Facial clefts are uncommon congenital deformities in comparison to the clefts of the lip and palate. the clinical expression of the craniofacial clefts is highly variable. the face can be marred by a faint expression of the cleft or be disfigured by a full representation of the defect. the extent of the soft tissue and skeletal components is also variable, and they are seldom affected to an equal degree. Generally, discription of the clefts are based on the bony malformation, since the skeletal landmarks tend to be more constant. I report six cases of rare craniofacial clefts that I recently experienced. the soft tissue repair was accomplished with local flaps from cheek, eyelid and nose. Additional vertical length was obtained from the lower Z-plasty flaps in the sutures. the coloboma was corrected with local flaps and a cartilage graft, the depression of cheek with a dermofat graft, and the macrostomia with the repositioning of orbicularls oris muscle and a Z-plasty. the results were cosmetically acceptable.
Cartilage ; Cheek ; Coloboma ; Congenital Abnormalities ; Depression ; Eyelids ; Lip ; Macrostomia ; Nose ; Palate ; Sutures ; Transplants

OBJECTIVES: OSAS (obstructive sleep apnea syndrome) is a common disorder and its consequences are often serious. It is important to detect the disorder early in the course for proper treatment. This study is to grasp the snoring clinic visitors' knowledge level of OSAS. METHODS: One hundred and seventy-nine visitors at the of snoring clinic of Seoul National University Hospital were surveyed by questionnaire about reasons of visit and knowledge of treatment methods of snoring and OSAS, diagnostic method, OSAS-related symptoms, and complications. RESULTS: Most of the respondents (89.4%) "have already heard about OSAS" and the major sources of information was the mass media (58.1%) such as television and radio. More than half (60.3%) were aware that snoring is closely related to OSAS. More than half (59.8%) recognized that a nocturnal polysomnograpy was necessary for proper diagnosis. Two thirds (67%) of the respondents noted surgery as a treatment for snoring. More than half (55.9%) answered that they would follow the doctor's advice on the treatment choice. Only 12.3% of respondents "have heard about nCPAP". No one chose nCPAP (nasal continuous positive airway pressure) as a treatment for either snoring or OSAS. About one third (34.6%) of the respondents were aware that OSAS is related to hypertension. Only 12.8% noted that OSAS is related to diabetes mellitus. CONCLUSION: Visitors at the snoring clinic were found to have substantially limited knowledge of health risks and proper treatments of OSAS. We suggest that it is crucially important to educate patients and offer easy-to-understand information on snoring and OSAS. We predict that provision of educaiton and information to patients and general public will faciliate the diagnosis and treatment of snoring and OSAS and reduce the related disorders such as hypertension, stroke, and diabetes mellitus.
Diabetes Mellitus ; Hand Strength ; Humans ; Hypertension ; Mass Media ; Surveys and Questionnaires ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive ; Snoring ; Stroke ; Television

No abstract available.
Humans ; Ranitidine* ; T-Lymphocyte Subsets* ; T-Lymphocytes*

BACKGROUND: Dementia Screening Questionnaire is sensitive to detect early dementia patients and is not influenced by age and educational level. We conducted a case-control study to assess the validity and reliability of the Korean Dementia Screening Questionnaire (KDSQ) for the diagnosis of early dementia. METHODS: We developed KDSQ in a semi-structured manner with the questionnaire of 15 items about cognitive dysfunctions and 5 items of ischemic and depression scales respectively to evaluate the possibility of vascular dementia and degree of depression. It was adminis-trated to informants of 72 dementia patients (39 Alzheimer's disease, 33 vascular dementia) with Clinical Dementia Rating (CDR) scales of 0.5, or 1.0 and to those of 66 hospital control subjects. Test-retest data for the KDSQ were obtained from informants within a time interval of 20.82 days. RESULTS: The KDSQ was not influenced by education level, age, or sex. KDSQ score correlated with the K-MMSE (r=-0.75) and Short form Samsung Dementia Questionnaire (r=0.80). The area under the receiver operating characteristic curve for the KDSQ was 88.9% (S.E.=0.028). KDSQ depression score was correlated with Geriatric Depression Scale (r=0.34). With respect to a diag-nosis of dementia, the KDSQ (cut-off point 6) had a sensitivity of 79% and a specificity of 80%. The KDSQ was found to have a high test-retest reliability (r=0.81) CONCLUSIONS: The KDSQ has high validity and reliability for the diagnosis of early dementias. It may be a useful tool to screen early stage of dementias.
Alzheimer Disease ; Case-Control Studies ; Dementia* ; Dementia, Vascular ; Depression ; Diagnosis ; Education ; Humans ; Mass Screening* ; Surveys and Questionnaires* ; Reproducibility of Results ; ROC Curve ; Sensitivity and Specificity ; Weights and Measures

