The blue rubber bleb nevus syndrome(CRBNS) is a rare disorder characterized by distinctive vascular malformations of the skin and gastrointestinal tract. The syndrome is associated commonly with iron deficiency anemia due to gastrointestinal bleeding. Most cases are sporadic, although a few have been reported with autosomal dominant inheritance. We report a case with clinical characteristics of the blue rubber bleb nevus syndrome. The patient had typical skin manifestations of the BRBNS and chronic iron deficiency anemia. However, we could not find any gastrointestinal vascular malformations radiologically.
Anemia, Iron-Deficiency ; Blister* ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Nevus* ; Rubber* ; Skin ; Skin Manifestations ; Vascular Malformations ; Wills

No abstract available.

The incidence of contralateral reflux after unilateral reimplantation in children with primary unilateral vesicoureteral reflux(VUR) is reported to be 0.8-32%. We evaluated the characteristics of contralateral reflux after endoscopic or open surgical correction of primary unilateral VUR in children. 30 children who underwent unilateral reimplantation by Paquin (25pts) and submucosal Macroplastique injection(5pts) were evaluated. The association between postoperative contralateral reflux and age, sex, ipsilateral implant side, postoperative urinary tract infection, and surgical method were evaluated. There were 18 male and 12 female patients. Initial reflux was observed in the right in 18 and 12 in left. The initial reflux grades were II, III, IV, and V in 2, 11, 14, and 3 patients, respectively. Postoperative urinary tract infection was observed in 4 patients of whom 1 had contralateral reflux. In conclusion, there was no single factor that could predict the development of contralateral reflux after unilateral correction of unilateral primary VUR. Furthermore, the fact that contralateral reflux occurred even after submucosal Macroplastique injection suggests that the method of surgery is not related to the subsequent development of contralateral reflux.
Child* ; Female ; Humans ; Incidence* ; Male ; Replantation ; Ureter ; Urinary Bladder ; Urinary Tract Infections ; Vesico-Ureteral Reflux*

BACKGROUND: Vitiligo is an acquired depigmentary disorder characterized by loss of melanocytes from the epidermis. Autografting using the suction blistered epidermis technique is one of the surgical modalities of vitiligo treatment, and has been successfully used by several authots. OBJECTIVE: The purpose of this study was to evaluate the effect of the autografting using the suction blistered epidermis technique for the treatment of vitiligo. METHODS: 142 sites from 39 patients with vitiligo were treated with autografting using the suction blistered epidermis technique. The recipient sites were prepared by freezing with liquid nitrogen of the sites 48 hours prior to grafting. RESULTS: Better results were seen in cases with the following Factors: a) cases where the disease had been present for more than 3 years b) the post-operative period had been Longer than a year c) the Lesional sites of the vitiligo were on the trunk and neck rather than the neck and extremities d) the vitiligo had affected the grabous rather than the hairy areas on the face. However, there were no differences between the clinical types(such as generalized, localized, and segmental) in the success rate of treatment. Preopera'tive PUVA or post operative PUVA also did not affect the statistical results. CONCLUSION: On autografting using the suction blistered epidermis, it is better to select the patients who have had the disease for more than 3 years, and graft the epidermis which has increased melanocytes by preoperative PUVA for good treatment results and even pigmentation.
Autografts* ; Blister* ; Epidermis* ; Extremities ; Freezing ; Humans ; Melanocytes ; Neck ; Nitrogen ; Pigmentation ; Suction* ; Transplantation, Autologous* ; Transplants ; Vitiligo*

Scedosporium(S). apiospermum is the asexual stage of Pseudallescheria boydii. This ubiquitous fungus causes not only mycetoma but also infection of a variety of body sites including the skin. Localized skin infection without grain production due to this organism is much rarer than mycetoma. We report a case of cutaneous S. apiospermum infection which occured in a 75-year old female. She had multiple suppurative nodules with pustules on a dark red plaque at the dorsum of the right forearm. Cultural isolation for definitive diagnosis showed typical S. apiospermum. The patient was treated successfully with oral terbinafine 250mg daily for 1 week and oral itraconazole 200mg daily for 3 weeks.
Aged ; Edible Grain ; Diagnosis ; Female ; Forearm ; Fungi ; Humans ; Itraconazole ; Mycetoma ; Pseudallescheria ; Scedosporium* ; Skin*

