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Background Glomus tumors were first described by Wood in 1812 as painful subcutaneous tubercles. It is an uncommon benign neoplasm involving the glomus body, an apparatus that involves in thermoregulation of cutaneous microvasculature. Glomus tumor constitutes 1%-5% of all hand tumors. It usually occurs at the subungual region and more commonly in aged women. Its classical clinical triad consists of pain, tenderness and temperature intolerance, especially cold sensitivity. This study reviews 15 cases of glomus tumor which were analyzed according to its anatomic location, surgical approach and histologic findings. Methods Fifteen patients with subungual glomus tumors of the hand operated on between January 2006 and March 2013, were retrospectively reviewed. Patients were evaluated preoperatively with standard physical examination including ice cube test and Love's test. Diagnostic imaging consisted of ultrasonography, computed tomography, and magnetic resonance imaging. All procedures were performed with tourniquet control under local anesthesia. Eleven patients underwent excision using the transungual approach, 3 patients using the volar approach and 1 patient using the lateral subperiosteal approach. Results Total of 15 cases were reviewed. 11 tumors were located in the nail bed, 3 in the volar pulp and 1 in the radial aspect of the finger tip. After complete excision, patients remained asymptomatic in the immediate postoperative period. In the long term follow up, patients exhibited excellent cosmetic results with no recurrence. Conclusions Accurate diagnosis should be made by physical, radiologic and pathologic examinations. Preoperative localization and complete extirpation is essential in preventing recurrence and subsequent nail deformity.

The absence or disfigurement of the umbilicus is both cosmetically and psychologically distressing to patients. The goal of aesthetically pleasing umbilical reconstruction is to create a neoumbilicus with sufficient depth and good morphology, with natural-looking superior hooding and minimal scarring. Although many reports have presented techniques for creating new and attractive umbilici, we developed a technique that we term the "four flaps technique" for creating a neoumbilicus in circumstances such as the congenital absence of the umbilicus or the lack of remaining umbilical tissue following the excision of a hypertrophic or scarred umbilicus. This method uses the neighboring tissue by simply elevating four flaps and can yield sufficient depth and an aesthetically pleasing shape with appropriate superior hooding.

