The presence of epicanthal folds in Asian eyelids is one of their unique features, in combination with the lack of supratarsal folds. Western culture has influenced many people to prefer to eliminate the prominent epicanthal fold. A number of surgical techniques have been suggested for their correction. However, difficulty with design, excessive and prominent scarring of medial canthal and nasal area, recurrence, and rigidity of application are potential problems associated with many procedures. This paper describes a epicanthoplasty with three-dimensional Z-plasty. Through epicanthal fold incision, the medial canthal tecdon is medially advanced and sutured to the periosteum of nasal bone. After the transposition of the flaps, trimming of the flap is usually required. Three-dimensional Z-plasty crates the attactive eyes. From March, 1995 to March, 1997, the technique was applied to 37 patients with epicanthal fold and was performed with or without double-fold operation. There were 34 females and 3 males with ages ranging from 17 to 30 years. Through 2 years follow-up, this techniques has delivered esthetically good results with minimal postoperative scar and could made the reduction of ICD from 40 +/- 2.13mm to 34 +/- 1.98mm. The advantages of epicanthoplasty procedure using three-dimensional Z-plasty(Yoon's method) are as follows; 1) simple in design 2) minimal postoperative scar in the medial canthal area 3) versatile in its application 4) no recurrence 5) no hypertrophic scar 6) preserving ethnic identity.
Asian Continental Ancestry Group ; Cicatrix ; Cicatrix, Hypertrophic ; Eyelids ; Female ; Follow-Up Studies ; Humans ; Male ; Nasal Bone ; Periosteum ; Recurrence

BACKGROUND: Colistin (polymyxin E) is active against multidrug-resistant Gram-negative bacteria (MDR-GNB). However, the effectiveness of inhaled colistin is unclear. This study was designed to assess the effectiveness and safety of aerosolized colistin for the treatment of ventilator-associated pneumonia (VAP) caused by MDR-GNB. METHODS: In this retrospective longitudinal study, we evaluated the medical records of 63 patients who received aerosolized colistin treatment for VAP caused by MDR-GNB in the medical intensive care unit (MICU) from February 2012 to March 2014. RESULTS: A total of 25 patients with VAP caused by MDR-GNB were included in this study. The negative conversion rate was 84.6% after treatment, and acute kidney injury (AKI) occurred in 11 patients (44%, AKI group). The average length of MICU stay and colistin treatment- related factors, such as daily and total cumulative doses and administration period, were not significantly different between groups. In-hospital mortality tended to be higher in the AKI group (p = 0.07). Multivariate analysis showed that a body mass index less than 18 was an independent risk factor of mortality (odds ratio [OR] = 21.95, 95% confidence interval [CI] 1.59-302.23; p = 0.02). Notably, AKI occurrence was closely related to the administration of more than two nephrotoxic drugs combined with aerosolized colistin (OR = 15.03, 95% CI 1.40-161.76; p = 0.025) and septic shock (OR = 8.10, 95% CI 1.40-161.76; p = 0.04). CONCLUSIONS: The use of adjunctive aerosolized colistin treatment appears to be a relatively safe and effective option for the treatment of VAP caused by MDR-GNB. However, more research on the concomitant use of nephrotoxic drugs with aerosolized colistin will be necessary, as this can be an important risk factor of development of AKI.
Acute Kidney Injury ; Body Mass Index ; Colistin* ; Drug Resistance, Microbial ; Gram-Negative Bacteria ; Hospital Mortality ; Humans ; Intensive Care Units ; Longitudinal Studies ; Medical Records ; Mortality ; Multivariate Analysis ; Pneumonia* ; Pneumonia, Ventilator-Associated ; Retrospective Studies ; Risk Factors ; Shock, Septic ; Treatment Outcome*

Preeclampsia is defined as the development of hypertension with proteinuria, edema induced by pregnancy after 20th week of gestation. Eclampsia implies the occurrence of convulsions unrelated to any coexisting neurologic disease in a preeclamptic. The leading cause of maternal death in preeclampsia-eclampsia is intracranial hemorrhage. Other causes of morbidity include congestive heart failure with pulmonary edema, pulmonary aspiration of gastric contents, disseminated intravascular coagulation, acute renal failure, and septic shock. We experienced a case of death from intracranial hemorrhage in eclamptic patient undergoing cesarean section.
Acute Kidney Injury ; Cesarean Section* ; Disseminated Intravascular Coagulation ; Eclampsia ; Edema ; Female ; Heart Failure ; Humans ; Hypertension ; Intracranial Hemorrhages* ; Maternal Death ; Pre-Eclampsia ; Pregnancy ; Proteinuria ; Pulmonary Edema ; Seizures ; Shock, Septic

BACKGROUND: Electroconvulsive therapy (ECT) can produce dangerous complications, such as arrhythmias, transient hypertension, and increases in intraocular pressure. This study was designed to whether propofol, in comparision with thiopental, would attenuate these hypertensive responses and increases in intraocular pressure. METHODS: Twenty patients were studied during courses of ECT administrations, each patient receiving propofol or thiopental on different occasions. The induction dose was 1.6 mg/kg of propofol and 3 mg/kg of thiopental sodium. Mean arterial pressure, heart rate, cardiac rhythm and intraocular pressure were checked before induction (control), after administration of succinylcholine, immediately, 5 min, and 10 min after ECT administration. Recovery time was also compared between two groups. RESULTS: Mean arterial pressure was lower following propofol than thiopental (p<0.05) immediately after ECT. Heart rate was lower following propofol than thiopental (p<0.05) immediately, 5 min, and 10 min after ECT. Cardiac rhythm abnormalities were infrequent and not serious. Intraocular pressure was lower following propofol than thiopental (p<0.05) immediately, 5 min, and 10 min after ECT. Recovery time of propofol (6.5+/-0.8 min) was shorter than thiopental (7.5+/-0.9 min). CONCLUSIONS: Propofol for ECT induction would seem to be an ideal drug, as it attenuates hypertensive responses and increases in intraocular pressure.
Anesthesia ; Anesthetics ; Arrhythmias, Cardiac ; Arterial Pressure ; Electroconvulsive Therapy* ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension ; Intraocular Pressure* ; Propofol* ; Succinylcholine ; Thiopental*

