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

This clinical study was conducted to survey 300 cases of total laparoscopic hysterctomy (TLH) by the Department of Obstetrics and Gynecology of Boram Hospital in Ulsan, Korea from January, 2000 to June, 2001. TLH has been described in much of the recent literature. We analyzed 300 cases of TLH to evaluate the clinical data such as distribution of age, parity, clinical indication, previous operation history, type of surgery, operation time, weight of uterus, Hb change of post-operation first day and the complications of using this technique. The mean age of patients was 41.3. The mean parity of patients was 2.6. The clinical indications for TLH were myoma (72.3%), adenomyosis (11.3%), PID (5.3%), CIS (4%) and others (5.7%). The most previous operation was bilateral tubal ligation. Others were cesarean section, appendectomy. The most concomitant procedure with TLH was posterior colpoperineorrhaphy. Salpingo-oophorectomy and appendectomy were also carried out concomitantly. The mean operation time was 124 minutes. The mean weight of the uterus was 230 gm. The mean Hb change post-operation on the 1st day was 1.3g/dL. The complications of TLH were bleeding to need blood transfusion, ureteral injury and bladder injury. Thus this technique can be safely performed by skilled laparoscopists for properly selected patients but there is a need for prospective studies for comparision with various laparoscopic hysterctomies.
Adenomyosis ; Appendectomy ; Blood Transfusion ; Cesarean Section ; Female ; Gynecology ; Hemorrhage ; Humans ; Hysterectomy* ; Korea ; Myoma ; Obstetrics ; Parity ; Pregnancy ; Sterilization, Tubal ; Ulsan ; Ureter ; Urinary Bladder ; Uterus

PURPOSE: To evaluate changes in tuberculous cavities, one of the major factors used to determine the activityof tubereulosis, by high-resolution CT(HRCT) in active pulmonary tuberculosis patients after antituberculoustherapy. MATERIALS AND METHODS: The HRCT findings of 41 patients with active tuberculosis were analyzed withparticular emphasis on the appearance of tuberculous cavities before and after therapy. We measured the largestdiameter and maximal wall thickness of the cavities, as well as accompanying changes occurring during follow-up.The mean interval between initial and follow-up study was 8.7 months(minimum:4.1, maximum:33.2;S.D.: +/-5.0) andthe mean duration of antituberculous therapy was 7.5 months(minimum:4.7, maximum:14.8;S.D.: RESULTS: Among 41patients, 54 cavities were found on initial HRCT. Thirty one(57.4%) of these disappeared during follow up HRCTwith residual changes such as residual fibrotic scar(n=15), granuloma(10), paracicatrical emphysema(7),calcification(3), traction bronchiectasis(3), consolidation(3) and bullous emphysema(1). Twenty three of thecavities(42.6%) decreased in size and wall thickness, but did not disappear completely during follow-upexamination. Mean largest diameter and maximal thickness of 23 cavities were 32.0mm(+/-13.9) and 7.9mm(+/-4.8) oninitial HRCT, falling to 20.9mm(+/-12.5) and 4.1mm(+/-2.6), respectively, during follow-up HRCT. Among four patientswho underwent a second follow-up, the largest diameter and maximal thickness of the cavities decreasedcontinuously. In two patients, however, the cavities did not did not disappeas, though in the other two they haddisappeared by the time follow-up HRCT was performed a second time. CONCLUSION: During follow-up HRCT afterantituberculous therapy(mean duration of 7.5 months), 57.4%(31/54) of cavities were seen to have disappeared, withresidual changes such as fibrotic scars, granulomas, paracicatrical emphysema and calcification ; 42.6% of thecavitivies still remained, however, with retractive and fibrotic change. Such fibrotic and retractive changesshould not, therefore, be taken as indicative of active tuberculosis, especially in patients who have successfullycompleted their medication.
Cicatrix ; Emphysema ; Follow-Up Studies ; Granuloma ; Humans ; Lung ; Traction ; Tuberculosis ; Tuberculosis, Pulmonary

