BACKGROUND: The forehead, which occupies about one third of the face, is one of the major determinants of a feminine or masculine look. Various methods have been used for the augmentation of the forehead using autologous fat grafts or alloplastic materials. Methylmethacrylate (MMA) is the most appropriate material for augmentation of the forehead, and we have used an injection-molding technique with MMA to achieve satisfactory results. METHODS: Under local anesthesia with intravenous (IV) sedation, an incision was made on the scalp and a meticulous and delicate subperiosteal dissection was then performed. MMA monomers and polymers were mixed, the dough was injected into the space created, and manual molding was performed along with direct inspection. This surgery was indicated for patients who wanted to correct an unattractive appearance by forehead augmentation. Every patient in this study visited our clinics 3 months after surgery to evaluate the results. We judged the postoperative results in terms of re-operation rates caused by the dissatisfaction of the patients and complications. RESULTS: During a 13-year period, 516 patients underwent forehead augmentation with MMA. With the injection-molding technique, the inner surface of the MMA implant is positioned close to the underlying frontal bone, which minimizes the gap between the implant and bone. The borders of the implant should be tapered sufficiently until no longer palpable or visible. Only 28 patients (5.4%) underwent a re-operation due to an undesirable postoperative appearance. CONCLUSIONS: The injection-molding technique using MMA is a simple, safe, and ideal method for the augmentation of the forehead.
Anesthesia, Local ; Forehead ; Frontal Bone ; Fungi ; Humans ; Inlays ; Methylmethacrylate ; Polymers ; Scalp ; Surgery, Plastic ; Transplants

PURPOSE: A lot of patients with stress urinary incontinence(SUI) have lower urinary tract symptoms. So we evaluated the changes of voiding pattern following transobturator tape(TOT) operation, and investigated the factors for predicting persistent urinary frequency after operation. MATERIALS AND METHODS: The items of preoperative evaluations consisted of history taking, physical examination, cystometrography, 3 day frequency-volume chart and symptoms questionnaire. Patients with anticholinergics or any neurologic diseases that affect the voiding pattern were excluded. Between January to November 2006, 46 patients with TOT operation were enrolled, and were reevaluated with physical examination, 3 day frequency-volume chart and symptom questionnaires, postoperatively. RESULTS: The patients who voided 8 or more times per day had shorter symptom duration and higher body mass index(BMI) than those who voided under 8 times per day(each p<0.05). In 30 patients who void 8 or moretimes per day preoperatively, 17(56.7%) patients became void under 8 times, postoperatively. In each patient who had urgency or urge incontinence symptoms preoperatively, respective 72.7 and 82.8% resolved their symptoms, postoperatively. No one complained de novo urgency or urge incontinence, postoperatively. In a multivariate analysis, the patient with a history of previous pelvic surgery or moderate to severe urge incontinence was tightly associated with an increased likelihood of persistent urinary frequency after TOT operation (odd ratio[OR] 24.8, 95% confidence interval[CI] 2.044-301.284, p=0.012 and OR 31.9, 95% CI 1.662- 613.619, p=0.022, respectively). CONCLUSIONS: The TOT operation can improve the symptoms of urinary frequency, urgency and urge incontinence in patients with SUI. However, the patients who had previous pelvic surgeriesor moderate to severe urge incontinence should be fully advised for the risk of sustaining frequency, postoperatively
Cholinergic Antagonists ; Female ; Humans ; Lower Urinary Tract Symptoms ; Multivariate Analysis ; Physical Examination ; Suburethral Slings ; Urinary Incontinence ; Urinary Incontinence, Stress ; Urinary Incontinence, Urge

The spontaneous regression (SR) of cancer is defined as the complete disappearance of a malignant disease without adequate treatment. SR is a very rare biological event, particularly in a pulmonary sarcoma. We report the first documented case of an endobronchial sarcoma that regressed spontaneously in Korea. We encountered a rare case of a 72-year-old woman with an undiagnosed intrapelvic cystic mass, who presented with a smooth surfaced endobronchial tumor obstructing the orifice of the right lower lobe bronchus on a bronchoscopic examination. She had a prior history cervical cancer and adenocarcinoma in the right middle lobe lateral segment of her lung for which she had undergone radiation therapy. The tumor was diagnosed as an endobronchial sarcoma by the histopathology findings and immunohistochemistry. It was unclear if the tumor was a primary sarcoma of the lung or a metastatic lesion of an intrapelvic cystic mass because she refused a diagnostic exploratory laparotomy. Two months later, obstructive pneumonia of the right lower lobe with parapneumonic effusion developed with fever above 38.5degrees C for 10 days. After recovering from pneumonia, she was followed up regularly in the outpatient clinic without any specific treatment. One year later after treating the obstructive pneumonia, the follow-up bronchoscopy revealed complete SR of endobronchial sarcoma. It is believed that the obstructive pneumonia accompanied by fever above 38.5degrees C for 10 days might have played a role in this SR.
Adenocarcinoma ; Aged ; Ambulatory Care Facilities ; Bronchi ; Bronchoscopy ; Female ; Fever ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Korea ; Laparotomy ; Lung ; Pneumonia* ; Sarcoma* ; Uterine Cervical Neoplasms

