PURPOSE: To report a case of delayed orbital cellulitis with subperiosteal abscess after orbital floor fracture repair using an absorbable sheet implant (Macropore®, Medtronic Inc., Minneapolis, MN, USA). CASE SUMMARY: A 16-year-old male visited the oculoplastic clinic for left eye pain, lower eyelid swelling and vertical diplopia for 1 day. The patient had a history of inferior orbital wall fracture repair surgery using Macropore® 20 months prior. The orbital computed tomography scan showed a subperiosteal cystic mass with surrounding infiltration at the left orbital floor, and ethmoidal and maxillary sinusitis; however, sheet implant was not clearly observed. Despite systemic antibiotic treatment for 3 days, his clinical findings did not improve, thus we decided to drain the subperiosteal abscess through a transconjunctival approach. Intraoperatively, the Macropore® sheet was almost dissolved, but small pieces remained. The culture of drained contents showed no microorganisms. Systemic antibiotics were continued for 18 days after surgery, and clinical symptoms completely improved. CONCLUSIONS: Delayed orbital cellulitis should be considered in patients with extraocular muscle movement limitation and painful orbital swelling if the patient has a history of orbital wall fracture repair, even if a bioresorbable implant was used. Prompt imaging evaluation should be emphasized for early diagnosis and proper treatment.
Abscess ; Absorbable Implants* ; Adolescent ; Anti-Bacterial Agents ; Diplopia ; Early Diagnosis ; Eye Pain ; Eyelids ; Humans ; Male ; Maxillary Sinus ; Maxillary Sinusitis ; Orbit* ; Orbital Cellulitis* ; Orbital Fractures

The characteristics of hand trauma are changing due to automation of industrial facilities, improved access to health care, and the aging population. Since the inception of hand surgery as a subspecialty, hand defects have been reconstructed with the restoration of the original functionality as the primary goal. With advancement and maturation of surgical techniques, however, restoration of aesthetics also began to take hold as an important aspect of hand surgery practice. After the first successful replantation of an amputated digit, the rapid development of microsurgical techniques had a significant impact on the field of reconstructive hand surgery. In the first two decades, the success of replantation was evaluated by the survival rate for a single operator or a specialized institution. These days, however, microsurgical techniques have been widely adopted, with digital replantation possible even for infants. In addition to various local flaps, the evolution of free flaps has vastly expanded the repertoire of reconstructive options for hand surgeons. With the wide variety of free flaps available, it is possible for a severely injured hand to be salvaged and restored to its original functional and aesthetic status. In South Korea, hand surgery is becoming an established profession with a separate subspecialty certification. Hand surgery has a bright outlook, with future research directed at new biocompatible materials and novel reconstructive methods.
Aging ; Automation ; Biocompatible Materials ; Certification ; Esthetics ; Free Tissue Flaps ; Hand* ; Health Services Accessibility ; Humans ; Infant ; Korea ; Microsurgery ; Replantation ; Survival Rate

