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

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

Serotonin syndrome is an unexpected fatal adverse event related to serotonergic medication. This case report is the first report describing the possible treatment effect of famotidine on serotonin syndrome. Furthermore, this is the first case report of serotonin syndrome induced by meperidine alone in a patient with no previous history suggesting a susceptibility to serotonin syndrome. A 70-year-old male with no recent history of serotonergic drug use presented with severe serotonin syndrome following ureteroscopy, possibly due to postoperative meperidine administration. The patient's symptoms included hypertension, tachycardia, tachypnea, hyperthermia, myoclonus, diaphoresis, retching, nausea, agitation, and semicoma mentality with no pupillary light reflex. Symptoms began to subside immediately after the administration of intravenous famotidine for prevention of aspiration pneumonia, with mental and neurological symptoms showing improvement initially, followed by autonomic symptoms. This case report suggests that the histamine type 2 receptor antagonist famotidine may be an effective emergency treatment for serotonin syndrome.
Aged ; Dihydroergotamine ; Emergency Treatment ; Famotidine ; Fever ; Histamine ; Histamine H2 Antagonists ; Humans ; Hypertension ; Male ; Meperidine ; Myoclonus ; Nausea ; Pneumonia, Aspiration ; Reflex ; Serotonin Syndrome* ; Serotonin* ; Tachycardia ; Tachypnea ; Ureteroscopy

Serotonin syndrome is an unexpected fatal adverse event related to serotonergic medication. This case report is the first report describing the possible treatment effect of famotidine on serotonin syndrome. Furthermore, this is the first case report of serotonin syndrome induced by meperidine alone in a patient with no previous history suggesting a susceptibility to serotonin syndrome. A 70-year-old male with no recent history of serotonergic drug use presented with severe serotonin syndrome following ureteroscopy, possibly due to postoperative meperidine administration. The patient's symptoms included hypertension, tachycardia, tachypnea, hyperthermia, myoclonus, diaphoresis, retching, nausea, agitation, and semicoma mentality with no pupillary light reflex. Symptoms began to subside immediately after the administration of intravenous famotidine for prevention of aspiration pneumonia, with mental and neurological symptoms showing improvement initially, followed by autonomic symptoms. This case report suggests that the histamine type 2 receptor antagonist famotidine may be an effective emergency treatment for serotonin syndrome.
Aged ; Dihydroergotamine ; Emergency Treatment ; Famotidine ; Fever ; Histamine ; Histamine H2 Antagonists ; Humans ; Hypertension ; Male ; Meperidine ; Myoclonus ; Nausea ; Pneumonia, Aspiration ; Reflex ; Serotonin Syndrome* ; Serotonin* ; Tachycardia ; Tachypnea ; Ureteroscopy

This study investigated the status and evaluated factors associated with knowledge and attitudes regarding pediatric concussions among Korean parents of children aged 6 to 18 years. Methods A cross-sectional online survey was employed to collect data from a panel of parents in Korea in 2023. To assess knowledge and attitudes regarding concussions, participants completed a validated questionnaire. The outcome variables of total knowledge score (range, 0–30) and total attitude score (range, 7–49) were categorized into tertiles. We conducted multivariable ordinal logistic regression analyses with participants and their children based on demographic information and characteristics as covariates. Results A total of 260 parents responded to the survey and demonstrated moderate concussion-related knowledge (median total score, 21; interquartile range [IQR], 18–22.5). The respondents exhibited favorable attitudes toward concussions (median total score, 39; IQR, 34–43), except the attitude of the importance of reporting concussion. Multivariable ordinal regression analysis for outcomes revealed only career of healthcare provider (adjusted odds ratio, 3.15; 95% confidence interval, 1.13–8.75) to be associated with parental concussion-related knowledge. No factors exhibited a significant association with parental attitudes toward concussions. Conclusion Our results confirmed the knowledge-attitude gap regarding pediatric concussions among Korean parents. Effective strategies are warranted to improve parental knowledge and attitudes.

