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Calcinosis cutis is a very rare disease characterized by insoluble calcium salt deposits in the skin. There are five types of calcinosis, dystrophic type being the most common among them. Dystrophic calcinosis is generally caused by local tissue damage. We present the dystrophic calcinosis cutis case of a patient with no underlying diseases but a burn injury which occurred 10 years ago. She visited the hospital for an ulcerative wound on the same area. She also had sustained a dog bite injury on the same site 9 months ago, which was treated at an oriental clinic with no improvement. Physical examination by palpation revealed a hard mass under the skin. As the mass was of a large size, the possibility of a foreign body was considered. Surgical resection and biopsy of the mass diagnosed it as dystrophic calcinosis cutis. Although clinical features of this case were unlike previous calcinosis cutis cases, performing a biopsy proved helpful towards its diagnosis.

Background The placement of a closed suction drain is indispensable for preventing serious infections; however, closed suction drains are inevitably accompanied by increases in local infections, pain, and length of hospital stay, and delays in breast cancer treatment including postoperative chemotherapy and radiotherapy. We analyzed predictive factors of total drainage volume and duration. Methods Among patients who were diagnosed with primary breast cancer between January 2016 and December 2017, we retrospectively analyzed those who underwent immediate implant-based breast reconstruction. Factors that could affect the total volume and duration of drainage, including lipo-prostaglandin E1 use, preoperative chemotherapy, resected breast issue weight, age, body mass index (BMI), serum white blood cell count, erythrocyte sedimentation rate, and C-reactive protein (CRP) level, were analyzed. Results The mean volume and duration of drainage were 1,213.6 mL and 14.8 days respectively. BMI and CRP on postoperative day (POD) 1 were correlated with the total drainage volume. Age, BMI, and resected breast tissue weight were correlated with the drainage duration. Multiple regression analysis showed that CRP level on POD 1, age, and resected breast tissue weight significantly affected the drainage duration. Multiple regression analysis also showed that the total drainage volume was significantly affected by BMI and CRP level on POD 1. Conclusions The factors found to affect the duration of drainage in patients undergoing implant-based breast reconstruction were CRP on POD 1, age, resected breast tissue weight, and BMI. The CRP level on POD 1 and BMI influenced the total volume of drainage.

Odontogenic cutaneous fistula of dental origin at the alar-facial groove is rarely reported. As many patients present with only skin lesions without dental problems, it is often confused with a cyst, abscess or pyogenic granuloma. We report the case of a 52-year-old man who presented with a relapsing cutaneous ulcer in the left alar-facial groove area. Ultrasonography findings suggested a ruptured epidermal cyst, and an excisional biopsy was performed. At 10 days after the surgery, wound dehiscence and pus discharge were observed. Computed tomography revealed a sinus tract, and a diagnosis of odontogenic cutaneous fistula was made. After consultation with the dental department, endodontic treatment was performed. During reoperation, a remnant fistula from the left alar-facial groove area to the left upper central incisor was observed, for which fistulectomy was performed. The patient remained disease-free postoperatively. With early accurate diagnosis, patients with odontogenic cutaneous fistula can be protected from unnecessary surgical intervention and ineffective antibiotic therapy.

After a partial mastectomy, large or ptotic breasts can be reconstructed using breast reduction techniques. Wise-pattern reduction is typically used to remove masses in any quadrant of the breast, but this technique leaves a large inverted T-shaped scar. Instead, the short scar periareolar inferior pedicle reduction (SPAIR) technique involves a periareolar line and does not result in a scar along the inframammary fold (IMF). A 49-year-old patient with macromastia and severely ptotic breasts was diagnosed with invasive cancer of the left breast. Her large breasts caused pain in her back, shoulders, and neck. She also expressed concern about postsurgical scarring along the IMF. In light of this concern, we chose the SPAIR technique, and we designed and performed the procedure as described by Hammond. During surgery, we removed 36 g of breast tumor and 380 g of breast parenchyma from the left breast. To establish symmetry, we also removed 410 g of tissue from the right breast. Postoperatively, the patient reported satisfaction regarding the reduction mammaplasty and, in particular, noted decreased back, shoulder, and neck pain. In summary, we used the SPAIR technique to achieve oncologic and aesthetic success in a patient with macromastia and a tumor located lateral to the nipple-areolar complex.

Crohn’s disease is difficult to diagnose owing to its varied symptoms, among which fistulae are a late-stage symptom that appears mainly in the form of a perianal fistula. A patient who was previously healthy without clinical history visited our hospital with an ulcer of unknown cause at the right flank and gluteal region. Using computed tomography (CT) and colonoscopy, we diagnosed the ulcer as an enterocutaneous fistula caused by Crohn’s disease and successfully treated it with general surgery. In young, lean men with skin lesions of unknown cause, a CT or colonoscopy test may be useful for diagnosing underlying gastrointestinal problems.

Background Direct-to-implant breast reconstruction following nipple-sparing mastectomy is becoming increasingly common. The weight of the breast specimen informs implant selection. However, specimens of the same weight may have different volume. Therefore, identifying the factors affecting the density of breast specimens may facilitate the selection of implants with an appropriate volume. Methods From December 2015 to May 2018, 108 patients underwent direct-to-implant reconstruction following nipple-sparing mastectomy. The weight of the breast specimens was measured using an electronic scale in the operating room. Furthermore, the volume of specimens was measured using the water displacement technique. Multiple regression analysis was performed on factors that can affect breast density, such as menopause, neoadjuvant chemotherapy (CTx), age, body mass index, and diabetes mellitus. Results The average density of breast specimens in patients older than 50 years (n=36) was 0.96±0.04 g/mL, which was significantly lower than the 1.01±0.08 g/mL observed in patients younger than 50 years (n=72) (P=0.007). The mean density of breast specimens in patients who underwent neoadjuvant CTx (n=25) was 0.96±0.06 g/mL, which was significantly lower than the value of 1.00±0.08 g/mL in those who did not (n=83). Conclusions It is advisable to select an implant slightly larger than the mastectomy specimen weight in patients older than 50 years or in those who have undergone neoadjuvant CTx.