PURPOSE: There is no consensus about a definition of benign prostatic hyperplasia, but there are various definitions based on a combination of clinical parameters used to describe the properties of BPH: symptoms of prostatism, increase of prostate volume, and bladder outlet obstruction. The prevalence of clinical BPH in Asian was believed to be lower than Caucasian. The lower urinary tract symptoms associated with BPH in Korea was reported by some authors and it was similar to the results of other studies in western countries. We report the prevalence of BPH in Korean men through a community-based study in Jeong-Eup county, Korea. MATERIALS AND METHODS: A total of 653 men aged 50 and over in Jeong-Eup area, Korea was randomly selected for determination of the prevalence of BPH. The definition of BPH in this study was combination of moderate(8-19) to severe(>19) I-PSS, enlargement of the prostate over 30gms on digital rectal examination by one board certified urologist, and decreased peak flow rate below 15ml/sec. Men with abnormal digital rectal examination(DRE) and elevated serum prostate specific antigen(PSA) above 3.5ng/ml were undergone sextant prostate biopsy to exclude the prostate cancer. RESULTS: I-PSS questionnaires were completed in 431 men and the response rate was 66.1%. Based on I-PSS, 162 men(37.6%) had moderate symptoms and 51 men(11.9%) severe symptoms. Of 213 men with moderate to severe symptoms, 35.7% had enlarged prostate by DRE, and 63.1% decreased flow rate. The prevalence of BPH by the definition in this study was 4.3% in their fifties, 13.2% in sixties and 16.3% in seventies and over eighty(overall, 11.1%). The population-adjusted prevalence of BPH in Korean men aged 50 and over was 8.7%. A good correlation was found between the total symptom score and the quality of life score that is included in the I-PSS. CONCLUSIONS: Men with moderate to severe I-PSS was 49.5%, which was similar to the results from other studies in Caucasian and Japanese. The prevalence of BPH in Korea by aforementioned definition was 8.7%, which seems to be lower than Caucasian. This results suggest that approximately 1,600,000 Korean men had moderate to severe urinary symptoms and 300,000 clinical BPH by the definition in this study.
Asian Continental Ancestry Group ; Biopsy ; Consensus ; Digital Rectal Examination ; Humans ; Jeollabuk-do* ; Korea ; Lower Urinary Tract Symptoms ; Male ; Prevalence* ; Prostate ; Prostatic Hyperplasia* ; Prostatic Neoplasms ; Prostatism ; Quality of Life ; Surveys and Questionnaires ; Urinary Bladder Neck Obstruction

Purpose: To minimize ultrasound power use and surgical phaco time in illuminated chop cataract surgery. Methods: The charts of patients who underwent senile cataract surgery by a single surgeon were reviewed retrospectively. A conventional intracameral endoilluminator was used in a Stop & Chop group (n = 45), while an illuminated chopper was used in an illuminated chop (I-Chop) group (n = 71). EFX, a unitless value that roughly correlates with ultrasound energy during phacoemulsification, surgical phaco time, and changes in endothelial cell count were compared between the two groups and the ratio of zero phacoemulsification in the I-Chop group was evaluated. Results: EFX of the Stop & Chop and I-Chop groups was 18.08 ± 16.15 and 0.82 ± 3.53, respectively (p = 0.001), while the surgical phaco time was 185.08 ± 41.42 and 162.04 ± 49.65 seconds (p = 0.01). However, the endothelial loss did not differ in the two groups (7.03 ± 7.89 vs. 7.13 ± 9.47%, p = 0.76). In the I-Chop group, 56 (86%) eyes had zero phaco energy and patients with EFX >1 (n = 6) had more severe nuclear sclerosis grading (2.90 ± 0.71 vs. 4.5 ± 1.0; p = 0.001). Conclusions The I-Chop group had lower EFX and shorter surgical phaco time than the Stop & Chop group. Illuminated chop using an illuminated chopper is one way to attain minimal phacoemulsification.

The purpose of this article is to review the past history of hand surgery briefly and to overview of a vision of hand surgery over next generations in republic of Korea. There were three characteristics of the past history of digit replantation in Korea. Due to the tremendous use of press machine, the replantation surgery for finger amputation had been developed rapidly from 1980's to 1990's period. Also new microsurgery techniques had been introduced such as toe pulp free flap for digit reconstruction. These techniques had been developed based on the medical health insurance system for the factory employees. Future of hand surgery in Korea can be anticipated as followings: operative microscopy and robotics may help surgeons to anastomosis very tiny micro-vessels; the functional recovery of fingers and hands will be more important; incidence of degenerative disease, musculoskeletal system disorder due to excessive use and injury during sports will increase; new materials such as artificial joint will be used more frequently according to the innovation of tissue engineering and regenerative medicine; specialist system for hand surgeon will be settled. Since there are a lot of hand surgeon who has a mission to alleviate patient's pain and injury, there will be a continuous growth of hand surgery in Korea.
Amputation ; Family Characteristics ; Fingers ; Free Tissue Flaps ; Hand ; Humans ; Incidence ; Insurance, Health ; Joints ; Korea ; Microscopy ; Microsurgery ; Missions and Missionaries ; Musculoskeletal Diseases ; Replantation ; Republic of Korea ; Robotics ; Specialization ; Sports ; Tissue Engineering ; Toes ; Vision, Ocular

