Nowadays infracture technique for the zygomatic body and arch reduction has been popularized in North East Asians. Previously, we could obtain sufficient operative field to handle the zygoma through the intraoral and temporopreauricular incision, and control the amount of shaving and infracturing of zygomatic prominence. To reduce the length of the large temporopreauricular incision, we developed a technique using short 22 mm preauricular incision. We performed malar reduction with the technique in 91 cases from September, 2000 to June, 2001 using infracture technique through short 22 mm preauricular and intraoral incision. We performed posterior bony cutting on the zygomatic arch through the preauricular incision and anterior bony greenstick cutting through the intraoral incision. Then, lateral bulging of zygomatic arch was reduced with infrature and the posterior fractured ends were fixed with a microplate and 3 screws. Advantages of the technique are operative time saving, improved external scar and reduction of postoperative edema around the operative site. However, due to decreased operative field through small preauricular incision, shaving of the lateral portion of zygomatic body is limited and postoperative complications may occur such as asymmetry, undercorrection, overcorrection and incorrect contour lines. To overcome these, the correct understanding of the anatomy and much experience of operator are imperative. With this combined approach, we can sufficiently expose the zygomatic arch and body and change the lateral convex arch to a concave one. We can effectively perform the infracture technique through much smaller preauricular incision without resulting in a large and conspicuous external scar.
Asian Continental Ancestry Group ; Cicatrix ; Edema ; Humans ; Operative Time ; Postoperative Complications ; Zygoma

In North East Asians, they have many anatomical characteristics different from Caucasians: thick skin, heavy subcutaneous tissue, relatively weak SMAS and platysma muscle, prominent zygoma and mandible. In addition, Caucasians have lean and narrow face, so facial flap can easily be lifted superiorly and posteriorly, but North East Asians have short and wide face, so facial flap cannot be lifted easily in a three dimensional direction especially superiorly and posteriorly. Recent facial rejuvenation has been improved to solve these problems through various combined adjuvant surgery. We performed facial rejuvenation with following surgical emphases:1. Shaving and infracture of zygomatic prominence and multistaged curved osteotomy of the prominent mandibular angle, body and symphysis 2. Earlier Skin resection before flap dissection protects the skin incision margin 3. Sufficient fat removal by facial liposuction4. Plane of dissection; suborbicularis and submalar fat pad in midface: preplatysmal layer in lower face and neck 5. Excision of lateral part of orbicularis oculi muscle for correction of crow's feet. 6. SMAS plication and platysmal sling. Based on our experiences, we offer these personal techniques for facial rejuvenation of North East Asians.
Adipose Tissue ; Asian Continental Ancestry Group* ; Foot ; Humans ; Mandible ; Neck ; Osteotomy ; Rejuvenation ; Skin ; Subcutaneous Tissue ; Zygoma

OBJECTIVE: Endometriosis is a common and enigmatic disease affecting the reproductive life and health of women. Although the retrograde menstruation is a well established model for both transplantation and induction theories, the discrepancy between an incidence of retrograde menstruation and a prevalence for endometriosis suggests the possibility that the development and the progression of endometriosis is associated with individual susceptibility such as altered immune function. An impaired immune response may result in a defect in the ability to remove refluxed menstrual debris, thereby increasing the possibility of endometriosis. We carried out the study to elucidate the immunologic alteration in patients with endometriosis. MATERIALS and METHODS: Fifty-six patients undergoing pelviscopic surgery or open laparotomy for benign gynecological disease were enrolled in this study. The study groups consisted of group I (normal control patients, N=22), group II (endometriosis stage I and II, N 17), and group III (endometriosis stage III and IV, N=17). Lymphocyte subset including total T cell, helper T cell, suppressor T cell, B cell, helper/suppressor ratio, natural killer (NK) cell, monocyte population and cytokine profile including interleukin (lL)-1, soluble interleukin-2 receptor (slL-2R), IL-2, IL-6, IL-S, monocyte chemoattractant protein (MCP)-1 of peripheral blood and peritoneal fluid were analyzed using flow cytometry and enzyme-linked immunosorbant assay (ELISA) method respectively. RESULTS: Peripheral blood and peritoneal fluid lymphocyte subset were indistinguishable among the 3 groups (p>0.05). And there were no significant difference in peripheral blood and peritoneal fluid cytokine profile among the 3 groups except peripheral blood MCP-1 level. Group III showed higher peripheral blood level of MCP-1 than control patients (p<0.05). CONCLUSION: In this study, lymphocyte subset and cytokine profile except MCP-1 in peripheral blood and peritoneal fluid from patients with endometriosis did not differ from those of the control group. Immunologic alterations of patients with endometriosis might be resulted not from the changes of the number of lymphocyte subsets and cytokine, but from the modification of functions.
Ascitic Fluid* ; Endometriosis* ; Female ; Flow Cytometry ; Humans ; Incidence ; Interleukin-2 ; Interleukin-6 ; Interleukins ; Laparotomy ; Lymphocyte Subsets* ; Lymphocytes* ; Menstruation Disturbances ; Monocytes ; Prevalence

