Air-bags have received widespread support as an effective means of enhancing automotive safety, and they are becoming more common as standard automobile equipment on many cars. Although air-bag induced ocular injuries are rare, they present a serious concern because of the possibility of permanent damage or visual impairment. To date, most reports have investigated ocular injury from high velocity motor vehicle accidents and reports of ocular injury from low speed motor vehicle accidents have been rare. We describe a patient who sustained severe ocular injury, including periorbital fracture, hyphema, vitreous hemorrhage, and choroidal rupture of the macular area, due to an inflated air-bag in a low speed motor vehicle accident.
Accidents, Traffic ; Adult ; Air Bags/*adverse effects ; Choroid/*injuries ; Eye Injuries/*etiology ; Female ; Humans ; Hyphema/*etiology ; Orbital Fractures/*etiology/radiography ; Rupture ; Tomography, X-Ray Computed ; Vitreous Hemorrhage/*etiology/ultrasonography

The anesthetic management of a patient with pheochromoctoma in pregnancy is presented. Preoperative phenoxybenzamine therapy and careful intraoperative monitoring preduced successful cesarean section and tumor reseetion in this patient. Problems that occurred during mamagement of this patient are hypoxemia(R/0 pulmonary edema) and cardiovascular flucctuation according to the operative procedure. Hypoxemia oceurred possibly due to large amount of crystalloid infusion in a short time and was solved with applying positive end expiratory pressure and using diuretics. Blood pressure was controlled effectively with sodium nitroprusside or phenylephrine infusion according to the operative procedure. Preoperative pregnancy induced liver disease in this patient was recovered after delivery.
Anesthesia, General ; Anoxia ; Blood Pressure ; Cesarean Section ; Diuretics ; Female ; Humans ; Liver Diseases ; Monitoring, Intraoperative ; Nitroprusside ; Phenoxybenzamine ; Phenylephrine ; Pheochromocytoma* ; Positive-Pressure Respiration ; Pregnancy* ; Surgical Procedures, Operative

The two main screening tests during pregnancy are those for chromosomal abnormalities and neural tube defects (NTDs). In particular, for NTDs, measurement of maternal serum alpha-fetoprotein (MSAFP) levels early in the second trimester (15-18 weeks of gestation) has been considered the gold standard screening test for the past 4 decades. However, with remarkable technological advancements and the widespread use of ultrasound during those periods, mid-trimester ultrasonography has gradually replaced the role of measuring MSAFP levels as a screening method for NTDs. This change was initiated more about 10 years ago in some countries, which have issued national guidelines to use mid-trimester ultrasonography instead of measuring MSAFP levels as a prenatal screening method for NTDs. However, no significant changes have occurred in Korea, where second-trimester ultrasonography is routinely performed with high-quality equipment. We aimed to provide information regarding the importance of changing the screening method for NTDs from MSAFP measurement to ultrasonography, and to detail methods of implementing mid-trimester ultrasonography for screening purposes. We also share our experience of operating a prenatal diagnostic program for NTDs without using MSAFP for more than 15 years.

BACKGROUND: Nasal framework-supporting procedures such as septal extension grafts, derotation grafts, and columellar strut grafts are usually required in rhinoplasty in Asian patients because the skin envelope is tight, but the nasal framework is small and weak. Autologous materials are preferred, but they have some limitations related to the amount that can be harvested and the frequency of use. Therefore, synthetic materials have been used to overcome these limitations. METHODS: A total of 114 patients who received a polydioxanone (PDS) plate as an adjuvant material in rhinoplasty from September 2016 to August 2017 were retrospectively investigated. The PDS plate was used as to support the weak framework and to correct the contour of the alar cartilages. The PDS plate was used for reinforcement of columellar struts and septal L-struts, alar cartilage push-down grafts, fixation of septal extension grafts, and correction of alar contour deformities RESULTS: Primary and secondary rhinoplasty was performed in 103 and 11 patients, respectively. Clinically, no significant inflammation occurred, but decreased projection of the tip was observed in seven patients and relapse of a short nose was noted in five patients. CONCLUSIONS: PDS plates have been used in the United States and Europe for more than 10 years to provide a scaffold for the nasal framework. These plates can provide reinforcement to columellar struts, L-struts, and septal extension grafts. In addition, they can assist in deformity correction. Therefore, PDS plates can be considered a good adjuvant material for Asian patients with weak and small nasal cartilage.
Asian Continental Ancestry Group ; Cartilage ; Congenital Abnormalities ; Europe ; Humans ; Inflammation ; Nasal Cartilages ; Nose ; Polydioxanone ; Recurrence ; Retrospective Studies ; Rhinoplasty ; Skin ; Transplants ; United States

