In many cases the breast reconstruction surpasses the goal of a normal breast mound appearance in clothing and achieves a result that, in time, may look almost normal in the unclothe state. Breast reconstructions with autologous transverse rectus abdominis myocutaneous (TRAM) flaps are well known to produce the most aesthetically excellent results. the pedicled to TRAM flap cannot be used in high risk patient such as obese or smoking patients due to partial flap necrosis. But, the free TRAM flap have more robust blood supply and less donor site morbidity than the pedicled TRAM flap and is therefore the currently preferred technique in western. However, the free TRAM flaps has a problem related to the anastomotic failure which has been reported as high as 6% to 10%. Moreover many Korean women have smaller sized breast than western women and have no risk factors compromising flap circulation. So the single pedicled TRAM flap can be safely used for breast reconstruction without any flap necrosis. 60% of the elevated flap area has a sufficient volume to mold a new breast that matches with the contralateral breast and the unneccessary distal portion of the flap that has the marginal circulation can be resected. In this study we review our 20 consecutive cases of breast reconstruction using the pedicled TRAM flap and have a conclusion that the pedicled TRAM flap produce an aesthetically acceptable new breast in Korean mastecotmy patients without any flap necrosis or donor site morbidity.
Breast* ; Clothing ; Female ; Fungi ; Humans ; Mammaplasty* ; Necrosis ; Rectus Abdominis* ; Risk Factors ; Smoke ; Smoking ; Tissue Donors

We report the first case of ocular benign lymphoid hyperplasia (BLH) treated with subconjunctival injection of bevacizumab (Avastin). A 27-year-old man presented to our clinic with conjunctival masses and limbal neovascularization. An incisional biopsy yielded the diagnosis of BLH. The patient was subsequently given a subconjunctival injection of bevacizumab (1.25 mg / 0.1 mL). The patient did not experience recurrence or malignant metaplasia during the one-year follow-up period. In patients with conjunctival BLH, subconjunctival injection of bevacizumab can be a useful treatment option in patients unable to undergo a surgical procedure due to limbal neovascularization.
Adult ; Angiogenesis Inhibitors/*administration & dosage ; Antibodies, Monoclonal/*administration & dosage ; Conjunctiva ; Conjunctival Diseases/*drug therapy/*pathology ; Humans ; Hyperplasia ; Injections, Intraocular ; Limbus Corneae/blood supply ; Lymphoid Tissue/*pathology ; Lymphoproliferative Di ; Male ; Neovascularization, Pathologic/drug therapy

PURPOSE: To report a case of drug-resistant Fusarium deep keratitis following sclera graft. CASE SUMMARY: A 48-year-old woman, who underwent excision of the pterygium nine years previous, received a scleral graft for scleromalacia and ocular pain. After surgery, due to melting of the scleral graft and the presence of Fusarium deep keratitis, she received surgical and intensive medical treatment including three intracameral injections of antifungal agent, administration of topical voriconazole 1%, scleral re-graft, autologous conjunctival graft, and amniotic membrane transplantation. Nevertheless, the patient's ocular condition deteriorated with increased hypopyon, corneal opacity, and perforation. Enucleation was ultimately performed.
Amnion ; Corneal Opacity ; Female ; Freezing ; Fusarium ; Humans ; Keratitis ; Middle Aged ; Pterygium ; Pyrimidines ; Sclera ; Transplants ; Triazoles

PURPOSE: We investigated the surgical anatomy of the deep lateral orbital wall via dissection of Korean cadavers and analysis of the orbit in normal adults using computed tomography. METHODS: Twelve cadavers were used to determine the exact anatomic index of the orbital lateral wall, and computed tomography images of 20 patients were used for surgical anatomic measurements during deep lateral orbital wall decompression. Additionally, the anatomic indexes measured in the cadavers and in the computed tomography study were compared and analyzed. RESULTS: In the cadaver study, the mean distance from the orbital rim to the end of the superior orbital fissure was 36.7 +/- 1.98 mm, to the rim of the frontosphendoial suture was 18.2 +/- 1.92 mm, and from the end of the superior orbital fissure to the inferior orbital fissure was 17.1 +/- 1.19 mm. In the computed tomography study, the mean value from the orbital rim to the end of the superior orbital fissure was 39.2 +/- 2.46 mm, and from the rim to the frontosphenoidal suture was 17.8 +/- 1.56 mm. CONCLUSIONS: The present study regarding the surgical index of the lateral orbital wall in Koreans will assist surgeons to safely and confidently perform deep lateral orbital wall decompression.
Adult ; Cadaver ; Decompression ; Humans ; Orbit ; Sutures

