A 23-year-old man had multiple small, skin-colored firm papules on the both sides of the nasolabial folds since the age of approximately 17. His mother had a similar skin lesions on her face. The histopathological findings of skin biopsy specimens from patient(son) showed horn cysts consist of a fully keratinized center surrounded by basophilic cells and tumor islands composed of basophilic cells arranged in a lacelike or adenoid network and occasional solid aggregates and there are also a foreign body giant cell reaction in the vicinity of the ruptured horn cysts.
Adenoids ; Animals ; Basophils ; Biopsy ; Giant Cells, Foreign-Body ; Heredity ; Horns ; Humans ; Islands ; Mothers* ; Nasolabial Fold ; Skin ; Young Adult

We present a case of mycosis fungoides of an 52-year-old woman who showed multiple pruritic erythematous papules, plaques with ulcers on the trunk, extremities and face. Her skin biopsy specimens were studied irnmunohistochemically with, monoclonal antibodies against T cells(80%, Leu-4, OKT11), T-cell subsets (60% Leu-3a, OKT4a, 40% OKT8) and Langerhans cell(OKT6). We think that this case should be considered in the differential diagnosis of adult T-cell leukemia/lymphoma. The proliferating cells were negative for anti-Tac.
Adult ; Antibodies, Monoclonal ; Biopsy ; Diagnosis, Differential ; Extremities ; Female ; Humans ; Middle Aged ; Mycosis Fungoides* ; Skin ; T-Lymphocyte Subsets ; T-Lymphocytes ; Ulcer

Progressive idiopathic atrophoderma of Pasini and Pierini is an asymptomatic atrophic disorder of the skin characterized by sharply demarcated, slightly depressed and slate-gray to brownish patches. The affected skin may be thin but of normal consistency. We herein described a 32-year-old female who showed on the trunk and extremities well-defined, brownish and atrophic areas without induration, but the central portion of the abdominal lesion was slightly thickened. Histopathologic findings showed slight thinning of the epidermis and dermis with mild perivascular infiltrate, however, the central portion of the abdominal lesion showed a focal, slightly sclerotic change of the collagen fibers.
Adult ; Collagen ; Dermis ; Epidermis ; Extremities ; Female ; Humans ; Skin

PURPOSE: The aim of this study was to confirm the factors that affect the mortality associated with the open surgical repair of ruptured abdominal aortic aneurysm (rAAA) and to analyze the long-term survival rates. METHODS: A retrospective review was performed on a prospectively collected database that included 455 consecutive patients who underwent open surgical repair for AAA between January 2001 and December 2012. We divided our analysis into in-hospital and postdischarge periods and analyzed the risk factors that affected the long-term survival of rAAA patients. RESULTS: Of the 455 patients who were initially screened, 103 were rAAA patients, and 352 were non-rAAA (nAAA) patients. In the rAAA group, 25 patients (24.2%) died in the hospital and 78 were discharged. Long-term survival was significantly better in the nAAA group (P = 0.001). The 2-, 5-, and 10-year survival rates of the rAAA patients were 87%, 73.4%, and 54.1%, respectively. Age (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.02–.08; P < 0.001) and aneurysm rupture (HR, 1.96; 95% CI, 1.12–.44; P = 0.01) significantly affected long-term survival. CONCLUSION: Preoperative circulatory failure is the most common cause of death for in-hospital mortality of rAAA patients. After excluding patients who have died during the perioperative period, age is the only factor that affects the survival of rAAA patients.
Aneurysm ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal* ; Aortic Rupture ; Cause of Death ; Hospital Mortality* ; Humans ; Mortality ; Perioperative Period ; Prospective Studies ; Retrospective Studies ; Risk Factors ; Rupture ; Shock ; Survival Rate

