Neurofibromatosis is an autosomal dominant abnormality that may affect multiple organ systems. The eyelids, the orbits, the adjacent tissues and bones may be involved with varying frequency and severity. The management of orbitotemporal neurofibromatosis depends very much on the type and severity of the orbital involvement and on the functional state of the eye. Experience with surgical management of orbitotemporal neurofibromatosis involved in the orbit, the temporal soft tissue and bone with blind eye is reported. The goal of surgery is tumor resection, reconstruction of the orbital socket, aesthetic eyelids, and insertion of the artificial prosthesis. A two stage approach is recommended. In the first stage, tumor is resected and the orbital socket is reconstructed with titanium mesh plate and cranial bone graft. After reconstruction of the orbital socket, galeal flap is rotated posteriorly to cover the mesh plate and canthopexy is accomplished. Mask lift is performed to enhance aesthetics. In the second stage, correction of the bulky eyelids is achieved and orbital space for insertion of the artificial prosthesis is reconstructed. Authors have managed a orbitotemporal neurofibromatosis with blind eye of a 41-year-old male using titanium mesh plate and bone graft with satisfactory results.
Adult ; Esthetics ; Eyelids ; Humans ; Male ; Masks ; Neurofibromatoses* ; Neurofibromatosis 1 ; Orbit ; Prostheses and Implants ; Titanium ; Transplants

No abstract available.
Anterior Cruciate Ligament* ; Autografts* ; Polyethylene*

PURPOSE: In addition to regulating calcium and phosphorus homeostasis and bone metabolism, vitamin D is known as an immune modulator. Recently, there has been increased worldwide interest in the association between low levels of vitamin D and allergic diseases. The purpose of this study was to assess the relationship between serum vitamin D levels and allergic/vasomotor rhinitis (AR/VR) in children. METHODS: This study included 164 patients. The sample included 59 patients with AR, 42 patients with VR, and 63 controls. Their ages ranged from 0 to 16 years. We examined the levels of 25-hydroxyvitamin D, Immunoglobulin E, specific IgE, and eosinophil cationic protein; peripheral blood eosinophil count; and the results of a skin prick test. RESULTS: Serum 25-hydroxyvitamin D levels were 19.0+/-8.5 ng/mL in the AR group, 25.5+/-10.9 ng/mL in the VR group, and 26.9+/-10.7 ng/mL in the control group. After adjustment for body mass index and season at the time of blood sampling, vitamin D levels in the AR group were lower than those of the VR group (P=0.003) and control group (P<0.001). Vitamin D levels were inversely correlated with Immunoglobulin E levels (r=-0.317, P<0.001). AR patients with food allergy or atopic dermatitis did not have lower levels of 25-hydroxyvitamin D than AR patients without these diseases. CONCLUSION: This study demonstrates a possible relationship between vitamin D levels and allergic rhinitis in Korean children.
Body Mass Index ; Calcium ; Child* ; Dermatitis, Atopic ; Eosinophil Cationic Protein ; Eosinophils ; Food Hypersensitivity ; Homeostasis ; Humans ; Immunoglobulin E ; Immunoglobulins ; Metabolism ; Phosphorus ; Rhinitis ; Rhinitis, Vasomotor* ; Seasons ; Skin ; Vitamin D* ; Vitamins*

PURPOSE: This study describes the experience of using multiple types of visual educational tools in the setting of problem-based learning (PBL). The author intends to demonstrate their roles in diverse and efficient ways of clinical reasoning and problem solving. METHODS: Visual educational tools were introduced in a lecture that included their various types, possible benefits, and some examples. Each group made one mechanistic case diagram per week, and each student designed one diagnostic schema or therapeutic algorithm per week, based on their learning issues. The students were also told to provide commentary, which was intended to give insights into their truthfulness. Subsequently, the author administered a questionnaire about the usefulness and weakness of visual educational tools and the difficulties with performing the work. Also, the qualities of the products were assessed by the author. RESULTS: There were many complaints about the adequacy of the introduction of visual educational tools, also revealed by the many initial inappropriate types of products. However, the exercise presentation in the first week improved the level of understanding regarding their purposes and the method of design. In general, students agreed on the benefits of their help in providing a deep understanding of the cases and the possibility of solving clinical problems efficiently. The commentary was helpful in evaluating the truthfulness of their efforts. Students gave suggestions for increasing the percentage of their scores, considering the efforts. CONCLUSION: Using multiple types of visual educational tools during PBL can be useful in understanding the diverse routes of clinical reasoning and clinical features.
Humans ; Learning ; Problem-Based Learning ; Surveys and Questionnaires