We report a case of laparoendoscopic single-site surgery (LESS) for a symptomatic left seminal vesicular cyst and ipsilateral renal agenesis. A 49-year-old man presented with a 1-year history of severe irritation upon voiding and intractable, recurrent hematospermia. A computed tomography scan showed a 68x41x38 mm sized left seminal vesicular cyst with ipsilateral renal agenesis. LESS was performed successfully to treat the seminal vesicle cyst. The total operative time was 125 minutes, and blood loss was minimal. The patient was discharged from the hospital on the second postoperative day.
Congenital Abnormalities ; Hemospermia ; Humans ; Kidney ; Kidney Diseases ; Laparoscopy ; Middle Aged ; Operative Time ; Seminal Vesicles ; Surgical Procedures, Minimally Invasive

BACKGROUND: General anesthesia often produces some degree of hypothermia and hypothermia causes much more blood loss during surgery than normothermia. Electrically heated humidifiers (EHHs) have been used for patients under general anesthesia and in the intensive care unit. However, the benefits of the EHH have not been widely reported in the literature. METHODS: Patients scheduled for posterior lumbar spine fusion, were randomly assigned to a mechanically ventilated with EHH circuit group or to a conventional respiratory circuit group. Their tympanic membrane temperature was monitored every 30 min after induction up to 180 min, and perioperative blood losses, transfusion requirements during surgery, and other complications were noted. RESULTS: Patients in the control group (n = 40) showed a lower mean body temperature at all times than immediately after induction, while the EHH group (n = 40) showed a lower body temperature from 60 minute after induction comparing to the initial temperature. Furthermore, patients in the EHH group had a higher mean body temperature than patients in the control group during surgery (35.9 +/- 0.4 vs 35.4 +/- 0.5, P < 0.001). Mean intraoperative blood loss (9.75 +/- 5.4 vs 7.48 +/- 3.9, P = 0.035) and transfusion requirements (57.5% vs 25%, P = 0.006) were significantly less in the EHH group, but postoperative blood loss, duration of hospitalization, and other complications were not significantly different in the two study groups. CONCLUSIONS: The use of an electrically heated humidifier did not prevent a body temperature drop under general anesthesia. However, it helped maintain body temperature and was associated less blood loss and transfusion requirement during surgery.
Anesthesia, General ; Body Temperature ; Hospitalization ; Hot Temperature ; Humans ; Hypothermia ; Intensive Care Units ; Postoperative Hemorrhage ; Spine ; Tympanic Membrane

PURPOSE: To perform a prospective analysis of the clinical outcomes of prophylactic antibiotic treatment before the standard surgical modality of living donor nephrectomy (LDN) without postoperative antibiotic treatment. MATERIALS AND METHODS: From November 2005 to June 2010, a total of 470 patients underwent LDN at our medical institution, and 280 of these patients were injected with 1 g cephalosporin 30 minutes before the operation. The group receiving prophylactic antibiotics was compared with a control group composed of 190 patients who received injections of 2 g cephalosporin per day for 5 days after the operation. The presence of fever, incidence of blood transfusion, and period of drainage use were compared between the two groups. RESULTS: There were no significant differences in gender, age, body mass index, incidence of blood transfusion after the operation, fever over 38degrees C 3 days after the operation, or period of drain insertion between the single-dose group and the control group. The follow-up was conducted for 1 month after the operation, and 1 case of surgical site infection (SSI) was observed in each group (p=0.783). CONCLUSIONS: Of 280 patients in the single-dose group, 1 contracted SSI. In comparison with the control group, which was dosed with prophylactic antibiotics for 5 days after the operation, the single-dose group did not have a significantly different occurrence of SSI. We found that the incidence rate of SSI did not increase, even though prophylactic antibiotics were not used after standard and conventional open surgeries, such as video-assisted minilaparotomy surgery.
Anti-Bacterial Agents ; Antibiotic Prophylaxis ; Blood Transfusion ; Body Mass Index ; Contracts ; Drainage ; Fever ; Follow-Up Studies ; Humans ; Incidence ; Laparotomy ; Living Donors ; Nephrectomy ; Prospective Studies ; Surgical Wound Infection ; Tissue Donors ; Video-Assisted Surgery