Hepatic solitary fibrous tumors (SFTs) are mostly benign and rare because of information regarding the clinical symptoms, treatment, and prognosis of their malignant forms is currently lacking. A literature review concerning malignant SFTs revealed that there were a few cases where patients experienced abdominal right upper quadrant (RUQ) pain as their first clinical symptom, and metastases were found after being diagnosed with hepatic SFT. Here, we report a patient who was previously healthy without any clinical symptoms such as RUQ pain or weight loss, but had the appearance of a metastatic mass as the first clinical presentation before a primary hepatic SFT was detected (J Liver Cancer 2019;19:143-148)

Summary:. Costochondritis after breast reconstruction and radiation therapy is rarely reported. Moreover, it is difficult to diagnose using computed tomography and magnetic resonance imaging; as such, wound debridement and reconstruction must be performed in several stages. A 51-year-old woman was diagnosed with invasive cancer of the right breast, and she underwent nipple sparing mastectomy and direct-to-implant breast reconstruction in November 2007. Thirteen years later, in September 2020, she experienced pain and swelling on her right breast. Incisional drainage and implant removal were performed in another clinic; however, the infection was not controlled. An implant-induced infection was suspected, and debridement was performed to a level where fresh tissue appeared in the upper layer of the intercostal muscle. Antibiotics and open dressing were used for 10 days; however, yellowish debris was noted, and third to fifth ribs and costal cartilages turned dark brown. Radiation-induced costochondritis was diagnosed based on clinical findings from the intraoperative field, wound course, and cartilage biopsy. Radical chest wall resection and reconstruction was performed using Teflon (Dupont/Chemours, Wilmington, Del.) and latissimus dorsi musculocutaneous flap. The patient was discharged 2 weeks after surgery without any complications. Costochondritis should be clinically diagnosed while performing the first debridement in staged operation. Radical chest wall resection is essential with chest wall reconstruction using Teflon and a latissimus dorsi musculocutaneous flap.

Background:. Upper blepharoplasty in elderly patients has characteristics that differ from those of younger patients. Blepharoptosis in elderly patients causes not only aesthetic problems but also functional problems such as entropion, visual disturbance, and sore eyes. We hypothesized that factors influencing patient satisfaction with upper blepharoplasty in elderly patients include aesthetic outcomes, functional outcomes, and personal factors. Methods:. This study included 57 patients aged >65 years who underwent upper blepharoplasty between April 2018 and March 2019. All surgeries were performed through the “Upper Blepharoplasty Service Project” of the public health center in Geoje City. To evaluate the individual characteristics of the patients, a preoperative questionnaire (including sociodemographic characteristics, main symptoms of discomfort in the upper eyelid, and degree of expectation of surgical results) was administered to the patients. After 6 months, a satisfaction survey was conducted accordingly. Results:. The main symptoms of discomfort were sagging of the skin of the upper eyelid. The mean score for patient satisfaction was 3.84 ± 0.40, and satisfaction with the results of surgery relative to the cost was 4.53 ± 0.63, which was the highest score. Significant verification of the regression coefficients showed that functional improvement and cognitive degree of postsurgery precautions had a significant effect on patient satisfaction, whereas aesthetic outcomes and expectations of surgical results were not correlated with patient satisfaction. Conclusion:. The findings indicated that elderly patients tended to be satisfied with functional improvement that resolved their symptoms of discomfort and personal factors such as cost and cognitive degree of precautions after upper blepharoplasty.

Background Minimizing scarring has long been a challenge in plastic surgery. Factors affecting scar formation are well known, but the effect of some patient-specific factors such as dermal thickness remains unverified. Management of factors predictive of scarring can improve postoperative patient satisfaction and scar treatment. Methods For 3 years, we used ultrasonography to measure dermal thickness in female patients who had undergone thyroidectomy for cancer at our hospital. We confirmed the influence of dermal thickness on hypertrophic scar formation and the Patient and Observer Scar Assessment Scale scar score 6 months after surgery. Results There was a positive correlation between dermal thickness and scar score (pl0.05), and dermal thickness appears to be a cause of hypertrophic scar formation (pl0.05). Conclusion Thick dermis was found to cause poor scar formation and hypertrophic scarring. Prediction of factors that can influence scar formation can be used to educate patients before surgery and can help in scar management and improvement in patient satisfaction.

Typical transcranial approaches are insufficient for adequate visualization and resection of skull base tumors. Different approaches with multiple modifications have been attempted. Here, we describe a new approach for a lesion that is central and hard to treat by conventional craniotomy and successful reconstruction with calvarial bone graft and titanium mesh plate. A 69-year-old female patient presented with recurrent meningioma. The tumor had invaded the frontal lobe, right supraorbital rim, and ethmoidal bone. We performed a modified anterior craniofacial approach that fully exposed the tumor and invaded bone. In consideration of the patient's age and cosmetic result, the tumor and invaded bone was resected and the defect area was reconstructed with titanium mesh and calvarial bone graft. At 6 months postoperative the patient had no complications and was satisfied with the esthetic result. We report this case to demonstrate the successful approach and reconstruction using this technique.

Background Several oncoplastic approaches have been implemented in recent years to enhance cosmetic results and to reduce complications. The round block technique is a volume displacement technique for breast reconstruction after breast-conserving surgery (BCS). However, its indications are currently limited according to tumor location, and its cosmetic results and complications have not been clearly established. We hypothesized that the round block technique could produce favorable cosmetic results without major complications regardless of tumor location or nipple-tumor distance, below a certain resected tumor volume and tumor-breast volume ratio. Methods All breast reconstructions using the round block technique after BCS were included in this analysis. Patients’ data were reviewed retrospectively to investigate complications during follow-up, and clinical photos were used to evaluate cosmetic results. The relationships of tumor location, nipple-tumor distance, tumor volume, and the tumor-breast volume ratio with cosmetic results were investigated. Results In total, 108 breasts were reconstructed. The mean resected tumor volume was 30.2±15.0 mL. The cosmetic score was 4.5±0.6 out of 5. Tumor location, nipple-tumor distance, tumor volume, tumor-breast volume ratio, radiotherapy, and chemotherapy had no significant effects on cosmetic results or complications. There were no major complications requiring reoperation. Conclusions Breast reconstruction using the round block technique after BCS can lead to good cosmetic results without major complications regardless of the tumor location, nipple-tumor distance, radiotherapy, or chemotherapy. Below the maximum tumor volume (79.2 mL) and the maximum tumor-breast volume ratio (14%), favorable results were consistently obtained.

