Primary repair of untreated cleft palate in an elderly patient:a case report

Untreated adult or elderly cleft lip and palate patients are rarely seen, but studies on delayed primary palatal closure have been performed in the less developed Asian and African countries, where access to medical care is difficult. A 64-year-old woman visited our clinic with untreated cleft palate with a 40×20-mm-wide defect in the medial palate. Two-flap palatoplasty under general anesthesia was performed to close the cleft palate. After 1 month, the result was favorable without any complications including oronasal fistula. Cleft palate primary repair in an elderly patient is rare and has some surgical problems that are associated with a wide range of defects, but good results can be obtained if surgery is performed well with appropriate considerations.

Langerhans cell histiocytosis of the mandible: two case reports and literature review

Langerhans cell histiocytosis (LCH) is a rare disorder characterized by the proliferation of dendritic cells resulting in local or systemic symptoms. The clinical symptoms of patients with Langerhans cell histiocytosis depend on the site and the degree of involvement. This article describes two case histories of unifocal bony Langerhans cell histiocytosis with mandibular involvement and further discusses the appropriate management of such via a review of the literature.

Langerhans cell histiocytosis of the mandible: two case reports and literature review

Langerhans cell histiocytosis (LCH) is a rare disorder characterized by the proliferation of dendritic cells resulting in local or systemic symptoms. The clinical symptoms of patients with Langerhans cell histiocytosis depend on the site and the degree of involvement. This article describes two case histories of unifocal bony Langerhans cell histiocytosis with mandibular involvement and further discusses the appropriate management of such via a review of the literature.

Medical adhesive related skin injury after dental surgery

An 87-year-old woman was referred for the extraction of residual teeth and removal of tori prior to prosthetic treatment. After surgery under general anesthesia, the surgical tape was removed to detach the bispectral index sensor and the hair cover. After the surgical tape was removed, skin injury occurred on the left side of her face. After epidermis repositioning and ointment application, a dressing was placed over the injury. Her wound was found to have healed completely on follow-up examination. Medical adhesive related skin injury (MARSI) is a complication that can occur after surgery and subjects at the extremes of age with fragile skin are at a higher risk for such injuries. Careful assessment of the risk factors associated with MARSI is an absolute necessity.

Effects of an Education Program on Prevention of Malpractice using Precedent Cases related to Patient Safety in Safety Perception, Safety Control, Autonomy and Accountability in Clinical Nurses / 간호행정학회지

PURPOSE: The purpose of this study was to identify the effects of an education program on safety perception, safety control, autonomy and accountability in clinical nurses. Precedent cases related to patient safety were used in the education program. METHODS: A quasi-experimental design with pretest and posttest measures was used. Participants in the study, 72 nurses in the experimental group, 71 nurses in the control group, were enrolled for 3 months. The education program was composed of the 20 precedent cases related to patient safety from home and foreign countries. RESULTS: The major findings of this study were as follows: Safety perception (p=.000), Safety control (p=.000), attitude toward autonomy (p=.000), and attitude toward accountability (p=.000) improved after the education program. CONCLUSION: The findings from this study indicate that an education program using precedent cases is an efficient method to improve behavior and change attitudes towards protecting patients' safety and preventing malpractice claims against nurses.

The Impact of Local and Regional Recurrence on Distant Metastasis and Survival in Patients Treated with Breast Conservation Therapy / 한국유방암학회지

PURPOSE: We evaluated the effect of local recurrence (LR) and regional recurrence (RR) on distant metastasis and survival in patients treated with breast conservation therapy (BCT). METHODS: We analyzed 907 patients who were treated for invasive breast cancer between 1993 and 2006. With 53 months of follow-up, 28 patients (3.1%) developed LR in the breast and 12 patients (1.3%) developed RR before distant metastasis. LR and RR were separated into four patterns to determine the prognostic relevance of recurrence site and time to recurrence: LR within 3 years (early LR), LR after 3 years (late LR), RR within 3 years (early RR), and RR after 3 years (late RR). RESULTS: Early LR (hazard ratio [HR], 4.76; p=0.003) and early RR (HR, 18.16; p<0.001) were independent predictors of distant metastasis. In terms of overall survival, early LR (HR, 5.24; p=0.002), and early RR (HR, 18.80; p<0.001) were significantly related with poor survival. Patients with late LR/RR had a similar favorable prognosis compared with patients who never experienced LR/RR. CONCLUSION: The result suggests that time to LR/RR following BCT is a significant predictor developing a distant metastasis and surviving.

