PURPOSE: The sunken chest deformity without breast asymmetry is not a rare condition encountered in augmentation mammaplasty. Therefore, failure to recognize the deformity and improper surgical plan will lead to a suboptimal result. The authors review the experience of breast augmentation in simple sunken chest patient based on retrospectively collected data. METHODS: From January, 2008 to January, 2009, patients with simple sunken chest underwent endoscopic submuscular augmentation mammaplasty through axilla, using silicone implants. Patient demographics were queried and outcomes were assessed. RESULTS: Eleven patients (22 breasts) were followed up for 8.2 months after surgery. Sunken chests were augmented with implant size of approximately 248.9 cc (range: 213~286 cc) and contralateral chest with 211.4 cc (range: 180~235 cc). Simultaneous camouflaging the chest wall depression with breast augmentation resulted in good aesthetic outcome. All of the patients were satisfied with the surgery. There were no complications among all patients. CONCLUSION: We have demonstrated proper surgical planning with precise implant selection to optimize results in patients with small breast and simple sunken chest. Even though asymmetry still remains after the operation, it is still considered as acceptable.
Axilla ; Breast ; Congenital Abnormalities ; Demography ; Depression ; Female ; Humans ; Mammaplasty ; Retrospective Studies ; Silicones ; Thoracic Wall ; Thorax

PURPOSE: To compare the incidence of postoperative de novo voiding dysfunction and to identify the risk factors affecting the development of de novo voiding dysfunction after various midurethral sling (MUS) procedures for female stress urinary incontinence (SUI). MATERIALS AND METHODS: Women with SUI underwent MUS by various procedures [tension-free vaginal tape (TVT(R)), tension-free vaginal tape obturator (TVTO(R)), tension-free obturator tape (TOT(R)), or TVT-secure(R)]. Cases were reviewed retrospectively with follow-up of at least 6 months. The subjects were divided into 2 groups according to the presence of postoperative de novo voiding dysfunction. De novo voiding dysfunction was defined as a low maximal uroflow rate (Qmax<15 ml/s) or a large post-voided residual urine volume (PVR>100 ml) observed at 6 months postoperatively. Clinical and urodynamic parameters were compared between the voiding dysfunction (Group I) and normal voiding (Group II) groups according to MUS procedure. RESULTS: Of the 625 subjects, 163 (26%) patients showed evidence of de novo voiding dysfunction (Group I). Of these 163 subjects, 12 (7.3%) patients complained of voiding symptoms. There was no difference in the incidence of de novo voiding dysfunction according to MUS procedure. Multivariate analysis showed Qmax to be the only independent risk factor for de novo voiding dysfunction. CONCLUSIONS: This study confirmed the considerable incidence of postoperative de novo voiding dysfunction, which is, however, mostly asymptomatic. As preoperative Qmax decreased, the chance of postoperative de novo voiding dysfunction increased. Identification of risk factors of voiding dysfunction in women undergoing MUS may help in planning for better follow-up and early detection of possibly inherent late complications of voiding dysfunction.
Animals ; Female ; Follow-Up Studies ; Humans ; Incidence ; Mice ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Suburethral Slings ; Urinary Bladder ; Urinary Incontinence ; Urodynamics

The purposes of this study were 1) to analyze the effect of the information quality of standard menu system of ERP on the user's satisfaction 2) to analyze the effect of the information quality of standard menu system of ERP on the user's performance. The questionnaires were distributed to 260 end users(dietitians, foodservice management managers) in charge of managing the institutional foodservice such as the office(government agencies, factories), schools(universities, middle and high school) and hospitals which were managed by contract foodservice management company "C" in Seoul and Kyunggi. The surveys were performed from July 26 to July 30, 2004. Two hundred and fifty questionnaires were responded(response rate : 96.2%). The statistical analysis was conducted by using SPSS Win(11.5). And the descriptive analysis, factor analysis, reliability test, pearson correlation and simple regression analysis were performed. The results showed that the information quality of standard menu system of ERP have a significant positive effect on the user's satisfaction(p<0.001) and user's performance(p<0.001). When constructing standard menu system on ERP in the contract foodservice management company, the information quality of standard menu system of ERP should be guaranteed in order to satisfy the end-user and to improve the user's performance.
Factor Analysis, Statistical ; Gyeonggi-do ; Surveys and Questionnaires ; Regression Analysis ; Seoul