Objective The use of different expressions between physicians frequently results in confusion in the process of diagnosis and treatment of patients with headaches due to problems in the nose and nasal cavity. The aim of this study was to assess the terminologies that have been used most frequently to standardize these terminologies. Methods Terminologies that are most frequently used in general, including rhinogenic migraine, sinus headache, rhinogenic contact point headache, middle turbinate headache syndrome, and rhinogenic headache, were found by searching PubMed, Web of Science, and Google Scholar. These terminologies were objectively assessed on the basis of existing research and definitions and the range of diagnoses by organizations with public credibility. Results There were many terminologies in use for headache related to nose; however, these were not logical expressions and only partly explained the phenomenon. Among the terms, "rhinogenic headache" was most appropriate in expressing and describing the related symptoms. Conclusion The results indicated that the term "rhinogenic headache" is most appropriate for describing pain in the nose and eyes in patients with deformation within the nose or the nasal cavity due to external injuries or underlying diseases related to nose as observed on computed tomography.

Background Most nasal bone fractures are corrected using non-invasive methods. Often, patients are dissatisfied with surgical outcomes following such closed approach. In this study, we compare surgical outcomes following blind closed reduction to that of ultrasound-guided reduction. Methods A single-institutional prospective study was performed for all nasal fracture patients (n=28) presenting between May 2013 and November 2013. Upon research consent, patients were randomly assigned to either the control group (n=14, blind reduction) or the experimental group (n=14, ultrasound-guided reduction). Surgical outcomes were evaluated using preoperative and 3-month postoperative X-ray images by two independent surgeons. Patient satisfaction was evaluated using a questionnaire survey. Results The experimental group consisted of 4 patients with Plane I fracture and 10 patients with Plane II fracture. The control group consisted of 3 patients with Plane I fracture and 11 patients with Plane II fracture. The mean surgical outcomes score and the mean patient dissatisfaction score were found not to differ between the experimental and the control group in Plane I fracture (p=0.755, 0.578, respectively). In a subgroup analysis consisting of Plane II fractures only, surgeons graded outcomes for ultrasound-guided reduction higher than that for the control group (p=0.007). Likewise, among the Plane II fracture patients, those who underwent ultrasound-guided reduction were less dissatisfied than those who underwent blind reduction (p=0.043). Conclusion Our study result suggests that ultrasound-guided closed reduction is superior to blind closed reduction in those patients with Plane II nasal fractures.

As the incidence of thyroid cancer has increased, hypocalcemia, a common complication of thyroid surgery, has become a serious problem. However, no definite predictor of postoperative hypocalcemia is known. In this study, our purpose was to investigate the potential role of vitamin D as a predictor of postoperative hypocalcemia. A prospective observational study was performed on patients who underwent total thyroidectomy for thyroid cancer performed by a single experienced surgeon between October 2013 and September 2014. Their serum 25-OH vitamin D levels were measured preoperatively. On the day after surgery, serum calcium and intact parathyroid hormone levels were measured, and symptoms of hypocalcemia were recorded. Of the 134 patients, laboratory and symptomatic hypocalcemia developed in 52 patients (39 %) and 25 patients (19 %), on the day after surgery. The preoperative vitamin D level was 16.5 ± 9.2 ng/mL, and this value did not differ according to laboratory or symptomatic hypocalcemia (p = 0.94). The incidence of laboratory or symptomatic hypocalcemia did not differ according to vitamin D deficiency. Only incidental parathyroidectomy was associated with symptomatic hypocalcemia (p = 0.03). Vitamin D level is not a predictor of hypocalcemia after total thyroidectomy for thyroid cancer. Thus, routine preoperative screening for vitamin D is not recommended.

To determine intraocular pharmacokinetic properties of intravitreally injected vascular endothelial growth factor (VEGF)-Trap in a rabbit model. VEGF-Trap was intravitreally injected in 18 rabbit eyes. Eyes were enucleated 1 h and 1, 2, 5, 14, and 30 days after injections and immediately frozen at −80 °C. Concentration of VEGF-Trap in vitreous, aqueous humor, and retina/choroid was determined using an indirect enzyme-linked immunosorbent assay and analyzed to obtain pharmacokinetic properties. Maximum concentration of VEGF-Trap was achieved at 1 h in all three tissues. A one-compartment model of distribution was selected as the final model for all tissues studied. Estimated half-life of VEGF-Trap in vitreous, aqueous humor, and retinal/choroid was 87.1, 36.8, and 35.0 h, respectively, and estimated mean residence time was 125.7, 53.1, and 50.5 h, respectively. Area under the curve from time 0 to the end point was 10009.8, 3945.1, and 1189.3, respectively. Total exposure of the aqueous humor and retina/choroid to VEGF-Trap was 39.4% and 11.9% of vitreous exposure, respectively. The vitreous half-life of VEGF-Trap is 3.63 days. This is shorter than that of bevacizumab (6.99 days) and longer than that of ranibizumab (2.51 days), as shown in studies using the same experimental settings. The concentration of VEGF-Trap peaked at 1 h after injections in all eye tissues studied.

Background Lymph node (LN) metastasis is common in papillary thyroid microcarcinoma (PTMC). The aim of this study was to investigate the impact of LN metastasis and its risk stratification on PTMC recurrence. Methods We retrospectively reviewed the data of 336 patients with PTMC who underwent surgery from 2005 to 2006 at a single institution. LN metastasis was stratified according to the number of metastatic LNs, the ratio of metastatic to removed LNs, the size of metastatic foci in LNs, and the presence of extranodal extension and desmoplasia. Results Of the 336 patients, 93 (28%) had LN metastasis. During the follow-up of 5.3 years, 16 (4.8%) experienced locoregional recurrence. Among several clinicopathologic factors, LN metastasis was the most important risk factor for recurrence ( P = .02). Lateral LN metastasis was correlated with recurrence-free survival ( P P = .20). When central LN metastasis was stratified, a high number of metastatic LNs (≥3), larger metastatic foci (≥0.2 cm), and the presence of desmoplasia were associated with recurrence-free survival ( P Conclusion The prognostic significance of central LN metastasis can differ according to the number of metastatic LNs, the size of metastatic foci, and the presence of desmoplasia. Patients with a high number of metastatic LNs, larger metastatic foci, and presence of desmoplasia in LNs should be treated aggressively and supervised carefully for PTMC recurrence.