The Feasibility of Endoscopy-Assisted Breast Conservation Surgery for Patients with Early Breast Cancer / 한국유방암학회지

PURPOSE: Breast conservation surgery (BCS) has become a standard treatment method for patients with early breast cancer. Endoscopy-assisted BCS (EABCS) can be performed through an inconspicuous periareolar and a small axillary incision for sentinel node biopsy, which may give better cosmetic outcomes than conventional BCS skin incisions. This study was designed to evaluate the feasibility of EABCS for patients with early breast cancer. METHODS: Forty-three patients were candidates for EABCS, and EABCS was performed in 40 patients with breast cancer between January 2008 and July 2010. Their clinicopathological features were retrospectively analyzed. Operative time, margin status, complications, and relapse-free survival were compared with those of patients treated by conventional BCS and who were treated at the same institute during the same period. RESULTS: The most common lesion site of the EABCS and conventional BCS groups was the upper area of the breast. Tumor size in all patients was less than 4 cm (range, 0.4-3.7 cm), and nodal involvement was found in eight (20%) patients in the BCS group. The mean operative time was 110 minutes for the EABCS group and 107 minutes for the conventional BCS group, and those were not significantly different. No significant difference in frozen or final margin status was observed between the EABCS and conventional BCS groups. Relapse-free survival was statistically equivalent between the groups with a median follow-up of 12 months. Postoperative complications occurred in five cases in four patients with EABCS, which was not significantly different from conventional BCS. CONCLUSION: Performing EABCS in patients with early breast cancer seems to be feasible and safe. Further study with a longer-term follow-up may be needed to confirm the clinical value of EABCS.

How Many Sentinel Lymph Nodes Are Enough for Accurate Axillary Staging in T1-2 Breast Cancer? / 한국유방암학회지

PURPOSE: During a sentinel lymph node biopsy (SLNB) for breast cancer, the appropriate number of sentinel lymph nodes (SLNs) to be removed for accurate axillary staging is still controversial. We hypothesized that there might be an optimal threshold number of SLNs. We investigated how many SLNs should be removed to achieve an acceptable accuracy and ensure minimal morbidity. METHODS: We reviewed data of 328 patients with invasive breast cancer who underwent SLNB followed by complete level I and II axillary dissection between January 2004 and December 2005. The false negative rate (FNR) and accuracy of SLNB according to the number of removed SLNs were evaluated. RESULTS: The mean number of SLNs removed was 3.0 (range, 1-14), and that of total retrieved axillary lymph nodes was 17.5 (range, 10-40). In total, 111 (33.8%) patients had positive nodes on the permanent pathological report. Among them, 12 patients had negative SLNs; thus, the overall FNR of SLNB was 10.8% (12/111) and the accuracy was 96.3% (316/328). The FNR was 26.6% for a single SLN, 8.0% for two, and 11.1% for three. In cases where four or more SLNs were removed, the FNR decreased to 0% and accuracy reached 100%. CONCLUSION: Our data suggest that a SLNB should not only remove one or two of the hottest node(s) when other hot nodes exist. We also suggest that four might be an optimal threshold number of SLNs to be removed and that removal of more than four SLNs does not improve axillary staging accuracy.

Clinical Significance of Age at the Time of Diagnosis among Young Breast Cancer Patients / 한국유방암학회지

PURPOSE: The aims of this study were to investigate outcomes corresponding to age at diagnosis as categorized into 5-year intervals and to explore whether endocrine-responsive tumors display clinical benefits from endocrine therapy after chemotherapy among young breast cancer patients. METHODS: A total of 1,171 patients who were under 40 years old at diagnosis between 1985 and 2007 were divided into 3 subgroups: < or =30 years (Group I, 13.3%), 31-35 years (Group II, 30.5%), and 36-40 years (Control group, 56.2%). Clinicopathological factors and outcomes were compared using a chi-square test, the Kaplan-Meier method, and Cox's hazards models. RESULTS: There were no significant differences in the characteristics and treatment patterns between the 3 groups, except for the grade, hormone receptors expression, and use of endocrine therap. Group I showed the worst survival and subsequently Group II presented worse outcomes than the Control group, mainly among hormone receptors-positive patients. Groups I and II showed increased risks of recurrence and death in multivariate analyses. Among 529 hormone receptors-positive patients who received chemotherapy, favorable outcomes for patients who were treated with endocrine agents were demonstrated, mainly in patients aged 35 years or less. However, interaction tests between the use of endocrine therapy and age at diagnosis were not significant. CONCLUSION: Age at diagnosis is an independent prognostic factor and the age of 35 years is a rational cut-off among young patients. Our subgroup analysis suggests that endocrine therapy may provide additional benefits even in young breast cancers. Therefore, further researches should be directed towards improving outcomes for this population.

