In the East, Probably one of the most commonly performed esthetic operation is the piercing of the earlobes for earring. the complication of this procedure includes infection, the formation of the hypertrophic scar or keloid, and tearing. Keloid formation is one of the disaterous common complications of the ear piercing. the patients regard the keloid as a cosmetic blemish and they complain that they cannot wear earrings. We have experienced 5 patients of earlobe keloid complicated from piercing of the earlobes. We used intralestional steroid njection, in conjunction with surgical excision and pressure therapy for treatment of the keloid. Among various techniques for reconstructing a piercing, we chose modified Pardue's method for artificial earlobe cleft after wide excision of the keloid. the result was good and satisfactory without any complication after 4 to 24 months of follow-up. the purpose of this paper is to present a simple method of treatment of the earlobe keloid with preservation of the perforation for an earring.
Body Piercing ; Cicatrix, Hypertrophic ; Ear* ; Follow-Up Studies ; Humans ; Keloid*

BACKGROUND AND PURPOSE: Cilostazol, a phosphodiesterase III inhibitor, is known to be a useful antiplatelet agent that inhibits the progression of atherosclerosis in ischemic stroke. This study investigated the effects of combining cilostazol with aspirin on the expressions of P-selectin and PAC-1 on activated platelets in acute ischemic stroke. METHODS: We analyzed 70 patients with acute ischemic stroke (<72 hrs of an ischemic event). The daily intake was 100 mg of aspirin in 37 patients and 100 mg of aspirin plus 200 mg of cilostazol in 33 patients. The expressions of P-selectin and PAC-1 on activated platelets were measured on the day of admission and 5 days later. We also evaluated the clinical progression using the National Institutes of Health Stroke Scale (NIHSS) at the same times. RESULTS: After 5 days the extent of PAC-1 expression on activated platelets was significantly lower for combined aspirin and cilostazol treatment (61.0+/-19.3%, p=0.008; mean+/-standard deviation) than the baseline level (70.9+/-12.9%), but did not differ between aspirin alone (66.0 +/-19.0%) and baseline (70.1+/-15.7%). The expression of P-selectin did not differ between combined aspirin and cilostazol treatment and baseline. The clinical progression did not differ between the two groups, as indicated by the absence of significant changes on the NIHSS in the acute period. CONCLUSIONS:This study found that the combined regimen of aspirin and cilostazol exerts the beneficial effect of reducing PAC-1 activity on activated platelets in acute ischemic stroke. However, the clinical outcome of this regimen was no better than that of the aspirin-only regimen. Therefore, further detailed studies of the possible clinical benefits of cilostazol in acute ischemic stroke are needed.
Aspirin ; Atherosclerosis ; Blood Platelets ; Cyclic Nucleotide Phosphodiesterases, Type 3 ; Humans ; National Institutes of Health (U.S.) ; P-Selectin ; Stroke ; Tetrazoles

BACKGROUND: Diffusion-perfusion mismatch (DPM) on MRI has been considered an ischemic penumbra. However, several reports have demonstrated limitation of DPM on MRI as a predictable marker of the ischemic penumbra. In this study, we investigated the relationship between DPM and the clinical progression in acute ischemic stroke patients. METHODS: We consecutively recruited fifty-seven patients showing acute ischemic stroke (within 24 hours) in the middle cerebral artery (MCA) territory. The clinical outcomes were determined by serial measurement of National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) during 30 days after their ischemic event. We also evaluated the relationship among the parameters of perfusion MRI and the clinical worsening in patients with DPM on initial MRI. RESULTS: Nineteen (33.3%) patients had DPM on MRI within 24 hours after stroke onset. Even though the frequency of clinical worsening for 30 days after stroke onset was higher in DPM group (26%) than in non-DPM group (11%), it did not reach statistical significance (p=0.143). However, extent of MCA stenosis (p<0.001) and time to peak (TTP) delay on MRI (p<0.001) were significantly greater in patients with DPM than in those without DPM. Among several parameters of the perfusion MRI, only relative cerebral blood volume (rCBV) was significantly related to the clinical worsening (62.9+/-24.7% vs 96.1+/-19.2%, p=0.007) in patients with DPM. CONCLUSIONS: This study shows that DPM on MRI does not always predict the clinical worsening in acute ischemic stroke. To overcome this problem, we should analyze rCBV map based DPM as well as TTP map based DPM.
Blood Volume ; Brain ; Constriction, Pathologic ; Diffusion ; Humans ; Magnetic Resonance Imaging ; Middle Cerebral Artery ; Perfusion ; Stroke ; Thymine Nucleotides