BACKGROUND: Hemodynamic evaluation of the brain may be helpful for the identification of a risk of stroke in patients with middle cerebral artery (MCA) or internal carotid artery (ICA) steno-occlusive disease. The aim of this study was to evaluate the hemodynamic state in patients with steno-occlusive disease of ICA or MCA on the base of MRI/MRA and acetazolamide (ACZ)-challenged Tc-99m ECD brain perfusion SPECT findings. METHODS: An analysis of 68 patients who underwent MRI/MRA and ACZ-challenged Tc-99m ECD brain perfusion SPECT was performed. We divided these patients into two groups - MCA and ICA steno-occlusions. RESULTS: The cerebrovascular reserve (CVR) was impaired in 18 of 32 (56.3%) MCA disease patients (20 stenosis and 12 occlusions), and in 19 of 36 (52.8%) ICA disease patients (20 stenosis and 16 occlusion). The CVR was impaired in 22 of 28 (78.6%) occlusive patient, whereas in 15 of 40 (37.5%) stenotic patient (p< 0.01). The insular lesion was more commonly involved in the occlusion group (54%) than in the stenosis group (15%) (p< 0.01). CONCLUSIONS: There was no difference in CVR between MCA and ICA steno-occlusion groups. Incidence of impaired CVR was higher in occlusion group than stenosis group.
Acetazolamide ; Brain* ; Carotid Artery, Internal* ; Cerebral Infarction ; Constriction, Pathologic ; Hemodynamics ; Humans ; Incidence ; Middle Cerebral Artery* ; Perfusion* ; Stroke ; Tomography, Emission-Computed, Single-Photon*

BACKGROUND: Hemodynamic evaluation of the brain may be helpful for the identification of a risk of stroke in patients with middle cerebral artery (MCA) or internal carotid artery (ICA) steno-occlusive disease. The aim of this study was to evaluate the hemodynamic state in patients with steno-occlusive disease of ICA or MCA on the base of MRI/MRA and acetazolamide (ACZ)-challenged Tc-99m ECD brain perfusion SPECT findings. METHODS: An analysis of 68 patients who underwent MRI/MRA and ACZ-challenged Tc-99m ECD brain perfusion SPECT was performed. We divided these patients into two groups - MCA and ICA steno-occlusions. RESULTS: The cerebrovascular reserve (CVR) was impaired in 18 of 32 (56.3%) MCA disease patients (20 stenosis and 12 occlusions), and in 19 of 36 (52.8%) ICA disease patients (20 stenosis and 16 occlusion). The CVR was impaired in 22 of 28 (78.6%) occlusive patient, whereas in 15 of 40 (37.5%) stenotic patient (p< 0.01). The insular lesion was more commonly involved in the occlusion group (54%) than in the stenosis group (15%) (p< 0.01). CONCLUSIONS: There was no difference in CVR between MCA and ICA steno-occlusion groups. Incidence of impaired CVR was higher in occlusion group than stenosis group.
Acetazolamide ; Brain* ; Carotid Artery, Internal* ; Cerebral Infarction ; Constriction, Pathologic ; Hemodynamics ; Humans ; Incidence ; Middle Cerebral Artery* ; Perfusion* ; Stroke ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: Reduction malarplasty is a popular aesthetic surgery for contouring wide and prominent zygoma. However a few patients complain postoperative results and want to revise the midfacial contour. We analyzed the etiology of unfavorable results and treated unsatisfied midfacial contours after reduction malarplasty. METHODS: Total 53 patients were performed secondary operation for correction of unfavorable results after primary reduction malarplasty from elsewhere. Midfacial contour was evaluated with plain films and three- dimensional computed tomography. Unfavorable midfacial contours were corrected by secondary malarplasty. Flaring of zygomatic arch was reduced with infracturing technique and prominent zygomatic body was reduced with shaving. Drooped or displaced zygoma complex has been suspended to higher position and fixed with interosseous wiring. As adjuvant procedure, autologous fat injection has been performed in the region of depressed zygomatic body region. RESULTS: The etiology of unfavorable midfacial contour after reduction malarplasty was classified into 7 categories: undercorrection of zygomatic arch(n=8), undercorrection of zygomatic arch and undercorrection of zygomatic body(n=6), undercorrection of zygomatic arch and overcorrection of zygomatic body(n=28), overcorrection of zygomatic body(n=3), simple asymmetry(n=4), malunion(n=2) or nonunion(n=2). Slim and balanced malar contour was achieved with treatment. And most of the patients were satisfied with the results of the surgery. CONCLUSION: To prevent the unfavorable results after reduction malarplasty, complete analysis of facial contour, choice of appropriate operation technique, precise osteotomy under direct vision, and security of zygoma position are important.
Body Regions ; Humans ; Osteotomy ; Vision, Ocular ; Zygoma