PURPOSE: The performance of rhinoplasty on the patient who has already undergone unsatisfactory results or complications after augmentation rhinoplasty is a challenging surgical problem. Because the dead space is remained after removal of the foreign body and the thickness of the skin is not even, the deformity would be more conspicuous if the nose is reconstructed again with hard implant only or autogenous cartilage. In these cases, the autogenous fascia can be used to get a good result. We present our clinical experience of secondary rhinoplasty using Scarpa's fascia of lower abdomen. METHODS: Thirty-two patients underwent the procedure from March of 2002 to February of 2007. Nine patients were reconstructed with Scarpa's fascia only, eighteen patients were reconstructed with silicone implant and fascia, and five patients were reconstructed with cartilage and fascia for secondary rhinoplasty. RESULTS: There were no major complications. Most of the patients were satisfied with the results. The deviation of the silicone implant and postoperative hypertrophic scar of the donor site were seen in one case each. Postoperative absorption of fascia were seen in two cases using Scarpa's fascia only. CONCLUSION: Secondary rhinoplasty using Scarpa's fascia is very useful method which offers a minimized donor site scar, low complication rate, shorter operation time and patient satisfaction and prevents the alopecia caused by the harvest of temporalis fascia.
Absorption ; Alopecia ; Cartilage ; Cicatrix ; Cicatrix, Hypertrophic ; Congenital Abnormalities ; Fascia ; Foreign Bodies ; Humans ; Nose ; Patient Satisfaction ; Rhinoplasty ; Silicones ; Skin ; Tissue Donors

OBJECTIVE: By using a functional magnetic resonance imaging (fMRI) technique we assessed brain activation patterns while subjects were viewing the living environments representing natural and urban scenery. MATERIALS AND METHODS: A total of 28 healthy right-handed subjects underwent an fMRI on a 3.0 Tesla MRI scanner. The stimulation paradigm consisted of three times the rest condition and two times the activation condition, each of which lasted for 30 and 120 seconds, respectively. During the activation period, each subject viewed natural and urban scenery, respectively. RESULTS: The predominant brain activation areas observed following exposure to natural scenic views in contrast with urban views included the superior and middle frontal gyri, superior parietal gyrus, precuneus, basal ganglia, superior occipital gyrus, anterior cingulate gyrus, superior temporal gyrus, and insula. On the other hand, the predominant brain activation areas following exposure to urban scenic views in contrast with natural scenes included the middle and inferior occipital gyri, parahippocampal gyrus, hippocampus, amygdala, anterior temporal pole, and inferior frontal gyrus. CONCLUSION: Our findings support the idea that the differential functional neuroanatomies for each scenic view are presumably related with subjects' emotional responses to the natural and urban environment, and thus the differential functional neuroanatomy can be utilized as a neural index for the evaluation of friendliness in ecological housing.
Adult ; Brain Mapping/*methods ; Emotions/physiology ; Environment ; Female ; Humans ; Image Processing, Computer-Assisted ; Linear Models ; Magnetic Resonance Imaging/*methods ; Male ; *Photic Stimulation

