We hypothesized that lower proportion of serum phospholipid docosahexaenoic acid (DHA) is inversely associated with increased cardiovascular risk and vascular function in metabolically healthy men. To elucidate it, we first compared serum phospholipid free fatty acid (FA) compositions and cardiovascular risk parameters between healthy men (n = 499) and male patients with coronary artery disease (CAD, n = 111) (30-69 years) without metabolic syndrome, and then further-analyzed the association of serum phospholipid DHA composition with arterial stiffness expressed by brachial-ankle pulse wave velocity (ba-PWV) in metabolically healthy men. Basic parameters, lipid profiles, fasting glycemic status, adiponectin, high sensitivity C-reactive protein (hs-CRP) and LDL particle size, and serum phospholipid FA compositions were significantly different between the two subject groups. Serum phospholipid DHA was highly correlated with most of long-chain FAs. Metabolically healthy men were subdivided into tertile groups according to serum phospholipid DHA proportion: lower (< 2.061%), middle (2.061%-3.235%) and higher (> 3.235%). Fasting glucose, insulin resistance, hs-CRP and ba-PWVs were significantly higher and adiponectin and LDL particle size were significantly lower in the lower-DHA group than the higher-DHA group after adjusted for confounding factors. In metabolically healthy men, multiple stepwise regression analysis revealed that serum phospholipid DHA mainly contributed to arterial stiffness (β'-coefficients = -0.127, p = 0.006) together with age, systolic blood pressure, triglyceride (r = 0.548, p = 0.023). Lower proportion of serum phospholipid DHA was associated with increased cardiovascular risk and arterial stiffness in metabolically healthy men. It suggests that maintaining higher proportion of serum phospholipid DHA may be beneficial for reducing cardiovascular risk including arterial stiffness in metabolically healthy men.
Adiponectin ; Blood Pressure ; C-Reactive Protein ; Coronary Artery Disease ; Fasting ; Glucose ; Humans ; Insulin Resistance ; Male ; Particle Size ; Pulse Wave Analysis ; Triglycerides ; Vascular Stiffness*

Body dysmorphic disorders can be often diagnosed among the group of patients seeking plastic surgery with excessiveness. For the correction of unrealistic body images tied up in their minds, they have a tendency to choose improper plastic operation or unlicensed procedures rather than the psychiatric intervention. So- called 'illegal injection' performed by the unlicensed has been readily accessible tempting alternatives, which could result in disastrous outcomes due to multiple compulsive injections. Nowadays injection of foreign materials, such as paraffin oil or liquid silicon, is thought to be obsolete in modern medical procedures. Nevertheless, these illegal procedures have been in extensive use among some Asian countries, including Korea, by the unlicensed. Local complication, particularly, granulomatous inflammatory responses of variable severity can occur, despite skillful techniques and even small amount of injection. Futhermore, these lesions frequently persist or recur after treatment. We have a case of a body dysmorphic disorder manifesting severe, huge foreign body granulomas caused by silicon, paraffin and oil injected. Our case was a 38- years-old woman who had multiple huge masses on head and neck which had slowly grown after multiple injections for about 16 years. After a psychiatric intervention, we performed partial resection of masses in cheek and neck area, followed by liposuction of forehead, neck and scalp. A brief history of case and the clinical significance of foreign body injection in body dysmorphic disorder were described.
Asian Continental Ancestry Group ; Body Dysmorphic Disorders* ; Body Image ; Cheek ; Female ; Forehead ; Foreign Bodies* ; Granuloma ; Granuloma, Foreign-Body ; Head ; Humans ; Korea ; Lipectomy ; Neck ; Paraffin ; Scalp ; Silicones ; Surgery, Plastic

No abstract available.
Catheters* ; Cystic Adenomatoid Malformation of Lung, Congenital* ; Fetal Therapies* ; Lung*

