Sinus pericranii is a rare vascular anomaly characterized by abnormal venous communication betweenthe inner and outer regions of the cranial cavity. Here, we report a case of sinus pericraniiand venous malformations in the right periorbital region of a 2-year-old girl. Radiologic findingsshowed venous malformations in the right parietal region communicating with the superior sagittalsinus in the intracranial region. There were notable improvements following surgical resectionfor the abnormal venous lesions and several sclerotherapies. Presence of a bluish and pulsatingmass on the scalp, which showed bruit on auscultation, may indicate sinus pericranii, whichshould be included in the differential diagnosis.

Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to provide guidance on the implementation of a surgical treatment of oral cancer. MEDLINE databases were searched for articles on subjects related to “surgical management of oral cancer” published in English. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. The quality of evidence was rated with use RoBANS (Risk of Bias Assessment Tool for Nonrandomized Studies) and AMSTAR (A Measurement Tool to Assess the Methodological Quality of Systematic Reviews). Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. Additional directives are provided as expert opinions and Delphi questionnaire when insufficient evidence existed. The Committee developed 68 evidence-based recommendations in 34 categories intended to assist clinicians and patients and counselors, and health policy-makers. Proper surgical treatment selection for oral cancer, which is directed by patient- and subsite-specific factors, remains the greatest predictor of successful treatment outcomes. These guidelines are intended for use in conjunction with the individual patient's treatment goals.
Advisory Committees ; Bias (Epidemiology) ; Carcinoma, Squamous Cell ; Counseling ; Expert Testimony ; Humans ; Mouth Neoplasms ; Neck ; Republic of Korea

OBJECTIVE: To investigate the musculoskeletal symptoms of migrant workers. We focused on the relationship between job stress and musculoskeletal symptoms. METHOD: A questionnaire was administered to 502 migrant workers who visited NGO migrant worker centers located in Gyung-gi province. A structured, self-reported questionnaire was administered to participants in order to capture the following information: sociodemographics, health factors including past medical history, work related characteristics, job stress, and musculoskeletal symptoms. The job stress questionnaires were used according to KOSS-26 and musculoskeletal symptoms were measured using KOSHA Code H-30-2003. We used multiple logistic regression analysis to assess the relationship between risk factors which included job stress, and musculoskeletal symptoms. RESULTS: The prevalence rate of musculoskeletal symptoms in survey subjects was 35.1%. Other than job stress factors, past medical history was the only factor that had a statistical relationship to musculoskeletal symptoms (P<0.01). In the domains of job stress, physical environment (OR 1.62, 95% CI: 1.03~2.54), job demand (OR 2.43, 95% CI: 1.46~4.03), job insecurity (OR 1.59, 95% CI: 1.03~2.47), occupational climate (OR 2.30, 95% CI: 1.27~4.19) were most likely experience musculoskeletal symptoms. CONCLUSION: The job stress factor appeared to correlate more with musculoskeletal symptoms than with sociodemographics or other factors. Hence, in order to prevent migrant worker's musculoskeletal symptoms, we believe that intervention in job stress (physical environment, job demand, job insecurity, occupational climate) is necessary.
Climate ; Humans ; Logistic Models ; Prevalence ; Questionnaires ; Risk Factors ; Transients and Migrants

BACKGROUND: Soft tissue sarcoma is a rare condition with many causative factors. However a soft tissue sarcoma from a metallic foreign body and injury is rare. We report a case of a soft tissue sarcoma caused by a metallic foreign body and injury. CASE: The patient had been worked as a metal cutter for 17 years. While working, his palms were constantly pricked by small metallic splinters, which were generally removed after work. On march 2004, he had palpitated mass on his right palm. On November 2006, a right hand x-ray showed a mass and metallic foreign body at the 1st volar space which was confirmed to be an epitheloid sarcoma. All metallic products of his workplace contained chromium and Nickel. which are known to cause soft tissue sarcomas. A review of the literature revealed foreign-body and injury induced oxidative and nitrative stress to be associated with a developing sarcoma. In addition, Cr and Ni are associated with the development of sarcoma. Therefore it was concluded this case of epitheloid sarcoma was associated with his employment. CONCLUSION: A soft-tissue sarcoma associated with a metal foreign-body and injury is rare and their relationship is difficult understand. If a case of sarcoma is encountered on a metal associated worker, their job association should be considered.
Chromium ; Foreign Bodies ; Hand ; Humans ; Nickel ; Sarcoma

