The Efficacy and Safety of Ablative Fractional Resurfacing Using a 2,940-Nm Er:YAG Laser for Traumatic Scars in the Early Posttraumatic Period

BACKGROUND: Skin injuries, such as lacerations due to trauma, are relatively common, and patients are very concerned about the resulting scars. Recently, the use of ablative and non-ablative lasers based on the fractional approach has been used to treat scars. In this study, the authors demonstrated the efficacy and safety of ablative fractional resurfacing (AFR) for traumatic scars using a 2,940-nm erbium: yttrium-aluminum-garnet (Er:YAG) laser for traumatic scars after primary repair during the early posttraumatic period. METHODS: Twelve patients with fifteen scars were enrolled. All had a history of facial laceration and primary repair by suturing on the day of trauma. Laser therapy was initiated at least 4 weeks after the primary repair. Each patient was treated four times at 1-month intervals with a fractional ablative 2,940-nm Er:YAG laser using the same parameters. Post-treatment evaluations were performed 1 month after the fourth treatment session. RESULTS: All 12 patients completed the study. After ablative fractional laser treatment, all treated portions of the scars showed improvements, as demonstrated by the Vancouver Scar Scale and the overall cosmetic scale as evaluated by 10 independent physicians, 10 independent non-physicians, and the patients themselves. CONCLUSIONS: This study shows that ablative fractional Er:YAG laser treatment of scars reduces scars fairly according to both objective results and patient satisfaction rates. The authors suggest that early scar treatment using AFR can be one adjuvant scar management method for improving the quality of life of patients with traumatic scars.

A Giant Sebaceous Epithelioma on the Scalp: A Case Report

PURPOSE: Sebaceous epithelioma (sebaceoma) is a benign tumor with sebaceous differentiation. It presents primarily as a yellowish papule or nodule on the face and scalp. It must be differentiated from basal cell carcinoma and other appendageal tumors. We report a giant sebaceous epithelioma on the scalp and describe the immunohistochemical character of the cells in sebaceous epithelioma to epithelial membrane antigen (EMA). METHODS: A 55-year-old-man who presented with 5-cm-diameter 2-cm-height, round shape exophytic ulcerated tumor on his head presented for treatment. The patient had noticed the lesion 40 years prior as a small yellowish plaque and 18 months ago, the plaque started to grow progressively larger. We excised the lesion with 1 cm resection margin, considering the possibility of malignancy because this lesion grossly resembled basal cell carcinoma (BCC). The defect was repaired with the use of a split-thickness skin graft. RESULTS: When we excised the lesion, the margin was clear. Histology showed nodules that consisted of an admixture of basaloid cells and mature adipocytes lacking an organized lobular architecture. Strong expression of EMA on mature adipose cells confirmed the differential diagnosis from BCC with sebaceous differentiation because of the absence of a nuclear palisade pattern and cleft-like spaces on the hematoxylin and eosin (H&E) section. CONCLUSION: We treated the giant sebaceous epithelioma on the scalp with surgical excision and a split-thickness skin graft. It is important to know that the diagnosis of sebaceous epithelioma should be made based on the histologic pattern of the H&E section. Immunohistochemistry with EMA can help to confirm the differential diagnosis between sebaceous epithelioma and BCC.