Behcet's Disease (BD) is a chronic inflammatory disorder characterized by vasculitis of unknown cause, involving multiple organs. In the past years, renal involvement has not been regarded as a feature of BD. However, renal lesions in BD, although uncommon, have increasingly been recognized in recent years. Five categories of renal lesions associated with BD have been identified, including glomerulonephritis, amyloidosis, renal vascular involvement, interstitial nephritis, and other problems, such as complications of drug therapy or abnormalities of the genitourinary tract. On the other hand, regional differences in the disease expression of BD are well appreciated. Renal lesions accompanied by BD have rarely been reported in Korea, although it have been described occasionally in the Middle Eastern countries. Hereby, we described a 46-year-old female patient who had BD with persistent hematuria and proteinuria, whose renal biopsy specimens were consistent with thin glomerular basement membrane disease. Interestingly, some portions of her glomerular capillary walls were filled with fuchsinophilic fibrin-like materials.
Amyloidosis ; Basement Membrane ; Biopsy ; Capillaries ; Drug Therapy ; Female ; Glomerular Basement Membrane* ; Glomerulonephritis ; Hand ; Hematuria ; Humans ; Korea ; Middle Aged ; Nephritis, Interstitial ; Proteinuria ; Vasculitis

Macrocephaly commonly occurs in children with untreated or neglected hydrocephalus, and in most cases this is accompanied with discrepancy between the volume of the brain and the cranial cavity. Macrocephaly usually interferes with head control, seating, locomotion, and social acceptance. So the goals of the reduction cranioplasty lie in reconstruction of the head shape, control of intracranial pressure, obstruction of the growth of the head, which enables to ambulate. However, reports about surgery of macrocephaly are scanty. A 24-month-old girl suffered from hydrocephalus with macrocephaly. Her head circumference was 71cm and couldn't control her head or lie in lateral position. The surgical technique we used was a one-stage operation, using a sagittal hinge flap. This technique includes infracturing with wedge resection of the marginal skull and pushing it inward. The dura mater in the frontal region was plicated, while care was taken to maintain attachment of the superior sagittal sinus, the fixation was done with microplates, screws and wirings. After the operation, she had no air embolism, venous infarction, infection, neurologic deficit and had satisfactory cosmetic results. History of the operation of macrocephaly, tactical considerations and possible risks are discussed with our surgical experience in this publication.
Brain ; Child ; Child, Preschool ; Dura Mater ; Embolism, Air ; Female ; Head ; Humans ; Hydrocephalus ; Infarction ; Intracranial Pressure ; Locomotion ; Macrocephaly* ; Neurologic Manifestations ; Publications ; Skull ; Social Distance ; Superior Sagittal Sinus

Anesthesia and surgery in a patients with undiagnosed or untreated hypothyroidism can carries the risk of potential complications such as prolonged unconsciousness, respiratory insufficiency, hypotension, hyponatremia, congestive heart failure, and even coma. A 33-year-old gravida was admitted at 36 weeks gestation with hypertension, proteinuria, generalized edema, and intrauterine fetal growth retardation. She had thyroidectomy for thyroid mass six years ago. Because of doubt of uterine abruption, emergency cesarean section was performed without result of thyroid function test. Preeclamsia and mild hypothyroidism show similar symptoms and it can make difficult to diagnose hypothyroidism. We experienced delayed recovery and respiratory insufficiency in a patient with preeclamsia and undetected hypothyroidism during emergence from general anesthesia. She was fully recovered after ventilatory care in intensive care unit.
Adult ; Anesthesia ; Anesthesia, General ; Cesarean Section ; Coma ; Edema ; Emergencies ; Female ; Fetal Growth Retardation ; Heart Failure ; Humans ; Hypertension ; Hyponatremia ; Hypotension ; Hypothyroidism ; Intensive Care Units ; Pregnancy ; Proteinuria ; Respiratory Insufficiency ; Thyroid Function Tests ; Thyroid Gland ; Thyroidectomy ; Unconsciousness

Hashimoto's thyroiditis is an autoimmune thyroid disease characterized by a gradual enlargement of the thyroid gland, extensive lymphocytic infiltration and fibrosis of thyroid follicles. Hashimoto's thyroiditis occurs frequently in conjunction with a wide range of organ-specific and systemic autoimmune diseases. The association of chronic lymphocytic leukemia with other autoimmune diseases also has been recognized. Here, we report a case of chronic lymphocytic leukemia diagnosed by abrupt painful swelling of the thyroid gland in a 69-year-old woman with Hashimoto's thyroiditis. The painful enlargement of goiter and elevated levels of antibodies to thyroglobulin were improved after chemotherapy with cyclophosphamide, vicristine and prednisolone.
Aged ; Antibodies ; Autoimmune Diseases ; Cyclophosphamide ; Drug Therapy ; Female ; Fibrosis ; Goiter ; Humans ; Leukemia, Lymphocytic, Chronic, B-Cell* ; Prednisolone ; Thyroglobulin ; Thyroid Diseases ; Thyroid Gland* ; Thyroiditis* ; Thyroiditis, Autoimmune

