Most common signs of human aging often include skin fold and wrinkles in the lateral canthal area. It is called "crow's feet". The accordion-like activity of the orbicularis oculi muscle during movements of facial expression accentuates this phenomenon because the muscle shortens but the skin does not. The purpose of this study is to present the classification of the crow's feet and to look for it's clinical characteristics in Koreans. The pictures of lateral view of the crows feet in 105 patients taken with digital camera are classified by their age, sex, types and degree of direction. Results show that there are three types of crows feet such as upper, lower and bidirectional types. Bidirectional type is the most common type(85%), lower directional type is 15% and upper directional type is 5%. In thirties, bidirectional type is 50% but the rate of this type increases in older groups. So in over sixties, bidirectional type is almost 100%. There are no differences between the two sexes. The degree of the direction of wrinkles increases in thirties and forties, but in fifties or over no difference was seen. In summary, this study could be helpful to decide the procedure in correction of the crow's feet.
Aging ; Classification* ; Crows ; Facial Expression ; Foot* ; Humans ; Skin

There are several surgical or non-surgical methods for osmidrosis, which have their own merits and drawbacks. Especially, recurrence and scarring of operation site are cumbersome problems. One of the limitations of each method is recurrence of osmidrosis. The authors evaluated surgical treatments of recurrent cases. The authors experienced 14 recurrent osmidrosis cases from January 1998 to December 2003. Previous methods in recurrent cases are as follows; dermal shaving with Inaba dermal shaver(3 cases), liposuction method(10 cases), non-surgical hair removal method(4 cases). The authors managed recurrent cases with radical excision in 4 recurrent cases which had severe scar with large fibrotic tissue due to previous operations, and dermal manual resection in 10 cases. We had no recurrence in our series and no complications like hematoma, seroma, infection, wound disruption or dehiscence and brachial plexus compression. In conclusion, dermal manual resection can be applied to recurrent osmidrosis cases, and radical resection is also applicable to managing recurrent cases with severe scar with large fibrotic tissue.
Brachial Plexus ; Cicatrix ; Hair Removal ; Hematoma ; Lipectomy ; Recurrence ; Seroma ; Wound Infection

BACKGROUND AND OBJECTIVES: Until now, only a little is known about the mode of parotid involvement in external auditory canal (EAC) carcinoma. We examined the incidence of parotid node metastasis and direct parotid invasion in patients with EAC carcinoma. The purpose of this study was to evaluate the role of parotidectomy and to provide the guidelines for performance of parotidectomy when dealing with EAC carcinoma. MATERIALS AND METHOD: The study comprised of 11 patients with squamous cell carcinomas (SCC) and 10 patients with adenoid cystic carcinomas (ACC). A retrospective review of the surgical specimens was undertaken with specific reference to parotid node metastasis and parotid invasion. RESULTS: Parotid node metastasis was noted only in two cases of advanced staged SCC, whereas none of the ACC patients showed parotid node metastasis. Direct parotid invasion occurred only in advanced staged SCC;however, it did occur in early stage ACC. CONCLUSION: Our data indicated that elective parotidectomy for control of occult parotid node metastasis is necessary only in advanced SCC carcinoma, whereas parotid management to secure adequate safety margin is mandatory for advanced SCC and all cases of ACC.
Carcinoma, Adenoid Cystic ; Carcinoma, Squamous Cell ; Ear Canal* ; Humans ; Incidence ; Lymph Nodes* ; Neoplasm Metastasis* ; Parotid Gland ; Retrospective Studies

Blow-out fractures usually occur at the weakest point of orbital wall such as medial wall or orbital floor. The operative treatment of blow-out fracture involve restoration of intra-orbital soft tissue and bony structural integrity. The surgical reduction of medial blow-out fracture are mainly transcutaneous, transnasal and transconjunctival approaches. The conventional methods has several disadvantages, such as external scar, narrow operative field and injury of neurovascular bundle. But medial transconjunctival approach has advantages such as minimal scar, short operative time and relative safety. We experinced 26 cases of medial blow-out fracture using medial transconjunctival approach from June 2001 to May 2003. Preoperatively 21 cases showed diplopia and 14 cases showed enophthalmos. In postoperative complications, diplopia were 2 cases, enophthalmos was 1 case, anterior displacement of implant were 2 cases, conjunctival scar were 2 cases and injury of caruncle was 1 case. We report the medial transconjunctival approach that was effective treatment for medial blow-out fracture without specific complications.
Cicatrix ; Diplopia ; Enophthalmos ; Operative Time ; Orbit ; Orbital Fractures* ; Postoperative Complications

Non-Hodgkin's lymphoma is monoclonal expansion of malignant B or T cells. The immunocompromised status in this disease is accompanied by many infections. The cryptococcosis, caused by Cryptococcus neoformans, frequently occurs in leukemia, Hodgkin's disease, sarcoidosis, diabetes mellitus, tuberculosis, and long-term steroid-using patients. Recent increasing incidence of fungal infection could be due to the spread of AIDS and transplantation. We experienced one patient with lung mass in Non-Hodgkin's lymphoma after three cycles of chemotherapy, which could not be discriminated from the newly developed lymphoma mass. Cryptococcus neoformans was isolated from the lung tissue obtained by thoracoscopic biopsy. Herein we report this case with brief review of pertinent literature.
Biopsy ; Cryptococcosis* ; Cryptococcus neoformans ; Diabetes Mellitus ; Drug Therapy* ; Hodgkin Disease ; Humans ; Incidence ; Leukemia ; Lung ; Lymphoma ; Lymphoma, Non-Hodgkin* ; Sarcoidosis ; T-Lymphocytes ; Tuberculosis