Allogeneic stem cell transplantation (allo-SCT) using related or unrelated donor could eradicate paroxysmal nocturnal hemoglobinuria (PNH) clones and may cure the disease. Chronic graft-versus host disease (GVHD) is a major complication of patients who have undergone allo-SCT. Nephrotic syndrome has been described as one of the rare manifestations of chronic GVHD following the usual myeloablative allo-SCT. We report a case of nephrotic syndrome that developed 25 months after non-myeloablative allo-SCT for PNH. The patient had grade II acute GVHD and extensive chronic GVHD after non-myeloablative allo-SCT. Typically the patient presented with preserved renal function and full nephrotic syndrome including generalized edema, proteinuria, hypoalbuminemia, and hypercholesterolemia. Renal biopsy revealed findings of membranous glomerulopathy (MG). The patient is alive with a stable engraftment and full donor chimerism under the administration of tacrolimus for control of chronic GVHD and MG without refractory hemolysis and cytopenia.
Adult ; Diagnosis, Differential ; Female ; Glomerulonephritis, Membranous/drug therapy/*etiology/pathology ; Graft vs Host Disease/drug therapy/*etiology/pathology ; Hemoglobinuria, Paroxysmal/*therapy ; Human ; *Stem Cell Transplantation/*adverse effects ; Treatment Outcome

We investigated the effectiveness of lamivudine to prevent hepatitis flare up due to reactivation of hepatitis-B virus (HBV) in hepatitis-B surface antigen (HBsAg)-positive patients with Non-Hodgkin's lymphoma (NHL) during cytotoxic chemotherapy. HBsAg-positive patients with NHL were identified from the lymphoma database of the Asan Medical Center from January 1995 to August 2002, and their medical records were reviewed. We found that 31 patients were received cytotoxic chemotherapy among 41 NHL patients with HBsAg-positive during same period. We divided them into 2 groups of HBsAg patients with NHL as follows: Group A who received cytotoxic chemotherapy with lamivudine 100 mg daily; Group B without any prophylactic antiviral therapy. There were no significant differences between Group A and B in several clinical variables. Seventeen patients (85%) in group B and one patient (9%) in Group A had hepatitis due to reactivation of HBV (p<0.001), with one hepatic failure related death in Group B and none in group A. The mean dose intensity of adriamycin actually delivered was 13.3 mg/m2/week (80% Relative Dose intensity (RDI)) in Group A and 9.1 mg/m2/week (55% RDI) in Groups B (p<0.001). Our data suggest that the frequency of chemotherapy-related HBV reactivation may be significantly decreased by lamivudine prophylaxis with maintenance of the dosage of adriamycin.
Adult ; Aged ; Antibiotics, Antineoplastic/*therapeutic use ; Doxorubicin/*therapeutic use ; Female ; Hepatitis B/complications/diagnosis/*drug therapy ; Hepatitis B Surface Antigens/*analysis ; Hepatitis B Virus/metabolism ; Human ; Lamivudine/*therapeutic use ; Lymphoma, Non-Hodgkin/complications/*drug therapy/metabolism ; Male ; Middle Aged ; Reverse Transcriptase Inhibitors/*therapeutic use ; Survival Rate ; Virus Activation

BACKGROUND: Diffuse large B-cell lymphoma (DLBL) category in the REAL classification includes histologically heterogeneous subtypes in Working Formulation or Kiel classification. Some investigators insist that the prognosis of B-cell immunoblastic lymphoma (IBL) is worse than other types of DLBL. This study was performed to determine the clinical significance of histological subclassification of DLBL. METHODS: All non-Hodgkin's lymphomas diagnosed at 3 hospitals in Korea between 1989 and 1995 were reclassified according to the REAL classification. Medical records of 404 patients with DLBL were reviewed. Their pathologies were categorized into IBL or non-IBL according to Working Formulation. We compared clinical characteristics and treatment outcomes of IBL with those of non-IBL. RESULTS: Of 404 DLBL patients, 341 cases (84%) were classified as non-IBL and 63 cases (16%) as IBL. Male patients were more common in IBL than in non-IBL (76% vs. 62%). IBL presented more often with advanced stage (III or IV) and B-symptoms than non-IBL (57% vs. 42%, 40% vs. 27%, respectively). In other clinical characteristics, no significant differences were found between the two groups. Complete response rates were 59% in IBL and 68% in non-IBL (p=0.137). With a median follow-up of 52 months (range 1-108 months), the median progression-free survival was 11 (95% confidence interval [95% CI] 8-14) months for IBL and 41 (95% CI 18-64) months for non-IBL (p=0.004). The median overall survival was 21 (95% CI 13-29) months for IBL and 72 months for non-IBL (p=0.002). A multivariate analysis for progression-free survival and overall survival showed that histological subtype (non-IBL vs. IBL) was a significant prognostic factor independent of International Prognostic Index (p=0.013 for progression-free survival, p=0.003 for overall survival). CONCLSUION: DLBL includes heterogeneous subtypes with different prognosis. Subclassification of DLBL into IBL and non-IBL has prognostic significance. IBL needs to be separated from other types of DLBL.
B-Lymphocytes* ; Classification* ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Korea ; Lymphoma ; Lymphoma, B-Cell* ; Lymphoma, Non-Hodgkin ; Male ; Medical Records ; Multivariate Analysis ; Pathology ; Prognosis ; Research Personnel