Background: The intraoperative parathyroid hormone (IOPTH) assay is widely used in patients with primary hyperparathyroidism (PHPT). We investigated the usefulness of the IOPTH assay in Korean patients with PHPT. Methods: We retrospectively reviewed the data of 33 patients with PHPT who underwent parathyroidectomy. Neck ultrasonography (US) and 99m Tc-sestamibi scintigraphy (MIBI scan) were performed preoperatively and IOPTH assays were conducted. Results: The sensitivity of neck US and MIBI scans were 91% and 94%, respectively. A 50% decrease in parathyroid hormone (PTH) levels 10 minutes after excision of the parathyroid gland was obtained in 91% (30/33) of patients and operative success was achieved in 97% (32/33) of patients. The IOPTH assay was 91% true-positive, 3% true-negative, 0% false-positive, and 6% falsenegative. The overall accuracy of the IOPTH assay was 94%. In five cases with discordant neck US and MIBI scan results, a sufficient decrease in IOPTH levels helped the surgeon confirm the complete excision of the parathyroid gland with no additional neck exploration. Conclusion: The IOPTH assay is an accurate tool for localizing hyperfunctioning parathyroid glands and is helpful for evaluating cases with discordant neck US and MIBI scan results.

Background Liposuction is a procedure to reduce the volume of subcutaneous fat by physical force. Intracellular storage fat is composed of triglyceride, whereas circulating fat particles exist as cholesterol or triglycerol bound to carrier proteins. It is unavoidable that the storage form of fat particles enters the circulation system after these particles are physiologically destroyed. To date, however, no studies have clarified the fatal characteristics of fat embolism that occurs after the subclinical phase of free fat particles. Methods A mixture of human lipoaspirate and normal saline (1:100, 0.2 mL) was injected into the external jugular vein of rats, weighing 200 g on average. Biopsy specimens of the lung and kidney were examined at 12-hour intervals until postoperative 72 hours. The deposit location and transport of the injected free fat particles were confirmed histologically by an Oil Red O stain. Results Inconsistent with previous reports, free fat particles were transported from the intravascular space to the parenchyma. At 24 hours after infusion, free fat particles deposited in the vascular lumen were confirmed on the Oil Red O stain. At 72 hours after infusion, free fat particles were accumulated compactly within the parenchymal space near the perivascular area. Conclusions Many surgeons are aware of the fatal results and undiscovered pathophysiologic mechanisms of free fat particles. Our results indicate that free fat particles, the storage form of fat that has been degraded through a physiological process, might be removed through a direct transport mechanism and phagocytotic uptake.

Background: Several comparative studies have documented the outcomes of negative pressure drain use after thyroidectomy. However, these previous studies did not focus on scar formation. The aim of this study was to compare thyroidectomy outcomes with and without negative pressure drain use in terms of scar formation.Methods: Nine hundred seventy-five patients who underwent thyroidectomy between January 2012 and December 2013, at Kosin University Gospel Hospital were enrolled in this study. Patients were assigned to one of two groups at the surgeon's discretion: the negative pressure drain group (n=515) or the no drain group (n=460). Medical records were reviewed, and the incidence and severity of scar formation were compared. We estimated patient satisfaction seven months postoperatively based on aesthetic and functional outcomes using the patient and observer scar assessment scale.Results: The incidence of mild scarring was higher in the no drain group, but this difference was not statistically significant (p=0.069). The incidence of severe scarring was significantly higher in the negative pressure drain group (5.83%, p

Ectopic adrenocorticotropic hormone (ACTH) syndrome is caused most frequently by a bronchial carcinoid tumor or by small cell lung cancer. Medullary thyroid carcinoma (MTC) is a rare etiology of ectopic ACTH syndrome. We describe a case of Cushing syndrome due to ectopic ACTH production from MTC in a 48-year-old male. He was diagnosed with MTC 14 years ago and underwent total thyroidectomy, cervical lymph node dissection and a series of metastasectomies. MTC was confirmed by the pathological examination of the thyroid and metastatic mediastinal lymph node tissues. Two years after his last surgery, he developed Cushingoid features, such as moon face and central obesity, accompanied by uncontrolled hypertension and new-onset diabetes. The laboratory results were compatible with ectopic ACTH syndrome. A bilateral adrenalectomy improved the clinical and laboratory findings that were associated with Cushing syndrome. This is the first confirmed case of ectopic ACTH syndrome caused by MTC in Korea.

Keloid is a scar tissue that undergoes recovery and excessive growth over the origi- nal wounds when the collagen is excessively accumulated in the dermis during the wound healing process. The common sites of keloid occurrence include the anterior thorax, shoulder, upper extremities and ear. To our knowledge, however, there are few cases of keloid that occurs in the axilla. In addition, there are fewer cases of ke- loid that bilaterally occurs at the operated sites postoperatively in individuals with no past or family history. 21-year-old male had undergone subdermal shaving for the management of osmidrosis but had not received appropriate scar management dur- ing the military service. He visited us with a keloid-like scar formed in the bilateral ax- illae. We excised the scar tissue and treated it with local steroid injection and postop- erative axilla compression. In histopathological report, no flattening of the overlying epidermis, and presence of keloid collagen which confirms diagnosis of keloid. We report our clinical experience with a rare case of keloid occurring in the axilla and treatment process.

It has been known that the post-burn scar may cause symptoms including pigmentation, pruritus, pain, and contracture, and result in psychosocial depression of individuals due to the loss of physical functions and dysmorphia depending on the location and severity of the burn scar, leading to substantial disruption in social life. In the particular case of hand and extremities where burn occurs frequently, although there have been a great deal of literature concerning the recovery of functional loss due to the burn contracture, the interest in the aesthetic recovery of the burning scar on the hand tends to be gradually increasing lately, reflecting the words “the hand is the secondary face”. The aesthetic treatments of the post-burn scar on the hand include tattoo, punch grafting, epidermal graft after dermabrasion, chip skin graft and thin sheet skin graft [1-6]. However, the tattoo generated different skin color, and the simple skin graft may result in regrettable outcomes such as prominent scar around the boundary of the burn site, collapse of skin graft site, donor site scar, and pigmentary degeneration over time. Accordingly, we aim to confirm the outcomes of the thin splitthickness skin graft with a thickness of less than 8/1,000 inches that was carried out following the tangential excision of burn scar using an electrical dermatome for the aesthetic improvement of the post-burn scar of the hand.

