Performing a skin graft is not feasible for tendon-exposed defect reconstruction because tendons are fibrous connective tissues with relatively poor blood supply. This study proposes a method to effectively perform skin graft surgery in tendon-exposed wounds. A 48-year-old male patient with diabetes mellitus had a very large left dorsal foot defect (8×8 cm). The wound bed had healthy granular tissue, with tendon exposure. The tendons were turned over so that the posterior side would behave as the anterior side. The edge of the paratenon was then fixed together to the surrounding granulation tissue or dense remnant fascia using absorbable sutures, and the close granulation tissue was approximated and buried. A split-thickness skin graft was performed after 1 week. The graft site was stably taken on postoperative day 3. A small disruption was then observed at the graft site within 1 week postoperatively, but conservative treatment was continued for 1 month, after which the defect site was completely restored. This technique can increase the success rate of skin grafts for defects with tendon exposure.

Tumor of follicular infundibulum (TFI) is a rare benign cutaneous appendage tumor that does not have characteristic clinical features. It is mainly present in the head, neck, and trunk as a solitary lesion. In particular, TFI typically manifests as a plate-like proliferation with multiple thin epidermal connections comprise of monomorphic cells. TFI do not represent cutaneous characteristics, but have clinical significance because TFI is associated with basal cell carcinoma and Cowden's syndrome. We report a case of TFI in parietal scalp with a review of literatures.

Mucinous cystadenocarcinoma (MCA) is a malignant tumor that mainly occurs in the breast or ovary, but MCA is internationally rarely reported in head and neck region. Especially MCA in minor salivary gland of oral cavity is even more rare. It is characterized by cystic spaces lining of epithelial cells containing intracytoplasmic mucin. We report a case of MCA in the labial mucosa of upper lip considered to develop from minor salivary gland with a review of literatures.

Mucinous cystadenocarcinoma (MCA) is a malignant tumor that mainly occurs in the breast or ovary, but MCA is internationally rarely reported in head and neck region. Especially MCA in minor salivary gland of oral cavity is even more rare. It is characterized by cystic spaces lining of epithelial cells containing intracytoplasmic mucin. We report a case of MCA in the labial mucosa of upper lip considered to develop from minor salivary gland with a review of literatures.

BACKGROUND: Pollen allergens are one of the main contributors to the development and/or aggravation of allergic rhinitis, allergic conjunctivitis, and asthma. OBJECTIVE: An examination of the airborne pollen in residential areas should be conducted to aid the diagnosis and treatment of allergic diseases. METHODS: Airborne pollen samples were collected from 2 sites in Incheon and 2 in Seoul from 2015 to 2016. RESULTS: The highest monthly concentration of airborne pollen was observed in May and September each year. Pollen from 32 families and 50 genera was identified over the 2 years; of these, Pinus spp. showed the highest pollen concentration (41.6%), followed by Quercus spp. (25.3%), and Humulus spp. (15.3%), the latter of which had the highest concentration among weed pollen. The total pollen concentration was significantly higher in Incheon than in Seoul (p = 0.001 in 2015, p < 0.001 in 2016) and higher in 2016 than in 2015. The concentrations of pollen from weed species (Cupressaceae, Humulus spp., Artemisia spp., Ambrosia spp., and Chenopodiaceae) and grass species (Gramineae) were significantly higher (p < 0.001) than those from tree species. Pollen was distributed from February to November. The first pollen identified in both regions in each year was Alnus spp. Overall, the total concentration of Quercus spp., Betula spp., Humulus spp., Artemisia spp., Ambrosia spp., and Chenopodiaceae pollen increased significantly over the 2 years. CONCLUSION: Region-specific differences exist in the pollen of major allergenic plants. Continuous monitoring of pollen is thus essential for management of pollen-related allergic disorders in each region.
Allergens ; Alnus ; Ambrosia ; Artemisia ; Asthma ; Betula ; Chenopodiaceae ; Conjunctivitis, Allergic ; Diagnosis ; Humans ; Humulus ; Hypersensitivity ; Incheon ; Pinus ; Poaceae ; Pollen ; Quercus ; Rhinitis, Allergic ; Seoul ; Trees

