OBJECTIVES: To investigate the common causes of persistent septal deviation in revision septoplasty and to report the surgical techniques and results to correct them. METHODS: A total of 100 consecutive patients (86 males) who had revision septoplasty due to persistent septal deviation from 2008 and 2014 were included in the study. Their mean age was 35.6 years and the mean follow-up duration was 9.1 months. Presenting symptoms, sites of persistent septal deviation, techniques used to correct the deviation, and surgical results were reviewed. RESULTS: The mean interval between primary and revision surgery was 6.2 years. Forty-eight patients received revision septoplasty and 52 received revision septoplasty combined with rhinoplasty. Nasal obstruction was the most presenting symptom in almost all patients. The most common site of persistent septal deviation was middle septum (58%) followed by caudal septum (31%). Correcting techniques included further chondrotomy and excision of deviated portion in 76% and caudal batten graft in 39%. Rhinoscopic and endoscopic exams showed straight septum in 97% and 92 patients had subjective symptom improvement postoperatively. CONCLUSION: Middle septum and caudal septum were common sites of persistent deviation. Proper chondrotomy with excision of deviated middle septum and correction of the caudal deviation with batten graft are key maneuvers to treat persistent deviation.
Follow-Up Studies ; Humans ; Nasal Obstruction ; Rhinoplasty ; Transplants

sodium hyaluronate in beagle dogs. METHODS:In group 1, hGH(Eutropin, r-hGH) 0.29mg/kg was injected subcutaneously to 6 beagle dogs everyday for 7 days. In group 2, 1mg/kg in sustained- release formulation using sodium hyaluronate(SR-hGH), was injected subcutaneously to 6 beagle dogs. In group 3, 2mg/kg of the same formulation(SR-hGH) was injected subcutaneously to 6 beagle dogs. Blood samplings were done for the measurement of GH and IGF-1 concentrations with ELISA kit(Diagnostic Systems laboratories, Inc., USA) RESULTS:GH concentration in group 1 was below 0.5ng/ml before injection and elevated to 98.1+/-15.7 at 1 hr, 124.2+/-15 at 2 hr, 57.8+/-18.1 at 4 hr, 23.8+/-4.8 at 6hr, 10.8+/-3.7 at 8 hr, 2.8+/-1.6 at 10 hr, 1.0+/-0.7 at 12 hr, and 0.5+/-0.1ng/ml at 24hr after injection. Peak GH concentration was observed in 2 hr and thereafter decreased progressively and returned to basal level at 10 hr after injection. From the 2nd day GH concentration was measured only at 6 hr after daily GH injection, indicating the values of 20.9+/-8.7, 16.2+/-14.9, 23.1+/-8.5, 34.3+/-9.9, 16.1+/-7.0, and 21.8+/-13.0ng/ml at 2nd, 3rd, 4th, 5th 6th, and 7th day, respectively. GH concentrations in group 2(SR- hGH 1mg/kg) were 136.7+/-22.8 at 1hr, 149.3+/-29.9 at 2hr, 110.6+/-17.8 at 4hr, 103.7+/-18.2 at 6hr, 108.3+/-21.0 at 8hr, 91.4+/-21.4 at 10hr, 79.6+/-15.9 at 12hr, 23.7+/-8.3 at 24hr, 5.5+/-1.5 at 30hr, 0.7+/-0.2 at 48hr, 1.4+/-1.4 at 54hr, and 0.5+/-0.1ng/ml at 72hr after injection. GH concentration was elevated above the basal level for 72hr with the peak at 2hr after injection of SR-hGH of 1mg/kg. GH concentrations in group 3(SR-hGH 2.0mg/kg) were 196.7+/-45.2 at 1hr, 219.4+/-39.8 at 2hr, 198.1+/-38.0 at 4hr, 196.0+/-31.4 at 6hr, 179.2+/-28.3 at 8hr, 151.8+/-19.5 at 10hr, 141.3+/-23.1 at 12hr, 72.9+/-14.7 at 24hr, 43.7+/-14.2 at 30hr, 3.8+/-1.6 at 48hr, 1.6+/-0.5 at 54hr, 0.8+/-0.5 at 72hr, 0.5+/-0.1 at 78hr, and 0.5+/-0.2ng/ml at 120hr. Peak GH concentration occurred at 2hr after injection and remained high concentration till 72hr and returned to basal level thereafter. IGF-1 concentrations in group 1 changed from 190.5+/-68.1ng/ml before injection, to 326.4+/-96.2, 346.4+/-79, 391.4+/-86.9, 417.0+/-96.1, 422.1+/-92.0, 429.9+/-86.4, and 478.0+/-90.2ng/ml at 12hr, 30hr, 54hr, 78hr, 102hr, 126hr, and 150hr, respectively. IGF-1 concentrations in group 2 were 128.5+/-37.0 ng/ml before and 268.0+/-64.2, 307.6+/-63.1, 374.8+/-55.3, 335.5+/-39.4, 301.9+/-44.8, 288.5+/-42.5, 272.8+/-51.8, 273.9+/-46.0, 251.1+/-40.9, and 239.2+/-45.0ng/ml at 24hr, 30hr, 48hr, 54hr, 72hr, 78hr, 96hr, 102hr, 126hr, and 150hr, respectively after injection. Peak IGF-1 concentration was measured at 48hr and remained in high concentration till 150hr after injection. IGF-1 concentrations in group 3 were 116.0+/-68.9ng/ml before and 365.5+/-118.6, 400.0+/-135.1, 463.6+/-138, 450.2+/-140.0, 337.2+/-122.4, 301.4+/-113.4, 236.3+/-89.1, 226.3+/-75.5, 148.9+/-55.2, and 129.8 48.4ng/ml at 24hr, 30hr, 48hr, 54hr, 72hr, 78hr, 96hr, 102hr, 126hr, and 150hr, respectively after injection. Peak IGF-1 concentration was at 48hr and remained in high concentration till 150 hr after injection. There was no significant difference in IGF-I conc between group I and group 3. CONCLUSION: Sustained-release form(1mg or 2mg/kg) of hGH with sodium hyaluronate released GH for 72 hours with the peak level at 2 hours and higher concentration of IGF-I above baseline maintained for 150 hour after injection with peak level at 48 hour. There was no difference in IGF-1 concentration between SR-hGH 1mg/kg and 2mg/kg injection. So sustained release form 1mg/kg will be more effective for GH therapy as weekly injection mode. More extensive study is needed to permit for new therapeutic application.
Animals ; Dogs* ; Drug Delivery Systems ; Enzyme-Linked Immunosorbent Assay ; Growth Hormone* ; Hyaluronic Acid ; Insulin-Like Growth Factor I ; Sodium

