A 24-year-old female was seen with multiple, pinkish to skin colored and brownish to black pigmented macules, papules, patch and plaque on the face, neck, upper chest, extensor surface of both forearms and dorsal hands. Histopathological diagnoses from the 75 skin biopsy specimens taken during the follow-up period of 22 months include 29 skin tumors : one malignant melanoma, one precancerous melanosis, 16 basal cell carcinamas, four squamous cell carcinomas, four actinic keratoses, one melanoacanthoma, one keratoacanthoma and one angiofibroma. It was discussed that melanoacanthoma would be considered as the one of the associated beniign skin tumors in xeroderma pigmentosum.
Angiofibroma ; Biopsy ; Carcinoma, Squamous Cell ; Diagnosis ; Female ; Follow-Up Studies ; Forearm ; Hand ; Humans ; Ichthyosis* ; Keratoacanthoma ; Keratosis, Actinic ; Melanoma ; Melanosis ; Neck ; Skin* ; Thorax ; Xeroderma Pigmentosum* ; Young Adult

In order to establish the predicted normal values of the systolic time intervals the duration of the systolic time intervals measured from simultaneous recordings of the electrocardiogram, the phonocardiogram and the carotid pulse tracing. The subjects studied were 160 healthy males and 160 females. The mean ages of males and females were 29 and 31 years old, respectively. The transformation period was not closely related to heart rate, and its mean values for males and females were 58 and 56 msec., respectively, and the mean for males and females combined was 57 msec. The remainder of the systolic time intervals, however, showed a significant linear and inverse relation to heart rate. Thus, based upon these data regression equations for the prediction of the normal values of electromechanical systole, left ventricular ejection time, mechinical systole, precjection period andisovolumiccontraction time for males, females, and males and females combined were obtained.
Adult ; Electrocardiography ; Female ; Heart Rate ; Humans ; Male ; Reference Values* ; Systole*

The antihypertensive effect and side reaction of pindolol were studied in 48 cases of essential hypertension 5mg to 15mg once regiment for average period of 6 weeks. 1) Average reduction of 25.11mmHg in systolic and 16.36mmHg in diastolic pressure were observed and their percentile reduction was 15.20% and 14.79%, respectively. The overall effect rate was 83.21%. The blood pressure was lowered significantly since 1 week of both in systolic and diastolic pressure with the daily of 10-15mg. 2) There was no significant change in heart rate before and after treatment. 3) No specific side reaction was observed except 1 cases in which discontinued the medication because of severe headache and fatigability on 2nd day of medication.
Blood Pressure ; Headache ; Heart Rate ; Hypertension ; Pindolol

OBJECTIVE: To evaluate the efficacy of epidural injections of steroid and local anesthetics with the modified Dallas pain questionnaire in the low back pain patients. METHOD: Before and after epidural injections with triamcinolone and local anesthetics, we examined the patients with modified Dallas pain questionnaire. The efficacy was assessed by paired t test to compare the results of this questionnaire. RESULTS: Four aspects of the patient's life (daily activity, work and leisure activity, anxiety- depression, and social interest) were significantly improved after epidural injection in low back pain patients. And their improvements were more definite in patients diagnosed with herniatied lumbar disc, relatively acute onset of symptom, and more serious findings in MRI. CONCLUSION: Epdiural injections of steroid and local anesthetics are effective for patients with low back pain, espercially for improving life quality of patients such as daily activity and work-leisure activity. It also decreases anxiety and increases social interest in some patients. However, validity of modified Dallas pain questionnaire must be proved in the future.
Anesthetics, Local ; Anxiety ; Depression ; Humans ; Injections, Epidural* ; Leisure Activities ; Low Back Pain* ; Magnetic Resonance Imaging ; Quality of Life ; Surveys and Questionnaires* ; Triamcinolone

OBJECTIVE: To evaluate the efficacy of epidural injections of hypertonic saline, steroid and local anesthetics in patients with low back pain and sciatica. METHOD: Retrospective study of 325 patients with low back pain and sciatica. Group I, 261 patients, were treated with epidural injection of steroid (Depo-medrol ) weekly for 2 weeks and local anesthetics (lidocaine and bupivacaine) daily via epidural catheter. Group II, 64 patients, were treated with epidural injection of hypertonic saline for three successive days and same method of group I via epidural catheter. The efficacy was assessed with Visual Analog Scale (VAS) on the day of pre- and post- (2weeks later) epidural injection. RESULTS: (1) VAS score changes from pre- to post-epidural injections were from 6.1+/-3.6 to 3.6+/-1.8 (p<0.05) in Group I and from 6.2+/-1.6 to 2.6+/-1.4 (p<0.05) in Group II. (2) VAS score decrease of Group II was more than that of Group I (p<0.05). CONCLUSION: Epidural injections of hypertonic saline, steroid and local anesthetics are effective for patients with low back pain and sciatica in the short term, and more effective than that of steroid and local anesthetics, but prospective long-term follow up studies will be necessary in the future.
Anesthetics, Local* ; Catheters ; Follow-Up Studies ; Humans ; Injections, Epidural* ; Low Back Pain ; Retrospective Studies ; Sciatica ; Visual Analog Scale

