Malignant melanoma of the vulva is a rare neoplasm and accounts for approximately 10% of all vulvar malignancies. Five-year survival rates range from 8% to 54%, with occuring predominantly in postmenopausal white women. As compared with malignant melanoma of the skin, vulvar melanoma infiltrates early deep into the tissues with abundant lymphatic channels and blood vascularization, so its prognosis is mostly poor. Depth of invasion has been reported as the single most important indicator of prognosis. Historically the treatment of choice for vulvar melanoma has been en bloc radical vulvectomy with bilateral inguinofemoral lymphadenectomy. But recently there have been reports suggesting that acceptable survival may be achieved by less radical operation. The authors report a 84-year old woman with malignant melanoma of the vulva. She underwent wide local excision of the lesion. Now we are following her up with no clinical evidence of cancer recurrence and remnant.
Aged, 80 and over ; Female ; Humans ; Lymph Node Excision ; Melanoma* ; Prognosis ; Recurrence ; Skin ; Survival Rate ; Vulva*

Vertebral artery hypoplasia (VAH) can be easily overlooked if the contralateral side vertebral artery is intact, because of compensation by the contralateral artery or cerebral collateral network. The clinical relevance and hemodynamic impact of VAH is still controversial. However, VAH has recently been considered a risk factor for posterior circulation ischemia. Ischemic stroke is seldom caused by free floating thrombi (FFT) in the artery. Pathophysiology of FFT has not yet been clarified. The state of reduced blood flow such as a vertebral artery origin stenosis may cause FFT. Their instability may make them sources of recurrent artery to artery embolism. Patients with FFT will require appropriate medical and endovascular treatment. The current case illustrates a short-term angiographic change of spontaneous thrombolysis of VAH and multiple thrombi at the distal region of the stenosed lesion after stent-assisted angioplasty for a vertebral artery origin stenosis.
Angioplasty* ; Arteries ; Compensation and Redress ; Constriction, Pathologic* ; Embolism ; Follow-Up Studies* ; Hemodynamics ; Humans ; Ischemia ; Risk Factors ; Stroke ; Vertebral Artery*

Von Meyenburg complexes (VMC) have many synonyms such as bile duct hamartomas and biliary hamartoma. These rare benign disorders are considered as congenital diseases caused by malformed differentiation of ductal plate. The diagnosis of VMC by common radiologic modality such as ultrasound and computed tomography was nearly impossible until the emergence of cholangiopancreatography by magnetic resonance imaging (MRCP) and the pathologic examination was the only way to confirm the diagnosis of VMC. But MRCP is now considered as most accurate noninvasive method for diagnosis of VMC. We report a histologically proven case of VMC associated with calculous cholecystitis, cerebral aneurysm and renal cortical cyst. To our knowledge, no comparable case has been reported and this would be the only second reported case of VMC, which was diagnosed by MRCP.
Bile Ducts ; Cholecystitis* ; Diagnosis ; Hamartoma ; Intracranial Aneurysm* ; Magnetic Resonance Imaging ; Ultrasonography

BACKGROUND AND OBJECTIVES: Canalith repositioning procedure (CRP) is an effective treatment for benign paroxysmal positional vertigo (BPPV). However, there is a significant number of patients who require multiple treatment visits for reliefs of symptoms. The purpose of this study is to identify factors that may be associated with these difficult to treat cases. MATERIALS AND METHODS: A retrospective review was made of 179 patients who were diagnosed as BPPV. 20 patients who required more than three treatment visits for CRP were included in this study. Statistical analysis included age and sex of patients, the kind of involved semicircular canal (SCC), direction of nystagmus, latency of nystagmus on electronystagmography (ENG) and duration of symptoms. RESULTS: There was no significant statistical association between the number of treatment visit and patient's age, sex. Although significant statistical association was not found, the therapeutic efficacy of lateral SCC BPPV was lower than that of posterior SCC BPPV. In the cases where the direction of nystagmus was ageotrophic, the efficacy of CRT was decreased and statistical significant association was found. Also when short latency of nustagmus on ENG and long duration of symptoms appeared, more trial of CRP was needed and statistical significant association was found. CONCLUSION: In the treatment of BPPV by CRP, we can consider latency of nystagmus on ENG, duration of symptoms, direction of nystagmus and type of involved semicircular canal as prognostic factors.
Electronystagmography ; Humans ; Rehabilitation* ; Retrospective Studies ; Semicircular Canals ; Vertigo*

