Septal perforation is an anatomical defect of the nasal septum that leads to impaired nasal function, including obstruction and respiratory issues. In this study, a novel surgical approach was introduced to address septal perforations, focusing on the use of costal composite chondro-perichondrial grafts bilaterally in a symmetric manner. This composite graft, composed of costal cartilage and perichondrium, provides mechanical support, aids vascularization, and minimizes perichondrial shrinkage. A case study of a 23-year-old patient with septal perforation resulting from multiple rhinoplasty procedures is presented. The surgical procedure involved the use of a composite graft to close the septal perforation and correct the nasal deformity. The postoperative results demonstrated successful septal perforation closure and relief from nasal discomfort. This study highlights the advantages of this method, particularly its simplicity and straightforward surgical procedures for closing septal perforations of various sizes, and its suitability for rhinoplasty surgeons who are familiar with costal cartilage harvesting.

With the development of gray scale ultrasonography, detection and evaluation of hepatic parenchymal diseaseincluding space occupying lesions are easitly performed and frequently used in the world. Thirty-five cases ofhistopathologically proven and ultrasonographically suggested hepatocellular carcinoma are retrospectivelystudied. The results were as follows; 1. Ultrasonographic findings of hepatocellular carcinoma show hyperechoicpattern in 22 cases (63%), hypoechoic pattern in 2 cases (6%), and mixed pattern in 11 cases (31%). 2. The marginof tumor is ill-defined in 19 cases (54%) and well defined in 16 cases (46%). 3. The size of tumor by sonographicmeasurement was larger than 5cm in diameter in 33 cases (94%). 4. The number of tumor is solitary in 19 cases andmultiple in 16 cases. The sites of involved lobe were right lobe in 22 cases (63%), left lobe in 2 cases (6%), andboth lobes in 11 cases (31%). 5. Associated sonographic findings were hepatomegaly with focal contour change in 25cases (71%), splenomegaly in 16 cases (46%), cirrhosis of liver in 15 cases (43%), ascites in 11 cases (31%) andtumoral thrombosis in portal vein in 8 cases (23%). 6. The sex ratio is 6:1 male predominence and the age rangesfrom 32 to 76 years with highest incidence in 5th and 6th decades.
Ascites ; Carcinoma, Hepatocellular ; Fibrosis ; Hepatomegaly ; Humans ; Incidence ; Liver ; Male ; Portal Vein ; Sex Ratio ; Splenomegaly ; Thrombosis ; Ultrasonography

PURPOSE: This study aimed to evaluate the status of renal function and the presence of urinary abnormalities in early adult patients with Turner syndrome (TS). METHODS: Sixty-three girls with TS, who are attending pediatric endocrine clinics in Busan Paik Hosp., were studied. Urine and blood chemistry tests were performed in every visiting times. Renal ultrasonography was performed in all patients at the initial diagnosis, and intravenous pyelography, DMSA renal scan and renal CT were also performed, if necessary. RESULTS: Of the 63 patients, the karyotype showed 45,X in 32 (50.8%) , mosaicism in 22 (34.9%) and structural aberration in 9 (14.3%). The renal function at the latest visit was shown as normal in all patients. Nephrotic syndrome had developed in one patient. Hematuria was observed in seven patients. Renal anomalies were observed in 20 of the 63 TS (31.7%). Of the 32 TS patients with 45,X karyotype, 13 (40.6%) had renal anomalies, while these were found in 7 (22.6%) of 31 TS patients with mosaicism/structural aberration. But there was no significant statistical difference between two karyotype groups. CONCLUSION: Based on this study, most of the patients with TS do not have any significant problems related to renal function until early adulthood, regardless of renal malformation or hematuria.
Adult* ; Busan ; Chemistry ; Diagnosis ; Female ; Hematuria ; Humans ; Karyotype ; Mosaicism ; Nephrotic Syndrome ; Succimer ; Turner Syndrome* ; Ultrasonography ; Urography

OBJECTIVE: We wanted to evaluate whether tumors located in a segmental border zone are predisposed to local recurrence after performing segmental transarterial chemoembolization for hepatocellular carcinoma. MATERIALS AND METHODS: Seventy-three hepatocellular carcinoma nodules were retrospectively analyzed for local tumor recurrence after performing segmental transarterial chemoembolization by using follow-up CT studies (median follow-up period: 20 months, range: 4-77 months). The tumors were divided into two groups according to whether the lesions were located at the segmental border zone (Group I) or not (Group II). Comparison of the tumor characteristics and chemoembolization methods between the two groups was performed using the chi-square test. The local recurrence rates were compared by Kaplan-Meyer method and analyzed with the log rank test. RESULTS: Local tumor recurrence occurred for 25 hepatocellular carcinoma nodules (42.9%). The follow-up periods, tumor characteristics and chemoembolization methods between Groups l and ll were comparable. The local recurrence rate was 64.0% (16/25) in Group I and 18.8% (9/48) in Group II. The difference was statistically significant on the univariate and multivariate analyses (p = 0.000 for both). CONCLUSION: Tumor location in a segmental border zone was a significant risk factor for local tumor recurrence after performing segmental transarterial chemoembolization for hepatocellular carcinoma.
Risk Factors ; Retrospective Studies ; Proportional Hazards Models ; Neoplasm Recurrence, Local ; Middle Aged ; Male ; Liver Neoplasms/*pathology/*therapy ; Iodized Oil/administration & dosage ; Humans ; Female ; Doxorubicin/administration & dosage ; Chi-Square Distribution ; *Chemoembolization, Therapeutic ; Carcinoma, Hepatocellular/*pathology/*therapy ; Aged ; Adult

