In the majority of East Asian eyelids, the presence of a medial epicanthal fold is one of the unique anatomic characteristics. Roundness of medial canthal area and a narrow, short palpebral fissure are aesthetic consequences of this anatomic features. But, the idea of beauty has changed with time by influence of western culture. Many people are favorable to the wide open eye without epicanthal fold, which make improved facial balance. Double-eyelid operation is the most commonly performed procedure of aesthetic surgery field in Korea. However, many cases of successfully done double-eyelid operation results in only partial improvement by leaving medial epicanthal folds. We can get the improved results by utilizing epicanthopasty that lengthens the palpebral fissure, and thus producing the image of a larger, open eye. Consequently the requirements for epicanthoplasty has increased in modern time. The Uchida's split V-W plasty is one of the most frequently used methods. But, it has disadvantages of completely exposed scar, potential for dog-ear formation, and two stage procedure with some cases of double-eyelid operation. We modified the Uchida's method by moving the position of 2 triangular flaps more laterally and conjoining the incision line of double-eyelid operation with that of epicanthoplasty. The purposes of our modification are not complete elimination but relieving the epicanthal fold, hiding the minimal scar behind the new relieved the new relieved fold and preventing the dog-ear on the transitional zone. From January, 1995 to June, 1999, this method was applied to 93 patients who have medial epicanthal folds and performed with double-eyelid operation concomitantly. Age ranged From 12 to 47 years and the mean age was 23 years. Through the mean 15 months of follow up, the mean widening of the palpebral fissure width was 2.5mm and the mean reduction of the intercanthal distance was 5mm. The modified Uchida's method has advantages of simplicity in procedure, effectiveness in results, minimal scarring with hiding behind the new small fold, and one stage procedure with double-eyelid operation. We think it can be applied generally to almost of all double-eyelid operation except epicanthal fold is marked severe.
Asian Continental Ancestry Group ; Beauty ; Cicatrix ; Eyelids ; Follow-Up Studies ; Humans ; Korea

Better palliative management of patients with disseminated cancer has prolonged their lives but has raised the incidence of pathologic fractures in their variable lives. The essence of treatment is to prolong life, maintain comfort, and stabilize the patient with metastatic disease. The treatment of pathologic fractures with internal fixation has long been accepted by orthopedic surgeons and the benefits afforded to the patient are well known, so adequate fixation is essential. A combination of methylmethacrylate and internal fixation devices can greatly enhance the stability of fixation, because diseased bone is a poor base on which to insert an internal fixation device. The authors have treated 19 cases of the pathologic fracture of spine, humerus and femur by use of bone cement with and without internal fixation devices. The results are as follwed. 1. All cases utilized methylmethacrylate and there was no complication in methylmethacrylate in itself. 2. All cases had received various type of ancillary treatment: radiation in 9 cases, chemotherapy in 4 cases and in 8 cases, conservative pain control. 3. In spinal pathologic fracture with paraplegia or neurologic deficiency, the patients could walk with walker at an average of two weeks after operation. 4. Among the 19 cases, the pain was relieved markedly and ambulation was possible easily and early after operation in 16 cases. 5. Among the 19 cases, two survived less than 2 months, 7 surrived from 2 month to 3 month, five survived from 3 months to 6 months, four survived from 6 months to a year and one survived more than a year.
Drug Therapy ; Femur ; Fractures, Spontaneous ; Humans ; Humerus ; Incidence ; Internal Fixators ; Methylmethacrylate ; Orthopedics ; Paraplegia ; Spine ; Surgeons ; Walkers ; Walking