A Giant Sebaceous Epithelioma on the Scalp: A Case Report

PURPOSE: Sebaceous epithelioma (sebaceoma) is a benign tumor with sebaceous differentiation. It presents primarily as a yellowish papule or nodule on the face and scalp. It must be differentiated from basal cell carcinoma and other appendageal tumors. We report a giant sebaceous epithelioma on the scalp and describe the immunohistochemical character of the cells in sebaceous epithelioma to epithelial membrane antigen (EMA). METHODS: A 55-year-old-man who presented with 5-cm-diameter 2-cm-height, round shape exophytic ulcerated tumor on his head presented for treatment. The patient had noticed the lesion 40 years prior as a small yellowish plaque and 18 months ago, the plaque started to grow progressively larger. We excised the lesion with 1 cm resection margin, considering the possibility of malignancy because this lesion grossly resembled basal cell carcinoma (BCC). The defect was repaired with the use of a split-thickness skin graft. RESULTS: When we excised the lesion, the margin was clear. Histology showed nodules that consisted of an admixture of basaloid cells and mature adipocytes lacking an organized lobular architecture. Strong expression of EMA on mature adipose cells confirmed the differential diagnosis from BCC with sebaceous differentiation because of the absence of a nuclear palisade pattern and cleft-like spaces on the hematoxylin and eosin (H&E) section. CONCLUSION: We treated the giant sebaceous epithelioma on the scalp with surgical excision and a split-thickness skin graft. It is important to know that the diagnosis of sebaceous epithelioma should be made based on the histologic pattern of the H&E section. Immunohistochemistry with EMA can help to confirm the differential diagnosis between sebaceous epithelioma and BCC.

A Case of Scar Sarcoidosis

PURPOSE: Sarcoidosis is a systemic noncaseating granulomatous disease of an unknown origin, and can involve any organ including the skin. The infiltration of sarcoid granuloma in an old cutaneous scar is an uncommon cutaneous manifestation of sarcoidosis. This paper reports a 35-year old female who presented with cutanesous nodules in previous facial scars. METHODS: A 35-year-old female presented with cutaneous nodules for 2 months in previous scars of the forehead and lower lip that she had acquired in the childhood. An excisional biopsy of the lower lip mass, serologic examinations and radiologic studies were performed. RESULTS: The excisional biopsy revealed noncaseating granulomas consistent with sarcoidosis. Chest CT revealed both hilar and paratracheal lymphadenopathy with nodular densities in both lung fields. Routine laboratory tests, serologic tests, serum angiotensin converting enzyme level, sputum for acid-fast bacilli, ophthalmoscopic examination, TB-PCR and NTM-PCR showed normal findings. Therefore, the patient was diagnosed with sarcoidosis. The patient refused fiberoptic bronchoscopy and medication with oral steroid. Currently, the clinical manifestation and progress are being monitored closely, and treatment is expected to start with oral steroid according to the progress. CONCLUSION: For the proper management of cutaneous sarcoidosis, particularly scar sarcoidosis, plastic surgeons should be aware of the many clinical and histopathological features of sarcoidosis and recommend a systemic evaluation for early diagnosis and proper treatment.

A Case of Endometrioma at the Abdominal Scar

PURPOSE: Plastic surgeon can easily misdiagnose the mass on the postoperative scar as hypertrophic scar. We present a case of endometrioma at abdominal scar after cesarean section. METHODS: A 36 year-old female visited with a protruding, rubbery hard mass on her abdominal scar. The mass grew slowly after cesarean section performed 7 years ago. She has felt intermittent pain, not with menstrual cycle, for 2 months. The ultrasonography showed a solid irregular, ill defined mass with heterogenous echogenicity. The MRI finding is suggestive of malignant soft tissue tumor with deep fascial invasion. Incisional biopsy showed acanthosis, melanophage, lymphoplasmacytic infiltration. So we excised mass elliptically, we could see chocolate-like discharge from the mass, adhering to external oblique muscle fascia. The mass confirmed histologically as an endometrioma. RESULTS: The mass was completely removed and did not recurr. The patient does not complain more about pain or any discomfort. CONCLUSION: Plastic surgeons should be aware of the possibility of endometrioma when the patient present with mass on her abdominal scar after surgery of the pelvis and abdomen.

