PURPOSE: While the principles of eyelid reconstruction are well established, the rapid choice of a method of upper and lower eyelid defect reconstruction is difficult. The authors present a successful case of simultaneous reconstruction of upper and lower eyelid defects with a modified paramedian forehead flap resulting from a dog bite. CASE SUMMARY: The authors report a case of a 77-year-old woman with total hyphema and extensive skin defects involving the forehead, cheek, and upper and lower eyelid resulting from a dog bite. The wound on the left periorbital area was treated with microimplantation and skin grafts from the left thigh and groin. In the weeks following, sequential failure of the flap and skin graft was observed, and exposed keratitis worsened, resulting in corneal perforation. Evisceration with hydroxyapatite implantation and paramedian forehead flap was performed. After 3 weeks, division of the pedicle, transverse division of the flap, and socket reconstruction were performed. CONCLUSIONS: Reconstruction of large, full thickness defects of both upper and lower eyelids with a paramedian forehead flap is associated with a good cosmetic outcome. Paramedian forehead flap should be considered as an effective choice for simultaneous upper and lower eyelid reconstruction.
Aged ; Animals ; Bites and Stings ; Cheek ; Corneal Perforation ; Cosmetics ; Dogs ; Durapatite ; Eyelids ; Female ; Forehead ; Groin ; Humans ; Hyphema ; Keratitis ; Skin ; Thigh ; Transplants

No abstract available.
Cerebrospinal Fluid* ; Cholesteatoma*

BACKGROUND: The zoonotic disease Q fever is caused by Coxiella burnetii and usually affects high-risk human populations. We conducted a serological survey of dairy cattle farmers in Korea to determine seroreactivity and identify risk factors for C. burnetii infection. METHODS: This cross-sectional study included 1,824 of 7,219 dairy cattle farms (25.3%) in the study region. The selected dairy cattle farmers visited the nearest public health centers or branches with completed questionnaires. Serum samples from the farmers were tested using an indirect immunofluorescence assay to detect phase II C. burnetii immunoglobulin (Ig) G or M antibodies. RESULTS: A total of 1,222 dairy cattle farmers from 784 dairy cattle farms (43.0%) participated in this study, and 11.0% (134/1,222) exhibited seroreactivity, defined as a phase II antigen IgG or IgM titer ≥ 1:16. In the multivariate analysis, male sex, residence in Gyeonggi Province, a larger herd size, and ocular/oral contact with birth products during calf delivery were significantly associated with a higher risk of C. burnetii infection. Furthermore, the risk was significantly lower among farmers who always wore protective gloves while cleaning cattle excretion, compared to those who sometimes or rarely wore protective gloves. CONCLUSION: Dairy cattle farmers should exercise caution by avoiding ocular/oral contact with birth products during calf delivery and by using protective equipment (including gloves).
Agriculture ; Animals ; Antibodies ; Cattle* ; Coxiella burnetii* ; Coxiella* ; Cross-Sectional Studies ; Farmers* ; Fluorescent Antibody Technique, Indirect ; Gloves, Protective ; Gyeonggi-do ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Immunoglobulins ; Korea* ; Male ; Multivariate Analysis ; Parturition ; Public Health ; Q Fever* ; Risk Factors* ; Serologic Tests ; Zoonoses

A 50-year-old woman who had chronic headache was admitted to the hospital. Stent-assisted coil embolization of the aneurysm in the right vertebral artery was performed. After the procedure, the patient experienced a transient memory impairment. A microembolic lesion in the right medial temporal lobe and cerebral hemisphere was observed on diffusion-weighted imaging. We report a case of transient global amnesia caused by microembolus in the medial temporal lobe after embolization of an aneurysm.
Amnesia, Transient Global* ; Aneurysm ; Cerebrum ; Embolization, Therapeutic* ; Female ; Headache Disorders ; Humans ; Intracranial Aneurysm* ; Memory ; Middle Aged ; Temporal Lobe ; Vertebral Artery

Continuous venovenous hemodiafiltration (CVVHDF) was used to eliminate pentobarbital from the blood of a 30-year-old potentially brain dead male patient with traumatic intracranial hemorrhage after a motorcycle accident. The Acute Physiology and Chronic Health Evaluation (APACHE) II score of hospital day 1 was 24, but by day 8 it was 36, when the patient was considered to be brain dead. To control seizures and reduce intracranial pressure, pentobarbital had been administered in a continuous flow (2,880 mg/day for 5 days). Coma can be induced by pentobarbital at a serum level of 1~5 mg/dL. However, drug intoxication should be excluded from a brain death evaluation; therefore, the patient was not given any drug for approximately 88 hrs after ceasing pentobarbital in order for serum level to dip below 0.5 mg/dL (which is the hypnotic level). At 48 hours from CVVHDF, the pentobarbital level was close to the hypnotic level (0.1~0.5 mg/dL). Before stopping, the serum level of pentobarbital was 3.89 mg/dL and between 48 and 72 hours from CVVHDF, 4 cycles of pentobarbital half-life elimination (0.24 mg/dL) could be measured. Therefore, we suggest that in case of potential brain dead patients who have been administered pentobarbital, CVVHDF can enhance the elimination of pentobarbital from the circulatory system and shorten the waiting time for a brain death evaluation.
Adult ; APACHE ; Brain ; Brain Death ; Coma ; Half-Life ; Hemodiafiltration ; Humans ; Intracranial Hemorrhage, Traumatic ; Intracranial Pressure ; Male ; Motorcycles ; Pentobarbital ; Seizures