In cases of follicular neoplasm identified by thyroid fine-needle aspiration (FNA), surgery is required to achieve a precise diagnosis. We investigated potential clinical factors for the preoperative prediction of malignancy in thyroid nodules with a cytological diagnosis of follicular neoplasm. We retrospectively reviewed the data of 97 patients who were diagnosed with follicular neoplasm by FNA and had undergone surgery at the Korea Cancer Center Hospital between April 2010 and April 2012. Age, sex, laboratory data (such as thyroid-stimulating hormone, free T4, thyroglobulin (Tg), and Tg antibody), and ultrasonographic findings were reviewed from the electronic medical records. Of 97 patients, 50 (51.5 %) were diagnosed with benign nodules, 16 (16.5 %) with follicular thyroid carcinoma (FTC), and 31 (32.0 %) with papillary thyroid carcinoma (PTC). In comparison with the features of benign nodules, FTC presented with a large nodule size, high serum Tg level, isoechogenicity, calcifications, and peripheral halo, whereas PTC exhibited traits similar to those of benign nodules, except for high serum Tg level and the presence of calcifications on ultrasonography. Therefore, a high serum Tg level (≥75 ng/mL) and calcification were the only significant predictive factors for malignancy in case of follicular neoplasm (p

Free tissue transfer is a useful method to cover soft tissue defects following trauma or tumor excision. At the time of transfer of the pedicle, its status is not investigated. Therefore, kinking of the pedicle can occur, and pedicle injuries can result from surgical instruments. The authors would like to introduce a simple, safe, and effective method to overcome these problems using a Penrose drain. The present method can help reconstructive microsurgeons with the transfer of pedicle vessels through a tunnel without torsion or injury.

Background Chronic exposure to elevated levels of free fatty acids contributes to pancreatic β-cell dysfunction. Although it is well known that metformin induces cellular energy depletion and a concomitant activation of AMP-activated protein kinase (AMPK) through inhibition of the respiratory chain, previous studies have shown inconsistent results with regard to the action of metformin on pancreatic β-cells. We therefore examined the effects of metformin on pancreatic β-cells under lipotoxic stress. Methods NIT-1 cells and mouse islets were exposed to palmitate and treated with 0.05 and 0.5 mM metformin. Cell viability, glucose-stimulated insulin secretion, cellular adenosine triphosphate, reactive oxygen species (ROS) levels and Rho kinase (ROCK) activities were measured. The phosphorylation of AMPK was evaluated by Western blot analysis and mRNA levels of endoplasmic reticulum (ER) stress markers and NADPH oxidase (NOX) were measured by real-time quantitative polymerase chain reaction analysis. Results We found that metformin has protective effects on palmitate-induced β-cell dysfunction. Metformin at a concentration of 0.05 mM inhibits NOX and suppresses the palmitate-induced elevation of ER stress markers and ROS levels in a AMPK-independent manner, whereas 0.5 mM metformin inhibits ROCK activity and activates AMPK. Conclusion This study suggests that the action of metformin on β-cell lipotoxicity was implemented by different molecular pathways depending on its concentration. Metformin at a usual therapeutic dose is supposed to alleviate lipotoxic β-cell dysfunction through inhibition of oxidative stress and ER stress.

Soft tissue chondroma is a rare benign tumor, and it mainly affects hands and feet. Its prevalence reaches the highest level in individuals aged between 30 years and 60 years. In addition, it is known that there is no sex-related difference in its incidence. Repeated microtrauma has also been reported to be responsible for its occurrence. A 72-year-old woman visited us with a chief complaint of a 3-year-history of a palpable, skin protuberance on the left third toe. The patient had a past history of taking surgical excision for skin protuberance at the department of dermatology of other hospital. Thereafter, however, the patient received resection of the skin protuberance again because of its recurrence. Nevertheless, the patient had a palpable mass at the surgical sites and complained about discomfort in the toe. Therefore, the patient visited us. On physical examination, the patient had a round, ill-defined skin protuberance with a diameter of approximately 1 cm. On palpation, it was a rather solid mass. In addition, the patient had a scratch on the skin surface (Fig. 1). On preoperative plain radiography, the patient had a calcified lesion with a diameter of