OBJECTIVE: To determine the prognostic factors for local recurrence of nodular hepatocellular carcinoma after segmental transarterial chemoembolization. MATERIALS AND METHODS: Seventy-four nodular hepatocellular carcinoma tumors < or = 5 cm were retrospectively analyzed for local recurrence after segmental transarterial chemoembolization using follow-up CT images (median follow-up of 17 months, 4-77 months in range). The tumors were divided into four groups (IA, IB, IIA, and IIB) according to whether the one-month follow-up CT imaging, after segmental transarterial chemoembolization, showed homogeneous (Group I) or inhomogeneous (Group II) iodized oil accumulation, or whether the tumors were located within the liver segment (Group A) or in a segmental border zone (Group B). Comparison of tumor characteristics between Group IA and the other three groups was performed using the chi-square test. Local recurrence rates were compared among the groups using the Kaplan-Meier estimation and log rank test. RESULTS: Local tumor recurrence occurred in 19 hepatocellular carcinoma tumors (25.7%). There were: 28, 18, 17, and 11 tumors in Group IA, IB, IIA, and IIB, respectively. One of 28 (3.6%) tumors in Group IA, and 18 of 46 (39.1%) tumors in the other three groups showed local recurrence. Comparisons between Group IA and the other three groups showed that the tumor characteristics were similar. One-, two-, and three-year estimated local recurrence rates in Group IA were 0%, 11.1%, and 11.1%, respectively. The difference between Group IA and the other three groups was statistically significant (p = 0.000). CONCLUSION: An acceptably low rate of local recurrence was observed for small or intermediate nodular tumors located within the liver segment with homogeneous iodized oil accumulation.
Adult ; Aged ; Carcinoma, Hepatocellular/*pathology/radiography/*therapy ; Chemoembolization, Therapeutic/*methods ; Chi-Square Distribution ; Female ; Humans ; Iodized Oil/administration & dosage ; Liver Neoplasms/*pathology/radiography/*therapy ; Male ; Middle Aged ; Neoplasm Recurrence, Local/radiography ; Prognosis ; Retrospective Studies ; Risk Factors ; Tomography, X-Ray Computed

PURPOSE: The purpose of this study was to investigate the clinical features and laboratory findings of enteroviral meningitis according to the presence of cerebrospinal fluid (CSF) pleocytosis, and to investigate the factors influencing pleocytosis in children. METHODS: A retrospective study was conducted in 300 children with enteroviral meningitis confirmed by CSF reverse transcriptase polymerase chain reaction (RT-PCR) between 2012 and 2016. Electronic medical records including clinical and laboratory data were assessed. Clinical factors were compared between patients with and without pleocytosis. RESULTS: Of the total 300 children with enteroviral meningitis, 73 had no pleocytosis. The proportion of infants under the age of two years was higher in patients without pleocytosis than in patients with pleocytosis (39.7% vs 14.5%, P<0.001). Patients without pleocytosis were younger (43.4 months vs 66.2 months, P<0.001), had less prevalence of headache and vomiting, lower peripheral white blood cell count (9,740±3,555/mm³ vs 11,632±3,872/mm³) and a shorter interval between the onset and lumbar puncture than those with pleocytosis. In multiple regression analysis, younger age, vomiting, lower white blood cell count, and interval less than 24 hours from onset to spinal tap were associated with the absence of pleocytosis. CONCLUSION: This study showed that children younger than two years of age had high proportion of absence of pleocytosis and some of the factors analyzed correlated with CSF inflammation. Therefore, absence of pleocytosis in the initial CSF sample cannot exclude meningitis, and rapid RT-PCR testing should be performed with high suspicion in young infants.
Cerebrospinal Fluid* ; Child* ; Electronic Health Records ; Enterovirus ; Headache ; Humans ; Infant ; Inflammation ; Leukocyte Count ; Leukocytosis* ; Meningitis* ; Prevalence ; Retrospective Studies ; Reverse Transcriptase Polymerase Chain Reaction ; Spinal Puncture ; Vomiting

