Angiokeratoma circumscriptum is present at birth or early childhood and is an uncommon dermatosis characterized by papules and small nodules that may coalesce to form plaques. Histopathologically, there are varying degrees of hyperkeratosis, papillomatosis, and irregular acanthosis. In the papillary dermis, greatly dilated capillaries are observed, The acanthotic epidermis encircles the vascular spaces(blood cysts) where, occasionally, organized thrombi may be found. The use of pulsed-dye lasers to treat cutaneous vascular lesions is based on the theory of selective photothermolysis. We report a case of an angiokeratoma circumscriptum in an 48-year-old woman for whom the flashlamp pulsed tunable dye laser proved to be a highly successful means of treatment.
Angiokeratoma* ; Capillaries ; Dermis ; Epidermis ; Female ; Humans ; Lasers, Dye* ; Middle Aged ; Papilloma ; Parturition ; Skin Diseases

OBJECTIVE: Our purpose was to compare the pregnancy outcomes of nulliparous women aged 40 years and older with those of nulliparous women under 35 years of age. METHODS: From January 1989 to December 1998 total 57,563 deliveries were seen in Gachon Gil Medical Center. Among them we experienced 59 cases of nulliparas at 40 years and older. These women were compared with 188 young nulliparas under 35 years of age as the control group. The statistical analysis was performed using Chi-square tests, and statistical significance was defined as p<0.05. RESULTS: The incidence rate of elderly nulliparas aged 40 years and older was increased from 0.04% in 1989 to 0.30% in 1998. The age distribution was from 40 years to 45 years. The gravidity of eldery nulliparas was 2.2 in comparison with 1.6 in control group. The incidence of uterine myoma, gestational DM, IUGR and oligohydramnios was significantly high rate in elderly nulliparas. There was significantly high rate of cesarean section in elderly nulliparas(88.1%) in comparison with control group(40.4%). The reasons of cesarean section were her demand(39.0%), CPD(15.3%) and breech presentation(13.6%) in decreasing order. The preterm delivery rate was 10.2% in elderly nulliparas in comparison with 4.3% in the control group. Placenta accreta and uterine atony were significantly high in elderly nulliparas and mean estimated blood loss was also high. There was no difference in 5-minute Apgar score between both group, but there were more cases of neonatal intensive care unit admission in neonates of elderly nulliparas(6.8% vs 0%). CONCLUSION: The incidence of elderly nulliparas is continuously increasing. The elderly nulliparas and their babies are at greater risk than young women. Therefore all elderly nulliparas aged 40 years and older can be regarded as high risk patients and they must be managed with careful attention.
Age Distribution ; Aged ; Apgar Score ; Cesarean Section ; Female ; Fetal Growth Retardation ; Gravidity ; Humans ; Incidence ; Infant, Newborn ; Intensive Care, Neonatal ; Leiomyoma ; Oligohydramnios ; Placenta Accreta ; Pregnancy ; Pregnancy Outcome ; Uterine Inertia

Split hand and split foot(SHSF) is a human developmental defect characterized by missing digits, fusion of remaining digits, and a deep median cleft resulting in a clawlike appearance of the hands and feets. SHSF is usually inherited in an autosomer dominant fashion. The incidence of SHSF is between 1/10,000 and 1/90,000. Thirteen cases of SHSF and chromosomal aberrations involving 7q21-22 have been described so far in the world. We experienced a case of typical tetramelic SHSF in neonate. Chromosome studies showed a pericentric inversion of chromosome 7:46,XY,inv(7) (p22q22). Inspection of the extremities and chromosome studies in the parents were normal.
Chromosome Aberrations ; Chromosomes, Human, Pair 7* ; Extremities ; Foot* ; Hand* ; Human Development ; Humans ; Incidence ; Infant, Newborn ; Parents

Objectives: The aim of this study was to examine the effect of cognitive behavioral therapy (CBT) and motivational enhancement therapy (MET) based psychoeducation with mindfulness meditation (PMM) on hazardous drinking (HD) and motivation for change. Methods: The participants were people who received order of lecture due to drunk driving. A total of 75 subjects participated in 6-session CBT/MET based PMM for 3 weeks as order of lecture program. Age, sex, and alcohol related problems (physical symptoms, occupational problem, economic difficulty, use of mental health service, and family conflict), HD, motivation for change and insight into HD, and depressive symptoms were assessed. Results: Compared with before the order of lecture program, the portion of those with HD significantly decreased (86.7% to 50.7%, pConclusions This study demonstrated significant effects of CBT/MET based PMM on HD and motivation for change in drunk drivers. Our findings suggest that integrating approaches from CBT, MET, and mindfulness meditation can contribute to preventing and reducing HD.

