Romberg's disease is an uncommon condition manifested by progressive hemifacial atrophy of the skin, soft tissue and bone. Facial asymmetry with soft tissue deficiency in Romberg's disease causes a significant disability affecting the social life and can bring about many psychological problems. The aim of surgical treatment is cosmetic amelioration of the defect. Several conventional reconstructive procedures have been used for correcting facial asymmetry. They include fat injections, dermal fat grafts, silicone injections, cartilage and bone grafts, pedicled flaps and free flaps. We report our experience with 6 patients involving 6 free flaps with a minimun of 1 year follow-up who were treated from October 1989 to March 1998. All patients were classified as having moderate to severe atrophy. The average age of disease onset was 4.5 years. The average duration of atrophy was 5.2 years. No patient was operated on with a quiescent interval of less than 1 year. The average age at operation was 14.1 years, ranging from 10 to 24 years. Follow-up ranged from 1 to 9 years. Reconstruction was performed using 2 groin dermofat free flaps and 4 latissimus dorsi muscular free flaps. To achieve the finest symmetrical and aesthetic results, several ancillary procedures were performed in 4 patients. These procedures included Le-Fore 1 1/2 leveling osteotomy, sagittal split ramus osteotomy, reduction malarplasty and angleplasty, rib and calvarial bone graft, correction of alopecia and additional dermofat graft. All patients were satisfied with the results. We believe that free flap is one of the best choices for contoured restoration of facial asymmetry in Romberg's disease.
Alopecia ; Atrophy ; Cartilage ; Facial Asymmetry ; Facial Hemiatrophy ; Follow-Up Studies ; Free Tissue Flaps* ; Groin ; Humans ; Osteotomy ; Osteotomy, Sagittal Split Ramus ; Ribs ; Silicones ; Skin ; Superficial Back Muscles ; Surgical Flaps ; Transplants

Concurrent use of instrumentation has been shown to increase fusion rates and satisfactory results for surgical treatment of the lumbar stenosis. The objectives of the present study were to evaluate clinically and radiologically two groups of lumbar stenosis who were surgically treated with pedicular screw fixation system and posterior lumbar interbody or posterolateral autogenous bone graft following complete posterior decompression. One group was degenerative type and the other group was spondylolisthetic type spinal stenosis. We analyzed the results of 39 cases of lumbar stenosis who underwent pedicular screw and rod fixation system and posterior lumbar interbody or posterolateral autogenous iliac bone fusion following complete posterior decompressive operation during the period from May 1988 to December 1992. There were 27cases of degenerative type and 12 cases of spondylolisthetic type lumbar stenosis. The were 25 women and 14 men. Their age was ranged 20 to 76 years old with an average of 51.7 years old. The follow up period was the interval from 18 months to 6 years with an average of 3.2 years. The radiologic union rate was average 94.9% and 96.3%(26cases) in degenerative spinal stenosis and 91.7%(11 cases) in spondylolisthetic spinal stenosis. The clinical success rate was average 92.3%(36 cases), 88.9%(24 cases) in degenerative spinal stenosis and 100%(12 cases) in spondylolisthetic spinal stenosis. The patients with spondylolytic spinal stenosis showed better result in their life than the patient with degenerative spinal stenosis.
Constriction, Pathologic ; Decompression ; Female ; Follow-Up Studies ; Humans ; Male ; Pedicle Screws ; Spinal Stenosis ; Transplants

As modern society becomes increasingly complex, there has been a steady increase in violence, as well as in automobile and industrial accidents. This has resulted in an increased incidence of facial injuries, including mandibular fractures. Many methods have been advocated to achieve reestablishment of normal feature and function. The choice generally depends upon such factors as location of the fractures, displacements, status of the dentition and favorability of the fracture line. Many cases of mandibular fracture are treated by intermaxillay fixation using an arch bar or bite block(acrylic splint)for rapid bone union and minimal displacement. However, there had been some problems, such as discomfort to patients, limitation to eating and weight loss, poor oral hygiene, and temporomandibular joint ankylosis. As a consequence, we have modified the shape of the acrylic splint and method of fixation for circum-mandibular fixation instead of intermaxillary fixation. Acrylic splints are rigid, strong, easily adjusted and repaired, translucent, lightweight and well tolerated by the oral mucosa. The splints are properly secured to each tooth and bind all the teeth together as a single unit. Authors have used modified acrylic splints as tools of circum-mandibular fixation in 12 cases of mandibular symphysis and body fracture from May 1997 to August 1998, achieving the results of very good occlusal relationship, oral hygiene and comfort to patients.
Accidents, Occupational ; Ankylosis ; Automobiles ; Dentition ; Eating ; Facial Injuries ; Humans ; Incidence ; Mandibular Fractures* ; Mouth Mucosa ; Oral Hygiene ; Splints* ; Temporomandibular Joint ; Tooth ; Violence ; Weight Loss

