Verrucous hemangioma is a variety of capillary, cavernous or mixed hemangioma that can develop into acanthosis, hyperkeratosis, and papillomatosis. Most verrucous hemangiomas appear on the lower extremities, and are present at birth or appear during infancy. It is important, from a prognostic and therapeutic point of view, to make a correct diagnosis between verrucous hemangioma and angiokeratoma circumscriptum. The former needs a large and deep excision, while the latter responds to the common means of physical therapy. We observed two patients who showed typical clinical and histopathological findings of verrucous hemangioma. Treatment was by wide sugical excision and skin graft. The two patients responded positively to this tratment.
Angiokeratoma ; Capillaries ; Diagnosis ; Hemangioma* ; Humans ; Lower Extremity ; Papilloma ; Parturition ; Skin ; Transplants

No abstract available.
Osteogenesis Imperfecta* ; Osteogenesis*

BACKGROUND: Anesthesiologist must be aware of the common problems that occur in pediatric anesthesia. The purpose of this survey was to collect information to help improve the quality of pediatric anesthesia by comparing the opinions of anesthesiologists that treat children and those that do not treat children. METHODS: A questionnaire surveying the attitudes of 103 anesthesiologists with regard to pediatric problems was analyzed. The questionnaire inquired about the number of years worked in field, the form of work and the responsibilities with regard to the pediatric anesthesia. Each question was rated from 1 (very infrequent) to 5 (very common) for the frequency of problems and from 1 (not importance) to 5 (very important) for the importance of the problem. Then we calculated the average of each item and combined the scores to obtain an average frequency and an average importance. RESULTS: The list of problems had high combined scores for preoperative anxiety (10.62), incision pain (9.59), postoperative agitation (9.53), hypothermia (9.40), and vomiting (9.30) for the pediatric anesthesiologist group. In addition, the problem list had high combined scores for propofol injection pain (11.25), preoperative anxiety (10.92), vomiting (10.17), hypothermia (9.44), and postoperative agitation (9.42) for the non-pediatric anesthesiologist group. CONCLUSIONS: The results of this study showed a difference in the pediatric and non pediatric anesthesiologist groups for propofol injection pain. Differences were noted for the average importance (2.34 : 2.80) compared to the average frequency (3.93 : 4.01). The pediatric anesthesiologists regarded propofol injection pain to be less of a problem than did the anesthesiologists who did not care for pediatric patients.
Anesthesia ; Anxiety ; Child ; Dihydroergotamine ; Humans ; Hypothermia ; Propofol ; Vomiting ; Surveys and Questionnaires

BACKGROUND AND OBJECTIVES: Bone resorption of adjacent structures in aural cholesteatoma is mostly responsible for serious complication of the disease. Recent researches have been aimed at preventing bone resorption with tools of non-surgical therapy. The effect of pam-idronate disodium on systemic bone resorption is mainly attributed by its function against osteoclast recruitment and activation. In this study, we investigated the effect of systemic pam-idronate disodium on localized osteoclastic bone resorption in experimental cholesteatoma. MATERIAL AND METHODS: Experimental cholesteatomas were induced in 40 mongolian gerbils. pam-idronate disodium (Aredia(R), Ciba-Geigy Limited)were injected subcutaneously once a week in 20 gerbils (treated group)and none were injected in the other 20 gerbils (untreated group). pam-idronate disodium were injected with a dose of 2 mg/kg in 10 of the treated group (low dose group) and with a dose of 4 mg/kg in the remainder (high dose group). Gerbils were sacrificed at 12 weeks (3 month group) or 17 weeks (4 month group) after the injection. Harvested temporal bones were examined by light microscope and transmission electron microscope. RESULTS: The clinical stage of cholesteatoma tended to be more advanced in the untreated group than in the treated group although it was not statistically significant. Scores of osteoclast number per total bone length in millimeter were lower in the treated group than in the untreated, although the percentage of surface occupied by osteoclasts per total bone surface were not different between the groups. CONCLUSION: These results will provide fundamental data for further studies on the prevention and treatment of osteoclastic bone resorption in aural cholesteatoma.
Bone Resorption ; Cholesteatoma* ; Cholesteatoma, Middle Ear ; Gerbillinae ; Osteoclasts ; Temporal Bone

