The surgical treatment of long duration lagaphthalmos was traditionally conducted using the Gillies (1934) method of temporal muscle transfer. This method has been effective in cases of simultaneous lagaphthalmos in the upper eyelid and ectropion in the lower eyelid. In the past, we treated 18 leprosy patients who suffered complications of ptosis in the upper eyelid and ectropion in the lower eyelid after the application of the Gillies method. To treat these complications, we removed the fascia strips emplaced during temporal muscle transfer from the upper and lower eyelid. Thereafter, we implanted a 1.0 gram gold plate in the upper eyelid and either a conchal cartilage graft. In the treatment of Lagaphthalmos over the past seven years, we have applied gold plate lid loading in 120 cases. However, in five of these cases, patients suffered from exposure of the gold plate due to paralytic orbicularis oculi muscle tearing. Recently, to correct this, we covered the gold plate with AlloDerm tissue to protect and support the muscle. In the treatment of ectropion over the last six years, we have had over 30 cases of cartilage grafts (over 35mm in length and 5mm in breadth) in the lower eyelid. However, the end of the cartilage graft would warp and create new partial ectropion several months later. Because of this, we shifted from cartilage to AlloDerm. We applied 40mm (length) and 7mm (breadth) to the lower border of the tarsus and fixed at each end with medial and canthal ligament. From 1997 to 2002, in the Institute of Leprosy Research, we operated on 25 patients suffering from Lagaphthalmos and Ectropion using a newer treatment to correct ectropion more effectively. The levator muscle of the upper eyelid loses the funtion of its antagonistic muscle, namely the orbicularis oculi due to facial nerve palsy, and results in retraction of the upper eyelid. To correct upper eyelid retraction, we severed the levator and muller muscle from the superior tarsal border and discontinued the use of gold lid loading which is visually evident. This method does not result in ptosis and the eye is more normal in appearance.
Ankle ; Cartilage ; Ectropion ; Eyelids* ; Facial Nerve ; Fascia ; Humans ; Leprosy ; Ligaments ; Paralysis ; Temporal Muscle ; Transplants

BACKGROUND: The reference list is an important part of a scientific article. To be useful it must be accurate. OBJECTIVE: The purpose of this study was to evaluate the accuracy of reference citations in the Korean Journal of Dermatology and the Annals of Dermatology. METHODS: We randomly selected 200 references (100 references from Korean language journals and 100 references from foreign language journals) from the Korean Journal of Dermatology and 100 references from the Annals of Dermatology and checked them against the .original articles. RESULTS: The overall rate of citation error was 32%, and errors in the title and author names of the citation were common, each occurring in about two fifths of the citation errors. CONCLUSION: This study shows that the rate of citation errors is unacceptably high in the Korean Journal of Dermatology and the Annals of Dermatology, which significantly diminishes the value of the reference list.
Dermatology*

No abstract available.
Carcinoma, Renal Cell*

No abstract available.
Carcinoma, Renal Cell*

Purpose: To report the surgical skills needed, and the clinical results of, minimally invasive hip surgery with dynamic hip screws and the comparison with the classical technique in stable pertrochanteric fractures of the femur. Materials and Methods: Thirty-two patients with pertrochanteric fractures of the femur who were treated with dynamic compression hip screws between April 1999 and March 2004, and were evaluated retrospectively, and were followed up for more than 12 months. 16 cases were treated with a classical dynamic hip screw technique and 16 cases with a minimally invasive technique in random order. The mean age was 73.2 years, and there were 11 males and 21 females. The operative times, total hemovac bleeding loss, functional scores, and average hemoglobin decrease ratios were evaluated. The clinical assessments were performed with the Harris Hip Score (HSS) and bony union was evaluated with serial follow-up plain radiographs. Results: The average operative time was 63.9 minutes with the classical technique and 42.5 minutes with the minimally invasive technique. The total average hemovac blood loss was 640 cc with the classical technique and 143 cc with the minimally invasive technique. Clinically, the HHS was an average of 85.9 and 89.2 in groups 1 and 2, respectively, by the last follow-up and there were no statistically significant differences between the two groups (P <0.05) The hemoglobin decrease ratio was the same in both groups and there was no nonunion. Conclusion: Minimally invasive dynamic hip screw insertion was useful in stable pertrochanteric fractures, because it decreased blood loss and operative times; and there were no changes in fracture healing and functional outcomes.
Female ; Femur ; Follow-Up Studies ; Fracture Healing ; Hemorrhage ; Hip* ; Humans ; Male ; Operative Time ; Retrospective Studies ; Surgical Procedures, Minimally Invasive

