We compared the diagnostic accuracy of the simple x-ray with that of the computed tomography, and analyzed the surgical results according to the timing of operation in 52 patients with suspected orbital blowout fractures who complained diplopia after midfacial trauma. Of all the cases, 40 orbital fractures were confirmed with CT and forced duction test and the remaining 12 patients were thought to have transient functional impairment because the clinical signs were resolved with time. CT detected all the 40 actual fractures, so the dignostic accuracy(100%) was higher than that of the simple x-ray(75%) which detected 30 fractures of the 40 actual fractures(p=0.001). We operated 19 patients who have persistent diplopia, enophthalmos of more than 2 mm, and large fracture defect, and there was significant improvement of symptoms and signs in patients on whom operations were performed within 2 weeks after trauma rather than after 2 weeks.
Diagnosis* ; Diplopia ; Enophthalmos ; Humans ; Orbit* ; Orbital Fractures

The purpose of this study was to investigate disinfection state and effective factors of foodservice facilities and utilities of elementary schools in Busan area. Foodservice facilities and utilities investigated in this study were ceiling, wall, floor, trench, greasetrap, hood, pest and dumb waiter. The questionnaire which was administered to 196 dietitians was used as a survey method. The results were as follows. The washing method of foodservice facilities and utilities was mainly used by detergent washing-natural dry. The disinfection method of foodservice facilities and utilities was mainly sanitized by sodium hypochlorite. Dumb waiter and hood were sanitized by 70% ethyl alcohol and iodine. In washing and disinfection frequencies of foodservice facilities and utilities ceiling was twice/year, wall, hood and pest control facilities were once/week, floor, trench, greasetrap and dumb waiter were everyday, respectively. Floor, trench, greasetrap and dumb waiter were disinfected properly, whereas ceiling, wall, hood and pest were not disinfected properly. The washing method was related to dietitian's marital status and education. The disinfection state was related to dietitian's age and career, having of sanitation check list. The disinfection method was also affected dietitian's marital status, number of employee, duration of foodservice, number of total serving and having of sanitation check list. Therefore based on the results of this study, it should be given to the microbiological study on disinfection of facilities and utilities such as ceiling, wall, floor, trench, greasetrap, hood, pest and dumb waiter and the dietitian and employee's sanitation training also should be conducted continuously.
Busan* ; Surveys and Questionnaires ; Detergents ; Disinfection* ; Education ; Ethanol ; Humans ; Iodine ; Marital Status ; Nutritionists ; Pest Control ; Sanitation ; Sodium Hypochlorite

OBJECTIVE: Screening tests for dysphagia have been introduced to prevent complications arising from dysphagia in stroke patients. Among them, Gugging swallowing screen (GUSS) was proven as an effective screening tests for dysphagia of stroke patients in 24 hours after onset. We compared several screening tests and clinical scales including GUSS. METHOD: Subjects were 37 stroke patients 3 months after onset. GUSS, 3 oz water test, Burke dysphagia screening test (BDST) and Standardized swallowing assessment (SSA) were carried out at bedside. VFS was performed in 24 hours after other studies were done. Functional dysphagia scale (FDS) and Penetration-aspiration scale (P/A scale) were derived from VFS. Clinical scales such as American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS) swallowing scale and Clinical dysphagia scale (CDS) were measured to see the correlation between GUSS and another dysphagia scales. RESULTS: GUSS had a sensitivity of 90.9% and a specificity of 69.2%. 3 oz water test had a sensitivity of 81.8% and a specificity of 76.9%. Sensitivity and specificity of BDST were respectively 90.9%, 61.5%. Sensitivity of SSA was 90.9%, specificity 61.5%. Correlation between GUSS and FDS was significant (r =-0.527, p<0.01). Correlation between GUSS and P/A scale also showed significance (r=-0.747, p<0.01). ASHA NOMS swallowing scale and GUSS showed significant correlation (r=0.432, p<0.01). CDS and GUSS showed significant correlation as well (r=-0.815, p<0.01). CONCLUSION: The screening ability of GUSS was equal to other screening tests for dysphagia of stroke patients. Correlations among GUSS and other VFS and clinical scales showed availability of GUSS as a clinical scale for dysphagia.