Shape and innervation of popliteus muscle / 대한해부학회지

The aim of this study was to delineate the shape of the popliteus muscle and determine the correct motor point site for treating spasticity. A total of 22 legs from 13 fresh Korean cadavers were evaluated. The x-axis was set as a transverse line across the lateral and medial epicondyle of the femur and the y-axis as a vertical line at the midpoint of the medial malleolus of the tibia and lateral malleolus of the fibula. The popliteus muscle is an obtuse triangle in shape. Superior, medial, and inferior angles were 27.2+/-4.3degrees, 114.8+/-19.8degrees, and 38.0+/-18.8degrees respectively. The lengths of the superior, medial, and lateral sides of the triangle were 7.6+/-1.0 cm, 6.2+/-1.0 cm, and 11.9+/-1.5 cm respectively. Nerve branches ran superficially on the periosteum of the tibia and entered the popliteus on its superficial surface. The diverging point of the nerve branch entered the popliteus from the tibial nerve located at the midline of the popliteal fossa and 17% of the leg length above the intercondylar line. Most nerve entry points (83.3%) were within a 2.0x3.0 cm rectangle with the center located at -1.0 cm (-7%) on the x-axis and -3.3 cm (-9%) on the y-axis.

Reconstruction of Lower Eyelid Defect using Neighboring Remnant Skin

PURPOSE: Facial tumor excision is a common cause of lower eyelid defect in old patients. Many methods have been introduced for the reconstruction of lower eyelid. However, conventional surgical method can cause various complications like scar, ectropion and unnatural color matching. Thus, we introduce a simple and aesthetically acceptable method for the reconstruction of lower eyelid defect. METHODS: Three elderly patients with skin cancer in the unilateral lower eyelid were operated by the new method. Following a wide excision of skin cancer, subcilliary incision of lower blepharoplasty was carried out. Elevated skin flap of lower eyelid was redrapped for the correction of defect and the remnant skin from lateral portion of lower eyelid was used for full thickness skin graft(FTSG) to correct the remaining defect. RESULTS: All grafts survived and color match of the graft was excellent without ectropion. Furthermore, wrinkles of the lower eyelid were improved after the blepharoplasty. CONCLUSION: Lower eyelid defect resulting from wide excision of malignant tumor in old patients could be reconstructed successfully by modifying the conventional lower eyelid blepharoplasty along with FTSG using the remnant skin.

Herpes Zoster Ophthalmicus in Minor Facial Burn

PURPOSE: Many conditions can mimic the presentation of burns. Herpes zoster is one of them. The characteristic features of herpes zoster such as vesicles, pustular lesions and crusts can also be found in burns. Herpes zoster ophthalmicus is a disease caused by recurrent infection of varicella-zoster virus in the ophthalmic division of the trigeminal nerve. This virus frequently affects nasociliary branch and serious ocular complications can occur. Thus, early diagnosis and proper treatment of this disease is important to prevent further ocular manifestations. We report a man who sustained minor facial burn injury that was complicated with herpes zoster ophthalmicus. METHODS: A 66-year-old man visited emergency room with multiple whitish vesicles with serous discharge on right forehead, right medial canthal area and nose. Firstly he was observed as having a secondary infection of facial burn injury. The vesicles on his face began to form crust the next day. Since his skin lesion was located on the ophthalmic division of trigeminal nerve, we also suspected herpes zoster ophthalmicus. He was referred to dermatologist and ophthalmologist. RESULTS: We used antiviral agent (Acyclovir) and NSAIDs for treatment. The patient had no ocular complications. His skin lesion was almost healed after 1 month and remained scars. We treated the patient with minor facial burn complicated with herpes zoster ophthalmicus with antiviral agent. CONCLUSION: In this work, we describe a case of an old patient with herpetic infection and emphasize the needs for careful examination to diagnose accurately.

Incidence of Polydactyly and Triphalangism of Thumb

PURPOSE: Preaxial polydactyly is the most common congenital anomaly of upper extremities. In this study, we classified 112 patients of preaxial polydactyly for investigation of recent incidences of each types. METHODS: We reviewed 120 cases of preaxial polydactyly diagnosed at university hospitals of Incheon and Bucheon from 2000 to 2008. All cases were grouped using simple radiographs and all cases were classified according to the Upton modified Iowa system. RESULTS: Among the 120 cases of preaxial polydactyly, 7 cases(6%) were in type I polydactyly, 35 cases(29%) type II, 1 case(1%) type III, 48 cases(40%) type IV, 12 cases(10%) type V, 5 cases(4%) type VI, 12 cases(10%) type VII, respectively. All cases in type VII polydactyly were triphalangism. CONCLUSION: Comparing with Wassel's study and Upton's study, our study showed similar distribution of each types of preaxial polydactyly.