OBJECTIVE: To investigate whether an audible cracking sound during shoulder manipulation following distention arthrography is clinically significant in patients with adhesive capsulitis of the shoulder. METHODS: A total of 48 patients (31 women, 17 men) with primary adhesive capsulitis of the shoulder completed the study. All participants underwent C-arm-guided arthrographic distention of the glenohumeral joint with injections of a corticosteroid and normal saline. After distention, we performed flexion and abduction manipulation of the shoulder. The patients were grouped into sound and non-sound groups based on the presence or absence, respectively, of an audible cracking sound during manipulation. We assessed shoulder pain and disability based on a Numeric Rating Scale (NRS), the Shoulder Pain and Disability Index (SPADI), and passive range of motion (ROM) measurements (flexion, abduction, internal and external rotation) before the procedure and again at 3 weeks and at 6 weeks after the intervention. RESULTS: The patients were divided into two groups: 21 were included in the sound group and 27 in the non-sound group. In both groups, the results of the NRS, SPADI, and ROM assessments showed statistically significant improvements at both 3 and 6 weeks after the procedure. However, there were no significant differences between the two groups except with respect to external rotation at 6 weeks, at which time the sound group showed a significant improvement in external rotation when compared with the non-sound group (p<0.05). CONCLUSION: These findings showed that manipulation following distention arthrography was effective in decreasing pain and increasing shoulder range of motion. In addition, the presence of an audible cracking sound during manipulation, especially on external rotation, was associated with better shoulder range of motion.
Adhesives* ; Arthrography* ; Bursitis* ; Female ; Humans ; Range of Motion, Articular ; Shoulder Joint ; Shoulder Pain ; Shoulder*

Freeman-Sheldon syndrome is a rare congenital myopathy principally characterized by facial and skeletal abnormalities. We report a case of a Freeman-Sheldon syndrome in 12-year-old girl correction of undergoing kyphoscoliosis under somatosensory evoked potential monitoring. She had a characteristic appearance of Freeman-Sheldon syndrome such as hypoplastic alae nasi, high narrow palate, marked microstomia with pursed lips and clenched fingers. On arriving at the operating room, she was intubated by awake nasotracheal intubation with fiberoptic bronchoscopy and anesthetized with propofol and fentanyl.
Bronchoscopy ; Child ; Evoked Potentials, Somatosensory ; Female ; Fentanyl ; Fingers ; Humans ; Intubation ; Lip ; Microstomia ; Muscular Diseases ; Operating Rooms ; Palate ; Propofol

PURPOSE: The aim of this study was to compare a negative pressure drain with a natural drain in order to determine whether a negative pressure drainage tube causes an increase in the drainage volume. MATERIALS AND METHODS: Sixty-two patients who underwent total thyroidectomy for papillary thyroid carcinoma (PTC) were enrolled in the study between March 2010 and August 2010 at Gyeongsang National University Hospital. The patients were prospectively and randomly assigned to two groups, a negative pressure drainage group (n=32) and natural drainage group (n=30). Every 3 hours, the volume of drainage was checked in the two groups until the tube was removed. RESULTS: The amount of drainage during the first 24 hours postoperatively was 41.68+/-3.93 mL in the negative drain group and 25.3+/-2.68 mL in the natural drain group (p<0.001). After 24 additional hours, the negative drain group was 35.19+/-4.26 mL and natural drain groups 21.53+/-2.90 mL (p<0.001). However, the drainage at postoperative day 3 was not statistically different between the two groups. In addition, the vocal cord palsy and temporary and permanent hypocalcemia were not different between the two groups. CONCLUSION: These results indicate that a negative pressure drain may increase the amount of drainage during the first 24-48 hours postoperatively. Therefore, it is not necessary to place a closed suction drain when only a total thyroidectomy is done.
Adult ; Aged ; Carcinoma/*surgery ; Drainage/*instrumentation/*methods ; Female ; Humans ; Male ; Middle Aged ; Postoperative Care/methods ; Postoperative Complications/surgery ; Postoperative Period ; Pressure ; Prospective Studies ; Reproducibility of Results ; Surgical Procedures, Operative ; Thyroid Neoplasms/*surgery ; Thyroidectomy/*instrumentation/*methods ; Time Factors ; Treatment Outcome