Background: Spontaneous pneumopericardium is a very rare condition. Spontaneous pneumothorax and pneumomediastinum have been reported to be associated with an idiopathic pulmonary fibrosis (IPF). However, spontaneous pneumopericardium has not yet been reported in association with IPF. Here we report a case of spontaneous pneumomediastinum and pneumopericardium in a patient with acute exacerbation of IPF with a review of the relevant literature.
Humans ; Idiopathic Pulmonary Fibrosis* ; Mediastinal Emphysema* ; Pneumopericardium* ; Pneumothorax

PURPOSE: S. pneumoniae is one of major pathogens of community-acquired respiratory infections. The rate of antibiotic resistance to this organism has increased, and resistance to multiple antimicrobial agents in a single strain of S. pneumoniae may compromise the efficacy of empiric antimicrobial treatment commonly used for respiratory infections. We did this study to find out the penicillin resistant distributions and oral antibiotics susceptibility patterns against S. pneumoniae, isolated from pediatric patients with community-acquired respiratory infections in Korea. METHODS: One hundred fifty six pneumococcal isolates obtained from pediatric patients with community-acquired respiratory infections such as acute otitis media(AOM), sinusitis and pneumonia between May 2000 to June 2003. And MICs of penicillin and oral antibiotics(amoxicillin, amoxicillin- clavulanate, cefaclor) were performed by broth microdilution methods according to the NCCLS(2003a). RESULTS: Seventy eight percent of the isolates were resistant to penicillin. The isolates, collected from AOM patients showed the highest penicillin resistance(92.7%). The resistant rates of amoxicillin (16.7%) and amoxicillin-clavulanate(9.6%), based on susceptibility breakpoints established by the NCCLS, were markedly lower than these of penicillin. But, the resistant rate of cefaclor was very high, above 95%. CONCLUSION: We concluded that pneumococci isolated from study cases may be one of the world's highest penicillin resistant rates. But, amoxicillin and amoxicillin-clavulanate can be used as a first- line antibiotics. Finally, we hope that a continuous surveillance study to monitor resistant patterns of pneumococcal respiratory infections will be needed for the standard guidelines of empiric antibiotic treatment.
Amoxicillin ; Anti-Bacterial Agents* ; Anti-Infective Agents ; Cefaclor ; Clavulanic Acid ; Community-Acquired Infections ; Drug Resistance, Microbial ; Hope ; Humans ; Korea* ; Otitis ; Penicillin Resistance ; Penicillins* ; Pneumonia ; Respiratory Tract Infections* ; Sinusitis ; Streptococcus pneumoniae* ; Streptococcus*

OBJECTIVE: While the prognostic factors of survival for patients with hepatocellular carcinoma (HCC) who underwent transarterial chemoembolization (TACE) are well known, the clinical significance of performing selective TACE for HCC patients has not been clearly documented. We tried to analyze the potential factors of disease-free survival for these patients, including the performance of selective TACE. MATERIALS AND METHODS: A total of 151 patients with HCC who underwent TACE were retrospectively analyzed for their disease-free survival (a median follow-up of 23 months, range: 1-88 months). Univariate and multivariate analyses were performed for 20 potential factors by using the Cox proportional hazard model, including 19 baseline factors and one procedure-related factor (conventional versus selective TACE). The parameters that proved to be significant on the univariate analysis were subsequently tested with the multivariate model. RESULTS: Conventional or selective TACE was performed for 40 and 111 patients, respectively. Univariate and multivariate analyses revealed that tumor multiplicity, venous tumor thrombosis and selective TACE were the only three independent significant prognostic factors of disease-free survival (p = 0.002, 0.015 and 0.019, respectively). CONCLUSION: In our study, selective TACE was a favorable prognostic factor for the disease-free survival of patients with HCC who underwent TACE.
Adult ; Aged ; Antibiotics, Antineoplastic/administration & dosage ; Carcinoma, Hepatocellular/mortality/*therapy ; *Chemoembolization, Therapeutic ; Contrast Media/administration & dosage ; Disease-Free Survival ; Doxorubicin/administration & dosage ; Female ; Humans ; Iodized Oil/administration & dosage ; Liver Neoplasms/mortality/*therapy ; Male ; Middle Aged ; Prognosis

Myotonic dystrophy is the most common and serious form of myotonic disease. It is a multisystem disease, although skeletal muscles are principally affected. Its most common complication is postoperative respiratory failure. We report such a case in a patient undergoing total abdominal hysterectomy after inhalational anesthesia. The patient had preoperative muscular weakness, which was, we concluded, induced by hypothyroidism and an old lacunar infarction in left thalamus with mild cerebral atrophy by preoperative thyroid function testing and brain CT. We studied electromyographic results and more intensively queried family history after postoperative respiratory failure. It was confirmed that the patient had myotonic dystrophy.
Anesthesia ; Anesthesia, General* ; Atrophy ; Brain ; Humans ; Hypothyroidism ; Hysterectomy ; Muscle Weakness ; Muscle, Skeletal ; Myotonic Dystrophy* ; Respiratory Insufficiency* ; Stroke, Lacunar ; Thalamus ; Thyroid Function Tests