PURPOSE: To evaluate the efficacy of five-layered reinforced amniotic membrane (AM) transplantation for treating deep corneal ulcer or perforation. CASE SUMMARY: We performed a five-layered reinforced AM transplant in three cases of corneal ulceration or perforation using mechanical compressed lyophilized AMs. In all cases, the perforated cornea healed with re-epithelization within 2 weeks and the ocular surface was stabilized for more than 1 year. CONCLUSIONS: Five-layered reinforced AM transplantation may be an alternative method for treating deep corneal ulcers or perforations.
Amnion ; Cornea ; Corneal Perforation ; Corneal Ulcer ; Transplants ; Ulcer

PURPOSE: To assess clinical features and efficacy of spectacles and low vision devices in pediatric patients with albinism. METHODS: A retrospective study was performed of 15 pediatric patients with albinism for whom glasses and low vision devices had been prescribed to determine subjective satisfaction and objective improvement in visual acuity (VA), strabismus, contrast sensitivity, number of reading letters during 1 minute with refractive correction and low vision devices. RESULTS: The median refractive correction was +0.12 +/- 5.45 diopter (D) spherical equivalent with -0.71 +/- 3.62 D astigmatism. Most patients complained of reading difficulty and photophobia. Hand-held magnifier and Keplerian telescope were commonly prescribed low vision devices. In addition, VA, strabismic deviation, contrast sensitivity and number of reading letters during 1 minute significantly improved after wearing glasses and low vision devices. CONCLUSIONS: The present study showed a significant improvement in corrected VA, alignment and subjective symptoms in pediatric patients with albinism by wearing glasses and low vision devices. Additionally, high compliance can improve final patients' satisfaction through using training of low vision devices.
Albinism ; Astigmatism ; Compliance ; Contrast Sensitivity ; Eyeglasses ; Glass ; Humans ; Photophobia ; Retrospective Studies ; Strabismus ; Telescopes ; Vision, Low ; Visual Acuity

PURPOSE: Surgery for thyroid gland requires skin incisions that can result in postsurgical neck scar. To overcome this, many surgeons performed a endoscopic thyroidectomy. But, this approach had a some problems. One of postoperative problems, iatrogenic cervical dystonia(CD) may occur. At common, CD is defined as a syndrome characterized by prolonged muscle contraction causing twisting, repetitive movements or abnormal posture. Botulinum toxin A(BTA, Botox(R), Allergan, Irvine, CA, USA) is well known treatment agent in the treatment of CD. So, the authors applied BTA injection in rare case with iatrogenic CD resulting in endoscopic thyroidectomy. METHODS: A 43-year-old female had endoscopic subtotal thyroidectomy operation 3 years ago. She had symptoms such as progressive cervical pain, abnormal neck posture, depression, and sleep difficulty. About 1 year later, the patient who had previous myomectomy of the clavicular head of sternocleidomastoid muscle, however, symptoms were not improved. And then the patient received BTA therapy in our department. The 2 units per 0.1mL solution was administered in a 1mL tuberculin syringe. RESULTS: The dose of BTA used in the patient was 36 units for vertical platysmal bands, superficially, and 10 units for ipsilateral sternocleidomastoid muscle, intramuscularly. After 2 weeks, additional the dose of BTA used in the patient was 5 points for remained scar bands, superficially. Complications related to injection such as significant swallowing difficulties, neck muscle weakness, or sensory change were not observed. In 9 months follow-up, the patient maintained a good result from the method of BTA injection alone. CONCLUSION: The basic concept is selective denervation for the hyperactive individual muscles and scar bands. We conclude that BTA is an effective and safe treatment for CD despite the iatrogenic and complex presentation of this complication.
Adult ; Botulinum Toxins ; Cicatrix ; Deglutition ; Denervation ; Depression ; Female ; Follow-Up Studies ; Head ; Humans ; Muscle Contraction ; Muscles ; Neck ; Neck Muscles ; Neck Pain ; Posture ; Skin ; Thyroid Gland ; Thyroidectomy ; Torticollis ; Tuberculin