Ganglion cyst, although its precise etiology is not determined, is generally considered a degeneration of the mucoid connective tissue, collagen in specific, and was reported for the first time by Ledderhose in 1893 [1]. It is a benign soft-tissue tumor that usually appears near joints such as the hand, wrist, or foot. A ganglion cyst of the temporomandibular joint (TMJ) is a rare disease, and few cases of this condition have been reported in the English language literature. It may develop from a myxoid decay of the collagenous tissue of the TMJ capsule, without an epithelial or endothelial lining. Unconnected with the joint cavity, this cyst arises from the capsule of the joint. The cyst is filled with a gelatinous material and lined with a fibrous connective tissue wall without cells [2]. We present important aspects of the clinical findings, histologic features, and therapeutic options of a rare case of a ganglion cyst of TMJ with a review of the previous articles. A 48-year-old man was admitted at the Department of Head and Neck Surgery at our hospital for an acute spinning type of dizziness lasting a week. An otolaryngologist's first impression was vestibular neuritis, and magnetic resonance imaging (MRI) was performed for further evaluation. The MRI revealed chronic otomastoiditis and a cystic mass in the left pre-auricular region (Fig. 1). The otolaryngologist prescribed medications for vestibular neuritis. Because the otolaryngologist and a radiologist regarded the patient's preauricular mass to be a simple subcutaneous benign mass, the patient was also referred to the Plastic and Reconstructive Department for mass removal. Preoperatively, the patient had no typical symptoms and signs such as malocclusion, trismus, a clicking sound, or TMJ tenderness except for the mild swelling at the preauricular area. Physical examination revealed a 1-cm round, slightly mobile mass in front of the right tragus. As the junior author regarded the mass to be a simple subcutaneous cyst such as a lipoma or an epidermal cyst, he performed a surgical excision of the tumor under local anesthesia. The surgeon injected local anesthetics (2% lidocaine with 1:80,000 epinephrine) very superficially into the subcutaneous layer. Then, he made a direct vertical small incision in front of the right tragus over the protruding mass and performed dissection with a pair of blunt Metzenbaum scissors. During dissection around the mass, he inadvertently found that the mass penetrated into the depth of the temporalis fascia, and he started to use a nerve stimulator. After retraction of the superficial temporal vessels anteriorly with the skin flap, with the aid of a nerve stimulator, the surgeon made an oblique incision parallel to the frontal branch of the facial nerve, through a superficial layer of the temporalis fascia above the zygomatic arch. Then, he inserted the periosteal elevator beneath the superficial layer of the temporalis fascia and stripped the periosteum off the lateral zygomatic arch. Dissection was carried out inferiorly to expose the capsule of the TMJ. Intraoperatively, a cystic mass sized 10 mm in diameter was found. Its surface was soft, round, and translucent. The cystic mass was filled with a jelly-like material and connected with the lateral surface of the TMJ capsule by a short, narrow stalk. The tumor was successfully extirpated without injury to the facial nerves (Fig. 2). Histopathologic examination confirmed a ganglion cyst (Fig. 3). There was no sign of recurrence 8 months postoperatively, and the patient's symptom of dizziness disappeared. Fig. 1 (A) Preoperative axial T2-weighted magnetic resonance image. (B) Coronal T1-weighted magnetic resonance image shows a cystic lesion (white arrows) lateral to the left condyle. Fig. 2 Intraoperative photograph showing the ganglion cyst in the lateral aspect of the temporomandibular joint capsule. Fig. 3 (A) Histopathologic photomicrographs show a cystic wall of fibroconnective tissue with H&E, ×40. (B) Cystic wall consisted of a myxoid degeneration of the collagenous tissue (black arrow), ×200. The ganglion cyst of the TMJ is more frequently seen in middle-aged women than in men or women of other ages and usually presents as a parotid or preauricular mass because of its anatomical region [3]. Because a ganglion cyst in the TMJ is not common, an accurate preoperative diagnosis is not easily made. The differential diagnosis of the preauricular mass has extensive lists. A variety of conditions or diseases must be considered in the differential diagnosis of a ganglion cyst at the TMJ, such as parotid tumor, parotid cyst, retention cyst, sebaceous cyst, branchial cleft cyst, vascular tumor, and lymphangioma. Besides, rare TMJ lesions, such as synovial chondromatosis, osteochondroma, osteoma, pigmented villonodular synovitis, bone cyst, Langerhans cell histiocytosis, plasma cell myeloma, and sarcoma, must also be considered. Among the most commonly used radiological modalities, that is, sonography, computed tomography, and MRI, MRI remains the best diagnostic imaging technique to determine TMJ pathology [2] as MRI usually reveals the location, size, and density of the lesion, as well as its connection with the surrounding structures [1]. Despite their distinct entities, ganglion cysts and synovial cysts are often mistakenly used alternatively in the literature. Although ganglion cysts and synovial cysts seem similar clinically, synovial cysts are true cysts filled with synovial fluid and lined with endothelial cells because they are produced by the movement and herniation of the synovial lining due to an increased pressure in the associated joint. On the other hand, ganglion cysts, which are not connected to the joint cavity, appear to be developed from a myxoid degeneration of the collagenous tissue of the joint capsule. They are not true cysts because they lack a cellular lining and are made of a gelatinous, viscous material and surrounded by fibrous connective tissue [2]. These two kinds of cysts can be clearly differentiated from each other only through histological examination. The treatment options of the ganglion cyst vary from conservative treatment to surgical removal. The surgical excision of symptomatic ganglion cysts of the TMJ remains the mainstay of the treatment, with the most common complication being recurrence due to incomplete excision. Surgical excision has usually been performed by using a preauricular approach and is considered to be the procedure of choice. Although there is a case establishing facial nerve palsy and intracranial extension, patients with asymptomatic lesions may undergo some period of conservative management, because there are some cases of spontaneous regression [4]. We emphasize that if a patient has a mass adjacent to the TMJ and shows concomitant vague symptoms related to TMJ disorders such as headache, otalgia, TMJ sounds or crepitus, dizziness or vertigo, fullness of the ear, and tinnitus, surgeons must consider the possibility of a ganglion cyst of the TMJ [5]. We expect our rare case to be helpful to surgeons for making an early diagnosis and planning a treatment strategy for the ganglion cyst of the TMJ.