Moll's cyst is one of the apocrine sweat gland cysts that occur on the margin eyelid. Thus far, however, only a few cases of Moll's cyst occurring in the orbital septum have been reported [1]. A 29-year-old woman complained of gradual swelling of the right upper eyelid. The patient had a history of undergoing blepharoplasty 7 years ago at another hospital. However, the patient had no other notable findings such as trauma. Upon physical examination, the patient was found to have a protruded mass when she had her eyes closed (Fig. 1). Ultrasonography revealed that the isoechoic mass was 1.6 cm×0.6 cm in size and had a well-defined margin and a fluid-containing lesion (Fig. 2). Under local anesthesia, we made a transverse incision along the double-eyelid line. The mass presented in the orbital septum. Through an incision of the orbital septum, we exposed the mass (Fig. 3). The mass was encapsulated by a transparent, white fibrous tissue. We carefully dissected it while paying special attention to not damage the levator aponeurosis. The patient wanted a mild blepharoptosis correction at the same time; therefore, we performed surgery on both eyes. Postoperatively, the mass contained a transparent fluid in the unilocular capsule. Histopathological examinations revealed that the tumor was composed of two layers of cuboidal epithelium. These two layers had a columnar shape (Fig. 4). Further, a 1-year follow-up revealed that the patient had no notable findings without recurrence (Fig. 5). Fig. 1 Preoperative findings: When the patient's eyes are closed, the protruded mass (yellow arrow) on the right upper eyelid becomes noticeable; this mass was soft, pliable, and round. Fig. 2 Preoperative ultrasonography: 1.6 cm×0.6 cm in size, an isoechoic mass with a well-defined margin and fluid-containing lesion (yellow arrow) on the lateral side. Fig. 3 Intraoperative findings. The cystic mass was in the orbital septum, surrounded by the periorbital fat. It contained fluid and was encapsulated by transparent, white fibrous tissue. Fig. 4 Histopathological findings. The tumor was composed of two layers of cuboidal epithelium surrounded by adipose fibrous tissue. The two layers of cuboidal epithelium had a columnar shape (H&E, ×200). Fig. 5 Postoperative findings (1 year later). The patient had no notable findings without recurrence. Moll's cyst may also occur in the orbital septum because of congenital factors. That is, it occurs when there are disturbances in the development of the epidermis that should have developed on Moll's gland in the embryonic stage [2]. Further, it has been reported that Moll's cyst may also occur as a result of the epidermal invagination of the eyelid from certain acquired causes such as trauma or other iatrogenic factors [3]. Our case developed this cyst for acquired reasons and not congenital ones. This is attributed to the following: Moll's cyst occurs very rarely in the orbital septum. Concurrent deformities of the adjacent tissue may also occur during the growth to the adult stage in congenital cases of Moll's cyst. The patient complained of the discomfort on the eyelid only recently. The patient had a history of blepharoplasty. Moll's cyst is surrounded by a thin white wall and contains a transparent fluid. Histologically, a cuboidal epithelium composed of two layers of secretory cells forms the inner wall of the cyst, and the rest of the cyst undergoes a fibrotic change. Of the two layers of secretory cells, the inner layer is composed of columnar epithelium and protrudes into the cyst. Further, its apical portion contains an eosinophilic substance. These findings are similar to those of Moll's gland [4]. In the current case, the clinical characteristics and histopathological findings were typically suggestive of Moll's cyst. In other words, we witnessed a rare case of Moll's cyst occurring in the orbital septum.

Adequate glycemic control is important for patients with end-stage renal disease on maintenance hemodialysis (HD). Continuous glucose monitoring (CGM) systems are reported as a useful method for glucose monitoring in patients under maintenance HD. The object of this study was to describe glucose profiles and hypoglycemia associated with HD in diabetes patients using a CGM system.We recruited nine medically stable patients with type 2 diabetes under maintenance HD. CGMS System Gold (Medtronic MiniMed, Northridge, CA) was applied to the subjects for 144 h. During the period, HD using glucose-containing dialysate was performed every other day. Various glucose profiles were calculated from the CGM readings and compared between the day on and the day off dialysis.Mean ± SD for age, duration of diabetes, and hemoglobin A1c were 67 ± 9 years, 24 ± 9 years, and 8.6 ± 1.2%, respectively. Hemoglobin A1c was correlated with mean glucose (ρ = 0.780, P0.05) and with area under the curve for glucose above 180 mg/dL (ρ = 0.797, P0.05). Although there was no difference for mean amplitude of glycemic excursion between the day on and off HD, hypoglycemia occurred predominantly with day on HD. In the subjects who maintained antidiabetes agents with day on HD, glucose levels decreased with initiation of HD, causing significantly lower glucose levels compared to those during the equivalent time of the following day without HD.According to the CGM system, glucose variability was not affected by HD. However, in spite of glucose-containing dialysate, HD seemed to increase the risk of hypoglycemia.

Ectopic nail is a very rare disease entity where the nail grows in other places than the nail bed due to the abnormal location or direction of the nail matrix. Since it was first reported in 1931, approximately 50 cases have been described in the literature. It is generally classified into two types: congenital ectopic nail due to genetic aberrations and the acquired one, also known as posttraumatic ectopic nail. The former accounts for most cases [1-3]. An 8-year-old girl visited us with a chief complaint of nail deformity in the left thumb (Fig. 1A). At the age of 2 years, the patient sustained a soft tissue crushing injury because of the entrapment of the distal phalanx of the left thumb in a chink in the door. Three months after spontaneous wound healing, the patient developed a swelling of the nail root accompanied by a hard eschar. Afterwards, the patient presented with a nail-like keratotic lesion. It had grown persistently up to the time of presentation at our clinic with a similar rate of growth as the normal nail. However, the patient presented with no other symptoms such as pain or tenderness. The patient had normal radiological findings (Fig. 1B). On physical examination, the patient had an additional nail-like keratotic lesion 7 mm×5 mm in size, growing in the eponychium, whose location was remote from the normal nail. The clinical impression was posttraumatic ectopic nail. Under intravenous anesthesia, we made a 1-cm longitudinal incision from the radial edge of the lunula to the proximal side, taking care not to damage the matrix of the normal nail. We found a fully developed the ectopic nail unit separate from the normal one. There was no adhesion between the ectopic and normal nail units. Thus, using a No. 15 blade, we successfully removed the ectopic nail plate including its matrix en bloc (Fig. 2A, B). On histopathology, the nail bed was slightly stained with the hematoxylin-eosin (H&E) dye. In addition, there was an underlying presence of the nail matrix without a granular layer. Based on these findings, the patient was diagnosed with posttraumatic ectopic nail (Fig. 2C). At the most recent follow-up (6 months), it was determined that the patient had undergone an uneventful course without recurrent episodes or complications. Fig. 1 Preoperative findings of the case. (A) A solitary, localized, well-demarcated, 7 mm×5 mm, whitish hyperkeratotic nail-like skin lesion on the center of the left thumb. (B) No underlying bone deformity is visible on plain radiography. Fig. 2 Intraoperative view and histologic findings. (A) Exposure and identification of the ectopic nail. (B) Excision of the ectopic nail and its matrix. (C) Histopathologic findings showing keratotic squamous epithelium in a fully-developed nail unit (H&E, ... Ectopic nail, also termed onychoheterotopia, is a pathologic condition characterized by the persistent growth of the ectopic nail plate due to the presence of the ectopic nail matrix in other regions than the normal nail bed. Little is known about the exact pathogenesis of ectopic nail, for which various hypotheses have been proposed. According to Ohya et al., an ectopic nail is a teratoma that is formed by stray germ cells (cited in Jeong et al. [2]). According to Kikuchi et al. [4], the pathogenesis of ectopic nail is closely associated with rudimentary nail or hidden polydactyly. According to some reports, it is associated with congenital palmar nail syndrome, Pierre Robin syndrome, or the aberration of the long-arm of chromosome 6. This provides a possibility that its pathogenesis might have a familial tendency or genetic inheritance. On the other hand, posttraumatic ectopic nail may occur as a result of acute single overwhelming injury or chronic repeated minor injury. That is, posttraumatic ectopic nail occurs when the germinal matrix of the nail is split and its split section is implanted in the skin [1-4]. Clinical characteristics of ectopic nail include the small outgrowth of a deviant nail or complete double fingernail malformation. In congenital cases, an ectopic nail typically grows alongside the normal nail. Due to the abnormal location of the nail matrix, however, it may also be deviated from the normal nail. Congenital ectopic nail most commonly affects the palmar aspect of the fifth finger, followed by the palmar surface of the fourth finger, the first and third finger, and the second digit in decreasing order. On the other hand, posttraumatic ectopic nail affects the dorsal aspect of the finger the most commonly. However, few case reports have shown that it occurs in the toe or other body regions than the finger or toe [1-4]. Most cases of ectopic nail are asymptomatic, but their clinical findings may include pain, pruritis, and swelling. It may also invade the normal nail matrix, thus disturbing the growth of the normal nail and causing a nail deformity. In addition, due to its contact with the underlying bone, it may also disturb the intramembranous ossification, thus leading to bone deformity [1-4]. Lew et al. [5] reported that ectopic nail is radiologically characterized by such findings as hypoplasia, thinning, or depression of the phalanx. It has also been reported that these radiological findings gradually disappear over time after surgical excision without causing serious problems. Radiological findings with an ectopic nail may vary depending on the depth and location of its matrix [2,5]. A diagnosis of ectopic nail is routinely made based on its typical clinical and histopathologic findings. Its histopathological findings are similar to those of the normal nail. That is, an ectopic nail is histopathologically characterized by the presence of keratotic squamous epithelium, a corneous plate, and a matrix in a fully-developed nail unit. The ectopic nail is devoid of a nail bed but it also has a nail matrix [1-4]. The differential diagnosis should include foreign body reactions, rudimentary polydactyly, teratoma, hamartoma, split nail deformity, cutaneous horn, polyonychia associated with syndactyly, epidermolysis bullosa, and congenital ectodermal dysplasia [1-4]. The standard treatment regimen for ectopic nail is surgical excision. To prevent recurrence, the matrix of an ectopic nail should be removed. According to a review of the literature, however, there are few cases of recurrence after surgical excision [1-4]. Because ectopic nail is an extremely rare condition, it is likely to be overlooked during diagnosis. Based on its typical clinical and histopathologic findings, however, it may be easily diagnosed. Moreover, it may also be easily corrected with surgical excision. It is therefore mandatory to accurately understand the clinical characteristics of ectopic nail.

