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

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*

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

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

OBJECTIVE:To determine whether elevated or low levels of maternal serum alpha- fetoprotein(AFP) measured at 15-20 weeks of gestation predict increased risk of adverse pregnancy outcome, including preterm birth(before 36 weeks of gestation), fetal growth retardation(FGR), preeclampsia, placental abruption, FDIU, placenta previa and fetal anomaly. METHOD: Data of pregnancy outcomes in singleton pregnancies with elevated or low maternal serum AFP levels measured at 15-20 weeks of gestation were gathered retrospectively. As a part I study, case-control study including 106 women with maternal serum AFP) 2.0 MOM(Multiples of median) and matched control group of 212 women with 0.5 MOM Abruptio Placentae ; alpha-Fetoproteins* ; Case-Control Studies ; Female ; Fetal Development ; Follow-Up Studies ; Humans ; Mothers ; Placenta Previa ; Pre-Eclampsia ; Pregnancy ; Pregnancy Outcome* ; Pregnancy* ; Pregnant Women ; Retrospective Studies