The treatment of facial bone fractures aims at restoring normal anatomical feature and obtaining the physiologic function by accurate fracture reduction and adequate stability. Among various facial bone fractures, displaced mandibular angle and subcondylar fractures are common injuries. Their structural problems such as increased risk of oromasticatory dysfunction and aesthetic drawbacks can be corrected by surgical treatment. In case of displaced comminuted fracture of zygoma, the zygomatic arch should be reduced and rigidly fixed, because it can be used as a key landmark for reconstruction. In case of these fractures, we performed external incision and conventional bicoronal incision to repair mandibular fractures and expose zygomatic arch. However, there are some disadvantages associated with these extensive incisions: a possible facial nerve injury, prolonged massive swelling, noticeable external scarring and increased risk of blood loss. On the other hand, the intraoral incision approach for mandibular angle, subcondyle and zygomatic arch makes possible the anatomic reduction and rigid internal fixation by using a trocar method concomitantly, which requires only an additional small skin incision over the perpendicular point of the fracture site. Additionally, this approach has several advantages, including decreased possibility of facial nerve injury, decreased blood loss, early subsidence of postoperative swelling and minimal external scarring. From March 1997 to November 1999, we used the trocar method for the treatment of various facial bone fractures of 15 males and 3 female patients (age ranged from 17 to 60 years). In this approach, operative endoscope or C-arm was used concomitantly in order to improve the limited operative visual field and to allow surgical access. The use of trocar method through the intraoral and tiny skin incisions provides the accurate reduction and rigid internal fixation. It is considered a good method to minimize the disadvantages of external approaches for the treatment of various facial bone fractures.
Cicatrix ; Endoscopes ; Facial Bones* ; Facial Nerve Injuries ; Female ; Fractures, Comminuted ; Hand ; Humans ; Male ; Mandibular Fractures ; Skin ; Surgical Instruments* ; Visual Fields ; Zygoma

TMJ dysfunction has difficulties for diagnosing and treating, and its symptoms are variable. TMJ dysfunction is classified as muscular problem, capsular problem, ligamentous problem, internal derangement, or condylar dislocation etc. Treatment modalities for TMJ dysfunction are surgical or conservative one, but they haven't be standardized. Because of anatomical complexities and difficulties of surgical approaches, conservative treatment have been preferred. We've had 30 cases having impressed capsular tightness or internal derangement. They have made an appeal for pain on TMJ area, ROM limitation of joint, clicking etc. We have used the interocclusal splint as treatment modality. In general, the interocclusal splint is classified as the stabilization splint, the repositioning splint, the pivot splint, the soft splint etc. We have applied the stabilization splint or the repositioning splint to the patients according to diagnosis or symptoms. The interocclusal splint is reported to induced the changing activities of muscle, altering the stress or loading of the joint and recapturing or changing condyle- disc-fossa position. As a result, the pain has become reduced and ROM limitation of joint was improved, clicking is eliminated initially. From January 2001 to May 2002, we treated 30 patients who having TMJ dysfunction. Our treatment modality was performed that the interocclusal splints were worn full time for one to four weeks, then phased out. During the mean 10.5 months of follow-up period there had been significant improvements in pain, ROM limitation of joint and clicking. After 6 months, there had been no recurrence in pain and ROM limitation of joint, but 2 cases recurred in clicking that has disappeared. The appliance of interocclusal splint has been an effective method for the initial nonsurgical treatment of the symptoms of TMJ dysfunction. However, more in-depth study by long term follow-up is needed to evaluate recurrence.
Diagnosis ; Dislocations ; Follow-Up Studies ; Humans ; Joints ; Ligaments ; Recurrence ; Splints* ; Temporomandibular Joint*

Scars can be problematic if they accompany the skin rash, tenderness, pruritus, limited joint motion, or various cosmetic complaints. Burn scar contractures, hypertrophic scars, irregular elevated scars and keloids are defined as problem scars. Many treatment modalities for control of excessive scars were introduced, but the results was often difficult to predict and some had high recurrence rates. Among current therapies for scar management, calcium antagonists were reported to induce the increasing activity of collagenase and promote the phenotypic changes in fibroblast. As a result, softening of the scars and lightening of color were established by intralesional calcium antagonist injection. From March 2001 to February 2002, we had treated 25 patients who had problem scars. Our treatment modality was performed that the calcium antagonist, as verapamil, was injected intralesionally with a total of 4 times at intervals of 3 weeks. Through the mean 6.2 months of follow-up period, there were 19 patients who had significant improvement in volume, texture, and color of scars. No complications and recurrence occurred with calcium antagonist injections. Intralesional injection of calcium antagonists has been an effective method for the treatment of problem scars, especially in case of worrying side effects or contraindicated situations in steroid therapy.
Burns ; Calcium* ; Cicatrix* ; Cicatrix, Hypertrophic ; Collagenases ; Contracture ; Exanthema ; Fibroblasts ; Follow-Up Studies ; Humans ; Injections, Intralesional ; Joints ; Keloid ; Pruritus ; Recurrence ; Verapamil