The purpose of this study is to observe and compare the dynamic change of artificially demineralized enamel by remineralization solutions of different degrees of saturation at pH 4.3. In this study, 30 enamel specimens were demineralized artificially by lactic acid buffered solution. Each of 10 specimens was immersed in pH 4.3 remineralization solution of three different degrees of saturation (0.22, 0.30, 0.35) for 10 days. After demineralization and remineralization, images were taken by a polarizing microscope (x 100). The density of lesion were determined from images taken after demineralization and remineralization. During remineralization process, mineral deposition and mineral loss occurred at the same time. After remineralization, total mineral amount and width of surface lesion increased in all groups. The higher degree of saturation was, the more mineral deposition occurred in surface lesion and the amount of mineral deposition was not much in subsurface lesion. Total demineralized depth increased in all groups.
Dental Enamel ; Hydrogen-Ion Concentration ; Lactic Acid

OBJECTIVE: To assess inter-modality variability when evaluating cervical intervertebral disc herniation using 64-slice multidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI). MATERIALS AND METHODS: Three musculoskeletal radiologists independently reviewed cervical spine 1.5-T MRI and 64-slice MDCT data on C2-3 though C6-7 of 51 patients in the context of intervertebral disc herniation. Interobserver and inter-modality agreements were expressed as unweighted kappa values. Weighted kappa statistics were used to assess the extents of agreement in terms of the number of involved segments (NIS) in disc herniation and epicenter measurements collected using MDCT and MRI. RESULTS: The interobserver agreement rates upon evaluation of disc morphology by the three radiologists were in fair to moderate agreement (k = 0.39-0.53 for MDCT images; k = 0.45-0.56 for MRIs). When the disc morphology was categorized into two and four grades, the inter-modality agreement rates were moderate (k-value, 0.59) and substantial (k-value, 0.66), respectively. The inter-modality agreements for evaluations of the NIS (k-value, 0.78) and the epicenter (k-value, 0.79) were substantial. Also, the interobserver agreements for the NIS (CT; k-value, 0.85 and MRI; k-value, 0.88) and epicenter (CT; k-value, 0.74 and MRI; k-value, 0.70) evaluations by two readers were substantial. MDCT tended to underestimate the extent of herniated disc lesions compared with MRI. CONCLUSION: Multidetector-row computed tomography and MRI showed a moderate-to-substantial degree of inter-modality agreement for the assessment of herniated cervical discs. MDCT images have a tendency to underestimate the anterior/posterior extent of the herniated disc compared with MRI.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cervical Vertebrae/pathology/*radiography ; Female ; Humans ; Intervertebral Disc Displacement/*radiography/therapy ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Multidetector Computed Tomography/*methods ; Observer Variation ; Young Adult

In Asian rhinoplasty, allograft materials are often required due to insufficient amount of autologous sources for dorsal augmentation. Nowadays, Silicon and polytetrafluoroethylene are commonly used allograft materials although these can often lead to postoperative complications such as protrusion, migration or infection of implanted graft. Permacol® is a collagen sheet which is indicated for soft tissue reinforcement or repair of the head and face area in plastic and reconstructive surgery. Its clinical safety and stability is well established with low complication rates. However, its histopathology has rarely investigated, especially in human. Thus, we reviewed histopathology of two graft-removal cases of patients who had undergone rhinoplasty using Permacol®. In conclusion, Permacol® can lead to fibrosis of imbedded tissues with or without absorption in long-term follow-up. Although Permacol® is gradually absorbed as time passes, the implanted graft can maintain its volume by replaced fibrotic connective tissues.
Absorption ; Allografts ; Asian Continental Ancestry Group ; Collagen* ; Connective Tissue ; Fibrosis ; Follow-Up Studies ; Head ; Humans ; Plastics ; Polytetrafluoroethylene ; Postoperative Complications ; Rhinoplasty* ; Silicon ; Transplants

Rhinocerebral mucormycosis is a type of opportunistic infections, which can often be lethal in immunocompromised patients. The infection usually occurs in the nose and can spread to adjacent structures. The most typical symptom is facial pain, followed by headache, fever and bloody tinged rhinorrhea. We experienced three cases of rhino-orbito-cerebral mucormycosis, which showed atypical initial presentations. In our cases, patients visited hospital for unilateral ophthlamoplegia and facial palsy without having any nasal symptoms. After evaluating neurologic and ophthalmic problems, they were referred to the Otolaryngology Head and Neck Surgery Department for confirming nasal invasions. Despite using early a parenteral antifungal agent with immediate surgical debridement, patients died due to a residual cerebral lesions and multiple organ failure. In this article, we present the prognosis and management of rhinocerebral mucormycosis patients with atypical symptoms, as well as a review of the published literatures.
Debridement ; Facial Pain ; Facial Paralysis* ; Fever ; Head ; Headache ; Humans ; Immunocompromised Host ; Mucormycosis* ; Multiple Organ Failure ; Neck ; Nose ; Ophthalmoplegia* ; Opportunistic Infections ; Otolaryngology ; Prognosis ; Tolnaftate