Thymic carcinoma is a relatively rare neoplasm of thymus and about 150 cases have been reported until now. It is a thymic epithelial neoplasm with obvious cytologic atypia and usually located in the anterior and superior mediastinum. It has several histologic typeswell-differentiated (keratinizing) squamous cell carcinoma and pooly-differentiated (nonkeratinizing) squamous cell carcinoma, small cell carcinoma, clear cell carcinoma and adenosquamous cell carcinoma. The symtoms of thymic carcinoma is anterior chest pain, dyspnea, coughing and SVC syndrome usually caused by compression of mediastinal organs. Histologic grade is the most important prognostic factor. The prognosis of well-differentiated (keratinizing) squamous cell carcinoma subtype is better than other subtypes. But all of the variants of thymic carcinoma are highly lethal and should be treated aggressively with all modalities of therapy. Authors report three cases of thymic carcinoma diagnosed by clinical, radiographic, and histologic findings with review of the literature.
Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Chest Pain ; Cough ; Dyspnea ; Mediastinum ; Neoplasms, Glandular and Epithelial ; Prognosis ; Thymoma* ; Thymus Gland

BACKGROUND: Postprimary pulmonary tuberculosis is located mainly in upper lobes. The tuberculous lesion involving the lower lobes usually arises from the upper lobe cavity through endobronchial spread. When tuberculosis is confined to the lower lung field, it often masquerades as pneumonia, lung cancer, bronchiectasis, or lung ahscess. Thus the correct diagnosis may be sometimes delayed for a long time. METHODS: We carried out, retrospectively, a clinical study on 50 patients confirmed with lower lung field tuberculosis who visited the Department of Pulmonary Medicine at Hanyang University Hospital from January 1992 to December 1994. The following results were obtained. RESULTS: Lower lung field tuberculosis without concomitant upper lobe disease occurred in fifty patients representing 6.9% of the total admission with active pulmonary tuberculosis over a period of 3 years. It occurred most frequently in the third decade but age distribution was relatively even. The mean age was 43 years old. Female was more frequently affected than male (male to female ratio 1:1.9). The most common symptom was cough(68%), followed by sputum(52%), fever(38%), and chest discomfort(30%). On chest X-ray of the S0patients, consolidation was the most common finding in 52%, followed by solitary nodule(22%), collapse(16%), cavitary lesion(l0%), in decreasing order. The disease confined to the right side in 25 cases, left side 20 cases, and both sides 5 cases. Endobronchial tuberculosis (1) Endobronchial involvement was proved by bronchoscopic examination in 20 of S0patients. (2) Mean age was 44years old and female was more affected than man (male to female ratio 1 : 3). Sputum AFB stain and Mycobacterium tuberculosis culture were positive only in 50% of cases unlikely upper lobe tuberculosis, additional diagnostic methods were needed. In our study, bronchoscopic examination and percutaneous fine needle aspiration biopsy increased diagnostic yield by 18% and 32%, respectively. The most common associated condition was diabetes mellitus(18%) and others were anemia, anorexia nervosa, stomach cancer, and systemic steroid usage. CONCLUSION: When we find a lower lung field lesion, we should suspect tuberculosis if the patient has diabetes mellitus, anemia, systemic steroid usage, malignancy or other immune suppressed states. Because diagnostic yield of sputum AFB smear & Mycobacterium tuberculosis culture was low, additional diagnostic methods such as bronchoscopy and fine needle aspiration biopsy were needed.
Adult ; Age Distribution ; Anemia ; Anorexia Nervosa ; Biopsy ; Biopsy, Fine-Needle ; Bronchiectasis ; Bronchoscopy ; Diabetes Mellitus ; Diagnosis ; Female ; Humans ; Lung Neoplasms ; Lung* ; Male ; Mycobacterium tuberculosis ; Pneumonia ; Pulmonary Medicine ; Retrospective Studies ; Sputum ; Stomach Neoplasms ; Thorax ; Tuberculosis* ; Tuberculosis, Pulmonary

