The nasal tip of the Asian is characterized by a bulbous appearance due to thick and tense skin. flaring of nostrils, and a short nasal tip projection due to underdevelopment of alar cartilages and retruded columella. Conventional augmentation rhinoplasty using silicone implant which has been routinely performed at the Asian nose has its limitations. Over the past 2 years, a total 33 patients, aged 19 to 47 years(mean 29 years) underwent open rhinoplasty to correct columellar retraction, to lengthen the nose and to improve the appearance of the nasal tip using columellar strut in conjunction with augmentation with silicone dorsal implant. The columellar strut for control of columellar shape is optimally constructed from 0.85 mm thickness porous polyethylene(Medpor)sheet. The columellar strut is placed between the medical crura and fixed to the caudal septum. With the strut stabilized, each medial crus is advanced to the desired position. The fixation sutures are placed at 3 points: the dormal segment of the middle crus, the junction of the middle and medial crus, and the junction of the columellar segment and the footplate segment of the medial crus of the alar cartilage. Twenty-five surface measurements based on the works of Farkas included 9 singles and 5 paired lengths, and 3 angles indirectly taken from the surface of the nasal stone model. The preoperative measurements were compared with those of the postoperative. The mean follow up period was 17 months(15-24 months). The analysis of the results was conducted using Wilcoxan matched-pairs signed-ranks test.The nose length, the nasal tip protrusion, the alar length, the alar half arc, the columellar length, the nostril length, and the alar rim-columellar length were significantly increased. The intercanthal distance, the nose width, the nostril width, and the upper lip length were significantly decreased. The nasolabial angle was also significantly increased. Good to excellent asethetic results were noted in all patient, although one patient did experience mild deviation of a columella. No extrusions occurred. Using the control columellar polyethlene strut, the retracted columella was advanced, the tip was projected, the nose was lengthened, and the nostril were narrowed and elongated. This technique is valuable in the rhinoplasty patient was has retracted columellar, short nose and long upper lip.
Asian Continental Ancestry Group ; Cartilage ; Follow-Up Studies ; Humans ; Lip ; Nose ; Polyethylene* ; Rhinoplasty ; Silicones* ; Skin ; Sutures ; Transcutaneous Electric Nerve Stimulation

A retrospective study was performed on 64 patients who underwent orbital blow-out fracture reconstruction with autogenous or Medpor implant following blunt facial trauma between 1992 and 1997. Hospital records were reviewed especially for preoperative and postoperative diplopia, enopthalmos and extraocular muscle movement limitations between the autogenous material group and Medpor implant group. The autogenous material used was mostly conchal cartilage graft. The average follow-up period was 36 months with a range of 5 to 64 months. There was no significant statistical difference between both groups on incidence of postoperative complications of diplopia, enophthalmos and extraocular muscle movement limitations. Postoperative infection, ectropion, implant extrusion and migration were absent in both groups. The use of Medpor implant for orbital blow-out fracture reconstruction was associated with a low incidence of complication. In addition, the Medpor implant is readily available, easy to use, cut, contour, position, fixate and has no potential for graft resorption, and precludes the need to harvest an autogeneous graft. In conclusion, Medpor is a stable and reliable substitute for autogeneous graft reconstruction of the orbital blow-out fracture.
Cartilage ; Diplopia ; Ectropion ; Enophthalmos ; Follow-Up Studies ; Hospital Records ; Humans ; Incidence ; Orbit* ; Orbital Fractures ; Polyethylene* ; Postoperative Complications ; Retrospective Studies ; Transplants

