Verrucous carcinoma is a slow growing, low grade squamous cell carcinoma, which usually occurs on oropharynx, genitalia and soles. When it occurs on feet, it is known as epithelioma cuniculatum. Epithelioma cuniculatum is characterized by its histologic sinuses and cystic formations in a cuniculate(rabbit burrow-like) pattern. A 59-year-old man was consulted to our department for a well circumscribed, 5 × 5 cm sized, round, hyperkeratotic, verrucous plaque on the right great toe. He suffered from diabetes mellitus for 16 years and was managed by peritoneal dialysis three times a week due to chronic renal failure for last two years. The plaque had gradually increased in size. The biopsy specimen taken from the tumor mass showed chronic ulcerative inflammation with atypical squamous cell proliferation. We herein report a case of verrucous carcinoma occurring in a patient with diabetes melli-t tus and chronic renal failure.
Biopsy ; Carcinoma ; Carcinoma, Squamous Cell ; Carcinoma, Verrucous* ; Cell Proliferation ; Diabetes Mellitus* ; Foot ; Genitalia ; Humans ; Inflammation ; Kidney Failure, Chronic* ; Middle Aged ; Oropharynx ; Peritoneal Dialysis ; Toes ; Ulcer

The objective of the present study was to investigate the vertical and horizontal location of the molar furcations in korean. The samples used in this study included 132 maxillary molars and 120 mandibular molars. Of them, 47 maxillary molars and 34 mandibular molars had the fused roots. So, 85 maxillary molars(54 1st and 31 2nd molars) and 86 mandibular molars(46 1st and 40 2nd molars) were measured. The vertical and horizontal location of molars were measured with divider and digimatic micrometer and their means and standard deviation calculated. The results were summarized as follows: 1. The ratio of fused roots found in this study was the highest in the maxillary second molars with 59%, followed by mandibular second molars(46%) and maxillary first molars(7%) and none were discovered in the mandibular first molars. 2. In the study of the vertical location of molar furcation, the results were as follows : In the maxillary first molars, the length in descending order were distal(5.06mm), mesial(4.52mm) and buccal(4.01mm) and in the maxillary second molar, distal(4.04mm), mesial(4.02mm) and buccal(3.87mm). In the mandibular first molar, the length was 3.69mm on the lingual side and 2.81mm on the buccal side, and in the mandibular second molar, 3.87mm on the lingual and 3.61mm on the buccal side. 3. The location of the mesial and distal furcations in horizontal dimension measured showed following results : buccal and mesial furcations of the maxillary molars and buccal and lingual furcations of the mandibular molars generally found at the center, but the mesial furcation of the maxillary molars were found approximately two thirds toward the palatal aspect.

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

Objectives: Despite precise iliosacral (IS) screw placement, we encountered a case of a neurological deficit due to a bony fragment that remained around the nerve root after reduction of the fracture gap in a patient with a pelvic ring injury.Summary of Literature Review: Percutaneous IS screw fixation is a commonly used procedure because it enables an adequate fixation force to be secured through a minimally invasive method in patients with pelvic ring fractures. Percutaneous IS screw fixation using C-arm fluoroscopy has been well described. In addition, several studies have investigated methods to prevent neurological damage. Materials and Methods: A 48-year-old man was diagnosed with a lateral compression type 1 pelvic ring fracture. Bilateral IS screw fixation was performed in the patient, who had no preoperative neurological abnormalities. He complained of pain around the sacroiliac joint that radiated to the lower leg after percutaneous IS screw fixation, and he was diagnosed with S1 radiculopathy on electromyography. Results: While reviewing the patient’s preoperative computed tomography images, a bony fragment in the fracture gap on the left S1 root was noted. After confirming S1 root entrapment, decompressive laminectomy was performed. Conclusions Surgeons should be aware that postoperative neurological symptoms may be caused by a bony fragment resulting from the fracture, regardless of screw malposition in percutaneous IS screw fixation. Preoperative planning with meticulous image review and intraoperative neurological monitoring, as well as using full-threaded screws, may help to prevent this problem.

Bartter's syndrome is characterized by hyperreninemia, hyperaldosteronism, hypokalemic hypochlorenlic alkalosis, normal blood pressure, juxtaglomerular apparatus hyperplasia, general weakness, and muscle weakness. We experienced a case of hypokalemic myopathy associated with Bartter's syndrome in 15 years old male. He had experienced paroxysmal muscle weakness without sensory change and myalgia since 10 years old. Subsequently, he had complaints of progressive muscle weakness, especially proximal muscles. Prominent juxtaglomerular apparatus with cellular proliferation biopsy was seen in the kidney. And there were mild perivascular inflammatory cell infiltration, small degenerating and/or regenerating muscles fibers, and normal muscle fiber distribution without evidence of chronic myopathy in the muscle biopsy. The patient was sucessfully managed with indomethacin and oral potassium chloride.
Adolescent ; Alkalosis ; Bartter Syndrome* ; Biopsy ; Blood Pressure ; Cell Proliferation ; Child ; Humans ; Hyperaldosteronism ; Hyperplasia ; Indomethacin ; Juxtaglomerular Apparatus ; Kidney ; Male ; Muscle Weakness ; Muscles ; Muscular Diseases* ; Myalgia ; Potassium Chloride

