An Algorithmic Roadmap for the Surgical Management of Degenerative Cervical Myelopathy: A Narrative Review

Degenerative cervical myelopathy (DCM) is a leading cause of disability, and its surgical management is crucial for improving patient neurological outcomes. Given the varied presentations and severities of DCM, treatment options are diverse. Surgeons often face challenges in selecting the most appropriate surgical approach because there is no universally correct answer. This narrative review aimed to aid the decision-making process in treating DCM by presenting a structured treatment algorithm. The authors categorized surgical scenarios based on an algorithm, outlining suitable treatment methods for each case. Four primary scenarios were identified based on the number of levels requiring surgery and K-line status: (1) K-line (+) and ≤3 levels, (2) K-line (+) and ≥3 levels, (3) K-line (−) and ≤3 levels, and (4) K-line (−) and ≥3 levels. This categorization aids in determining the appropriateness of anterior or posterior approaches and the necessity for fusion, considering the surgical level and K-line status. The complexity of surgical situations and diversity of treatment methods for DCM can be effectively managed using an algorithmic approach. Furthermore, surgical techniques that minimize the stages and address challenging conditions could enhance treatment outcomes in DCM.

A Clinical Study on the Tattoos of Young Korean Males / 대한피부과학회지

BACKGROUND: Recently, tattooing of the body has become popular, and its associated psychological, sociological, and cultural implications have changed compared to past years. However, little is known about the current clinical features, including motive and satisfaction for having a tattoo, because of societal repulsions toward the practice. OBJECTIVE: To evaluate the clinical manifestations of tattooed young Korean males and to compare the findings with previous studies. METHODS: Between September 2010 and July 2011, 223 patients with tattoos who visited the Eulji Medical Center and Armed Forces Yangju Hospital were selected. The patients were evaluated through a self-administrated questionnaire and physical examinations. RESULTS: The majority of patients were classified into the "did not complete university" education group (56.1%). Most tattooed males had two living parents (83.4%) and were raised in households whose income statuses were not marked by poverty. The average age at which their first tattoo was received was 19.0 years. Most tattooed males had a negative attitude towards their tattoos (67.3%). The most common motivation for getting a tattoo was curiosity, but cosmetic purposes were also important (19.4%). A majority of the tattooing was conducted by a tattoo artist (73.3%). The most common tattoo content was letters. Black-colored tattoos were most frequently observed. The complication rate was 13.9%. The most common motivation for tattoo removal was negative comments that were made at work, in public, and in school (38.2%). CONCLUSION: Recent patterns of tattooing have changed significantly since previous reports. The satisfaction rate in getting a tattoo was not favorable. Understanding the current clinical features related to tattooing is important and it is necessary for dermatologists to provide professional advice regarding tattooing among young males.

Primary Papular Xanthoma in an Infant / 대한피부과학회지

Papular xanthoma is one of the clinicopathologic variants of normolipemic cutaneous non-Langerhans cell histiocytosis. It is a very rare condition that is characterized by non-confluent, yellowish papules located on the face, trunk and mucous membranes with no internal involvement. It has been predominantly reported in adults but childhood cases were also recently seen. We report a typical case of papular xanthoma in a 14-month-old boy who presented numerous yellow-brown papules on the face, arm and buttock. On histologic findings, it showed typical features of papular xanthoma.

Clinical Experience in the Treatment of Port-Wine Stains with Blebs

BACKGROUND: The current modality of choice for the treatment of Port-wine stains (PWS) is laser photocoagulation. Laser therapy for the treatment of PWS, especially with a pulsed dye laser (PDL), has been proven safe and effective; however, because penetration of the PDL is too shallow for an effective ablation of the blebs, treatment of blebbed PWS, using PDL, may be insufficient. OBJECTIVE: We demonstrated the clinical efficacy of a 1,064 nm long pulsed Nd:YAG laser with contact cooling device for blebbed PWS. METHODS: Twenty one patients with blebbed PWS (Fitzpatrick skin types II-V) underwent a treatment, using a 1,064 nm long pulsed Nd:YAG laser with a contact cooling device at 8-week intervals. Treatments were done using 5~6 mm spot sizes at 20~30 ms and 95~170 J/cm2. Laser parameters were adjusted in order to meet the needs of each individual patient's lesions. RESULTS: All subjects tolerated the treatments well, and showed clinical improvement from blebs. Of the 21 patients, 18 of them experienced either moderate or excellent response. CONCLUSION: Use of a 1,064 nm long pulsed Nd:YAG laser results in a greater depth of vascular coagulation. A 1,064 nm long pulsed Nd:YAG laser with contact cooling device may be regarded as a promising therapeutic option for the treatment of blebbed PWS.

