Macrostomia is a relatively rare malformation. There have been many surgical methods for the correction of macrostomia. The old method, a simple straight line closure , did not include reconstruction of the orbicularis oris muscle. Postoperatively, a depressed scar and severe contraction on the cheek were found, especially with animation. As a result, many authors have known that reconstruction of the orbicularis oris muscle was very important to avoid a depressed scar for the correction of macrostomia. The tendency toward lateral displacement of the reconstructed commissure has been attributed to linear scar contraction, and Z-plasty is advocated to prevent this deformity. However, we found that the Z-plasty scar may be conspicuous when the patient smiles. So we performed reconstruction of the orbicularis oris muscle to avoid a depressed scar, and straight line closure to avoid a conspicuous scar. In order to prevent linear scar contracture due to straight line closure, we overcorrected the new commissure. We treated 6 cases of macrostomia form May 1, 1996 to April 30, 1999 using straight line closure and reconstruction of the orbicularis oris muscle. Periods of follow-up were from 12 months to 35 months, with an average of 20,2 months. Every patient was analyzed clinically by ordinary scale method and anthropometrically by the ratio of abnormal distances to normal distances between cheilion and crista philtri. In 3 clinical assessments : symmetry of the commissure was excellent: degree of the scar at rest was good: and degree of depression with animation was excellent. The anthropometrical ratio was 1:1.05. Despite the fact that the linear scars were perpendicular to the minimal skin tension lines, the scars were inconspicuous. The muscle repair provided reconstruction to the modiolus and gave a natural appearance to the commissure, however it did not seem to provide sufficient bulkiness around the commissure. The straight line skin closure and repair of the orbicularis oris muscle provide effective functional and aesthetic reconstruction.
Cheek ; Cicatrix ; Congenital Abnormalities ; Contracture ; Depression ; Follow-Up Studies ; Humans ; Macrostomia* ; Skin

No abstract available.
Epilepsies, Myoclonic* ; Neuroblastoma*

The authers had successfully treated two cases of primary corneal peripheral ischemic syndrome by subconjunctival heparin injection. The first 60 years male patient had a history of a progressive visual disturvance, photophobia and ocular pain in both eyes for 5 months. At the time of his first visit to our hospital, deep ring shaped ulceration at corneal periphery was observed. So he was treated by subconjunctival heparin injection and systemic steroid administration. The second 70 years female patient had a history of Progressive visual disturbance since 3 ears ago and photophobia tearing and ocular pain. At the time of her first to our hospital, deep ring shaped ulceration at corneal periphery was found. So she was treated by subconjunctival heparin injection and systemic steroid administration too. We found no evidence of further ulceration in two cases.
Ear ; Female ; Heparin ; Humans ; Male ; Photophobia ; Ulcer

The mandible with the lower maxilla comprises the lower third of the face. A correction of the mandible in facial asymmetry would be helpful in improving aesthetic appearance. In general, surgical techniques for improving the contour of lower jaw deformities include correcting the deficient mandible by osteotomies, distraction osteogenesis and the augmentation of the mandible with alloplastic or autogenous materials. In a patient with satisfactory occlusal relationships and mild hypoplasia, alloplastic material for augmentation of the mandible on the affected side is more practical than autogenous augmentation. The porous high density polyethylene (PHDPE) implant is a widely available alloplast which is an attractive alternative to other alloplasts and autogenous tissues. Thirteen patients (8 men, 5 women), ages ranging from 17 to 47 years old, have types IA (n = 6) and IB (n = 5) hemifacial microsomia(Munro and Lauritzen, 1985), Klippel-Feil syndrome (n = 1), Romberg's disease (n = 1) were corrected with prefabricated porous high density polyethylene over a 4 year period (1996- 1999). The average follow-up period was 12 months, however the range has been between 6 and 36 months. Preoperative planning was done based on an aesthetic assessment of thickness of the soft tissue, the use of life size photographs, cephalometric and panorex x-rays and three dimensional computed tomography. The surgical technique consists of an intraoral approach incision, the an implant was placed subperiostealy, appropriately sculptured and fixed to posterior and inferior border of the mandible at the gonial angle. In four patients the implant had to be removed due to complications which included three cases of infection and one case of extrusion by iatrogenic trauma. One of the above four patients' implant was replaced with a smaller one, approximately 3 months after its removal. With the others nine patients there was no infection or permanent morbidity. Postoperative appearance was considered very satisfactory, the mandible was well outlined, and the facial proportions were improved. Porous high density polyethylene implant is recommended for hypoplastic mandible augmentation when proper indication are strictly observed and surgical steps are accurately followed.
Congenital Abnormalities ; Facial Asymmetry ; Facial Hemiatrophy ; Follow-Up Studies ; Humans ; Jaw ; Klippel-Feil Syndrome ; Male ; Mandible* ; Maxilla ; Middle Aged ; Osteogenesis, Distraction ; Osteotomy ; Polyethylene*