OBJECTIVE: To evaluate the early clinical experience associated with radiofrequency (RF) ablation in patients with renal cell carcinoma (RCC). MATERIALS AND METHODS: The RF ablation treatment was performed on 17 tumors from 16 patients (mean age, 60.5 years; range, 43-73 years) with RCC. The treatment indications were localized, solid renal mass, comorbidities, high operation risk, and refusal to perform surgery. All tumors were treated by a percutaneous CT (n = 10), followed by an US-guided (n = 2), laparoscopy-assisted US (n = 2), and an open (n = 2) RF ablation. Furthermore, patients underwent a follow-up CT at one day, one week, one month, three and six months, and then every six months from the onset of treatment. We evaluated the technical success, technical effectiveness, ablation zone, benign periablation enhancement, irregular peripheral enhancement, and complications. RESULTS: All 17 exophytic tumors (mean size, 2.2 cm; range, 1.1-5.0 cm) were completely ablated. Technical success and effectiveness was achieved in all cases and the mean follow-up period was 23.8 months (range, 17-33 months). A local recurrence was not detected in any of the cases; however, five patients developed complications as a result of treatment, including hematuria (n = 2), mild thermal injury of the psoas muscle (n = 1), mild hydronephrosis (n = 1), and fistula formation (n = 1). CONCLUSION: The RF ablation is an alternative treatment for exophytic RCCs and represents a promising treatment for some patients with small RCCs.
Adult ; Aged ; Carcinoma, Renal Cell/radiography/*surgery ; *Catheter Ablation/adverse effects ; Female ; Humans ; Kidney Neoplasms/radiography/*surgery ; Male ; Middle Aged ; Tomography, X-Ray Computed

Probably the three most important components to a comprehensive evaluation of patients with attention-deficit hyperactivity disorder(ADHD) are the clinical interview, the medical examination, and the completion and scoring of behavior rating scales. Teachers and other school personnel are often the first to recognize that a child or adolescent might have ADHD, and often play an important role in the help-seeking/referral process. A diagnostic evaluation for ADHD should include questions about ADHD symptoms, other problems including alcohol and drug use, family history of ADHD, prior evaluation and treatment for ADHD. Screening interview or rating scales as well as interviews should be used. When it is feasible, clinicians may wish to supplement these components of the evaluation with objective assessments of the ADHD symptoms, such as psychological tests. These tests are not essential to reaching a diagnosis, however, or to treatment planning, but they may yield further information about the presence and severity of cognitive impairments that could be associated with some cases of ADHD. Screening for intellectual ability and academic achievement skills is also important in determining the presence of comorbid developmental delay or learning disabilities. The number and type of symptoms required for a diagnosis of ADHD vary depending on the specific subtype. To receive a diagnosis of ADHD, the person must be experiencing significant distress or impairment in daily functioning, and must not meet criteria for other mental disorders which might better account for the observed symptoms such as mental retardation, autism or other pervasive developmental disorders, mood disorders, anxiety disorders. This report aims to suggest a practice guideline of assessment and diagnosis for children and adolescents with ADHD in Korea.
Adolescent ; Anxiety Disorders ; Autistic Disorder ; Child ; Diagnosis* ; Humans ; Intellectual Disability ; Korea ; Learning Disorders ; Mass Screening ; Mental Disorders ; Mood Disorders ; Psychological Tests ; Weights and Measures

Alternative sources of mesenchymal stem cells (MSCs) for replacing bone marrow (BM) have been extensively investigated in the field of bone tissue engineering. The purpose of this study was to compare the osteogenic potential of canine MSCs derived from adipose tissue (AT), BM, umbilical cord blood (UCB), and Wharton's jelly (WJ) using in vitro culture techniques and in vivo orthotopic implantation assays. After canine MSCs were isolated from various tissues, the proliferation and osteogenic potential along with vascular endothelial growth factor (VEGF) production were measured and compared in vitro. For the in vivo assay, MSCs derived from each type of tissue were mixed with beta-tricalcium phosphate and implanted into segmental bone defects in dogs. Among the different types of MSCs, AT-MSCs had a higher proliferation potential and BM-MSCs produced the most VEGF. AT-MSCs and UCB-MSCs showed greater in vitro osteogenic potential compared to the other cells. Radiographic and histological analyses showed that all tested MSCs had similar osteogenic capacities, and the level of new bone formation was much higher with implants containing MSCs than cell-free implants. These results indicate that AT-MSCs, UCB-MSCs, and WJ-MSCs can potentially be used in place of BM-MSCs for clinical bone engineering procedures.
Adipocytes, White/cytology/physiology ; Alkaline Phosphatase/metabolism ; Animals ; Biocompatible Materials/metabolism/*therapeutic use ; Bone Diseases/*therapy ; Bone Marrow Cells/cytology/physiology ; Calcification, Physiologic ; Calcium/metabolism ; Calcium Phosphates/metabolism/therapeutic use ; Cell Proliferation ; Dogs ; Female ; Fetal Blood/cytology/physiology ; Flow Cytometry ; Male ; Mesenchymal Stromal Cells/cytology/*metabolism ; *Osteogenesis ; Polyesters/metabolism/therapeutic use ; Tissue Engineering/*methods ; Vascular Endothelial Growth Factor A/metabolism