Microform cleft lip is a mild form of incomplete cleft lip, also known as a minimal occult, abortive, forme fruste cleft lip. However, it has no definition and few methods have been reported for its correction. A microform cleft lip is characterized as the incomplete union of the superficial portion of the orbicularis oris muscle. It is more prominent during facial expression than in a resting state. We confined microform cleft lip in our study to the absence of philtral skin change and a contracted position on the top of cupid's bow. During the past 5 years, 17 patients of microform cleft lip were operated on. We corrected the defect of the upper vermilion border and nostril sill with minimal incision, and repaired the underlying lip musculature in superficial discontinuity. Reduction of the widened alar base was performed. Deformed alar cartilage was dissected via rim incision, and suspended in a medial and upper direction with pull-out sutures. The most important thing is precise repair of the superficial portion of the separated orbicularis oris muscle via minimal incision, and it is best to operate after 1-year of age for accurate repair. The results were satisfactory and the parents were also satisfied. The advantages of this procedure are as follows: 1. Less visible, minimal scar on upper lip 2. Simultaneous correction of vermillion notching, deformed cupid's bow and nasal deformity. 3. Eversion of philtral ridge due to tenting effect of horizontal mattress suture 4. Philtral elongation effect by reduction of alar base and Z-plasty of cupid's bow.
Cartilage ; Cicatrix ; Cleft Lip* ; Congenital Abnormalities ; Facial Expression ; Humans ; Lip ; Microfilming* ; Parents ; Skin ; Sutures

Intussusception is common cause of intestinal obstruction in children. Most of intussusceptions can be treated with non-operative reduction using air or barium. However, about 10% patients need operative treatment due to failure of reduction, peritonitis, and recurrence after reduction. We introduce our experience of laparoscopic surgery for intussusception. From April 2010 to March 2013, we reviewed 57 children who diagnosed intussusception. Twelve patients underwent an operation. The cause of operation was 7 of failure of air reduction and 5 of recurrence after air reduction. Median age was 21.5 months (range: 5.0~57.7 months) and 11 children (91.7%) underwent successful laparoscopic reduction. Median operating time was 50 minutes (range: 30~20 minutes) and median hospital days was 4.5 days (range: 3~8 days). One patient had a leading point as a heterotopic pancreas and underwent bowel resection through conversion. There was neither intra-operative nor postoperative complication. Laparoscopic reduction for intussusception can bring an excellent cosmetic effect with high success rate.
Barium ; Child* ; Humans ; Intestinal Obstruction ; Intussusception* ; Laparoscopy* ; Pancreas ; Peritonitis ; Postoperative Complications ; Recurrence

OBJECT: In order to estimate the frequency and risk factors for adenomyosis. METHOD: The clinical records of 1127 women undergoing hysterectomy were retrieved in the Department of Obstetrics and Gynecology, Incheon Christian Hospital, during 7 years, from Jan. 1st 1991 to Dec. 31st 1997. RESULT: The following results were obtained. 1. Adenomyosis was found in 206 of 1127 patients(18.3%). 2. The highest incidence was 41-50 years of age group, an incidence of 55% and mean age group was 46.9 years. 3. Adenomyosis was more frequently observed in parous woman than non-parous woman, such as 8.3% and 91.7%, respectively. 4. Grossly, the size of uterus was enlarged more than 10 weeks gestational size in adenomyosis, an incidence of 62.4%. 5. Pelvic pain, dysmenorrhea and metrorrhagia were common symptom of adenomyosis, an incidence of 26.7%, 25.2% and 19.4%, respectively. 6. Myoma was the most combined disease in adenomyosis, showing the incidence of 53.4%. 7. Combined pelvic endometriosis was not observed in this study. 8. Endometrial findings of adenomyosis showed proliferative phase of normal endometrial cycle in the highest incidence, giving 72.3% of all cases. 9. Preoperative diagnostic accurracy of adenomyosis was 8.2%. CONCLUSION: This results show that deeply understanding of the common symptom and epidemiology of adenomyosis improve the preoperative diagnostic accuracy.
Adenomyosis* ; Dysmenorrhea ; Endometriosis ; Epidemiology ; Female ; Gynecology ; Humans ; Hysterectomy* ; Incheon ; Incidence ; Menstrual Cycle ; Metrorrhagia ; Myoma ; Obstetrics ; Pelvic Pain ; Risk Factors ; Uterus