PURPOSE: Various mechanical causes which induce shoulder impingement syndrome have been identified with the help of MRI. The aim of this study is to evaluate the incidence of such causes. MATERIALS AND METHODS: A total of 54 patients with clinically confirmed shoulder impingement syndrome and a normal control group(n=20) without symptoms were included. We evaluated the incidence of hook shaped acromion, low lying acromion, downward slope of the acromion, subacromial spur, acromioclavicular joint hypertrophy, coracoacromial ligament hypertrophy, high cuff muscle bulk, and os acromiale. RESULTS: Among the 54 patients, the following conditions were present: acromioclavicular joint hypertrophy(n=36), coracoacromial ligament hypertrophy(n=20), subacromial spur(n=18), downward sloping of the acromion(n=16), hook shaped acromion(n=11), relatively high cuff muscle bulk(n=6), low lying acromion relative to the clavicle(n=3), and os acromiale(n=1). In the normal control group there were nine cases of acromioclavicular joint hypertrophy, nine of coracoacromial ligament hypertrophy, nine of downward sloping acromion, and three of low lying acromion, but hook shaped acromion, high cuff muscle bulk, and os acromiale were not found. Among 54 patients, the syndrome was due to five simultancous causes in one patient, four causes in two, three causes in 12, two causes in 22, and one cause in 17. CONCLUSION: Hook shaped acromion and subacromial spur are the statistically significant causes of shoulder impingement syndrome. In 69 % of patients, the condition was due to more than one cause.
Acromioclavicular Joint ; Acromion ; Deception ; Humans ; Hypertrophy ; Incidence ; Ligaments ; Magnetic Resonance Imaging* ; Shoulder Impingement Syndrome* ; Shoulder*

We report a rare case of a gastric plasmacytoma treated with endoscopic resection and oral thalidomide therapy. A 70-year-old man was admitted to our hospital with indigestion. He had no specific medical history and unremarkable laboratory results. Gastroendoscopic findings revealed a focal, erythematous, flat elevated lesion in the anterior wall of the stomach antrum. A biopsy revealed atypical lymphocytes. Endoscopic submucosal dissection (ESD) with an insulation-tipped knife was performed 45 days after diagnosis. Radiological and hematological evaluations, including a bone marrow biopsy, were performed and showed no involvement of other organs. The patient was diagnosed with extramedullary gastric plasmacytoma. Follow-up gastroendoscopy was performed three times during a 2-year period and showed nonspecific ESD scarring. The patient's condition was found to be stable.
Aged ; Biopsy ; Bone Marrow ; Cicatrix ; Diagnosis ; Dyspepsia ; Follow-Up Studies ; Humans ; Lymphocytes ; Plasmacytoma* ; Stomach ; Thalidomide*

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

BACKGROUND: Progressing stroke (PS) variably develops from initially the same size and severity, and is most frequently observed in lacunar infarctions. We investigated fractional anisotrophy (FA), mean diffusivity (MD) and infarct volume by using diffusion tensor imaging during the acute phase of ischemic stroke to determine whether these parameters are useful in characterizing and predicting PS. METHODS: In this study, 55 consecutive patients admitted within 24 hours of the onset of their first ischemic stroke were included. NIH stroke scale (NIHSS) and Canadian Neurological scale (CNS) were performed upon admission, twice a day, and at discharge. Modified Rankin scale and Barthel index were also evaluated. PS was defined as a 2-point drop in NIHSS and a 1-point drop in CNS from admission to day 3. A correlation analysis was performed between clinical scale scores and imaging parameters, and the distribution of those values was compared between the two groups with and without PS. RESULTS: Significant correlations were observed between clinical scale scores and infarct volumes. The FA ratio in 14 patients with PS was lower than the patients without PS (p=0.004). Other characteristics including infarct volume and MD ratio were not different. The FA ratio remained as an independent predictor of PS (OR, 1.055; p=0.011). CONCLUSIONS: In acute ischemic stroke within the first 24 hours, only infarct volume was correlated with clinical status. However, patients with PS showed lower FA values, which accounts for rapid and severe vasogenic edema involving the disruption of the cell membrane and axonal fibers. Moreover, FA may be a predictor of PS.
Anisotropy* ; Axons ; Cell Membrane ; Diffusion Tensor Imaging* ; Diffusion* ; Edema ; Humans ; Stroke* ; Stroke, Lacunar