A Pigmented Follicular Cyst of the Axilla with Atypical Distribution / 대한피부과학회지

A pigmented follicular cyst typically presents as an asymptomatic, solitary papule on head and neck in adult men. The histologic features of pigmented follicular cysts are cross-sectioned, terminally-differentiated hair shafts in an epidermal cyst. There are no sebaceous lobules or other appendages within the wall or in close proximity. We herein report a case of pigmented follicular cyst of the axilla in a 31-year-old man.

Squamous Cell Carcinoma Developing within Lesions of Disseminated Superficial Actinic Porokeratosis

Disseminated superficial actinic porokeratosis (DSAP) consists of multiple annular, hyperkeratotic lesions that have a bilateral distribution on sun-exposed areas, particularly the extremities. DSAPs have a wider distribution than porokeratosis of Mibelli and usually develop during the 3rd or 4th decade of life. Squamous cell carcinoma that arises in the classical type of porokeratosis of Mibelli is well-documented, but there are only a few reports of squamous cell carcinoma in DSAP. Here, we describe a 62-year-old man with DSAP who developed squamous cell carcinoma on his right forearm.

Complete and Partial-Thickness Tears of the Anterior Cruciate Ligament: Differential Features Seen on MRImaging

PURPOSE: To evaluate the differential features of complete and partial-thickness tears of the anteriorcruciate ligament, as seen on magnetic resonance imaging(MRI). MATERIALS AND METHODS: We retrospectvely reviewedMR images of 36 patients with ACL injuries (complete tear 16, incomplete tear 20). In all cases, the presence ofan ACL tear was determined by arthroscopy or surgery. Primary and secondary signs of ACL injury and associatedinjuries were assessed. RESULTS: Ligamentous discontinuity of the ACL was observed in ten complete tears (63 %),but in only four (10%) of those that were partial (p=0.009). In addition, complete tears were more likely to showa low degree of ACL axis, less than 45 degree(11/16 : 2/20, p=0.001). There was, however, no statistically significantdifference between complete and partial tears with regard to signal intensity of ACL, PCL buckling or angle,anterior dis-placement of the tibia, uncovered meniscus sign, deep notch sign, empty notch sign, and associatedinjuries. CONCLUSION: Ligamentous discontinuity and the ACL axis are features which usefully differentiatebetween complete and partial tears of the ACL.

Molecular Genetic Investigation of Sporadic Renal Cell Carcinoma: Analysis of Allele Loss on Chromosome 3p / 대한비뇨기과학회지

PURPOSE: Renal cell carcinoma has been characterized by an abnormality on the short arm of chromosome 3, which suggests the presence of a tumor suppressor gene at this location. The aim of study was to investigate the role of tumor suppressor genes on the short arm of chromosome 3 in the mechanism of tumorigenesis in sporadic renal cell carcinoma. MATERIALS AND METHODS: The DNA from normal and tumor tissue from 48cases with renal cell carcinoma was analyzed for allele loss on chromosome 3p by polymerase chain reaction using microsatellite marker. RESULTS: A total of 37 of 48 informative tumors(77%) showed loss of heteroxygosity(LOH) at one or more loci. Detailed analysis of the pattern of LOH on the chromosome 3p suggested that mutations of other genes in chromosome 3p13-p24, in addition to VHL gens in chromosome 3p25, are required for malignant tumor growth. There was the statistically significant correlation between the extent of LOH and cancer cell type(clear vs. others)(p=value 0.048, Fisher's exact test). A total of 26 of 37 clear cell types(70%)revealed LOH on chromosome 3p, but all of 11 non clear cell types including 2 granular cell types, 3 chromophobe types, 1 sarcomatoid cell type and 5 mixed cell types showed LOH. There was no correlation between LOH and other clinico-pathological factors including patients age, sex, symptom, tumor size, stage of disease and tumor cell grade. CONCLUSIONS: Our data suggest that, in addition to VHL gene, at least one tumor suppressor gene for the genesis of sporadic remal cell carcinoma exists on the short arm of chromosome 3.