Double eyelid operation is one of the most common aesthetic surgical procedure performed in Korea. In correlation with the cultural background and social changes, most patients prefer a nonincision method rather than an incision method at the present. Forty-two consecutive patients were operated on for creation of double eyelids, with the subconjunctival buried suture method through conjunctival approach, from June of 1999 to September of 2000. The choice of procedure was based on the age of the patient and the amount of subcutaneous fat and redundant skin. This method was especially advisable if the young patient wants not to leave any visible scar and rapid recovery. The follow-up period ranged from two months to one year. Of forty-two patients undergoing this procedure, three patients(7.1%) required reoperation because of asymmetry, disappearance of fold, and irrtation respectively. This method is similar to various ordinary nonincisional methods previously described except for subconjunctival buried suture. But authors could obtain better cosmetic result with the advantage of shorter operation time, less morbidity, no scarring, and natural look earlier in the appropriate candidates.
Cicatrix ; Eyelids* ; Follow-Up Studies ; Humans ; Korea ; Reoperation ; Skin ; Social Change ; Subcutaneous Fat ; Sutures*

Various methods of nasal reconstruction were performed over time. The physiology and anatomy of nose were clarified and its aesthetic subunits were employed, more improvement and modification were performed. The bilobed flap is particularly suitable for reconstruction of small or medium sized nasal defect up to 1.5 cm in diameter. Authors performed 6 cases of the bilobed flap for the defect of nasal dorsum (4 cases: basal cell carcinoma, 2 cases: compound nevus) from March 2000 to February 2001. The bilobed flap was medially based and second lobe was positioned on the nasal alar groove. This flap results in little or no distortion around tissue, by which scars of nasal dorsum and dog-ear deformity are reduced. Moreover we could achieve better cosmetic results for the scar, primary repair site of the second lobe, which is concealed by nasal alar groove.
Carcinoma, Basal Cell ; Cicatrix ; Congenital Abnormalities ; Nose ; Physiology

Nose is the most prominent of part of the face and prone to traumas. Therefore posttraumatic deformities are easily seen and play a major effect on the personal impression. Result of clinical analysis of nasal bone fracture that gives general understands and advices of diagnosis and treatment of nasal bone fracture is presented with reports discussed. The author has performed radiologic evaluation, clinical study and statistical analysis in 1488 cases of nasal bone fracture treated in Department of Plastic and Reconstructive Surgery, Inje University Sanggye Paik hospital, from March, 1992 to February, 2002 Most of operation were performed on 5th-10th posttraumatic days(80.7%), and 1040 cases were treated with closed reduction using C-arm. We could obtain satisfactory results using C-arm. In satisfaction rate, 1296 cases(87%) had satisfactory results. The rate of dissatisfaction was high in the patients performed operation after 11th posttraumatic days and who had septal fracture. The author used C-arm during closed reduction of nasal bone fracture and verified the outcomes intraoperatively and were able to get more accurate reduction. With this method, we could obtain satisfactory results cosmetically and functionally. We should follow-up for longer time and we think that further research will be needed in treatment of nasal bone fracture
Congenital Abnormalities ; Diagnosis ; Follow-Up Studies ; Humans ; Nasal Bone* ; Nose ; Plastics ; Retrospective Studies

Success of skin grafts depends on sufficient immobilization and early intervention for hematoma, seroma, or infection. To stabilize and cover skin grafts with a tie-over technique was used with translucent silicone gel sheet on flat surface. Skin defect was resurfaced with skin grafts. A sterile silicone gel sheet was placed over the skin graft. Gel was fixed to the wound edges with skin sutures. Skin graft healed without any complications. Using silicone gel sheet in skin graft on flat surface is an effective method for stabilization, which also allows direct visualization of the graft designed to inspect hematoma-like complications.
Bandages* ; Early Intervention (Education) ; Hematoma ; Immobilization ; Seroma ; Silicone Gels* ; Skin* ; Sutures ; Transplants* ; Wounds and Injuries

