Epiblepharon is frequently encountered n oriental eyelid, especially in children. It is characterized by a horizontal fold of redundant skin and abundant orbicularis muscle near lid margin, which the lashes vertically, or posteriorly towards the eye. Surgical therapy of epiblepharon in correcting the trichiasis includes lid bracing sutures, burried sutures, skin resection, a Hotz procedure or its modification, and a Jones procedure. In our opinion, these procedures are not sufficient, because these procedures will not correct the epicanthal folds. Epicanthal folds have been a one of the characteristics of Asian over 50 percents of population in Japan and South Korea, and it either reduce the aesthetic result of the double-eyelid procedure or make the correction of the entropion and epiblepharon difficult. Although many surgical procedures are available to eliminate epicanthal folds, scarring on the medial canthus is in still and obstacle for surgeons to overcome. From January of 1998 to October of 1998, we used half z-plasty procedures in 5 cases to correct epicanthal folds in epiblepharon. There were few complications in our series. We believe that half z-plasty can get a good result in the correction of epibolepharon and oriental epicanthal folds.
Asian Continental Ancestry Group ; Braces ; Child ; Cicatrix ; Entropion ; Eyelids ; Humans ; Japan ; Korea ; Skin ; Sutures ; Trichiasis

No abstract available.
Arthrogryposis* ; Humans ; Twins, Monozygotic*

No abstract available.

There are several considerations in performing free vascularized fibular graft for the treatment of the large bone defect, e.g., bone fixation, additional bone graft, and management of complication. Authors have analyzed 25 cases treated with free vascularized fibular graft at Holy Family Hospital between Jun. 1985 and Dec. 1994. The mean follow up was 27.4 months The results were as follows: 1. The causes of the defect were traumatic defect with infection of 16 cases, bone tumor of 4 cases, congenital pseudoarthrosis of tibia of 3 cases and osteomyelitis of 2 cases. 2. Hypertrophy of the graft was more common in the lower extremity and in the patient under the age of 15. 3. Nonunion of graft occurred in 4 cases(16%). These cases were fixed with screws and/or pin ini tially and subsequently treated with rigid internal fixation. 4. Stress fracture of graft occurred in 3 cases(12%). Two cases of them were treated with internal fixation. 5. Additional bone graft were performed in 6 cases(24%), among 17 cases who had bone defect of lower extremity in adult. In conclusion, authors emphasize that rigid internal fixation and additional bone graft in performing free vascularized fibular graft are recommended for obtaining early solid bony union and achieving early rehabilitation.
Adult ; Follow-Up Studies ; Fractures, Stress ; Humans ; Hypertrophy ; Lower Extremity ; Osteomyelitis ; Pseudarthrosis ; Rehabilitation ; Tibia ; Transplants

Incidence of non-contiguous multiple spine fracture was increased from 3.2%~4.5% at 1960th and 70th to 5.7% ~23.8% at 80th and 90th. But there is no reports in Korea which has high incidence of traffic and industrial accidents. In 345 consecutive patients with acute spine fracture, we found that 43 patients (12.5%) had multiple non-contiguous spine fractures. At the 43 patients studies 37 (87.4%) sustained fractures at 2 levels while 6 had more than 3 levels of injury, 26 were injured by fall from heights, 27 (62.8%) had 2.33 associated injuries on an average, and 12 (27.9%) had a neurologic deficit. There are five patterns account for 26 (50%) of the total number of patients. In 19 patients (44.2%), there was a mean 29.3 days delay (from 3 to 233 days) in diagnosis of the minor lesions. In 19 delay diagnosed minor lesions, it confirmed by bone scan in 12 patinets(63.6%). Two patients died within 24 hours after accident, and 41 patients (41 major and 50 minor fractures) were treated in our hospital. Among them, 21 (51.2%) needed modification of treatment by the presence of non-con- tiguous multiple spine fractures. According to above findings, the physician must be aware of the possible noncontiguous multiple spine fractures when examine and treat the patients with spine fracture.
Accidents, Occupational ; Diagnosis ; Humans ; Incidence ; Korea ; Neurologic Manifestations ; Spine

PURPOSE: Cryoablation has been used successfully for the local treatment of renal cell carcinoma. Besides local destruction, Cryoablation has an immunogenic nature. In this study, we evaluated the anti-tumor immune response induced by cryoablation in renal cell carcinoma murine model. MATERIALS AND METHODS: Renal cell carcinoma was produced in BALB/c mice by the subcutaneous inoculation of Renca cells in the thigh. After 7 days, the tumors were removed using liquid nitrogen in cryoablation group and bipolar electrocoagulation in electrocautery group. For twelve days after re-inoculation of Renca cells at contralateral thigh, tumor volumes were measured daily to assess the effect against the growth of tumor. The immunocyte levels (T4, T8, B and NK cell) were determined to evaluate immune activity by FACS (Fluorescence activated cell sorter) analysis. The effect of cryoablation to induce apoptosis of tumor was evaluated by TUNEL (Terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-digoxigenin nick end-labeling) assay. RESULTS: The tumor volume of cryoablation group was significantly smaller than that of electrocautery group and control (p<0.05). Comparing with control, T cell level was significantly increased after cryoablation (p<0.05), but no group had a significant difference in the levels of B cell and NK cell by FACS analysis. The apoptosis index % of cryoablation group was significantly increased than that of control group (p<0.05) by TUNEL. CONCLUSIONS: Cryoablation could result in the inhibition of re-inoculated tumor growth and induce T cell mediated immune response. The active immune response may be attributed to the apoptosis of tumor after cryoablation.
Allergy and Immunology ; Animals ; Apoptosis ; Carcinoma, Renal Cell* ; Cryosurgery* ; DNA Nucleotidylexotransferase ; Electrocoagulation ; Immunity, Active ; In Situ Nick-End Labeling ; Killer Cells, Natural ; Mice ; Nitrogen ; Thigh ; Tumor Burden