PURPOSE: In general, orientals including Korean, have a mesocephalic face whereas Caucasians, among the western, have a dolichocephalic face .Unlike the western, in orientals including Korean, prominent malar bones are recognized as stubborn and unattractive appearance. That is why reduction malarplasty is one of the most popular aesthetic surgical procedure in Korea. Many surgical methods to reposition prominent malar bones have been performed by means of a coronal incision or a combined incisions, using both the intraoral and the external incision. Bicoronal approach has advantage such as wide operative field, easy to maintain symmetry and possibility of combining facial lift but has shortcoming, such as external scars, long operative time, and the possibility of facial nerve or artery injury. Intraoral approach has advantages of short operative time, simplicity of procedure and no external scar. But this approach is associated with problems of cheek drooping, limited exposure and difficulty in making symmetry. METHODS: During 8 years, we performed a reduction malarplasty without internal fixation through an minimal intraoral incision and dissection in 39 patients. RESULTS: The patients were followed for 46 months, with satisfactory results and no cheek drooping. There was no patient who want to revise the inappropriate operative result such as asymmetry and incomplete correction. CONCLUSION: We conclude that minimal intraoral incision and dissection could acquire satisfactory result of reduction malarplasty along with prevention of cheek drooping.
Arteries ; Cheek ; Cicatrix ; Facial Nerve ; Humans ; Imidazoles ; Korea ; Nitro Compounds ; Operative Time ; Zygoma

BACKGROUND AND OBJECTIVES: The purpose of this study was to investigate the criterion-related concurrent validity of two standardized auditory-perceptual assessments and the Acoustic Voice Quality Index (AVQI) for measuring dysphonia severity in patients with vocal cord paralysis (VCP). MATERIALS AND METHODS: Total 210 patients with VCP and 236 normal voice subjects were asked to sustain the vowel [a:] and to read aloud the Korean text “Walk”. A 2 second mid-vowel portion of the sustained vowel and two sentences (with 26 syllables) were recorded. And then voice samples were edited, concatenated, and analyzed according to Praat script. Two standardized auditory-perceptual assessment (GRBAS and CAPE-V) were performed by three raters. RESULTS: The VCP group showed higher AVQI, Grade (G) and Overall Severity (OS) values than normal voice group. And the correlation among AVQI, G, and OS ranged from 0.904 to 0.926. In ROC curve analysis, cutoff values of AVQI, G, and OS were < 3.79, < 0.00, and < 30.00, respectively, and the AUC of each analysis was over .89. CONCLUSION: AVQI and auditory evaluation can improve the early screening ability of VCP voice and help to establish effective diagnosis and treatment plan for VCP-related dysphonia.
Acoustics* ; Area Under Curve ; Diagnosis ; Dysphonia* ; Humans ; Mass Screening ; ROC Curve ; Vocal Cord Paralysis* ; Vocal Cords* ; Voice ; Voice Quality

BACKGROUND AND OBJECTIVES: Extranodal non-Hodgkin's lymphoma (NHL) of the head and neck (H & N) accounts for 10-20% of all cases of NHL. Despite their frequency, the cause of these lymphomas is still poorly understood. Recently, the role of viral origin in NHLs, including Epstein-Barr virus (EBV), as the main cause of sinonasal lymphomas of T/NK cell phenotype and HTLV-1 as a cause of acute T-cell lymphoma/leukemia has been well documented. We investigated the clinicopathologic findings, immunophenotypic profile, and status of EBV and HTLV-1 DNA of patients with H & N lymphoma. MATERIALS AND METHODS: Twenty-seven patients with NHL of H & N region were studied. There were 15 males and 12 females with the median age of 50 years. All patients were reclassified according to the Working formulation (WF) and REAL classificaton. EBV genome DNA and HTLV-1 RNA were surveyed by PCR assay using formalin-fixed and paraffin-embedded tissue blocks. RESULTS: The tonsil was the most commonly involved site (44.4%), followed by nasal cavity (18.5%), nasopharynx (18.5%) and orbit (7.4%). Immunophenotyping revealed 19 cases of B cell lineage, 7 cases of T cell lineage and one case of null cell type. Most of B-cell lymphomas were diffuse large cell lymphomas (58%). Tonsillar lymphomas were all B-cell origin. Four of the five nasal cavity lymphomas and one nasopharyngeal lymphoma showed an angiocentric T/NK cell phenotype with strong association with EBV. EBV genome was detected in 15 of 26 H & N NHLs (57.7%). Seven of 19 B-cell lymphomas (36.8%) and all T/NK or null cell type lymphomas were positive for FBV DNA. However, there was no HTLV-1 positive cases found. CONCLUSIONS: It could be concluded that the high incidence of EBV of angiocentric T/NK-cell lymphomas of the nasal cavity may indicate a probable role of EBV in the development of these lymphomas.
B-Lymphocytes ; Cell Lineage ; DNA ; Female ; Genome ; Head* ; Herpesvirus 4, Human* ; Human T-lymphotropic virus 1* ; Humans ; Immunophenotyping ; Incidence ; Lymphocytes, Null ; Lymphoma* ; Lymphoma, B-Cell ; Lymphoma, Large B-Cell, Diffuse ; Lymphoma, Non-Hodgkin ; Male ; Nasal Cavity ; Nasopharynx ; Neck* ; Orbit ; Palatine Tonsil ; Phenotype ; Polymerase Chain Reaction ; RNA ; T-Lymphocytes

