Merkel cell carcinoma (MCC) is an aggressive neuroendocrine carcinoma with a high rate of metastasis. MCC is rarely suspected during clinical examination, thus requiring biopsy to establish a pathologic diagnosis. In addition, MCC sometimes occurs in double primary cancers. Although there have been reviews on double primary cancers, only a few cases involving MCC have been described. Herein, we report a case of a 54-year-old female patient who presented to our clinic with a diagnosis of earlobe MCC following an excisional biopsy performed by another clinic. Further evaluation, including chest imaging, revealed a mass in the lung. The patient underwent a wide excision of the right earlobe, and video-assisted thoracic surgery on the lung. Pathology confirmed MCC in the right earlobe and adenocarcinoma in the lung. The patient underwent postoperative adjuvant chemotherapy followed by radiotherapy. Up to this point, 3 years after the surgery, there has been no evidence of recurrence.

Recurrent bacterial meningitis can be caused by acquired or congenital anatomic defects, infection, or alterations in immune mechanism. Intracranial anatomical defects possibly combined with trauma can be the major cause of recurrent bacterial meningitis. Mucocele is a chronic, expansile and cyst-like lesion of the paranasal sinuses, most frequently found in the frontal sinus containing sterile mucoid secretions. Secondary infection of a mucocele may create a pyocele. Although pathogenesis of a primary mucoceles remains uncertain, causatives factors of secondary mucoceles have been suggested to include chronic inflammation, trauma, allergy and obstructing tumors. We experienced a case of recurrent bacterial meningitis with frontal sinus mucocele, which might be secondary to cranial trauma.
Coinfection ; Frontal Sinus ; Hypersensitivity ; Inflammation ; Meningitis, Bacterial* ; Mucocele* ; Paranasal Sinuses

Closed mouth impression technique by using bite tray is preferred for single tooth impression taking. However, for implant impression taking, open mouth impression technique by using single arch tray is generally used whether it is for single implant or multiple implant. Closed mouth impression technique by using bite tray can save time and materials. It also decreases the chance of error occurrence when a model is mounted on an articulator. In this case report, we tried to show a satisfying result of fabricating single implant fixed prosthodontics after bite tray impression taking by using two different copings for closed mouth impression.
Dental Articulators ; Mouth* ; Prosthodontics ; Tooth

The Shikani Optical Stylet(TM) (SOS, Clarus Medical, USA) is another tool to facilitate tracheal intubation. It combines the benefits of a lightwand and a fiberoptic bronchoscope. We report the application of SOS in facilitating the tracheal intubation of two-person with history of difficult airway management. A 25-year-old woman with micrognathia was scheduled to undergo an exploratory laparotomy. Intubation attemps failed with a direct laryngoscope because of difficulty in her mouth opening. Although airway management was re-attempted by a laryngeal mask airway, it also failed for the same reason. Airway management was successfully performed using the SOS instead of a laryngeal mask airway. The second case was a 38-year-old woman with ankylosing spondylitis, scheduled for spinal fusion. She had difficulty in extending her neck. Intubation was successfully performed via the SOS. We believe that intubation by the SOS is a useful and readily available alternative technique for patients with difficult airways.
Adult ; Airway Management ; Bronchoscopes ; Female ; Humans ; Intubation ; Laparotomy ; Laryngeal Masks ; Laryngoscopes ; Mouth ; Neck ; Spinal Fusion ; Spondylitis, Ankylosing

Both vitiligo and psoriasis are common skin disorders, which rarely coexist. We report a case of psoriasis which developed on a vitiligo lesion in a 58-year-old woman. We also discuss the possible mechanism of co-localization of vitiligo and psoriasis, including the role of autoimmunity, Koebner phenomenon, and common neuropeptides.
Autoimmunity ; Female ; Humans ; Middle Aged ; Neuropeptides ; Psoriasis* ; Skin ; Vitiligo*

