The orbitozygomatic area occupies a key anatomic position in midface, is prone to injury, and plays a prominent role in facial aesthetics. So the facial appearance including orbital shape can be altered by complications of orbitozygomatic fractures. Most possible initial complications include blindness, hyphema, retinal detatchment, and paralysis or entrapment of extraocular muscles. Long term sequelaes include infraorbital nerve dysfunction, loss of malar projection, enophthalmos, and dystopia. Accurate anatomic reduction and rigid fixation is essential for management of orbitozygomatic fractures to minimize those late sequelaes. Conventional fixation devices to fix displaced fracture of facial bone are interosseous wire and miniplate. But interosseous wirings are unstable for primary bone healing and time consuming. Miniplates have great deal in rigid fixation but their high profile and palpability are the main complaints in many patients, especially in orbital rim area. In this article, we reviewed the 30 cases of zygomamaxilla complex fractures with orbital rim fracture fixed with microplates, and discussed the stability of microplate and superiorities in final aesthetics result. The use of microplates in these area permits enough stability of fracture segment with ease of procedures and superiorities in final results without any palpability.
Blindness ; Enophthalmos ; Esthetics ; Facial Bones ; Humans ; Hyphema ; Muscles ; Orbit* ; Paralysis ; Retinaldehyde

No abstract available.
Heart* ; Thoracic Surgery*

The recent development of microsurgical tissue transfer has enabled any defect in any area to be reconstructed with free flaps. However, the need for a more functional and thinner flap has been raised due to bullkiness of the flap and donorsite morbidity. For better functional and aesthetic results, various perforator flaps excluding muscles or adjacent subcutaneous tissue have been recently reported. We report 44 cases of perforating artery pedicled flaps from April 1995 to August 1998, including 21 cases of anterolateral thigh flap, 12 cases of gluteal artery perforator flap, 4 cases of posterior interosseous flap, and 7 cases of paraumbilical perforator flap for various soft tissue defects. Even though marginal necrosis of flap occurred in 9 cases, complete healing without significant problem was possible. The advantages of perforator flaps are as follows: 1. It is possible to obtain a relatively thin fasciocutaneous flap, but still with sufficient volume 2. Donor site morbidity was reduced without damage of main artery. 3. In spite of diverse vascular pattern of the perforator, the location of perforating arteries can be Detected with relative ease and mapped preoperatively with an ultrasound Doppler. The need of meticulous and tedious dissection could be a sole disadvantage of these flaps. This report describes the clinical experience with a perforator-based flap, anticpating applications of many other types of perforator flap in the future.
Arteries* ; Free Tissue Flaps ; Humans ; Muscles ; Necrosis ; Perforator Flap ; Subcutaneous Tissue ; Surgical Flaps* ; Thigh ; Tissue Donors ; Ultrasonography

No abstract available.
Abscess*

No abstract available.
Clubfoot*

The spine is the most common site of metastatic cancer in the skeletal system. Managment of the lesion site due to the relation of the spinal cord or nerve root and post-operative treatment present coplicated and difficult problems. One hundred and ninety-three cases of metastatic cancer of the spine were seen and treated during the 5 year period from January 1981 to December 1985 in the Department of Orthopedic Surgery, Severance Hospital Yonsei University, College of Medicine in Seoul, Korea. This study was based on the clinical symtoms, radiological studies, laboratory studies, and tissue pathology of selected cases. Most of cases were treated by chemotherapy, radiation therapy, and hormonal therapy in selected terminal cases. In cases of intractable pain and neurological deficit, surgical intervention is advocated for relief of pain and to improve nursing care and daily activity. Unfortunately in Korea most patients and families refuse surgical intervention, the main reason being that surgery can not cure the disease itself. The results of the study lead us to conclude that; The incidende of spinal metastasis was 31.8% of the metastatic lesions of all skeletal systems, and was almost equally distributed in males and females l. 14: l. The primary site of the tumor was in decreasing order lung (25.9%), breast(9.8%), cervix of the uterus(6.7%), stomach(5.7%), liver(5.3%), kidney(3.7%), thyroid(3.7%), prostate(2.6%), bladder(2.6%), rectum(2.0%), ovary(1.0%), pancreas(1.0%), skin(1.0%), colon(0.5%), larynx(0.5%), and unknown origins (27.5 %). The peak age of the patient was the 7th decade in males and the 6th decade in females. The prominent clinical symtom was diffuse back pain (79.0%) which was characteristically worse in a resting position especially at night. The most significant laboratory finding was an elevated serum alkaline phosphatase in 28% of the cases. The predilection site of metastasis was the thoraco-lumbar junction. Diagnostically a whole body bone scan was more sensitive than a plain film.
Alkaline Phosphatase ; Back Pain ; Cervix Uteri ; Drug Therapy ; Female ; Humans ; Korea ; Lung ; Male ; Neoplasm Metastasis ; Nursing Care ; Orthopedics ; Pain, Intractable ; Pathology ; Seoul ; Spinal Cord ; Spine

