Paraffin injection has been widely used to improve body contouring or to augment various body parts, although it has now been abandoned owing to serious complications. Paraffin injection may lead to complications after a long latency period, ranging from several years to several decades. Here, we present the rare case of a 77-year-old woman who suffered from recurrent wound problems after a bilateral paraffin injection into her hands 40 years ago. Initially, conservative debridement was carried out due to the patient’s reluctance to undergo extensive surgery and cost concerns. However, this resulted in recurrent wound dehiscence and infection. After serial debridement procedures, a skin graft was performed on her right hand. The patient complained of a depressed contour and numbness at the skin graft site, and tightness and discomfort of her right hand during flexion of the metacarpophalangeal joint. Three years later, the patient presented with a highly similar wound on her left hand. Thorough excision of the soft tissue infiltrated by paraffin was performed, followed by reconstruction using a sensate free anterolateral thigh flap. The patient responded well postoperatively without complications, displaying a fair range of motion without discomfort, sensory restoration of the flap, and satisfaction with the contour of the dorsum. This case report highlights the importance of complete excision of soft tissues infiltrated by paraffin for definitive treatment. Among the various reconstruction options, a sensate free flap is a good choice for achieving favorable functional and esthetic outcomes in hand reconstruction after radical excision of a paraffinoma.

Endometriosis is one of the most common diseases in reproductive ages, and it affects patients' quality of life and fertility. However, few Korean guidelines are available for the evaluation and management of endometriosis. Korean Society of Endometriosis reviewed various literatures and trials, and to provide seventy-one evidence-based recommendations. This review presents guidelines for the diagnosis and management of endometriosis with emphasis on: it's role in infertility, treatment of recurrence, asymptomatic women, endometriosis in adolescents and menopausal women, and possible association of endometriosis with cancer.
Adolescent ; Diagnosis ; Dysmenorrhea ; Endometriosis* ; Female ; Fertility ; Humans ; Infertility ; Pelvic Pain ; Quality of Life ; Recurrence

OBJECTIVE: The objective of this study was to determine the correlations between changes in thrombogenesis or thrombolysis related factors, and the acute increase of a spontaneous intracerebral hemorrhage (sICH). MATERIALS AND METHODS: From January 2009 to October 2011, 225 patients with sICH were admitted to our hospital within 24 hours of onset. Among them, 111 patients with hypertensive sICH were enrolled in this study. Thrombogenic or thrombolytic factors were checked at admission. The authors checked computed tomography (CT) scans at admission and followed up the next day (between 12-24 hours) or at any time when neurologic signs were aggravated. Cases in which the hematoma was enlarged more than 33% were defined as Group A and the others were defined as Group B. RESULTS: Group A included 30 patients (27%) and group B included 81 patients (73%). Factors including activated partial thromboplastin time, prothrombin time, fibrinogen, and D-dimer showed a greater increase in group A than in group B. Factors including antithrombin III, factor V, and factor X showed a greater increase in group A than in group B. CONCLUSION: Based on the results of this study, it seems that the risk of increase in hematoma size can be predicted by serum thrombogenic or thrombolytic factors at admission.
Antithrombin III ; Cerebral Hemorrhage* ; Factor V ; Factor X ; Fibrinogen ; Hematoma ; Humans ; Neurologic Manifestations ; Partial Thromboplastin Time ; Prothrombin Time

The blood blister-like aneurysm (BBA) of the internal carotid artery (ICA) is a rare but clinically important cause of subarachnoid hemorrhage (SAH), which accounts for 0.5% of incidences of ruptured intracranial aneurysms. BBA is a thin-walled, broad-based aneurysm that lacks an identifiable neck and is one of the most difficult lesions to treat. In this paper, a case is presented of a 57-year-old woman with SAH. Her cerebral angiography demonstrated a small BBA on the dorsal wall of her right ICA. Endovascular treatment that consisted of a stent-within-a-stent was attempted, but the replacement of the second stent failed, and the aneurysm became bigger. Surgery was performed by clipping the BBA with a Sundt slim-line encircling graft clip. The patient completely recovered with no complications. This treatment may be a salvageable option for BBA, especially when endovascular treatment has failed.
Aneurysm ; Carotid Artery, Internal ; Cerebral Angiography ; Endovascular Procedures ; Female ; Humans ; Incidence ; Intracranial Aneurysm ; Middle Aged ; Neck ; Stents ; Subarachnoid Hemorrhage ; Transplants

