Augmentation rhinoplasty is one of the most popular aesthetic procedures in Asians. Numerous alloplastic implants have been used, however alloplastic implants may cause many problems in nasal and perinasal areas because of thin soft tissue cover. For these reasons, an ideal implant should be nonpalpable, readily exchangeable and biocompatible. Among these alloplastic implants, Gore-Tex(R) is a polymer of carbon bound to fluorine composed of solid nodes connected by very fine fibers. It has been reported that this material become permeated and surrounded by mature connective tissue, forming a strong supporting envelop for the material, yet the implant is easily removed because of limited tissue ingrowth. Since it's development, Gore-Tex(R) has found many applications in the field of facial plastic and reconstructive surgery. From November, 2001 to December, 2002, Gore-Tex(R) implants were removed from 17 patients due to several problems such as; decreased dorsal height, tip deformity, chronic inflammation. The implants were very hard to remove and coinciding injury of the surrounding tissue were inevitable. An analysis of the length and thickness changes in these removed implants was made. The results showed, decrease in length and thickness with a volume loss averaging, 46.3% in 45x4.0mm implants, 49.3% in 50x5.0mm implants. In view of the experiences of 17 cases of Gore-Tex(R) implants in rhinoplasty, we have concluded that Gore-Tex(R) implants were structurally unstable, fibrovascular tissue ingrowth into pores were minimal, the implants were very hard to remove and the implants caused a postoperative volume reduction. Therefore, Gore-Tex(R) use in augmentation rhinoplasty should be approached with caution.
Asian Continental Ancestry Group ; Carbon ; Congenital Abnormalities ; Connective Tissue ; Fluorine ; Humans ; Inflammation ; Plastics ; Polymers ; Polytetrafluoroethylene* ; Rhinoplasty*

Augmentation rhinoplasty is one of the most popular aesthetic procedures in Korea. It is precise surgery in which the margin of error is measured in millimeters, thus the surgeon must have a full knowledge of nasal anatomy and the basic principle of surgical procedures. In fact, many surgeons, in particular, inexperienced with lack of the basic principle, face dissatisfactory surgical result frequently. While a considerable number of studies have been made on the "advanced procedures" of rhinoplasty over the past few years, few attempts have so far been made on the "basic principle". This article shows what is the basic principle of successful augmentation rhinoplasty. The six steps for successful augmentation rhinoplasty are as follows: incision, approach, pocket dissection, implant fabrication, suture, and dressing. Marginal incision should be made at the caudal border of the alar cartilages to avoid disruption of soft triangle area and visible scar formation, which could be occurred when it is made at the immediate nostril rim area. The soft tissue envelope is sharply elevated in a plane intimate to the perichondrium with Peck- Joseph dissecting scissors to minimize tissue trauma and bleeding. The periosteum is sharply elevated with a Joseph periosteal elevator at the caudal margin of the nasal bone and dissection continued superiorly in a subperiosteal plane to the radix area. This pocket must be made with ample and symmetric dissection. Silicone rubbers, especially, soft type are the best as implants for rhinoplasty. It should be fabricated at the nasofrontal angle and its contact surface with the nasal bone should be carved more concavely to have a plastic suction pad effect. Silicone rubbers carved like this adhere closely to the nasal bone and make an even capsular formation. The incision should be closed very carefully, if not, asymmetric nostril or deviated columella can be occurred. Joseph dressing is routinely placed at the final step. In this procedure, we expect that any dead space between implants and the nasal bone can be obliterated by placing two or three pieces of gauze on the nasal root. We are sure that this article can be a little help to inexperienced plastic surgeons by providing the basic principle of successful augmentation rhinoplasty.
Bandages ; Cartilage ; Cicatrix ; Elevators and Escalators ; Hemorrhage ; Korea ; Nasal Bone ; Periosteum ; Rhinoplasty* ; Rubber ; Silicones ; Suction ; Sutures

Ramsay-Hunt syndrome (RHS) is a well known disease caused by varicella-zoster virus infection in the geniculate ganglion of the facial nerve. Although the otic vesicle and facial palsy are easily recognized clinical signs of RHS, cases of associated multiple cranial nerve palsies present a difficult diagnostic challenge and furthermore, the mechanisms is unclear. We report a case of an 86-year-old man with otic crusted vesicles and peripheral typed facial palsy preceded by severe headache and fever. Several days later, he developed diplopia, dysphagia, hiccup and abdominal myoclonus. On fluid attenuated inversion recovery image of brain, diffuse subdural inflammatory exudates, which disappeared after treatment of acyclovir and corticosteroid, and ipsilateral facial nerve enhancement were observed in follow-up imaging.
Acyclovir ; Aged, 80 and over ; Brain ; Cranial Nerve Diseases ; Cranial Nerves ; Deglutition Disorders ; Diplopia ; Exudates and Transudates ; Facial Nerve ; Facial Paralysis ; Fever ; Follow-Up Studies ; Geniculate Ganglion ; Headache ; Herpesvirus 3, Human ; Hiccup ; Humans ; Myoclonus

