Cloverleaf skull deformity is not a syndrome or a disease, but one of the most severe forms of craniosynostosis which may or may not be associated with various syndromes such as achondroplasia, Crouzon's disease or Apert's syndrome. This deformity accompanies serious elevation of intracranial pressure which necessitates early surgical intervention to avoid death, mental retardation, and decreased visual acuity. Until recently, near total calvariectomy, staged anterior and posterior cranioplasty, and total calvarial remodelling using barrel stave osteotomy are used, but result in limited success only. High mortality and morbidity rates are related to multiple operations with long operation time in young age, difficulties in maintenance of patient position, and persistent deformity and bony defect. Therefore, the authors integrated various cranioplasty techniques originally developed for simple skull deformities and modified them according to the exact nature of the individual deformities under the unique original concept of 'Comprehensive Cranioplasty'. A fourteen week old male patient presented with trilobed skull shape, bony constriction band between the lobes, prominent forehead, flat occiput, and enlarged scalp veins. Three dimensional CT scan revealed premature fusion of total cranial sutures including metopic, sagittal, bilateral coronal, lambdoidal, and squamosal sutures. To release all the closed sutures and to correct the deformity in three dimensions, we adopted various cranioplasty techniques under the concept of comprehensive cranioplasty as follows; first, release of all cranial sutures by frontal craniotomy, bilateral temporal craniotomy, bilateral parasagittal strip craniectomy, and bilateral partial lambdoidal strip craniectomy, second, lengthening of skull anteroposterior dimension by fronto- orbital advancement and modified calvarial remodelling (infracture & outfracture), third, reduction of skull width by barrel stave osteotomy and bilateral parasagittal strip craniectomy, four, reduction of skull height by modified calvarial remodelling and split and transposition of craniotomized frontal bone segment, which also correct flat occiput and prominent forehead, respectively. All the operative procedures were performed under supine position. Without modified prone position, posterior cranium could be exposed to the inion level and it is sufficient to do the partial lambdoidal strip craniectomy and backcut osteotomy. We think modified prone position is not needed even in cases of posterior cranial deformity unless complete removal, ex vivo remodelling, and reattachment of occipital cranium are necessary. Eighteen months after the operation, the patient shows significant growth and improvement on both functional and aesthetic aspects despite persistent microcephalus, and insufficient reduction in cranial height and width. In summary, the authors experienced a quite satisfactory result both functionally and aesthetically in a complex cloverleaf skull deformity patient by combination and modification of previously developed various cranioplasty techniques according to the exact nature of the individual deformities under the concept of comprehensive cranioplasty.
Achondroplasia ; Congenital Abnormalities* ; Constriction ; Cranial Sutures ; Craniofacial Dysostosis ; Craniosynostoses ; Craniotomy ; Forehead ; Frontal Bone ; Humans ; Intellectual Disability ; Intracranial Pressure ; Male ; Mortality ; Orbit ; Osteotomy ; Prone Position ; Scalp ; Skull* ; Supine Position ; Surgical Procedures, Operative ; Sutures ; Tomography, X-Ray Computed ; Veins ; Visual Acuity

No abstract available.
Infectious Mononucleosis*

PURPOSE: For the best possible aesthetic reconstruction after craniofacial bone tumor resection, pasteurization has been adopted to devitalize neoplastic cells while maintaining osteoinductive properties and mechanical strength. This case report aims to demonstrate a long-term follow-up result of a monostotic fibrous dysplasia in frontal bone which was reconstructed by pasteurized tumoral autograft in situ. METHODS: A 14-year-old girl presented with a hard, nontender, slowly growing mass of 6-year duration on her left supraorbital area. CT showed 5 x 4 x 3 cm sized well defined bony mass confined to frontal bone with heterogeneous density. Tumor was excised completely through bicoronal approach and reimplanted to its original site after pasteurization at 60feminineC for 30 minutes. The pathologic examination confirmed fibrous dysplasia. RESULTS: She revisited our clinic 5 years later after suffering some assault on her face. On CT examination, pasteurized tumoral autograft was incorporated to host bone except the fractured upper orbital rim without any evidence of recurrence. She has been satisfied with the result. CONCLUSION: Pasteurization offers a simple, reliable, cosmetic, economic, and durable reconstruction method for craniofacial skeletal tumor. It has advantages of both biologic incorporation ability and mechanical strength without risk of recurrence. So, it should be considered as one of the primary options in benign as well as resectable malignant tumors of craniofacial skeleton.
Adolescent ; Cosmetics ; Fibrous Dysplasia, Monostotic ; Follow-Up Studies ; Frontal Bone ; Humans ; Orbit ; Pasteurization ; Recurrence ; Skeleton ; Stress, Psychological

