BACKGROUND: A number of factors can cause dark circles around the eyes including excessive pigmentation, thin and translucent lower eyelid skin overlying the orbicularis oculi muscle, and shadowing due to skin laxity and tear trough. Autologous fat graft is an effective method for the treatment of lower lid dark circles, but irregularities caused by leaving visible lumps of the fat can occur. Tonnard et al. suggested 'nanofat' grafting and introduced its characteristics and clinical applications. The authors used their nanofat grafting to correct lower eyelid dark circles. METHODS: Nanofat grafting was performed in 19 patients for dark lower eyelids. The grafts were injected into subdermal layer using blunt cannula. Microfat grafting with nasojugal fold was performed to all the patients. Among them, 18 patients received transconjunctival fat removal at the same time. RESULTS: All the patients showed much improvement from preoperative dark coloration. There were no visible lumps of fat, contour irregularities, or fat necrosis. Postoperative edema and ecchymosis were minimal. CONCLUSIONS: Nanofat grafting methods provide a good alternative for correcting dark circles by augmenting thin skin with lower complications. This simple, cost effective procedure is suitable for correction of dark circles and various skin rejuvenation purposes.
Catheters ; Ecchymosis ; Edema ; Eyelids* ; Fat Necrosis ; Humans ; Hyperpigmentation ; Pigmentation ; Rejuvenation ; Shadowing (Histology) ; Skin* ; Transplantation ; Transplants*

BACKGROUND: Skin cancer is divided into two categories, melanoma and nonmelanoma skin cancer, by its malignant potential. The former is prone to be metastatic and it often requires regional lymph node dissection and chemotherapy, while the latter is rarely metastatic with no need for such further treatment. We report here on the reconstruction methods after surgical removal of skin cancers, with excluding melanoma. OBJECTIVE: Our purpose was to analyze the reconstruction methods according to the location and size of the lesions after surgical removal of nonmelanoma skin cancers and we report on the clinical findings. METHODS: We analyzed 186 cases of nonmelanoma skin cancers that were treated Between January, 2000 and December, 2006 at the Department of Dermatology, Chonbuk University Hospital. The cases were analyzed according to the reconstruction methods for the defects after surgery, the gender ratio, the age range, the lesion site and the lesion size. RESULTS: The mean age of onset was 67.7 years old. The ratio of men to women was 1:1.02. The most common nonmelanoma skin cancer was basal cell carcinoma (66.7%), followed by squamous cell carcinoma (22.1%), and Bowen's disease (4.3%). The most common site of all the nonmelanoma skin cancers was the face (68.8%), followed by the trunk (7.5%) and scalp (6.5%). The most common reconstruction method was local flap (40.3%), followed by primary closure (38.7%), skin graft (18.8%) and secondary intention (2.2%). In terms of location, the most commonly used method was local flap for the face (50.0%) and primary closure for the trunk (53.3%), scalp (83.3%) and the upper (44.4%) and lower extremities (63.6%). According to the lesions' size, the most common method was flap for tumor between 10 mm and 30 mm in diameter (95.1%), primary closure for tumor less than 10 mm in diameter (66.7%) and graft for tumor greater than 30 mm in diameter (66.7%). CONCLUSION: We offer this data for the reconstruction methods of nonmelanoma skin cancers and their clinical findings in Korea.
Age of Onset ; Bowen's Disease ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Dermatology ; Female ; Humans ; Intention ; Korea ; Lower Extremity ; Lymph Node Excision ; Male ; Melanoma ; Scalp ; Skin ; Skin Neoplasms ; Transplants

Hobnail hemangioma is a benign vascular tumor that typically presents as a small, single lesion on the skin of the trunk or limb. It occurs mainly in young or middle-aged adults (mean age: 30 years) but rarely in childhood. Histologically, hobnail hemangioma is characterized by a biphasic growth pattern, with dilated vascular spaces lined by hobnail endothelial cells in the superficial dermis, and collagen dissection narrow vascular channels in the deeper dermal parts, as well as inflammatory aggregates, fibrosis, and hemosiderin deposits. We report a case of hobnail hemangioma in a 10-year-old girl who had a violaceous papule surrounded by an ecchymotic halo on the left thigh. She underwent treatment with surgical excision with primary closure. To the best of our knowledge, our case is the first reported case of childhood hobnail hemangioma in Korean dermatological literatures.
Adult ; Child ; Collagen ; Dermis ; Endothelial Cells ; Extremities ; Female ; Fibrosis ; Hemangioma* ; Hemosiderin ; Humans ; Skin ; Thigh

