PURPOSE: Most unilateral secondary cleft lip nose deformities have depressed nostril base and sill on the cleft side. To obtain a symmetric nose, correction of the recession on nostril is critical. The authors have worked out effective methods to elevate the nostril of the cleft side according to the extent of the depression. METHODS: A total of 115 unilateral secondary cleft lip nose deformity patients with nostril depression were evaluated. Data were acquired from patients' charts and photography with special reference to the height difference of the nostrils between the cleft side and the non-cleft side. Patients were divided into three groups based on the difference and operated with various techniques :(1) mild degree(< 1mm) with graft,(2) moderate degree(1-3mm) with C-flap or suspension suture of septal cartilage(3) severe degree(> 3mm) with graft, C-flap and suspension suture. Follow-up period averaged 21.3 months. RESULTS: Forty-six patients(40 percent) were in mild group, and forty-two(37 percent) were in moderate. In twenty-seven patients(23 percent), nostril recession was more than 3mm. The elevated nostril base and sill were maintained without height alteration during follow-up. CONCLUSION: The symmetry of the nostril base, especially projection of nostril sill influences successful correction of unilateral cleft lip nose deformity. Our tolerable techniques can be applied to most deformities with nostril depression and can present a new guideline.
Cleft Lip ; Congenital Abnormalities ; Depression ; Follow-Up Studies ; Humans ; Nose ; Photography ; Sutures ; Transplants

Epidural steroid injections (ESI) are commonly used for managing radicular pain. They are generally considered to be a safe treatment with a low incidence of complications, which may be very mild and transient symptoms. We describe here one case of a delayed onset of hiccups, facial flushing and hypertension associated with a lumbar epidural steroid injection.
Flushing ; Hiccup ; Hypertension ; Incidence

Epidural steroid injections (ESI) are commonly used for managing radicular pain. They are generally considered to be a safe treatment with a low incidence of complications, which may be very mild and transient symptoms. We describe here one case of a delayed onset of hiccups, facial flushing and hypertension associated with a lumbar epidural steroid injection.
Flushing ; Hiccup ; Hypertension ; Incidence

PURPOSE: A brain abscess is a serious disease of the central nerve system. We conducted this study to summarize the clinical manifestations and outcomes of brain abscesses. METHODS: A retrospective chart review of pediatric patients diagnosed with brain abscesses from November 1994 to June 2009 was performed at Samsung Medical Center, Seoul, Korea. RESULTS: Twenty-five patients were included in this study. On average, 1.67 cases per year were identified and the median age was 4.3 years. The common presenting clinical manifestations were fever (18/25, 72%), seizure (12/25, 48%), altered mental status (11/25, 44%), and signs of increased intracranial pressure (9/25, 36%). A total of 14 (56%) patients had underlying illnesses, with congenital heart disease (8/25, 32%) as the most common cause. Predisposing factors were identified in 15 patients (60%). The common predisposing factors were otogenic infection (3/25, 12%) and penetrating head trauma (3/25, 12%). Causative organisms were identified in 64% of patients (16/25). The causative agents were S. intermedius (n=3), S. aureus (n=3), S. pneumoniae (n=1), Group B streptococcus (n=2), E. coli (n=1), P. aeruginosa (n=1), and suspected fungal infection (n=5). Seven patients received medical treatment only while the other 18 patients also required surgical intervention. The overall fatality rate was 16% and 20% of patients had neurologic sequelae. There was no statistical association between outcomes and the factors studied. CONCLUSION: Although uncommon, a brain abscess is a serious disease. A high level of suspicion is very important for early diagnosis and to prevent serious consequences.
Abscess ; Brain ; Brain Abscess ; Child ; Early Diagnosis ; Fever ; Head Injuries, Penetrating ; Heart Diseases ; Humans ; Intracranial Pressure ; Korea ; Pneumonia ; Retrospective Studies ; Seizures ; Streptococcus

Endobronchial lipomas are rare benign tumors that arise from the lung. They partially or totally obstruct the bronchial lumen, producing a variable degree of collapse, irreversible bronchiectasis, and pulmonary damage. Although bronchoscope, CT and MR are reported to be helpful in establishing the diagnosis, CT is highly specific and sensitive in detecting fatty tumor. They may be removed by endoscope or thoracotomy or lobectomy. We present a case of endobronchial lipoma completely obstructing the right middle lobe and postobstructive irreversible pulmonary change with review of literatures.
Bronchiectasis ; Bronchoscopes ; Diagnosis ; Endoscopes ; Lipoma* ; Lung ; Thoracotomy ; Thorax* ; Tomography, X-Ray Computed*