Cementless Total Hip Arthroplasty using Ceramic-on-ceramic Osteonics(R) System: Minimum 8-year Follow up Results / 대한정형외과학회잡지

PURPOSE: To evaluate the 8-year follow up results of the clinical and radiographic of the cementless total hip arthroplasty using the Osteonics(R) system with ceramic-on-ceramic articulation on a retrospective basis. MATERIALS AND METHODS: Between March 1999 and February 2000, 31 primary total hip arthroplasties were performed in 27 patients using the cementless Osteonics(R) system. The mean follow-up period was 101 months (96-107 months). The mean age at surgery was 56.5 years of age (28-62 years). Preoperative diagnoses were the following in the 27 patients: 5 cases of primary osteoarthritis, 15 cases of avascular necrosis, and 7 cases of secondary osteoarthritis. The clinical results were evaluated using the Harris hip score and radiographic evaluation was done in terms of the fixation of components, the prevalence of osteolysis, and wear of ceramics. RESULTS: The mean preoperative Harris hip score at was the most recent follow-up was 91. Complications were calcar fracture in 8 cases, posterior dislocation in 2 cases, continuous thigh pain in 2 cases, squeaking sound in 3 cases, and limping gait lasting at least 1-year post operation in 6 cases. All cases had fixation by bony ingrowth was and there was no migration of acetabular cups nor osteolysis. There was no loosening of the femoral stem. It was not possible to measure ceramic wear and there were no ceramic fractures. CONCLUSION: At the 8-year follow-up, results of the cementless total hip arthroplasty using the Osteonics(R) system with ceramic-on-ceramic articulation demonstrated favorable results of osseointegration of the components and unmeasurable ceramic wear. However, longer-term-follow up was necessary. We believe that further study is required to determine the high incidence of squeaking.

Gasless Endoscopic Thyroidectomy using the Trans-axillary Approach for Benign Thyroid Tumor / 대한내분비외과학회지

PURPOSE: The techniques for minimally invasive surgery in various surgical fields have recently become markedly developed. The endoscopic surgical methods for head and neck surgery have been introduced somewhat later due to some technical limitations. However, various endoscopic techniques have been remarkably developed during the last 10 years. We also introduced a novel method of gasless endoscopic thyroidectomy using the trans-axillary approach. The aim of this study is to evaluate the feasibility and surgical outcome of this method for treating patients with benign thyroid tumor. METHODS: From Jan. 2002 to Dec. 2007, 171 patients with benign thyroid tumors underwent gasless endoscopic thyroidectomy via an axillary approach. We retrospectively analyzed the clinical and pathologic characteristics of the patients, the type of operation, the operative time, the post-operative hospital stay and the post-operative complications. RESULTS: Among the 171 patients, the mean age of the patients was 33.3±10.0 years and the gender ratio was 1: 84.5 (males-2, females-169). The type of operation was classified according to the extent of surgery and there was no conversion to open thyroidectomy. The mean operation time and the mean length of the post-operative hospital stay were 129.7±51.6 minutes and 3.3±1.7 days, respectively. The mean tumor size was 2.70±1.18 cm and the most common pathologic diagnosis was adenomatous hyperplasia (106 cases, 62%). For the post-operative complications, transient hoarseness occurred in 6 patients, transient hypocalcemia occurred in 1 patient and trachea and esophageal injury occurred in 1 patient each. A tumor size larger than 5 cm and concurrent thyroiditis at time of the operation both increased the mean operation time (P= 0.009, P=0.023). CONCLUSION: According to our experience, gasless endoscopic thyroidectomy using a trans-axillary approach is a feasible and safe method for treating benign thyroid tumor. Moreover, the cosmetic benefits can be maximized by this method as compared with the other methods. Endoscopic thyroid surgery has become a new treatment modality for selected patients with benign thyroid tumors.

Two Cases of Venous Lakes / 대한피부과학회지

Venous lakes are small, bluish-purple, slightly-raised, soft papules or nodules occurring on the exposed skin of elderly people. The lips and ears are the most common sites. Histopathologically, large, dilated and irregular thin-walled venules are located on the upper and mid-dermis. Venous lake is not a rare disease, however, there has been no report of this condition in Korean literature. We report two cases of venous lake together with a review of the pertinent papers.