This study investigated the status and evaluated factors associated with knowledge and attitudes regarding pediatric concussions among Korean parents of children aged 6 to 18 years. Methods A cross-sectional online survey was employed to collect data from a panel of parents in Korea in 2023. To assess knowledge and attitudes regarding concussions, participants completed a validated questionnaire. The outcome variables of total knowledge score (range, 0–30) and total attitude score (range, 7–49) were categorized into tertiles. We conducted multivariable ordinal logistic regression analyses with participants and their children based on demographic information and characteristics as covariates. Results A total of 260 parents responded to the survey and demonstrated moderate concussion-related knowledge (median total score, 21; interquartile range [IQR], 18–22.5). The respondents exhibited favorable attitudes toward concussions (median total score, 39; IQR, 34–43), except the attitude of the importance of reporting concussion. Multivariable ordinal regression analysis for outcomes revealed only career of healthcare provider (adjusted odds ratio, 3.15; 95% confidence interval, 1.13–8.75) to be associated with parental concussion-related knowledge. No factors exhibited a significant association with parental attitudes toward concussions. Conclusion Our results confirmed the knowledge-attitude gap regarding pediatric concussions among Korean parents. Effective strategies are warranted to improve parental knowledge and attitudes.

This study investigated the status and evaluated factors associated with knowledge and attitudes regarding pediatric concussions among Korean parents of children aged 6 to 18 years. Methods A cross-sectional online survey was employed to collect data from a panel of parents in Korea in 2023. To assess knowledge and attitudes regarding concussions, participants completed a validated questionnaire. The outcome variables of total knowledge score (range, 0–30) and total attitude score (range, 7–49) were categorized into tertiles. We conducted multivariable ordinal logistic regression analyses with participants and their children based on demographic information and characteristics as covariates. Results A total of 260 parents responded to the survey and demonstrated moderate concussion-related knowledge (median total score, 21; interquartile range [IQR], 18–22.5). The respondents exhibited favorable attitudes toward concussions (median total score, 39; IQR, 34–43), except the attitude of the importance of reporting concussion. Multivariable ordinal regression analysis for outcomes revealed only career of healthcare provider (adjusted odds ratio, 3.15; 95% confidence interval, 1.13–8.75) to be associated with parental concussion-related knowledge. No factors exhibited a significant association with parental attitudes toward concussions. Conclusion Our results confirmed the knowledge-attitude gap regarding pediatric concussions among Korean parents. Effective strategies are warranted to improve parental knowledge and attitudes.

Subacute thyroiditis is a self-limiting inflammation of the thyroid, presenting with painful thyroid swelling, thyrotoxicosis and low radioactive iodine uptake. The characteristic US findings for this disease are focal ill-defined hypoechoic areas in one lobe or diffuse hypoechoic areas in both lobes. Thyroid carcinomas should be included in the differential diagnosis for a lesion with focal hypoechoic areas and have been rarely reported to coexist with subacute thyroiditis. Takayasu's arteritis is an autoimmune disease that affects the aorta and its branches as well as pulmonary arteries. Subacute thyroiditis associated with Takayasu's arteritis is extremely rare, with only three cases being reported. We report here on the first case with the simultaneous diagnosis of subacute thyroiditis, papillary thyroid carcinoma and Takayasu's arteritis.
Aorta ; Autoimmune Diseases ; Carcinoma ; Diagnosis, Differential ; Inflammation ; Iodine ; Pulmonary Artery ; Takayasu Arteritis ; Thyroid Gland ; Thyroid Neoplasms ; Thyroiditis, Subacute ; Thyrotoxicosis

BACKGROUND: Abdominal pain is a common complaint seen at emergency centers. Various diseases can cause abdomin al pain making it difficult to make a correct diagnosis. In the elderly, however, the consequences of an incorrect or delayed diagnosis can be more critical. We investigated the accuracy of initial diagnoses in the emergency center and analyzed the associations among medical factors including age. METHODS: We compared the ICD 10 codes of initial diagnoses to the codes of final diagnoses, defined the 'degree of agreement' using a 5 point scale, and classified patients into 'high degree of agreement' or 'low degree of agreement' groups. According to the severity of illness, we classified patients as 'admission' or 'out patient follow up'. According to their illness, we classified them as 'surgical' or 'medical'. According to age, we classified them as 'elderly' or 'adult'. Finally, we analyzed the statistical significance of each association. RESULTS: Overall, admitted patients and surgical diagnoses had higher degrees of agreement. 'Elderly' patients had no significant difference in 'degree of agreement' from 'adult' patients. CONCLUSION: Among patients presenting with acute abdominal pain to the emergency center, the degree of agreement between initial diagnosis and final diagnosis is dependent on the diagnostic characteristics of the disease, and not on the age of the patients. Further studies on the diagnostic accuracy of individual diseases are needed. Additional diagnosis associated variables, for example comorbidity and prognosis, needs to be studied regarding relationship to diagnostic accuracy.
Abdominal Pain ; Aged ; Comorbidity ; Delayed Diagnosis ; Emergencies ; Humans ; Prognosis