BACKGROUND AND OBJECTIVES: The use of drug-eluting stent implantation for in-stent restenosis (ISR) has shown some promising results. This study investigated the clinical and angiographic results of performing sirolimuseluting stent (SES) implantation for the treatment of patients with ISR as compared with treatment with cutting balloon angioplasty (CBA). SUBJECTS AND METHODS: Forty one patients with ISR (43 lesions) were treated with SES implantation and they were retrospectively compared with a group of patient with matched lesions that were treated with CBA (57 patients with 61 lesions). Routine angiographic follow-up was obtained at about 6 months after treatment and the incidence of major adverse cardiovascular events was evaluated. RESULTS: The baseline clinical characteristics, the patterns of ISR and the minimal luminal diameters (MLD) were not different between the two groups. There was no procedural failure and no immediate major cardiovascular adverse events (MACE) in the two groups. There were two target lesion revascularizations during the clinical follow-up in the CBA group and no MACE was found in the SES group (4% vs. 0%, respectively p<0.001). On the follow-up angiogram, the MLD and the stenosis diameter were significantly lower in the SES group than in the CBA group (2.82+/-0.33 vs. 1.80+/-0.82 mm, p<0.001; and 11.3+/-9.6 vs. 41.2+/-24.8%, p<0.001, respectively). The acute gain was significantly higher and the late loss was significantly lower in the SES group than in the CBA group (2.64+/-0.38 vs. 2.02+/-0.44 mm, p<0.001; and 0.21+/-0.28 vs. 0.71+/-0.73, p<0.001, respectively). CONCLUSION: The sirolimuseluting stent was safe, feasible and highly effective for treating the patients suffering with in-stent restenosis as compared with cutting balloon angioplasty.
Angioplasty ; Angioplasty, Balloon* ; Constriction, Pathologic ; Coronary Restenosis ; Drug-Eluting Stents ; Follow-Up Studies ; Humans ; Incidence ; Phenobarbital ; Retrospective Studies ; Sirolimus ; Stents*

The p16/INK4A is one of the major target genes in carcinogenesis and its inactivation has frequently been reported in other types of tumors. The purpose of this study is to evaluate inactivation patterns of p16/INK4A in oral squamous cell carcinoma. Six different oral cancer cell lines, SCC-4, SCC-9, SCC-15, SCC-25, KB, and SNUDH- 379 were examined for inactivation of p16/INK4A genes. In the analysis of p16/INK4A gene inactivation, PCR amplification, direct sequencing, and methylation-specific PCR methods were adopted for evaluation of homozygous deletion, point mutation, and promoter hypermethylation, respectively. Homozygous deletion was detected in SCC-25 and SCC-9. SCC-15 showed hypermethylated promoter region within p16/INK4A gene. It is suggestive in the present study that inactivation patterns of p16/INK4A were mainly homozygous deletion, promoter methylation rather than point mutation in oral squamous cancer cell lines, so treatment modalities of oral squamous cell carcinoma should be focused on these types of inactivation.
Carcinoma, Squamous Cell/*genetics ; Cell Line, Tumor ; DNA Methylation ; *Gene Silencing ; Homozygote ; Humans ; Mouth Neoplasms/*genetics ; Point Mutation ; Promoter Regions (Genetics)/genetics ; Protein p16/*genetics

PURPOSE: This study was to investigate depression prevalence and related factors of depression in Jeju Province. METHODS: The study sample selected using randomized cluster sampling method, and the unit of cluster was 25 households. Data were collected from 1275 adults in 723 households through home visit interview. The response rate was 89.4%. The instrument used for measuring depression was CES-D, the cut-off score was 21. Data were analyzed using Chi-square test and logistic regression. RESULTS: The prevalence of depression in Jeju was 18.1%. The significant differences were found with depression prevalence rate by the group of gender, age, inhabited area, marital status, educational status, monthly household income, life satisfaction, socioeconomic status, perceived health status, morbidity during last 2 weeks, perceived stress, perceived fatigue, participation in social activities, and family life satisfaction. The most predictive factors among those variables were perceived fatigue with 17.93 of odds ratio, family life satisfaction with 9.86 odds ratio, and perceived stress with 9.66 of odds ratio. CONCLUSION: The prevention and management of depression program development was suggested and mental health promotion program for the prevention of depression was suggested.
Adult* ; Depression* ; Educational Status ; Family Characteristics ; Fatigue ; House Calls ; Humans ; Logistic Models ; Marital Status ; Mental Health ; Odds Ratio ; Prevalence* ; Program Development ; Risk Factors ; Social Class