OBJECTIVE: To evaluate the accuracy of combined transvaginal ultrasound and beta-hCG discriminatory zone for diagnosing intrauterine pregnancy, abortion, and ectopic pregnancy in early abnormal pregnancy. METHODS: Initial ultrasound findings and beta-hCG level were compared with final pregnancy outcome in 164 early pregnant women who visit our hospital with vaginal bleeding or abdominal pain. The sensitivity, specificity, and predictive value by the combination of two diagnostic tools were calculated. Statistic analysis of collected data used x2 of SPSS(9.0). RESULTS: Of 90 women with normal outcome, 64(71.1%) had a gestational sac 5mm, and in 47 cases, the hCG level was above 1,800 mIU/ml. Transvaginal ultrasound was non-diagnostic in 47(28.6%) of 164 women, and especially, 43(53.1%) of 81 cases with beta-hCG levels below 1,800 mIU/ml. The portion of accurate ultrasound diagnosis was significantly higher in women above 1,800 mIU/ml (85.5%, 71 of 83 cases) compard with levels below 1,800 mIU/ml (37.0%, 30 of 81 cases) : P < 0.001; Relative Risk(RR) 2.31; CI 95%. Sensitivity of transvaginal ultrasound diagnosis of intrauterine pregnancy, abortion, and ectopic pregnancy was 90.2%, 79.3%, and 66.7% in women who presented with beta-hCG levels above 1,800 mIU/ml, and 41.0%, 23.5%, and 75% below 1,800 mIU/ml, respectively. And, negative predictive value was 83.9%, 89.7%, and 98.8% in each of intrauterine pregnancy, abortion, and ectopic pregnancy above 1,800 mIU/ml, and 64.6%, 60%, and 97.3% below 1,800 mIU/ml, respectively. CONCLUSIONS: The sensitivity, specificity, and predictive value of transvaginal ultrasound for diagnosing abnormal early pregnancy were poor except cases of ectopic pregnancy when beta-hCG levels were low than discriminatory zone. Ultrasound impressions were well related with beta-hCG levels.
Abdominal Pain ; Diagnosis ; Female ; Gestational Sac ; Humans ; Pregnancy Outcome ; Pregnancy* ; Pregnancy, Ectopic ; Pregnant Women ; Sensitivity and Specificity ; Ultrasonography* ; Uterine Hemorrhage

Five patients with brain tumors have been treated with an afterloaded removable Iridium-192 interstitial brachytherapy using Brown-Roberts-Wells stereotactic system. There were two cases of glioblastoma multiforme, one case of recurrent glioblastoma multiforme, one case of recurrent metastatic brain tumor and one case of recurrent astrocytoma grade II. The patients were treated by combination of surgery or stereotactic biopsy and external radiation previously. Tumor doses ranging from 4100 to 8600 cGy were delivered to these patients. There was no death and 4 patients showed definite tumor regression 3 months following interstitial brachytherapy. The method was safe and appeared to be effective madality to achieve local control of brain tumors.
Astrocytoma ; Biopsy ; Brachytherapy ; Brain Neoplasms ; Brain* ; Glioblastoma ; Humans

