Zygoma fracture is very common in facial trauma because zygoma composes a prominent part of the midface. For the zygoma fracture, its precise reduction and fixation is very important to prevent residual facial asymmetry. There are various modalities of treatment of fractured zygoma and now open reduction with multiple rigid fixation technique is widely accepted. The method of internal fixation enables accurate reduction and stable fixation. However, closed reduction can be used in simple and uncomminuted cases. Although the closed reduction has some advantages of simplicity, it has lost popularity because of the inadequate mechanical fixation and poor visualization. We designed an improved technique of the closed reduction and fixation using double Kirschner's wires. 19 patients were treated with this technique and all cases showed successful results without any complications. The potential advantages of this technique include simple procedure, short operation time, less incisional scar and soft tissue violation and fairly low price without use of foreign materials like miniplates. We conclude that double Kirschner's wire suspension technique is a simple and effective method in the treatment of uncomminuted zygoma fracture.
Cicatrix ; Facial Asymmetry ; Humans ; Zygoma*

Composite graft and local flaps are good modality for the correction of deformatic scars in facial area but there are several limitations in size, shape and graft bed condition. Hyperbaric oxygen therapy is a good adjunctive therapy for the successful take of the composite graft and local flaps by providing high arterial oxygen pressure and hyperoxic state promoting angiogenesis and collagen synthesis. However, it has some substantial risks of systemic oxygen toxicity to central nervous system, lung and eyes, and needs hyperbaric chamber system and high cost. We designed a modified technique for administrating hyperbaric oxygen topically with the use of simple materials and wall oxygen for the composite graft and local flap wound. 8 patients who had undergone composite graft and local flap on facial scar area were treated with topical hyperbaric therapy for average 6 days. Grafts were relatively large in size and all of the graft bed was scar tissue due to previous operation, trauma and burn injury. All cases showed successful result and there was no complication reported. The potential advantage of this method includes fairly low expense, no need for specialized equipment, simplicity of the application and lack of systemic complication. We conclude that topical hyperbaric oxygen therapy was a simple, cost-effective and safe method for the adjunctive treatment to the composite graft and local flaps.
Burns ; Central Nervous System ; Cicatrix ; Collagen ; Humans ; Hyperbaric Oxygenation* ; Lung ; Oxygen ; Transplants* ; Wounds and Injuries

BACKGROUND AND OBJECTIVES: Total laryngectomy is usually used for patients with advanced laryngeal cancer, and causes injuries to hypopharyngeal mucosa, cricopharyngeal muscle, pharyngeal constrictor muscle. These damages induce postoperative swallowing difficulties, although accurate and objective data have not been reported. The purpose of this study is to evaluate the changes and functional difficulties of swallowing mechanism in patients with total laryngectomy by manometric analysis. MATERIALS AND METHODS: We used station pull-through technique in two groups. The study group consisted of 11 total laryngectomized patients, and the control group consisted of 10 cases. We measured resting pressure, length, pressure after relaxation of UES (upper esophageal sphincter), and pharyngeal pressure. And 5 parameters were analyzed for coordination of hypopharynx and UES during swallowing. RESULTS: In the study group, the resting pressure, the maximal pressure after relaxation, and the length of UES was 36.3+/-10.5 mmHg, 149.8+/-14.6 mmHg, and 3.4+/-0.8 cm respectively. In the control group, the results was 34.9+/-9.6 mmHg, 85.5+/-12.3 mmHg, 2.2+/-0.6 cm respectively. The pharyngeal pressure was 81.8+/-10.1 mmHg in the study group, and 67.1+/-12.3 mmHg in the control group. The interval of pharyngeal constriction was 3.0+/-0.23 sec in the study group and 0.49+/-0.04 sec in the control group. The interval of UES relaxation was 2.43+/-0.14 sec in the study group and 0.99+/-0.03 sec in the control group. CONCLUSION: Manometric analysis showed higher pressure of the pharynx and UES in the total laryngectomized patients than in the normal adults. And there was a failure in the coordination between pharyngeal constriction and UES relaxation.
Adult ; Constriction ; Deglutition ; Esophageal Sphincter, Upper* ; Humans ; Hypopharynx ; Laryngeal Neoplasms ; Laryngectomy ; Mucous Membrane ; Pharyngeal Muscles ; Pharynx* ; Relaxation

