BACKGROUND: Silicone implants are frequently used in augmentation rhinoplasty in Asians. A common complication of silicone augmentation rhinoplasty is capsular contracture. This is similar to the capsular contracture after augmentation mammoplasty, but a classification for secondary contracture after augmentation rhinoplasty with silicone implants has not yet been established, and treatment algorithms by grade or severity have yet to be developed. METHODS: Photographs of 695 patients who underwent augmentation rhinoplasty with a silicone implant from May 2001 to May 2015 were analyzed. The mean observation period was 11.4 months. Of the patients, 81 were male and 614 were female, with a mean age of 35.9 years. Grades were assigned according to postoperative appearance. Grade I was a natural appearance, as if an implant had not been inserted. Grade II was an unnatural lateral margin of the implant. Clearly identifiable implant deviation was classified as grade III, and short nose deformation was grade IV. RESULTS: Grade I outcomes were found in 498 patients (71.7%), grade II outcomes in 101 (14.5%), grade III outcomes in 75 (10.8%), and grade IV outcomes in 21 patients (3.0%). Revision surgery was indicated for the 13.8% of all patients who had grade III or IV outcomes. CONCLUSIONS: It is important to clinically classify the deformations due to secondary contracture after surgery and to establish treatment algorithms to improve scientific communication among rhinoplasty surgeons. In this study, we suggest guidelines for the clinical classification of secondary capsular contracture after augmentation rhinoplasty, and also propose a treatment algorithm.
Asian Continental Ancestry Group ; Classification* ; Contracture ; Female ; Humans ; Implant Capsular Contracture ; Male ; Mammaplasty ; Nose* ; Prostheses and Implants ; Rhinoplasty ; Silicon* ; Silicones* ; Surgeons

We reviewed 40 consecutive patients having a primary total hip replacement(THR) and 60 patients having a primary total knee replacement(TKR) for osteoarthritis to compare the qu;dity of hfe(QoL) before and after operation. Bilateral arthroplasties were perfomed 10 cases of THR and 25 cemes of TKR. We used a modified Harris hip score and a knee score of American knee society, the Rosser Lndex Matrix and authors eval- uation system to generate these scores. Quality of life was highly improved by Rossers and authors evalua- tion system after THR and TKR. The median values of QoL scores before and after operation were signifi- cantly different(p<0.05). The median preoperative QoL score in THR was t>etter than in TKR. Postoperative QoL scores for both groups were similar. Quality of life evaluated by Rossers score and authors evaluation system in bilateral THR was better than bilateral TKR. We think better quality of life in bilateral THR over bilateral TKR by authors evaluation system is because the hip joint is mcire stable and has better range of motion than knee joint. We conclude that change of life style including the use of bed, toilet seat elevation, and the use of dinning table will be neccesary after bilateral TKR.
Arthroplasty ; Arthroplasty, Replacement, Hip* ; Climacteric ; Hip ; Hip Joint ; Humans ; Knee Joint ; Knee* ; Osteoarthritis ; Quality of Life* ; Range of Motion, Articular