PURPOSE: Although Bednar's aphthae are common and regress spontaneously, these lesions may lead to feeding intolerance and are often misdiagnosed, rendering examinations useless. This study sheds new light on the clinical features of Bednar's aphthae. METHODS: Sixteen neonates and infants were newly diagnosed with Bednar's aphthae via routine health check-ups in an outpatient clinic. Medical records were retrospectively reviewed, and the following parameters were analyzed; sex, gestational age, birth weight, mode of delivery, and perinatal problems. A physical examination was carried out during the next outpatient visit to examine the healing process and check for the existence of scars or complications. RESULTS: Initial presentation included changes in feeding habits (n=10), longer feeding time, reduced intake, and increased irritability. In 6 patients, Bednar's aphthae were discovered incidentally, without prior symptoms. Feeding posture and method of feeding are important causes of Bednar's aphthae. Eleven patients were fed in a horizontal position, whereas 5 patients were fed in a semiseated position. Fifteen patients were bottle-fed, whereas 1 patient was exclusively breastfed. After correcting the feeding position, the ulcerative lesions disappeared within 1 month of diagnosis. During the follow-up period, lesions did not recur in any of the patients. CONCLUSION: This study suggests that Bednar's aphthae are caused by mechanical pressure. A diagnosis of Bednar's aphthae should be considered when lesions are found on the palate of infants and when symptoms seem to be feeding related. Proper education of parents can both treat Bednar's aphthae and easily prevent its recurrence.
Ambulatory Care Facilities ; Birth Weight ; Cicatrix ; Diagnosis ; Education ; Follow-Up Studies ; Gestational Age ; Humans ; Infant* ; Infant, Newborn ; Medical Records ; Mouth Mucosa ; Outpatients ; Palate ; Parents ; Physical Examination ; Posture ; Recurrence ; Retrospective Studies ; Stomatitis, Aphthous* ; Ulcer

Neck pain is a common musculoskeletal condition, which causes substantial medical cost. In Korea, prevalence of neck pain in community based population, especially in elderly subjects, has scarcely been reported. We evaluated the prevalence, the severity and the risk factors of neck pain in elderly Korean community residents. Data for neck pain were collected for 1,655 subjects from a rural farming community. The point, 6-months and cumulative lifetime prevalence of neck pain was obtained in addition to the measurement of the severity of neck pain. The mean age of the study subjects was 61 yr and 57% were females. The lifetime prevalence of neck pain was 20.8% with women having a higher prevalence. The prevalence did not increase with age, and the majority of individuals had low-intensity/low-disability pain. Subjects with neck pain had a significantly worse SF-12 score in all domains except for mental health. The prevalence of neck pain was significantly associated with female gender, obesity and smoking. This is the first large-scale Korean study estimating the prevalence of neck pain in elderly population. Although the majority of individuals had low-intensity/low-disability pain, subjects with neck pain had a significantly worse SF-12 score indicating that neck pain has significant health impact.
Adult ; Aged ; Asian Continental Ancestry Group ; Female ; Humans ; Male ; Mental Health ; Middle Aged ; Neck Pain/complications/*epidemiology ; Obesity/complications/diagnosis ; Odds Ratio ; Prevalence ; Questionnaires ; Republic of Korea/epidemiology ; Risk Factors ; Rural Population ; Severity of Illness Index ; Sex Factors ; Smoking

Surgical treatment for afferent loop syndrome (ALS) in patients with recurrent gastric cancer is usually not feasible because of the recurrent tumor mass at the anastomosis site and/or extensive carcinomatosis resulting in bowel loop fixation. Furthermore, ALS usually makes oral intake impossible, resulting in a rapid deterioration in general condition. In this situation, gastroscopic stenting at the anastomotic site and/or percutaneous external drainage may be a more feasible alternative for palliation. We herein report a recurrent gastric cancer whose ALS was successfully treated with internal and external drainage procedures.
Afferent Loop Syndrome* ; Carcinoma ; Drainage* ; Humans ; Stents* ; Stomach Neoplasms*

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*

Hereditory Sensory Autonomic Neuropathy(HSAN) is variable rare disorder. So the classification of HSAN could be somewhat unsettled. There are intermingled overlap variants of HSAN in view of clinical manifestations and pathologic findings. Five types of HSAN have been described by Dyck(1993). Type I is dominantly inherited and affects both myelinated(MFs) and unmyetinated fibers(Ufs). Type II is recessively inherited and nerve biopsies show total absence of MFs but presence of Ufs. Type III is a recessive inherited dysautonomia. Type IV is characterized by insensitive to pain anhidrosis, and mild mental retardation with virtually absence of Ufs. Type V affects small MFs. We report a 5 year-old girl who presented with congenital insensitivity to pain, anhidrosis with mild mental retardation. In sural nerve biopsy, Ufs were virtually absent by electron microscopy. We reconfirmed previous pathologic findings in sural nerve of HSAN IV.
Biopsy ; Child, Preschool ; Classification ; Female ; Hereditary Sensory and Autonomic Neuropathies ; Humans ; Hypohidrosis* ; Intellectual Disability ; Microscopy, Electron ; Pain Insensitivity, Congenital* ; Primary Dysautonomias ; Sural Nerve