Vascularized fibular graft is one of the treatment option for avascular necrosis of femoral head (ANFH) and has been known as providing a strut mechanical support and new vascular bed. It is very important to evaluate a healing process in femoral head after vascularization procedure. But a plain radiographic finding has a problem to assess pathological changes of ANFH treated with vascularized fibular graft. Authors analyzed chronogical changes of Tc-99m-HDP bone scan in 31 cases of ANFH treated with vascularized fibular graft from April, 1991 to May, 1994 and following results were obtained. l. Until 2 months after surgery, no change in size of cold defect area and no significant change in extent of RI uptake in reactive zone were noted. 2. During 2 months and 6 months after surgery, slight decrease in size of cold defect area and minimal changes in extent of RI uptake in reactive zone were observed. 3. During 6 months and 12 months after surgery, size of cold defect area decreased to 1/2 and changes in extent and degree of RI uptake in reactive zone were observed. 4. During 1 year and 2 years after surgery, size of cold defect area were minimal and sometimes faded away. RI uptake with decreased density in reactive zone broadened and moved to subchondral area. 5. After 2 years after surgery, cold area faded away and small increased RI uptake were observed in same site. In conclusion, Tc-99m-HDP bone scan which is economic and easily applicable in a patient is very useful for follow up study in ANFH treated with vascularized fibular graft.
Follow-Up Studies ; Head* ; Hip ; Humans ; Necrosis* ; Transplants*

PURPOSE: To evaluate the safe triangle within the femoral triangle for the potential space of the true anterior hip approach. MATERIALS AND METHODS: Cadaveric dissections were carried out on 28 femoral triangles from 14 cadavers. This study measured the length of the direct head of the rectus femoris from the anterior inferior iliac spine (AIIS) to the patella upper pole, the AIIS to the lateral border of the femoral nerve, and the entry point of the femoral nerve and vessel branches to the rectus. The safe portion within the risky femoral triangle was analyzed and applied to two clinical situations, a femoral head fracture and septic hip arthritis. RESULTS: The examination showed that there were three terminal branches to the rectus femoris from the femoral nerve. The entry point of the first branch was at the proximal 20.0-28.9% portion of the rectus femoris. The second and the third branch entered at the proximal 22.5-37.5% and 24.9-41.0%, portion, respectively. The vessel entry was at 21.4-37.3%. The length from the AIIS to the femoral nerve was 3.5- 8.0 cm. Using this space, the procedure was easier to perform in the two situations mentioned above. CONCLUSION: The space within the femoral triangle between the proximal 20% of the rectus femoris and iliacus can be used as one of the potential spaces for femoral head fracture fixation and septic hip irrigation in children, and as an arthroscopy portal.
Arthritis ; Arthroscopy ; Cadaver ; Child ; Femoral Nerve ; Fracture Fixation ; Head ; Hip* ; Humans ; Patella ; Quadriceps Muscle ; Spine

Background: To investigate the clinical and microbiological features of febrile patients with upper urinary tract calculi and factors that affect empirical antibiotic resistance. Methods: A retrospective analysis was performed on 203 febrile patients hospitalized between January 2011 and December 2016 with antibiotic treatment for urinary tract infections and upper urinary tract calculi at three institutions. We collected and analyzed data, including patients' age, sex, body mass index, underlying diseases, stone-related factors, and the results of urine and blood culture examinations and antibiotic sensitivity tests. Results: The male-to-female ratio was 1:2.3. Bacteria were identified in 152 of the 203 patients (74.9%). The most commonly cultured microorganisms included Escherichia coli (44.1%), followed by Enterococci spp. (11.8%), Proteus spp. (8.6%), Streptococcus agalactiae (6.6%), Klebsiella spp. (5.3%), Pseudomonas spp. (4.6%), coagulase-negative Staphylococcus (4.0%), Staphylococcus epidermidis (4.0%), Serratia spp. (2.6%), Enterobacter spp. (0.7%), Acinetobacter spp. (0.7%), and mixed infections (7.2%). Cultured bacterial species showed sex-specific differences. Multivariate analysis revealed that calculi's multiplicity was an independent predictive factor for quinolone resistance (P = 0.008). Recurrent infections were a significant predictor of cefotaxime resistance during multivariable analysis (P = 0.041). Conclusion Based on the present study results, quinolone was not recommended as the empirical treatment in febrile patients with upper urinary tract calculi. Combination antibiotic therapy is recommended in cases of recurrent infections due to the possible occurrence of cefotaxime resistance.

Papillary thyroid carcinoma (PTC) typically has a good prognosis, but it frequently metastasizes to the regional lymph nodes. Although survival impact of lymph node metastasis is not clear, complementary treatment is generally added after surgery when lymphatic metastasis exists. Several previous studies have reported that the multifocal PTC is associated with poor prognosis and requires selective neck dissection to prevent regional lymph node metastasis, but they are under controversy. In this study, we present a 24-year-old female patient, diagnosed as PTC with intrathyroidal spread and regional lymph node metastases. Intrathyroidal spread of PTC can only be observed microscopically and is believed to have the similar origin of unicentric multifocal PTC. As multifocal PTC is highly associated with regional lymph node metastasis and requires an additional treatment, PTC with intrathyroidal spread may follow a similar clinical course and treatment plan. Here we report the case with a brief literature review and expect its attribution to further academic interest of treatment choice.