PURPOSE: This study was performed to investigate clinical findings of acute neurologic complications and risk factors for chronic neurologic complications of bacterial meningitis in children. METHODS: Pediatric patients with community acquired bacterial meningitis diagnosed at Seoul National University Children's Hospital and Bundang Seoul National University Hospital were included. We investigated the relative frequency of neurologic complications and distribution of causative organisms. Chronic neurologic complication was defined as persistent neurologic deficit including recurrent seizures 6 months from the diagnosis. Multiple logistic regression analysis was used to identify risk factors for epilepsy and motor deficits, which were the most frequently reported chronic neurologic complications. RESULTS: A total of 90 cases were included in the study. Thirteen cases with less than 6 months follow-up duration were excluded from the analysis of risk factors for chronic neurologic complications. The mean age at diagnosis was 15.6 months. Streptococcus agalactiae was the most common pathogen accounting for 27 cases, followed by Streptococcus pneumoniae (19 cases), Hemophilus influenzae type b (13 cases), and Neisseria meningitidis (12 cases). Acute neurologic complications were found in 28 cases (31%): cerebral infarction in 16 cases, subdural effusion in 15 cases, and hydrocephalus in 9 cases. Chronic neurologic complications were found in 41 (53%) cases: epilepsy in 28 cases, motor deficit in 16 cases, hearing loss in 6 cases, and cognitive impairment in 4 cases. Cerebral infarction and S. pneumoniae infection were identified as risk factors for epilepsy. Cerebral infarction was a unique risk factor for motor deficit. CONCLUSION: Cerebral infarction is the important risk factor for the development of chronic neurologic complications including epilepsy and motor deficit in pediatric patients with bacterial meningitis.
Accounting ; Cerebral Infarction ; Child ; Epilepsy ; Follow-Up Studies ; Haemophilus influenzae type b ; Hearing Loss ; Humans ; Hydrocephalus ; Logistic Models ; Meningitis, Bacterial ; Neisseria meningitidis ; Neurologic Manifestations ; Pneumonia ; Risk Factors ; Seizures ; Streptococcus agalactiae ; Streptococcus pneumoniae ; Subdural Effusion

An 18-year-old boy was admitted with chest discomfort, nausea, and dyspnea at rest. At the age of 3 years, he underwent muscle biopsy and dystrophin gene analysis owing to an enlarged calf muscle and elevated serum kinase level (6,378 U/L) without overt weakness; based on the results, Becker muscular dystrophy (BMD) was diagnosed. The dystrophin gene showed deletion of exons 45 to 49. He remained ambulant and could step upstairs without significant difficulties. A chest roentgenogram showed cardiomegaly (cardiothoracic ratio, 54%), and his electrocardiogram (ECG) showed abnormal ST-T wave, biatrial enlargement, and left ventricular hypertrophy. The 2-dimensional and M-mode ECGs showed a severely dilated left ventricular cavity with diffuse hypokinesis. The systolic indices were reduced, including fractional shortening (9%) and ejection fraction (19%). Despite receiving intensive medical treatment, he died from congestive heart failure 5 months after the initial cardiac symptoms. We report a case of BMD with early-onset dilated cardiomyopathy associated with deletion of exons 45 to 49. Early cardiomyopathy can occur in BMD patients with certain genotypes; therefore, careful follow-up is required even in patients with mild phenotypes of BMD.
Adolescent ; Biopsy ; Cardiomegaly ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Dyspnea ; Dystrophin ; Electrocardiography ; Exons ; Genotype ; Heart Failure ; Humans ; Hypertrophy, Left Ventricular ; Muscles ; Muscular Dystrophy, Duchenne ; Nausea ; Phenotype ; Phosphotransferases ; Thorax

BACKGROUND: The 24-hour mean blood pressure (mBP) is the best predictor of organ damage; however, it is not easily applicable in clinical practice. The APrODiTe study suggested that systolic blood pressure (SBP) values at 7:00 AM and 9:30 PM were associated with the 24-hour mSBP in patients with chronic kidney disease (CKD). We investigated the association of the SBP values at these time-points with the renal outcomes in patients with diabetic CKD during 1-year follow-up. METHODS: Ninety-six patients with diabetic CKD were included at 1-year follow-up. The renal outcomes were an increase in the random urine protein/creatinine ratio or estimated glomerular filtration rate (eGFR) deterioration, which means a decrease in eGFR ≥5 mL/min/1.73 m² compared to the baseline values. RESULTS: The baseline SBP values at 7:00 AM, and 9:30 PM, and the 24-hour mSBP were 135.6±24.9 mmHg, 141.7±25.6 mmHg, and 136.4±20.7 mmHg, respectively. The SBP values measured at the same time-points after 1 year were similar to those at baseline. The SBP at 7:00 AM was significantly associated with eGFR deterioration in the univariate and multivariate analyses (odds ratio [OR]: 1.032; 95% confidence interval [CI]: 1.006–1.059; p=0.016). The SBP at 7:00AM and 24-hour mSBP did not show a concordant association with sustained proteinuria in the linear and logistic analyses. In the subgroup analysis, the association between the SBP at 7:00 AM and eGFR deterioration persisted in patients with CKD stage 3–5 (OR: 1.041; 95% CI: 1.010–1.073; p=0.010). CONCLUSION The SBP at 7:00 AM, in addition to the 24-hour mSBP, is also associated with eGFR deterioration in patients with diabetic CKD, particularly in those with CKD stage 3–5.