The safety of fake anti-impotence drugs (fake Viagra : 26 samples, fake Cialis : 25 samples) dis- tributed in Gyeonggi province was studied by monitoring the concentrations of anti-impotence pharmaceutical ingre- dient and their analogues. The concentrations of anti-impotence pharmaceutical ingredient 4 specis and their analogues 17 specis were estimated using by HPLC/PDA, LC-MS/MS. The range of concentration of sildenafil in fake viagra was 40~199 mg/tablet, among them the portion of the concentrations of sildenafil over 150 mg/tablet exceeded 65%. 3 cases in tested samples contained sildenafil and tadalafil. The range of concentration of sildenafil in fake cialis was 102~249 mg/tablet, among them the portion of the concentrations of sildenafil over 150 mg/tablet exceeded 88%. One case in tested samples contained demethylhongdenafil (90 mg/tablet). These results indicate that there were many fake anti-impotence drug contained high level of anti-impotence pharmaceutical ingredients, a sus- tainable monitoring and the blocked distribution of fake anti-impotence drugs recommended.

Cosmetics using natural materials which was purchased in retail stores, distributed in Gyeonggi province(32 samples) and online through internet(24 samples) were analyzed by pesticide residues and target preser- vatives for assessing the safety of it. Natural or organic certifications was identified in 22 samples among 56 samples and most of them were Ecocert. Pesticide residues was detected in 3 samples among 56 samples and each compound and concentration was permethrin(0.6 mg/kg), tricyclazole(11.7 mg/kg) and malathion(0.05 mg/kg). All of it was pur- chased through internet. Target preservatives was detected in 13 samples among 56 samples and one of them was over the maximum allowed concentration and the rest of them were within the maximum allowed concentration of the respective preservatives. The compound which was over the maximum allowed concentration was benzoic acid and compounds which were within the maximum allowed concentration were sorbic acid, benzoic acid and methylpara- ben. They were all identified substances in products and the number of detected preservatives in retail stores were higher than online samples purchased through internet. As a result of this study, The method of analyzing pesticide residues and limit in cosmetics using natural materials should be set up as soon as possible and the monitoring about preservatives in cosmetics using natural materials should be conducted on continuously.

Quantitative HPLC analysis for the determination of in herbal liquid preparations was improved from the general test method besides the Korean Pharmacopeia. Good chromatographic separation of samples containing parabens, interferences, and other pharmaceutical excipients was effectively achieved by using acetonitrile water (containing 1% glacial acetic acid) mixture (30:70 v/v) as mobile phase. To monitor preservatives (benzoic acid, parabens, sorbic acid, dehydroacetic acid, and their salts) in herbal liquid preparations, a group of 47 samples was divided into two different group: preservative labeled group and unlabeled group. From the results, the contents of preservatives in 31 samples of preservative labeled group fell under KFDA regulations, and the contents of dehydroacetic acid in 6 samples of preservative labeled group were not followed by KFDA regulations. Preservatives were detected in 3 samples out of 10 samples in preservative unlabeled group.