Spinal muscular atrophy (SMA) is a rare lower motor neurone disease in which anesthetic management is often difficult as a result of muscle weakness, hypersensitivity to non-depolarizing neuromuscular blocking agent, and succinylcholine induced hyperkalemia. We describe a 50-year-old patient with type IV SMA for synovectomy. We decided to use an epidural technique to avoid muscle relaxants and tracheal intubation. After operation, there was no exacerbation of neurologic signs and symptoms.
Anesthesia, Epidural ; Humans ; Hyperkalemia ; Hypersensitivity ; Intubation ; Middle Aged ; Motor Neurons ; Muscle Weakness ; Muscles ; Muscular Atrophy, Spinal ; Neurologic Manifestations ; Neuromuscular Blockade ; Succinylcholine

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BACKGROUND AND PURPOSE: Repetitive transcranial magnetic stimulation (rTMS) has potential as a noninvasive neuromodulation treatment method for various neuropsychiatric disorders, and repeated sessions of rTMS are more likely to enhance the therapeutic efficacy. This study investigated neurophysiologic and spatiodynamic changes induced by repeated 1-Hz rTMS of the temporal cortex using transcranial magnetic stimulation (TMS) indices and fluorodeoxyglucose positron emission tomography (FDG-PET). METHODS: Twenty-seven healthy subjects underwent daily 1-Hz active or sham rTMS of the right temporal cortex for 5 consecutive days. TMS indices of motor cortical excitability were measured in both hemispheres daily before and after each rTMS session, and 2 weeks after the last stimulation. FDG-PET was performed at baseline and after the 5 days of rTMS sessions. RESULTS: All subjects tolerated all of the sessions well, with only three of them (11.1%) reporting mild transient side effects (i.e., headache, tinnitus, or local irritation). One-Hz rTMS decreased motor evoked potential amplitudes and delayed cortical silent periods in the stimulated hemisphere. Statistical parametric mapping of FDG-PET data revealed a focal reduction of glucose metabolism in the stimulated temporal area and an increase in the bilateral precentral, ipsilateral superior and middle frontal, prefrontal and cingulate gyri. CONCLUSIONS: Repeated rTMS sessions for 5 consecutive days were tolerated in all subjects, with only occasional minor side effects. Focal 1-Hz rTMS of the temporal cortex induces cortico-cortical modulation with widespread functional changes in brain neural networks via long-range neural connections.
Brain ; Evoked Potentials, Motor ; Glucose ; Headache ; Positron-Emission Tomography ; Salicylamides ; Tinnitus ; Transcranial Magnetic Stimulation

Soft triangle of nose is composed of only two skin layer between dome of alar cartilage and nostril. If soft triangle is damaged in rhinoplasty, the notching deformity can be caused by scar contracture. For correction of notching deformity, some methods such as composite graft or filler injection have been introduced, however these methods have some disadvantages like need for donor site or unpredictable long term results. We could correct notching deformity of soft triangle with V-Y advancement flap on the vestibular skin with great ease. Our method was undergone for 3 patients with notching deformity among 120 patients who had rhinoplasty during from March 2004 to February 2007 in our clinic. The elapse of time to definitive deformity was mean 2 months and the corrective procedure was performed 4 months later after formation of definitive deformity. Under the local anesthesia, the triangular flap proximally based was designed on the vestibular skin and this flap was sutured in V-Y fashion. There was no complication and no recurrence. This method is thought to be very useful because of some advantages: easy controlling advancement of flap according to the severity of deformity, no need for donor site, predictable outcome, and economic.
Anesthesia, Local ; Cartilage ; Cicatrix ; Congenital Abnormalities ; Contracture ; Humans ; Nose ; Recurrence ; Rhinoplasty ; Skin ; Succinates ; Tissue Donors ; Transplants

Nose is the most three dimensional structure located on the central portion of the face. Therefore, the nasal shape is one of the most important factors on deciding upon one's impression. Hump-nose is characterized by nasal hump, acute tip angle, drooping or/and under-projection of tip, and broad nasal dorsum. Because of these characteristics, recently more patients with hump-nose are inclined to correct their problematic nose. The purpose of this study was to classify hump-nose according to hump size and provide proper operating methods in each group. From August 2003 to August 2005, in 46 cases, we classified the hump nose into three groups, small(group A; n=30), medium(group B; n=6), and large(group C; n=10) in accordance with size and location of hump and in each group we effectively corrected the hump with our proper operating methods. In the large group, one case of tension nose temporarily appeared but soon improved and we obtained satisfactory results in the other cases.
Humans ; Nose