Recently, some forms of non-surgical treatment modalities for BPH such as microwave or laser induced hyperthermia have been available and its demand by patient is increasing. The advantage of these treatment is its out-patient basis of treatment(no admission & no anesthesia). However, it leaves no surgical specimens for the pathological examination and detection of stage A prostate cancer may be impossible. Therefore, early detection of prostatic cancer prior to the non-surgical treatment of BPH is considered important if there are any suspicious signs of prostate cancer from the results of prostate specific antigen (PSA), digital rectal examination (DRE), or transrectal ultrasound(TRUS). The aims of our study is to compare the predictability of the DRE, PSA, and TRUS in the detection of prostate cancer before planning to take non- surgical treatment of BPH. One hundred thirty three patients between 50 to 85 years old (mean age 67.9) with symptoms of prostatism were examined serum PSA, DRE and TRUS prior to the treatment of BPH and predictability for the detection of prostatic cancer by each test were analyzed. Of the 133 cases, 3 were diagnosed as inflammations, 1 as tuberculosis, 1 as infarct, 110 as nodular hyperplasia, 18 as prostate cancers. Positive predictability of each test were as followed: 59.3% of the patients with abnormal DRE, 57.7% of the patients with abnormal TRUS and, 34% of the patients with abnormal PSA level( > 10 ng/ml). For the 44 patients with abnormal PSA level( > l0 ng/ml) and, coexisting abnormalities on either TRUS or DRE, positive predictability was 72%. However, in the 26 patients with abnormal PSA( >10ng/ml) with normal findings at DRE and TRUS, only 2 patients have prostate cancer. Of the 17 patients showing abnormal findings at DRE and TRUS irrespective of PSA level, 15 patients(positive predictability of 90%) have prostate cancer. Of the 12 patients having abnormal DRE and TRUS with elevated PSA level(more than 10.0 ng/ml), all patients had cancer. Conclusively, cancer predictability of single application of these screening test was low. Positive predictability of the elevated PSA level above 10 ng/ml was low if there were no abnormalities at DRE and TRUS. However, if there were abnormalities at DRE and TRUS, predictability of cancer became high. It is suggested that, if there were no abnormalities found at DRE and TRUS, prostate needle biopsy seem to be necessary despite the normal level of PSA( < 4 ng/ml). For the gray zone of the PSA level( 4-10 ng/ml) with no suspicious findings at DRE and TRUS, careful observation with follow up PSA measurement could be suggested.
Aged, 80 and over ; Biopsy, Needle ; Digital Rectal Examination ; Humans ; Hyperplasia ; Hyperthermia, Induced ; Inflammation ; Mass Screening ; Microwaves ; Outpatients ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms* ; Prostatism ; Tuberculosis

Nerve injury leads to chronic neuropathic pain syndromes. Activation of microglia has been studied to investigate the role in pain development. Minocycline is known as a potent inhibitor of microglial activation in many types of the brain injury models. But it is not known whether minocycline interferes with pain and microglial activation after the peripheral nerve injury. In this study, we investigated the time course of pain and microglial activation after sciatic nerve injury and also tested the effect of minocycline using sciatic nerve ligation model. All experiments were performed using 150~180 g male Sprague-Dawley rats. The chronic constriction injury (CCI) of the sciatic nerve with four 4.0 chromic gut suture was used to induce neuropathic pain in the left sciatic nerve. The behavioral response of rats to the stimuli (heat, cold & pressure) was assessed by measuring the lifting of the foot and the avoidance of touching the floor at pre-surgical day 1, post-surgical day 1, 4, 7, and 10. The L4 ~6 spine was fixed and used to detect microglia. Oral minocycline (50 mg/kg) was administered daily to the last day of the experiment. Minocycline was administered to one group of rats from pre-surgical day 1 and minocycline treatment was initiated from post-surgical day 1, 3, and 5 in other groups. Neuropathic pain was evident from day 4 and the peak response was observed at 10 days after CCI. Minocycline significantly attenuated neuropathic pain even when treatment was delayed by 3 days. But, it had no effet when treatment initiated 5 days after injury. Minocycline also attenuated microglial activation. In summary, a correlation was evident between the neuropathic pain and microglial activation in our model and minocycline reduced both development of pain and microglial activation. Thus, minocycline can be a good candidate for the treatment of neuropathic pain. However, the administration should be initiated prior to microglial activation.
Animals ; Brain Injuries ; Constriction ; Foot ; Humans ; Lifting ; Ligation ; Male ; Microglia ; Minocycline* ; Models, Animal* ; Neuralgia ; Peripheral Nerve Injuries ; Rats* ; Rats, Sprague-Dawley ; Sciatic Nerve ; Sciatic Neuropathy* ; Spine ; Sutures