A case of thyroid tuberculosis diagnosis by FNAB associated with miliary tuberculosis / 대한내과학회지

Thyroid tuberculosis is rare. We experienced case of a 50-year-old woman with tuberculosis of the thyroid associated with miliary tuberculosis. She complained of chronic cough and weight loss. She was clinically and biochemically euthyroid. Thyroid sonogram demonstrated 3 2 cm sized heterogenous echogenic mass on upper pole of the left lobe of thyroid with calcification. Fine needle aspiration biopsy showed epithelioid granuloma in the caseous necrosis and acid-fast bacilli. She took antituberculous agents. One month later, radiologic finding improved and thyroid mass decreased also.

A case of thyroid tuberculosis diagnosis by FNAB associated with miliary tuberculosis / 대한내과학회지

Thyroid tuberculosis is rare. We experienced case of a 50-year-old woman with tuberculosis of the thyroid associated with miliary tuberculosis. She complained of chronic cough and weight loss. She was clinically and biochemically euthyroid. Thyroid sonogram demonstrated 3 2 cm sized heterogenous echogenic mass on upper pole of the left lobe of thyroid with calcification. Fine needle aspiration biopsy showed epithelioid granuloma in the caseous necrosis and acid-fast bacilli. She took antituberculous agents. One month later, radiologic finding improved and thyroid mass decreased also.

A Case of Apocrine Gland Carcinoma on Axilla / 대한피부과학회지

A 84-year-old man presented a nodular lesion on his left axillary area for 7 years. Excisional biopsy revealed characteristic findings of apocrine carcinoma showing from relatively differentiated immature apocrine glands to cord-like infiltrations of anaplastic cells without luminal formation. Apocrine carcinoma is rarely reported in the world. Only cases have been reported in Korean literature up until the present time.

Surgical Treatment of Pincer Nail Associated with Osteophyte / 대한피부과학회지

A 63-year-old woman had pronounced pincer nail of her big toenails. Her nail condition was markedly painful and associated with the underlying osteophyte. Under digital anaesthesia the nail plate was completely avulsed and the lateral portions of the matrix were destroyed by electrodessication. Then a longitudinal incision of the distal nail bed was made to separate it from the underlying structure and to expose the osteophyte. The exposed osteophyte was removed and the nail bed was sutured. Tie-under sutures were used to hold the bed in the appropriate transverse curvature. With this surgical correction, the treated nail showed a normal shape at 18 months of follow-up.

A Clinical Study of 1505 Cases of Alopecia Patients / 대한피부과학회지

BACKGROUND: In the patients complaining of alopecia or hair thinning, many different disease entities are included. Although there have been many clinical studies on each individual disease of them, few reports dealing with all of the alopecia patients in a dermatologic clinic are found. OBJECTIVE: We attempted to reveal the collective clinical aspects of all of different diseases resulting in loss of hairs in a dermatologic clinic. METHOD:Clinical records of 1505 patients with various alopecia seen from March 1978 to July 1998 at the department of Dermatology, Chonbuk National University Medical School were analyzed for their diagnosis, age, sex, and annual distribution in all dermatoses. Among them, 1252 cases were further studied for their subtypes, causes, result of treatments and other details. RESULTS: 1. The incidence of total alopecia patients among the total new patients during the period was 2.9%(1505/51140), 1.24% in average during the 1980s and 4.7% during the 1990s. 2. The incidence of different alopecia was as follows:alopecia areata; 55.0%(827/1505), androgenetic alopecia; 26.1%(392/1505), telogen effluvium; 7.0%(106/1505), trichotillomania; 3.6%(54/1505), accidental alopecia; 1.9%(28/1505), seborrheic alopecia; 1.2%(18/1505), and nutritional alopecia:0.9%(14/1505). 3. The sex distribution showed 761 men and 744 women. The age distribution showed a peak incidence in the third decade(37.4%, 563/1252). 4. The duration from the recognition of initial hair loss to the time of the first visit to the hospital was less than 3 months in 46.4%(581/1252), and less than 6 months in 60%. 5. The subtypes of 686 cases of alopecia areata consist of 549(80%) cases of common type, 77(11.3%) cases of alopecia totalis, and 60(8.7%) cases of alopecia universalis. 6. The relapse rate after treatment in alopecia areata was 29.4%. In 7.4% there was no response to the treatment. 7. Of the 160 male androgenetic alopecia patients Hamilton's type II and III were most common (92.5%). Of the 60 female androgenetic alopecia patients Ludwig's type I was most common(58.5%) 8. The presumed causes of telogen effluvium was as follow:delivery(23.1%), febrile illness (22.0%), traction(8.8%), drug administration(6.6%), crash diet(5.5%). 9. In trichotillomania, the male to female ratio was similar. 70% of the patients belonged to the 1-20 year age group. 10. Accidental alopecia or the alopecia caused by accidental trauma occurred most commonly in women(79%, 22/28). 11. All patients of nutritional alopecia or the alopecia due to diminished diameter of the hair(14cases) and traction alopecia (6cases) were women. CONCLUSION: We made clinical analysis of all of the patients complaining of hair loss by any causes during the past 20 years from March 1978 to July 1998.

