Hyper-activated depressor septi nasi is an important factor caused a nasal tip drooping and many studies have been carried out, however it still remains controversial. This study presents a surgical modality for its intervention, based on the anatomical study. Eleven fixed and six fresh cadavers were used for the study. We found that the depressor septi nasi was consisted of three fascicles. Medial fascicles were inserted into the dermocartilaginous ligament, and deep fibers of the medial fascicles were attached to the anterior nasal spine. After superficial fibers were interdigitated with the orbicularis oris, they were attached to the alveolar bone. Intermedial fascicles were inserted to the footplates of the medial cruses and the caudal septum. After they were interdigitated with the medial fascicle and the orbicularis oris, they were attached to the alveolar bone. From April to August 2008, five patients had surgical intervention for hyper-activated depressor septi nasi. Medial and intermedial fascicles were detached completely from the anterior nasal spine and the septum through intranasal approach. Tip droopings were improved in all cases. Specific complications were not found. We believe that surgical intervention through intranasal approach is a useful method for correction of tip drooping.

PURPOSE: The aim of our study was to examine the discrepancies between the Pneumonia Severity Index (PSI) score, the CURB-65 [confusion, blood urea nitrogen, respiratory rate and blood pressure with age (65 years)] and the clinical judgment for making admission decisions, and we also wanted to evaluate the value of the PSI and CURB-65 as the indicators for detecting inappropriate hospitalization among the patients with low risk CAP. METHODS: The medical records of 286 patients who visited the emergency department with CAP were identified by their PSI and their CURB-65, and we reviewed whether there existed a clinical basis to justify their hospitalization. RESULTS: Of a total 286 patients, 225 patients were admitted to the hospital. Sixty five patients with a PSI of I or II, and 117 patients with a CURB-65 of 0 or 1 were admitted by clinical judgment. The factors that justified admission of a lower risk CAP group were medical conditions other than CAP (56.9% vs 70.1%; PSI vs CURB-65), failure of outpatient therapy (24.6% vs 19.6%), social needs (6.2% vs 2.6%) and hypoxemia in 1 patient (1.5% vs 0.9%, respectively). Of the patients in the low risk group according to the CURB-65, one five patient was hospitalized for suspicion of sepsis. The positive predicted values of the PSI and CURB- 65 for inappropriate hospitalization of low risk CAP patients were 10.8% and 5.9%, respectively. CONCLUSION: The PSI and CURB-65 had unacceptably low positive predictive values and this was due to the comorbid conditions that required in-hospital care for the patients with low risk CAP. These indices did not supersede clinical judgment for making the decision to hospitalize low risk patients with CAP.
Anoxia ; Blood Pressure ; Blood Urea Nitrogen ; Community-Acquired Infections ; Emergencies ; Hospitalization ; Humans ; Judgment ; Medical Records ; Outpatients ; Pneumonia ; Respiratory Rate ; Sepsis ; Severity of Illness Index

BACKGROUND: We evaluated the analytical performances of Diasys reagents manufactured by Diasys Diagnostic Systems (Holzheim, Germany) with Hitachi 747. METHODS: We evaluated AST, ALT, ALP, gamma-GT, calcium, and glucose. Only two tests were adapt-ed to different methods from the current ones: the photometric test using the arsenazo III for calci-um, the kinetic colorimetric test according to Szasz/Persijin using l-gamma-glutamyl-3-carboxy-4-nitranilide as a substrate for gamma-GT. Precision, interference, linearity, and method comparisons were evaluated by NCCLS guidelines. RESULTS: The coefficient of variation (CV) of total precision was less than 6.8% in all items. Preci-sions and linearities of all items were acceptable. Correlation coefficients were more than 0.9884 and all items showed excellent agreement compared to the current reagents in the reportable range. We could not find any significant interference for six test items up to 750 mg/dL triglyceride, 50 mg/dL hemoglobin, and 20 mg/dL bilirubin, except that the latter ALT showed a negative bias by more than 5 mg/dL of bilirubin. CONCLUSIONS: Diasys reagents showed high precision, linearity and correlation in comparison to the current reagents. So we conclude that these reagents are good for routine clinical use with Hitachi 747.
Arsenazo III ; Bias (Epidemiology) ; Bilirubin ; Calcium ; Glucose ; Indicators and Reagents* ; Triglycerides

