Mandibular prognathism was defined by Johe Hunter as follows : 'The lower jaw projecting too far forwards so that the foreteeth pass before those of upper jaw, therefore disfigurement and malocclusion are the two of facial main characteristics.' Mandibular ramus osteotomy by vertical osteotomy or sagittal splitting osteotomy recently has come into more common use. Although preoperative and postoperative orthdontic management is indispensable in surgery of this type, we occasionally encounter patients who are intolerant to a long duration of orthodontic treatment and intermaxillary fixation. We describe surgical refinement accomplishing mandibular anterior segmental osteotomy, recession genioplasty by horizontal osteotomies and decortication of the anterior portion of the bony bar for a minor degree of mandibular prognathism. In results, the amount of setback is limited to 4 to 5mm, no intermaxillary fixation is required and no orthodontic treatment, in this operation, is needed. This procedure can obtain a rapid aesthetic improvement. We used this preocedure in 8 patients (3 males and 5 females) with a mild mandibular prognathism. No major complications occurred throughout the follow-up period except transient paresthesia of the mental nerves, otherwise all patients were satisfied with the result.
Follow-Up Studies ; Genioplasty* ; Humans ; Jaw ; Male ; Malocclusion ; Osteotomy* ; Paresthesia ; Prognathism*

A multitude of methods for correction of the residual cleft lip nose deformity have been developed. Inspite of the development it appears that no one procedure has achieved satisfactory results. In addition, the appropriate timing for surgical correction still remains unsettled. The philtrum plays a keyhole in the appearance of the upper lip and nostril sill. But the formation of philtrum with muscle flap or conchal cartilage have been resulted in a unsatisfactory aesthetic outcome. We performed 26 cases of the correction of unilateral cleft lip nose deformity between May 1993 and September 1996, and we always used autogenous palmaris longus tendon for reconstruction of philtral column and nostril sill augmentation. Palmaris longus tendon creates a more definite philtral unit comparing to other materials which have been used and it is easy to harvest and transfer and it does not affect normal function of the hand. And we followed up all patients and confirmed that disappearance of newly formed philtrum is rare. In conclusion, this study shows that autogenous palmaris longus tendon is a useful material for reconstruction of philtral column.
Cartilage ; Cleft Lip* ; Congenital Abnormalities* ; Hand ; Humans ; Lip ; Nose* ; Tendons*

The characteristics of modern society's trauma is a propensity for multiple and severe trauma, specially, the fatal damage accompanied by facial bone fracture. We observed the malocclusion owing to delayed prompt treatment If the fractured fragments is crushed severely, it is difficult to make them positioned into the normal anatomical states and to fix them tightly. Post-traumatic malocclusion is usually caused by a delay in treatment and inadequate anatomic reduction. Inadequately treated facial bone fractures result in facial disfiguring and functional impairment of mastication and speech.We performed 27 cases of correction of post-traumatic malocclusion between April 1994 and June 1996. We used various operative techniques such as anterior segmental osteotomy, Le Fort osteotomy, maxillary segmental osteotomy and mandibular sagittal split osteotomy. If the malocclusion was due to disarrangement segmental osteotomy. If that malocclusion was attributed to a malpositioned skeletal bone, we take maxillary segmental osteotomy or mandibular sagittal split osteotomy. We acquired the desirable occlusion first followed by a fixation between the mandible and maxillary skeletal bones with the bite block. The aim in the correction of malocclusion was to create a harmony of centric relation and centric occlusion. After operation, intermaxillary fixation with bite block have many advantages in the treatment of malocclusion.
Centric Relation ; Facial Bones ; Malocclusion* ; Mandible ; Mastication ; Maxillary Osteotomy ; Osteotomy ; Osteotomy, Le Fort

The inverted nipple presents many problems including both cosmetic and functional aspects and impairment in breast feeding. the histopathologic characters of inverted nipple are that inverted nipple has less fibromuscular tissue than normal nipple and has short lactiferous duct and dense fibrous tissue. Many surgical and non-surgical techniques have been designed for correction of the inverted nipple. But most of these techniques have produced unsatisfactory problems. especially undesirable recurrence is most important problem. We experienced 19 inverted nipples in 12 patients between March 1995 and January 1998. We combined modified Teimourian method, purse-string suture and Z-plasty. and had good result for 3weeks to 30months follow up. This method was effective for correction of the inverted nipple with low recurrence rate and simple techniques.
Breast Feeding ; Follow-Up Studies ; Humans ; Nipples* ; Recurrence ; Sutures