Laryngopharyngeal reflux disease (LPRD) refers to the retrograde flow of gastric content to the laryngopharynx, where it comes in contact with tissues of the upper aerodigestive tract. In Korea, up to 1 out of every 5 patients who visit otorhinolaryngology clinic is supposed to have LPRD with symptoms and physical findings. In the absence of definite diagnostic criteria, LPRD is suspected when the history and laryngoscopy findings are suggestive of the diagnosis. A diagnosis of LPRD is usually based on response of symptoms to empirical treatment. Most patients with LPRD are treated with proton pump inhibitor with education of life style modification, but there is still little or no solid evidence on the treatment as well as the diagnosis. Failure to respond to a usual treatment suggests the need for confirmatory studies and consideration of alternative diagnoses. LPRD appears to be a common but controversial disorder, with conflicting data on pathophysiology, diagnosis, and treatment. Whereas trends are observed and many clinical practices are accepted widely on the basis of experience, we need definitive, prospective, evidence-based studies. In this article, we will review current concept of diagnosis and treatment of LPRD.
Gastroesophageal Reflux ; Humans ; Hypopharynx ; Korea ; Laryngopharyngeal Reflux ; Laryngoscopy ; Life Style ; Otolaryngology ; Proton Pump Inhibitors ; Proton Pumps

Acute retropharyngeal calcific tendinitis or calcific tendinitis of the longus is an under-recognized clinical syndrome first described by Hartley in 1964. This syndrome is caused by calcium hydroxylapatate deposition in the longus colli muscle and tendon. Patients typically present with acute neck pain, neck spasm, a restrained range of motion, odynophagia, dysphagia and sore throat. Clinically, it can be misconceived as acute retropharyngeal abscess because of its rather non-specific presentation and rare occurrence. Diagnosis of retropharyngeal calcific tendinitis can be made radiographically with plain radiograph and CT by detecting calcifications anterior to C1-C3 and swelling prevertebral soft tissue. Recognizing this radiologic imaging findings and features can prevent unnecessary treatment and test. We report three patients with acute prevertebral calcific tendinitis, which was misdiagnosed as acute retropharyngeal abscess.
Calcium ; Deglutition Disorders ; Humans ; Muscles ; Neck ; Neck Pain ; Pharyngitis ; Range of Motion, Articular ; Retropharyngeal Abscess ; Spasm ; Tendinopathy ; Tendons

Recently, endoscopic sinus surgery (ESS) has been acknowledged as a standard surgical procedure for the treatment of chronic rhinosinusitis. Orbital complications of varying degrees that may occur during ESS have been widely reported. Blindness, one of the major complications that can occur during or immediately after ESS, is mainly attributed to orbital hematoma or direct injury to the optic nerve. In contrast to such direct mechanical trauma caused during ESS, we report a case of acute loss of vision that followed ESS without a definite cause. A postulated mechanism for idiopathic optic neuropathy is that it is ischema resulted from vasospasm in the branches of ophthalmic artery due to topical use of vasoconstrictive agents. Otorhinolaryngologists should be aware that this condition may occur following an uncomplicated ESS procedure. When loss of sight is diagnosed postoperatively, patients should be given prompt ophthalmological consultation and possible causes should be considered.
Blindness ; Hematoma ; Humans ; Ophthalmic Artery ; Optic Nerve ; Optic Nerve Diseases ; Optic Neuropathy, Ischemic ; Orbit ; Vision, Ocular