PURPOSE: Biliary cancer is a highly malignant neoplasm with poor prognosis and most patients need to undergo palliative chemotherapy, however major clinical problem associated with the use of chemotherapy is chemoresistance. So far, we aimed at investigating clinical implications of apurinic/apyrimidinic endodeoxyribonuclease 1 (APEX1) and Jagged1 as chemoresistance factors in biliary tract cancer. METHODS: We used 5 human biliary tract cancer cell lines (SNU-245, SNU-308, SNU-478, SNU-1079, and SNU-1196), and investigated the chemosensitivity of APEX1 and Jagged1 through 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay and Western blot. Alternately, the 10 patients of advanced biliary cancer consist of 2 group according to the chemotherapy response examined by immunohistochemistry using APEX1 and Jagged1 antibody, and protein expression level was scored for staining intensity and percent positive cell. RESULTS: The result of MTT assay after APEX1 knockdown showed that strong coexpression of APEX1 and Jagged1 cell line (SNU-245, SNU-1079, and SNU-1196) showed a greater decrease in IC₅₀ of chemotherapeutic agent (5-fluorouracil, gemcitabine and cisplatin). The Western blot analysis of APEX1 and Jagged1 expression in biliary cancer cell lines after APEX1 knockdown definitively demonstrated decreased Jagged1 expression. The APEX1 and Jagged1expression level of immunohistochemistry represented that chemorefractory patients had higher than chemoresponsive patients. CONCLUSION: These results demonstrate that simultaneous high expression of APEX1 and Jagged1 is associated with chemoresistance in biliary cancer and suggest that is a potential therapeutic target for chemoresistance in advanced biliary cancer.
Biliary Tract Neoplasms* ; Biliary Tract* ; Blotting, Western ; Cell Line ; Cisplatin ; Drug Therapy ; Fluorouracil ; Humans ; Immunohistochemistry ; Prognosis

BACKGROUND: Generally hernia is diagnosed with simple chest or gastrointestinal x-ray. Sometimes CT or MRI can give lots of information for the diagnosis. However, there was no study for the differentiation with using CT findings between Morgagni hernia and pleuropericardial fat. The aim of this study was to evaluate the useful CT findings for differentiating Morgagni hernia from pleuropericardial fat. MATERIAL AND METHOD: We retrospectively analyzed CT scans of eight patients with Morgagni hernia and 20 patients with abundant pleuropericardial fat without peridiaphragmatic lesions. All CT scans were performed with coverage of the whole diaphragm in the inspiration state. We evaluated 1) the presence of the defect of the anterior diaphragm, 2) the interface between the lung and fat, 3) the angle between the chest wall and fat, 4) the continuity between the extrapleural fat and fat, 5) the presence of the vessels within fat, and 6) the presence of a thin line surrounding fat. RESULT: In all cases with Morgagni hernia, the defect of the anterior diaphragm was seen. The interface was well-defined, smooth, and convex to the lung. The angle with the chest wall was acute. The continuity with the extrapleural fat was not seen. In the cases with abundant pleuropericardial fat, the defect of the anterior diaphragm was seen in three (15%). The interface was usually irregular (n=10) and flat (n=17). The angle with the chest wall was variable. The continuity with the extrapleural fat, that was markedly increased in amount, was usually seen (n=16). The thin line surrounding fat was seen in four cases with Morgagni hernia, however, not seen in all cases with pleuropericardial fat. All of the above findings were statistically significant, however, vessels within fat was not significant to differentiate Morgagni hernia (n=8/8) from pleuropericardial fat (n=14/20). CONCLUSION: The useful CT findings of Morgagni hernia were fatty mass with sharp margin, convexity toward lung, acute angle with chest wall, and thin line surrounding hernia. Branching structure within fatty mass representing omental vessels that has been known as a characteristic finding of Morgagni hernia was not useful for differentiating Morgagni hernia from pleuropericardial fat.
Diagnosis ; Diaphragm ; Hernia* ; Humans ; Lung ; Magnetic Resonance Imaging ; Retrospective Studies ; Thoracic Wall ; Thorax ; Tomography, X-Ray Computed