OBJECTIVES: To evaluate preoperative anti-Mullerian hormone (AMH) levels in women with endometrioma or other benign ovarian cysts and differences of AMH changes according to various characteristics. METHODS: Ninety-seven patients aged 20 to 39 years who underwent surgery for benign ovarian cyst were enrolled retrospectively. Of these, 65 patients were diagnosed as endometriomas, and 32 had other benign cysts. Serum AMH, mean, maximum, and total diameter of ovarian cysts were measured. The AMH levels were compared according to pathology (endometrioma vs. other benign cyst), size of ovarian cyst, age-matched AMH quartile percentile and characteristics of endometrioma. RESULTS: Preoperative serum AMH level was significantly lower in endometrioma group than other benign cyst group (4.12 +/- 2.42 ng/mL vs. 6.02 +/- 2.29 ng/mL, P < 0.001). Serum AMH level was significantly lower in endometrioma group, especially in patients aged 30 to 39 years. Dividing to age-matched AMH quartile percentile, there were significantly fewer patients with AMH level > or = 75 percentile in endometrioma group (24.6% vs. 50.0%, P = 0.035). Among 4 subgroups of endometrioma, patients with AMH level > or = 75 percentile were significantly decreased in multiple bilateral endometrioma group. Mean and total diameter of cysts were negatively correlated with preoperative serum AMH level in other benign cyst group. CONCLUSION: We suggest that preoperative AMH level measurement might be considered in women with endometrioma, especially in 30 to 39 years old, multiple bilateral type, or big-sized other benign ovarian cyst to assess the diminished ovarian reserve.
Anti-Mullerian Hormone* ; Endometriosis* ; Female ; Humans ; Ovarian Cysts* ; Pathology ; Retrospective Studies

OBJECTIVE: The aim of this study is to assess the relationships between maternal plasma and umbilical cord leptin concentrations and their effects on newborn birth weights, maternal body mass indices and fetal sex in term normotensive (NT) and preeclampsia (PE) women. METHODS: Blood samples were obtained at delivery from 20 NT group and another 20 from PE group of at least 36 weeks of gestation. And the umbilical cord samples were also taken from their newborns at birth. Plasma leptin levels were determined in both groups using a human recombinant leptin 125-I radioimmunoassay. RESULTS: Mean maternal plasma and umbilical cord leptin concentrations were 16.16+/-2.05 ng/ml and 7.11+/-1.01 ng/ml in NT group, 17.09+/-1.67 ng/ml and 8.55+/-6.63 ng/ml in PE group, and there was no statistical significances among them. The differences of leptin concentrations in maternal plasma and umbilical cord according to baby sex were not significant in both NT and PE groups. Plasma leptin concentrations were related with maternal weight gain and BMI in NT group and with body weight in PE group. The BMI and birth weights of the neonates have significant effects on the umbilical cord leptin concentrations in both NT and PE groups. CONCLUSION: In this study, no correlation was found between maternal plasma and umbilical cord leptin concentrations in both NT and PE groups. But maternal plasma leptin concentrations had positive correlations with maternal body weight, BMI, and body weight changes during pregnancy in both NT and PE groups. There were also positive correlations among umbilical cord leptin concentrations, BMI and birth weights of the neonates of NT and PE groups term. Therefore umbilical cord leptin is considered to be the index of fetal birth weight.
Birth Weight ; Body Weight ; Body Weight Changes ; Female ; Fetal Blood* ; Fetal Weight* ; Humans ; Infant, Newborn ; Leptin* ; Parturition ; Plasma* ; Pre-Eclampsia* ; Pregnancy ; Radioimmunoassay ; Umbilical Cord ; Weight Gain

OBJECTIVE: The aim of this study is to assess the relationships between maternal plasma and umbilical cord leptin concentrations and their effects on newborn birth weights, maternal body mass indices and fetal sex in term normotensive (NT) and preeclampsia (PE) women. METHODS: Blood samples were obtained at delivery from 20 NT group and another 20 from PE group of at least 36 weeks of gestation. And the umbilical cord samples were also taken from their newborns at birth. Plasma leptin levels were determined in both groups using a human recombinant leptin 125-I radioimmunoassay. RESULTS: Mean maternal plasma and umbilical cord leptin concentrations were 16.16+/-2.05 ng/ml and 7.11+/-1.01 ng/ml in NT group, 17.09+/-1.67 ng/ml and 8.55+/-6.63 ng/ml in PE group, and there was no statistical significances among them. The differences of leptin concentrations in maternal plasma and umbilical cord according to baby sex were not significant in both NT and PE groups. Plasma leptin concentrations were related with maternal weight gain and BMI in NT group and with body weight in PE group. The BMI and birth weights of the neonates have significant effects on the umbilical cord leptin concentrations in both NT and PE groups. CONCLUSION: In this study, no correlation was found between maternal plasma and umbilical cord leptin concentrations in both NT and PE groups. But maternal plasma leptin concentrations had positive correlations with maternal body weight, BMI, and body weight changes during pregnancy in both NT and PE groups. There were also positive correlations among umbilical cord leptin concentrations, BMI and birth weights of the neonates of NT and PE groups term. Therefore umbilical cord leptin is considered to be the index of fetal birth weight.
Birth Weight ; Body Weight ; Body Weight Changes ; Female ; Fetal Blood* ; Fetal Weight* ; Humans ; Infant, Newborn ; Leptin* ; Parturition ; Plasma* ; Pre-Eclampsia* ; Pregnancy ; Radioimmunoassay ; Umbilical Cord ; Weight Gain

