The basic technique for total reconstruction of the microtia was established by Tanzer, who utilized autologous rib cartilages for constructing the auricular framework. In order to decrease the number of surgical stages and to achieve maximal convolution, we employed a surgical procedure with simultaneous three layered costal cartilage grafting for the high profiled auricle, concha formation and lobule rotation. However, we performed ear elevation as an additional procedure for some patients who had decreased helical height due to absorption of cartilage framework or postoperative trauma and who had wanted to wear the spectacles or to have more natural appearance of auriculocephalic sulcus. From August 1988 to October 1997 we had performed surgeries for the ear elevation of 58 patients in 177 patients with total ear reconstruction, using various elevation methods; skin graft, local flap, and local with costal cartilage block. When the ear elevation was performed with skin graft, postoperative contraction of the grafted skin was inevitable. In cases with two skin flaps, it was difficult to stabilize and maintain the correct projection of the constructed ear. So we elevated the reconstructed ear by utilizing a costal cartilage block, two skin flaps to cover the posterior region and skin graft. We conclude that the local flap with costal cartilage block is one of the most favorable methods in ear elevation which can maintain the adequate projection and make natural looking auriculocephalic sulcus.
Absorption ; Cartilage ; Ear* ; Eyeglasses ; Humans ; Ribs ; Skin ; Transplants

Tanzer reported microtia reconstruction using autogenous costal cartilage, thereafter so many plastic surgeons have tried various modification to get further refinement of reconstructed auricle. But the multiple stages of ear reconstruction required prolonged hospitalization and cost. In order to decrease the number of surgical stages and for the maximal convolution, we have employed a surgical procedure with three layered costal cartilage graft for the high profile auricle, concha formation and lobule transposition at the same time. However, it has still been difficult to reconstruct the tragus in cases of microtia that lack such component. We reconstructed the tragus using part of the microtic ear in addition to our above procedure simultaneously. This procedure is started with transposition of the lower two-thirds of the microtic ear to make lobule and then the upper third of the microtic ear is elevated as a chondrocutanenous flap which is then transposed 120-180degree C downwards to reposition at the area anterior to the conchal cavity. Using this technique, we have reconstructed 28 microtic ears. Adequate positioning of the auricle and tragus have been achieved and a more natural auricle obtained.
Cartilage ; Ear ; Hospitalization ; Transplants

The prominent mandibular angle is one of the disfiguring features in the Oriental, commonly seen and considered to be unattractive. Because it gives a square and muscular facial appearance, its surgical correction is dine frequently as a modality of facial contouring surgery in the Oriental. The reduction mandibular angleplasty is not a simple surgical technique for the unexperienced surgeon. We adopted C-arm fluoroscopy as a method of identifying the osteotomy line for the beginners. The reduction mandibular angleplasties assisted by C-arm fluoroscopy were performed in 9 patients, providing symmetric and satisfactory results. Now we are sure that the reduction mandibular angleplasty assisted by C-arm fluoroscopy can be an accurate and safe method for the unexperienced surgeon, especially the patient with deep-seated prominent mandibular angle.
Fluoroscopy* ; Humans ; Osteotomy

No abstract available.
Epidermis* ; Urocanic Acid*

PURPOSE: The aim of this study is to evaluate the value of preoperative MRCP prior to laparoscopic cholecystectomy by analysis of postoperative outcomes. METHODS: Between 2009.12~2010.12, 283 patients underwent laparoscopic cholecystectomy for treatment of benign biliary disease. Among these patients, 125 underwent preoperative MRCP and were classified as the MRCP group. The remaining 158 patients who did not undergo MRCP were classified as the non MRCP group. We compared perioperative data, including the rate of bile duct injury, operative complication, conversion rate, hospital stay, and hospital cost between the two groups. In addition, we analyzed preoperative MRCP findings, including common bile duct (CBD) stones and bile duct anomaly. RESULTS: Findings on pre-operative MRCP scan revealed silent CBD stones in five patients (4.0%) and bile duct anomalies were identified in 17 patients (13.6%). Three cases of bile duct injury occurred in the non MRCP group, whereas, no bile duct injury occurred in the MRCP group. No significant statistical difference in postoperative complication was observed in either group. Mean duration of operation was 50.5 (+/-30.4) minutes in the MRCP group, and 52.2 (+/-29.9) minutes in the non MRCP group (p=0.630). Post operative hospital stay was 2.1 (+/-1.4) days (mean) in the MRCP group, and 2.5 (+/-2.5) days in the non MRCP group. No statistical difference was observed between the two groups (p=0.110). CONCLUSION: MRCP may be useful for evaluation of bile duct anomaly and identification of hidden bile duct stones. However, this modality did not show statistical benefits for postoperative outcomes in patients who underwent laparoscopic cholecystectomy.
Bile Ducts ; Cholangiopancreatography, Magnetic Resonance ; Cholecystectomy, Laparoscopic ; Common Bile Duct ; Gallbladder ; Hospital Costs ; Humans ; Length of Stay ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Postoperative Complications