BACKGROUND/AIMS: Delayed post-endoscopic submucosal dissection (ESD) bleeding (DPEB) is difficult to predict and there is controversy regarding the usefulness of prophylactic hemostasis during second-look endoscopy. This study evaluated the risk factors related to DPEB, the relationship between clinical outcomes and the Forrest classification, and the results of prophylactic hemostasis during second-look endoscopy. METHODS: Second-look endoscopy was performed on the day after ESD to check for recent hemorrhage or potential bleeding and the presence of artificial ulcers in all patients. RESULTS: DPEB occurred in 42 of 581 patients (7.2%). Multivariate analysis determined that a specimen size ≥40 mm (odds ratio [OR], 3.03; p=0.003), and a high-risk Forrest classification (Forrest Ib+IIa+IIb; OR, 6.88; p<0.001) were risk factors for DPEB. DPEB was significantly more likely in patients classified with Forrest Ib (OR, 24.35; p<0.001), IIa (OR, 12.91; p<0.001), or IIb (OR, 8.31; p<0.001) ulcers compared with Forrest III ulcers. There was no statistically significant difference between the prophylactic hemostasis and non-hemostasis groups (Forrest Ib, p=0.938; IIa, p=0.438; IIb, p=0.397; IIc, p=0.773) during second-look endoscopy. CONCLUSIONS: The Forrest classification of artificial gastric ulcers during second-look endoscopy seems to be a useful tool for predicting delayed bleeding. However, routine prophylactic hemostasis during second-look endoscopy seemed to not be useful for preventing DPEB.
Classification* ; Endoscopy* ; Hemorrhage ; Hemostasis ; Hemostasis, Endoscopic ; Humans ; Multivariate Analysis ; Risk Factors ; Stomach Neoplasms ; Stomach Ulcer ; Ulcer*

BACKGROUND: We investigated relationships between generalized joint laxity and primary lumbar disc herniation occurrence and compared clinical outcomes after conservative treatment in lumbar disc herniation patients with and without generalized joint laxity. METHODS: The study group included 128 men, and the control group included 276 men matched for age and body mass index with the study group. The primary outcome measure was the presence or absence of generalized joint laxity using the Beighton scale. Clinical outcomes measured by the visual analog scale and the Oswestry disability index 2 years after conservative treatment were the secondary outcome measure. RESULTS: Generalized joint laxity prevalence was 13.2% in the study group and 5.1% in the control group, a significant difference (P=0.01). Spearman correlation analysis revealed that weight (r=0.162, P=0.03), body mass index (r=0.131, P=0.03), and generalized joint laxity (r=0.372, P<0.01) significantly correlated with lumbar disc herniation occurrence. In multivariate regression analysis, generalized joint laxity was the only significant lumbar disc herniation predictor (P=0.002; 95% confidence interval, 1.08 to 5.26). Generalized joint laxity in lumbar disc herniation patients was associated with worse clinical outcomes after conservative treatment measured by visual analog scale scores for lower extremity pain (P=0.02), lower back pain (P=0.03), and Oswestry disability index scores (P=0.03). CONCLUSION: Generalized joint laxity might be associated with lumbar disc herniation occurrence and might also be a negative predictor of worse clinical outcomes after conservative treatment.
Body Mass Index ; Humans ; Intervertebral Disc Displacement ; Joint Instability* ; Low Back Pain ; Lower Extremity ; Lumbar Vertebrae ; Male ; Outcome Assessment (Health Care) ; Prevalence ; Treatment Outcome* ; Visual Analog Scale