PURPOSE: Recurrent inguinal hernia repairs provide a considerable technical challenge and greater risk of further recurrence. The purpose of this study was to establish a preventive method and management plan for recurrent inguinal hernia. METHODS: The medical records of adult having undergone an inguinal hernia operation at the Dankook university hospital, between June 1994 and December 2004, were analyzed. The patients' characteristics, types of hernia and operation methods were recorded. In the recurrent cases, the numbers and names of previous operation, types of recurrent hernia, and times to reoperation were analyzed. RESULTS: Of the 470 inguinal hernia cases, 35 were operated on for a recurrent hernia. With the recurrent hernias, the operation times were longer and the use of general anesthesia was more frequent. Of the recurrent hernia types, direct hernias were the most frequent. More than half the recurrent hernias were operated on 5 years after the primary hernia repairs. The recurrent hernia was treated with or without a mesh in 33 (94.3%) and 2 cases (5.7%), respectively. In the previous operations, mesh had or had not been used in 30 (85.7%) and 5 cases (14.3%), respectively. CONCLUSION: In the recurrent hernia group, the most frequent type of previous repair was an operation without a mesh. A direct hernia was the most frequent type of recurrence. The recurrent hernias were mostly repaired using a mesh.
Adult ; Anesthesia, General ; Hernia ; Hernia, Inguinal* ; Herniorrhaphy ; Humans ; Medical Records ; Recurrence ; Reoperation

PURPOSE: Nitric oxide (NO) has recently been identified as the main neurotransmitter involved in the nonadrenergic-noncholinergic (NANC) pathway and is responsible for penile erection. Nitric oxide synthase (NOS)-containing nerve regeneration can be seen 6 months after unilateral cavernosal nerve neurotomy in rats. However its molecular mechanism is still unknown. It is believe that growth factors are involved in this phenomenon. In this study I investigated the change of NOS containing nerve fibers and the RNA expression of insulin like growth factor (IGF)-I, nerve growth factor (NGF), transforming growth factor (TGF)-alpha, TGF-beta 1, TGF-beta 2, TGF-beta 3, vascular endothelial growth factor(VEGF), nNOS and eNOS on the penis after cavernosal neurotomy in rats. MATERIALS AND METHODS: Male rats were divided into three groups: sham operation (n=12); unilateral neurotomy of a 5-mm segment of the cavernosal nerve (n=18); and bilateral neurotomy (n=18). Electrostimulation of the cavernosal nerve of pelvic ganglion was performed at 1,3 and 6 months. Nicotinamide adenine dinucleotide phosphate (NADPH) diaphorase staining was used to identify NOS in the penile nerve fibers. The gene expressions for growth factors, nNOS and eNOS were investigated in corporal tissue by reverse transcriptase-polymerase chain reaction (RT-PCR) using specific oligonucleotide primers. RESULTS: One month after neurotomy, both unilateral and bilateral neurotomy groups showed significant decreases in NOS-containing nerve fibers on the dorsal and intracavernosal nerves on the side of neurotomy and significantly lower mRNA expressions of nNOs, IGF-I and TGF-beta 2, and the unilateral neurotomy group showed higher mRNA expression of eNOS and VEGF189. At 3 months, the number of NOS-containing nerve fibers in the unilateral neurotomy group increased only slightly but at 6 months, those in the intracavernosal nerve increased in a significant amount (p<0.0001),however mRNA expressions of nNOs, IGF-I and TGF-beta . , showed significant increases as early as at 3 months, After bilateral neurotomy, the NOS-positive nerve fibers in the dorsal and intracavernosal nerve were significantly decreased at 1 month and remained so at 6 months; no erectile response could be elicited by pelvic ganglion stimulation. In the unilateral neurotomy group at 6 months, more NOS-positive neurons in the pelvic ganglia were found on the intact side than on the side of the neurotomy (p<0.005), indicating that the regeneration derived from pelvic ganglion neurons on the intact side. Furthermore, electrostimulation in the unilateral neurotomy group revealed a greater maximal intracavernosal pressure and a shorter latency period at 6 months than at 1 month (p<0.001, p<0.001, respectively). CONCLUSION: These data suggest that IGF-I and TGF-beta 2, may play a key role in regeneration of NOS-containing nerve fibers in the dorsal and intracavernosal nerves, and eNOS increases temporarily in the intracavernosum involving VEGF189 after unilateral cavernosal nerve injury.
Animals ; DNA Primers ; Ganglia ; Ganglion Cysts ; Gene Expression ; Humans ; Insulin ; Insulin-Like Growth Factor I ; Intercellular Signaling Peptides and Proteins* ; Latency Period (Psychology) ; Male ; NADP ; Nerve Fibers ; Nerve Growth Factor ; Nerve Regeneration ; Neurons ; Neurotransmitter Agents ; Nitric Oxide ; Nitric Oxide Synthase ; Penile Erection ; Penis ; Rats* ; Regeneration* ; RNA ; RNA, Messenger ; Transforming Growth Factor beta ; Transforming Growth Factors