Non-Hodgkin's lymphoma is monoclonal expansion of malignant B or T cells. The immunocompromised status in this disease is accompanied by many infections. The cryptococcosis, caused by Cryptococcus neoformans, frequently occurs in leukemia, Hodgkin's disease, sarcoidosis, diabetes mellitus, tuberculosis, and long-term steroid-using patients. Recent increasing incidence of fungal infection could be due to the spread of AIDS and transplantation. We experienced one patient with lung mass in Non-Hodgkin's lymphoma after three cycles of chemotherapy, which could not be discriminated from the newly developed lymphoma mass. Cryptococcus neoformans was isolated from the lung tissue obtained by thoracoscopic biopsy. Herein we report this case with brief review of pertinent literature.
Biopsy ; Cryptococcosis* ; Cryptococcus neoformans ; Diabetes Mellitus ; Drug Therapy* ; Hodgkin Disease ; Humans ; Incidence ; Leukemia ; Lung ; Lymphoma ; Lymphoma, Non-Hodgkin* ; Sarcoidosis ; T-Lymphocytes ; Tuberculosis

Situs inversus is a rare condition with genetic predisposition and is characterized by transposition of both heart and intra-abdominal viscera to the opposite side of the body. Cholangiocarcinoma in this condition has rarely been reported. We present a case of adenocarcinoma of the common hepatic duct proximal to the cystic duct in a 68-year-old male with total situs inversus. The patient presented with complaints of abdominal pain, intermittent fever and chilling sensation without jaundice. Magnetic resonance cholangiopancreatography prior to surgery demonstrated segmental narrowing of the common hepatic duct proximal to the cystic duct and two stones in the proximal portion of the narrowed segment. Open laparotomy was performed to remove the lesion. Cholangiocarcinoma was confirmed pathologically. Magnetic resonance cholangiopancreatography was the only pre-operative diagnostic method which had suggested malignancy in this case.
Abdominal Pain ; Adenocarcinoma ; Aged ; Cholangiocarcinoma* ; Cholangiopancreatography, Magnetic Resonance* ; Cystic Duct ; Diagnosis* ; Fever ; Genetic Predisposition to Disease ; Heart ; Hepatic Duct, Common ; Humans ; Jaundice ; Laparotomy ; Male ; Sensation ; Situs Inversus* ; Viscera

A 29-year-old man was admitted because of melena for 5 days. Two years ago, he underwent allogenic bone marrow transplantation for chronic myeloid leukemia and received immunosuppressive agents. Esophagogastroduodenoscopy showed a picture - multiple scattered deep ulcers and friable pseudomembranes - of highly suggestive of a herpes simplex esophagitis and biopsy revealed multinucleated giant cells and pathognomonic intranuclear inclusion bodies. Esophageal lesions and melena improved after acyclovir therapy.
Acyclovir ; Adult ; Biopsy ; Bone Marrow Transplantation ; Endoscopy, Digestive System ; Esophagitis* ; Esophagus ; Giant Cells ; Herpes Simplex* ; Humans ; Immunosuppressive Agents ; Intranuclear Inclusion Bodies ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Melena* ; Ulcer

Colonic pseudo-obstruction (CPO) is a syndrome characterized by obstructive symptoms and signs without mechanical obstruction. Parkinson's disease is one of the various clinical situations developing CPO. Recently, one study group reported that neostigmine was significantly more effective than placebo in rapidly decreasing colonic dilatation in the majority of patients with acute CPO. We experienced a 69-year-old male patient with Parkinson's disease who complained abdominal distension. There was a marked colonic dilatation on plain abdominal radiographs without mechanical obstruction. Colonic dilatation failed to improve with conservative management. Immediate clinical response was achieved after patient received 2.0 mg of neostigmine intravenously under monitoring by electrocardiography. One month later, he had recurrent colonic dilatation, but no clinical response to second administration of neostigmine, leading to colonic decompression. After a third recurrence of colonic dilatation, the patient was refractory to conservative management, and he underwent surgical treatment.
Aged ; Colon* ; Colonic Pseudo-Obstruction* ; Decompression ; Dilatation ; Electrocardiography ; Humans ; Male ; Neostigmine ; Parkinson Disease* ; Recurrence

The most common type of food-related foreign body in esophagus is impacted meat bolus and sudden esophageal obstruction after eating poorly chewed meat has been called the "steakhouse syndrome". It is frequently caused by underlying esophageal stenosis including abnormal ring, the sequalae of reflux esophagitis, malignancy and rarely esophageal motility disorders. A 55-year-old male patient was admitted to our hospital complaining swallowing difficulty after ingestion of a lump of chicken 3 days ago. Impacted meat bolus was found at distal esophagus on emergency endoscopy. However, there was no definite anatomical stenotic lesion after removal of meat with the polypectomy snare. Esophageal manometry showed segmental, high amplitude of esophageal pressure at lower esophagus with normal peristalsis and occasional triple peaked waves. The manometry finding was consistent with nutcracker esophagus. We report a case of steakhouse syndrome associated by nutcracker esophagus without abnormality on endoscopy and esophagography.
Chickens ; Deglutition ; Eating ; Emergencies ; Endoscopy ; Esophageal Motility Disorders* ; Esophageal Stenosis ; Esophagitis, Peptic ; Esophagus ; Foreign Bodies ; Humans ; Male ; Manometry ; Meat ; Middle Aged ; Peristalsis ; SNARE Proteins