No abstract available.
Pseudohypoaldosteronism*

In this study, the trypsin gene (bgtryp-1) from the German cockroach, Blattella germanica, was cloned via the immunoscreening of patients with allergies to cockroaches. Nucleotide sequence analysis predicted an 863 bp open reading frame which encodes for 257 amino acids. The deduced amino acid sequence exhibited 42-57% homology with the serine protease from dust mites, and consisted of a conserved catalytic domain (GDSGGPLV). bgtryp-1 was determined by both Northern and Southern analysis to be a 0.9 kb, single-copy gene. SDS-PAGE and Western blotting analyses of the recombinant protein (Bgtryp-1) over-expressed in Escherichia coli revealed that the molecular mass of the expressed protein was 35 kDa, and the expressed protein was capable of reacting with the sera of cockroach allergy patients. We also discussed the possibility that trypsin excreted by the digestive system of the German cockroach not only functions as an allergen, but also may perform a vital role in the activation of PAR-2.
Allergens/analysis/chemistry/*genetics ; Amino Acid Sequence ; Base Sequence ; Blattellidae/*genetics ; Blotting, Western ; Catalytic Domain/genetics ; DNA, Complementary/genetics ; Escherichia coli/metabolism ; Female ; *Genes, Insect ; Humans ; Male ; Molecular Sequence Data ; Molecular Weight ; Receptor, PAR-2/metabolism ; Recombinant Proteins/analysis/biosynthesis/chemistry ; Research Support, Non-U.S. Gov't ; Sequence Alignment ; Sequence Homology, Amino Acid ; Trypsin/analysis/chemistry/*genetics

No abstract available.
Child* ; Humans ; Seizures, Febrile*

Backgrounds: End-tidal CO2 (PETCO2) monitoring is becoming one of essential respiratory monitoring systems during anesthesia. In this study, the differences between PETCO2 values measured from the 4 different sites were evaluated. METHODS: Healthy adult patients were studied (n=30). During N2O-O2-Enflurane anesthesia, PETCO2 was measured from the 4 possible monitoring sites, 3 from the breathing circuit and 1 from the monitoring lumen site of the specialized endotracheal tube connected to the distal endotracheal tube. After intubation, repeated PETCO2 measurements at 15mins (T15), 30mins (T30), 60mins (T60) and 90mins (T90) and ABGAs at T30 and T90 were done and the differences between arterial Pco2 and PETCO2 (P (a-ET)CO2) were calculated. In addition, to study the effect of changing fresh gas flow rate upon the PETCO2 values, PETCO2 measurements were done by varying the total gas flow rate from 4 L/min to 2 L/min to 6 L/min at T60. RESULTS: The Y-connector area (PETCO2- (1)) showed the lowest PETCO2 value, the elbow connector (PETCO2- (2)) and heat-moisture exchanger (PETCO2- (3)) areas, the intermediate, and the distal endotracheal site (PETCO2- (4)), the highest. The difference between the most proximal and distal sites was varied 2.4 to 3.0 mmHg and not statistically significant. PETCO2 values showed significant decreasing trend with time at each site (p<0.05). At T30 and T90, PaCO2 was not significantly different from PETCO2- (4) but significantly different from PETCO2- (1), (2), (3). The effect of changing fresh gas flow rate upon the amount of PETCO2 values of the different sites was not statistically significant. CONCLUSION: PaCO2 was significantly different from PETCO2 values measured from the breathing circuit sites but not significantly different from those measured from the distal endotracheal tube. It might be said that we have to pay special attention to these differences if we want to estimate real P (a-ET)CO2 difference.
Adult ; Anesthesia ; Elbow ; Humans ; Intubation ; Respiration

A Comparative study was retrospectively performed with 374 infants in order to find protective effect of breast feeding for infection. This study shows that breast feeding protect infant against gastrointestinal and respiratory infection. Breast feeding offers advantage by reducing gastraintestinal and respiratory infection when they should maintain breast feeding for at least three months. 1) First year morbidity increased with extent of artificial feeding and was nearly two fold for babies not breast-fed. 2) Prescence of older sibling, low birth weight and male sex are associated with increased morbidity. 3) Infant illness from 0~3 months, 4~6 months, 7~10 months, 11~12 moths was analyzed. Compared with the 108 bottle fed babies, the babies who had been partially (40) or fully (136) breast fed had significantly lower rate of gastrointestinal illness at 7~10 month (p<0.05), 11~12 month (p<0.005) and respiratory illness at 7~10 month (p<0.05). 4) Between the early weaning group (90) and the bottle group (108) showed no siggnificant difference. 5) Among the babies observed throughout the first year of life, 35 (9%) and 46 (12) were admitted to hospital with gastrointestinal and respiratory infection. Babies who were breast fed for more than 3 month had significant lower rate for hospital admission due to gastrointestinal and respiratory infection when compared with bottle fed babies. Breast feeding durning more than 3 month of life confers protection against gastrointestinal and respiratory infection.
Breast Feeding* ; Breast* ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Male ; Moths ; Nutritional Support ; Retrospective Studies ; Siblings ; Weaning

Cis A2B3 is a rare blood type with unusual inheritance pattern of A2, B3 genes on the same chromosome in contradiction to the general Mendelian pattern. Unlike the AB blood type, cis A2B3 shows weaker B antigenicity and unexpectedly has moderate amount of anti-B antibody in serum. Thus it has the potential of misidentification as blood type A or AB and the possibility of acute major transfusion reaction from transfusion of the usually known AB blood group RBCs. This is a case report of anesthetic management of one patient with his blood type discovered as cis A2B3 preoperatively. During hip surgery he received 2 units of washed O RBCs without any problems. I report the anesthetic experience with a brief review of literature.
Blood Group Incompatibility ; Hip ; Humans ; Inheritance Patterns