Reconstruction of the auricle is one of the most fastidious fields in plastic and reconstructive facial surgery, because the ear is made up of complex cartilage framework arid its thin skin envelope. Insertion of carved rib cartilage is the most popular method for framework fabrication. But it has some disadvantages such as donor site morbidity, lesser flexibility of rib cartilage, difficulty in carving structure and distortion of cartilage after calving. Furthermore surgeon's talent and sufficient practice are necessary for a satisfactory result. So we introduced the concept of perichondral graft to improve the framework fabrication. In 1972 Skoog and associates reported that free perichondral grafts could be used to produce new cartilage. And several other reports supported the chondrogenesis of free perichondral graft. We molded the human ear using silicone rubbed impression material. And the eat mold was wrapped up in perichodrium of rabbit ear and placed in a subcutaneous pocket in formes of graft and flap. Six and eight weeks later, rabbits were sacrified and the newly formed cartilage framework was harvested. Grossly it showed the same appearance as the human eat and elastic property of normal cartilage. In histologic examination, it showed mature structure of normal cartilage; large lacunae containing spherical chondrocytes surrounded by well defined capsule.
Aptitude ; Cartilage ; Chondrocytes ; Chondrogenesis ; Ear ; Ear Cartilage* ; Fungi ; Humans ; Plastics ; Pliability ; Rabbits ; Ribs ; Silicones ; Skin ; Tissue Donors ; Transplants*

Complications after a median sternotomy incision, which is used currently in most open heart surgery, are serious, although it is infrequent. Reconstruction of the sternal defect resulting from dehiscence of median sternotomy is still big challenge to the most plastic surgeons. Since vascularized greater omentum was transposed to eliminate mediastinal wound problems, many vascularized regional muscle flaps became mainstay in reconstruction of median sternotomy wound. We treated 13 patients with median sternotomy dehiscence between October of 1993 and March of 1998. In two patients, the wound problems were so confined to superficial tissue that debrided and closed primarily. Eleven patients with deep wound infection were managed with vigorous debridement of all necrotic tissues and resultant defects were covered with regional muscle flaps: rectus myocutaneous flap(3) and bilateral pectoralis advancement flap(8). We used the pectoralis major advancement flaps without counter incision at humeral insertion site and the dissections were limited only medial to the anterior axillary line to preserve the axillary fold. In five patients with larger defects, we elevated muscle and cutaneous flaps separately to make these flaps more mobile. Large portion of two rectus abdominis flaps could not survive, whereas pectoralis advancement flaps had mo special wound problems. Only one patient developed fistula due to remained wire, regardless to flap surgery.
Debridement ; Fistula ; Humans ; Omentum ; Rectus Abdominis ; Sternotomy* ; Thoracic Surgery ; Wound Infection ; Wounds and Injuries

No abstract available.
Erythema* ; Hydroxychloroquine* ; Sjogren's Syndrome*

No abstract available.
Meningitis* ; Meningitis, Viral*

No abstract available.
Hedgehogs ; Tinea ; Trichophyton

We report a case of primary cutaneous cryptococcosis on the left knee of a 67 year-old woman. She had a large ulcerated and indurated plaque with yellowish purulent exudates on her left knee. A histopathological examination from the lesion showed numerous encapsulated, round spores. Cultures from the lesion showed the presence of Cryptococcus neoforrnans. This may have resulted from an immunosuppressive state due to long-term use of oral corticosteroids.
Adrenal Cortex Hormones ; Cryptococcosis* ; Cryptococcus ; Exudates and Transudates ; Female ; Humans ; Knee ; Spores ; Ulcer