BACKGROUND/AIMS: The objective of this study was to evaluate a monoclonal antibody-based test to detect Helicobacter pylori-specific antigen in gastric aspirates from humans. METHODS: Sixty-one volunteers were enrolled in the study. All of the subjects underwent a 13C-urea breath test (UBT) before esophagogastroduodenoscopy. Gastric aspirates were analyzed for pH and ammonia and used for polymerase chain reaction (PCR), culture, and monoclonal antibody-based detection of H. pylori. Multiple biopsies of the gastric antrum and body were obtained for a rapid urease test (RUT) and histological evaluation. RESULTS: Thirty-six subjects were H. pylori-positive and 25 were H. pylori-negative according to the UBT results. Compared with the H. pylori-negative subjects, H. pylori-positive subjects had a higher pH (4.77+/-1.77 vs 3.49+/-1.30, p<0.05) and ammonia level (1,130.9+/-767.4 vs 184.2+/-126.3, p<0.0001). The sensitivities and specificities of the PCR test, RUT, culture test, and monoclonal antibody-based test were 100% and 72%, 89% and 100%, 47% and 100%, and 78% and 100%, respectively. CONCLUSIONS: The monoclonal antibody-based test for diagnosing H. pylori infection in gastric aspirates has increased sensitivity compared with the culture test and specificity as high as that of the RUT. The test may be useful as an additive test for examining gastric aspirates.
Ammonia ; Biopsy ; Breath Tests ; Endoscopy, Digestive System ; Helicobacter ; Helicobacter pylori ; Hydrogen-Ion Concentration ; Polymerase Chain Reaction ; Pyloric Antrum ; Sensitivity and Specificity ; Urease

BACKGROUND/AIMS: To evaluate a new monoclonal antibody for Helicobacter pylori urease in gastric tissue. METHODS: A total of 107 volunteers were enrolled. All subjects underwent a 13C-urea breath test and esophagogastroduodenoscopy. Gastric aspirates were analyzed for pH and ammonia. Six biopsy specimens in the gastric antrum and body were obtained for a rapid urease test and histology. The new monoclonal antibody-based H. pylori urease test (HPU) was performed to rapidly and qualitatively detect urease in two biopsy specimens. RESULTS: H. pylori infection was diagnosed in 73 subjects. The sensitivity and specificity of the HPU was 89% and 74%, respectively. The subjects were divided into two groups: one with true-positive and true-negative HPU results (n = 90) and the other with false-positive and false-negative HPU results (n = 17). Across all subjects, ammonia levels were 900.5 +/- 646.7 and 604.3 +/- 594.3 mumol/L (p > 0.05), and pH was 3.37 +/- 1.64 and 2.82 +/- 1.51 (p > 0.05). Sensitivity was higher in the presence of atrophic gastritis or intestinal metaplasia. CONCLUSIONS: HPU detected H. pylori in approximately 10 min. Gastric aspirate ammonia and pH levels did not affect the test results. Sensitivity was good in the presence of atrophic gastritis or intestinal metaplasia.
Adult ; Antibodies, Monoclonal/*immunology ; Bacterial Proteins/*analysis/immunology ; Biomarkers/analysis ; Biopsy ; False Negative Reactions ; False Positive Reactions ; Female ; Gastritis, Atrophic/*diagnosis/microbiology ; Helicobacter Infections/*diagnosis/microbiology ; Helicobacter pylori/*enzymology/immunology ; Humans ; *Immunologic Tests ; Male ; Metaplasia ; Middle Aged ; Predictive Value of Tests ; Pyloric Antrum/*microbiology/pathology ; Reproducibility of Results ; Time Factors ; Urease/*analysis/immunology ; Workflow