The presence of epicanthal folds in Asian eyelids is one of their unique features, in combination with the lack of supratarsal folds. Western culture has influenced many people to prefer to eliminate the prominent epicanthal fold. A number of surgical techniques have been suggested for their correction. However, difficulty with design, excessive and prominent scarring of medial canthal and nasal area, recurrence, and rigidity of application are potential problems associated with many procedures. This paper describes a epicanthoplasty with three-dimensional Z-plasty. Through epicanthal fold incision, the medial canthal tecdon is medially advanced and sutured to the periosteum of nasal bone. After the transposition of the flaps, trimming of the flap is usually required. Three-dimensional Z-plasty crates the attactive eyes. From March, 1995 to March, 1997, the technique was applied to 37 patients with epicanthal fold and was performed with or without double-fold operation. There were 34 females and 3 males with ages ranging from 17 to 30 years. Through 2 years follow-up, this techniques has delivered esthetically good results with minimal postoperative scar and could made the reduction of ICD from 40 +/- 2.13mm to 34 +/- 1.98mm. The advantages of epicanthoplasty procedure using three-dimensional Z-plasty(Yoon's method) are as follows; 1) simple in design 2) minimal postoperative scar in the medial canthal area 3) versatile in its application 4) no recurrence 5) no hypertrophic scar 6) preserving ethnic identity.
Asian Continental Ancestry Group ; Cicatrix ; Cicatrix, Hypertrophic ; Eyelids ; Female ; Follow-Up Studies ; Humans ; Male ; Nasal Bone ; Periosteum ; Recurrence

BACKGROUND: Early esophageal cancer has a good prognosis compared with advanced esophageal cancer, so early detection of the cancer is emphasized. Early esophageal cancer is considered as esophageal cancer located within the submucosal layer and without metastasis in the operative specimen. Despite this criterion, evidence has accumulated suggesting that submucosal tumors have a very different prognosis from intra-epithelial and intramucosal lesions. The purpose of this study is to define the characteristics of and the appropriate operative method for esophageal cancer. METHODS: Medical records of 19 patients who had received an esophagectomy and who had been diagnosed as having early esophageal cancer between 1981 and 1996 at this hospital were reviewed. RESULTS: There was 17 cases of submucosal lesions and 2 cases of mucosal lesions. 74% of the patients had alcohol or smoking history. When endoscopic findings were classified according to the endoscopic classification of JSED, there were 5 cases of type 0-I, 4 cases of type 0-III, 4 cases of type 1, and others. Type 0-I and 0-III were common. The accuracy of the endoscopic ultrasonographic finding was 39% compared with the postoperative pathologic finding. The mean duration of follow-up was 21 months, and there were 2 recurrences during follow-up. One recurred 13 months after the operation and the other 23 months after the operation. Both of them were submucosal lesions and received a transhiatal esophagectomy. CONCLUSIONS: Annual endoscopic examination with lugol staining may be needed for early detection of esophageal cancer. Submucosal lesions of early esophageal cancer should be managed with an esophagectomy and lymph node dissection. Also, expertness of the endoscopist is very important in deciding on an of operative method.
Classification ; Esophageal Neoplasms* ; Esophagectomy ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Medical Records ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Smoke ; Smoking

We report a case of Castleman`s disease of the hyaline-vascular type which was located in retroperitoneum. A 20-year-old girl was admitted because of a history of postprandial epigastric discomfort. Computed tomography of the abdomen demonstrated a solid 7 x 7 cm mass between the abdominal aorta and the left kidney in the retroperitoneum. At surgery, a solid 9 x 8 x 6 cm tumor was resected. Pathologic diagnosis was Castleman`s disease of the hyaline-vascular type.
Abdomen ; Aorta, Abdominal ; Diagnosis ; Female ; Humans ; Kidney ; Young Adult

PURPOSE: To investigate the incidence of thromboembolic events and complications related to bleeding after total knee arthroplasty (TKA) with a mechanical compression device alone or in combination with low-molecular-weight heparin (LMWH). MATERIALS AND METHODS: A total of 489 TKA patients (776 knees) were retrospectively reviewed for the incidence of thromboembolic events and complications related to bleeding. While 233 patients (354 knees) were treated with a mechanical compressive device without LMWH, 256 patients (422 knees) were treated with the mechanical compressive device along with LMWH. RESULTS: The incidences of deep vein thrombosis (DVT) and pulmonary embolism (PE) were 15 of 375 knees (4.0%) and 5 of 375 knees (1.3%), respectively, in the group that used only a mechanical compressive device, and 14 of 401 knees (3.4%) and 5 of 401 knees (1.2%), respectively, in the group that used the mechanical compressive device with LMWH. There was no significant difference between the two groups (p=0.125 and p=0.146, respectively). The postoperative hemovac drainage amount was 635±57 mL in the group with a mechanical compressive device only and 813±84 mL in the group with the device and LMWH; therefore, the amount of drainage was significantly greater in the latter group (p=0.013). CONCLUSIONS: Mechanical compression alone for prophylaxis against DVT and PE after TKA can be an attractive option in Korean patients.
Arthroplasty ; Arthroplasty, Replacement, Knee ; Drainage ; Hemorrhage ; Heparin, Low-Molecular-Weight ; Humans ; Incidence ; Knee ; Pulmonary Embolism ; Retrospective Studies ; Thromboembolism ; Venous Thrombosis