In order to study the effect of spinal morphine on the tourniquet pain, 40 patients scheduled for orthopedic surgery on the lower extremity under spinal anesthesia were allocated randomly to two groups. In the experimental group, 20 patients received hyperbaric T-cain 10 mg and morphine 0.3 mg (0. 15 ml). In the control group, 20 patients received T-cain 10 mg and saline 0.15 ml. The levels of analgesia and motor block were similar in both groups. During surgery, patients in both groups did not complain of tourniquet pain, whereas one patient in the control group required general anesthesia for surgical pain although the sensory block extended to T(7). In the recovery room, when the sensory block had regressed to the Tdermatomal level, the pain response was checked on the contralateral unoperated thigh in a 60 min tourniquet pressure experiment (350 mmHg for 20 min, 0 mmHg for 20 min, 350 mmHg for 20 min). Seventeen patients in the experimental group experimenced no pain in this test, compared with four patients in the control group. From this study, it is suggested that intrathecal morphine prevents tourniquet pain and it may have some inhibitory effect on tourniquet pain transmission at the spinal cord level.
Analgesia ; Anesthesia, General ; Anesthesia, Spinal ; Humans ; Lower Extremity ; Morphine* ; Orthopedics ; Recovery Room ; Spinal Cord ; Thigh ; Tourniquets*

The intramedullary nailing for humeral shaft fractures has become popular fixation method. It affords less invasive procedure, good stability and early rehabilitation. However many complications were reported such as nonunion, pain and motion limitation of shoulder. We managed 33 patients using interlocking intramedullary nail for the humeral shaft fractures, and nonunion occurred in 9 patients. We reviewed these 9 cases and analyzed the relationship between the nonunions and the fracture sites as well as fracture types. The results were as follows; 1. Nonunion occurred in 9 patients of 25 patients treated closed reduction, but did not occur in 8 patients treated open reduction. 2. The union was obtained in all 6 patients with proximal one third fracture. But nonunion occurred in 6 patients of 19 patients with middle one third fracture and in 3 patients of 8 patients with distal one third fracture. 3. Nonunion after interlocking nails for humeral shaft fractures did not occur in all 6 spiral fracture patients. Nonunion occurred in 5 patients of 8 comminuted fracture patients, in 3 patients of 6 transverse fracture patients and in 1 patient of 3 oblique fracture patients with below the middle one third of humerus. Our study showed that the high rate of nonunion occurred in the comminuted, transverse and oblique fracture below the middle one third of humerus. On the basis of these findings, we recommend that closer attention should be paid when choose the fixation method in these types of the humeral shaft fractures.
Fracture Fixation, Intramedullary ; Fractures, Comminuted ; Humans ; Humerus ; Rehabilitation ; Shoulder

Fibroepithelial polyp of the ureter is a extremely rare benign tumor which is mesodermal origin. It should be suspected preoperatively in cases with a long history of loin pain or hematuria, or both, in a younger patient with the radiologic finding of long ureteric filling defect. Unfortunately. in the majority of cases reviewed. the diagnosis was not made preoperatively but the diagnostic confirmation was made intraoperatively or postoperatively. Herein, we report a case of fibroepithelial polyp or the ureter which was diagnosed preoperatively with ureteroscope. The management was local segmental excision and end-to-end anastomosis of the ureter.
Diagnosis ; Hematuria ; Humans ; Mesoderm ; Polyps* ; Ureter* ; Ureteroscopes ; Ureteroscopy

Fibroepithelial polyp of the ureter is a extremely rare benign tumor which is mesodermal origin. It should be suspected preoperatively in cases with a long history of loin pain or hematuria, or both, in a younger patient with the radiologic finding of long ureteric filling defect. Unfortunately. in the majority of cases reviewed. the diagnosis was not made preoperatively but the diagnostic confirmation was made intraoperatively or postoperatively. Herein, we report a case of fibroepithelial polyp or the ureter which was diagnosed preoperatively with ureteroscope. The management was local segmental excision and end-to-end anastomosis of the ureter.
Diagnosis ; Hematuria ; Humans ; Mesoderm ; Polyps* ; Ureter* ; Ureteroscopes ; Ureteroscopy

