Open carpal release using local anesthesia without a tourniquet: Does bleeding tendency affect the outcome?

Background@#The aim of this study was to analyze the clinical results of minimal single palmar-incision carpal tunnel release without a tourniquet. @*Methods@#We reviewed the medical records of 75 patients (90 cases of carpal tunnel syndrome) who underwent minimal single-palmar incision carpal tunnel release without a tourniquet from June 2010 to January 2018. Ten patients had a bleeding tendency. We compared the preoperative and postoperative Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) scores. We also analyzed outcomes and complications according to the presence of a bleeding tendency. @*Results@#In all cases, there was a complete disappearance or marked improvement in symptoms within 6 months, with no recurrence. The postoperative BCTQ score showed a significant improvement compared to the preoperative score, and no statistically significant difference in BCTQ scores was detected according to the presence of a bleeding tendency. @*Conclusions@#Carpal tunnel release without a tourniquet using a minimal single palmar incision is effective and reliable. This technique prevents unnecessary pain associated with the tourniquet and is especially helpful in patients with a bleeding tendency or those treated with hemodialysis.

Meningothelial hamartoma of the scalp

Meningothelial hamartoma is a benign tumor composed of ectopic meningothelial elements in the dermis and subcutaneous tissue. It mainly occurs in the scalp; however, the incidence is extremely low. The origin of meningothelial hamartoma has not been elucidated; nevertheless, it has been theorized that it derives from ectopic meningothelial rests displaced during embryologic development. It can be diagnosed histologically as proliferation of connective tissue elements and cells arranged in solid nests, resembling vascular tumors. On immunohistochemistry, it stains positively for epithelial membrane antigen and vimentin. At least 17 cases have been reported, verifying the rarity of the lesion. We present the case of a 16-year-old male patient with a soft scalp mass which was thought to be a lipoma, but turned out to be a meningothelial hamartoma on histology.

Health Problems and Coping of Workers under Special Employment Relationships: Home-visit Tutors, Insurance Salespersons, and Credit Card Recruiters / 산업간호학회지

PURPOSE: This study aimed to determine health problems experienced by workers in special employment relationships (WSER) and identify coping strategies used when such problems occur.METHODS: This qualitative study used the focus group interview method. Thirteen study participants included five home-visit tutors, five insurance salespersons, and three credit card recruiters. The interviews were conducted from November 2018 through January 2019, with each occupational group interview lasting about 2 hours. Analysis based on phenomenological research was independently performed by two researchers.RESULTS: Most participants had common health problems involving vocal cord symptoms, and stress related to emotional labor and traffic accidents. The unique health problems included cystitis, musculoskeletal, and digestive symptoms in home-visit tutors; reduced vision and hearing in insurance salespersons; and mental distress in credit card recruiters. There was no protection system for their health coverage, and the company emphasized their self-employed status to avoid taking responsibility for them. Twelve participants did not purchase occupational accident insurance owing to both not having adequate information and economic burden concerning premium status.CONCLUSION: WSER experienced both physical and mental health problems. These problems were caused by their unstable employment status, and the social security system for their coverage being non-functioning.

Health Problems and Coping of Workers under Special Employment Relationships: Home-visit Tutors, Insurance Salespersons, and Credit Card Recruiters / 한국직업건강간호학회지

PURPOSE@#This study aimed to determine health problems experienced by workers in special employment relationships (WSER) and identify coping strategies used when such problems occur.@*METHODS@#This qualitative study used the focus group interview method. Thirteen study participants included five home-visit tutors, five insurance salespersons, and three credit card recruiters. The interviews were conducted from November 2018 through January 2019, with each occupational group interview lasting about 2 hours. Analysis based on phenomenological research was independently performed by two researchers.@*RESULTS@#Most participants had common health problems involving vocal cord symptoms, and stress related to emotional labor and traffic accidents. The unique health problems included cystitis, musculoskeletal, and digestive symptoms in home-visit tutors; reduced vision and hearing in insurance salespersons; and mental distress in credit card recruiters. There was no protection system for their health coverage, and the company emphasized their self-employed status to avoid taking responsibility for them. Twelve participants did not purchase occupational accident insurance owing to both not having adequate information and economic burden concerning premium status.@*CONCLUSION@#WSER experienced both physical and mental health problems. These problems were caused by their unstable employment status, and the social security system for their coverage being non-functioning.

Location of the umbilicus in Korean women and its changes after breast reconstruction with an ipsilateral pedicled rectus abdominis musculocutaneous flap

BACKGROUND: The umbilicus makes an important contribution to the natural appearance of the abdomen. To date, studies on its position in Korean women are lacking, and no standards have been established. The purpose of this study was to investigate the position of umbilicus in Korean women and to review changes in its position after ipsilateral pedicled rectus abdominis musculocutaneous (IP-RAM) flap. METHODS: This research consisted of two studies. In first study, 100 females who visited the emergency department with gastroenteritis between 2007 and 2011 were included. In second study, 40 women who underwent IP-RAM flap in the same period were included. Using abdominal computed tomography, we measured the distance between xiphoid process and umbilicus, represented by value a, and the distance between umbilicus and symphysis pubis, represented by value b. Thus, the location of the umbilicus was represented by the ratio a/b. The data were analyzed using Pearson correlation test and paired t-test. RESULTS: In study 1, the mean value of a/b was 1.07. Pearson correlation test revealed a significant correlation between age and a/b. In study 2, the mean value of a/b was 1.16 in preoperative measurements and 1.01 in postoperative measurements. The paired t-test showed a significant difference between preoperative and postoperative measurements, indicating cephalic migration of the umbilicus after surgery. CONCLUSIONS: The natural position of the umbilicus showed caudal migration with aging. Additionally, in a comparison of preoperative and postoperative measurements in patients who underwent IP-RAM flap, cephalic migration of the umbilicus was observed after surgery.

