Nipple size varies from person to person, but having a large nipple, or macrothelia, can be a concern for some women; therefore, some surgical methods have been developed for the reduction of nipple size. Conventional surgical methods for nipple reduction are classified into two types according to their purpose: reduction of length and reduction of diameter. For reduction of length, soft tissue is resected (except the central supplying vessel) and shortened by circumferential repair. The disadvantage of this method is possible necrosis of the nipple and impairment of the lactiferous duct. For reduction of diameter, a wedge-shaped resection is done from side to center and the defect is covered by a local advancement flap. The disadvantage of this method is the locally focused tension line, which is associated with unfavorable aesthetic outcomes. In this article, we present a case involving a novel method of nipple reduction surgery, referred to as the tripod wedge resection technique, which has three benefits compared to conventional nipple reduction surgery: simultaneous reduction of both length and diameter, relative safety for the vasculature and lactiferous duct, and an evenly tensioned incision line.

Nipple size varies from person to person, but having a large nipple, or macrothelia, can be a concern for some women; therefore, some surgical methods have been developed for the reduction of nipple size. Conventional surgical methods for nipple reduction are classified into two types according to their purpose: reduction of length and reduction of diameter. For reduction of length, soft tissue is resected (except the central supplying vessel) and shortened by circumferential repair. The disadvantage of this method is possible necrosis of the nipple and impairment of the lactiferous duct. For reduction of diameter, a wedge-shaped resection is done from side to center and the defect is covered by a local advancement flap. The disadvantage of this method is the locally focused tension line, which is associated with unfavorable aesthetic outcomes. In this article, we present a case involving a novel method of nipple reduction surgery, referred to as the tripod wedge resection technique, which has three benefits compared to conventional nipple reduction surgery: simultaneous reduction of both length and diameter, relative safety for the vasculature and lactiferous duct, and an evenly tensioned incision line.

OBJECTIVE: The current study aimed to examine the association of implicit self-esteem, explicit self-esteem and their interaction with paranoia and attributional bias. The relationship of the size and the direction of the discrepancy between implicit and explicit self-esteem with paranoia and attributional bias was examined. METHODS: A total of 128 female college students participated. We administered the Implicit Association Test to assess implicit self-esteem, and the Rosenberg Self-Esteem Scale to measure explicit self-esteem. Paranoia Scale was used, and the attributional bias was assessed using the Ambiguous Intentions Hostility Questionnaire. RESULTS: Results showed that explicit but not implicit self-esteem was negatively associated with paranoia, blame bias and hostility perception bias in ambiguous situations. The interaction of implicit and explicit self-esteem was associated with hostility perception in ambiguous situations. As for the discrepancy, the size of the discrepancy between implicit and explicit self-esteem was positively associated with hostility perception in ambiguous situations. Moreover, the direction of the discrepancy was specifically relevant: damaged self-esteem (high implicit and low explicit self-esteem) was associated with increased levels of paranoia, blame bias and hostility perception in ambiguous situations. CONCLUSION: These findings provide new insights into the role of the implicit and explicit self-esteem in attributional bias and paranoia and point to damaged self-esteem as a possible vulnerability marker for illogical attribution of blaming others and perceiving hostility in social situations.
Bias (Epidemiology) ; Female ; Hostility ; Humans ; Intention ; Paranoid Disorders

A 6-year-old boy with underlying hemolytic anemia of unknown etiology, atopic dermatitis, and recurrent urticaria visited our hospital because of acute respiratory failure induced by influenza A. Despite mechanical ventilation after endotracheal intubation along with inhalation of nitric oxide, respiratory acidosis and hypoxemia persisted. Veno-venous extracorporeal membrane oxygenation (VV ECMO) insertion was performed to provide respiratory support. After performing flexible bronchoscopy, we found that thick mucus plugs were obstructing the right bronchus intermedius and the upper lobe orifice. After bronchial washing and removal of the plugs, we were able to wean the patient off VV ECMO and transfer him to the general ward. He was discharged without any neurologic or pulmonary sequelae.
Acidosis, Respiratory ; Anemia, Hemolytic ; Anoxia ; Bronchi ; Bronchitis ; Bronchoscopy ; Child ; Dermatitis, Atopic ; Extracorporeal Membrane Oxygenation ; Humans ; Influenza A virus ; Influenza, Human ; Inhalation ; Intubation, Intratracheal ; Male ; Mucus ; Nitric Oxide ; Patients' Rooms ; Plastics ; Pneumonia ; Respiration, Artificial ; Respiratory Insufficiency ; Urticaria