Mode of Parotid Invasion and Parotid Lymph Node Metastasis in External Auditory Canal Carcinoma / 대한이비인후과학회지

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.

Anthropometric Analysis of Buddha's Face of Korea and Joseon Dynasty in Buddhist Paintings and Comparison with the Beauty's Face of Joseon Dynasty

The aim of this study is to measure and to analyze the Buddha's face of Korea dynasty and Joseon dynasty in buddhist paintings. We also attempted to compare the Buddha's face with the face of the beauty of Joseon dynasty. Six paintings of the Korea dynasty and ten paintings of the Joseon dynasty were analyzed. Twenty anthropometric items on each paintings were measured and 17 proportional indices were calculated. There was no significant differences between the proportions of the Buddha's face of the Korea and Joseon dynasty except the thickness of the vermilion where the Korea dynasty were thicker than Joseon dynasty. Proportions of the Buddha's face was very similar to that of Beauty of Jeseon dynasty except three points. The differences are as follow. First, Buddha's ears are longer than the beauty's. Second, Buddha's eye inclination was higher than the beauty's. Third, Buddha's vermilion was thicker than the beauty's. The similarity of the proportions of the face of Buddha and the beauty strongly suggest that in the Korea dynasty and Joseon dynasty, the ideal face were regarded as Buddha's face.

Expression of Nonsteroidal Anti-Inflammatory Drug-Activated Gene-1(NAG-1) in Human Nasal Mucosa and Cultured Nasal Epithelial Cells / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nonsteroidal anti-inflammatory drug-activated gene-1 (NAG-1) is a recently discovered TGF-beta superfamily cytokine. But localization and functions of NAG-1 have not been thoroughly studied. So, we wanted to investigate its expression and localization in human nasal mucosa and also wanted to investigate the change of NAG-1 expression as a function of mucociliary and squamous differentiation. MATERIALS AND METHODS: Anterior and middle portion of human inferior turbinate were used and immunohistochemistry with NAG-1 antibody was done. Passage-2 normal human nasal epithelial cell culture using air-liquid interface method was performed for 14 days and the cells were divided as retinoic acid (RA)-sufficient and RA-deficient group. Hematoxylin and eosin staining was done on each group to study the degree of differentiation. Western blot analysis for NAG-1 expression was performed on each group on 0, 7, and 14 days. RESULTS: NAG-1 expression of muco-ciliated epithelium was noted in ciliated cells and serous acini, but was not found in goblet cells and mucous acini. In the squamous epithelium, its expression was weaker than in the mucociliated epithelium. In the RA-sufficient culture, NHNE cells were differentiated into ciliated epithelium, but in the RA-deficient culture, keratinizing squamous epithelium was noted. In the Western blot analysis, NAG-1 expression was significantly higher in the RA-sufficient culture than in the RA-deficient culture and this expression was time-dependent. CONCLUSION: NAG-1 may be related to differentiation and apoptotic process of nasal epithelial cells. However, it is still unclear whether NAG-1 is an inducer or a byproduct of differentiation or apoptosis. The role of NAG-1 protein remains to be solved.