No abstract available.
Decompression* ; Follow-Up Studies* ; Spine* ; Titanium*

PURPOSE: Fungi, rhinoviruses (RVs), and eosinophils are associated with upper respiratory diseases. We evaluated the effects of fungal stimulation and eosinophil co-culture on the expression of mucin genes in RV-infected nasal polyp epithelial cells. METHODS: Nasal polyp epithelial cells were obtained from chronic rhinosinusitis patients. Cultured epithelial cells were stimulated with Alternaria and Aspergillus with or without RV-16 infection. The epithelial cells were co-cultured with eosinophils for 16 h. MUC4, MUC5AC, MUC5B, and MUC8 mRNA expressions in the epithelial cells were quantified using real-time RT-PCR. To determine the underlying mechanism, nuclear factor-kappaB (NF-kappaB), activator protein-1 (AP-1), and mitogen-activated protein kinase (MAPK) inhibitors were used to inhibit mucin gene expression. RESULTS: Fungi and RV-16 induced mucin gene expression in nasal polyp epithelial cells. However, there was no synergistic increase in mucin gene expression, with the exception of MUC4 mRNA expression stimulated by 25 microg/mL Aspergillus. When RV-16-infected epithelial cells were stimulated with fungi and then co-cultured with eosinophils, MUC4, MUC5B, and MUC8 mRNA expressions increased. Mucin gene expression was inhibited by NF-kappaB inhibitors. CONCLUSIONS: RV-16, airborne fungi, and eosinophils may exacerbate the inflammatory process in nasal mucosal diseases by enhancing mucin gene expression.
Alternaria ; Aspergillus ; Coculture Techniques ; Eosinophils* ; Epithelial Cells* ; Fungi* ; Gene Expression* ; Humans ; Methods ; Mucins* ; Nasal Polyps ; NF-kappa B ; Protein Kinases ; Rhinovirus ; RNA, Messenger ; Transcription Factor AP-1

BACKGROUND AND OBJECTIVES: Allergic fungal sinusitis is characterized by allergic mucin which includes eosinophils and fungal hyphae. But we don't know why eosinophils are accumulated at the nasal secretion and activated, so authors tried to explain the pathophysiologic function of eosinophils by directly stimulating eosinophils with fungal antigens. SUBJECTS AND METHOD: Eosinophils were isolated from healthy volunteers and stimulated with extracts from 5 common fungal species (Alternaria, Aspergillus, Candida, Cladosporium, and Penicillium). Superoxide production and eosinophil derived neurotoxin (EDN) were measured to determine whether fungi activated eosinophils. An inhibition study was done using serine and cystein protease inhibitors. RESULTS: When cultured with fungal antigens, eosinophils produced superoxide by Alternaria and Cladosporium but only Alternaria induced EDN production. Serine protease inhibitors (PMSF, Pefabloc?) and heat treatment of fungi significantly inhibited the activation of eosinophils but the cystein protease inhibitor (E-64) wasn't inhibited. CONCLUSION: Eosinophils are directly activated by Alternaria and their activity was inhibited by serine protease inhibitors. In AFS, fungal serine proteases may activate eosinophils which play important roles in the pathogenesis of AFS, resulting in the destruction of fungi and respiratory epithelial cells.
Alternaria ; Antigens, Fungal ; Aspergillus ; Candida ; Cladosporium ; Eosinophil-Derived Neurotoxin ; Eosinophils* ; Epithelial Cells ; Fungi* ; Healthy Volunteers ; Hot Temperature ; Hyphae ; Mucins ; Protease Inhibitors ; Serine ; Serine Proteases ; Serine Proteinase Inhibitors ; Sinusitis ; Superoxides

