PURPOSE: The goals of a blow-out fracture reconstruction are to restore the osseous continuity, provide support for the orbital contents and prevent functional and anatomic defects. Over the past several years, a range of autogenous and synthetic implants have been used extensively in orbital reconstructions. None of these implants have any absolute indications or contraindications in certain clinical settings. However, in extensive blow-out fractures, it is difficult to restore support of the orbital contents, which can cause more complications, such as enophthalmos. This study examined the clinical outcomes of extensive or comminuted blow-out fractures that were reconstructed by the simultaneous use of a titanium mesh plate and Medpor(R). METHODS: Eighty six patients with extensive orbital fractures, who were admitted between March 1999 and February 2007, were reviewed retrospectively. The patients' chart and CT were inspected for review. Twenty three patients were operated on with both a titanium mesh plate (Matrix MIDFACE pre-formed orbital plate, Synthes, USA) and Medpor(R) (Porex, GA, USA). The patients underwent pre-operative CT scans to evaluate the fracture site and measure the area of the fracture. A transconjunctival approach was used, and titanium mesh plates were inserted subperiosteally with screw fixation. Medpor(R) was inserted above the titanium mesh plate. The patients were evaluated post-operatively for enophthalmos, diplopia, sensory disturbances and eyeball movement for a period of at least 6 months. RESULTS: No implant-related complications were encountered during the follow-up period. Enophthalmos occurred in 1 patient, 1 patient had permanent sensory disturbance, and 3 patients complained of ocular pain and fatigue, which recovered without treatment. Although there were no significance differences between groups, the use of 2 implants had fewer complications. Therefore, it can be an alternative method for treating blow out fractures. CONCLUSION: The use of both a titanium mesh plate and Medpor(R) simultaneously may be a safe and acceptable technique in the reconstruction of extensive blow-out fractures.
Diplopia ; Enophthalmos ; Fatigue ; Follow-Up Studies ; Humans ; Orbit ; Orbital Fractures ; Polyethylene ; Retrospective Studies ; Titanium

Pheochromacytoma, although occasionally present with adrenal cortical hyperfunction, is rarely associated with nonfunctioning adrenal cortical tumor. To our knowledge, eight cases of phemchromocytoma associated with adrenocortical adenoma have been reported in the literature, including a case in a Korean adult female. An adrenal mass is considered an incidentaloma when there is no history or physical findings suggesting an adrenal functional disorder or tumor. The majority of adrenal masses are nonfunctioning adrenocortical adenomas. In our case, left adrenal mass was found incidentally by ultrasonography after birth, done because of mother's oligohydroamnios. Abdomial CT study revealed an adrenal tumor, and a surgical resection was performed. The specimen showed a coincident pheochromocytoma and adrenocortical adenoma. The patient seems to be the first case of coexistence of nonfunctioning pheochromocytoma and adrenocortical adenoma in one adrenal tumor. We report this case with the review of literatures.
Adrenocortical Adenoma* ; Adult ; Female ; Humans ; Infant* ; Parturition ; Pheochromocytoma* ; Ultrasonography

In order to explore the existence and distribution of phospholipase (PLC) isozymes in the rat retina, immunohistochemical staining was applied using monoclonal antibodies against PLC isozymes (PLC beta; K92, PLC gamma; D7, F7, PLC delta; R32, S11). For immunohistochemical detection, avidin-biotin peroxidase complex (ABC) method was performed on frozed tissue sections of rat retina. Our study showed that PLC isozymes have particular distributional patterns in the retina. Namely, PLC beta is broadly distributed in the outer and inner segments of photoreceptor cell layer, nuclear layer and ganglion cell layer. PLC gamma is mainly appeared in the nerve fiber layer, ganglion cell layer and inner nuclear layer. PLC delta is confined only in the ganglion cell layer. These results clearly demonstrate the PLC isozymes may have their own role in the transduction of light pathway in the retina. However, further studies will be required to verify theirs precise role in the photoreception.
Animals ; Antibodies, Monoclonal ; Ganglion Cysts ; Immunohistochemistry ; Isoenzymes* ; Nerve Fibers ; Peroxidase ; Phospholipase C beta ; Phospholipases* ; Photoreceptor Cells ; Rats* ; Retina* ; Type C Phospholipases*

In order to explore the existence and distribution of phospholipase (PLC) isozymes in the rat retina, immunohistochemical staining was applied using monoclonal antibodies against PLC isozymes (PLC beta; K92, PLC gamma; D7, F7, PLC delta; R32, S11). For immunohistochemical detection, avidin-biotin peroxidase complex (ABC) method was performed on frozed tissue sections of rat retina. Our study showed that PLC isozymes have particular distributional patterns in the retina. Namely, PLC beta is broadly distributed in the outer and inner segments of photoreceptor cell layer, nuclear layer and ganglion cell layer. PLC gamma is mainly appeared in the nerve fiber layer, ganglion cell layer and inner nuclear layer. PLC delta is confined only in the ganglion cell layer. These results clearly demonstrate the PLC isozymes may have their own role in the transduction of light pathway in the retina. However, further studies will be required to verify theirs precise role in the photoreception.
Animals ; Antibodies, Monoclonal ; Ganglion Cysts ; Immunohistochemistry ; Isoenzymes* ; Nerve Fibers ; Peroxidase ; Phospholipase C beta ; Phospholipases* ; Photoreceptor Cells ; Rats* ; Retina* ; Type C Phospholipases*