OBJECTIVE: The authors analyze the incidence, etiological and prognostic factors between contralateral and ipsilateral delayed epidural hematoma after evacuation of initial hematoma and to formulate recommendations for early detection of evolving hematoma and improvement of outcome. METHODS: Between July 1997 and December 1999, 417 patients underwent craniotomy at department of neurosurgery to evacuate an acute posttraumatic intracranial hematoma. Analysis of these clinical and neuroradiologic data showed that we underwent a second operation on 24 patient(5.8%) for removal of delayed epidural hematoma. In 10(2.4%) of these patients the second operation was undertaken to evacuate a new hematoma that had developed at a contralateral side from the initial hematoma. In 14 patients(3.4%), the second operation was to remove a epidural hematoma at the same site as the first craniotomy. RESULTS: 24 patients were divided into two groups. In Group A, 10 patients who developed contralateral delayed epidural hematoma were 31.5 years(11-61) of age and had skull fracture at the site of delayed epidual hematoma formation. Two of these patients revealed severe brain swelling during the evacuation of acute subdural hematoma. Eight of them were diagnosed within 24 hours after craniotomy through immediately postoperative computed tomography scan. In Group B, 14 patients who developed ipsilateral epidural hematoma were 56.1 years(27-75) of age. Six of them had hemorrhagic tendency related to past medical history. Eleven of these patients were associated with thrombocytopenia and consumptive coagulopathy when required second operation. Twelve patients were diagnosed within 48-72 hours after craniotomy due to clinical deterioration or failure to improve. There was no significant difference in outcome between two groups. CONCLUSION: The authors sought differential factors between contralateral and ipsilateral delayed epidural hematoma. Delayed epidural hematoma after craniotomy may need an urgent operation or lead to serious complication or disability. Postoperative computed tomography scan, intracranial pressure monitoring and repeat computed tomography scan within 72 hours of injury are strongly recommended in these cases, especially after decompression of cranial cavity.
Brain Edema ; Craniotomy ; Decompression ; Hematoma* ; Hematoma, Subdural, Acute ; Humans ; Incidence ; Intracranial Pressure ; Neurosurgery ; Skull Fractures ; Thrombocytopenia

PURPOSE: To evaluate the usefulness and effectiveness of endoscopic management for recurrent hematospermia, we performed transurethral endoscopy of the seminal vesicles in patients with recurrent hematospermia, despite the administration of oral medication. MATERIALS AND METHODS: Sixteen patients were enrolled this study. Initially, all patients were treated with oral antibiotics for 6-8 weeks. Transrectal ultrasound (TRUS) and/or MRI were performed to find the anatomic abnormality and its relation with pelvic organs. The mean patient age and duration of symptoms were 43.9 years (range 24-64 years) and 21.3 months (range 1-108), respectively. We used a 6.5Fr. rigid ureteroscope and/or 14Fr. endoureterotomy instruments for the seminal vesiculoscopic examination. Patients were followed for more than 12 months after the procedures. RESULTS: An endoscopic seminal vesicle examination was able to be successfully performed in all patients. A midline cyst was found at 10 cases, which were fulgurated. Endoscopic incisions or dilation of the ejaculatory duct were performed in all patients. An ejaculatory duct stone was found at 5 cases, and removed endoscopically. All patients reported improvement of hematospermia after the procedure, and 3 with perineal discomfort became symptom free. Postoperative complications, such as epididymitis, orchitis and ejaculatory abnormalities, were not observed in any patient. CONCLUSIONS: Transurethral endoscopic interventions of the seminal vesicles can be performed easily with a conventional 6.5Fr. rigid ureteroscope and/or 14Fr. endoureterotomy instruments. Transurethral endoscopic managements were effective and safe treatment options in recurrent hematospermia patients.
Anti-Bacterial Agents ; Ejaculatory Ducts ; Endoscopy ; Epididymitis ; Hemorrhage ; Hemospermia* ; Humans ; Magnetic Resonance Imaging ; Male ; Orchitis ; Postoperative Complications ; Semen ; Seminal Vesicles ; Ultrasonography ; Ureteroscopes