OBJECTIVES: This study was conducted to investigate whether air pollution levels in Seoul have short term effects on respiratory disease outpatients. METHODS: We analyzed five air pollutants (CO, NOy, Oy, SOp, PMyp) and daily counts of outpatient for respiratory disease divided by age group ((15yrs, 15-64yrs, 65+yrs) during the period of July 1997-June 1998 using Generalized Additive Model(GAM). RESULTS: After controlling for seasonal trends, day of the week, week of the month, temperature and humidity, CO (RR=1. 041 ~ l. 051, 0-day lag) and NOy (RR=1. 024~1. 050, 3-day lag) were significantly associated with daily counts for respiratory disease in all age groups. 0, and SO, were associated, with a 3-day lag in the age group under 15 years (O RR=1. 047, 95% CI=1. 045- 1. 049 i SOp RR=1. 018, 95% CI=1. 017- l. 020) and with a 0-day lag in the age group 15 to 64 years (0, RR=1. 035, 95% CI=1. 032-1. 037; SO, RR=1. 037, 95% CI=1. 035-1. 039), in the age group over 65 years (O RR=1. 042, 95% CI=1. 033-1. 051; SO RR=1.029, 95% CI=1.022-1.036). PM was weakly associated, with a 1-day lag in the age group under 15 years (RR=1.011, 95% CI=1.010-1.013) and with a 0-day lag in the age group 15 to 64 years (RR=1. 021, 95% CI=1. 019-1. 023), in the age group over 65 years (RR=1. 025, 95% CI=1. 018-1. 032). In the two pollutant model, the magnitudes of the relative risk for CO, NOy and Oq were maintained, but SOy was not associated with daily counts for respiratory disease in the age group under 15 years after controlling for NO,. PMyp was not associated in all age groups after controlling for CO, so the association with PMyp in the single pollutant model might be confounded by CO. In this study, the impact Of PMyp on the respiratory disease was not large as compared with other pollutants. CONCLUSIONS: Air pollution in Seoul may increase the incidence of the respiratory disease, so more positive attention for the control of air pollution should be paid.
Air Pollutants* ; Air Pollution ; Humans ; Humidity ; Incidence ; Outpatients* ; Seasons ; Seoul*

BACKGROUND: Moyamoya disease is a chronic cerebrovascular disorders in which stenosis of the major arteries of the circle of Willis at the base of the skull progresses to occlusion. We observed two kinds of collateral pathways from the extracranial to the intracranial arteries. Also we evaluated clinlcal and neuroimaging features of moyamoya disease to give on aid in diagnosis. METHODS: We analysed 17 patients with moyamoya disease through the medical record and neuroimaging (conventional angiography and/or MR angiography) review. Six out of 17 patients were children(< OR =15 years) and the other 11 patients were adults(15 years). There were 8 males and 9 females. RESULTS: In our result, moyamoya disease was more common in the adult. There was bimodal age distribution, so average age of onset in children was 8-year-old and in adult 37-year-old. Common clinical features are seizure (66%), TIA (17%), and psychotic behavior (17%) in childrens and hemorrhages (73%), infarction (18%), seizures (9%) in adults. According to angiographic staging classification of Suzuki et al. (1967), our cases showed distribution of stage I (13%), stage II (8.8%), stage III (65.3%), stage IV (4.3%), stage V (4.3%), stage VI (4.3%). In collateral vessels of moyamoya disease, there were 7 cases of ethmoidal moyamoya, 3 of vault moyamoya and 1 of mixed form. It is interesting that there were five cases of unilateral moyamoya disease and one case had pseudoaneurysm. CONCLUSION: According to our results, we may say that seizures are common in the children and hemorrhages are in the adult. Unilateral moyamoya were mainly occurred in the adult. Ethmoidal collaterals were common among collaterals and stage III had a more cases than others in our neuroimaging data. These clinical and neuroimaging data may help interpretation and diagnosis of moyamoya disease.
Adult ; Age Distribution ; Age of Onset ; Aneurysm, False ; Angiography ; Arteries ; Cerebrovascular Disorders ; Child ; Circle of Willis ; Classification ; Constriction, Pathologic ; Diagnosis ; Female ; Hemorrhage ; Humans ; Infarction ; Male ; Medical Records ; Moyamoya Disease* ; Neuroimaging* ; Seizures ; Skull