PURPOSE: To evaluate the clinical course of patients who had completed 14 ranibizumab or aflibercept monocular treatments. METHODS: Retrospective medical record analysis was performed to 24 patients who were diagnosed with monocular neovascular age-related macular degeneration and had completed 14 ranibizumab or aflibercept monocular injections, allowed by the Korean National Health Care system. Time to completion was measured along with the percentage and timing of medication switch. Best-corrected visual acuity (BCVA) was measured at the time of diagnosis, after 3-loading injections, and the time of completion. Additionally, we searched for any other factors that had influenced the time to completion. RESULTS: The average time to completion of 14 injections was 32.3 ± 6.2 months (21–48 months). The switching was performed in 17 eyes (70.8%), and it was done after 9.4 ± 2.1 injections (4–14 injections) with prior medication. After 14 injections, the BCVA improved in 6 eyes (25.0%), unchanged in 8 eyes (33.3%), and worsened in 10 eyes (41.7%). Complete resolution of intraretinal fluid and subretinal fluid after 3 loading injections were observed in 20 eyes, and it was significantly related to time to the first recurrence and time to the completion of 14 injections (p = 0.007, r = 0.583). CONCLUSIONS: The average time to completion of 14 injections was 32.3 months, and switching of medication was performed in 70.8%. Longer time to the first recurrence was related to longer completion time. This study will provide useful facts when informing the patients their future treatment plans under the Korean Health Care system.
Choroidal Neovascularization ; Delivery of Health Care ; Diagnosis ; Endothelial Growth Factors* ; Humans ; Macular Degeneration* ; Medical Records ; Ranibizumab ; Recurrence ; Retrospective Studies ; Subretinal Fluid ; Visual Acuity

PURPOSE: To evaluate the characteristics of patients aged ≥ 90 years who were diagnosed with neovascular age-related macular degeneration (AMD). METHODS: A retrospective review of medical records was performed for 44 patients aged ≥ 90 years diagnosed with neovascular AMD. History of cerebrovascular or cardiovascular disorder and visual acuity at diagnosis were assessed. Fellow eye visual acuity data were also collected. When the fellow eye visual acuity was worse than 0.5, the primary reason for the visual deterioration was identified. RESULTS: The mean patient age was 91.5 ± 1.5 years (range: 90–95 years). Ten (22.7%) patients had histories of cerebrovascular or cardiovascular disorders. The mean logarithm of the minimal angle of resolution (logMAR) of visual acuity was 1.11 ± 0.51 and the visual acuity was worse than 0.1 in 20 eyes (45.5%). The fellow eye visual acuity was worse than 0.5 in 26 eyes (59.1%). The primary reason was neovascular or atrophic AMD in 23 eyes (88.5%). CONCLUSIONS: The incidence of cerebrovascular or cardiovascular disorders was relatively high in patients aged ≥ 90 years. Patients also had poor visual acuity at diagnosis and a high incidence of fellow eye visual deterioration. These systemic conditions should be considered when treating these patients. Additionally, a regular ophthalmic examination is recommended for the early detection of these disorders.
Choroidal Neovascularization ; Diagnosis ; Humans ; Incidence ; Macular Degeneration ; Medical Records ; Retrospective Studies ; Visual Acuity

Negative pressure pulmonary edema is an uncommon complication related to general anesthesia. Its main pathophysiology is excessive negative intrathoracic pressure that is caused by an acute upper airway obstruction. Pneumopericardium, the presence of air within the pericardial sac, is another rare condition. The common pathophysiology of pneumopericardium, except for that caused by blunt or penetrating trauma, is barotrauma-induced alveolar rupture caused by positive intrathoracic pressure. Here, we report the case of a 61-year old female patient with negative pulmonary edema and pneumopericardium after general anesthesia. She recovered after conservative management.
Airway Obstruction ; Anesthesia, General* ; Female ; Humans ; Pneumopericardium* ; Pulmonary Edema* ; Rupture

PURPOSE: Community-Acquired Pneumonia (CAP) is a common cause of mortality and serious morbidity. Regardless of the condition of the patients, almost all are hospitalized. And it seems to be a standard procedure to obtain blood cultures before the administration of antibiotics in suspected pneumonic patients. Recent studies show that the blood cultures don't affect the treatment of the patients with CAP. Accordingly, this study was designed to examine the usefulness of the blood cultures routinely performed and to evaluate the stratification of the patients with CAP by Pneumonia Severity Index (PSI) in the Emergency Department (ED). METHODS: Research subjects were patients over 16 years old who had been diagnosed with CAP in a general hospital between January and December 2008 and were admitted by way of the ED. We evaluated their records retrospectively. RESULTS: A total of 261 patients were diagnosed with CAP. According to the PSI, 155 (59%) of the 261 were classified as being in the low risk group and 106 (41%) in the high risk group. Blood cultures were positive in 13 of 261 (5%). Three of 13 patients belonged to the low risk group, and 10 to the high risk group. Antibiotics were changed in 43 of 261 patients. Nineteen of those belonged to the low risk group and 24 to the high risk group. Of the 13 bacteremic patients, blood cultures results altered therapy for 4 patients. CONCLUSION: Most often, blood cultures performed in the ED do not alter the therapy of patients with CAP. But we do recommend blood cultures for the high risk group.
Anti-Bacterial Agents ; Community-Acquired Infections ; Emergencies ; Hospitals, General ; Humans ; Pneumonia ; Research Subjects ; Retrospective Studies ; Severity of Illness Index