Management of Takayasu's arteritis of the left main coronary artery (LMCA) is difficult because of the possibility of restenosis. Clinically significant stenotic lesions must be considered anatomical correlation. Many studies have reported that the management of stenotic lesions of the LMCA with endoluminal stenting and balloon angioplasty and de-novo stenting is safe and effective for patients with Takayasu's arteritis. We report the case of a patient with Takayasu's arteritis of the LMCA. The patient had undergone two consecutive percutaneous coronary interventions because of recurrent restenosis of in-stent lesions, and eventually underwent coronary artery bypass graft (CABG) surgery for myocardial infarction in the same lesion. We suggested treatment with CABG because the pathophysiology of Takayasu's arteritis is different from that of atherosclerotic stenosis.
Angioplasty, Balloon ; Angioplasty, Balloon, Coronary ; Constriction, Pathologic ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Vessels ; Humans ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Stents ; Takayasu Arteritis ; Transplants

An anomalous union of the pancreaticobiliary duct is defined as a condition in which the junction between the common bile duct and the pancreatic duct is located outside the duodenal wall. Therefore, the sphincter of Oddi does not influence the junction; there is always communication between these ducts, and so pancreatic juice flows into the biliary tract through the communication, which may cause pancreaticobiliary diseases. Pancreas divisum is a congenital variant of the pancreatic ductal anatomy, and the mechanism is that the dorsal and ventral pancreatic buds fail to fuse during the gestation. We report here on a 21 year old woman who previously had suffered with recurrent pancreatitis, and an anomalous union of the pancreaticobiliary duct associated with the incomplete type of pancreas divisum was revealed by ERCP. She was treated with minor papilla sphincterotomy and stent insertion.
Biliary Tract ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Drainage* ; Female ; Humans ; Pancreas ; Pancreatic Ducts ; Pancreatic Juice ; Pancreatitis ; Pregnancy ; Sphincter of Oddi ; Sphincterotomy, Endoscopic ; Stents ; Young Adult

A volvulus of the colon is a twisting of a redundant segment of the colon at its narrow mesentery. A sigmoid volvulus is the most common type. This disorder may spontaneously reduce and recur as a chronic problem. However, it more frequently becomes acute as a result of an obstruction, which can lead to strangulation and gangrene with a high mortality if not treated promptly. Colonoscopic reduction and decompression is the preferred initial treatment for patients with a sigmoid volvulus who show no signs of bowel strangulation, which may be the cause of the high mortality associated with emergency surgery. We experienced 2 cases of a sigmoid volvulus in a 44-year-old female and a 51-year-old male. The sigmoid volvulus was diagnosed by simple abdominal film and treated successfully by an emergency colonoscopic reduction. We report our experience on the use of colonoscopy to treat sigmoid volvulus with a reviews of the relevant literlature.
Female ; Humans ; Mortality

A pulmonary epithelioid hemangioendothelioma (PEH) is a rare tumor with a vascular origin. A PEH can arise in many organ systems, such as the lung, liver, bone and soft tissues. It is a borderline malignancy but the clinical course is usually benign. In this report, we describe three cases of PEH. Case 1, a 61-year-old man, had nonspecific chest discomfort and the chest X-ray showed a solitary lung nodule. This nodule was diagnosed by an open lung biopsy. The pathologic findings including abundant necrosis, mitosis and hyperchromatic and pleomorphic nuclei, indicated a malignancy. The electron microscopic study showed Weibel-Palade bodies and the immunohistochemical stain for CD31 showed a positive reaction in the tumor cells, and linear staining along the vascular lumina. Case 2, a 34-year-old man, was admitted for an evaluation of multiple small nodules, incidentally detected a screening chest X-ray. The nodules were diagnosed by a immunohistochemical stain for the factor VIII-related antigen. Case 3, a 34-year-old woman, complained of left pleuritic chest pain. A simple chest film and the chest CT scan revealed multiple bilateral nodules and a left pleural effusion. An immunohistochemical stain for the factor VIII-related antigen was used to diagnose the nodules. Forth-one months after the diagnosis, she died of pulmonary insufficiency.
Female ; Humans