PURPOSE: Advanced techniques now make it possible to remove considerable amounts of subcutaneous adipose tissue more safely with minimum blood loss. However, few have analyzed the metabolic consequences of liposuction. The purpose of this study was to identify the early effects of the surgical removal of subcutaneous fat on metabolic changes in patients who have undergone liposuction. METHODS: Nineteen patients were evaluated from June 2005 to December 2005. Preoperative body weight, serums levels of lipids, apolipoprotein A1, dehydroepiandrosterone(DHEA), uric acid, insulin, and glucose were evaluated. Insulin resistance was determined using the homeostasis model assessment of insulin resistance (HOMA-IR), which is based on fasting glucose and insulin concentrations. All of these data were remeasured in 1 and 4 weeks postoperatively. Tumescent fluid was infiltrated using the superwet technique. The liposuction device used was a Liposlim(R) power-assisted unit. RESULTS: Average volumes of infiltrate and aspirate were 3,268mL and 2,892mL, respectively. Results in 1 week postoperatively demonstrated a significant difference in high-density lipoprotein(HDL) cholesterol, apolipoprotein A1, insulin, and HOMA-IR levels. However, all values were within normal limits and returned to baseline in 4 weeks postoperatively. CONCLUSION: This study provides little to support the presumed therapeutic effect of liposuction. And, it is unclear whether liposuction can prevent or be used to treat the metabolic complications of obesity. However, the results of the present study lead us to believe that liposuction is a metabolically safe procedure.
Apolipoprotein A-I ; Body Weight ; Cholesterol ; Fasting ; Glucose ; Homeostasis ; Humans ; Insulin ; Insulin Resistance ; Lipectomy ; Obesity ; Subcutaneous Fat ; Uric Acid

Plasmacytoma in patients with multiple myeloma usually develops in the advanced stage of the disease. We report herein an atypical case of extramedullary relapse of multiple myeloma that presented as mechanical obstruction of the small bowel in a patient who had achieved complete remission after chemotherapy. A 75-year-old man was diagnosed with multiple myeloma 25 months previously and treated with a bortezomib-containing chemotherapy regimen. He presented for evaluation of abdominal pain. A circumferential mass resulting in mechanical ileus was observed by abdominal computed tomography. Biopsy after surgical resection confirmed the diagnosis of plasmacytoma. The patient was subsequently treated with thalidomide-containing chemotherapy, but he died of disease progression after 6 months. We suggest careful observation of unusual relapses of multiple myeloma in patients who have achieved complete remission after antimyeloma therapy.
Abdominal Pain ; Aged ; Biopsy ; Diagnosis ; Disease Progression ; Drug Therapy ; Humans ; Ileus ; Intestinal Obstruction ; Multiple Myeloma* ; Plasmacytoma ; Recurrence*

BACKGROUND: Obstructive sleep apnea (OSA) is a common sleep disorder that causes daytime dysfunction and cardiovascular diseases. Nocturnal polysomnography (NPSG) is the standard method of evaluating OSA; however, it is time-consuming, inconvenient, and expensive. Selective performance of NPSG would be possible if we could better predict those who are more likely to have clinically significant OSA. The aim of this study is to define clinical and anthropometric predictors of OSA. METHODS: We included 100 consecutive patients in whom OSA was clinically suspected. Structured sleep interview, anthropometric measurement, and NPSG were performed in all subjects. Presence of OSA was defined when the apnea-hypopnea index was five or more. Parameters from sleep interview and anthropometric data were investigated with multiple logistic regression using the SAS program (ver 8.1, USA) to identify independent predictors of OSA. RESULTS: OSA was diagnosed in seventy-six patients after NPSG. Univariate analysis showed that the male sex, co-existing diabetes, overweight (BMI>or=25), habitual alcohol drinking, large neck circumference (>or=40 cm), high waist circumference/hip circumference (WC/HC) ratio (>or=0.94), and observed apnea were significantly more frequent in OSA patients (p<0.05). Using multivariate analysis, large neck circumference (>or=40 cm) (adjusted OR=4.43, 95% CI: 1.05~18.61) and high WC/HC ratio (adjusted OR=3.48, 95% CI: 1.12~10.80) were found to be the independent predictors of OSA on the NPSG. CONCLUSIONS: We report the predictors of OSA that could be easily identified by clinical and anthropometric evaluations before performing NPSG. This might aid the clinical decision whether or not to perform NPSG in subjects with clinically suspected OSA syndrome.
Alcohol Drinking ; Apnea ; Cardiovascular Diseases ; Humans ; Logistic Models ; Male ; Multivariate Analysis ; Neck ; Overweight ; Polysomnography ; Sleep Apnea, Obstructive* ; Waist-Hip Ratio