A Clinical Review on 173 Cases of Unilateral Vocal Cord Paralysis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Unilateral vocal cord paralysis is a common finding in the practice of otolaryngology. Having an idiopathic cause, requiring surgeries on neck and chest, presenting tumors, trauma and neurological diseases are considered to be its major etiology. We reviewed and compared both domestic and international papers and analyzed the trend of clinical characteristics and causes of unilateral vocal cord palsy in Korean patients. MATERIALS AND METHOD: We reviewed 173 patients who visited the Severance Hospital and the Yong dong Severance Hospital from April, 1995 to December, 2001. They were diagnosed with unilateral vocal cord palsy by reviewing systems, physical examination, radiographic studies, and endoscopy. They were analyzed according to sex, age, cause of vocal cord palsy, condition of the paralyzed vocal cord and treatment methods by a preestablished protocol. RESULTS: The male to female ratio was 1.6: 1. Patients in their fifties consisted of 24.3% of the total number of cases, and patients over 60 formed 30.6%, showing that the frequency of unilateral vocal cord palsy increased with age. The paralyzed vocal cord was fixed at paramedian position in 79.8% of the cases. The left vocal cord was paralyzed about twice as much as the right vocal cord. Among the causes of vocal cord palsy, 32.4% of the cases were due to postoperative paralysis, and most of those were developed after thyroid surgery. About 67% of the cases were not related to surgery, of which the causes were most commonly idiopathic, with tumor being the next frequent. In 38.4% of the patients, atrophy of the membranous portion of the paralyzed vocal cord was noted. Rotation of the arytenoid cartilage was seen in 25.3%. CONCLUSION: Vocal cord paralysis is not only a disease entity in itself, but can be seen as a sign of an underlying disease. Thus, determining the cause of vocal cord paralysis is extremely important. Although the number of cases of vocal cord paralysis due to surgery is now decreasing, those due to trauma or idiopathic causes are rising and paralysis due to tumor is increasing. Consequently, it is necessary to perform a complete and thorough search for the underlying cause of vocal cord paralysis.

Expression of 15-Lipoxygenase and Cyclooxygenase-2 in Human Nasal Mucosa and Cultured Human Nasal Epithelial Cells / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of our study was to examine the expression of 15-lipoxygenase (15-LO) in human nasal mucosa and to investigate the change of expression of 15-LO and cyclooxygenase-2 (COX-2) as a function of mucociliary and squamous differentiation. MATERIALS AND METHOD: Human inferior turbinates were used and immunohistochemistry with 15-LO and COX-2 antibody was done. Passage-2 normal human nasal epithelial cell culture using air-liquid interface method was performed for 14 days and the cells were divided as retinoic acid (RA)-sufficient and RA-deficient group. Western blot analysis for 15-LO and COX-2 expression was performed on each group on 0, 7, and 14 days. RESULTS: 15-LO expression of mucociliated epithelium was noted in ciliated cells and basal cells, but was not found in goblet cells and secretory acini. In squamous epithelium, the expression of 15-LO was weaker than that in the mucociliated epithelium, but the expression of COX-2 showed no difference between them. In Western blot analysis, 15-LO expression was significantly higher in RA-sufficient culture than in RA-deficient culture and this expression was time-dependent. COX-2 expression was almost same level in RA-deficient culture, but its expression was significantly higher in RA-sufficient culture on 7 and 14 days than on zero day. CONCLUSION: 15-LO and COX-2 may be related to differentiation and development of nasal epithelial cells. However, it is unclear whether this relationship is direct or indirect effect of 15-LO and COX-2. This question remains to be solved.

En-bloc Dissection of Deep and Superficial lobe of Parotid gland with Preserving the Facial Nerve / 대한이비인후과학회지

Total parotidectomy is indicated when the tumor is originated from a deep lobe of the parotid gland. Because of the facial nerve, the usual sequence of total parotidectomy of a deep lobe tumor is to first perform superficial parotidectomy separately and then to remove the deep lobe. However, it is desirable to remove the parotid gland en-bloc while preserving the facial nerve. We designed a simple procedure that could remove a deep lobe tumor without separating the superficial portion of the parotid gland. This surgical technique is discussed with the present cases.

The Analysis of Clinical Information by Building the Clinical Data Warehouse / 대한의료정보학회지

This paper presents the design and application of a clinical data warehouse. The clinical data warehouse is built based on past 10 years of clinical data of Seoul National University Hospital. We extracted the clinical data from the database of hospital information system database and the results of Health 21 Project' , which is mainly composed of chief complaints, final diagnosis, discharge notes and survival data. By normalizing the terms of chief complaint, we are able to analyze the distribution patterns of symptoms within a diagnosis, and that of diagnosis related with a certain clinical symptom. Through our involvement with this project, we have learned that in order for a useful clinical data warehouse system, normalization and structured data entry is the key element of building clinical data warehouse.