Coated sheet steels have been increasingly used in automotive industry for improving corrosion resistance. When GA outer plates processed the interfacing of the coating film and the metal matrix causes surface irregularities in the surface state of the sheet metal. Consequently, research to determine each phase composite’s friction coefficient is on-going. Investigating the effects that cause surface roughness, change and mechanical properties of outer automobile plates through temper rolling skin pass mill elongation is essential. Researching surface roughness in relation to surface friction properties requires the determination of a surface friction coefficient. This research demonstrates that there is a complex effect between the lubricant membrane and surface roughness when processing GA plates. Consequently, the strength of the lubricant membrane strongly influences the friction coefficient

The giant cell tumor of the tendon sheath (GCTTS) is a relatively common entity, and it is the second most frequent soft tissue tumor affecting the hand followed by ganglion cyst. It is clinically characterized by an asymptomatic, solitary, slowly-growing, palpable subcutaneous benign mass localized to the palmar aspect of the extremities adjacent to the distal interphalangeal (IP) joint. Its onset takes several months to years [1,2]. According to a review of literature, there are rare cases of multifocal origin of the tumor. More recent studies have reported a small number of cases of multifocal GCTTS [3]. We experienced a rare case of multifocal GCTTS with different types occurring simultaneously at two different sites (the upper and lower extremities) in the same patient. A 59-year-old woman presented with a slowly-growing mass of the right thumb and left plantar region, and the patient concurrently had an increasingly symptomatic, soft tissue swelling. The patient had neither sensory disturbances nor stiffness of the IP joint of the thumb. The interval between onset of symptoms and first visit to our clinic was three years. On physical examination, the patient had a mass on the plantar surface of the left foot as well as the radial aspect of the IP joint and the proximal phalanx of the right thumb. Both masses were solid, well-defined, and slightly tender. Mass was measured to be 2 cm on right thumb, 1.5 cm on left plantar region, respectively. On plain radiography of the right thumb, the mass showed a well-defined soft-tissue shadow. There were neither periosteal reactions nor articular involvement (Fig. 1). On plain radiography of the lesion on the left plantar region, there were no notable findings. Fig. 1 A lateral view of plain radiograph of the primary lesion on the right proximal phalanx level of the thumb shows a well-defined soft tissue contour. There were neither periosteal reactions nor articular involvement. Surgery was performed under general anesthesia with tourniquet control, using magnifying loupe. Bruner's incision to the volar aspect skin of the thumb was performed at the level of proximal phalanx. A meticulous dissection was performed with caution to achieve a complete resection of the tumor. Thus, the diaphysis of the right proximal phalanx was exposed. The mass had contact to neurovascular structures as well as both extensor pollicis longus (EPL) and flexor pollicis longus (FPL) tendons. The mass was removed along with the capsule. It was unavoidable, however, to perform a partial excision of the tendon sheath of both EPL and FPL for complete removal. Grossly, the lesion was a nodular type, multi-lobulated, and kidney shaped mass that is surrounded by pseudocapsule and yellowish in color, and it was measured as 2×1.5×1.5 cm (Fig. 2). The diffuse type mass involving the plantar fascia of the foot, had no bone involvement, and it was measured as 1.5×1.5×1.5 cm (Fig. 3). Both lesions were primarily closed without tension. Fig. 2 Grossly, the lesion is a multi-lobulated, kidney shaped mass that is surrounded by pseudocapsule and yellowish in color, and