The purposes of this study were 1) to analyze the effect of the ERP quality (system quality, information quality, service quality) on the performance (end user satisfaction, user's performance, system utilization) of business, 2) to conduct the causal-effect analysis between outcome variables (user's satisfaction, user's performance, system utilization) of ERP in the contract foodservice management company. The questionnaires were distributed to 260 end users (dietitians, foodservice management managers) in charge of managing the institutional foodservice such as the office (government agencies, factories), schools (universities, middle and high school) and hospitals which were managed by contract foodservice management company "C" in Seoul and Kyunggi. The surveys were performed from July 26, 2004 to July 30, 2004. Two hundred and fifty (250) questionnaires were responded (response rate: 96.2%). The statistical analysis was conducted using SPSS Win (11.5). And the descriptive analysis, factor analysis, reliability test, pearson correlation, simple and multiple regression analysis were performed. The results showed that among the 3 factors (system quality, information quality, service quality), the system quality and information quality were proved to have an effect on the user's satisfaction and user's performance significantly (p < .05). The influence of ERP quality (system quality, information quality, service quality) on system utilization were testified to be statistically significant (p < .05). The user's performance were affected significantly by system utilization (p < 0.001) and end user's satisfaction (p < 0.001). As a conclusion, to improve user satisfaction, which is the ultimate performance variable of an ERP system, high quality of an ERP system is the pre-requisite. And the user satisfaction and performance of business would be higher with the better quality ERP system. When constructing ERP system for the contract foodservice management company, we should improve system utilization and user satisfaction altogether so that user's performance could be ultimately enhanced and we should make efforts to enhance the quality level of ERP.
Commerce ; Gyeonggi-do ; Humans ; Seoul ; Surveys and Questionnaires

Successful cases of the implant-assisted removable partial denture and implant overdentures are reported in which a few implants are additionally placed to secure the maintenance, support, and stability of the denture when there are a few residual teeth. When the lateral force applied to the tooth abutment and implant surveyed crown is minimized, the horizontal and rotational movement of the denture is significantly reduced which is an effective method that can improve the address in patients who complain of reduced retention and stability of their dentures. In this case, a small number of implants were placed to fabricate an implant-assisted removable partial denture with implant surveyed crown in the maxilla and implant overdenture with Locator® attachment in the mandible to improve the retention, stability, and support of the dentures. The patient was satisfied with both functional and aesthetic aspects after the final dentures were delivered.

Glomerulonephritis associated with malignancy is deemed to be paraneoplastic glomerulonephritis. Myelodysplastic syndrome (MDS) is a group of heterogeneous clonal hematopoietic stem cell disorders characterized by impaired hematopoietic cell differentiation and cytopenia. The pathophysiology of MDS is thought to be immune-mediated in part. A few reports have documented various forms of glomerulonephritis in patients with MDS and suggested that immune dysregulation is important in the development of paraneoplastic glomerulonephritis. Here, we report a patient with MDS and refractory anemia with excess blast-2 accompanied by minimal change nephrotic syndrome. The patient was treated with prednisolone, and the nephrotic-range proteinuria and pancytopenia improved markedly.
Anemia, Refractory ; Cell Differentiation ; Glomerulonephritis ; Hematopoietic Stem Cells ; Humans ; Myelodysplastic Syndromes* ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Pancytopenia ; Prednisolone ; Proteinuria ; Steroids

BACKGROUND/AIMS: Acute kidney injury (AKI) is a common and serious complication in critically ill patients, especially in the intensive care unit (ICU). The present study was performed to evaluate the occurrence rate of AKI using the RIFLE (increasing severity classes risk, injury, and failure, and the two outcome classes loss and end-stage kidney disease) classification, to define factors associated with AKI and hospital mortality. METHODS: We performed a retrospective study of all ICU patients over a 6-month period at Keimyung University Dongsan Hospital, Daegu, Korea. AKI was evaluated according to the RIFLE classification. RESULTS: AKI occurred in 156 of the 378 patients (41.3%) during their ICU stay, with maximum RIFLE-R, I, and F in 13.8%, 12.4%, and 15.1%, respectively. In univariate analysis, the proportion of medical admission and maximum Sequential Organ Failure Assessment (SOFA) score (SOFAmax) were significantly higher in patients with AKI than in those without. However, these factors did not remain significant in a multivariate analysis. The overall mortality rate of ICU patients was 25.7%. In multivariate analysis, mean age, occurrence of AKI, SOFAmax score, pulmonary disease, and malignancy were independent risk factors for hospital mortality. CONCLUSIONS: In these ICU patients, AKI is associated with increased hospital mortality. The RIFLE classification is a simple and useful clinical tool to detect and stratify the severity of AKI, and may aid in the prediction of outcome.
Aged ; Critical Illness/*mortality ; Female ; Hospital Mortality ; Hospitals, University/statistics & numerical data ; Humans ; Intensive Care Units/*statistics & numerical data ; Kidney Failure, Acute/*mortality ; Male ; Middle Aged ; Multivariate Analysis ; Outcome Assessment (Health Care) ; Renal Insufficiency, Acute/*mortality ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Survival Analysis