Osseointegrated alloplastic ear reconstruction has revolutionized ear prosthetic retention. In this report, we evaluate the results of indirect osseointegration using the Epitec system and discuss the degree of the most serious side effect of this system, the adverse skin reactions close to osseointegrated implant post. During a three year period, Osseointegrated prosthetic ear reconstruction was performed to twenty eight patients with microtia(n = 25) and traumatic ear loss(n = 3), 22 males and 6 females aged from 6 to 43 years(mean 18.2 years). The patients, including 12 children, were treated with 58 titanium implant posts of Epitec system. These were inserted into a 3-dimensional carrier-plate which were fixed to the mastoid process with 7 to 12(mean 9.2) screws. Each patient was operated in a one-stage procedure. Two months of osseointegration of the screws was followed by fabrication of the ear prostheses. All implants were stable after follow-up at 20 to 31 months(mean 24.6 months). Fifty four of the 58 implants showed no sign of skin reactions (93.1 percent: 83.3 percent for children; 100 percent for adult). Hypertrophy of soft tissue surrounding the implants were observed only in children(2 out of 12 treated children) and did not recur after subcutaneous reduction and compressive dressing.In adults, the results of the Epitec system are very satisfactory. Use of the Epitec system in children is also promising because hypertrophy of soft tissue surrounding the implants are successfully managed. In addition, the 3-dimensional carrier-plate is well osseointegrated with bone screws and stability of the carrier-plate is reinforced by osseous covering of the thin bars of the carrier-plate by appositional bone growth of the skull.
Adult ; Bone Development ; Bone Screws ; Child ; Ear* ; Female ; Follow-Up Studies ; Humans ; Hypertrophy ; Male ; Mastoid ; Osseointegration* ; Prostheses and Implants* ; Skin ; Skull ; Titanium

PURPOSE: This study was conducted to identify the pain characteristics, family support and physical functioning and to determine predictors of the quality of life in aged women with chronic pain. METHOD: The questionnaires were collected through direct interview by a trained research assistant from July 2 to August 24, 2001. Subjects were 108 women clients with chronic pain over 65 years of age. Data analyzed frequency, percentage, mean, Pearson's correlation, ANOVA and stepwise multiple regression by SAS. RESULT: Care providers were mostly spouses and daughters in law. Care providers who took care of elderly for a few hours a day had the highest percentile. Aged women had persistently had chronic pain of moderate intensity and was moderately satisfied with pain management. The mean score of disability due to pain was 3 on a 10 point scale. The mean scores of physical function and quality of life were moderate and there were negative correlations between pain characteristics, physical functioning, and quality of life at the range from r=-.46 to r=-.83. Satisfaction with care, duration of pain, disability due to pain, and physical functioning accounted for 56% of the variance in perceived quality of life for aged women with chronic pain. Disability due to pain was the most predictable variable of quality of life and physical function was the second . CONCLUSION: The results suggest that care by family, education in pain control, prevention of disability, and maintenance of physical function are important to improve and maintain quality of life in aged women with chronic pain. Therefore, there is a need for program development that enhance family support and nursing intervention that focuses on active pain control.
Aged ; Chronic Pain* ; Education ; Family Characteristics ; Female ; Humans ; Jurisprudence ; Nuclear Family ; Nursing ; Pain Management ; Program Development ; Quality of Life* ; Surveys and Questionnaires ; Spouses

Despite increased utilization of microvascular anastomotic coupler (MAC) devices, the consequences have yet to be fully explored in terms of vascular regeneration. Removal of an exposed venous coupler is described herein, documenting normal circulatory flow through the remodeled site of application. A 25-year-old man who underwent open reduction and rigid fixation elsewhere for traumatic calcaneal fracture ultimately presented with a necrotic postoperative wound. The debrided defect was treated by free thigh perforator flap, incorporating a MAC device. Three months later, the flap remained viable, but the MAC itself was exposed. Structural integrity of the vessel and blood flow were sustained as the device was carefully removed, confirming true vascular remodeling in this example of MAC usage.
Adult ; Humans ; Perforator Flap ; Regeneration ; Thigh ; Wounds and Injuries

PURPOSE: The purposes of this study were to identify the prevalence of postprandial hypotension (PPH) and risk factors for PPH in Korean elderly people. METHODS: A cross-sectional descriptive study was conducted with community dwelling and nursing home residents. The blood pressure of 162 adults aged 65 yr or older was measured before meal as a baseline and then at 15 min intervals from immediately after the meal through 90 min after the meal. Descriptive statistics and logistic regression with the SPSS WIN 14.0 program were used to analyze the data. RESULTS: The prevalence of PPH was 29% and the PPH occurred immediately after the meal continuously through 90 min after the meal. The biggest drop in systolic blood pressure occurred at 45 min after the meal. Risk factors for PPH were age, base line systolic blood pressure, and presence of cardiovascular disease. CONCLUSION: To prevent side effects of PPH such as falls and syncope, nurses should provide careful management of PPH and prohibit activities until at least 90 min after a meal. We also recommend that risk of PPH should be included in fall prevention guidelines for elderly people.
Aged ; Aged, 80 and over ; Blood Pressure ; Cardiovascular Diseases/complications ; Cross-Sectional Studies ; Demography ; Female ; Humans ; Hypotension/*epidemiology/etiology ; Korea ; Male ; Nursing Homes ; Postprandial Period ; Prevalence ; Risk Factors ; Time Factors