Lepra bacilli invade the nasal mucosa from early stage. The infiltrated mucous membrane breaks down and ulcerates easily. Irritating crusts and ulcers occur, creating in perforation of the septum. When most of the septum and inner mucosal lining of the nose is destroyed, the nose is deprived of its support and it collapses. The nasal bones are typically intact, and the collapsed nose adheres to the facial skeleton, giving the characteristic 'sunken and short nose' deformities. We have operated on 25 patients with deformities such as short nose, sunken nose, collumela deformity and ala collapse since 1992. In short nose we operated with a paramedian forehead flap and rib cartilage graft in a cantilever pattern. In ala collapse we used a conchal cartilage graft. Lastly, in collumela deformity we used the local flap and a composite graft.
Cartilage ; Congenital Abnormalities* ; Forehead ; Humans ; Leprosy* ; Mucous Membrane ; Nasal Bone ; Nasal Mucosa ; Nose ; Ribs ; Skeleton ; Transplants ; Ulcer

BACKGROUND: Eyelash ptosis(ELP) is a common finding in patients with long-standing leprosy. However, it has rarely been reported in the literature previously, because it has been diagnosed as trichiasis or entropion. OBJECTIVE: To determine the prevalence of ELP in Hansen's disease. METHODS: We took both frontal and lateral photographs of eyes in 20 patients and evaluated the degree of ptosis using a 4-point rating scale, in which 0 indicates no ptosis; 1, minimal; 2, moderate; and 3, severe. The evaluation was also performed in 20 normal persons as control group. RESULTS: All patients demonstrated ELP. In general, severity of ptosis in patient group is greater than that in control group. While the mean eyelash ptosis rating was 2.0+/-0.6 in the latter, it was 0.6+/-0.4 in the former, which is statistically significant (p<0.01). CONCLUSIONS: ELP is common in the patients with Hansen's disease and moderate to severe forms occurred more commonly in disease group compared with control group. ELP must be considered as a characteristic ocular finding in long-standing leprosy.
Eye ; Humans ; Leprosy ; Prevalence ; Trichiasis

Paralytic lagophthalmos and ectropion in the treatment of leprosy patients are serious complications of facial paralysis, which may lead to exposure keratitis and corneal ulceration, which can further lead to blindness. In 1995, 1997, 1999 and 2001, we reported in this journal on the surgical treatment of paralytic lagophthalmos and ectropion. In the 1st report, made in 1995, for lid closing, I (Ahn) performed various methods of traditional surgery such as temporal muscle transfer, medial and lateral canthoplasty, as well as gold implantation. In the 2nd report, made in 1997, we (Ahn and Park) presented a combination treatment of gold plate with minor changes of design and weight in the upper lid and medial canthoplasty with horizontal shortening in the lower lid. In the 3rd report, made in 1999, we described an additional graft of conchal cartilage in the lower lid. However, the lateral end of the cartilage would warp and create new partial ectropion several months later. Therefore, we shifted from cartilage to Alloderm(R), acellular dermal graft. In the 4th report, made in 2001, we reported that Alloderm(R) is a good substitute for the cartilage and is also an effective volume filler to the atrophic lower lid. The medial portion of the lower lid often presented with a recurrence of the ectropion, despite having tightened the bilateral plication of the medial and lateral canthal ligaments with an Alloderm(R) graft in the inferior border of the tarsus. In order to treat the recurring ectropion, a modified permanent tarsorrhaphy was performed. We have noted that a modified permanent tarsorrhaphy on the medial canthal area in Z-plasty successfully corrected the partial ectropion and resulted in decreased epiphora and increased esthetic satisfaction.
Ankle ; Blindness ; Cartilage ; Corneal Ulcer ; Ectropion* ; Facial Paralysis ; Humans ; Keratitis ; Lacrimal Apparatus Diseases ; Leprosy ; Ligaments ; Recurrence ; Temporal Muscle ; Transplants