BACKGROUND: To evaluate the risk factor and long-term result of arterial switch operation , a retrospective study was done. MATERIAL AND METHOD: A retrospective analysis was done to evaluate the early and long-term results on 58 patients who underwent an arterial switch operation(ASO) for transposition of the great arteries(TGA) with intact ventricular septum, between January 1988 and December 1996. Beforesurgery, 36 patients(62.1%) underwent balloon atrial septostomy, 32 patients(51.7%) received PGE1 infusion, and preparatory banding of pulmonary artery was performed on 6 patients(mean LV/RV pressure ratio 0.53+/-0.11). RESULT: The age at operation ranged from 1 to 137 days(mean 24+/-26 days) and the weights ranged from 1.8 to 6.8 kg (mean 3.5+/-0.8 kg). There were 14 early deaths(24.1%), but of the last 24 patients operated on since 1994, there were only 2 early deaths(8.3%). In the risk factor analysis, the date of operation was the only risk factor for early death(p-value <0.01). Eight of the 14 early deaths were due to acute myocardial failure(mainly inadequate coronary blood flow). The length of follow-up ranged from 2 months to 8 years, average of 36+/-27 months. The follow-up included sequential noninvasive evaluations and 21 catheterizations and angiographic studies performed 5 to 32 months postoperatively with particular attention to the great vessel and coronary anastomosis, ventricular function, valvular competence, and cardiac rhythm. There were 5 late deaths(11.4%), one of thesedeaths was related to the late coronary problems, two to aspiration, one to uncontrolled chronic mediastinitis, and one to progressive aortic insufficiency and heart failure. The most frequent postoperative hemodynamic abnormality was supravalvular stenosis and the degree of pulmonary or aortic obstruction had slowly progressed in some cases, however there were no children who had to undergo a reoperation for supravalvular pulmonary or aortic stenosis. Aortic regurgitation was identified in 9 patients, which was mild in 7 and moderate in 2 and had progressed in some cases. Two patients who had an unremarkable perioperative course were identified as having coronary artery obstructions. The other late survivors were in good condition, were in sinus rhythm, and had normal LV functions. Actuarial survival rate at 8 years was 68.8%. CONCLUSION: We concluded that anatomic correction will be established as the optimal approach to the TGA with intact ventricular septum, though further long-term evaluations are needed.
Alprostadil ; Aortic Valve Insufficiency ; Aortic Valve Stenosis ; Arteries* ; Catheterization ; Catheters ; Child ; Constriction, Pathologic ; Coronary Vessels ; Follow-Up Studies ; Heart Failure ; Hemodynamics ; Humans ; Mediastinitis ; Mental Competency ; Pulmonary Artery ; Reoperation ; Retrospective Studies ; Risk Factors* ; Survival Rate ; Survivors ; Transposition of Great Vessels ; Ventricular Function ; Ventricular Septum* ; Weights and Measures

A symmetric approach, using external rhinoplasty, is presented to aid the plastic surgeon in obtaining improved aesthetic and functional results in patients with postoperative nasal deformities. The external approach yields a full visualization of the underlying nasal framework and intraoperative evaluation of the deformities to be corrected subsequently. The nasal septal cartilage is unequivocally one of the best graft sources for reconstruction of the dorsum, columella or tip. It has fairly even surface and pliability in carving and shaping the graft. The graft can be obtained during the surgery with less morbidity and prepared easily for need of the shape. The only real disadvantage is the limited amount of cartilage that can be obtained from the septum. The dorsal and caudal rims, one or more cm in width, of the nasal septum should not be disturbed to maintain the nasal frame during harvesting the septal graft. Authors invented novel instruments, J & D knife and Flat (Spatula) suction tip, and have employed the devices for harvesting the septal cartilage. We were unable to gain enough amount of the cartilage by using a swivel knife or cartilage scissors. The septal cartilage can be resected as much as needed with newly invented instruments which facilitate a separation(method) technique.
Cartilage* ; Congenital Abnormalities ; Humans ; Nasal Septum ; Pliability ; Rhinoplasty* ; Suction ; Transplants