We report a case of vaginal leiomyoma in a female patient, which presented with a palpable paraurethral mass with several urinary symptoms such as frequency, urgency and dysuria. The physical examination revealed a localized, mobile, nontender mass in the anterior vaginal wall. Pelvic magnetic resonance (MR) imaging showed a malignant-looking vaginal mass co-existing with multiple uterine leiomyomas. The diagnosis was made through transvaginal ultrasound-guided needle biopsy. The surgical excision was accomplished without any complication. Despite the rarity, a few cases of malignant lesion presented with paraurethral mass were previously reported. The surgical excision and pathological confirmation of the benignancy is necessary.
Biopsy, Needle ; Diagnosis ; Dysuria ; Female ; Humans ; Leiomyoma* ; Magnetic Resonance Imaging* ; Physical Examination

STUDY DESIGN: A retrospective study. PURPOSE: To evaluate the prevalence and risk factors of asymptomatic cervical or thoracic lesions in elderly patients who have undergone surgery for lumbar spinal stenosis. OVERVIEW OF LITERATURE: Concurrent multiple spinal lesions have been reported in many studies with a varied prevalence, and described the characteristics of the disease and its treatment options. However, the cervical or thoracic lesions without apparent symptoms in patients with symptomatic lumbar stenosis had not been evaluated. METHODS: A total of 101 elderly patients (aged 65 or more), who had undergone surgery for lumbar spinal stenosis from January 2005 to December 2005, were enrolled in this study. All patients underwent lumbar magnetic resonance imaging (MRI) along with T2-weighted cervical and thoracic sagittal MRI prior to surgery. The concurrent cervical or thoracic lesions were classified according to the disease entity, and the severity of the lesions was graded from grade 0 (no lesion) to grade 4 (any lesion compressing the cord with a signal change). The prevalence of concurrent cervical and thoracic lesions was then analyzed. In addition, the risk factors for the development of concurrent lesions were evaluated, and the risk factors affecting the severity of the concurrent lesion were analyzed individually. RESULTS: Seventy-seven (76.2%) and 30 (29.7%) patients had a concurrent cervical and thoracic lesion, respectively. Twenty-six patients (25.7%) had both a cervical and thoracic lesion. There was a positive correlation between the symptom duration of lumbar stenosis and the prevalence of both cervical (p = 0.044) and thoracic (p = 0.022) lesions. CONCLUSIONS: The incidence of asymptomatic cervical or thoracic lesions is apparently high in elderly patients who have undergone surgery for lumbar spinal stenosis, particularly in those with longer symptom duration. This highlights the need for a preoperative evaluation of the cervical and thoracic spine in these patients.
Aged ; Constriction, Pathologic ; Humans ; Incidence ; Magnetic Resonance Imaging ; Prevalence ; Retrospective Studies ; Risk Factors ; Spinal Stenosis ; Spine