Objective: The aim of this study was to compare the diagnostic performances of digital tomosynthesis (DTS) and conventional radiography in detecting osteonecrosis of the femoral head (ONFH) using computed tomography (CT), as the reference standard and evaluate the diagnostic reproducibility of DTS. Materials and Methods: Forty-five patients (24 male and 21 female; age range, 25–77 years) with clinically suspected ONFH underwent anteroposterior radiography, DTS, and CT. Two musculoskeletal radiologists independently evaluated the presence and type of ONFH. The diagnostic performance of radiography and DTS in detecting the presence of ONFH and determining the types of ONFH were evaluated. The interobserver and intraobserver reliabilities of each imaging modality were analyzed using Cohen’s kappa. Results: DTS had higher sensitivity (89.4%–100% vs. 74.5%–76.6%) and specificity (97.3%–100% vs. 78.4%–83.8%) for ONFH detection than radiography. DTS showed higher performance than radiography in identifying the subtypes of ONFH with statistical significance in one reader (type 1, 100% vs. 30.8%, p = 0.004; type II, 97.1% vs. 73.5%, p = 0.008). The interobserver agreement was excellent for DTS and moderate for radiography (kappa of 0.86 vs. 0.57, respectively). The intraobserver agreement for DTS was higher than that of radiography (kappa of 0.96 vs. 0.69, respectively). Conclusion DTS showed higher diagnostic performance and reproducibility than radiography in detecting ONFH. DTS may be used as a first-line diagnostic modality instead of radiography for patients suspected of having ONFH.

BACKGROUND AND OBJECTIVES: Many people have been concerned about voice change after laser assisted uvulopalatoplasty (LAUP). A number of studies reported acoustic changes after uvulopalatopharyngoplasty (UPPP) and LAUP. However, there have not been any reports on the association between anatomic change and acoustic results after LAUP. The purpose of this study is to analyze changes in the voice and changes in the vocal tract after LAUP and to evaluate whether the anatomical changes of vocal tract have an effect on the voice change or not. SUBJECTS AND METHOD: By using CSL, we analyzed fourteen LAUP cases on the formant frequencies of six vowels (/a/, /i/, /u/, /=, /o/, /e/) and four nasal consonants (/hana/, /eomma/, /eoungga/, /chiken/). By using MR image, we analyzed changes in the vocal tract eight weeks after LAUP with preoperative findings in three cases. RESULTS: In acoustic analysis, the second formant frequencies of /u/ and /= phonation were significantly reduced postoperatively compared to those of preoperative status. In imaging study of /u/ and /=, the uvula and soft palate were contracted, so coupling was occurred between nasal cavity and oropharynx in /u/ and /= phonation and the tongue was shifted toward posterior pharyngeal wall to compensate coupling. CONCLUSION: LAUP reduced the second formant of /u/ and /=, which did not result in serious voice changes.
Acoustics* ; Nasal Cavity ; Oropharynx ; Palate, Soft ; Phonation ; Tongue ; Uvula ; Voice*