Glossopharyngeal neuralgia is a relatively rare condition characterized by severe, paroxysmal episodes of lancinating pain in the tongue, throat, ear, and tonsil. This disorder is assumed to be due to compression of the glossopharyngeal nerve by vascular structures. A 47-year-old woman complaining of sharp and lancinating pain in the right periauricular and submandibular areas visited our hospital. Swallowing, chewing, and lying on her right side triggered the pain. Her neurologic examination revealed no specific abnormalities. The results of routine hematologic and blood chemistry studies were all within normal limits. Carbamazepine and gabapentin were given, but her symptoms persisted. Her pain was temporarily relieved only by narcotic pain medication. MRI showed an arachnoid cyst located in the right cerebellomedullary cistern extending to the cerebellopontine cistern. Cyst removal was performed via a right retrosigmoid approach. Lateral suboccipital craniotomy was performed using the right park-bench position. After opening the dura and cerebellopontine angle, the arachnoid cyst was exposed. The arachnoid cyst was compressing the flattened lower cranial nerves at the right jugular fossa. Her symptoms resolved postoperatively. Two months after the operation, she was completely free from her previous symptoms.
Amines ; Arachnoid ; Carbamazepine ; Cerebellopontine Angle ; Cranial Nerves ; Craniotomy ; Cyclohexanecarboxylic Acids ; Deception ; Deglutition ; Ear ; Female ; gamma-Aminobutyric Acid ; Glossopharyngeal Nerve ; Glossopharyngeal Nerve Diseases ; Humans ; Mastication ; Middle Aged ; Neurologic Examination ; Palatine Tonsil ; Pharynx ; Tongue

PURPOSE: Several treatment options have been reported for post-traumatic kyphosis (PTK) and neurologically compromised osteoporotic fractures. However, there is no ideal surgical procedure. This study evaluated the effectiveness of posterolateral decompression and anterior support with a titanium mesh in PTK by posterior surgery. MATERIALS AND METHODS: Seventeen patients with PTK and neurologically compromised osteoporotic fractures underwent a single posterior approach. During posterior decompression, a titanium mesh was inserted through the posterior approach after a transpedicular intracorporeal corpectomy. Complications, operating time and blood loss were noted, and radiographic studies and neurological status were evaluated before surgery, after surgery, and at final follow-up. RESULTS: The mean kyphosis was 35+/-9.7degrees (range; 17-58degrees) before surgery, 3.2+/-1.8degrees after surgery (correction; 90.5%) and 5.5+/-3.2degrees at the final follow-up (correction; 85.5%). There was 29.6degrees correction of the kyphosis with a 6% loss of correction. Postoperative neurological improvement using the Frankel classification was demonstrated in all patients. There was no new onset or progressive neurological deterioration, additional surgery or extrusion of mesh. Three complications were encountered: one care each of pneumonia, prolonged ventilator support and distal adjacent vertebral fracture. CONCLUSION: The posterior insertion of a titanium mesh for anterior support appears to maintain the length of the anterior column, stabilize the injured vertebra and facilitate spinal fusion. Posterolateral decompression allows as direct a decompression as the anterior approach.
Decompression ; Follow-Up Studies ; Humans ; Kyphosis ; Osteoporosis ; Osteoporotic Fractures ; Pneumonia ; Spinal Fusion ; Spine ; Titanium ; Ventilators, Mechanical

OBJECTIVE: Radiofrequency facet rhizotomy(RFFR) has been widely performed for treatment of chronic neck pain caused by cervical dorsal ramus syndrome(CDRS). To evaluate the therapeutic effectiveness of RFFR in the patients with CDRS, we analyzed patients with various cervical pathologic conditions. METHODS: The therapeutic results in forty-four patients who underwent RFFR for CDRS from January, 2000 to December, 2002 were analyzed according to the underlying pathologic conditions causing CDRS. The pathologic conditions were sprain (33 cases), herniated nucleus pulposus (6), foraminal stenosis (4), and compression fracture (1). The therapeutic results were evaluated one month after the operation and graded as excellent, good, fair or poor. Treatments were considered successful if the therapeutic results were graded as either excellent or good. RESULTS: The overall success rate in all patients was 72.7%. The success rate for treatment of cases with cervical sprain was 87.9%, but treatment of cases with herniated nucleus pulposus, foraminal stenosis, and fracture showed unsatisfactory results (mean success rate was 27.3%). Some patients complained of transient hypesthesia (4 cases) or transient dull pain at the electrode insertion sites (2 cases). CONCLUSION: RFFR is an effective and safe treatment for CDRS caused by cervical sprain, regardless of the patient's age, the duration of the symptoms, and the presence of radiating pain.
Constriction, Pathologic ; Electrodes ; Fractures, Compression ; Humans ; Hypesthesia ; Neck Pain ; Rhizotomy* ; Sprains and Strains