OBJECTIVE: To analyze the clinical characteristics of Korean pediatric, adolescent and premarital women who visited the Adolescent Gynecology Clinic at Samsung Medical Center. METHODS: A retrospective study was performed on the 2070 women visiting the Adolescent Gynecology Clinic at Samsung Medical Center from Feb. 1995 to Sep. 2003. The patients were divided into 3 groups according to patients' age; group I (~9 years, 258 patients), group II (10-20 years, 911 patients), group III (21-30 years, 901 patients). Clinical characteristics were analyzed by chart review and compared among three groups. RESULTS: The mean patient age was 18.4 +/- 6.9 years (mean SD) and the mean age at menarche was 13.4 +/- 1.5 years. The most common disease entity and disorder according to age groups were infectious disease and vaginitis in group I, menstruation associated problems and abnormal uterine bleeding (AUB) in group II, and menstruation associated problems and amenorrhea in group III. Among gynecologic problems, AUB was cited as the most common problem for the patients visiting the Adolescent Gynecology Clinic (425 cases, 20.5%), followed by amenorrhea (393 patients, 19.0%). 51.0% of primary amenorrhea had a congenital defects. Among the patients with pelvic tumor (293 patients), 85.3% was due to ovarian tumor, and 166 patients (66.4%) with ovarian tumor underwent operation. The most common pathologic diagnosis for ovarian tumor was endometrioma (60 cases, 36.1%). In primary dysmenorrhea (214 patients, 76.2% of total dysmenorrhea), treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) resulted in symptomatic improvement in 82.6% of the patients. The most common infectious disease was vaginitis and the most commonly isolated organisms varied according to age group (group I, II: E. coli, group III: Candida albicans). CONCLUSION: The most common gynecologic problem in korean pediatric, adolescent and premarital women is menstruation related disorders, presenting in 58.8% of patients visiting the Adolescent Gynecology Clinic.
Adolescent* ; Amenorrhea ; Candida ; Communicable Diseases ; Congenital Abnormalities ; Diagnosis ; Dysmenorrhea ; Endometriosis ; Female ; Gynecology* ; Humans ; Menarche ; Menstruation ; Retrospective Studies ; Uterine Hemorrhage ; Vaginitis

Despite the high prevalence of benign hepatic cysts, they rarely exhibit symptoms. Radiologic studies such as ultrasonography or computed tomography disclose these cysts incidentally. Occasionally, large cysts may compress organs next to them, resulting in accompanying symptoms in patients. Recently, some reports have shown that treatment with minocycline chloride instillation into the cyst, after aspiration of cystic fluid, produces good results. First, we instilled doxycycline into the cyst after aspiration of the cyst with a resultant decrease in size. We aspirated 25% of the cyst followed by instillation of minocycline chloride (200 mg in 10 ml of 2% lidocaine) into the recurrent cyst which became larger 45 days later. In the other case we succeeded in making the cyst decrease in 4 months with no recurrence by an instillation of minocycline chloride (500 mg in 10 ml of 2% lidocaine) following aspiration of 25% of the cyst. We report, with references, both cases in which we have succeeded.
Doxycycline ; Humans ; Minocycline* ; Prevalence ; Recurrence ; Ultrasonography