PURPOSE: Nonarteritic anterior ischemic optic neuropathy (NAION) is believed to result from inadequate blood supply to the posterior ciliary arteries. To date, NAION in a patient with acute angle-closure glaucoma (AACG) has been reported in only two studies in the English literature. Thus, the authors report a case of NAION following AACG in a Korean patient. CASE SUMMARY: A 59-year-old woman presented with a three-day history of acute ocular pain and decreased vision in her right eye; visual acuity was hand movement and the intraocular pressure (IOP) was 66 mm Hg in the right eye. Slit-lamp examination of the patient's right eye revealed diffuse corneal edema, shallow anterior chamber, and mid-dilated pupil. Gonioscopy revealed a grade 0 angle in the right eye, and a relative afferent pupillary defect was noted. Fundus photography showed disc hemorrhage and swelling of the optic disc. Fluorescein angiography demonstrated hyperfluorescence of the optic disc due to leakage. Visual evoked potential of the right eye at the initial visit showed a decreased amplitude of P100 compared with that of the left eye. A diagnosis of NAION following AACG was made. Laser iridotomy was successfully performed to the right eye. Two months later, IOP decreased from 66 to 21 mm Hg. However, visual acuity remained as hand movement and fundus examination revealed a pale optic disc. CONCLUSIONS: NAION following AACG may be attributed to an acute IOP rise with resultant perfusion pressure decrease in the vessels which supply the optic nerve. The result obtained from the patient in the present study indicates that evaluation for NAION should be considered in AACG cases.
Anterior Chamber ; Ciliary Arteries ; Corneal Edema ; Evoked Potentials, Visual ; Eye ; Female ; Fluorescein Angiography ; Glaucoma, Angle-Closure ; Gonioscopy ; Hand ; Hemorrhage ; Humans ; Intraocular Pressure ; Middle Aged ; Optic Nerve ; Optic Neuropathy, Ischemic ; Patient Rights ; Perfusion ; Photography ; Pupil ; Pupil Disorders ; Vision, Ocular ; Visual Acuity

With the recent progress of digital technology, the computer guided surgery utilizing a guide template in the placement of implant has been actively performed, and the method employing the intraoral scanner at the implant prosthesis introduced. Fabrication method of the guide template can be largely classified into design-related rapid prototyping (RP) system and vector milling system, and each of the method has its own weakness in the clinical application despite of excellent accuracy. Thus, in this case study, a working model was fabricated by the wax RP technology using images acquired by CBCT and an intraoral scanner, and the metal bushing was picked up with orthodontic resin cast upon the wax model. Using this method, a surgical guide template was fabricated and used in surgery. From this, we could obtain a satisfactory outcome clinically in the implant placement and the fabrication of the final prostheses and thus report this case herein.
Prostheses and Implants

No abstract available.
Glomerular Basement Membrane*

BACKGROUND: In vivo and/or in vitro diagnostic tests to identify possible allergens have been conducted for patients with chronic spontaneous urticaria (CSU) in order to identify any predisposing factors and avoid unnecessary restrictions. OBJECTIVE: The purpose of this study was to evaluate the diagnostic effectiveness of ImmunoCAP(R) ISAC (ISAC) in CSU patients. METHODS: A total of 31 patients with CSU were tested by ISAC and Multiple Allergen Simultaneous Test enzyme immunoassays (MAST-EIA). A skin prick test (SPT) was performed for 17 out of 31 patients. The results of ISAC and MAST-EIA were evaluated based on the SPT results. RESULTS: For 17 patients, with SPT used as the reference standard, ISAC compared with MAST-EIA showed lower sensitivity (22.2% vs. 26.5%), higher specificity (100% vs. 95.7%), higher positive predictive value (100% vs. 52.9%), and lower negative predictive value (86.9% vs. 87.7%). The agreement rate was more favorable for ISAC than for MAST-EIA (87.3% vs. 85.1%; kappa=0.324 vs. 0.263). For 31 patients, the agreement rate between ISAC and MAST-EIA was 83.9% for both Dermatophagoides farinae and Dermatophagoides pteronyssinus. Correlation coefficients (Rho) between ISAC and MAST-EIA for each allergen were 0.690 and 0.675, respectively. CONCLUSION: For CSU patients, specificity, positive predictive value, and the agreement rate of ISAC were similar or superior to those of MAST-EIA. In addition, ISAC provides valuable information on the possible sensitization to different allergen sources by elucidating cross-reactive components. With careful clinical correlations in interpretation, ISAC can be a useful diagnostic tool to detect allergens in CSU patients.
Allergens ; Causality ; Dermatophagoides farinae ; Dermatophagoides pteronyssinus ; Diagnostic Tests, Routine ; Humans ; Immunoenzyme Techniques ; Sensitivity and Specificity ; Skin* ; Urticaria*