Acquired fluconazole resistance (FR) in bloodstream infection (BSI) isolates of Candida albicans is rare. We investigated the FR mechanisms and clinical features of 14 fluconazole non-susceptible (FNS; FR and fluconazole-susceptible dose-dependent) BSI isolates of C. albicans recovered from Korean multicenter surveillance studies during 2006–2021. Mutations causing amino acid substitutions (AASs) in the drug-target gene ERG11 and the FR-associated transcription factor genes TAC1 , MRR1, and UPC2 of the 14 FNS isolates were compared with those of 12 fluconazole-susceptible isolates. Of the 14 FNS isolates, eight and seven had Erg11p (K143R, F145L, or G464S) and Tac1p (T225A, R673L, A736T, or A736V) AASs, respectively, which were previously described in FR isolates. Novel Erg11p, Tac1p, and Mrr1p AASs were observed in two, four, and one FNS isolates, respectively. Combined Erg11p and Tac1p AASs were observed in seven FNS isolates. None of the FR-associated Upc2p AASs were detected. Of the 14 patients, only one had previous azole exposure, and the 30-day mortality rate was 57.1% (8/14). Our data show that Erg11p and Tac1p AASs are likely to contribute to FR in C. albicans BSI isolates in Korea and that most FNS C. albicans BSIs develop without azole exposure.

Posttraumatic pseudoaneurysms of the sphenopalatine artery are rare. Only a few cases have been reported. We report two cases of hemorrhage due to pseudoaneurysm of the sphenopalatine artery. The hemorrhage was uncontrollable. It required embolization. Two patients visited our hospital for treatment of zygomaticomaxillary complex fracture. At the emergency room, patients presented with massive nasal bleeding which ceased shortly. After reduction of the fracture, patients presented persistent nasopharyngeal bleeding. Under suspicion of intracranial vessel injury, we performed angiography. Angiograms revealed pseudoaneurysms of the sphenopalatine artery. Endovascular embolization was performed, leading to successful hemostasis in both patients. Due to close proximity to pterygoid plates, zygomaticomaxillary complex fracture involving pterygoid plates may cause injury of the sphenopalatine artery. The only presentation of sphenopalatine artery injury is nasopharyngeal bleeding which is common. Based on our clinical experience, although pseudoaneurysm of maxillary artery branch after maxillofacial trauma has a low incidence, suspicion of injury involving deeply located arteries and early imaging via angiogram are recommended to manage recurrent bleeding after facial trauma or surgery.
Aneurysm, False ; Angiography ; Arteries ; Embolization, Therapeutic ; Emergency Service, Hospital ; Epistaxis ; Hemorrhage ; Hemostasis ; Humans ; Incidence ; Maxillary Artery

PURPOSE: In this study, we attempted to analyze the occupational accident experience rate by working life cycle of Korean workers considering entrance and turnover in their jobs. The specific goal of this study was to calculate the accident experience rate according to workers' turnover history and previous accident experience. METHODS: We constructed a cumulative data set of 90,338 cases of workers' accident experiences in their jobs from the Fourth Korean Working Conditions Survey. The accident experience rates according to workers' turnover and previous accident experiences were analyzed using descriptive statistics and analysis of variance. RESULTS: In this study, the cumulative accident experience rate of Korean workers was found to be 5.2%. It was confirmed that the accident experience rate of workers increased as the turnover frequencies increased. In addition, we analyzed only the data of the workers who had experienced turnover and found that the accident experience rate after turnover increased about 7.5 times when workers had experienced accidents in the past. CONCLUSION To prevent occupational accidents in workers, safety strategies should consider a worker's previous job history and injury experiences. It will also be necessary to focus preventive efforts on new and young workers through ongoing monitoring and on-the-job training.

PURPOSE: In this study, we attempted to analyze the occupational accident experience rate by working life cycle of Korean workers considering entrance and turnover in their jobs. The specific goal of this study was to calculate the accident experience rate according to workers' turnover history and previous accident experience. METHODS: We constructed a cumulative data set of 90,338 cases of workers' accident experiences in their jobs from the Fourth Korean Working Conditions Survey. The accident experience rates according to workers' turnover and previous accident experiences were analyzed using descriptive statistics and analysis of variance. RESULTS: In this study, the cumulative accident experience rate of Korean workers was found to be 5.2%. It was confirmed that the accident experience rate of workers increased as the turnover frequencies increased. In addition, we analyzed only the data of the workers who had experienced turnover and found that the accident experience rate after turnover increased about 7.5 times when workers had experienced accidents in the past. CONCLUSION: To prevent occupational accidents in workers, safety strategies should consider a worker's previous job history and injury experiences. It will also be necessary to focus preventive efforts on new and young workers through ongoing monitoring and on-the-job training.
Accidents, Occupational ; Dataset ; Inservice Training ; Life Cycle Stages

BACKGROUND: The alar rim is a complex structure that ensures the competence of the external valves and the patency of inlets to the nasal airways. Retraction of the alar rim is caused by congenital malpositioning, hypoplasia, or surgical weakening of the lateral crura, with the potential for both functional and aesthetic ramifications. Most previously introduced procedures involved a relatively long operation time and relatively high risks of surgical complications. The purpose of this study is to introduce a novel surgical technique for alar rim connection and to present its results. METHODS: After marking the extent of the correction, the recipient alar bed was created by making an incision through the vestibular skin 2-mm cephalad to the rim. Then, the composite graft was harvested from the cymba concha by removing the cartilage with its adherent anterior skin. According to the degree of retraction, the harvested composite graft was divided into 2 pieces considering the symmetry of both alar rims. The composite grafts were inserted into the defects and primary closure was done at the donor site. RESULTS: Our surgical technique was used to correct 12 retracted alar rims in 6 patients. Caudal advancement of the alar rims was observed and the contour of the ala was corrected in all 6 patients. The mean length of follow-up was 1-year, and there were no postoperative complications, such as graft loss or disruption. CONCLUSIONS: The alar rim composite graft is a safe and simple technique for correction of short nostril and caudal transposition of the retracted alar rim.
Bays ; Cartilage ; Esthetics ; Follow-Up Studies ; Humans ; Mental Competency ; Nasal Cartilages ; Nose ; Postoperative Complications ; Skin ; Tissue Donors ; Transplants*