PURPOSE: The aim of this study was to analyze anatomical popliteal artery entrapment syndrome (PAES) and to individualize the treatment of this condition according to the anatomical status of the artery and the adjacent structure. METHODS: A total of 35 anatomical PAES legs in 23 consecutive patients treated within the Asan Medical Center, Seoul, Korea between 1995 and 2011 were analyzed retrospectively. Anatomical PAES was diagnosed by MRI and/or CT scans of the knee joint, and CT or conventional transfemoral arteriography of the lower extremities. RESULTS: We noted a type II gastrocnemius medial head (GNM) anomaly, a type III GNM anomaly, or an aberrant plantaris muscle in 51.4%, 20%, and 28.6% of PAES legs, respectively. In assessments of the arterial lesions, popliteal or tibial artery occlusion was noted in 19 of 26 symptomatic PAES legs. For cases without popliteal artery lesions, myotomy of the anatomically deranged muscle was performed in 5 of 7 symptomatic and 4 of 9 asymptomatic PAES legs. For occluded popliteal arteries, we performed ten direct repairs of the pathological popliteal artery and 4 femoro-below the knee popliteal bypass surgeries. As a result of the arterial Surgery, 9 direct procedures with myotomy yielded a patent artery, while 3 graft failures were noted in the bypass group. The median follow-up period was 84 months (range, 12–206 months). CONCLUSION: We recommend that treatment of PAES should be individualized based on pathology, symptoms, and various imaging studies.
Angiography ; Arteries ; Chungcheongnam-do ; Follow-Up Studies ; Head ; Humans ; Knee ; Knee Joint ; Korea ; Leg ; Lower Extremity ; Magnetic Resonance Imaging ; Muscle, Skeletal ; Pathology ; Popliteal Artery* ; Retrospective Studies ; Seoul ; Tibial Arteries ; Tomography, X-Ray Computed ; Transplants

BACKGROUND AND OBJECTIVES: The aim of this study is to evaluate the clinical outcomes of two surgical techniques-modified Bondy technique and canal wall up mastoidectomy with tympanoplasty type I and scutumplasty (CWUM/T1)-to remove attic cholesteatoma while preserving ossicular chain intact. SUBJECTS AND METHOD: A retrospective study was performed on 23 surgical cases for the attic cholesteatoma with postoperative audiometry data of more than six months after surgery. The patients' postoperative clinical features and audiometric results were compared between the two surgical groups. RESULTS: Out of 23 patients, CWUM/T1 was performed in 13 cases and modified Bondy technique was used in 10 cases. There were no significant differences for the preoperative and postoperative audiograms between the two groups. But air-bone gap increased significantly after CWUM/T1 while it decreased after modified Bondy technique. Three cases with postoperative problems were seen after CWUM/T1 (recurrent cholesteatoma, pars tensa adhesion, recurrent otitis media with effusion). Two cases with postoperative problems were found after modified Bondy technique (mild attic retraction, pars tensa retraction). CONCLUSION: Both surgical techniques seem to be adequate to treat attic cholesteatoma while preserving intact ossicular chain. Given good postoperative hearing results and stability of open cavity against recidivism, the modified Bondy technique seems to be a good choice for the attic cholesteatoma with intact ossicular chain when mastoid is not highly pneumatized.
Audiometry ; Cholesteatoma* ; Hearing ; Humans ; Mastoid ; Methods ; Otitis Media ; Otologic Surgical Procedures ; Retrospective Studies ; Tympanoplasty*

PURPOSE: To evaluate the success rates, long-term patency rates and factors affecting the patency rates of percutaneous transluminal angioplasty (PTA) and thrombolysis in the management of insufficient access during hemodialysis. MATERIALS AND METHODS: Between January 1991 and March 1995, 37 insufficient shunts (23 native fistulae and 14 graft fistulae) were treated in 31 patients. PTA was performed in 24 shunts, and thrombolysis in13; in seven of these latter, thrombolysis was followed by PTA. The success and long-term patency rates of PTA and thrombolysis were evaluated. Shunts were subdivided according to a patient's age, type and age of the shunt, and number and length of the stenosis, and the degree of residual stenosis and in each subgroup, patency rates was compared. RESULTS: The overall success rate of PTA and thrombolysis for insufficient hemodialytic access was 78.4% (29/37). The success rates of PTA and thrombolysis were 91.7% (22/24) and 53.8% (7/13), respectively. The patency rates of PTA (85.7% at 6 months, 78.6% at 12 months, and 55.9% at 24 months) were superior to those of thrombolysis (100% at 6 months and 0% at 12 months) (p=.014). Patency rates in each subgroup were not significantly different (p>.05). CONCLUSION: The success and patency rates of PTA were superior to those of thrombolysis, and after PTA or thrombolysis, no factors affected patency rates.
Angioplasty* ; Arteriovenous Fistula ; Constriction, Pathologic ; Fistula ; Humans ; Renal Dialysis* ; Transplants