For correction of myopia, we had performed 247 cases of 8-incision radial keratotomy from July 1986 to Dec. 1987. Among them, we experienced one case of complicated cataract in 23 year old man. During the surgery, there were no surgical complications, including microperforation. Postoperative uncorrected V.A. was 0.9 at 1 day after surgery. At 2 days after surgery, V.A. decreased abruptly, and corneal edema, hypotony, severe iritis were noted. Although corneal edema and iritis were improved 10 days later, decreased V.A. and hypotony persisted. Posterior synechia, iris atrophy and posterior subcapsular cataract could be seen on follow-up examination. An intumescent cataract developed about 6 weeks after the surgery. Successful extracapsular cataract extraction was done about 11 months after the original radial keratotomy. Postoperative corrected V.A. was excellent.
Atrophy ; Cataract Extraction ; Cataract* ; Corneal Edema ; Follow-Up Studies ; Humans ; Iris ; Iritis ; Keratotomy, Radial* ; Myopia ; Young Adult

The purpose of this study was to develop and evaluate a nutrition education program to prevent breakfast skipping for elementary school children. Subjects were 102 5th grade students (51 boys, 51 girls) as the "education group" and 200 5th grade students (102 boys, 98 girls) as the "non-education group." The nutrition education program consisted of 4 lessons over an 8-week period. Teaching materials, including flash animation, panel, PowerPoint, and a bingo game, were developed for this education program. After education, there was significant increase in the percentage of students who had eaten breakfast every day, understood that breakfast has a great effect on health, and will eat breakfast every day in the education group compared to non-education group. Parents' positive behavior toward daily breakfast preparation and the percentage of parents who had their children eat breakfast every day increased significantly. The students of the education group responded positively to the questions of the benefit and importance of nutrition education. The flash animation received high marks, especially in terms of understanding of contents, content clarity, emphasis of the core content, delivery of necessary knowledge, and applicability of breakfast. This study shows the effectiveness of a 4-lesson nutrition education taught during an 8-week time period to induce changes in recognizing the importance of breakfast and in behavior toward breakfast consumption.
Breakfast ; Child ; Humans ; Parents ; Teaching Materials

Management of incisional scar is intimately connected to stages of wound healing. The management of an elective surgery patient begins with a thorough informed consent process in which the patient is made aware of personal and clinical circumstances that cannot be modified, such as age, ethnicity, and previous history of hypertrophic scars. In scar prevention, the single most important modifiable factor is wound tension during the proliferative and remodeling phases, and this is determined by the choice of incision design. Traditional incisions most often follow relaxed skin tension lines, but no such lines exist in high surface tension areas. If such incisions are unavoidable, the patient must be informed of this ahead of time. The management of a surgical incision does not end when the sutures are removed. Surgical scar care should be continued for one year. Patient participation is paramount in obtaining the optimal outcome. Postoperative visits should screen for signs of scar hypertrophy and has a dual purpose of continued patient education and reinforcement of proper care. Early intervention is a key to control hyperplastic response. Hypertrophic scars that do not improve by 6 months are keloids and should be managed aggressively with intralesional steroid injections and alternate modalities.
Cicatrix/*prevention & control/surgery ; Cicatrix, Hypertrophic/prevention & control ; Humans ; Keloid/prevention & control/radiotherapy ; Sebaceous Glands/physiology ; Skin/physiopathology ; Wound Healing

As the average life expectancy in Korea continues to rise, the number of elderly patients with pancreatobiliary disease is also expected to increase. Thus, it has been important to perform safe and quality-controlled endoscopic retrograde cholangiopancreatography in nowadays. However, there has been no standard educational programs of endoscopic retrograde cholangiopancreatography and quality control system, so Korean Pancreatobiliary Association has a plan to make credentialing organizations especially for pancreatobiliary certification. In this article, we would like to discuss the suitable framework and practical problems about the process and renewal of pancreatobiliary certification system.