A Case of Verrucous Carcinoma / 대한피부과학회지

Verrucous carcinoma, also known as oral florid papillomatosis, is characterized by relentless local persistence, little tendency to metastasis and failure to respond to treatment. The disease is encountered in dermatological clinic as well as dental or otolaryngological clinics. The present case, a 57-year-old man, was first diagnosed as oral lichen planus and eventually developed verrucous carcinoma involving most of the oral mucous membrane including the lower lip and entire gum. Various treatment modalities were done only to result in failures. The overall course of the case for 10 years is reported.

4 Case of Rhabdomyolysis due to Doxylamine Intoxication / 대한신장학회잡지

Doxylamine is common over-the-counter sleep preparations & frequently involved in overdoses. The clinical course is dominated by the anticholinergic effects, including central nervous system & autonomic effects. We report 4 cases of suicide attempts in adults where ingestion of the doxylamines were complicated by rhabdomyolysis. They ingested doxylamines variable amount & were carried to emergency department. They complained gastrointestinal or central nervous system symptoms. Gastric lavages & administrations of activated charcoal were done. Creatine phosphok inase levels were normal or markedly elevated on arrival, but peaked several days later. Serum creatinine levels were normal. 99mTc-MDP bone scans were showed increased muscle labelling at the regions of muscle injury. They were treated with hydration, urine alkalinization, & supportive measures in hospital. On considering cause of rhabdomyolysis, our patients did not show any evidence of viral illness or coingestion of other potential myopathic toxins to support a secondary cause of rhabdomyolysis. The mechanism of rhabdomyolysis in cases of doxylamine overdose seems to be a direct toxic effect of the drug on striated muscle, but the exact mechanism is not clear. In all cases where such overdoses are suspected, consideration should be given to obtaining a urinalysis & a creatine phosphokinase level on arrival & creatine phosphokinase levels are carefully followed. Primary detoxication included gastric lavage & administration of activated charcoal. The patient's urine output & renal function should be closely monitored.

Relationship between Pruritus and Eosinophilia in Patients on Hemodialysis / 대한신장학회잡지

BACKGROUND: Pruritus is one of the most common complaints of patients with chronic renal failure undergoing hemodialysis. But its etiology is not clear, and there is no universally effective treatment. Recently we have experienced eosinophilia in hemodialysis patients suffering from pruritus. OBJECTIVE: The purpose of the this study was to evaluate the relationship between pruritus and eosinophilia in patients on hemodialysis. METHODS: We examined degree of pruritus and eosinophilia in 65 patients with end stage renal disease who were on hemodialysis from September 1996 to August 1997 in artificial kidney center of Chonbuk National University Hospital. The study was conducted by means of personal interview, physical examination, and review of medical records. The degree of pruritus was measured by scores from minimal 0 point to maximal 48 points and more than 5% or 500/mm3 eosinophils in peripheral blood was regarded as eosinophilia. RESULTS: 1)Incidence of each cutaneous symptoms were pruritus(61.5%), xerosis(35.4%), hyperpigmentation (30.8%), easy bruising(16.9%), nail change(12.3%), decreasing in sweating(10.8%), hypotrichosis(7.7%), and acne(4.6%). 2)Forty(61.5%) of 65 patients undergoing hemodialysis had pruritus, 32.3% in mild, 20% in moderate, and 9.2% in severe degree by pruritus score. 3)Nineteen(29.2%) of the 65 patients had eosinophilia:23.8%(5/21) of patients with mild pruritus, 30.7%(4/13) of patients with moderate pruritus, and 66.7%(4/6) of severe pruritus. It could be said that prevalence of eosinophilia was related to the severity of pruritus. 4)With repeated hemodialysis the severity of pruritus increased in 65%(26/40), decreased in 22.5% (9/40), did not change in 12.5%(5/40) of patients with pruritus. 5)Pruritus was not related to the serum calcium (Ca), inorganic phosphorus(PO4), CaxPO4 product, BUN, or creatinine. There was, however, significant correlations with the serum alkaline phohphatase. CONCLUSION: There was a positive correlation bet- ween the prevalence of eosinophilia and severity of pruritus in patients on hemodialysis.