ; Latex Hypersensitivity ; Latex* ; Meals ; Skin ; Solanum melongena* ; Spinacia oleracea* ; Urticaria ; Vegetables

BACKGROUND/AIMS: For more than a decade, triple therapy (proton pump inhibitor, amoxicillin, clarithromycin) has been the first line eradication regimen for Helicobacter pylori infection in Korea. However, recent studies have proven that its' efficacy is no longer tolerable due to increased resistance of antibiotics. This study is aimed to investigate the current status of triple therapy, quadruple therapy and dual therapy as first line regimen for H. pylori infection in single medical center. MATERIALS AND METHODS: Medical records of patients who received urea breath test after first line eradication therapy from August 2011 to November 2014 were retrospectively analyzed. Patients were divided into three groups according to the first line treatment regimen; triple therapy (proton pump inhibitor (PPI)+clarithromycin+amoxicillin), quadruple therapy (PPI+bismuth+tetracycline+metronidazole), dual therapy (PPI+amoxicillin). RESULTS: A total of 557 patients were reviewed and 429 patients (77.0%) had successful eradication. Among 511 patients who received triple therapy, the eradication rates were 77.1% (394 patients). Eradication rates were 95.2% among quadruple therapy group. Dual therapy group had exceptionally low eradication rates (60.0%). CONCLUSIONS: Even though triple therapy has been recommended as first line regimen in Korea, eradication rates were below 80%. Quadruple therapy as first line regimen showed promising future reaching over 90% eradication rates. However, due to the small number of patients in our study, further studies are necessary to estimate usefulness of quadruple therapy as first line regimen.
Amoxicillin ; Anti-Bacterial Agents ; Breath Tests ; Helicobacter pylori* ; Humans ; Korea ; Medical Records ; Retrospective Studies ; Urea