Endocarditis due to anaerobes is not a rare ocurrence. However, Clostridial endocarditis, most cases are caused by Clostridium perfringens, is an uncommon disease. Clostridium are gram positive spore forming obligate anaerobes that are found widely in soil, water, and foods. They naturally inhabit the respiratory, gastrointestinal, and female genital tract. We observed a case of Clostridium perfringens endocarditis in a 67 years old woman. Who experienced fever, chronic diarrhea and vegetation in the aortic valve.
Aged ; Aortic Valve ; Clostridium perfringens* ; Clostridium* ; Diarrhea ; Endocarditis* ; Female ; Fever ; Humans ; Soil ; Spores

A 62-year-old female visited our clinic with progressively decreased vision in both eyes beginning 12 years prior. Idiopathic corneal opacity in all layers of the cornea was found in both eyes. One year later, we performed penetrating keratoplasty on the undiagnosed right eye. During post-surgical follow-up, corneal edema and stromal opacity recurred, and penetrating keratoplasty was performed two more times. The patient's total serum protein level, which had previously been normal, was elevated prior to the final surgery. She was diagnosed with monoclonal gammopathy of undetermined significance. We made a final diagnosis of monoclonal gammopathy-associated crystalline keratopathy after corneal biopsy. Monoclonal gammopathy-associated crystalline keratopathy is difficult to diagnose and may lead to severe visual loss. A systemic work-up, including serologic tests like serum protein or cholesterol levels, is needed in patients with unexplainable corneal opacity.
Corneal Edema/etiology/*metabolism/physiopathology/surgery ; Corneal Neovascularization/etiology/*metabolism/physiopathology/surgery ; Corneal Opacity/etiology/*metabolism/physiopathology/surgery ; Crystallins/*metabolism ; Female ; Humans ; Keratoplasty, Penetrating ; Microscopy, Electron ; Middle Aged ; Monoclonal Gammopathy of Undetermined Significance/*complications/pathology ; Reoperation ; Visual Acuity

PURPOSE: Hypernatremia most frequently occurs in the immature newborn and be severe in association with intraventricular hemorrhage (IVH). This study examined the frequency, onset and risk factors of hypernatremia, and the relationship between hypernatremia and IVH in very low birth weight (VLBW; <1,250 g) infants. METHODS: We retrospectively reviewed the medical records of 55 VLBW infants admitted between January 2006 and December 2009 to the neonatal intensive care unit of Wonkwang University Hospital and who survived over 7 days. Serum sodium concentration, sodium intake, fluid and weight loss, as suggested risk factors of hypernatremia, and the incidence of IVH were evaluated. The infants were divided into a hypernatremia group (> or =150 mEq/L) and nonhypernatremia group, and were compared. RESULTS: Incidence of hypernatremia in the VLBW infants was 52.7%, and mean starting time of hypernatremia was 2.8+/-1.3 days. There were no differences in the sodium and fluid intake between the two groups. Weight loss at day 3 after birth was significantly higher in the hypernatremia compared to the nonhypernatremia group (P<0.05); thereafter weight loss was non-significantly higher. The incidence of IVH in VLBW infants was 38.2%, and the difference between the two groups was not significant. CONCLUSION: Hypernatremia occurs commonly in VLBW infants and is most commonly caused by weight loss in the early days after birth. Incidence of IVH is not likely influenced by hypernatremia with marginally elevated sodium concentration.
Hemorrhage ; Humans ; Hypernatremia ; Incidence ; Infant ; Infant, Newborn ; Infant, Very Low Birth Weight ; Intensive Care, Neonatal ; Medical Records ; Parturition ; Retrospective Studies ; Risk Factors ; Sodium ; Weight Loss