No abstract available.
Hyperpigmentation*

No abstract available.

Acquired nasolacrimal duct obstruction may result from chronic infection, lacrimal stones, anatomical variations such as aberrant ethmoid cells, facial fractures, or complications following nasal surgery. In Korea, there has been no reported case of secondary nasolacrimal duct obstruction due to a retention cyst in the lacrimal sac. Recently, the authors encountered a 65-year-old female patient who presented with epiphora, was diagnosed with a lacrimal sac retention cyst, and was successfully treated with endoscopic marsupialization.

Acanthamoeba keratitis is uncommon and rarely reported in Korea. It has been reported in world literature as a very severe, progressive necrotizing stromal keratitis due to a non-parasitic free-living amoeba. It is frequently associated with minimal corneal trauma especially from contact lens but sometimes occurs in patients without any past history. We report a case of acanthamoeba keratitis without a specific past history in a 42-year-old man. Light and electron microscopy demonstrated severe stromal keratitis with numerous thick-walled cysts, 10~15 m in diameter, scattered in the superficial and deep stroma. Because this keratitis is most often mistaken for fungal, bacterial or herpetic keratitis, early confirmatory diagnosis by direct smear, biopsy or culture is essentially required for the prevention of visual loss or devastating eyeball loss.
Acanthamoeba Keratitis* ; Acanthamoeba* ; Adult ; Amoeba ; Biopsy ; Diagnosis ; Humans ; Keratitis ; Keratitis, Herpetic ; Korea ; Microscopy, Electron

No abstract available.
Carcinoma, Merkel Cell* ; Lymph Nodes* ; Lymphoscintigraphy* ; Neoplasm Metastasis*

Intersphincteric resection (ISR) is the ultimate sphincter saving procedure for low rectal cancer. Hemorrhoids are a common benign condition. We present and discuss a case of ISR which developed painful edematous hemorrhoids after ISR. A 62-year-old female with low rectal cancer received neoadjuvant chemoradiotherapy with successful down staging of tumor before undergoing robot assisted ISR with coloanal hand-sewn anastomosis. She had pre-existing external hemorrhoids which were not excised. She developed painful and edematous external hemorrhoids 4 days after surgery. These were treated conservatively before discharge. Many colorectal surgeons performing ISR have experienced similar situations in their patients, but none have reported on this phenomenon. We discuss the possible factors that may contribute to this situation. A possible solution is prophylactic excision of the hemorrhoids during coloanal anastomosis. Painful hemorrhoids may occur after ISR and if managed conservatively, the outcome is skin tags.
Chemoradiotherapy ; Female ; Hemorrhoids ; Humans ; Middle Aged ; Rectal Neoplasms ; Skin

No abstract available.
Carpal Tunnel Syndrome*

Cochlear implantation (CI) has been regarded as a safe and effective treatment for patients with severe to profound sensorineural hearing loss. The increase of experience in CI thus has had the effect of leading more children with inner ear anomaly to be considered as cochlear implant candidates. For patients with inner ear anomaly, auditory rehabilitation has been reported to be improved after CI; however, there are several factors such as cerebrospinal fluid leakage, facial nerve injury and abnormal positioning of electrode during surgery and uncertainty of auditory rehabilitation and possibility of the recurrent meningitis after CI that should be considered. Several studies proved that the incidence of otogenic meningitis is higher in patients with inner ear anomaly than in patients with normal inner ear anatomy. We experienced a case of recurrent meningitis due to an unusual cause after cochlear implantation in a patient with inner ear anomaly.
Child ; Cochlear Implantation ; Cochlear Implants ; Ear, Inner ; Electrodes ; Facial Nerve Injuries ; Hearing Loss, Sensorineural ; Humans ; Incidence ; Meningitis ; Uncertainty