MR Patterns of Bone Marrow of Calvarium and Vertebral Body in Normal Subjects; Pattern Analysis According to Age Distribution

PURPOSE: The purpose of this study is to illustrate MR patterns of bone marrow of calvarium and vertebral body in normal subjects according the age distribution and to understand the course of the fatty replacement from red marrow. METHODS AND MATERIAL: We retrospectively evaluated MR examinations of the calvaria(n=71), cervical spine(n=71), thoracic spine(n=65), Imbar spine(n =68) in subjects without bone marrow abnormality whose age ranged 3 weeks to 74 years. Three distinctive patterns were categorized on Tl-weighted images of the skull. In pattern 1, uniformly low signal intensity with or without very small areas of high intensity in frontal and occipital bones is noted. In pattern 2, frontal and occipital bones have uniformly high signal intensity, and patchy area of high intensity appears in parietal bone. In pattern 3, the entire skull has uniformly high signal intensity. In the spine, four patterns were categorized on Tl-weighted MR images. In pattern 1, the vertebral body has uniformly low signal intensity except for linear areas of high intensity superior and inferior to basivertebral vein. In pattern 2, bandlike and triangular areas of high signal intensity are found in the periphery. Pattern 3 and 4 have diffusely distributed areas of high signal intensity; pattern 3 consist of numerous indistinct dots measuring a few millimeter or less, and pattern 4 consist of fairly well marginated areas ranging in size from 5 to 1.5cm. RESULT:In the calvaria, 73% of pattern 1 were younger than 20 years, pattern 2 were evenly distributed, and 86% of pattern 3 were older than 40 years. In the spine, 87% of pattern 1 were younger than 40 years, 72% of pattern 3 were in 40 to 50 years, and 87% of pattern 4 were older than 50 years. Pattern 2 were evenly distributed in the cervical and thoracic spine, but in the thoracic spine 62% were younger than 30 years. CONCLUSION:It is concluded that younger age group shows mainly pattern 1, whereas elderly group has pattern 3 or 4 in the calvarial and vertebral body marrow. This suggests that conversion to fatty marrow begin locally and progress diffusely with age.

MR Imaging of Lipomatous Soft Tissue Tumor: Histopathologic Correlation

PURPOSE: The purpose of this study to access MR findings of the lipomatous soft tissue tumor based on histopathologic correlation and its predictability of the histopathologic diagnosis. MATERIALS AND METHODS: We retrospectively analyzed the MR findings and photomicrographs of 9 patients with histopathologically proven lipomatous soft tissue tumors as follows;classic lipoma(4), fibrolipoma(1), lipoblastoma(2), atypical l ipoma(1) and well-differentiated liposarcoma(1). RESULTS: All cases of lipoma showed the same signal intensities as subcutaneous fat which is composed of mature fat cells. Linear low signal intensity lesions corresponded to fibrous connective tissues within lipomas. Two cases of lipoblastoma showed heterogeneous signal intensity with areas of high signal intensity brighter than subcutaneous fat on T2WI, corresponding to myxoid matrix of cytoplasm of immature lipoblasts, and the areas of myxoid degeneration within tumors. Both atypical lipoma and liposarcoma showed heterogeneous signal intensity with ill-defined margins due to presence of lipoblasts and infiltration to adjacent muscle bundles. CONCLUSION: MR image findings were well correlated with histopathologic findings of lipomatous soft tissue tumor, especially with maturity of fat cells and the signal intensity of mesenchymal components within the tumors. MR may predict the pathologic diagnosis of lipoblastoma by presence of myxoid degeneration within Ihe tumor, but atypical lipoma and liposarcoma revealed similar MR findings.