BACKGROUND: Becker's nevus is a relatively common pigmented smooth muscle harmatoma that develops during adolescence and occurs primarily in young men. The nevus, characterized by hypertrichosis and hyperpigmentation, is usually located unilaterally over the shoulder, upper arm, and scapula. These nevi are not only cosmetically undesirable but also psychologically distressing, as traditional surgical therapies have been either unsuccessful or have resulted in scarring. OBJECTIVE: We evaluated the clinical improvement of 14 patients with a becker's nevus who were treated with a Q-switched (QS) frequency doubled ND: YAG laser in order to decrease pigmentation. METHODS: Our study was designed by analyzing the clinical improvement of outpatients with becker's nevus via clinical examination and photography. RESULTS: The results were as follows; Male to female ratio of 2.5: 1. The mean age was 19.7 years old and the subjects in most of the studies were young adult. The mean age of onset was 5.7 years old (below 5 years old: n=8, 57%). We treated 14 patients with a QS ND: YAG laser. The patients' response to treatment was; excellent; 14%, good; 36%, fair; 21%, and poor; 29%. Conparison, was made, of the positive clinical improvement in patients who received treatment once (n=10) and those who received treatment more than twice (n=4). Multiple treatments (75%) showed superior improvement compared with single treatment (40%). The clinical improvement, the according to the area of lesions, was the best in the neck (100%) and the worst in the trunk (25%). The lesions were accompanied by hair in 6 cases. Among these, the excellent or good cases were 33%. The other patients (8 cases) without hairs had more positive results (63%). Treatment effects according to laser fluence were not shown to be significant. During the study, the most common complication was hyperpigmentation (36%), followed by transient erythema (14%). Scarring or hypopigmenatation had resulted in none. CONCLUSION: Our data suggested that QS ND: YAG laser irradiation is an effective and safe method to treat the hyperpigmentation characteristic of a becker's nevus. Long-term further evaluation will be necessary to determine whether the favorable results observed in these patient will be permanent.
Adolescent ; Age of Onset ; Arm ; Child, Preschool ; Cicatrix ; Erythema ; Female ; Hair ; Humans ; Hyperpigmentation ; Hypertrichosis ; Lasers, Solid-State* ; Male ; Muscle, Smooth ; Neck ; Nevus* ; Outpatients ; Photography ; Pigmentation ; Scapula ; Shoulder ; Young Adult

Duplication is the most common type of congenital anomaly of the ureter. It occurs more frequently in females and it is often accompanied by an ectopic orifice. Ectopic ureter is usually derived from the upper pole of the ipsilateral kidney and its orifice is attached medial & inferior from the normal opening according to Weigert-Meyer's law. Thus, sometimes the ectopic ureteral opening is made at a distal part of the external sphincter or even out of the urinary system. These conditions may result in urinary incontinence in female patients, so they can be treated early at the mean age of 5 and it's not common that ectopic ureter accompanying complete duplication of the ureter is presented in adults. We report here on a case of ectopic ureter accompanying complete duplication of the ureter in a 44 year old female who presented with leukorrhea.
Adult ; Female* ; Humans ; Jurisprudence ; Kidney ; Leukorrhea ; Middle Aged* ; Ureter* ; Urinary Incontinence ; Urogenital Abnormalities ; Vaginal Discharge*