BACKGROUND AND PURPOSE: Endothelial impairment is a linking mechanism between obstructive sleep apnea (OSA) and cardiovascular diseases. Profiles of endothelial microparticles (EMPs) and endothelial progenitor cells (EPCs) reflect the degree of endothelial impairment. The aims of this study were to measure the levels of EMPs and progenitor cells in OSA, determine the correlations between these factors and OSA severity and the degree of atherosclerosis, and document any changes in these factors after therapy. METHODS: Subjects with (n=82) and without (n=22) OSA were recruited prospectively. We measured the number of colony-forming units (CFU) in cell culture as the endothelial progenitor cell index, and the number of EMPs using flow cytometry with CD31 [platelet endothelial cell adhesion molecule (PECAM)], CD42 (platelet glycoprotein), annexin V, and CD62E (E-selectin) antibodies at baseline and after 4-6 weeks of continuous positive airway pressure (CPAP) therapy. Carotid intima-media thickness (IMT) was regarded as a marker of atherosclerosis. RESULTS: The levels of PECAM+CD42- (p<0.001), PECAM+annexin V+ (p<0.001), and E-selectin+ microparticles (p=0.001) were higher in OSA subjects than in non-OSA subjects. The number of CFU did not differ between the two groups. OSA severity independently predicted the levels of PECAM+CD42- (p=0.02) and PECAM+annexin V+ (p=0.004). Carotid IMT was correlated with OSA severity (p<0.001), PECAM+CD42- (p=0.03), and PECAM+annexin V+ (p=0.01). Neither OSA severity nor carotid IMT was correlated with either the number of CFU or E-selectin+. CPAP therapy decreased the occurrence of E-selectin+ (p<0.001) in 21 of the OSA subjects, but had no effect on the other microparticles of the number of CFU. CONCLUSIONS: OSA led to the overproduction of EMPs, which moderately correlated with OSA severity and the degree of atherosclerosis, and partly responded to therapy. The endothelial impairment might contribute to future cardiovascular events.
Annexin A5 ; Antibodies ; Atherosclerosis ; Cardiovascular Diseases ; Carotid Artery Diseases ; Carotid Intima-Media Thickness ; Cell Culture Techniques ; Colony-Forming Units Assay ; Continuous Positive Airway Pressure ; Endothelial Cells ; Endothelium ; Flow Cytometry ; Prospective Studies ; Sleep Apnea, Obstructive ; Stem Cells

Nicolau syndrome is a rare adverse reaction and characterized by the acute onset of necrosis of the skin and soft tissue following intramuscular drug injection. Conservative treatments with dressings, debridement, and pain control are the mainstay of therapy. Surgical intervention such as skin graft is rarely required. We report a case of 21-year-old man with this syndrome on the right buttock after an intramuscular injection of diclofenac in which skin graft was necessary. The lesion eventually required debridements and split-thickness skin graft for reconstruction because it was very extensive and not successfully treated by the conservative method for four months.
Bandages ; Buttocks ; Debridement ; Diclofenac ; Humans ; Injections, Intramuscular ; Necrosis ; Skin ; Transplants ; Young Adult

Ichthyosiform eruption as a specific manifestation of mycosis fungoides is very rare and only a few such cases have currently been reported in the medical literature. A 63- year-old Korean man presented with a 4-year history of a pruritic ichthyotic eruption. There was no personal or family history of ichthyosis or atopy. The ichthyosiform skin changes involved the abdomen, arms, thighs and shins. The face, palms and soles were spared. There was no peripheral lymphadenopathy or organomegaly. The typical lesions of mycosis fungoides were not present. The results of the routine investigations were normal or negative. A skin biopsy specimen revealed the findings of early mycosis fungoides. He was successfully treated with photochemotherapy.
Abdomen ; Arm ; Biopsy ; Humans ; Ichthyosis ; Lymphatic Diseases ; Mycosis Fungoides ; Skin ; Thigh

Purpose: To explore cerebrovascular reservoir (CVR) and arterial transit time (ATT) changes using acetazolamide-challenged multi-phase arterial spin labeling (MP-ASL) perfusion-weighted MRI in chronic cerebrovascular steno-occlusive disease. Materials and Methods: This retrospective study enrolled patients with chronic steno-occlusion who underwent acetazolamide-challenged MP-ASL between June 2019 and October 2020.Cerebral blood flow, CVR, basal ATT, and ATT changes associated with severe stenosis, total occlusion, and chronic infarction lesions were compared. Results: There were 32 patients (5 with bilateral steno-occlusion) in our study sample. The CVR was significantly reduced during total occlusion compared with severe stenosis (26.2% ± 28.8% vs. 41.4% ± 34.1%, respectively, p = 0.004). The ATT changes were not significantly different (p = 0.717). The CVR was marginally lower in patients with chronic infarction (29.6% ± 39.1% vs. 38.9% ± 28.7%, respectively, p = 0.076). However, the ATT was less shortened in pa-tients with chronic infarction (-54 ± 135 vs. -117 ± 128 ms, respectively, p = 0.013). Conclusion Acetazolamide-challenged MP-ASL provides an MRI-based CVR evaluation tool for chronic steno-occlusive disease.