Many Oriental women have prominent mandibular angle and short chin, in other words, 'squared' mandibular face or 'boxy' face. That kind of face is considered to be unattractive and causes big cosmetic problems for those who want to have an ovoid or almond shaped face. A squared mandibular face often needs to be corrected by operative procedure. A reduction mandibular angleplasty by bony angle resection is one of the operative procedures, but it is not always an adequate method. The successful correction of squared mandibular face can be accomplished by horizontal facial reduction and/or vertical facial lengthening procedure. From March 1996 to March 2000, We had operated 117 patients. The patients were divided into 3 groups. Group I had prominent mandibular angle and/or massetric hypertrophy. Patients in this group were operated by reduction angleplasty with/without resection of masseter muscle. Group II had prominent mandibular angle, cheek and mandibular body. In this case, we applied reduction angleplasty, contouring of body, resection of buccal fat pad and/or masseter muscle. Group III had prominent mandibular angle with short face. We used methods used for group II and Le Fort I lengthening and genioplasty. Ancillary procedures were forehead lengthening and reduction maloplasty. Successful correction of squared mandibular face could be performed by accurate analysis of facial profile and reduction mandibular angleplasty with proper ancillary procedures for each group. The results were as follows: 1) We obtained successful correction of squared mandibular face with multiple horizontal facial reduction procedures, which reduced anterior and posterior facial plane. 2) In case of short face, we made better mid-low facial balance with vertical facial lengthening and horizontal facial reduction.
Adipose Tissue ; Cheek ; Chin ; Female ; Forehead ; Genioplasty ; Humans ; Hypertrophy ; Masseter Muscle ; Prunus dulcis ; Surgical Procedures, Operative

Background: Mac-2 binding protein glycosylation isomer (M2BPGi) was introduced as a noninvasively measurable serologic marker for liver fibrosis. Acoustic radiation force impulse imaging (ARFI) elastography is another noninvasive method of measuring hepatic fibrosis. There are limited data about the correlations between histologic fibrosis grade and noninvasively measured markers, including M2BPGi and ARFI. Methods: This prospective study was conducted among patients admitted consecutively for liver resection, cholecystectomy, or liver biopsy. ARFI elastography, serum M2BPGi levels, and the AST to Platelet Ratio Index (APRI) score were evaluated before histologic evaluation. Histologic interpretation was performed by a single pathologist using the METAVIR scoring system. Results: In patients with high METAVIR scores, M2BPGi levels and ARFI values showed statistically significant differences between patients with fibrosis and those without fibrosis. In 41 patients with hepatocellular carcinoma, as METAVIR scores increased, M2BPGi levels also tended to increase (p=0.161). ARFI values changed significantly as METAVIR scores increased (p=0.039). In 33 patients without hepatocellular carcinoma, as METAVIR scores increased, M2BPGi levels significantly increased (p=0.040). ARFI values also changed significantly as METAVIR scores increased (p=0.033). M2BPGi levels were significantly correlated with ARFI values (r=0.604, p<0.001), and APRI values (r=0.704, p<0.001), respectively. Conclusions Serum M2BPGi levels increased with liver fibrosis severity and could be a good marker for diagnosing advanced hepatic fibrosis regardless of the cause of liver disease.

Background: In clinical fields, many types of insoles are used to not only realign movement patterns, but also treat pressurerelated foot diseases. However, the characteristics of and plantar pressure in each type of insole are still unclear. Therefore, the aim of this study was to validate the plantar pressure-relieving effect of three representative types of insoles (metatarsal padding insole [MPI], lateral heel wedge insole [LHI], and arch support insole [ASI]) in asymptomatic men. Methods: A total of 35 feet of 35 asymptomatic men with a mean age of 23.4 ± 2.0 years were included. Pedobarographic data were evaluated by dividing the foot into eight designated regions to compare the three types of insoles. Peak plantar pressure (PPP) and pressure time integral (PTI) were assessed using the Pedar-X system. A repeated measures analysis of variance was used for statistical analyses. Results: In the hallux region, there was no statistically significant difference. MPI showed highest pressure in the 2nd–5th toe and midfoot region, but lowest in the central and lateral forefoot regions. Meanwhile, ASI showed highest pressure in the medial forefoot region but lowest in the lateral heel region. Lastly, pressure in the lateral heel region was highest in LHI. Overall, results of PTI were similar to those of PPP. Conclusions This study demonstrated that the three types of insole each could reduce and redistribute pressure of specific part of the foot to help select an appropriate insole for each purpose.