This study was intended to investigate the sodium-related perception, dietary behavior, and practicability of methods for reducing sodium intake(RSI) according to the stage of change in consumers. The survey was conducted to 770 housewives, among them 553 subjects who answered the key questions for the stage of change were categorized into ''aintenance (M)' stage (maintaining reduced salt intake for more than 6 months; n = 287, 51.90%), 'Action (A)' stage (maintaining reduced salt intake for less than 6 months; n=139, 25.14%), and 'Pre-Action (P)'stage (not starting reduced salt intake; n = 127, 22.97%). The subjects in M and A were significantly older than those in P (p < 0.01). The scores of desirable dietary habit and dietary balance were the highest in M followed by A and P. When eating out, the subjects in P considered 'price' more and 'healthiness of food' less than those in M and A did. Among the guidelines for RSI, 'Avoid Processed Foods', 'Eat enough vegetables and fruits' and 'Add little amount of dipping sauce for fried food' were selected as the three easiest items to perform. With regard to the sodium-related perception, the subjects in M considered eating-out food to be more salty than homemade dishes, read nutrition labels more, avoided table salt or dipping sauce for fried food more, and had 'own low-sodium recipe' than those in P (p < 0.001). It is suggested that practicability of actions for RSI and the stage of change should be considered to develop effective personalized education program and nutrition guidance.
Eating ; Food Habits ; Humans ; Sodium ; Sodium Chloride, Dietary ; Vegetables

BACKGROUND/AIMS: Globus is a persistent or intermittent non-painful sensation of a lump or foreign body in the throat and a commonly encountered clinical condition. We aim to evaluate the prevalence of gastroesophageal reflux disease (GERD) and to determine the parameters for predicting the response to treatment with proton pump inhibitor (PPI) using wireless pH monitoring in patients with globus sense. METHODS: We retrospectively reviewed the medical records of 37 patients with atypical GERD symptoms. A total of 27 patients with dominant globus sense were enrolled. Endoscopic examination and 48-hour wireless esophageal pH monitoring were performed, and the patients underwent a therapeutic trial of full dose PPIs daily over a period of 4 weeks. RESULTS: Both typical and atypical GERD symptoms co-existed in 14 patients (51.9%, 14/27). According to ROME III criteria, 19 patients (70.4%, 19/27) were diagnosed as GERD. Twelve patients (44.4%, 12/27) were PPI responders. A significant difference in the frequency of symptom index (+) or symptom associated probability (+) was observed between the PPI responder group and the non-responder group (p<0.01). CONCLUSIONS: In patients with globus sense, 70.4% were diagnosed with GERD. Symptom index/symptom associated probability in wireless ambulatory pH monitoring was a good objective parameter for PPI responder.
Adult ; Aged ; Case-Control Studies ; Endoscopy, Digestive System ; Esophageal pH Monitoring ; Female ; Gastroesophageal Reflux/*diagnosis/drug therapy/pathology ; Humans ; Male ; Manometry ; Middle Aged ; Proton Pump Inhibitors/therapeutic use ; Retrospective Studies ; Severity of Illness Index ; Wireless Technology

OBJECTIVE: This study was performed to evaluate the results of conization by loop electrosurgical excision procedure (LEEP) and cold coagulation as a definitive treatment in the patients with FIGO stage Ia1 squamous cell carcinoma of the cervix. METHODS: One hundred eighty-seven patients were diagnosed as stage Ia1 cervical squamous cell carcinomas from 1995 to 2004 by conization with LEEP and cold coagulation. Fifty-nine patients who wanted to preserve fertility and/or refused further surgical treatment were followed-up without further treatment. Eleven patients of the 59 had involved ectocervical resection margins. All patients were followed-up with cervicovaginal smear and colposcopic examination at a regular interval. Disease recurrence was defined as a histologic diagnosis of dysplasia or more. RESULTS: The median follow-up period was 69.0 months (range 8 to 103). All 59 patients had no lymphvascular space invasion (LVSI). In four patients, the ectocervical margins were involved by dysplasia, in seven patients, by carcinoma in-situ. There were no specific differences in ages, depth of stromal invasion and HPV status between the groups with and without involved margins. All 59 patients did not recur during follow-up period. CONCLUSION: Conization with LEEP and cold coagulation was feasible and could be used as a definitive therapy for the patients with stage Ia1 cervical squamous cell carcinoma. This study suggests that conization might play a role in a patient with positive margins (dysplasia or CIS) when LVSI is not demonstrated.
Carcinoma, Squamous Cell* ; Cervix Uteri* ; Conization* ; Diagnosis ; Female ; Fertility ; Follow-Up Studies ; Humans ; Recurrence