We retrospectively analyzed 125 patients of salivary gland tumor operated at Asan medical center from 1989 to 1996. The most commonly involved gland was parotid(69.6%) and the most frequent tumor was pleomorphic adenoma(56%). The proportion of the malignancy was 25.8% in parotid, 17.6% in submandibular gland, respectively. Facial palsy was developed postoperatively in 29 patients, however, seven patients were lost of follow up because five were died of disease and two were transferred to other hospitals. Persistent facial palsy were seven:four in the benign tumor, three in the malignant tumor. Transient facial palsy were 15:12 in the benign tumor, three in the malignant tumor. In the transient facial palsy, 10 patients were recovered within three months. Among 32 malignant tumor, the number of recurrence or distant metastasis were 12:four were distant metastasis alone, two were metastasis to the cervical lymph node, four were local recurrence alone and two were local recurrence with distant metastasis. The highest recurrence of the tumor was found in high grade-mucoepidermoid carcinoma(83.3%). Overall tumor recurrences were significantly related to positive cervical lymph node metastasis or positive resection margin:recurrence rate of the positive lymph node metastasis was 44.4%(four of nine) and the recurrence rate of positive resection margin was 50%(seven of 14).
Chungcheongnam-do ; Facial Paralysis ; Follow-Up Studies ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Postoperative Complications* ; Prognosis* ; Recurrence ; Retrospective Studies ; Salivary Glands* ; Submandibular Gland

The present study was performed to investigate the relationship between the concentrations of tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI) and the CT images in 23 cases of chronic subdural hematomas (SDHs). The concentrations of t-PA and PAI-1 were quantified by enzyme-linked immunosorbent assay (ELISA). Chronic SDHs were divided into five groups according to their appearance on computed tomography: high-density (n = 4), isodensity (n = 8), low-density (n = 5), mixed-density (n = 3), layering (n = 3) types. The volume of hematoma was measured with an image analyzing software program. The concentrations of t-PA were higher in layering (41.2 +/- 0.3 ng/ml, mean +/- standard error of the mean) and high-density (40.0 +/- 1.1 ng/ml) types compared to those of low-density (23.3 +/- 4.1 ng/ml) and iso-density (25.1 +/- 3.7 ng/ml) types. The concentrations of PAI-1 were lower in layering (95.9 +/- 1.0 ng/ml) and high-density (103.4 +/- 34.5 ng/ml) types compared to that of low-density (192.5 +/- 2.6 ng/ml) type. So the ratio between t-PA and PAI-1 (t-PA/PAI) was greater in layering and high-density types. The volume of hematoma was larger in mixed-density and layering types but statistically insignificant. These results presumably suggest that the ratio between t-PA and PAI concentration may contribute to the pathogenesis of the chronic SDH.
Adult ; Aged ; Enzyme-Linked Immunosorbent Assay ; Female ; Hematoma, Subdural/*metabolism ; Human ; Male ; Middle Age ; Plasminogen Activator Inhibitor 1/*analysis ; Tissue Plasminogen Activator/*analysis ; Tomography, X-Ray Computed