The major risk factor for ovarian cancer (OC) is mutation of the BRCA1 or BRCA2 DNA mismatch repair genes, which occurs in approximately 10% of OC cases. Most previous studies have demonstrated that BRCA1- and BRCA2-mutated OCs are associated with better prognosis than sporadic OCs. However, information about the patterns and clinical course of the metastatic spread of BRCA-mutated OCs is limited. Herein, we describe a case of OC with a BRCA1 mutation and skin metastases in a 49-year-old patient, which to the best of our knowledge has not been reported previously.
DNA Mismatch Repair ; Humans ; Middle Aged ; Neoplasm Metastasis* ; Ovarian Neoplasms* ; Prognosis ; Risk Factors ; Skin*

BACKGROUND: Settlements between doctors and patients provide a solution to complicated disputes. However, some disputes may be renewed as a result of negligence by both parties. The purpose of this study was to review the legal issues that may potentially arise during the preparation of settlement agreements and to propose a list of requirements for ensuring the effectiveness of these settlement agreements. METHODS: Data from 287 civil cases concerning aesthetic surgery that took place between 2000 and 2015 were collected from a court database in South Korea. Factors that influenced the effectiveness of settlement agreements were analyzed. RESULTS: Among the 287 court precedents, there were 68 cases of covenant not to sue. Eighteen cases were dismissed because the settlement agreements were recognized as effective, and 50 cases were sent forward for judgment on their merits because the agreements were not recognized as effective. The types of surgery and types of complications were classified by frequency. We evaluated the geographical distribution of the precedents, the settlement timing, and the effectiveness and economic impact of the settlements. We found that there was no statistically significant relationship among these factors. Four major factors that made a settlement agreement legally effective were identified, and the data showed that fee-free reoperations were not considered by the court in determining the compensation amount. CONCLUSIONS: When preparing a settlement agreement, it is advisable to review the contents of the agreement rather than to take the preparation of a settlement agreement per se to be legally meaningful.
Compensation and Redress ; Dissent and Disputes ; Humans ; Judgment ; Jurisprudence* ; Korea* ; Malpractice ; Plastics* ; Surgery, Plastic*

Postoperative infections are rare after plastic surgery; however, when present, they can affect the aesthetic outcome. Currently, many malpractice lawsuits are associated with surgical site infection. The present study aimed to analyze malpractice claims associated with surgical site infection in the field of plastic surgery through a review of Korean precedents. We analyzed the type of procedure, associated complications, and legal judgment in these cases. Most claimants were women, and claims were most often related to breast surgery. The common complications related to surgical site infection were deformity, scar, and asymmetry. Among the 40 cases, 34 were won by the plaintiff, and the mean claim settlement was 2,832,654 KRW (USD 2,636.6). The reasons for these judgements were as follows: 1) immediate bacterial culture tests were not performed and appropriate antibiotics were not used; 2) patients were not transferred to a high-level hospital or the infection control department was not consulted; 3) surgical site infection control measures were not appropriate; and 4) surgical procedures were performed without preoperative explanation about surgical site infection. The number of claims owing to surgical site infection after surgery is increasing. Infection handling was one of the key factors that influenced the judgement, and preoperative explanation about the possibility of infection is important. The findings will help surgeons achieve high patient satisfaction and reduce liability concerns.
Anti-Bacterial Agents ; Breast ; Cicatrix ; Congenital Abnormalities ; Cross Infection ; Female ; Humans ; Infection Control ; Judgment ; Malpractice* ; Patient Satisfaction ; Plastics* ; Surgeons ; Surgery, Plastic* ; Surgical Wound Infection*

The typical presentation of intussusception includes intermittent severe abdominal pain, vomiting, rectal bleeding, and the presence of an abdominal mass. We present a case of intussusception after abdominal blunt trauma along with a literature review. A 4-year-old girl was admitted to the emergency department after a bicycle accident. She complained of progressively worsening abdominal pain, but there was no vomiting, fever, bloody stool, or abdominal mass. She was finally diagnosed with traumatic intussusception by ultrasonography and treated with air reduction. Because the typical symptoms are unusual in traumatic intussusception, close attention must be paid to avoid a delayed diagnosis.
Abdominal Pain ; Child, Preschool ; Delayed Diagnosis ; Emergency Service, Hospital ; Female ; Fever ; Hemorrhage ; Humans ; Intussusception* ; Pediatrics ; Ultrasonography ; Vomiting ; Wounds and Injuries