BACKGROUND: Several publications have reported the successful, safe use of Laryngeal Mask Airway (LMA)-Classic devices in patients undergoing laparoscopic surgery. However, there have been no studies that have examined the application of volume-controlled ventilation (VCV) or pressure-controlled ventilation (PCV) using a LMA during gynecological laparoscopy. The aim of this study is to compare how the VCV and PCV modes and using a LMA affect the pulmonary mechanics, the gas exchange and the cardiovascular responses in patients who are undergoing gynecological laparoscopy. METHODS: Sixty female patients were randomly allocated to one of two groups, (the VCV or PCV groups). In the VCV group, baseline ventilation of the lung was performed with volume-controlled ventilation and a tidal volume of 10 ml/kg ideal body weight (IBW). In the PCV group, baseline ventilation of the lung using pressure-controlled ventilation was initiated with a peak airway pressure that provided a tidal volume of 10 ml/kg IBW and an upper limit of 35 cmH2O. The end-tidal CO2, the peak airway pressures (Ppeak), the compliance, the airway resistance and the arterial oxygen saturation were recorded at T1: 5 minutes after insertion of the laryngeal airway, and at T2 and T3: 5 and 15 minutes, respectively, after CO2 insufflation. RESULTS: The Ppeak at 5 minutes and 15 minutes after CO2 insufflation were significantly increased compared to the baseline values in both groups. Also, at 5 minutes and 15 minutes after CO2 insufflation, there were significant differences of the Ppeak between the two groups. The compliance decreased in both groups after creating the pneumopertoneim (P < 0.05). CONCLUSIONS: Our results demonstrate that PCV may be an effective method of ventilation during gynecological laparoscopy, and it ensures oxygenation while minimizing the increases of the peak airway pressure after CO2 insufflation.
Airway Resistance ; Compliance ; Female ; Humans ; Ideal Body Weight ; Insufflation ; Laparoscopy ; Laryngeal Masks ; Lung ; Mechanics ; Oxygen ; Tidal Volume ; Ventilation

Operating Room nurses are required to have special skills and knowledge to do their job. However, because there is no systematic education program, which considers special circumstances in the OR, novice nurses have a great deal of difficulty adapting themselves to the work environment. The purpose of this study is to develope a multimedia education program, which provides the systematic learning environment, so novice nurses can adapt to the OR environment more effectively. This study has been implemented according to Computer Assisted Instruction Design Model(Il-Joo Na and In-Sung Jung, 1990), which goes through the following steps; 1). Education program analysis 2). Development, evaluation 3). CompletionLearning goals, objectives, motive strategy, and analysis of the education program are analyzed by the concepts based on basic education materials for novice surgery nurses of 6 Medical Centers in Seoul and 'Development of the job training program for newly employed nurses in operating rooms. 'written by Ji-Young Yoon(2000). We divided 9 areas of the contents in surgery education; 1. Basic orientation 2. OR nurses' roles and responsibilities 3. Asceptic technique 4. Disinfection and sterilization 5. OR safety 6. OR nursing care 7. Surgical positioning 8. OR Material management 9. Anesthetic care. We selected asceptic technique, which is the most fundamental concept in OR nursing care. The program screens consist of cover screen, screen for guide, mini menu screen, and test screen. We distributed questionnaires to fifteen experts and investigated their opinions to analyze learning contents and effects of the Courseware. The education program was modified based on respones provided by experts. This study offers an educational program, which allows the individuals to choose the areas they want to learn. The program is easy to use, which encourages the individuals to search for additional information more than one area.
Computer-Assisted Instruction ; Disinfection ; Education* ; Learning ; Multimedia* ; Nursing Care ; Operating Rooms* ; Surveys and Questionnaires ; Seoul ; Sterilization