OBJECTIVE: Morphometric data for the sympathetic ganglia (SG) of the upper thoracic spine was investigated to identify the exact location of the SG in order to reduce normal tissue injury in the thoracic cavity during thoracoscopic sympathectomy. METHODS: In 46 specimens from 23 formalin-fixed adult cadavers, the authors measured the shortest distance from the medial margin of the T1, T2 and T3 SG to the most prominent point and medial margin of the corresponding rib heads, and to the lateral margin of the longus colli muscle. In addition, the distance between the most prominent point of the rib head and the lateral margin of longus colli muscle and the width of each SG were measured. RESULTS: The shortest distance from the medial margin of the SG to the prominent point of corresponding rib head was on average 1.9 mm on T1, 4.2 mm, and 4.1 mm on T2, T3. The distance from the medial margin of the SG to the medial margin of the corresponding rib head was 4.2 mm on T1, 5.9 mm, and 6.3 mm on T2, T3. The mean distance from the medial margin of the SG to the lateral margin of the longus colli muscle was 6.7 mm on T1, 8.8 mm, 9.9 and mm on T2, T3. The mean distance between the prominent point of the rib head and the lateral margin of the longus colli muscle was 4.8 mm on T1, 4.6 mm, and 5.9 mm on T2, T3. The mean width of SG was 6.1 mm on T1, 4.1 mm, and 3.1 mm on T2, T3. CONCLUSION: We present morphometric data to assist in surgical planning and the localization of the upper thoracic SG during thoracoscopic sympathectomy.
Adult ; Cadaver ; Ganglia, Sympathetic ; Head ; Humans ; Muscles ; Ribs ; Spine ; Sympathectomy ; Thoracic Cavity ; Thoracic Vertebrae ; Thoracoscopy

From March 1988 to June 1994, 275 CarboMedics cardiac valve prostheses (199 mitral, 70 aortic and 3 tricuspid) were implanted in 226 consecutive patients(mean age 39 years, male/female 90/136) by one surgical team operating on adult cardiac patients at Kyungpook University Hospital. Total follow up represented 16,848 patient-months (mean 76 months) and follow up rate was 96%. One hundred and forty-nine patients (66%) wer in NYHA functional class III or IV preoperatively, and 204 patients (99.5%) were in class I or II postoperatively. Early mortality was 4.9% and late death was 9.3%. The actuarial survival at 81 months was 86.l2+/-3.1%. The linearized incidence of valve-related death, prosthetic valve thrombosis, anticoagulation-related hemorrhage, non-structural dysfunction and reoperation were 0.71%, 0.43%, 0.07%, 0.21%, and 0.14% respectively. The 81-month rate of freedom from all valve related complications and deaths including hospital mortality was 88.1+/-2.5%. Thee facts suggest that the CarboMedics cardiac valve has excellent result, low incidence of valve-related complications and no structureal deterioration.
Adult ; Follow-Up Studies ; Freedom ; Gyeongsangbuk-do ; Heart Valve Prosthesis ; Heart Valves ; Hemorrhage ; Hospital Mortality ; Humans ; Incidence ; Mortality ; Reoperation ; Thrombosis