Rhabdomyosarcoma is an aggressive malignant tumor rarely developing in the head and neck in adults. In the sinonasal region, rhabdomyosarcoma constitutes a clinically important group because of the difficulty of surgical resection and its generally poor prognosis. Inverted papilloma is a relative rare and benign sinonasal lesionconstituting 0.5% to 4% of all nasal tumors that has a known propensity for recurrence, local aggressiveness, and association with transformation to malignancy. Squamous cell carcinoma is the major malignancy that is associated with inverted papilloma. To our knowledge, this is the first case report of pleomorphic rhabdomyosarcoma accompanied with inverted papilloma, and we represent the case with a review of the related literatures.
Adult ; Carcinoma, Squamous Cell ; Head ; Humans ; Maxillary Sinus ; Maxillary Sinus Neoplasms ; Neck ; Papilloma, Inverted ; Prognosis ; Recurrence ; Rhabdomyosarcoma

Ultraviolet (UV) irradiation is a relevant environment factor to induce cellular senescence and photoaging. Both autophagy- and silent information regulator T1 (SIRT1)-dependent pathways are critical cellular processes of not only maintaining normal cellular functions, but also protecting cellular senescence in skin exposed to UV irradiation. In the present studies, we investigated whether modulation of autophagy induction using a novel synthetic SIRT1 activator, heptasodium hexacarboxymethyl dipeptide-12 (named as Aquatide), suppresses the UVB irradiation-induced skin aging. Treatment with Aquatide directly activates SIRT1 and stimulates autophagy induction in cultured human dermal fibroblasts. Next, we found that Aquatide-mediated activation of SIRT1 increases autophagy induction via deacetylation of forkhead box class O (FOXO) 1. Finally, UVB irradiation-induced cellular senescence measured by SA-β-gal staining was significantly decreased in cells treated with Aquatide in parallel to occurring SIRT1 activation-dependent autophagy. Together, Aquatide modulates autophagy through SIRT1 activation, contributing to suppression of skin aging caused by UV irradiation.
Autophagy ; Cell Aging* ; Fibroblasts ; Humans ; Skin ; Skin Aging

BACKGROUND: In many countries, nephrologists follow clinical practice guidelines for mineral bone disorders to control secondary hyperparathyroidism (SHPT) associated with abnormal serum calcium (Ca) and phosphorus (P) levels in patients undergoing maintenance hemodialysis (MHD). The Kidney Disease Outcomes Quality Initiative (KDOQI) Guidelines have long been used in Korea, and this study was undertaken to investigate the current status of serum Ca and P control in MHD patients. METHODS: Data were collected from a total of 1,018 patients undergoing MHD without intercurrent illness, in 17 hemodialysis centers throughout the country. Serum levels of Ca, P, and intact parathyroid hormone (iPTH) were measured over 1 year, and the average values were retrospectively analyzed. RESULTS: Serum levels of Ca, P, and the CaxP product were 9.1+/-0.7mg/dL, 5.3+/-1.4mg/dL, and 48.0+/-13.6mg2/dL2, respectively. However, the percentages of patients with Ca, P, and Ca x P product levels within the KDOQI guideline ranges were 58.7%, 51.0%, and 70.7%, respectively. Of the 1,018 patients, 270 (26.5%) had iPTH >300pg/mL (uncontrolled SHPT), whereas 435 patients (42.7%) showed iPTH <150pg/mL. Patients with uncontrolled SHPT had significantly higher values of serum Ca, P, and CaxP product than those with iPTH < or =300pg/mL. CONCLUSION: Despite the current clinical practice guidelines, SHPT seems to be inadequately controlled in many MHD patients. Uncontrolled SHPT was associated with higher levels of serum Ca, P, and Ca x P product, suggestive of the importance of SHPT management.
Calcium* ; Humans ; Hyperparathyroidism, Secondary ; Kidney Diseases ; Korea ; Parathyroid Hormone ; Phosphorus* ; Renal Dialysis* ; Retrospective Studies