PURPOSE: The visual analogue scale (VAS) pain score is widely and frequently used to evaluate the severity of pain. However, statistically significant differences in the VAS scores may not always mean differences in pain severity. This study is to determine clinically meaningful reductions in pain severity as measured by the VAS and by a verbal categorical rating of pain. METHODS: Three hundred adult patients presenting to the emergency department (ED) with acute pain resulting from trauma or non-traumatic diseases were enrolled in this prospective, descriptive study. A 100-mm non-hatched, horizontal visual analogue scale was used to measure pain severity. The VAS measurements were obtained two times 1 minute apart at admission, 30 minutes after admission, and 1 hour after treatment. At each VAS measurements, patients also gave verbal ratings of their pain as "more pain,""the same pain," or "less pain." Data from the groups reporting "the same pain" or "less pain" were compared with their preceding descriptions and yielded a VAS difference. The mean VAS change was calculated, from which a grand means and 95% confidence intervals (95% CI) were determined. RESULTS: At 30 minutes after admission and 1 hour after treatment, 256 and 31 patients, respectively described their pain as "the same pain,"and 33 and 269 patients described it as "less pain." The mean reduction in VAS for the group reporting that pain was "the same pain" was 13 to 16 mm (95% CI, 8 to 20 mm) instead of 'zero.'For the group reporting that pain was "less pain," the mean reductions in VAS score were 24 mm (95% CI, 20 to 28 mm) at 30 minutes after admission and 44 mm (95% CI, 42 to 46 mm) at 1 hour after treatment. CONCLUSION: When evaluating management for acute pain in the ED, a difference in VAS score of less than 20 mm without regard to the presence or absence of treatment is unlikely to signify a clinically meaningful reduction in pain severity. This study provides guidance to those who design and interpret clinical studies of the acute pain experience in the ED.
Acute Pain ; Adult ; Emergency Service, Hospital ; Humans ; Pain Management ; Prospective Studies

PURPOSE: Various electrocardiogram (ECG) changes can occur in patients with acute organophosphate poisoning (OPP) and may be associated with the clinical severity of poisoning. The present study aimed to evaluate the extent and frequency of ECG changes and cardiac manifestations, and their association with acute OPP clinical severity. METHODS: Seventy-two adult patients admitted to our emergency department with a diagnosis of acute OPP were studied retrospectively. ECG changes and cardiac manifestations at admission were evaluated. ECG changes between respiratory failure (RF) group and no respiratory failure (no RF) groups were compared. RESULTS: Prolongation of QTc interval (n=40, 55.6%) was the most common ECG change, followed by sinus tachycardia (n=36, 50.0%). ST-T wave changes such as ST segment elevation or depression and T wave change (inversion or non-specific change) were evident in 16 patients (22.2%). Prolongation of QTc interval was significantly higher in the RF group compared with the no RF group (p=0.03), but was not an independent predictor for RF in acute OPP (OR; 4.00, 95% CI; 0.70-23.12, p=0.12). CONCLUSION: While patients with acute OPP can display ECG changes that include prolongation of QTc interval, sinus tachycardia, and ST-T wave changes at admission, these changes are not predictors of respiratory failure.
Adult ; Depression ; Electrocardiography ; Emergencies ; Humans ; Organophosphate Poisoning ; Phenylpropionates ; Respiratory Insufficiency ; Retrospective Studies ; Tachycardia, Sinus