수부는 전체 체표면적의 5% 이하를 차지 하지만 기능적 역 할이 매우 중요하여 외상 후 기능적 장애를 최소화하기 위해 많은 노력이 이루어져 왔다. 손상 정도나 부위에 따라 단순봉 합부터 피부이식술, 국소피판술, 유리피판술 등 여러 수술 방 법들이 적용되어 왔다. 이 중 피부이식술은 결손을 동반한 상 처를 치유하는 가장 간단하면서도 유용한 방법으로 많이 이용 되어 왔다. 전층 피부이식의 경우 샅고랑(groin) 부위에서 얻 은 전층 피부를 사용하는 경우가 많았으나, 이식한 피부는 시 간이 경과 하면서 과색소침착이 생기게 되어 미용상의 부조화 를 보이는 경우가 많았다. 수부는 얼굴부위와 함께 항상 노출 되는 부위이기 때문에 미용적 특성에 대한 고려가 필요하다. 따라서 이 같은 부조화를 해결하기 위해 많은 다양한 부위에 서 피부이식편을 얻고자 하는 시도가 이루어져 왔으며 현재까 지 이식편의 제공부위로 발바닥, 발목, 손목, 손의 새끼두덩 (hypothenar) 등이 제시되고 있다. 저자들은 눈꺼풀, 코, 뺨 등 안면부의 다양한 결손을 재건하는데 이용되는 후이개부 전 층 피부이식술이 수술 후 색소침착이 적어 주위 조직과 피부 색의 조화가 우수하다는 점에 착안하여 수부의 전층 피부이식 술에 후이개부를 공여부로 사용하여 좋은 결과를 얻었기에 문 헌고찰과 함께 보고한다. The Usefulness of Retroauricular Full Thickness Skin Graft in Hand Reconstruction

Blepharoplasty is one of the most common anti-aging operations. Although rare, complications such as ectropion may occur. Thus, we introduced an operative technique to prevent ectropion of the lower lid after blepharoplasty. From January 2012 to August 2013, we performed a nonincisional suspension suture (NISS) technique for 30 patients who visited our clinic for lower blepharoplasty. These patients had a distance of greater than 7 mm on the distraction test and were suspected of having horizontal lid laxity. We performed a slit incision 3 mm superior to the junction between the lateral epicanthus and the orbital bone during lower blepharoplasty. We passed a 7-0 nylon suture through the subcutaneous layer and the orbicularis oculi muscle. Then, we punctured the tarsal plate at the lateral limbus and fixed it to the lateral orbital rim by puncturing the periosteum. We tied a suspension knot through the slit incision. Thirty patients had satisfactory results without major complications, such as scleral exposure or ectropion. The NISS technique could be an effective method by which to prevent postoperative ectropion in cases with a mild to moderate degree lower lid laxity. The use of a NISS procedure is also a simple surgical technique, which saves time and is minimally invasive.

Background Lipomas can be categorized into deep and superficial lipomas according to anatomical depth. Many cases of forehead lipomas are reported to be deep to the muscle layer. We analyze ultrasound in delineating depth of forehead lipomas. Methods A retrospective review was performed for all patients who underwent excision of forehead lipomas between January 2008 and March 2013 and for whom preoperative ultrasound study was available. Sensitivity and specificity of ultrasound imaging was evalauted against depth finding at the time of surgical excision. Results The review identified 42 patients who met the inclusion criteria. Preoperative ultrasound reading was 18 as deep lipomas and 24 as superficial. However, intraoperative finding revealed 2 of the 18 deep lipomas to be superficial and 13 of the 24 superficial lipomas to be deep lipomas. Overall, ultrasonography turned out to be 69% (29/42) accurate in correctly delineating superficial versus deep lipomas. Conclusion Lipomas of the forehead tend to be located in deeper tissue plane compared to lipomas found elsewhere in the body. Preoperative ultrasonography of lipomas can be helpful, but was not accurate in identifying the depth of forehead lipomas in our patient population. Even if a forehead lipoma is found to be superficial on ultrasound, operative planning should include the possibility of deep lipomas.