A sialo-cutaneous fistula is a communication between the skin and a salivary gland or duct discharging saliva. Trauma and iatrogenic complications are the most common causes of this condition. Treatments include aspiration, compression, and the administration of systemic anticholinergics; however, their effects are transient and unsatisfactory in most cases. We had a case of a patient who developed an iatrogenic sialo-cutaneous fistula after wide excision of squamous cell carcinoma in the parotid region that was not treated with conventional management, but instead completely resolved with the injection of botulinum toxin. Based on our experience, we recommend the injection of botulinum toxin into the salivary glands, especially the parotid gland, as a conservative treatment option for sialo-cutaneous fistula.
Botulinum Toxins* ; Carcinoma, Squamous Cell ; Cholinergic Antagonists ; Fistula* ; Humans ; Parotid Gland ; Parotid Region ; Saliva ; Salivary Gland Fistula ; Salivary Glands ; Skin

BACKGROUND: In an increasing number of lawsuits doctors lose, despite providing preoperative patient education, because of failure to prove informed consent. We analyzed judicial precedents associated with insufficient informed consent to identify judicial factors and trends related to aesthetic surgery medical litigation. METHODS: We collected data from civil trials between 1995 and 2015 that were related to aesthetic surgery and resulted in findings of insufficient informed consent. Based on these data, we analyzed the lawsuits, including the distribution of surgeries, dissatisfactions, litigation expenses, and relationship to informed consent. RESULTS: Cases were found involving the following types of surgery: facial rejuvenation (38 cases), facial contouring surgery (27 cases), mammoplasty (16 cases), blepharoplasty (29 cases), rhinoplasty (21 cases), body-contouring surgery (15 cases), and breast reconstruction (2 cases). Common reasons for postoperative dissatisfaction were deformities (22%), scars (17%), asymmetry (14%), and infections (6%). Most of the malpractice lawsuits occurred in Seoul (population 10 million people; 54% of total plastic surgeons) and in primary-level local clinics (113 cases, 82.5%). In cases in which only invalid informed consent was recognized, the average amount of consolation money was KRW 9,107,143 (USD 8438). In cases in which both violation of non-malfeasance and invalid informed consent were recognized, the average amount of consolation money was KRW 12,741,857 (USD 11,806), corresponding to 38.6% of the amount of the judgment. CONCLUSIONS: Surgeons should pay special attention to obtaining informed consent, because it is a double-edged sword; it has clinical purposes for doctors and patients but may also be a litigation strategy for lawyers.
Blepharoplasty ; Cicatrix ; Congenital Abnormalities ; Esthetics ; Female ; Humans ; Informed Consent* ; Judgment ; Jurisprudence* ; Lawyers ; Malpractice ; Mammaplasty ; Patient Education as Topic ; Plastics ; Rejuvenation ; Rhinoplasty ; Seoul ; Surgeons

OBJECTIVES: The aims of this study were to identify the intake and following process for subjects at high risk of transition to schizophrenia and to examine the neurocognitive, social, and emotional functions of the subjects compared with healthy controls. METHODS: Symptomatic individuals judged at high risk for schizophrenia ('clinical high risk') within Youth Clinic were assessed and followed up. They performed a neurocognitive function test, a social function test and an affective function test. Twenty healthy controls were recruited in this study. RESULTS: Among eighty-two subjects contacted through the Youth clinic, sixteen subjects were judged as the clinical high risk group. Fourteen subjects among the clinical high risk group showed deficits in several domains of neurocognitive functions, such as visual recall memory, verbal short term memory and executive function. Social and affective functions are also impaired in the clinical high risk group compared with healthy controls. Two of 15 subjects (13%) developed a psychotic disorder within 6 months. CONCLUSION: This study illustrates the state of follow-up study for a clinical high risk group. Despite low numbers and short durations, some impairment of several functions in the clinical high risk group suggests possible predictors of psychosis.
Adolescent* ; Executive Function ; Follow-Up Studies* ; Humans ; Memory ; Pilot Projects* ; Psychotic Disorders ; Schizophrenia*