OBJECTIVE: Decompressive craniectomy is an effective therapy to relieve high intracranial pressure after acute brain damage. However, the optimal timing for cranioplasty after decompression is still controversial. Many authors reported that early cranioplasty may contribute to improve the cerebral blood flow and brain metabolism. However, despite all the advantages, there always remains a concern that early cranioplasty may increase the chance of infection. The purpose of this retrospective study is to investigate whether the early cranioplasty increase the infection rate. We also evaluated the risk factors of infection following cranioplasty. METHODS: We retrospectively examined the results of 131 patients who underwent cranioplasty in our institution between January 2008 and June 2015. We divided them into early (≤90 days) and late (>90 days after craniectomy) groups. We examined the risk factors of infection after cranioplasty. We analyzed the infection rate between two groups. RESULTS: There were more male patients (62%) than female (38%). The mean age was 49 years. Infection occurred in 17 patients (13%) after cranioplasty. The infection rate of early cranioplasty was lower than that of late cranioplasty (7% vs. 20%; p=0.02). Early cranioplasty, non-metal allograft materials, re-operation before cranioplasty and younger age were the significant factors in the infection rate after cranioplasty (p<0.05). Especially allograft was a significant risk factor of infection (odds ratio, 12.4; 95% confidence interval, 3.24–47.33; p<0.01). Younger age was also a significant risk factor of infection after cranioplasty by multivariable analysis (odds ratio, 0.96; 95% confidence interval, 0.96–0.99; p=0.02). CONCLUSION: Early cranioplasty did not increase the infection rate in this study. The use of non-metal allograft materials influenced a more important role in infection in cranioplasty. Actually, timing itself was not a significant risk factor in multivariate analysis. So the early cranioplasty may bring better outcomes in cognitive functions or wound without raising the infection rate.
Allografts ; Brain ; Cerebrovascular Circulation ; Cognition ; Decompression ; Decompressive Craniectomy ; Female ; Humans ; Intracranial Pressure ; Male ; Metabolism ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Wounds and Injuries

OBJECTIVE: Treatment of intracranial dural arteriovenous fistulas (dAVFs) remains a challenge. However, after introduction of Onyx, transarterial approach is the preferred treatment option in many centers. We report our experience of dAVFs embolization with special emphasis on transarterial approach. METHODS: Seventeen embolization procedures were performed in 13 patients with dAVFs between Jan 2009 and Oct 2014. Clinical symptoms, location and type of fistulas, embolization methods, complications, radiological and clinical outcomes were evaluated using charts and PACS images. RESULTS: All 13 patients had symptomatic lesions. The locations of fistulas were transverse-sigmoid sinus in 6, middle fossa dura in 4, cavernous sinus in 2, and superior sagittal sinus in 1 patient. Cognard types were as follows : I in 4, IIa in 2, IIa+IIb in 5, and IV in 2. Embolization procedures were performed > or =2 times in 3 patients. Nine patients were treated with transarterial Onyx embolization alone. One of these required direct surgical puncture of middle meningeal artery. Complete obliteration of fistulas was achieved in 11/13 (85%) patients. There were no complications except for 1 case of Onyx migration in cavernous dAVF. Modified Rankin scale score at post-operative 3 months were 0 in 11, and 3 in 2 patients. CONCLUSION: Transarterial Onyx embolization can be a first line therapeutic option in patients with dAVFs. However, transvenous approach should be tried first in cavernous sinus dAVF because of the risk of intracranial migration of liquid embolic materials. Furthermore, combined surgical endovascular approach can be considered as a useful option in inaccessible route.
Cavernous Sinus ; Central Nervous System Vascular Malformations* ; Fistula ; Humans ; Meningeal Arteries ; Punctures ; Superior Sagittal Sinus

OBJECTIVE: Obturator neuropathy is a rare condition. Many neurosurgeons are unfamiliar with the obturator nerve anatomy. The purpose of this study was to define obturator nerve landmarks around the obturator foramen. METHODS: Fourteen cadavers were studied bilaterally to measure the distances from the nerve root to relevant anatomical landmarks near the obturator nerve, including the anterior superior iliac spine (ASIS), the pubic tubercle, the inguinal ligament, the femoral artery, and the adductor longus. RESULTS: The obturator nerve exits the obturator foramen and travels infero-medially between the adductors longus and brevis. The median distances from the obturator nerve exit zone (ONEZ) to the ASIS and pubic tubercle were 114 mm and 30 mm, respectively. The median horizontal and vertical distances between the pubic tubercle and the ONEZ were 17 mm and 27 mm, respectively. The shortest median distance from the ONEZ to the inguinal ligament was 19 mm. The median inguinal ligament lengths from the ASIS and the median pubic tubercle to the shortest point were 103 mm and 24 mm, respectively. The median obturator nerve lengths between the ONEZ and the adductor longus and femoral artery were 41 mm and 28 mm, respectively. CONCLUSION: The obturator nerve exits the foramen 17 mm and 27 mm on the horizontal and sagittal planes, respectively, from the pubic tubercle below the pectineus muscle. The shallowest area is approximately one-fifth medially from the inguinal ligament. This study will help improve the accuracy of obturator nerve surgeries to better establish therapeutic plans and decrease complications.
Cadaver ; Femoral Artery ; Ligaments ; Obturator Nerve* ; Spine