PURPOSE: This research investigated the extent of telephone advisers'satisfaction with respect for giving telephone advice and the working environment at 12 emergency medical information centers. METHODS: During July 2004, we approached 12 emergency medical information centers. We sent a three page postal questionnaire to each worker. The questionnaire had three parts questions about the working environment, giving telephone advice, and demographic characteristics. RESULTS: The response rate was 81.8%. The hundred (100) workers selected for this study were telephone advisers. As to the working environment, they were unsatisfied with the small workspace and the poor ventilation. Sixty-three (63) workers had telephone advice education. They felt that 'callers' overstatements' and 'not seeing the patients' left them stressed when giving telephone advice. They anticipated that 'protocol' and 'education about medical knowledge' were necessary for improving telephone advice. Seventy-three (73) workers had experienced burnout syndrome. CONCLUSION: Based on this survey on the extent of satisfaction with giving telephone advice and with the working environment, we think that improvements in the working environment and in the professional education for telephoneadvice skills are necessary. Also, we suggest that education to improve advisers'medical knowledge, development of advice protocols, and a program to prevent and manage burnout syndrome are required for enhanced work satisfaction in the future.
Burnout, Professional ; Counseling ; Education ; Education, Professional ; Emergencies* ; Information Centers* ; Job Satisfaction* ; Surveys and Questionnaires ; Telephone* ; Ventilation

PURPOSE: This study aimed to investigate the injury patterns of unrestrained front-seat passengers in traffic crashes. METHODS: Using 2000~2003 data from the Jeonbuk Provincial Police Agency and medical-chart review, we estimated the relationship between crash patterns and individual variables, such as age, sex, Injury Severity Score, prehospital care, outcome, injury types, passenger seats, velocity, and alcohol consumption. We also investigated whether the Injury Severity Score correlated with crash patterns, passenger seats, velocity, prehospital care, and alcohol consumption. RESULTS: The mean Injury Severity Scores in frontal and rollover crashes were 15.0(+/-0.7) and 22.6(+/-3.3), respectively and the difference was statistically significant (p<0.05). The mortality rate was higher in rollover crashes than in frontal crashes (p<0.05). The most common type of injury in unrestrained passengers during frontal and rollover crashes was head and face injury. In addition, chest and lumbar spine injuries were more common in rollover crashes than in frontal crashes, and this difference had statistical significance (p<0.05). The Injury Severity Score correlated with the crash patterns (rho=0.25, p<0.01), overspeeding (rho=0.44, p<0.01), prehospital care (rho=0.25, p<0.01), and alcohol consumption (rho=0.18, p<0.05). CONCLUSION: We estimate that rollover crashes are associated with an increased risk of injury to and death for frontseat passengers compared to frontal collisions. Knowledge of injury mechanisms should help emergency physicians to promptly evaluate all areas at risk, as well as the potential for fatality.
Alcohol Drinking ; Emergencies ; Head ; Humans ; Injury Severity Score ; Jeollabuk-do ; Mortality ; Police ; Seat Belts* ; Spine ; Thorax

A healthy 72-year-old male was referred to the emergency department (ED) for removal of a foreign body (FB) in the right bronchi from a local medical clinic. The FB was a dental part measuring 5×15 mm in size, which had been accidently aspirated into the lung during a dental procedure. On arrival at the ED, he only complained of mild chest discomfort, and there were no abnormal findings in on physical examination. ED physicians prepared bronchoscopic FB removal while the patient rested in bed. During the wait for bronchoscopy, the patient felt discomfort in the chest and epigastric area, and then he coughed forcefully and at the same time, epigastric thrust was performed with his fist. After several strong coughs with epigastric thrusts, the FB was expelled from his mouth. Chest roentgenogram showed no FB, and the patient was discharged from the ED with no complications. Bronchoscopy has been the only treatment option for bronchoscopic FB, and self-removal of FB is rare. This case report may be helpful to understanding a possible mechanism of self-clearance of FB in some healthy adult patients with a small-sized endobronchial FB.
Adult ; Aged ; Bronchi ; Bronchoscopy* ; Cough* ; Emergencies* ; Emergency Service, Hospital* ; Foreign Bodies* ; Humans ; Lung ; Male ; Mouth ; Physical Examination ; Thorax