Bast conservation therapy has become an accepted method of primary treatment for the early stage breast cancer. The extent of local excision and skin incision has been in controversy, owing to the risk of local recurrence and cosmesis. To improve breast cometic apperance following quadrantectomy for breast cancer, authors propose a novel surgical technique that is carried out local excision through circumareolar skin incision, remodeling of breast ot replace the volum loss. Level I&II axillary dissection were performed and radiotherapy were followed. Twenty-one patients underwent the novel method for breast conserving surgery from September 1995 to October 1998 in the department of surgery at Soonchunhyang University Hospital. Cosmetic outcome was evaluated by means of panel assessment and breast retraction assessment (BRA). The mean age of patient was 43.3 years(30 to 67 years). The distribution of the 22 tumors were located in the right of 11, left of 9 and both breast of 1. The mean fumor size was 1.7 cm(0.5 to 2.8cm). The type of histology was 5 of ductal carcinoma in situ, 13 infiltrating ductal carcinoma, 2 of tubular carcinoma and 1 medullary carcinoma. Five of 22 patients had metastases in the axillary nodes. The cosmetic evaluation was performed by the 3 panelist who scored it a 5-panel scale (E0 to E4). Eighteen cases were scored as E0 (excellent, 81.8%), 1 case as E1 (good), 1 case as E2 (moderate) and 2 cases as E3 (bad) cosmetic results. BRA values were calculated by simple vector geometry employing the Pythagorean theorem, BRA values for the patients ranged 0.5 to 4.4 cm with a mean of 1.6 cm and for a group of 30 control women values ranged from 0.4 to 1.8 cm with mean value of 0.9 cm. When panel scores and BRA values were compared, 18 cases of excellent (E0) scoring had under the 3.5 cm of BRA value. One of two cases with bed (E3) score had over 3.5 cm of BRA vale. Eighteen cases who were less than 60 years old had satisfactory cosmetic results by panel scoring and BRA value. Twenty one cases who underwent a novel method for breast conserving therapy were considered as excellent and fair cosmetic results. It is concluded that the remodeling of breast following modified quadrantectomy through circumareolar skin incision is useful for preventing breast deformity.
Adenocarcinoma ; Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Carcinoma, Medullary ; Congenital Abnormalities ; Female ; Humans ; Mastectomy, Segmental ; Middle Aged ; Neoplasm Metastasis ; Radiotherapy ; Recurrence ; Skin

PURPOSE: The aim of this study was to investigate the causative organisms, clinical manifestations, and prognosis of pediatric patients with bacterial meningitis in Daejeon and Chungcheong area, occurred from 2006 to 2010. METHODS: We retrospectively reviewed medical records of patients aged between 1 month and 15 years, diagnosed with bacterial meningitis at 8 university or general hospitals in Daejeon and Chungcheong area. The bacterial meningitis was defined by isolation of organism from cerebrospinal fluid(CSF). The data was collected from January 2006 to December 2010, and analyzed including patient's demographics, causative organisms, clinical presentation, laboratory findings and complications. RESULTS: During the 5-year study period, 24 patients were diagnosed with CSF culture-proven bacterial meningitis. The most common causative organism was Streptococcus pneumoniae (S. pneumoniae, 37.5%), and the others were group B streptococcus (GBS, 20.8%), Escherichia coli (E. coli, 16.7%), Neisseria meningitidis (N. meningitidis, 8.3%), Haemophilus influenzae (H. influenzae, 4.2%), respectively. They initially complained of fever (95.8%), vomiting (83.3%), anorexia (45.8%), seizure (29.2%), headache (20.8%). The leukocyte counts exceeding 1,000/mm3 in CSF was observed in 14 patients (58.3%). In 15 patients (62.5%), the glucose concentration in CSF was less than 50 mg/dL, 18 patients showed that the protein concentration in CSF was more than 100 mg/dL. Long-term neurologic sequelae were observed in 4 patients (16.7%) and described as hearing disturbance (2 patients), hemiparesis (1 patient) and endocrine dysfunction (1 patient). Ten patients (41.7%) showed abnormal neuroradiologic findings and the most common abnormalities was subdural effusion (25.0%). CONCLUSION: Compared to the previous study performed between 2001 and 2005, S. pneumonia continued to be the leading cause of the pediatric bacterial meningitis in Daejeon and Chungcheong area. The frequency of pneumococcal meningitis was not decreased, despite of the introduction of conjugated pneumococcal vaccination. On the other hand, H. influenzae meningitis was notably decreased.
Anorexia ; Demography ; Escherichia coli ; Fever ; Glucose ; Haemophilus influenzae ; Hand ; Headache ; Hearing ; Hospitals, General ; Humans ; Influenza, Human ; Leukocyte Count ; Medical Records ; Meningitis ; Meningitis, Bacterial* ; Meningitis, Pneumococcal ; Neisseria meningitidis ; Paresis ; Pneumonia ; Prognosis ; Retrospective Studies ; Seizures ; Streptococcus ; Streptococcus pneumoniae ; Subdural Effusion ; Vaccination ; Vomiting

Quetiapine is an atypical antipsychotic that is frequently used to manage delirium in geriatric patients. Acute pancreatitis associated with quetiapine has rarely been reported. A 70-year-old male presented with severe abdominal pain a few hours after taking a dose of quetiapine prescribed for delirium. Despite the lack of risk factors of pancreatitis in his medical history, the patient had a slight increase of serum lipase and amylase levels. His general condition improved on discontinuation of quetiapine. A month later, quetiapine was readministered for the recurrence of delirium. Subsequently, the patient developed the same symptom with a significant increase in serum pancreatic enzyme levels, confirming that quetiapine induced the pancreatitis. We reported the first case of quetiapine-induced pancreatitis in Korea, together with a review of the literature.
Abdominal Pain ; Aged* ; Amylases ; Delirium ; Humans ; Korea ; Lipase ; Male ; Pancreatitis* ; Recurrence ; Risk Factors ; Quetiapine Fumarate