BACKGROUND: The ongoing Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro) aims to observe the natural course of papillary thyroid microcarcinoma (PTMC), develop a protocol for active surveillance (AS), and compare the long-term prognosis, quality of life, and medical costs between the AS and immediate surgery groups. METHODS: This multicenter prospective cohort study of PTMC started in June 2016. The inclusion criteria were suspicious of malignancy or malignancy based on fine needle aspiration or core needle biopsy, age of ≥18 years, and a maximum diameter of ≤1 cm. If there was no major organ involvement, no lymph node/distant metastasis, and no variants with poor prognosis, the patients were explained of the pros and cons of immediate surgery and AS before selecting AS or immediate surgery. Follow-up visits (physical examination, ultrasonography, thyroid function, and questionnaires) are scheduled every 6 months during the first 2 years, and then every 1 year thereafter. Progression was defined as a maximum diameter increase of ≥3, ≥2 mm in two dimensions, suspected organ involvement, or lymph node/distant metastasis. RESULTS: Among 439 enrolled patients, 290 patients (66.1%) chose AS and 149 patients (33.9%) chose immediate surgery. The median follow-up was 6.7 months (range, 0.2 to 11.9). The immediate surgery group had a larger maximum tumor diameter, compared to the AS group (7.1±1.9 mm vs. 6.6±2.0 mm, respectively; P=0.014). CONCLUSION: The results will be useful for developing an appropriate PTMC treatment policy based on its natural course and risk factors for progression.
Biopsy, Fine-Needle ; Biopsy, Large-Core Needle ; Cohort Studies* ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Prognosis ; Prospective Studies* ; Quality of Life ; Risk Factors ; Thyroid Gland* ; Thyroid Neoplasms ; Ultrasonography

No abstract available.

BACKGROUND AND OBJECTIVES: We analyzed the clinicopathologic differences of thyroid cancer by diagnosis periods, diagnostic motives, residence history and clinical risk factors in thyroid cancer patients. MATERIALS AND METHODS: Total 1599 thyroid cancer patients who answered the questionnaires about family history of thyroid cancer, residence history including duration of residence and location were enrolled from two hospitals, Seoul National University Hospital and National Cancer Center in Korea. Demographics and environmental information were collected via questionnaires and clinical data were reviewed via electronic medical records. RESULTS: More thyroid cancer has been diagnosed in 2011 to 2013 by screening test without specific symptom than before 1990. The size of cancer at diagnosis was significantly smaller and multifocal tumor was more frequently found in 2011 to 2013 than before 1990 as well. The tumors of obese or overweight patients tended to harbor extrathyroidal extension and lymph node metastasis than normal weight subjects with statistical significance. However, there were no differences in clinicopathologic characteristics according to residence and smoking history. CONCLUSION: In this study, there were some different clinicopathologic characteristics according to the diagnosis era, diagnostic motives, family history of thyroid cancer and body mass index.
Body Mass Index ; Demography ; Diagnosis ; Electronic Health Records ; Humans ; Korea ; Lymph Nodes ; Mass Screening ; Neoplasm Metastasis ; Overweight ; Risk Factors* ; Seoul ; Smoke ; Smoking ; Thyroid Gland* ; Thyroid Neoplasms*

Keratosis follicularis squamosa (Dohi) is a keratinizing disorder which is a separate clinical entity from keratosis follicularis (Darier's disease). It occurs predominantly in Japanese and appears clinically as scaly patches of 3~10 mm in diameter with brownish follicular plugs in the center, which are symmetrically scattered on the trunks and thighs. Scales on the margin, slightly detached from the underlying epidermis, look like 'lotus leaves on the water'. The efficacy of minocycline has already been confirmed in many cases. In this report, we describe a case of using 1% of pimecrolimus cream for keratosis follicularis squamosa (Dohi) instead of minocycline.
Asian Continental Ancestry Group ; Darier Disease ; Epidermis ; Humans ; Keratins ; Keratosis ; Minocycline ; Tacrolimus ; Thigh ; Weights and Measures