BACKGROUND AND PURPOSE: Carotid endarterectomy (CEA) is performed to prevent cerebral infarction, but a common side effect is cerebral microinfarcts. This study aimed to identify the variables related to the production of microinfarcts during CEA as well as determine their association with delayed postoperative infarction. METHODS: This was a retrospective review of data collected prospectively from 548 patients who underwent CEA. The clinical characteristics of the patients and the incidence rates and causes of microinfarcts were analyzed. Microinfarcts were diagnosed by diffusion-weighted magnetic resonance imaging. The presence of delayed postoperative infarction was compared between microinfarct-positive and microinfarct-negative groups. RESULTS: In total, 76 (13.86%) patients were diagnosed with microinfarcts. Preoperative neurological symptoms were significantly related to the incidence of microinfarcts [odds ratio (OR)=2.93, 95% confidence interval (CI)=1.72–5.00, p<0.001]. Shunt insertion during CEA was the only significant procedure-related risk factor (OR=1.42, 95% CI=1.00–2.19, p=0.05). The presence of microinfarcts did not significantly increase the incidence of delayed postoperative infarction (p=0.204). CONCLUSIONS: In the present study, risk factors for microinfarcts after CEA included preoperative symptoms and intraoperative shunt insertion. Microinfarcts were not associated with delayed postoperative infarction.
Cerebral Infarction* ; Endarterectomy, Carotid* ; Humans ; Incidence ; Infarction ; Magnetic Resonance Imaging ; Prospective Studies ; Retrospective Studies ; Risk Factors*

PURPOSE: To evaluate the MRI appearance of Kienbock's disease and correlate this with radiographic findings. MATERIALS AND METHODS: Thirteen clinically confirmed cases of 12 patients with kienbock's disease wereretrospectively reviewed. The significance of signal intensity and pattern of Kienbock's disease on MR images was evaluated and the findings on MR images were compared with radiographic stages classified by Lichtman. Enhanced MR images were abtained in four cases. RESULTS: Lichtman's stage I accounted for one case; stage II, two; stage III, eight; stage IV, two. On T1-weighted MR images, the lunate showed focal low signal intensity in the stage I caseand in one of the two stage II case. Eleven wrists demonstrated a generalized loss of lunate signal. On T2-weighted images, the stage I case showed focal high signal intensity. In stage II, one showed focal low signal intensity and the other exhibited generalized low signal intensity with a high spot area. In stage III, five ofeight cases showed generalized low signal intensity, and one demonstrated high signal intensity. Two showed a high spot area within the generalized low signal intensity. In stage IV, one showed generalized low signal intensity and the other exhibited high signal intensity. No enhancement was seen in the three lesions with focal orgeneralized low signal intensity both on T1 and T2-weighted images. Conversely, one lesion with low signalintensity on T1-weighted imaes and high signal intensity on T2-weighted images showed contrast enhancement. CONCLUSION: Low signal intensity of the lunate on T1-weighted images is a consistent findings of Kienbock's disease. However, further studies such as follow-up MRIs, or pathologic correlation studies and MR contrast enhancement studies will be necessary to evaluate the sighificance of high signal intensity on T2-weighted images.
Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Osteonecrosis* ; Statistics as Topic ; Wrist

Necrotizing fasciitis is an uncommon severe infection involving the subcutaneous soft tissue, particularly the superficial and often deep fascia. It is usually associated with systemic toxicity, rapid progression and a mortality rate which varies between 20 and 60%. It can affect any part of the body but is most common on the extremities, especially the leg. Predisposing factors include diabetes mellitus, alcoholism, intravenous drug abusers, abdominal surgery, perineal infection. The prognosis for necrotizing fasciitis depends so heavily on early recognition and determination of the extent of necrosis. Whilist there are reports of acute renal failure occuring in the presence of necrotizing fasciitis, descriptions of the condition in patients with chronic renal failure are rare in the literature. Hence we report a case of necrotizing fasciitis, diagnosed by MRI(Magnetic Resonance Imaging) in chronic renal failure patient.
Acute Kidney Injury ; Alcoholism ; Causality ; Diabetes Mellitus ; Drug Users ; Extremities ; Fascia ; Fasciitis, Necrotizing ; Humans ; Kidney Failure, Chronic* ; Leg ; Magnetic Resonance Imaging ; Mortality ; Necrosis ; Prognosis