it is measured as 2×1.5×1.5 cm. Fig. 3 The lesion of the foot, releasing the plantar fascia after mass extirpation, has no bone pressure effect on metatarsal bones. On histopathology, both masses involving both the hand and the foot are composed of multinucleated giant cells, histiocytes and hemosiderin deposits. These findings established a diagnosis of giant cell tumor (Figs. 4, ​,55). Fig. 4 On histopathology, the mass involving the hand is composed of multinucleated giant cells (black arrow), histiocytes and hemosiderin deposits which is surrounded by fibrous capsule. These findings establish a diagnosis of giant cell tumor (H&E, ... Fig. 5 On histopathology, the mass involving the foot is composed of less multinucleated giant cells (black arrow) but more hypercellular (H&E, ×400). There was no metastatic disease on chest radiography or chest magnetic resonance imaging. The patient had a good range of active movement without further symptoms, stiffness and a substantial loss of function. The patient was followed up with a plain radiography after postoperative 3 and 6 months without recurrence. The GCTTS is a non-neoplastic benign lesion of giant cells occurring in the adjacent areas to the joint. On plain radiography, it is identified as soft-tissue contour that potentially causes a pressure-induced erosion of the cortex in the adjacent area [1]. There are rare cases of multifocal lesions of GCTTS. According to a retrospective study that was conducted in a consecutive series of 207 patients, there was only one patient who developed lesions at two different sites: the right ring finger and the left great toe [2]. Altaykan et al. [3] reported a case of GCTTS occurring simultaneously at two different sites on the flexor digitorum superficialis tendon of the little finger [3]. There is still a controversy as to the etiology and the pathogenesis of GCTTS. Therefore, its multifocal presence also remains unclear. Clinically based on histopathology, differential diagnoses of GCTTS include ganglion cyst, myxoid cyst, dermatofibroma, lipoma, glomus tumor, hemangioma, neurofibroma, foreign bodies, sweat gland tumor, synovial carcinoma, giant cell tumor of the soft tissue and bone, fibroma and rheumatoid nodules and primitive neuroectodermal tumor [1,2]. GCTTS is commonly characterized by adhesion to the extensor or flexor tendon sheath. It is such a relatively small-sized mass that its diameter rarely exceeds 5 cm. The most possible pathogenesis of GCTTS is an inflammatory response accompanied by reactive or regenerative hyperplasia due to chronic antigen exposure or a trauma history [4]. The treatment goals are to eliminate the lesions through a meticulous resection and to preserve the functions of the affected tendon and adjacent structures. With the development of operating microscopes and magnifying loupes, it has become easier not only to achieve a radical excision but also to prevent its recurrence [5]. A complete excision of the lesions might pose challenging problems for surgeons because they are located close to, or often involve, the tendon and neurovascular structures. Surgeons should avoid accidentally puncturing the lesion because potential seeding to adjacent soft-tissue structures may lead to the recurrence. It has been reported that the local recurrence after surgical excision occurred in up to 44% of total cases. Overall recurrence rate in patients with GCTTS reaches up to 27% at 2 years and 3 months on average after resection. Its recurrence had no significant correlation with GCTTS in a specific finger or phalanx [4]. We experienced a rare, multifocal case of GCTTS, nodular type involving both the EPL and FPL tendon, at the right proximal phalanx level and another diffuse type involving the left plantar fascia. In conclusion, our case indicates that it would be mandatory to evaluate the possibility of multifocal GCTTS in patients with soft-tissue swelling of the hand and the difference of tumor recurrence by type of giant cell tumor should bourn in mind.