BACKGROUND: Ischemic preconditioning (IPC) and some volatile anesthetics have been shown to attenuate ischemia-reperfusion injury in an isolated-heart model. The aim of this study was to determine whether sevoflurane has a cardioprotective effect on isolated-heart models when given before prolonged periods of global ischemia. METHODS: 48 male Sprague-Dawley rat hearts were randomly subdivided into four groups. Rats were anesthetized with 25 mg ketamine. After hearts had been removed, and perfused with a modified Krebs solution gassed with 5% CO2 balanced O2 at a constant temperature (37oC) and pressure (55 mmHg), a latex balloon was placed into the left ventricle to obtain isovolumetric contraction. After 20 min of equilibration, hearts were randomly allocated to 1) a control group, 2) an IPC group, two 5 min ischemic periods interspersed with 5 min normal perfusion, 3) an SPC (sevoflurane preconditioning) group, two 5 min sevoflurane periods interspersed with 5 min normal perfusion, 4) an SPC with Glibenclamide group. All groups were subjected to 30 min of global ischemia and 75 min of reperfusion. Left ventricular pressure, dP/dt max, and coronary flow were measured. Also flow responses to bradykinin were tested 15 min before IPC or SPC and 60 min after reperfusion. RESULTS: Sevoflurane administration before global ischemia was found to have protective effects like IPC on functional recovery, to reduce infarct size, and to conserve coronary endothelial function. LVP was less depressed in the SPC and IPC groups. dP/dt max in both the IPC and SPC groups recovered after global ischemia. Coronary flow was depressed in the control and in the SPC with Glibenclamide groups, but it was slightly depressed in the IPC and SPC groups. Smaller infarct sizes were observed in IPC and SPC groups. Flow increases due to bradykinin were greater after SPC and IPC. Moreover, these beneficial effects of sevoflurane were blocked by glibenclamide administration. CONCLUSIONS: Preconditioning with sevoflurane, like IPC, improves post ischemic contractility basal flow, and bradykinin-induced flow increases. Moreover, the protective effects of SPC and IPC were reversed by KATP channel antagonism.
Anesthetics ; Animals ; Bradykinin ; Glyburide ; Heart ; Heart Ventricles ; Humans ; Ischemia ; Ischemic Preconditioning ; Ketamine ; Latex ; Male ; Models, Animal* ; Myocardial Ischemia ; Perfusion ; Rats* ; Rats, Sprague-Dawley ; Reperfusion ; Reperfusion Injury ; Ventricular Pressure