Spontaneous brain stem hemorrhage usually results in higher mortality and morbidity with poorer prognosis than any other intracranial vascular lesions in spite of meticulous medical or surgical treatment. We have experienced 86 cases of spontaneous brain stem hemorrhage who were admitted to Wonju college of medicine from January 1983 to Octobr 1995. 33 cases were treated with operation and 53 cases with non-operative treatment. The results were as follows: 1) Clinical parameters in both operative and non-operative groups showed no significant differences. 2) Treatment results were better in the operative group. Operative treatment is recommended in cases of GCS score below 7, hematoma size larger than 10ml, young age, and normotensive patients. 3) Appropriate operative approaches should be considered according to the patient's status. Recently, we most frequently performed a stereotactic approach. 4) Better outcome was obtained when the patients were operated from 72 hours to one or two weeks following the h emorrhage. 5) Hypertension, old age, and GCS score above 7 showed no statistical differences in terms of outcome between the operative and non-operative groups.
Brain Stem* ; Brain* ; Gangwon-do ; Hematoma ; Hemorrhage* ; Humans ; Hypertension ; Mortality ; Prognosis

Objective: Although serum ferritin is considered the best measure of total body iron, with low levels indicating iron deficiency, recent studies have shown that high levels are associated with gestational diabetes, premature birth, and low birth weight. This study aimed to analyze the association between serum ferritin levels in the third trimester of pregnancy and low birth weight and preterm birth. Methods: This study included pregnant women who delivered a single fetus at Kangwon National University Hospital between January 2009 and December 2013 and in whom serum ferritin levels were measured between 28 and 34 weeks of gestation. The association between serum ferritin levels measured in the early third trimester of pregnancy and preterm birth and low birth weight infants was analyzed. Results: A total of 1,079 women fulfilled the study criteria and had their serum ferritin level measured during the third trimester (28–33.9 weeks of gestation) and later delivered at Kangwon National University Hospital. Comparison of the group with serum ferritin levels above the 75th percentile and those below the 25th percentile at the beginning of the third trimester revealed that the incidence of preterm births (<34 weeks of gestation, <37 weeks of gestation) and low birth weight were significantly higher in the group with serum ferritin levels above the 75th percentile than those below the 25th percentile (p<0.05). When variable factors were controlled through multiple regression analysis, the group whose serum ferritin levels were above the 75th percentile at 30–31.9 weeks of gestation had the highest risk of preterm birth before 34 weeks of gestation (adjusted odds ratio [OR], 7.85; 95% confidence interval [CI], 1.32–29.9) and low birth weight (adjusted OR, 6.49; 95% CI, 2.10–20.0). Conclusion In this study, when serum ferritin was high in the third trimester of pregnancy, it was significantly increased with preterm birth (<34 and 37 weeks) and low birth weight. In particular, when serum ferritin levels were high at 30–31.9 weeks of gestation, the risk of premature birth before 34 weeks and low birth weight was statistically highest.

Spontaneous rupture of an ovarian artery aneurysm is an extremely rare, life-threatening disease and has been reported to be most highly associated with pregnancy. The current study presents a case of intraperitoneal and retroperitoneal hematoma caused by spontaneous rupture of a right ovarian artery aneurysm in a 56-year-old woman. A 56-year-old woman visited the emergency room with right lower quadrant abdominal pain. Contrast-enhanced computed tomography showed a large retroperitoneal and intraperitoneal hematoma and active extravasation of contrast medium in the right retroperitoneum. Consequently, transcatheter arterial embolization was successfully performed. Spontaneous rupture of an ovarian artery aneurysm should be suspected in multiparous women with abdominal or flank pain even if it is unrelated to pregnancy. Suspicion of this entity is needed for earlier diagnosis and management.

Spontaneous rupture of an ovarian artery aneurysm is an extremely rare, life-threatening disease and has been reported to be most highly associated with pregnancy. The current study presents a case of intraperitoneal and retroperitoneal hematoma caused by spontaneous rupture of a right ovarian artery aneurysm in a 56-year-old woman. A 56-year-old woman visited the emergency room with right lower quadrant abdominal pain. Contrast-enhanced computed tomography showed a large retroperitoneal and intraperitoneal hematoma and active extravasation of contrast medium in the right retroperitoneum. Consequently, transcatheter arterial embolization was successfully performed. Spontaneous rupture of an ovarian artery aneurysm should be suspected in multiparous women with abdominal or flank pain even if it is unrelated to pregnancy. Suspicion of this entity is needed for earlier diagnosis and management.