Since 1970's, Tamoxifen has been used as an antiestrogen agent for adjuvant hormonal therapy, targeting hormone receptor positive breast cancer. Tamoxifen has adverse side effects such as menopausal hot flush, vaginal discharge, irregular menses, thromboembolism, and uterine endometrial carcinoma. Tamoxifen has structure and side effects similar to amphiphilic cationic agents like chlorpromazine, thorazine, amiodarone, and chloroquine. With long period use in high dose, tamoxifen can cause ocular side effects such as retinal crystalline deposition, macular edema, whorl-like corneal opacities, posterior subcapsular lens opacities, optic neuritis, and affected EOG. Recently several reports showed that ocular side effect could happen even in low dose standard treatment. We experienced a case of keratopathy of corneal opacity without disorder of retina, lens, and optic nerve in low dose tamoxifen therapy for breast cancer.
Amiodarone ; Breast Neoplasms* ; Breast* ; Cataract ; Chloroquine ; Chlorpromazine ; Corneal Opacity* ; Crystallins ; Electrooculography ; Endometrial Neoplasms ; Estrogen Receptor Modulators ; Female ; Humans ; Macular Edema ; Optic Nerve ; Optic Neuritis ; Retina ; Retinaldehyde ; Tamoxifen* ; Thromboembolism ; Vaginal Discharge

PURPOSE: Nevus sebaceus is a congenital hamartomatous lesion, typically involving head and neck. Various benign and malignant neoplasms can develop in association with nevus sebaceus. We report a case of simultaneous occurrence of squamous cell carcinoma and basal cell carcinoma in nevus sebaceus. METHODS: A 73-year-old man presented with erythematous to black verrucous nodules on the right subauricular area. The upper part was accompanied with inflammation and ulceration, and no specific findings suspicious for malignant degeneration were found in the lower part preoperatively. The mass was totally excised and the defect was directly closed. Lymph nodes were not involved on concomitant neck dissection. RESULTS: Histopathologic examination confirmed the presence of squamous cell carcinoma in the upper part and basal cell carcinoma in the lower part of a nevus sebaceus. Negative margins were achieved on resection. No clinical problems were found during the 3-month follow-up period. CONCLUSION: We experienced a rare case of simultaneous occurrence of squamous cell carcinoma and basal cell carcinoma within the same nevus sebaceus. Because patients with nevus sebaceus have risk of malignant changes, surgical excision and work-up for recurrence and metastasis should be considered in suspicious cases. And even in a totally asymptomatic case, the possibility of occult secondary cancer should be informed before surgery in aged patients.
Aged ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Follow-Up Studies ; Head ; Humans ; Inflammation ; Lymph Nodes ; Neck ; Neoplasm Metastasis ; Nevus ; Recurrence ; Ulcer

BACKGROUND: The present study tested the effect of midazolam administration after sevoflurane anesthesia against emergence agitation in children in the recovery phase. METHODS: A total of 60 children presenting for ophthalmic surgery under sevoflurane anesthesia were randomly placed in four groups from Group I to Group IV. Before the end of the surgery, we injected normal saline 2 ml in Group I and Group IV. We administered a 2-ml mixture of midazolam 0.025 mg/kg and midazolam 0.050 mg/kg to Group II and Group III respectively. Among the patients with agitation scores 4 or 5 in the peostanesthesia care unit (PACU), Group IV patients were intravenously given a 1-ml mixture of midazolam 0.025 mg/kg and normal saline up to 3 times. Agitation parameters, anesthesia recovery times, and the total administration amounts of midazolam were measured. RESULTS: Extubation time was significantly longer and maximum agitation scores higher in Group III than in Group I. The rate of the length of the period when the agitation score was 4 or 5 out of the length of stay in the PACU was significantly lower in Group II, Group III, and Group IV than in Group I. The length of stay in the PACU was significantly longer in Group III, and Group IV than in Group I. CONCLUSIONS: For pediatric patients under sevoflurane anesthesia, postoperative midazolam administration slightly prolonged the length of stay in the PACU. But it effectively reduced emergence agitation without any side effects.
Anesthesia ; Child ; Dihydroergotamine ; Humans ; Length of Stay ; Methyl Ethers ; Midazolam ; Strabismus