Synovial fluid (SF) aspiration cytology is a useful diagnostic tool. For patients with gouty arthritis, the diagnosis is confirmed by the presence of monosodium uric acid (MSU) crystals in the SF, and these crystals are long, pointed ended and needle-shaped and they show strongly negative birefringence. Sometimes, it is difficult to diagnosis between gouty arthritis and other type of inflammatory arthritis. We experienced two unusual cases of gouty arthritis that we performed SF analysis for. The first patient was a 35 year old male who presented with relatively typical clinical symptoms with hyperuricemia, but the SF showed acute inflammatory cells without crystals on light microscopy. Only a few suspected crystals of MSU were identified on polarizing microscopy. The second patient was a 45 year old male who presented with atypical symptoms and pain and swelling of the left ankle and knee joint for 3 weeks. The uric acid level in the serum and urine was increased, but not over the normal limit. However, on light and polarizing microscopy, there were numerous MSU crystals in the SF. Conclusively, in some cases of gouty arthritis, the crystals are not identified on light microscopy or the uric acid level is not dramatically increased. So, the polarizing microscopy, the clinical information and the laboratory findings are all included in the work-up when evaluating the SF cytology of arthritis patients.
Animals ; Ankle ; Arthritis ; Arthritis, Gouty ; Birefringence ; Gout ; Humans ; Hyperuricemia ; Knee Joint ; Light ; Male ; Microscopy ; Synovial Fluid ; Uric Acid

Postmenopausal squamous atypia (PSA) is a phenomenon characterized by cellular alterations mimicking condyloma in the uterine cervix of postmenopausal women. It is not associated with human papillomavirus (HPV) infection. The aim of this study is to correlate findings with HPV infection and the cytohistologic findings of PSA. Eighty-three smears from postmenopausal women, initially interpreted as ASCUS and low-grade squamous intraepithelial lesions(LSIL), were reviewed according to the criteria of PSA. Fifty-eight cases were subsequently reclassified as PSA. Forty cases categorized as PSA were available for HPV-DNA detection by a nested polymerase chain reaction. Eight of these 40 cases(20%) showed biopsy-proven LSIL lesions. The HPV-DNA was detected in 42.5%(17/40), compared to 25%(5/20) of control cases. The HPV-DNA detection rate of biopsy-proven LSIL was 62.5%(5/8). It has been concluded that cytologic differential diagnosis of PSA from LSIL is difficult due to because of poor histologic and viral correlation.
Cervix Uteri ; Diagnosis, Differential ; Female ; Humans* ; Papillomavirus Infections* ; Polymerase Chain Reaction

OBJECTIVE: The sensitivity of the AutoPap Primary Screening System with Location-Guided Screening (AutoPap LGS) for identifying atypical cells in cervicovaginal smears was evaluated. METHODS: Two hundred forty one slides with atypical cervical cytology randomly sampled were rescreened both manually and by the AutoPap LGS. The AutoPap LGS localized the atypical cells as 15 fields of view(FOVs), which were reexamined by manual review. The sensitivity was also evaluated in accordance with the cellularity of the smears. RESULTS: The AutoPap LGS successfully processed 232 out of 241 slides. The sensitivity of the AutoPap LGS identifying the atypical cells in successfully processed slides was 97.4%(226/232). The false negative rate was 2.6%(6/232). There was no false negative case in high grade squamous intraepithelial lesion (HSIL) or squamous cell carcinoma(SCC) smears in the AutoPap LGS. The FOVs localized the diagnostic-atypical cells in 97.8%(221/226). The number of diagnostic-atypical FOVs was increased in higher-degree of atypical cytology. The AutoPap LGS localized the atypical cells in 100% of adequately cellular smears and in 92.5% even in low cellular smears. CONCLUSION: The AutoPap LGS showed relatively good sensitivity to detect atypical cells. It can be a valuable system to localize atypical cells, especially in HSIL or cancer slides, even in smears with low cellularity.
Mass Screening* ; Vaginal Smears