OBJECTIVE: To explore the association of the estrogen receptor dinucleotide repeat polymorphism with the risk of endometriosis. DESIGN: Case-control study. METHODS: One hundred fifty-one women with surgically or histologically diagnosed endometriosis of stages I-IV (ASRM, 1997) were recruited, and 137 patients with no evidence of endometriosis by laparoscopy or laparotomy served as control. Dinucleotide repeat polymorphism of the estrogen receptor gene was assessed by fluorescent PCR with gene scan analysis. Allele frequencies of dinucleotide repeat polymorphism of the estrogen receptor gene were evaluated. RESULTS: Fifteen alleles of the estrogen receptor dinucleotide repeat polymorphism were found in subjects: from 12 repeats to 27 repeats except 26 repeats. There was no statistically significant difference in the allele distribution of dinucleotide repeat polymorphism between patients with endometriosis and controls. However, patients with stage I or II endometriosis (n=51) showed a higher incidence of alleles with fewer (TA)n repeats (12-15 repeats) compared with controls (67.6% vs 52.9%, p=0.010, odds ratio=1.860). CONCLUSION: These results suggest that dinucleotide repeat polymorphism of the estrogen receptor gene is associated with the risk of minimal or mild endometriosis in the Korean population.
Alleles ; Case-Control Studies ; Dinucleotide Repeats ; Endometriosis* ; Estrogens* ; Female ; Gene Frequency ; Humans ; Incidence ; Laparoscopy ; Laparotomy ; Polymerase Chain Reaction

Hemophagocytic lymphohistiocytosis is a reactive disorder characterized by a generalized non-malignant histiocytic proliferation with prominent hemophagocytosis by stimulated histiocytes in the bone marrow and reticuloendothelial systems resulting in pancytopenia and liver dysfunction. Several diseases including infection, malignancy and autoimmune disease are known to be causative disorders. This case demonstrated histiocytic hemophagocytosis in the bone marrow, resulting in pancytopenia during treatment of systemic lupus erythematosus and did not show any underlying disease.
Adjustment Disorders ; Autoimmune Diseases ; Bone Marrow ; Child* ; Histiocytes ; Humans ; Liver Diseases ; Lupus Erythematosus, Systemic* ; Lymphohistiocytosis, Hemophagocytic* ; Mononuclear Phagocyte System ; Pancytopenia

OBJECTIVE: To explore the association of the estrogen receptor PvuII and XbaI polymorphism with endometriosis. METHODS: One hundred sixty women with surgically or histologically diagnosed endometriosis of stages I-IV, and 142 patients with no evidence of endometriosis by laparoscopy or laparotomy served as control. Frequency and distribution of PvuII and XbaI polymorphisms for estrogen receptor gene were evaluated. RESULTS: There was no statistically significant difference in the allele distribution of PvuII polymorphism between the patients and the controls (pp of 35%, pP of 51%, PP of 14% vs. 42%, 44%, 15%, p>0.1); or in the frequency of the positive PvuII allele (0.61 vs. 0.63, p>0.1). And no significant difference was also observed in the allele distribution of XbaI polymorphism between the patients and the controls (xx of 66%, xX of 29%, XX of 5% vs. 68%, 30%, 1%, p>0.1); or in the frequency of the positive XbaI allele (0.80 vs. 0.83, p>0.1). CONCLUSION: These results suggest that the PvuII or XbaI polymorphism of the estrogen receptor gene is not associated with the risk for endometriosis in the Korean population.
Alleles ; Endometriosis* ; Estrogens* ; Female ; Humans ; Laparoscopy ; Laparotomy