프레스 기계는 플라스틱이나 금속 등의 가공재가 들어 있는 금형에 강한 힘을 가함으로써 재료를 성형하는 기계이다. 그 중에서 천공 프레스 기계는 상대적으로 작은 접촉면적에 강한 압력을 가해 타공하는 기계로서 조작 및 작업이 쉬워 널리 사 용되고 있다. 하지만 사용 과정에서 작업자의 부주의로 수부 의 손상이 발생할 위험이 있다. 천공 프레스에 의한 수지의 손 상은 금형의 형태에 따라 분절 절단(segmental amputation) 손상 형태를 보이는 경우가 많다. 그리고 작은 면적에 강한 압 력이 작용하므로 절단부 조직의 손상 정도가 심하지 않은 경 우가 많아서 수지의 분절 손상이 발생한 경우, 손상 부위의 원 위부는 반대측의 정상 수지 동맥을 통해 혈액순환이 온전하게 유지될 가능성이 높다. 이러한 경우 수지의 손상을 효과적으 로 재건해야 윈위부의 정상 조직들을 보존할 수 있다. 절단부 조직을 보존한 경우 재접합술을 시행하여 좋은 결과가 보고된 바 있다. 따라서 절단부 조직이 있는 경우 재접합술을 우선으 로 고려하며, 절단부 조직이 없거나 절단부 조직의 압궤 손상 이 심하여 재접합술을 할 수 없을 경우 결손 부위를 적절한 수 술 방법으로 재건하여야 한다. 저자들은 천공 프레스 기계에 의해 수지의 중간 부위에서 분절 절단 손상 후 손상 부위의 원위부 혈류 순환이 유지되는 Reconstruction of Digits Injured by Punch Press Machine

www.e-acfs.org pISSN 2287-1152 eISSN 2287-5603 124 Copyright © 2013 The Korean Cleft Palate-Craniofacial Association This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Correspondence: So-Min Hwang Aesthetic, Plastic and Reconstructive Surgery Center, Good Moonhwa Hospital, 119 Beomil-ro, Dong-gu, Busan 601-803, Korea Tel: +82-51-630-0199 / Fax: +82-51-630-0145 / E-mail: blueorange1009@hanmail.net Received August 31, 2013 / Revised September 19, 2013 / Accepted October 7, 2013 양성 종양으로 오인된 낭선암종 1례

www.kcpca.or.kr ISSN 2287-1152 68 Copyright © 2012 The Korean Cleft Palate-Craniofacial Association This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 외접근 비교정술 후 발생한 단순 포진 바이러스 감염 치험례

Background: Advanced information technology can be used when developing diagnostic and treatment strategies to provide better care for diabetic patients. However, the levels of need and demand for the use of technological advances have not been investigated in diabetic patients. We proposed and developed an individualized, ubiquitous (U)-healthcare service using advanced information technology for more effective glucose control. Prior to our service initiation, we surveyed patient needs and other pertinent information. Methods: During August 2009, we conducted a 34-item questionnaire survey among patients with diabetes who were older than 40 years in two certain hospitals in Korea. Results: The mean age of the 228 participants was 61.2±9 years, and males made up 49.1% of the sample. Seventy-one percent replied that they wanted individualized healthcare service, and they also wanted their health information to be delivered through mobile devices such as a cellular phone or a personal digital assistant (40.4%). Most patients had never heard of U-healthcare services (81.1%); however, after explaining the concept, 71.1% of participants responded that they would use the service if it was pro vided. Despite their willingness, participants were concerned about technical difficulty in using the service (26.3%) as well as the cost of the service (29.8%). Conclusion: The current study suggests that more than 70% of diabetic patients are interested in using U-healthcare services. To encourage widespread use, the application program or device of U-healthcare services should be simple, easy to use and afford able while also including a policy for the protection of private information.

Abdominal fat accumulation is known to be strongly implicated in development of metabolic syndrome (MetS). We examined diagnostic values of obesity-related parameters in 95 men and 185 women, and we determined optimal cutoff values of visceral fat area (VFA) and waist circumference (WC) for predicting the presence of multiple non-adipose components of MetS. Receiver operating characteristic (ROC) curve analysis revealed that VFA was the best indicator of MetS. WC and VFA exhibited similar diagnostic values for men and postmenopausal women, whereas WC was inferior to VFA for premenopausal women (area under ROC curve of VFA and WC was 0.76 and 0.52, respectively; P < 0.001). Optimal cutoff points of VFA and WC for predicting MetS were 136 cm(2) and 89 cm in men and 95 cm(2) and 82 cm in women, respectively. Subjects with VFA and WC above these cutoff values exhibited increased insulin resistance and increased carotid intima-media thickness. In conclusion, WC has a diagnostic value similar to VFA for predicting MetS in men and postmenopausal women, but not in premenopausal women. Further studies are necessary to develop a simple clinical parameter that reflects visceral fat in premenopausal women.

Herein, a case of a solitary primary paraganglioma arising in the mesentery, found in a hypertensive 70-year-old woman, who presented with nausea and postprandial abdominal discomfort, is reported. Ultrasonography and computed tomography showed a hypervascular mass abutting the second portion of the duodenum. An exploratory laparotomy revealed a 5.5×5.3×5 cm sized mass in the mesentery of the transverse colon, which was histologically proven to be a paraganglioma. No intraoperative hemodynamic changes developed, and the postoperative course was uneventful. To our knowledge, this is the first case of a paraganglioma arising in the mesentery reported in Korea. Considering the unusual locations and the associated operative risk, it is necessary to rule out the possibility of a functioning paraganglioma in the preoperative differential diagnosis of an abdominal mass (J Kor Soc Endocrinol 20:496～501, 2005).