BACKGROUND: Supravalvular aortic stenosis is a rare form of congenital cardiac anomaly involving ascending aorta distal to coronary orifice. MATERIALS AND METHODS: We operated 12 cases of supravalvular aortic stenosis between July 1986 and March 1997. Age ranged from 4 to 17 (mean 10.2) years and 11 of them were male. Nine patients had clinical features of Williams syndrome. We experienced two types of supravalvular aortic stenosis, including 10 hour glass type and 2 diffuse type. RESULTS: Preoperative transaortic pressure gradient ranged from 40 to 180 (mean 92) mmHg by cardiac catheterization. Pulmonary stenosis was associated in 5 and 2 of them required angioplasty. Operative techniques included 6 standard aortoplasty with elliptical patch, 4 extended aortoplasty with inverted Y shaped patch, and 2 modified Brom's repair. There were no operative deaths. Postoperative echocardiographic evaluation was done at a mean interval of 12 months. Grade I or II aortic regurgitation was found in 3 cases. Postoperative cardiac catheterization revealed a mean transaortic pressure gradient of 26 (range 0 to 75) mmHg. A mean pressure drop was 78 (range 30 to 114) mmHg. All patients were followed up for a mean of 40 (range 1 to 67) months with uneventful clinical course. CONCLUSIONS: Our data proved the low mortality and excellent hemodynamic improvement after surgical relief of supravalvular aortic stenosis in children.
Angioplasty ; Aorta ; Aortic Stenosis, Supravalvular* ; Aortic Valve Insufficiency ; Aortic Valve Stenosis ; Cardiac Catheterization ; Cardiac Catheters ; Child ; Echocardiography ; Glass ; Hemodynamics ; Humans ; Male ; Mortality ; Pulmonary Valve Stenosis ; Williams Syndrome

BACKGROUND AND OBJECTIVES: Hyperacute rejection (HAR) is a major obstacle to successful xenotransplantation of vascularized organs. This study was conducted to observe the effect of hemolysis of perfused human whole blood on pig heart function, and determine the major risk factors for preservation of xenoperfused cardiac function using ex-vivo pig to human xenogeneic cardiac perfusion model. MATERIALS AND METHODS: Harvested pig hearts were perfused with normal human whole blood (group 1), two different types of pre-treated human whole blood (group 2: immunoglobulins were depleted by plasmapheresis, group 3: pre-treated with plasmapheresis, GAS914, cobra venom factor (CVF) and steroid), and normal porcine whole blood as control (group 4) for 3 hours. RESULTS: Duration of heart beat was significantly prolonged in group 2 and group 3. Histological examination showed widespread HAR features but was gradually delayed in groups 2 and 3 compared to group 1. The absolute levels of serum creatine kinase-MB and Troponin I increased gradually, and was lower in group 3. Serum hemoglobin levels were rapidly increased in groups 3 and 4, compared to group 1. Extracellular potassium level increased sharply from the beginning of blood perfusion in groups 1, 2 and 3, compared to group 4. CONCLUSION: Pretreatment of human whole blood, including immunoglobulin depletion, CVF and steroid reduced and delayed the destruction of pig myocardium by HAR. However, the increased extracellular potassium levels in groups 1, 2 and 3 reflected that these treatments could not prohibit myocardial injury by HAR.
Cobra Venoms ; Creatine ; Diphtheria Toxoid ; Extracorporeal Circulation ; Haemophilus Vaccines ; Heart ; Hemoglobins ; Hemolysis ; Humans ; Hyperkalemia ; Immunoglobulins ; Myocardium ; Perfusion ; Plasmapheresis ; Potassium ; Rejection (Psychology) ; Risk Factors ; Transplantation, Heterologous ; Trisaccharides ; Troponin I

No Abstract Available.
Female ; Hormone Replacement Therapy* ; Humans ; Life Style* ; Osteoporosis*