BACKGROUND: We performed this study to compare response rate and survival according to treatment modalities, such as allogeneic bone marrow transplantation (BMT), immunosuppressive therapy (IS) and androgen therapy in patients with aplastic anemia (AA). METHODS: Medical records of one hundred and thirty-seven patients who diagnosed with aplastic anemia at the Asan Medical Center from September 1989 to December 2000 were retrospectively analyzed. RESULTS: Forty-one patients received supportive care only. Ninety-five out of 96 treated patients were evaluable for response. In severe AA group (N=79), the response rate according to treatment modalities was 25.0% in the androgen group (N=4), 30.3% in the ALG or ATG group (N=33), 25.0% in the cyclosporine (CSA) group (N=8), 44.4% in the ATG plus CSA group (N=9), and 73.8% in the BMT group (N=23) (P<0.001). Five- and 10-year survival of overall patients was 67.5% and 50.9%, respectively. Ten-year survival according to disease severity was 42.3% in severe AA group and 75.8% in non-severe AA group (P=0.0043). Five- year survival according to treatment modalities in patients with severe AA was 75.0% in the androgen group, 49.0% in the ALG or ATG group, 75.0% in the CSA group, and 88.9% in the ATG plus CSA group. Five-year survival was 82.6% in the BMT group and 57.7% in the IS group (P=0.0259). CONCLUSION: This study showes that BMT resulted in significantly better response rate and overall survival compared to IS in patients with severe AA.
Bone Marrow Transplantation

BACKGROUND/AIMS: In cirrhotic patients with esophageal variceal bleeding, bacterial infections are a frequent complication. Oral antibiotic prophylaxis decreases the incidence of bacterial infections. The administration of oral antibiotics, however, may be difficult in some cirrhotic patients with active bleeding.The purpose of this study was to assess the efficacy of prophylactic intravenous antibiotics for the prevention of bacterial infections in cirrhotic patients with esophageal variceal bleeding. METHODS: From December 1998 to September 2001, a total of 40 consecutive cirrhotic patients with Child-Pugh class B or C were enrolled after emergent endoscopic esophageal variceal ligation (EVL) was taken because of esophageal variceal bleeding. Enrolled patients were randomized into a treatment group and a control group. The treatment group (n=20) received the intravenous ciprofloxacin 200mg IV q 12 hours for 3 days while the control group(n=20) didn,t. RESULTS: Bacterial infection developed in nine patients (45%) of the control group and only two patients (10%) in the treatment group. The incidence of bacterial infections was significantly lower in the treatment group than the control group (p < 0.005). The hospital cost and length of hospital stay decreased in the treatment group compared with the control group (p < 0.001). There were no differences in the hospital course and mortality within 30 days between the two groups. CONCLUSIONS: In cirrhotic patients with variceal bleeding and with Child-Pugh class B or C, the use of intravenous ciprofloxacin for 3 days after EVL was not only effective in the prevention of bacterial infections but also cost-effective.
Adult ; Aged ; Anti-Infective Agents/*administration & dosage ; *Antibiotic Prophylaxis ; Bacterial Infections/*prevention & control ; Ciprofloxacin/*administration & dosage ; Endoscopy ; English Abstract ; Esophageal and Gastric Varices/complications/*surgery ; Female ; Gastrointestinal Hemorrhage/*complications ; Human ; Infusions, Intravenous ; Ligation ; Liver Cirrhosis/*complications ; Male ; Middle Aged ; Postoperative Complications/*prevention & control ; Prospective Studies

The solitary form of primary hepatic tuberculosis is a rare disease. We report an unusual case of primary solitary hepatic tuberculosis treated with surgical resection and second-line antituberculosis chemotherapy due to the recurrence after first-line antituberculosis chemotherapy alone. A 36-year-old man was presented with right upper abdominal discomfort, chills and weight loss for 2 months. Computerized tomography demonstrated the solitary space occupying lesion on the left lobe of liver suggesting a malignant disease. The open biopsy revealed chronic granulomatous inflammation with multinucleated giant cells and caseous necrosis. The patient was treated with antituberculosis chemotherapy for nine months and eighteen months respectively with the interval of eighteen months. But the hepatic lesion had become larger and symptoms were aggravated after the discontinuation of therapy. He underwent surgical excision of the lesioin. With second-line antituberculosis chemotherapy, the symptoms improved in postoperative days. Twenty four months later, no evidence of recurrence was noted in symptoms, laboratory findings and imaging studies.
Adult ; Biopsy ; Chills ; Drug Therapy* ; Giant Cells ; Humans ; Inflammation ; Liver* ; Necrosis ; Rare Diseases ; Recurrence ; Tuberculoma* ; Tuberculosis, Hepatic ; Weight Loss