BACKGROUND/AIMS: There are few data supporting the diagnostic yield of brush cytology depending on the order of cytologic preparation method or the location or shape of tumors in biliary strictures. We investigated diagnostic yields and variations in brush cytology with direct smear and cell-block preparations according to sampling preparation sequence and tumor location and shape in biliary strictures. METHODS: Patients who had undergone ERCP with tissue sampling between August 2009 and April 2013 were analyzed retrospectively. Group A was examined using brush cytology with direct smear followed by cell-block with or without biopsy, while the reverse order was performed for group B. RESULTS: Among 138 enrolled patients, 92 patients (A: 36, B: 56) underwent both brush cytology with direct smear and cell-block preparations. No differences in sensitivity, specificity, or accuracy were observed according to the sampling preparation method and the location or shape of tumors in biliary strictures. The cellularity observed from brush cytology with direct smear was better than that from cell-block according to the location of the tumor (p<0.01). The diagnostic yield was increased in both groups with addition of an endobiliary biopsy. CONCLUSIONS: No difference in diagnostic accuracy was observed between the sequences of preparation for brush cytology with direct smear and cell-block techniques. Brush cytology showed better cellularity for diagnosis.
Aged ; Aged, 80 and over ; Bile Duct Neoplasms/*pathology ; Cholangiocarcinoma/pathology ; Cholangiopancreatography, Endoscopic Retrograde ; *Cytodiagnosis ; Female ; Gallbladder Neoplasms/pathology ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Pancreatic Neoplasms/pathology ; Retrospective Studies ; Sensitivity and Specificity

This report discusses a pregnancy case following a series of two consecutive magnetic resonance imaging-guided focused ultrasound surgery (MRgFUS) procedures for the treatment of two different myomas in an individual patient. Both procedures were completed without adverse events, and the patient conceived naturally four months after treatment. At 39 weeks, she gave birth to a healthy baby girl, via a vaginal delivery. There were no complications in the pregnancy or during labor.
Adult ; Female ; Humans ; Magnetic Resonance Imaging, Interventional/*methods ; Myoma/*surgery ; Pregnancy ; Pregnancy Outcome ; Surgery, Computer-Assisted/*methods ; Uterine Neoplasms/*surgery

PURPOSE: We evaluated the technical aspect and efficacy of transcatheter arterial embolization (TAE) in cases of intractable postpartum bleeding by comparing the angiographic findings women patients according to their delivery pattern. MATERIALS AND METHODS: Between July of 2003 and March of 2008, 55 female patients were enrolled in this study. Of the 55 patients, 36 underwent a vaginal delivery (group 1), whereas 19 underwent a cesarean section delivery (group 2). We retrospectively evaluated the angiographic findings and the embolization technique between groups, using a Pearson Chi-Square test. Medical records and telephone interview findings were also reviewed to evaluate the efficacy of TAE and the outcome of fertility. RESULTS: Significantly greater positive angiographic findings were found in group 2 (63.2%) relative to group 1 (30.6%). For positive angiographic findings, except for AVM, the embolization was performed using coil or glue with gelfoam. For the negative angiographic findings or AVM, the gelfoam was the only embolic agent used. In all patients except for one, bleeding stopped after embolization. Major complications occurred in 2 patients only, and included uterine synechia and perforation. All patients except for one recovered after menstruation. In total, four patients became pregnant and one patient delivered a healthy infant. CONCLUSION: Positive angiographic findings requiring embolization with coil or glue, as well as gelfoam, were more commonly encountered in group 2 than in group 1. Based on the outcome of the study group, TAE is a safe and effective treatment for intractable postpartum bleeding and is also useful for preserving fertility.
Adhesives ; Angiography ; Cesarean Section ; Embolization, Therapeutic ; Female ; Fertility ; Gelatin Sponge, Absorbable ; Hemorrhage ; Humans ; Infant ; Interviews as Topic ; Medical Records ; Menstruation ; Obstetric Labor Complications ; Postpartum Hemorrhage ; Postpartum Period ; Pregnancy ; Retrospective Studies ; Uterus