Bake hardenability steel sheets are used increasingly more for automotive outer panels, because they exhibit high yield strength after painting the baking treatment while they have a good formability in the press stamping stage. Bake hardening utilizes the phenomenon of strain aging to provide an increase in the yield strength of formed components. So high carbon solubility levels increase the bake hardening response but reduce the room temperature aging resistance. This study is on the effect of annealing conditions such as soaking temperature, rapid cooling start temperature, cooling rate on BH(Bake hardenability), AI(Aging Index), YP-El(Yield point Elongation) and other mechanical properties.

Alloderm as a biomechanical scaffold in situations such as skin grafting has been previously demonstrated. In this paper we describe its utility in a broad range of post-traumatic and congenital hand defects. During the recent three years, 11 patients (7 male, 4 female) ranging in age from 8 to 84 years underwent hand resurfacing using acellular dermis graft. There were 10 traumatic and 1 congenital hand deformities (constriction ring syndrome). The acellular dermis was used as both a dermal filler and as a spacer construct. There was no obvious loss of the acellular dermis or infection. Stable resurfacing was achieved in all patients with reasonable functional and cosmetic outcomes.

One of the major challenges of designing a dissemination protocol for Wireless Sensor Networks (WSNs) is energy efficiency. Flooding and SPIN, which are very well-known proactive methods, spontaneously disseminate the sensed data without a request from an arbitrary sink node. However, these proactive protocols disseminate the data even to some nodes that do not need it, which is energy inefficient. In order to overcome this weakness, we introduce a novel semiproactive protocol to disseminate only to pertinent nodes instead of all nodes. Thus some nodes, such as arbitrary sink nodes that want the sensed data, are able to obtain the data easily within n hops. The simulation results show that the proposed protocol has higher average node energy efficiency than that of well-known earlier work, SPIN. If a proactive protocol, such as SPIN, is changed to semi-proactive and has only a 1hop burden, then the energy efficiency enhancement is up to 83.7% compared with SPIN.

One of the major challenges in facing the design of disseminating protocol for Wireless Sensor Networks (WSNs) is to find an energy efficiency way. Recently, several researches have been studied for this issue, and SPMS, that outperforms the well-known protocol SPIN, specially is a representative protocol. Also one of many characters of SPMS is the using of the shortest path to minimize the energy consumption. However, since it repeatedly uses the same path as the shortest path, the maximizing of the network lifetime is impossible, though it reduces the energy consumption. In this paper, we propose a novel data dissemination protocol, called E nergy and D istance A ware protocol based on S PIN (EDAS), that guarantees energy-efficient data transmission and maximizes network lifetime. EDAS solves the network lifetime problem by using the residual energy and the efficient distance between nodes to determine a path for data dissemination. The simulation results show that EDAS guarantees energy-efficient transmission and moreover increases the network lifetime by approximately 69% than that of SPMS.

To ensure efficient data transmission for multimedia services in Ethernet passive optical networks (EPON) which are considered as a promising solution to the last-mile problem in the broadband access network, they employ the media access control (MAC) mechanism by sharing efficiently the bandwidth of all optical network units (ONUs) and by avoiding data collisions in the upstream channel. The representative dynamic bandwidth allocation scheme, Interleaved Polling with Adaptive Cycle Time (IPACT), is considered as a standard approach in services for requests of ONUs. It reduces the performance of the entire network in terms of mean packet delay and packet loss ratio, due to congestion for the case that an ONU has burst traffic or highly loaded traffic. To handle this, the proposed scheme varies the cycle length in the basic period center and guarantees a maximum window size per ONU. In this paper, the proposed scheme demonstrates enhanced performance in terms of mean packet delay and packet loss ratio, of up to 58% and 10%, respectively.

As the Internet traffic continues to grow exponentially, Wavelength Division Multiplexing (WDM) networks with tera bps bandwidth per fiber naturally emerge as backbone for next generation optical Internet. In particular, much research regarding multicast services has progressed for connecting source to destination nodes efficiently because multicast demands are increasing. However, sparse-splitting networks are more realistic than fully-splitting ones, since multicast-capable cross-connectors are expensive. In this paper, a heuristic method to minimize the cost of a multicast tree based mainly on Multicast-Capable nodes in sparse-splitting networks is proposed. According to the results of comprehensive simulations and compared to the previous algorithms, the proposed algorithm provides performance improvement up to about 16% in terms of wavelength channel cost.

Ganglion cysts are the most common soft-tissue tumors of the hand. They are rarely found in specific anatomic structures such as the nerve, bone, and tendon. Intratendinous form of ganglion cyst is occasionally found in the hand. Only 10 cases in English papers and 7 cases in domestic papers on ganglion cysts in extensor digitorum tendons have been reported since its introduction in 1985. This study reports 2 cases of intratendinous ganglion cysts arising from the second and fourth extensor digitorum tendons and discusses general features and surgical plans for this entity.

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. www.e-acfs.org pISSN 2287-1152 eISSN 2287-5603 69 소아 전두골에 발생한 랑게르한스세포 조직구증