BACKGROUND: Early diagnosis and treatment of acute coronary syndrome(ACS) encompassing acute myocardial infarction(AMI) and unstable angina(UA) is very important. Cardiac troponin T(cTnT) is known to be more specific to myocardium, and the level increases early and persistently during the period of 7 to 14 days after the onset of symptoms. The aim of this study was to evaluate the usefulness of cTnT for the diagnosis of ACS comparing with other biochemical markers. METHODS: The precision, linearity, lower limit of detection and interferences for cTnT by electrochemiluminescence were evaluated. cTnT and other conventional cardiac markers were determined for 128 AMI, 96 UA and 72 stable angina(SA) patients. The medical records of these patients were reviewed. RESULTS: cTnT-positive rates in AMI patients were 87.5-100% in all periods. cTnT positive rate was maintained as 100% from 3 hours to 96 hours after heart attack. Although CK-MB positive rate was as high as 85.7% at 6 hours, it decreased after 61 hours. The positive rate of LD and LD isoenzyme were very low(33.8-75%). In UA patients, mean positive rates of cTnT and CK-MB were 22.6% and 22.9% respectively. For the diagnosis of ACS comparing with SA, the sensitivity and specificity of cTnT were 63% and 94%(cut-off, 0.1 microgram/ml), meanwhile these of CK-MB were 53% and 90%, respectively(cut-off, 5 microgram/ml). CONCLUSIONS: cTnT was more useful and sensitive than CK-MB, LD, or LD isoenzyme. ACS also could be diagnosed with cTnT and CK-MB with sufficiently high specificity. cTnT seemed to be slightly more specific than CK-MB for the diagnosis of ACS.
Acute Coronary Syndrome* ; Angina, Unstable ; Biomarkers ; Diagnosis ; Early Diagnosis ; Heart ; Humans ; Limit of Detection ; Medical Records ; Myocardial Infarction ; Myocardium ; Sensitivity and Specificity ; Troponin T* ; Troponin*

BACKGROUND: Serious organ shortage necessitates ABO incompatible (ABOi) kidney transplantation (KT). Recent reports utilizing rituximab instead of splenectomy and tacrolimus (FK)-based triple immunosuppressants showed excellent graft outcome. METHODS AND RESULTS: Thirteen cases of ABOi living donor KT have been performed since Feb. 2007 in our center. Donor and recipient blood group was B to O (n=5), A1 to O (2), AB to B (2), AB to A1 (1), A1 to B (2) and B to A1 (1). Rituximab was given at 4 weeks before transplantation. Plasmapheresis (PP) was initiated at 7~14 days before transplantation with concurrent immunosuppressants. The number of pretransplant PP was 5.7+/-1.4. Posttransplant PP was also performed in 6 patients with higher initial titer of ABO antibody (IgG > or =256; n=2), rapidly rising antibody titer during the critical period of 2 weeks posttransplantation (n=2), or increase in serum creatinine during the critical period while awaiting pathology report of graft biopsy (n=2). Mean number of posttransplant PP in these 6 patients was 2.2+/-1.3. Median IgG anti-ABO antibody titer before precondition, at transplantation, at 2 weeks and at 6 months was 64 (8~512), 2 (1~8), 2 (1~16) and 6 (1~16), respectively. IgM titer at corresponding time point was 16 (2~128). 1 (1~1), 1 (1~2) and 1.5 (1~4), respectively. Median follow up was 8 (5~27) months. No patient or graft was lost. No patient developed acute humoral rejection. Graft function remained stable with latest serum creatinine 1.2+/-0.3 mg/dl. CONCLUSIONS: ABOi living donor KT without splenectomy can be safely performed with the use of current preconditioning and immunosuppressive regimen, and is therefore a valuable option for expanding donor pool and should be actively performed in Korea.
Antibodies, Monoclonal, Murine-Derived ; Biopsy ; Creatinine ; Critical Period (Psychology) ; Follow-Up Studies ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Immunosuppressive Agents ; Kidney ; Kidney Transplantation ; Living Donors ; Plasmapheresis ; Rituximab ; Rejection (Psychology) ; Splenectomy ; Tacrolimus ; Tissue Donors ; Transplants