To evaluate the usefulness of brain SPECT as a tool with diagnostic and prognostic values m patients with acute cerebral infarction, twenty-four patients who were diagnosed as embolic(n=12) or thrombotic(n7-12) infarction by clinical manifestation and brain CT or MRI were selected. Both 99mTc-HMPAO & 99mTc-DTPA Brain SPECT were performed for each patients within 1 week after the attack Asymmetric index(Al) in both hemispheres was calculated as 200(l(right-left)l/(right+left)). Activities of daily livmg(ADL) was scored by Barthel Index on the admission day and the 21st day after the attack. The relationshiop between ADL index and Al of two types of brain SPECT was analysed by calculating correlation coefficient. 1.In embolic infarction, the Al of 99mTc-DTPA SPECT was markedly higher than that of 99mTc-HMPAO spect, but there was no difference in thrombotic type. 2. The AI of 99m'Tc-DTPA SPECT in embohc infarction was sigiuficantly higher than that m thrombotic type(p valu=.001), but the Al of 99mTc-HMPAO SPECT was similar in both types of infarction. 3.The correlation coefficient Al of 99mTc-DTPA Brain SPECT and ADL m the 21st day after stroke was statistically significated. These results suggested that the 99mTc-DTPA brain SPECT should be useful not only for the differemtial diagnosis between thrombotic and embolic infarctions but also for the prediction of prognosis in patients with ischemic stroke.
Activities of Daily Living ; Brain* ; Cerebral Infarction* ; Diagnosis* ; Humans ; Infarction ; Magnetic Resonance Imaging ; Prognosis* ; Stroke ; Technetium Tc 99m Exametazime ; Technetium Tc 99m Pentetate* ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: To determine the incidence of pseudolesions seen in the posterior aspect of segment IV of the liveron CT arterial portography(CTAP), and to evaluate the findings of CT hepatic arteriorgraphy(CTHA) and celiacangiography. MATERIALS AND METHODS: We retrospectively analysed 450 cases of patients who had undergone CTHA,CTAP and celiac arteriorgraphy for the diagnosis and treatment of hepatic lesion, and evaluated the incidence andimaging findings of pseudolesions in segment IV of the liver, as seen on CTAP, CTHA and celiac arteriography. RESULT: In 28 of 450 patients(6.2%), pseudolesions of focal perfusion defect were seen in segment IV on CTarterial portography. Pseudolesions were seen on CTAP on 39 different section slices ; these were wedge-shaped in41% of cases(16/39), rectangular in 30.8%(12/39), ovoid-shaped in 23.1%(9/39), and half moon-shaped in 5.1%(2/39); they were from 1 to 3cm(average, 1.5cm) in anteroposterior diameter, from 1 to 3cm(average, 1.9cm) in width, andfrom 1 to 4cm(average, 1.9cm) in craniocaudal diameter. Twenty-seven patients underwent CTHAs ; hyperattenuationwas seen in 13(48.2%), isoattenuation in 12(44.4%), and hypoattenuation in two(7.4%). In 19 of 28 celiacangiograms(67.9%), the right gastric artery was seen to arise from the hepatic artery, and aberrant right gastricveins directly draining into the left lobe of the liver were seen in three(10.7%). CONCLUSION: The incidence ofpseudolesion seen in segment IV of the liver on CTAP was 6.2% (28/450), and in 3 of 28 cases(10.7%), celiacangiography showed aberrant right gastric venous drainage. For pseudolesions, CTHA showed variable attenuation,and this modality is less sensitive than CTAP for the detection of pseudolesion.
Angiography ; Arteries ; Diagnosis ; Drainage ; Hepatic Artery ; Humans ; Incidence ; Liver* ; Perfusion ; Portography* ; Retrospective Studies

The nimodipine, calcium-channel blocker, is known to specific to brain tissue and effect on the ischemic stroke. To evaluate the efficacy and tolerability of nimodipine, we studied the 37 patients with Organic Brain Syndrome(OBS) who admitted to St. Mary's Hospital from January to August, 1989. We followed up for 12 weeks of their 18 items of neurologic outcome. The results and conclusion were as follows: 1) The pretreatment SCAG(Sandoz Clinical Assessment-Geriatric Scale) was used as a base-line measurement and the efficacy of the therapy was evaluated entirely in terms of changes in SCAG after 3, 6, 9 and 12 weeks of treatment. The total score was changed with meaningful improvement(p<0.01). 2) Among the 18 items of symptoms, the confusion, the level of alertness, the memory and the orientation were the area that have showed the most improvement. 3) No effect on heart, blood chemistry or other side effect was noted during medication. 4) We also found that those improvement has no specific relation to age, sex and causes of OBS. These result indicate that nimodipine has a possible therapeutic benefit in patients with OBS, especially who have the symptoms of confusion and impaired recent memory. These result should encouraged us to do further study such as double blind placebo in order to clarify the genuine pharmacological efficacy.
Brain* ; Chemistry ; Heart ; Humans ; Memory ; Nimodipine* ; Stroke

BACKGROUND AND OBJECTIVES: Because tinnitus can be generated from the damaged cochlear hair cells, patients with sudden sensorineural hearing loss frequently complain their tinnitus as an important symptom. We prospectively designed this study to understand the clinical characteristics of tinnitus in patients with sudden sensorineural hearing loss. MATERIALS AND METHOD: Thirty-seven patients with sudden sensorineural hearing loss who performed an audiologic study and questionnare of tinnitus before and immediately after the combination therapy for hearing loss were included. Their clinical and audiologic data were prospectively entered into a comprehensive data base to analyze the clinical characteristics of tinnitus. RESULTS: Most of the patients with sudden sensorineural hearing loss showed abrupt and concomitant onset of tinnitus in the same ear of hearing loss. The characteristics of tinnitus were changed according to the degree of hearing recovery of sudden hearing loss. CONCLUSION: Improvement of tinnitus in the patients with sudden sensorineural hearing loss may be closely related to the degree of hearing recovery. Understanding the characteristics of tinnitus in patients with sudden sensorineural hearing loss might be helpful in counselling them during the treatment period of hearing loss.
Ear ; Hair ; Hearing Loss* ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden* ; Hearing* ; Humans ; Prospective Studies ; Tinnitus*