Urethral caruncles are the most common benign tumors in the female urethra, and are usually found in the posterior lip of the urethral meatus of post-menopausal women. It is very rare in young girls. Its etiology is unknown. We add a case of urethral caruncle occurring in a 2 year and 5 month-old girl's mid-urethra. We believe that further accumulation of unusual cases may be helpful in discovering the pathogenesis.
Child, Preschool ; Female ; Humans ; Urethral Neoplasms/*pathology

BACKGROUND AND OBJECTIVES: We report our initial experience with percutaneous transvenous closure of atrial septal defects (ASD). MATERIALS AND METHOD: Between September 1997 and May 2000, we attempted transcatheter closure of ASD in 18 patients using CardioSEALTM (8), STARFlexTM (4) and Amplatzer septal occluder (6). The ages of patients ranged from 4.5-64.8 (mean 32.8) years, body weight ranging from 16-76 (mean 51) kg, Qp/Qs ratio from 1.3-3.4 (mean 2.2). RESULTS: Embolization of device occurred in two patients; right pulmonary artery in one and left atrium in the other. In one patient, the device slipped into the right atrium before detachment. After retrieval of the device, the defect seemed too large for transcatheter closure. There were no other complications apart from a transient aggravation of pre-existing atrial premature beats in two patients. There was no significant size difference between the data measured by transthoracic and transesophageal echocardiography. The stretched ASD diameter was larger (5.1 3.2 mm) than the size measured by transesophageal echocardiography. In the remaining 15 patients, complete closure of defects was confirmed by transthoracic echocardiography on the 1 day or 1 month follow-up. During the same period, transcatheter closure of patent foramen ovale(PFO) was also attempted in 7 patients with stroke. The guidewire could not be passed in 2 of the patients. In the other 5 patients, transcatheter closure was successfully performed without any problems. Though the follow-up period may have been short, no patients were found with further stroke attack. CONCLUSION: Transcatheter closure of ASD can be performed with high efficiency and safety if patient selection is adequate. The indication for ASD closure can be extended to patients with larger defects. Transcatheter closure of PFO is an easy and safe procedure, but the indications of PFO closure in patients with stroke is still unclear. Further evaluation is necessary for long-term results.
Body Weight ; Cardiac Complexes, Premature ; Echocardiography ; Echocardiography, Transesophageal ; Follow-Up Studies ; Heart Atria ; Heart Septal Defects, Atrial* ; Humans ; Patient Selection ; Pulmonary Artery ; Septal Occluder Device ; Stroke

No abstract available.
Hyperaldosteronism*

No abstract available.
Bacteremia*

BACKGROUND: This study was designed to compare analgesic efficacy and side effects of intrathecal morphine and fentanyl with epidural bupivacaine. METHODS: Twenty nine healthy women, ASA physical status 1 or 2 with an uncomplicated pregnancy and single fetus in vertex position were given lumbar epidural or combined spinal-epidural analgesia. In the epidural analgesia group (n = 18), 0.25% bupivacaine 8 - 10 ml and fentanyl 50 - 75ng was injected into the epidural space. In the CSE group (n = 11), analgesia performed dural puncture with a 27 gauge spinal needle and fentanyl 15ng and morphine 0.2 mg in 2 ml normal saline solution was injected. In both groups, whenever the patient requests further analgesia, we injected 0.125% bupivacaine 10 ml and fentanyl 50 - 75ng into the epidural space. RESULTS: There was no significant difference between the two groups in duration of analgesia, the second stage of labor and pushing. The CSE group offers rapid onset time. The total dose of bupivacaine and fentanyl administered during analgesia was significantly more in the epidural group than the CSE group. After intrathecal fentanyl 15ng and morphine 0.2 mg, the duration of analgesia was 162 +/- 122 min. After the first 0.25% bupivacaine 10 ml and fentanyl 50 - 75ng, it was 92.5 +/- 5 min in the epidural group and 190 +/- 101 min in the CSE group (P < 0.05). CONCLUSIONS: Compared with epidural analgesia, Intrathecal fentanyl 15ng and morphine 0.2 mg as part of CSE analgesia provide rapid onset time and prolonged analgesia, and a lower total dose of local anesthetics for labor and delivery. However women who received CSE analgesia were more likely to itch (64%) than solely epidural analgesia.
Analgesia* ; Analgesia, Epidural* ; Anesthetics, Local ; Bupivacaine ; Epidural Space ; Female ; Fentanyl ; Fetus ; Humans ; Morphine ; Needles ; Pregnancy ; Punctures ; Sodium Chloride

The Sertoli-Leydig cell tumor is a gonadal tumor of sex-cord type, similar to that seen in the various phase of testicular development in the male. It is the most common type of all virilizing ovarian tumors and account for less than 0.5% of all ovarian tumors. This case has been presented of a 16 years old girl who had Sertoli-Leydig cell tumor of the right ovary. The clinical manifestation included deepening voice and hirsutism. The removal of the tumor, which proved to be a Sertoli-Leydig cell tumor, so we present it with a brief review of literature.
Adolescent ; Female ; Gonads ; Hirsutism ; Humans ; Male ; Ovary ; Sertoli-Leydig Cell Tumor* ; Voice