BACKGROUND: Composite grafts have advantages for small nasal defect coverage. However, if the the outer skin defect and the inner skin defect have a different location, conventional composite grafts encounter considerable limitations. Therefore, we devised a 4-limbed graft to overcome this limitation by use of soft tissue transposition. METHODS: Over the course of 5 years, this auricular composite graft was used in 10 cases of reconstruction. We harvested skin and cartilage from the helix. The composite graft had 2 limbs of soft tissue to cover the nasal defect and another 2 limbs of cartilage to support nasal framework. The cartilage limbs extended 3 to 5 mm beyond the margin of the skin. The direction of each limb was modified according to defect position. RESULTS: All 10 composite grafts survived completely. All composite grafts shrank by a small percentage of their bulk. Nonetheless, the nasal framework was maintained to an acceptable extent because of the cartilage limbs. CONCLUSIONS: This technique was capable not only of covering defects in the alar and columellar area, but also of maintaining a satisfactory external appearance, because the 2 limbs of cartilage included in the graft strengthened the nasal framework and provided modest support to the nostril margin. The 2 limbs of soft tissue covered the defect area. Our 4-limbed auricular chondrocutaneous composite graft is reliable option for the reconstruction of alar and columellar defects in a single-stage procedure.
Cartilage ; Extremities* ; Reconstructive Surgical Procedures ; Skin ; Transplants*

We sought to describe the incidence rate of the urologic disease in the Korean military by reviewing diagnoses made in active duty soldiers from 2008 to 2013. A total of 72,248 first visits were generated in the Defense Medical Statistics Information System (DMSIS) with its gradually increasing trend over 6 years. A sharp increase of first visit was observed after implementation of the regular health check-up for all conscripted soldiers since 2013. Urolithiasis, prostatitis, epididymoorchitis, urethritis, and varicocele were prevalent. Prostatitis was the highest diagnosis made in the outpatient service, while varicocele was ranked the highest in the inpatient service. The incidence rates of urologic disease varied from 12.3 to 34.2 cases per 1,000 person-years. The urologic disease in conscripted men showed different distribution when we separated the population into conscripted and professional soldiers. Epididymoorchitis was the highest disease followed by urolithiasis, dysuresia, and balanoposthitis in 2013. This study underscores that the urologic disease has spent significant amount of health care resources in the Korean military. This calls for further study to find any significant difference and contributing factors of the urologic disease in the military and the civilian population.
Delivery of Health Care ; Diagnosis ; Epidemiology ; Humans ; Incidence ; Information Systems ; Inpatients ; Male ; Medical Records* ; Military Personnel* ; Outpatients ; Prostatitis ; Urethritis ; Urolithiasis ; Urologic Diseases* ; Urology ; Varicocele

BACKGROUND: Inverted nipples can pose aesthetic and functional problems, especially for young women. The objectives of inverted nipple correction are both sufficient aesthetic projection of the nipple and postoperative functional preservation of the lactiferous ducts. Recurrence of nipple inversion is still an unsolved problem in many cases. We present a new nipple suspension technique using nipple- and areola-based dermal flaps for correcting inverted nipples and preserving the lactiferous duct to minimize the risk of recurrence. METHODS: We corrected six inverted nipples in three patients, which were classified as grade II using the Han and Hong classification of nipple inversion. The anteroposterior and lateral medical-quality photographs of the respective patients were identified for nipple protrusion and recurrence during a 6-month follow-up period to evaluate aesthetical goal and assess the sensitivity of the nipple to confirm preservation of the main lactiferous ducts. Surgical details are described within the main text. RESULTS: Preoperative and postoperative photography revealed good nipple protrusion during the 6-month follow-up period without any complications such as skin necrosis and recurrence. We were unable to directly identify breast-feeding function because all three patients were young and unmarried women. However, we assumed preservation of the main lactiferous duct since no nipple sensory change was identified in the postoperative examination when compared with the preoperative examination. CONCLUSIONS: With this method, we were able to confirm the hardness of the column and minimize the injury of the main lactiferous duct.
Breast ; Classification ; Female ; Follow-Up Studies ; Hardness ; Humans ; Inlays* ; Methods* ; Necrosis ; Nipples* ; Photography ; Recurrence ; Single Person ; Skin ; Surgical Flaps

A 30-year-old male presented with multiple tender erythematous nodules, varying in size from 0.5 cm to 2 cm on the right shoulder of the body. He gave a history of pain associated with these lesions, especially on exposure to cold and touch. These lesions showed multi-segmental distribution; each began as a papule, which gradually increased both in size and number to form a nodule. The lesions, which were misdiagnosed as keloids at another hospital, were managed with numerous intralesional steroid injections. This treatment did not improve the symptoms. Based on the history and cutaneous findings during the physical examination, we considered a diagnosis of a benign tumor. Among the lesions, some of the larger ones were completely excised, followed by excision biopsy. We then made a diagnosis of cutaneous leiomyoma, more specifically, piloleiomyoma. The excisional lesions were covered by skin grafts and closed by primary repair.
Adult ; Biopsy ; Diagnosis ; Humans ; Keloid* ; Leiomyoma ; Male ; Physical Examination ; Shoulder* ; Skin ; Transplants