We report a rare case of multiple cerebral aneurysms associated with an extracranial internal carotid aneurysm. This 59-year-old woman had a history of hypertension and a stroke. Brain CT scan and angiographic findings are presented.
Aneurysm* ; Brain ; Female ; Humans ; Hypertension ; Intracranial Aneurysm* ; Middle Aged ; Stroke ; Tomography, X-Ray Computed

BACKGROUND: The aim of the study was to determine prevalence of potential heterogeneous vancomycin-resistant Staphylococcus aureus (h-VRSA) among methicillin-resistant S. aureus (MRSA) isolated in Korea by using Mu-3 agar and to determine the effect of in vitro vancomycin exposure on the resistance. METHODS: MRSAs isolated in 1980-1999 were screened for the presence of VISA or h-VRSA using Mu-3 agar. MIC of vancomycin was tested by NCCLS agar dilution and broth microdilution tests. Suspected h-VRSA were selected by vancomycin-containing media and change of resistance was determined by population analysis. A strain with Mu50 type growth was serially exposed to 8 pg/ml of vancomycin containing media and change of the vancomycin resistance was determined. RESULTS: Among the 455 MRSA isolates, 18 (3.9 %) grew on selective brain heart infusion agar (BHIA), and 354 (77,8%) on Mu-3 agar, 66 (14.5%) with Mu3 type growth and 78 (17.1%) with Mu50 type growth. MIC of vancomycin was 11 pg/ml for some of the isolates when inocula were approximately 10' CFU, but VISA was not present when tested by NCCLS broth microdilution test. Exposure of the isolates to van-cornycin raised the MIC. Serial exposure once to 8 pg/ml of vancomycin resulted in significant decrease of cells susceptible to 8-12 pg/ml of vancomycin. CONCLUSION: VISA was not present among the test isolates, but 34.2% were suspected to be potential h-VRSAs, suggesting possible emergence of VISA if vancomycin was administered prolonged period. It is considered that suitable screening media are vancomycin containing BHIA for VISA and Mu-3 agar for h-VRSA. The isolates showing Mu50 type growth on Mu-3 agar are not always VISA, but rather h-VRSA.
Agar* ; Brain ; Heart ; Korea ; Mass Screening ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Prevalence ; Staphylococcus aureus* ; Staphylococcus* ; Vancomycin Resistance ; Vancomycin*

BACKGROUND: Pretransplant HLA crossmatch is one of the most important parts in solid organ transplantation. Flow cytometic crossmatch (FCXM) is more sensitive than anti-human globulin enhanced complement dependent lymphocytotoxicity (AHG-CDC) in detecting anti-HLA antibodies. We compared the results of the two methods and analyzed the FCXM-positive cases in various aspects. METHODS: Sera from 212 patients were tested for the detection of anti-HLA antibodies by FCXM and 188 of them were also tested by AHG-CDC assay. The results were analyzed in relation to their histories of pregnancy, transfusion or organ transplantation and also according to the donor patient relationships. We compared the FCXM results obtained before and after desensitization therapy (using plasmapheresis and anti-CD20 antibody) in 5 sensitized patients. RESULTS: Concordance of the results between the two methods was 88.8% (167/188). FCXM results correlated with history of pregnancy, but not with that of transfusion. When the patients were divided into 4 groups according to donor-patient relationships, the T cell FCXM mean fluorescence intensity (MFI) ratio (sample/control) was significantly higher in the husband-to-multiparous wife group compared to the other 3 groups (children-to-mother, unrelated donor-to-multipara, and the rests). After desensitization therapy, MFI ratios of T cell FCXM decreased and those of B cell FCXM increased, probably due to rituximab effect, in all 5 patients. CONCLUSIONS: FCXM using a MFI ratio, has a higher sensitivity than AHG-CDC in detection of donor specific antibodies. Also it can be useful in monitoring antibody levels during desensitization therapy.
Antibodies ; Antibodies, Monoclonal, Murine-Derived ; Complement System Proteins ; Fluorescence ; Humans ; Organ Transplantation ; Plasmapheresis ; Pregnancy ; Spouses ; Tissue Donors ; Transplants ; Rituximab