No abstract available.
Abducens Nerve Diseases* ; Abducens Nerve* ; Headache* ; Intracranial Hypotension*

Mild cognitive impairment (MCI) has been defined as a transitional state between normal aging and Alzheimer disease. Diffusion tensor imaging (DTI) can estimate the microstructural integrity of white matter tracts in MCI. We evaluated the microstructural changes in the white matter of MCI patients with DTI. We recruited 11 patients with MCI who met the working criteria of MCI and 11 elderly normal controls. The mean diffusivity (MD) and fractional anisotropy (FA) were measured in 26 regions of the brain with the regions of interest (ROIs) method. In the MCI patients, FA values were significantly decreased in the hippocampus, the posterior limb of the internal capsule, the splenium of corpus callosum, and in the superior and inferior longitudinal fasciculus compared to the control group. MD values were significantly increased in the hippocampus, the anterior and posterior limbs of the internal capsules, the splenium of the corpus callosum, the right frontal lobe, and in the superior and the inferior longitudinal fasciculus. Microstructural changes of several corticocortical tracts associated with cognition were identified in patients with MCI. FA and MD values of DTI may be used as novel biomarkers for the evaluation of neurodegenerative disorders.
Aged ; Aged, 80 and over ; Aging/*pathology ; Anisotropy ; Biological Markers ; Cerebral Cortex/*pathology ; Cognition Disorders/*pathology ; Diffusion Magnetic Resonance Imaging/*methods ; Female ; Humans ; Male ; Middle Aged ; Neural Pathways/*pathology ; Severity of Illness Index

BACKGROUND: Long-term treatment of immunosuppresant CsA causes interstitial inflammation and fibrosis in the kidney. Renin-angiotensin system (RAS) plays the most important role in the pathogenesis CsA-induced renal injury. Accordingly we evaluated the anti-inflammatory effect of angiotensin II blockades using losartan (LSRT) in a rat model of chronic CsA nephropathy. METHODS: Male Sprague-Dawley rats, initially weighing 225 to 250 g, were used. After 1 week of a low-salt diet (0.05% sodium), the rats were randomized into four groups and treated for 4 weeks. The Vehicle (VH) group was treated with olive oil. The VH+LSRT group was treated with olive oil and LSRT. The CsA group received CsA. The CsA+LSRT group was simultaneously treated with CsA and LSRT. The anti-inflammatory effect of LSRT was evaluated with C-reactive protein (CRP) expression, osteopontin (OPN) mRNA and protein expression, and ED-1 infiltration RESULTS: The CsA treatment caused an increase in serum creatinine and a decrease in creatinine clearance compared with that of the VH group. Intrarenal CRP positive cells were significantly decreased in the CsA+LSRT group compared with the CsA group (38.0 +/- 2.1 vs. 65.0 +/- 5.1, p<0.01). In the CsA group, the degree of OPN mRNA expression was increased compared with that of the VH group. But, OPN mRNA expression was decreased in the CsA+LSRT group (387.5 +/- 56.6% vs. 719.8 +/- 58.5%, p<0.05). In the degree of ED-1 infiltration, we had a similar results such as CRP and OPN mRNA expression (CsA group 30.5 +/- 8.0 vs. CsA+LSRT 86.0 +/- 11.0, p<0.01). CONCLUSION: We concluded that the anti-inflammatory effects of angiotensin II blockade has a potential protective effect against CsA-induced renal injury.
Angiotensin II* ; Angiotensins* ; Animals* ; C-Reactive Protein ; Creatinine ; Diet, Sodium-Restricted ; Fibrosis ; Humans ; Inflammation ; Kidney ; Losartan ; Male ; Models, Animal* ; Olea ; Osteopontin ; Rats ; Rats, Sprague-Dawley ; Renin-Angiotensin System ; RNA, Messenger ; Olive Oil