Structural Bioinformatics Analysis of Disease-related Mutations

In order to understand the protein functions that are related to disease, it is important to detect the correlation between amino acid mutations and isease. Many mutation studies about disease-related proteins have been carried out through molecular biology techniques, such as vector design, protein engineering, and protein crystallization. However, experimental protein mutation studies are time-consuming, be it in vivo or in vitro. We therefore performed a bioinformatic analysis of known disease-related mutations and their protein structure changes in order to analyze the correlation between mutation and disease. For this study, we selected 111 diseases that were related to 175 proteins from the PDB database and 710 mutations that were found in the protein structures. The mutations were acquired from the Human Gene Mutation Database (HGMD). We selected point mutations, excluding only insertions or deletions, for detecting structural changes. To detect a structural change by mutation, we analyzed not only the structural properties (distance of pocket and mutation, pocket size, surface size, and stability), but also the physico-chemical properties (weight, instability, isoelectric point (IEP), and GRAVY score) for the 710 mutations. We detected that the distance between the pocket and disease-related mutation lay within 20 A (98.5%, 700 proteins). We found that there was no significant correlation between structural stability and disease-causing mutations or between hydrophobicity changes and critical mutations. For large-scale mutational analysis of disease-causing mutations, our bioinformatics approach, using 710 structural mutations, called "Structural Mutatomics," can help researchers to detect disease-specific mutations and to understand the biological functions of disease-related proteins.

Cresol Chemical Burn / 대한피부과학회지

Generally chemical burns are managed with immediate water irrigation. Cresol is one of the few chemicals that cannot be safely washed off with water. If cresol chemical burn is washed off with small amount of water, the involved area may extend. Thus cresol chemical burn must be managed with caution if a generous supply of water is not available. We report a case of cresol chemical burn with a review of literatures.

Influence of Sex on Patients with Behcet's Disease in Korea

Behcet's disease (BD) is a multisystemic inflammatory disorder known as having a histopathological findings of vasculitis. The influence of sexual difference on BD is a well-known fact and there are several reports suggesting a more severe course of the disease among young males. The purpose of our study was to determine the effects of gender on the severity and clinical features of BD patients in Korea. The study included 1,901 patients with BD who fulfilled the criteria of International Study Group for Behcet's Disease or corresponded to the complete or incomplete type for the revised criteria of Behcet's Disease Research Committee of Japan. BD in Korea showed a female predominance (M:F=0.61:1). The skin lesions were observed in 79.9% of patients, of which 77.6% had erythema nodosum-like lesion, which was more frequent in females. The ocular lesions were more common in males showing a higher frequency of uveitis. Ocular and vascular symptoms as clinical features with severe complications or mortality were more frequent in males than in females. The mean age at the onset of patients with the worst prognosis such as ocular, gastrointestinal, neurologic, and vascular involvements was significantly younger in male than in female patients (p<0.05). In conclusion, this study elucidated the influences of sexual difference on BD in Korea.

Dyskeratosis Congenita / 대한피부과학회지

Dyskeratosis congenita is a rare multisystemic genodermatosis of ectodermal dysplasia, and is characterized by the diagnostic triad consisting of reticulated hyperpigmentation, dystrophic nails, and leukoplakia. Complications such a malignancy and bone marrow involvement will be predisposition. A 44-year-old male was presented with reticulated hyperpigmentation, nail dystrophy, oral leukoplakia, mild hyperkeratosis of the palms and soles, and short stature. His brothers were presented with reticulated hyperpigmentation and nail dystrophy, and underwent a surgical operation due to oral cavity cancer. The histopathological findings taken from the reticulated lesion showed epidermal thinning and a mild inflammatory cell infiltration with melanophages in the dermis. We report a typical case of dyskeratosis congenita in a male with family history.

Tardy Ulnar Nerve Palsy Associated with Cubitus Varus Deformity

OBJECTIVES: Six cases of tardy ulnar neuropathy caused by cubitus varus deformity are presented. Clinical features and electrodiagnostic study of six cases were analysed to understand the mechanim of nerve palsy and the usefulness of electrodiagnostic study. METHODS: Electrodiagnostic study and elbow flexion test were performed and elbow varus angle, internal rotation angle of shoulder, biceps and brachioradialis muscle activities were measured in 6 patients RESULTS: Decreased ulnar nerve motor conduction velocities in the elbow segment was shown in 5 patients. Prolonged distal latency and reduced amplitude of ulnar sensory nerve action potentials were shown in one patient. Needle electromyography showed large amplitude motor unit action potentials in ulnar innervated forearm or hand muscles. The mean values of varus angle and internal rotation angle of humerus were 21degrees, and 28degrees, respectively. Brachioradialis showed relatively higher activity than biceps brachii in the early phase of elbow flexion. Three patients underwent surgery and showed immediate symptom relief. CONCLUSION: Tardy ulnar nerve palsy in cubitus varus thought to be caused by internal rotation of distal segment of humerus, stretching of ulnar nerve, snapping of the medial head of triceps on ulnar nerve and anterior transposition and compression of ulnar nerve. The three dimensional corrective osteotomy could be the most efficient treatment to restore the anatomic alignment of the elbow joint.