OBJECTIVES: The purpose of this study is to examine whether the neurocognitive deficits of schizophrenia may be associated with certain features of symptomatology or a stable vulnerability of disease itself. METHOD: The 42 schizophrenic patients and 35 matched normal controls with sex, age, and education level were examined for their sustained attention, sensory register, executive function, concentration and attention, and verbal memory and learning in the acute and remitted stages of schizophrenia using Degraded Stimulus Continuous Performance Test, Span Apprehension Task, Wisconsin Card Sorting Test, Digit Span, and Rey Auditory Verbal Learning Test, respectively. RESULTS: The schizophrenic patients showed significant deficits in the sustained attention, sensory register, executive function, and verbal memory and learning compared with the normal controls in both acute and remitted stages of schizophrenia. Regarding the concentration and attention, the schizophrenic patients showed significant deficits in the backward digit span compared with the normal controls during acute stages, but there was no difference between two groups in the forward and backward digit span during remitted stages. No difference was evident in the sustained attention, sensory register, executive function, and verbal memory and learning between acute and remitted stages of schizophrenia. But the forward and backward digit span of schizophrenic patients showed significant improvement in the remitted stages compared with acute stages. CONCLUSIONS: The sustained attention and sensory register deficits in the visual information processing associated with schizophrenia, detected by high-processing-load version of the Degraded Stimulus Continuous Performance Test and Span Apprehension Task, are highly possible to be stable vulnerability indicators. Executive functioning deficit in the schizophrenic patients detected by Wisconsin Card Sorting Test is not likely to be dependent on symptoms, so it is difficult to conclude that it is a stable vulnerability indicators of schizophrenia. In the digit span task, the forward digit span is more likely to be a episodic indicator but the backward digit span is likely to be a mediating vulnerability indicator. And the forward and backward digit span tasks seem to be tap different cognitive abilities that are differentially associated with the diathesis for schizophrenia. Some forms of the verbal memory and learning deficits associated with schizophrenia appear to be a stable vulnerability indicators.
Automatic Data Processing ; Disease Susceptibility ; Education ; Executive Function ; Humans ; Learning ; Memory ; Negotiating ; Schizophrenia* ; Verbal Learning ; Wisconsin

OBJECTIVES: In order to establish prevalence and characteristics of tinnitus and hearing thresholds according to tinnitus, this study was carried out. METHODS: Nine hundred and thirty two subjects, undergone human dock or general health check-up and been in college, were surveyed to the questionnaire on the general characteristics, past medical histories, life styles, subjective symptoms about hearing, taking ototoxic drugs and were conducted on the hearing thresholds by pure tone audiometry. RESULTS: Of the total population, 98 reported tinnitus, giving an overall prevalence of 10.5%, prevalence of tinnitus in the subjects with the factors infuencing hearing thresholds were 17.4 %, prevalence without the factors influencing hearing thresholds were 7.5 %. Frequency of tinnitus of the total population was the highest in 'once per several months'(39.6 %) and followed by' once per several days'(29.7 %), 'all day long'(16.5 %) and' several times per day'(14.3 %). Complaint site of tinnitus was 41.8 % in left ear or right ear 39.6 % in both ear and 18.7 % in head. The 13.6% of the total subjects complained sleep disturbance. Hearing thresholds in the subjects without the factors influencing hearing thresholds tended to increase or decrease in 20 and 30 years old according to tinnitus, but those with, tinnitus tended to increase more than chose without tinnitus in 40 and 50 years old. CONCLUSIONS: Results also provide evidence that reports of tinnitus at the time of annual audiometric testing may be useful in identifying workers at greater risk for developing significant shifts in hearing thresholds. Awareness of the possible occurrence of tinnitus may encourage worker to cooperate more actively in a company hearing conservation programme.
Adult ; Audiometry ; Ear ; Head ; Hearing* ; Humans ; Life Style ; Middle Aged ; Prevalence* ; Questionnaires ; Tinnitus*