Emergence and spread of low-level mupirocin resistance in staphylococci have been increasingly reported in recent years. The aim of this study was to characterize missense mutations within the chromosomal isoleucyl-tRNA synthetase gene (ileS) among clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA) with low-level mupirocin resistance. A total of 20 isolates of MRSA with low-level mupirocin resistance (minimal inhibitory concentration, 16-64 microgram/mL) were collected from 79 patients in intensive care units for six months. The isolates were analyzed for isoleucyl-tRNA synthetase (IleS) mutations that might affect the binding of mupirocin to the three-dimensional structure of the S. aureus IleS enzyme. All isolates with low-level mupirocin resistance contained the known V588F mutation affecting the Rossman fold, and some of them additionally had previously unidentified mutations such as P187F, K226T, F227L, Q612H, or V767D. Interestingly, Q612H was a novel mutation that was involved in stabilizing the conformation of the catalytic loop containing the KMSKS motif. In conclusion, this study confirms that molecular heterogeneity in ileS gene is common among clinical MRSA isolates with low-level mupirocin resistance, and further study on clinical mutants is needed to understand the structural basis of low-level mupirocin resistance.
Staphylococcus aureus/drug effects/*genetics ; *Mutation, Missense ; Mupirocin/*pharmacology ; Methicillin Resistance ; Isoleucine-tRNA Ligase/*genetics ; Intensive Care Units ; Humans ; Electrophoresis, Gel, Pulsed-Field ; Drug Resistance, Bacterial

OBJECTIVE: The aims of this study were to measure and compare the facial dimensions of the Miss Korea pageant contestants and a selected group of women from the general population by using three-dimensional (3D) image analysis, as well as to compare various facial ratios to the golden ratio within each group. METHODS: Three-dimensional images of 52 Miss Korea pageant contestants (MK group) and 41 young female adults selected from the general population (GP group) were acquired. Fifty-four variables and ratios were measured and calculated. Intergroup comparisons were performed using multivariate analysis of variance. RESULTS: Compared to the GP group, the MK group showed greater total facial height and eye width, lesser lower-facial height, and lesser facial, lower-facial, and nasal widths. Moreover, compared to the GP group, the MK group had more protruded noses with greater nasolabial angle, greater vertical curvature of the foreheads, lesser horizontal curvature of the cheek, and lesser lower-lip-and-chin volume. CONCLUSIONS: The MK group had longer faces but smaller lower lips and chins than did the GP group. The golden ratio was not matching the current facial esthetic standards. These data might be beneficial for treatment planning of patients undergoing orthognathic and plastic surgeries.
Adult ; Cheek ; Chin ; Esthetics* ; Female ; Forehead ; Humans ; Imaging, Three-Dimensional ; Korea* ; Lip ; Multivariate Analysis ; Nose ; Plastics

Since the reformation of the National Health Insurance Act in 2000, the Health Insurance Review and Assessment Service (HIRA) in the Republic of Korea has performed quality assessments for healthcare providers. The HIRA Value Incentive Program (VIP), established in July 2007, provides incentives for excellent-quality institutions and disincentives for poor-quality ones. The program is implemented based on data collected between July 2007 and December 2009. The goal of the VIP is to improve the overall quality of care and decrease the quality gaps among healthcare institutions. Thus far, the VIP has targeted acute myocardial infarction (AMI) and Caesarian section (C-section) care. The incentives and disincentives awarded to the hospitals by their composite quality scores of the AMI and C-section scores. The results of the VIP showed continuous and marked improvement in the composite quality scores of the AMI and C-section measures between 2007 and 2010. With the demonstrated success of the VIP project, the Ministry of Health and Welfare expanded the program in 2011 to include general hospitals. The HIRA VIP was deemed applicable to the Korean healthcare system, but before it can be expanded further, the program must overcome several major concerns, as follows: inclusion of resource use measures, rigorous evaluation of impact, application of the VIP to the changing payment system, and expansion of the VIP to primary care clinics.
Benchmarking ; Hospitals ; Humans ; *National Health Programs ; Quality Improvement/*economics ; Quality of Health Care/economics ; Reimbursement, Incentive/*organization & administration ; Republic of Korea