BACKGROUND: Conventional interventions for pyogenic granuloma include excision, electrodessication and curettage, cryotherapy, and laser ablation, all of which can be associated with local tissue destruction, scarring, and recurrence in some cases. Although imiquimod is commonly regarded as an immune response modifier, it also induces antiangiogenic factors such as tissue inhibition of matrix metalloproteinase-1 (TIMP-1), IL-12 and increases apoptosis in vascular tumors. OBJECTIVE: To investigate the therapeutic efficacy of imiquimod on pyogenic granuloma. METHODS: Twelve patients with pyogenic granuloma were treated with 5% imiquimod cream every night for up to 8 weeks. Therapeutic efficacy, side effects and patient's satisfaction scale were evaluated. RESULTS: The onset time of effects ranged from 1 to 11 days (mean: 4.6 days). The clearance rate at 8 weeks after treatment was 83.3% and the mean time for clearance was 3.6 weeks. 3 of 12 (25%) patients experienced local pain, erosion and hemorraging as adverse events. However, there has been no recurrence, scarring, or hypopigmentation after more than 8 months of follow-up. CONCLUSION: Imiquimod may represent a safe, simple and effective alternative in the management of pyogenic granuloma. This therapeutic modality may be of particular benefit in children and patients whose lesions are on the face.
Apoptosis ; Child ; Cicatrix ; Cryotherapy ; Curettage ; Follow-Up Studies ; Granuloma, Pyogenic* ; Humans ; Hypopigmentation ; Interleukin-12 ; Laser Therapy ; Matrix Metalloproteinase 1 ; Recurrence

BACKGROUND: Bowen's disease is a challenging condition to treat because lesions often affect the elderly who are usually intolerable to invasive treatment modalities and lesions are often located at sites that heal poorly. OBJECTIVE: The aim of this study was to evaluate the effectiveness and the safety of 5% imiquimod cream for the treatment of Bowen's disease. METHODS: Eleven patients with biopsy-proven Bowen's disease were treated with once-daily or twice-daily self- application of 5% imiquimod cream for a maximum of 16 weeks. RESULTS: Nine of ten (90%) patients who completed the treatment schedule showed complete clinicopathologic regression. One (11%) patient showed recurrence of Bowen's disease on the treated site. 5% imiquimod cream was generally well-tolerated and no serious side effects were observed. CONCLUSION: 5% imiquimod cream appears to be an effective modality for treatment of Bowen's disease and might represent a valuable alternative to surgery or other invasive treatment methods.
Aged ; Appointments and Schedules ; Bowen's Disease* ; Humans ; Recurrence

Semicircular lipoatrophy is a rare entity characterized by atrophic cutaneous indentation, typically involving the anterolateral thigh of young women. Although many previous reports have failed to reveal underlying trauma histories, repeated external microtraumas seem to be the most plausible causal factor at present. We report a case of semicircular lipoatrophy which occurred on both thighs of a 23-year-old woman after she started a new job as a waitress in fast-food restaurant.
Female ; Humans ; Restaurants ; Thigh ; Young Adult

Immunosuppressive therapy has been reported to exacerbate or initiate the development of porokeratosis. We report a patient who noted a dramatic worsening of previously unrecognized lesions of porokeratosis accompanied by malaise and fatigue. He was subsequently found to have myelodysplastic syndrome. On the basis of this case, the sudden appearance or exacerbation of disseminated porokeratosis without immunosuppressive therapy may justify the search for underlying immunodepressive conditions.
Fatigue ; Humans ; Myelodysplastic Syndromes* ; Porokeratosis*