BACKGROUND AND OBJECTIVES: Sinusitis is one of the most common chronic disease in otolaryngology but it's pathogenesis is not well understood. Fungi are known to induce the production of chemical mediators from respiratory epithelial cells and have been increasingly recognized as important pathogens in sinusitis. As neutrophils and fungi are commonly present in the rhinosinusitis tissues and nasal secretions, we conducted this study to figure out the relationship between fungi and neutrophils in the pathogenesis of rhinosinusitis. SUBJECTS AND METHOD: To make human nasal polyp epithelial cell conditioned media (HPECM), nasal polyp epithelial cells were stimulated with 25 microgram/ml of Aspergillus, Aspergillus, 50 microgram/ml of Alternaria and Bipolaris, respectively. Peripheral blood neutrophils were incubated with HPECM to activate and induce the migration of neutrophils. Superoxide production and myeloperoxidase (MPO) were measured as a marker of neutrophils activation. Neutrophil activation was inhibited with anti-IL-8, anti-GM-CSF, and anti-RANTES antibodies, and protease inhibitors (E-64, Pefabloc, Aprotinine). Neutrophil migration were inhibited with anti-IL-8, anti-GM-CSF, anti-RANTES antibodies. RESULTS: HPECM induced the activation of neutrophils. Although the superoxide productions were not strongly enhanced, neutrophils produced a large amount of MPO (61.69+/-47.54 ng/ml by Alternaria, 77.58+/-34.26 ng/ml by Aspergillus, 59.20+/-27.65 ng/ml by Bipolaris). Anti-chemical mediator antibodies and protease inhibitors didn't inhibit the activation of neutrophils. Neutrophil migrations were increased by HPECM and anti-IL8 antibody inhibited the migration of neutrophils (60.5% of Alternaria, 65.5% of Aspergillus, 87.2% of Bipolaris). CONCLUSIONS: Fungi induced the production of chemical mediators from the nasal epithelial cells. HPECM which contains the chemical mediator activated the neutrophils and enhanced their migration. Although the activating factors of neut-rophils couldn't be determined, IL-8 seems to play an important role in the migration of neutrophils.
Alternaria ; Antibodies ; Aspergillus ; Chronic Disease ; Culture Media, Conditioned ; Epithelial Cells* ; Fungi* ; Humans ; Interleukin-8 ; Nasal Polyps* ; Neutrophil Activation ; Neutrophils* ; Otolaryngology ; Peroxidase ; Protease Inhibitors ; Sinusitis ; Superoxides

Thirteen patients were operated for cubital tunnel syndrome and followed for an average of 26 months postoperatively. Ten patients had a history of relevant trauma and three patients had degenerative osteoarthritis of the elbow. The average duration of symptoms was 18 months (range, 2 to 96 months). Diagnosis was made by physical examination, electromyography and nerve conduction study. Among these, nerve conduction study was found to be the most valuable diagnostic method for the patients with atypical clinical findings. Most of the operations were performed by anterior transposition of the ulnar nerve. At the most recent follow-up, the result was excellent in two patients, good in eight, and fair in three; thus ten patients(77%) showed satisfactory results. The rating system for ulnar neuropathy based on sensory, motor dysfunction and pain was useful for evaluating the operative results. The postoperative gain of score for pain and sensory function were larger than that of motor function. Factors known to influence the result of the operation (age, duration of symptom, history of trauma, method of operation) did not effect the outcome in this study. For successful operation, the ulnar nerve must be thoroughly examined, all possible levels of compression must be released and new foci of compression must be created.
Cubital Tunnel Syndrome ; Diagnosis ; Elbow ; Electromyography ; Follow-Up Studies ; Humans ; Methods ; Neural Conduction ; Osteoarthritis ; Physical Examination ; Sensation ; Ulnar Nerve ; Ulnar Neuropathies

PURPOSE: To evaluate the results of Thompson quadricepsplasty in ankylosis of the knee joint by a comparison of the patients'ages, the causes, the duration of the ankylosis and the preoperative range of motion (ROM). MATERIALS AND METHODS: We reviewed 17 patients who received Thompson quadricepsplasty for knee ankylosis between 1991 and 1998, and who could be followed up for more than one year. We compared the results according to the patients'ages, the causes and degree of ankylosis and the duration. Since onset, the postoperative ROM, the final degree of the flexion, the flexion gain (difference between the preoperative and the postoperative ROM), and the loss of ROM (difference between the intraoperative ROM and the postoperative ROM) were also assessed. RESULTS: The preoperative mean arc of motion (26.2degrees, range 0degrees-80degrees) and the mean flexion (30degrees, range 5degrees-90degrees) were significantly increased up to a mean of 98.8degrees (75-100degrees) and 102.1degrees (80-130degrees) respectively. In the severe ankylosis group, the flexion gain was significantly increased. However, the correlation according to the patients'ages, causes and duration of the ankylosis were not statistically significant. The mean loss of ROM was 14.7degrees (-20-30degrees), and it occurred within the postoperative 2 month period in most patients. CONCLUSION: The Thompson quadricepsplasty procedure can be considered to be an acceptable technique for the treatment of ankylosis of the knee joint. Rehabilitation in the postoperative 2 month period is very important for a good outcome.
Ankylosis* ; Humans ; Knee Joint* ; Knee* ; Range of Motion, Articular ; Rehabilitation