BACKGROUND: Many patients received transfusion in emergency department because of blood loss. There are few studies on massive transfusion for non-traumatic patients. This study investigated mortality and risk factor for non-traumatic bleeding patients who received transfusion. METHODS: Non-trauma patients who received transfusion at the emergency department for 3 years from March 2009 to February 2011 were enrolled. The patients who are younger than 15 years, trauma patients, and transfused FFP or platelet alone are excluded. Medical records was investigated retrospectively. We investigated predictive factors for MT on non-trauma patients and predictive factors for mortality on MT patients. RESULTS: Among 1655 non-trauma patients, 150 patients (9.24%) received MT. The age of MT group was younger than that of non-MT group and systolic bloor pressure, diastolic blood pressure, mean arterial pressure were significantly lower. Base excess, pH, lactate levels were significantly different between MT and non-MT group. Intensive care unit length of stay was longer, mortality of 24 hours was higher and survival discharge was lower than non-MT group. Mortality rate of MT group was 20.7% which was significantly higher than non-MT group's 9.3%. FFP:RBC ratio was higher in MT group than non-MT group. Among the MT group, non-survival group used higher FFP:RBC ratio product than survival group. On multivariate analysis, sBP, MAP, lactate, pH, BE were significant as predictors of MT. CONCLUSION: For non-trauma patients in emergency department, if sBP, MAP, lactate, pH, BE are abnormal, massive transfusion could be expected. Like trauma patients, basic scoring system that can predict MT would be necessary and useful.
Arterial Pressure ; Blood Platelets ; Blood Pressure ; Blood Transfusion* ; Emergencies* ; Hemorrhage ; Humans ; Hydrogen-Ion Concentration ; Intensive Care Units ; Lactic Acid ; Length of Stay ; Medical Records ; Mortality ; Multivariate Analysis ; Retrospective Studies ; Risk Factors

BACKGROUND: Pilomatricoma is a benign appendageal tumor characterized by basaloid and shadow cells. Differentiation towards normal hair follicles is often observed in this condition. OBJECTIVE: The purpose of this study was to analyze the clinical and histopathological features of pilomatricoma and to confirm diverse types of differentiation towards normal hair follicles, and its origin. METHODS: We retrospectively reviewed medical records and histopathological findings of 64 patients who had visited our hospital in the last 7 years. The evolutional stages of tumor and differentiation were analyzed through histopathological findings. RESULTS: The majority of the tumors occurred in the first two decades (69.8%). Unlike previous reports, the male to female ratio was 1.1:1. The mean duration was 11.8 months. The predilection sites were the upper extremities (40.8%), face (33.8%), neck (15.5%), back (2.8%), scalp (2.8%), and thigh (2.8%) in that order. Histopathologically, most of the tumors were located in the lower dermis (76%) and enclosed by pseudocapsules. The evolution of tumor was divided into four groups- early, fully developed, early regressive, and late regressive stage, as previously reported. Our 71 cases were classified as: 2 early, 16 fully developed, 34 early regressive, and 19 late regressive stage. Calcification (60.5%) and ossification (8.4%) were observed, and the ratio increased as the tumor aged. Inflammatory cell infiltration and multinucleated giant cells were observed disorderly. Differentiation to normal hair follicles was observed: 14 cases to infundibulum, 10 isthmus, 17 outer root sheath, and 11 inner root sheath. CONCLUSION: Pilomatricoma is a benign tumor that differentiates toward the hair cortex. Basaloid and shadow cells correspond to hair matrix cells and immature hair cortex cells, respectively. Basaloid cell can also differentiate to normal hair follicles.
Aged ; Dermis ; Female ; Giant Cells ; Hair ; Hair Follicle ; Humans ; Male ; Medical Records ; Neck ; Pilomatrixoma ; Retrospective Studies ; Scalp ; Thigh ; Upper Extremity