PURPOSE: To study the effect of plapebral fissure height on astigmatism in epiblepharon patients. METHODS: The study consisted of 68 eyes of 34 patients who were diagnosed with epiblepharon and 88 eyes of 44 patients who had normal eyelids from September 2012 to July 2013. Data on palpebral fissure height and refractive errors were compared between the epiblepharon group and the control group. Epiblepharon patients were further divided into two subgroups depending on the degree of preoperative corneal erosion in order to study the effects of corneal erosion on corneal astigmatism. RESULTS: The mean age was 5.6 ± 2.2 years in the epiblepharon group and 6.1 ± 1.5 years in the control group (p = 0.339). The mean astigmatism was 2.28 ± 1.54 D in the epiblepharon group and 0.91 ± 1.07 D in the control group. The epiblepharon group showed higher astigmatism than the control group (p < 0.001). The mean palepebral fissure height was 6.70 ± 1.19 mm in the epiblepharon group and 7.63 ± 1.06 mm in the control group. The epiblepharon group exhibited smaller palpebral fissure height than the control group (p < 0.001). In the palpebral fissure height subgroups of the epiblepharon group, the <7.0 mm group showed higher astigmatism than the ≥7.0 mm group (p = 0.026). Higher astigmatism was associated with smaller palpebral fissure height (p = 0.022). CONCLUSIONS: Patients with epiblepharon had significantly higher corneal astigmatism, and higher astigmatism was associated with smaller palpebral fissure height.
Astigmatism* ; Eyelids ; Humans ; Refractive Errors

One of the most significant risk factors for prostate cancer (PC) is a family history of the disease, with germ-line mutations in the breast cancer predisposition gene (BRCA) 2 conferring the highest risk. We here report a 56-year-old man presented with painful gait disturbance and diagnosed PC with multiple disseminated bone metastases. The patient had a strong family history of breast cancer with his 2 nieces affected. Furthermore, his aunts and uncles from both sides were diagnosed with stomach, ovarian, and colorectal cancers. His genomic sequencing analysis of the BRCA genes revealed the same BRCA2 deleterious mutation that his breast cancer-affected nieces carried. Previous studies have suggested that BRCA2-mutated PC is associated with a more aggressive phenotype and poor prognosis. Our experience in the present case also indicated the urgent needs for novel treatment modality and PC screening in this high-risk group of patients.
Breast ; Breast Neoplasms ; Colorectal Neoplasms ; Gait ; Germ-Line Mutation ; Humans ; Mass Screening ; Middle Aged ; Neoplasm Metastasis ; Phenotype ; Prognosis ; Prostate* ; Prostatic Neoplasms* ; Risk Factors ; Stomach

BACKGROUND: This study was designed to analyze the clinical usefulness of mycophenolic acid trough concentration monitoring in kidney transplantation patients who were maintained with cyclosporine. METHODS: The data of patients who underwent mycophenolic acid trough concentration monitoring after their first kidney transplant between November 2006 and August 2013 and were prescribed with cyclosporine, mycophenolate, and methylprednisolone were reviewed retrospectively. Cox analysis was used to analyze the risk factors for acute rejection within 1 year post-transplantation. RESULTS: Among 90 patients, 41 (45.6%) achieved both the target levels of cyclosporine and mycophenolic acid, while three patients (3.3%) failed to achieve the target level of either cyclosporine or mycophenolic acid. Nine patients (10.0%) only achieved the mycophenolic acid target level and 37 patients (41.1%) only achieved the cyclosporine target level. While patients who achieved only the mycophenolic acid target concentration had no statistically increased risk compared to patients who achieved both target levels (hazard ratio [HR], 1.569; 95% confidence interval [CI], 0.316 to 7.778; P=0.581), patients who only achieved the cyclosporine target concentration showed an increased risk of rejection compared to the both achievement group (HR, 4.112; 95% CI, 1.583 to 10.683; P=0.004). Patients who had no achievement in the target levels showed significantly increased rejection risk compared to the patients who achieved both target levels (HR, 17.811; 95% CI, 3.072 to 103.28; P=0.001). CONCLUSIONS: Mycophenolic acid trough concentration monitoring combined with cyclosporine trough concentration monitoring is useful for avoiding acute cellular rejection if the first 1 year post-transplantation.
Cyclosporine* ; Drug Monitoring ; Humans ; Kidney Transplantation ; Kidney* ; Methylprednisolone ; Mycophenolic Acid* ; Retrospective Studies ; Risk Factors