Objective: : Our objective is to analyze the occurrence, clinical course and risk factors for glioma patients with leptomeningeal metastasis (LM) according to different metastasis patterns and clinical variables. Methods: : We retrospectively reviewed data from 376 World Health Organization (WHO) grade II–IV adult glioma patients who were treated in the National Cancer Center from 2001 to 2020. Patients who underwent surgery at other institutions, those without initial images or those with pathologically unconfirmed cases were excluded. LM was diagnosed based on magnetic resonance imaging (MRI) findings or cerebrospinal fluid (CSF) cytology. The metastasis pattern was categorized as nodular or linear according to the enhancement pattern. Tumor proximity to the CSF space was classified as involved or separated, whereas location of the tumor was dichotomized as midline, for tumors residing in the thalamus, basal ganglia and brainstem, or lateral, for tumors residing in the cerebral and cerebellar hemispheres. Results: : A total of 138 patients were enrolled in the study. A total of 44 patients (38%) were diagnosed with LM during a median follow-up of 9 months (range, 0–60). Among the clinical variables, tumor proximity to CSF space, the location of the tumor and the WHO grade were significant factors for LM development in univariate analysis. In multivariate analysis, the midline location of the tumor and WHO grade IV gliomas were the most significant factor for LM development. The hazard ratio was 2.624 for midline located gliomas (95% confidence interval [CI], 1.384–4.974; p=0.003) and 3.008 for WHO grade IV gliomas (95% CI, 1.379–6.561; p=0.006). Conclusion : Midline location and histological grading are an important factor for LM in glioma patients. The proximity to the CSF circulation pathway is also an important factor for WHO grade IV glioma LM. Patients carrying high risks should be followed up more thoroughly.

Despite improvements in dialysis care, the mortality of patients with end-stage renal disease(ESRD) remains high. One factor that has so far received little attention, but which might contribute to morbidity and mortality, is the timing of referral to the nephrologist. We performed a retrospective analysis in 358 patients(male 275, female 151) who were initiated renal replacement therapy first at this hospital from Jan 1995 to Dec 1996. Patients were defined by the time of first nephrology as early referral(E, n=163) encountered after more than 8 weeks; late early referral(LE, n=19) encountered between 8 weeks and 4 weeks; late referral(L, n=55) encountered from 1 week to 4 weeks; urgent referral(U, n= 121) encountered less than 1 week. There were no differences in age, gender, primary renal disease, cause of dialysis, and renal replacement therapy modalities. However, there were significant differences in rnean arterial pressure and serum phosphate levels between these 4 groups. The mean arterial pressures (mmHg) were 109.15 +/- 17.16, 105.37+/-18.76, 117.24 +/- 27.24 and 116.98+/-24.26 for E, LE, L and U, respectively(p<0.05, compared E to U). In the U group, serum phosphate levels were elevated at initiation of dialysis compared to the E group(6.39+/-1.72 vs 7.29 +/- 3.54mg/dL, p<0.05). One year mortality in the U group had on increased tendency compared to the E group, especially earlier mortality(7.4% vs 14.9N, p>0.05). In the E group, there was more controlled blood pressure and serum phosphate levels compared to the U group at initiation of renal replacement therapy, but other parameters were not significantly different among the 4 groups. Delays in initiation of renal replacement therapy may result in patients entering dialysis in a compromised state, therefore adequate long-term predialysis care by a nephrologist is important. Socioeconomic - and medical factors respon-sible for late referral and late initiation of dialysis need to be evaluated and corrected to further improve the outcome of these patients.
Arterial Pressure ; Blood Pressure ; Dialysis* ; Female ; Humans ; Mortality ; Nephrology ; Referral and Consultation* ; Renal Replacement Therapy ; Retrospective Studies