No abstract available.
Appendix* ; Carcinoid Tumor*

BACKGROUND AND OBJECTIVES: Standard unfractionated heparin (UFH) has long been used to prevent death and myocardial infarction in patients with acute coronary syndrome and acute occlusion undergoing percutaneous revascularization. However, UFH binds to several plasma proteins, platelets, and endothelial cells producing a highly variable anticoagulant response. In contrast, Low molecular weight heparin (LMWH) exhibits less protein binding and provides more predictable anticoagulant response with reduced need for patient monitoring and dosage adjustment. The purpose of this study was to assess the anti-Xa activities of LMWH in Korean patients with acute coronary syndrome after recommended dose for caucasians and to determine an optimal method of administration of LMWH. MATERIALS AND METHODS: Twenty five patients with acute coronary syndrome were enrolled and allocated to five separate groups (5 patients in each group) by types according to molecular weight (LMWH (A): (molecular weight of 4500 daltons, LMWH (B): molecular weight of 6400 daltons) and methods of administration (Group 1A and 1B: Subcutaneous and subcutaneous injections (SC-SC), Group 2: Intravenous and subcutaneous injections (IV-SC), Group 3A and 3B: Intravenous, subcutaneous and subcutaneous injections (IV-SC-SC). Five groups were as follows: Group 1A: LMWH (A) 1 mg/kg SC every 12 hours, Group 1B: LMWH (B) 100 IU/kg SC every 12 hours, Group 2: LMWH (A) 1 mg/kg IV bolus and 1 mg/kg SC 12 hours later, Group 3A: LMWH (A) 0.5 mg/kg IV bolus, 3 hours later 1 mg/kg SC every 12 hours, Group 3B: LMWH (B) 50 IU/kg IV bolus, 3 hours later 100 IU/kg SC every 12 hours. Anti-Xa activity was measured by amidolytic assay method (Rotachrome, Stago, France) in 555 samples from 25 patients. All the data of anti-Xa activity in each group were plotted along the sequential time and mean values of them were analyzed by Wilcoxon signed rank test. RESULTS: 1)The anti-Xa activity (mean 0.6216+/-0.238 IU/mL) of LMWH (A) was greater than that of LMWH (B)(mean 0.2587+/-0.1709 IU/mL) in the conventional SC-SC method (p<0.001). 2) The anti-Xa activity of LMWH (A) (mean 0.6203+/-0.2383 IU/mL) was also greater than that of LMWH (B)(mean 0.468+/-0.2428 IU/mL) in the IV-SC-SC method (p<0.001). 3) More rapid and effective anti-Xa activities were achieved by IV-SC-SC method compared with conventional SC-SC method. CONCLUSION: This study suggests that immediate achievement and optimum maintenance of anticoagulant activity can be accomplished by IV-SC-SC method rather than conventional SC-SC method in patients of acute coronary syndrome.
Acute Coronary Syndrome* ; Blood Proteins ; Endothelial Cells ; Heparin ; Heparin, Low-Molecular-Weight* ; Humans ; Injections, Subcutaneous ; Molecular Weight ; Monitoring, Physiologic ; Myocardial Infarction ; Protein Binding