Ischemic colitis is the most common vascular disorder of intestines, and usually affects older patients. Many predisposing conditions have been implicated in the pathogenesis of colonic ischemia, although many occurrences are spontaneous in nature. Ischemic colitis can induce a wide spectrum of radiological or endoscopic features, depending on the site, extend, and timing of its onset. The coexistence of colonic ischemia with carcinoma of large bowel is well documented. However It is less well recognized that a localized segment of ischemic colon can mimic a carcinoma. Here, we report a case of ischemic colitis mimicking colon cancer in a 66 year-old man.
Aged ; Colitis, Ischemic* ; Colon ; Colonic Neoplasms ; Humans ; Intestines ; Ischemia

PURPOSE: Marjolin's ulcer is rare but highly aggressive malignant cancer that is associated with chronic, nonhealing wounds such as burn wound. There are no confirmed effective protocols for treatment of this disease. This study was conducted to describe the clinical presentation and treatment modalities of Marjolin's ulcer in our hospital. METHODS: This was a retrospective study of Marjolin's ulcer. 20 cases were histologically confirmed malignant skin cancer seen at Chonbuk National University Hospital from January 2000 to December 2011. Data were retrieved from patients' medical records and photographs. RESULTS: The total 20 cases of Marjolin's ulcer were studied. Squamous cell carcinoma was the most common pathological type in 20 patients (100%). Lymph node metastasis at the time of diagnosis was recorded in 3 patient (15%). Wide excision was the most common surgical procedure performed in 17 patients (85%) of cases. The reconstruction modalities were various as free flap 3 patients (15%), skin graft 13 patients (65%), local advancement flap 2 patients (10%) and regional flap 1 patient (5%). Local recurrence was noted in 3 patients (15%) who had surgical treatment. And one patient (5%) expired in hospital. CONCLUSION: Marjolin's ulcer is an infrequent lesion. Unfortunately the diagnosis and treatment are often delayed. If the wound was histologically confirmed, aggressive excision and reconstruction is warranted in these highly malignant skin cancer. Early recognition and aggressive treatment of Marjolin's ulcers are essential to improve outcomes.
Burns ; Carcinoma, Squamous Cell ; Free Tissue Flaps ; Humans ; Lymph Nodes ; Medical Records ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Skin ; Skin Neoplasms ; Transplants ; Ulcer

No abstract available.
Intubation, Intratracheal* ; Lacerations*

INTRODUCTION: Lymphoepithelioma-like carcinoma of the skin (LELCS) is a rare cutaneous tumor of low grade malignancy and microscopically resembles lymphoepitheliomatous malignancies in the nasopharynx, palatine tonsils, salivary glands and uterine cervix. LELCS presents as scarlet-colored firm nodules or plaques on the face, scalp, or shoulder of middle-aged to elderly individuals. MATERIAL AND METHODS: A 72 year-old female had complained a papule like lesion with intermittent pruritis on the left temple for 2 years. But the lesion was changed to scarlet-colored firm nodule with ulceration. The mass was diagnosed as LELCS on the biopsy. And to confirm that the mass is not metastatic lymphoepithelioma-like carcinoma from other sites or direct tumor extension from the nasopharynx, selective radiographic and laboratory tests were done carefully. RESULTS: Wide excision was performed with general endotracheal anesthesia. The tumor is composed of island of large epithelial cells surrounded by as dense infiltrate of lymphocytes. Immunohistochemical staining with cytokeratin and epithelial membrane antigen(EMA), the tumor cells were positive reaction for stain. And Epstein-Barr virus genome was not detected by in situ hybridization. So, the tumor was confirmed as LELCS. CONCLUSION: LELCS was described by Swanson at 1988, but has not been reported in the field of plastic surgery of Korea. We report a case of primary LELCS that occurred in the left temple with clinical characteristics, histologic features and references.
Aged ; Anesthesia ; Biopsy ; Cervix Uteri ; Epithelial Cells ; Female ; Genome ; Herpesvirus 4, Human ; Humans ; In Situ Hybridization ; Keratins ; Korea ; Lymphocytes ; Membranes ; Nasopharynx ; Palatine Tonsil ; Pruritus ; Salivary Glands ; Scalp ; Shoulder ; Skin ; Surgery, Plastic ; Ulcer