Lymphocytic hypophysitis, an inflammatory disease of the pituitary gland that is often associated with pregnancy, is caused by autoimmune destruction of the pituitary gland evidenced by diffuse inflammatory cell infiltration of the pituitary gland and some kinds of detectable autoantibodies. We report a case of lymphocytic hypophysitis in a 31-year-old woman presenting with severe hypoglycemia and hyponatremia after delivery. Hormonal study revealed panhypopituitarism and magnetic resonance imaging with enhancement showed the bulging contour of the right side pituitary gland with an ill-defined mass-like lesion and nodular thickening of the stalk. The patient's symptoms and biochemical data improved greatly with replacement of L-thyroxine and glucocorticoid. Partial recovery of panhypopituitarism was also seen. The follow-up tests revealed dramatic resolution of the pituitary lesion.
Adult ; Autoantibodies ; Female ; Follow-Up Studies ; Humans ; Hypoglycemia* ; Hyponatremia ; Hypopituitarism ; Magnetic Resonance Imaging ; Pituitary Gland ; Pregnancy ; Thyroxine

A case of resected primary duodenal cancer associated with early gastric cancer is reported. A 67-year-old male complaining of nausea and vomiting was admitted. Endo-scopic examination showed an ulcerative lesion withblood clot in the angle of the stomach and stricture in the duodenum. The stomach lesion was proven to be signet ring cell carcinoma by biopsy. Exploratory laparotomy was done and frozen specimen of duodenum was revealed to be malignant. Subtotal gastrectomy and pancreaticoduodenectomy with lymph node dissection were done and the specimen from stricture of duodenum was proven to be adenocarcinoma. The gastric cancer was limited to the mucosa and metastasis was not recognized in regional lymph node, Furthermore, there was normal mucosa between gastric cancer and duodenal cancer. Therefore, cancers in the stomach and duodenum were considered to be a case of double prim~iary cancer.
Adenocarcinoma ; Aged ; Biopsy ; Carcinoma, Signet Ring Cell ; Constriction, Pathologic ; Duodenal Neoplasms* ; Duodenum ; Esophagus* ; Gastrectomy ; Humans ; Intestines* ; Laparotomy ; Lymph Node Excision ; Lymph Nodes ; Male ; Mucous Membrane ; Nausea ; Neoplasm Metastasis ; Pancreaticoduodenectomy ; Stomach Neoplasms* ; Stomach* ; Ulcer ; Vomiting

Hypercalcemia is one of the most common paraneoplastic syndromes and believed to occur through two general mechanisms, one humoral and the other local. The former mechanism has been termed humoral hypercalcemia of malignancy (HHM) and has been associated with the secretion of various cytokines, including parathyroid hormone-related protein (PTHrP). PTHrP beats sttuctural and functional similarities to PTH and seems to play a key role in the pathogenesis of HHM. We experienced the case of HHM associated with hepatoma, a rare cause of HHM, in 48 year-old male. We found no evidence of bone metastasis. In this case, contrary to our general acknowledgment, serum 1,25 (OH)D concentration was elevated. We report this case with a brief review of related literatures.
Carcinoma, Hepatocellular* ; Cytokines ; Humans ; Hypercalcemia* ; Male ; Middle Aged ; Neoplasm Metastasis ; Paraneoplastic Syndromes ; Parathyroid Hormone-Related Protein*