No Abstract available.
Academic Medical Centers* ; Infection Control*

BACKGROUND: After the World-Wide-Web(www) appeared, history has abruptly fallen in the new era of the Internet. In Korea, after the first medical internet site appeared, there was a major development in the WWW. But the quality and quantity of the web-page remains in infancy. Therefore, through the analysis of the Korean medical internet sites on present status, directions for development of Korean medical internet sites can be made. METHODS: From April 1st, 1999 to June 30th, 1999 in the Korean web sites, we visited 1044 sites. They included "Medmark Korea" representing medical search engine, "Eulji medical library" in the Eulji Medical College Hospital, and the medical sites of the "Yahoo Korea", "naver.com", and "simmani.com". Through this internet search, the information about locations, first publication year, classification by characteristics of homepage, speciality, web service form was obtained. Among these sites, acquireing from insufficient source further, questions were sent to the webmasters of 143 websites by e-mail. The questions included 7 items on the characteristic of webmasters, 8 items on the general characteristics of internet sites, 8 items on the contents, and their own comments. RESULTS: The occupation of webmasters was as follows: were physicians 94.4%, were male. According to age distribution, those in their thirties was 48.2%, and forties, 33.3%. Amone the 521 websites confirmed, there were 44 sites in 199 151 in 1996, 237 in 1997, and 79 in 1999. According to the distribution of location, metropolitan areas including Seoul, Inchon, Kyonggi occupied 68.9% among total. The main portion of the intentional visitors was ordinary people comprising 39.2%, members 9.8%, and physicians 7.7%. Concerning the purposes of publication, 38.7% of websites intended for health education to citizens, 31.0% for publicity of hospital or organizations, and 15.5% for exchange of information between members. For the most significant contents, 26.6% focused on the common-sense health issues, 35.7% on exchange of special medical information, 8.4% on education data for medical students, and 13.3% on publicity of hospitals. For the update interval, 22.0% renewed their sites within 1 week, 22.7% in 1 month, 23.4% in 3 months, and 20.6% in 6 months. For the effectiveness of homepage, the rate of `good' and `very good' response was 52.8%. CONCLUSION: Our investigation, showed that medical internet sites are lead by those in their thirties and forties. Web sites was concentrated to metropolitan areas where informational infrastructure was well developed. It is emphasized that efforts to informationalization by are needed by, governmental medical database systems should be established, and that the guidelines which enables validity of medical information should be set forth.
Age Distribution ; Classification ; Education ; Electronic Mail ; Gyeonggi-do ; Health Education ; Humans ; Incheon ; Internet* ; Korea* ; Male ; Occupations ; Publications ; Search Engine ; Seoul ; Students, Medical

No abstract available.
Pituitary Neoplasms*

OBJECTIVE: This study was conducted to evaluate payer-driven medication adherence intervention program from the patient's and counselor's perspectives. METHODS: Target patients for intervention were selected by retrospective adherence measures based on national health insurance claims data for hypertension, diabetes and hyperlipidemia. As a serial intervention for higher risk groups of medication non-adherence, initial direct mailing, the first direct telephone call and the second direct call or a home visit were followed. Interview approach to qualitative inquiry was used to evaluate intervention results. RESULTS: Participants including 4 patients received telephone calls, and 4 National Health Insurance Service staff and 4 pharmacists participated as counselors were interviewed regarding their impression of the intervention program. Three major themes arose: overall perception; necessities; and suggestions for success, of the intervention. Despite short period of intervention, educational intervention by telephone counseling involving pharmacists shows potential to improve self-management of chronic disease, and pharmacist-involvement. But more sophisticated selection of target patients requiring the intervention and complementation of electronic database system would be necessary. In addition, personal disposition of counselor was revealed to be an important factor for achieving successful outcome of intervention. CONCLUSION: The findings suggest that the individualized counseling intervention would be an efficient option for improved medication adherence. Further researches should include longer periods of interventions, a quantitative analysis using adherence measures based on claims data and consideration of clinical benefits associated with the intervention.
Chronic Disease* ; Complement System Proteins ; Counseling* ; House Calls ; Humans ; Hyperlipidemias ; Hypertension ; Medication Adherence ; National Health Programs ; Pharmacists ; Postal Service ; Retrospective Studies ; Self Care ; Telephone

BACKGROUND: This study was designed to investigate the relationship between psychiatric disease and systemic Internal Medical disease in psychiatric inpatients who were consulted to department of Internal Medicine and was directed to assess the physical problems and possible ways to resolve them in a closed psychiatric unit. METHOD: Through evaluation of medical records of 1549 inpatients who had consulted in department of internal medicine in Seoul National(mental) Hospital from January 1, 2002 to December 31, 2002. We classified the Physical illness according to ICD-9-CM and psychiatric disease according to DSM-IV RESULTS: The results were as follows: 1) In age and sex distribution, male was 64.4% and 45.9% of the subject was 4th and 5th decades. 2) The most systemic diagnosis were disease of respiratory system, disease of digestive system and endocrine system. 3) schizophrenia showed the highest rate in respiratory disease. Rate of digestive disease was the highest in alcohol use disorder. Disease of respiratory system and disease of digestive system were the most frequent in mood disorder 4) In 1st decade, Digestive system digease was the most frequent, others were respiratory system disease. 5) onset age of psychiatric disease was the oldest in circulatory disease. In genitourinary system disease, duration of psychiatric disease was the longest CONCLUSION: The clinical characteristics of psychiatric disease influenced to get systemic disease in psychiatric patients.
Age of Onset ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Digestive System ; Endocrine System ; Humans ; Inpatients* ; Internal Medicine ; International Classification of Diseases ; Male ; Medical Records ; Mood Disorders ; Respiratory System ; Schizophrenia ; Seoul ; Sex Distribution ; Urogenital System