It has been well known that long-term immune suppression in renal transplant patients increases the possibility of complications. Infectious disease is one of the representative complications. We experienced a case of nocardiosis with cytomegalovirus infection after third renal transplantation in China. Nocardiosis is an important opportunistic infection in immunosuppressed patients, lymphoma, sarcoidosis, and organ transplant patients. CMV can cause severe hepatitis, pneumonitis, enteritis, endometritis, and encephalitis. It can depress bone marrow, and impair the immune system so as to increase other bacterial infection and trigger rejections. Third renal transplantation causes long-term immune suppression or over-immune suppression on transplant patients. Very few cases of third renal transplantation have been reported in Korea. We reduced the dose of immune- suppressants, and treated it successfully with ganciclovir and Trimethoprim/Sulfamethoxazole (Bactrim(R)).
Bacterial Infections ; Bone Marrow ; China* ; Communicable Diseases ; Cytomegalovirus ; Cytomegalovirus Infections ; Encephalitis ; Endometritis ; Enteritis ; Female ; Ganciclovir ; Hepatitis ; Humans ; Immune System ; Kidney Transplantation* ; Korea ; Lymphoma ; Nocardia Infections* ; Opportunistic Infections ; Pneumonia ; Sarcoidosis ; Transplants

No abstract available.
Glutathione* ; Oligodendroglia*

Kidney transplantation (KTP) lowers the mortality and morbidity of patients with end-stage renal disease. Post-transplantation infection and antibody mediated rejection (AMR) are the most common complications. Hepatitis B surface antigen (HBsAg) positive carrier donors and high anti A/B antibody titer ABO incompatible KTP could lead to recipient hepatitis B virus (HBV) infection and AMR. Here, we report a case of successful KTP in a 41-year-old male with a high titer of ABO incompatible and HBsAg positive donor. He underwent seven rounds of plasmapheresis, low dose intravenous immunoglobulin and rituximab treatment to inhibit antibody production and remove antibodies from the serum, after which he was administered anti-viral agent for HBV prophylaxis. The recipient maintained successful allograft function for 6 months after transplantation; therefore, we report that desensitization and anti-viral treatment achieved successful outcome in a 1:512 anti A/B antibody titer ABO incompatible and hepatitis B carrier donor KTP.
Adult ; Allografts ; Antibodies ; Antibody Formation ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Hepatitis B* ; Hepatitis* ; Humans ; Immunoglobulins ; Kidney Failure, Chronic ; Kidney Transplantation* ; Kidney* ; Male ; Mortality ; Plasmapheresis ; Rituximab ; Tissue Donors

Goodpasture's syndrome is a clinical complex of anti-GBM (glomerular basement membrane) nephritis and lung hemorrhage. Anti-GBM nephritis is an autoimmune disease in which autoantibodies directed against type IV collagen induce RPGN (rapid progressive glomerulonephropathy) and crescentic glomerulonephritis. 50 to 70% of patients have pulmonary hemorrhage. We have one case of a successful renal transplantation in a patient with Goodpasture's syndrome. A 51 year old male had arrived in the emergency room due to dyspnea. 20 days prior to admission he had suffered from fever and then progressively developed nausea and weakness. He underwent hemodialysis with the dual lumen catheter which was inserted in the right internal jugular vein. Goodpasture's syndrome was confirmed by the measurement of serum anti-GBM Ab titer, renal biopsy and clinical manifestations of pulmonary hemorrhage. Renal biopsy findings showed diffuse proliferative glomerulonephritis on light microscopy and linear ribbon-like deposition of IgG along the GBM. The patient was placed on CAPD on the 30th hospital day. After six months of CAPD, the patient received a renal transplant from a HLA-haploidendical brother. Which was done after negative seroconversion of circulating antibody of GBM. With a induction of IL-2 receptor blocker (Basiliximab), cyclosporine-A and prednisone were administered for their immunosuppressants. He had good health for 37 months with excellent graft function.
Anti-Glomerular Basement Membrane Disease* ; Autoantibodies ; Autoimmune Diseases ; Biopsy ; Catheters ; Collagen Type IV ; Dyspnea ; Emergency Service, Hospital ; Fever ; Glomerulonephritis ; Hemorrhage ; Humans ; Immunoglobulin G ; Immunosuppressive Agents ; Jugular Veins ; Kidney Transplantation* ; Lung ; Male ; Microscopy ; Middle Aged ; Nausea ; Nephritis ; Peritoneal Dialysis, Continuous Ambulatory ; Prednisone ; Receptors, Interleukin-2 ; Renal Dialysis ; Siblings ; Transplants

Acute antibody-mediated rejection is the major cause of graft failure in the early stage of kidney transplantation. Preoperative treatment and early diagnosis of acute rejection is very important to prevent graft loss in sensitized patients. High panel reactive antibody (PRA) means a likelihood of acute rejection, and the recipient of high PRA needs adequate pretreatment for kidney transplantation. However, there is not sufficient time and chances for desensitization in deceased kidney transplants. We report a successful renal transplant outcome in a 47-year-old-woman with high PRA levels (Class I 97.5%, Class II 36.7%). The cross match was negative on the CDC (ELISA) and flowcytometric methods. Plasma exchange was performed on the recipient before transplantation (fresh frozen plasma replacement, 1.3 plasma volume) and immediately after plasma exchange she was given 200 mg of rituximab. She received basiliximab and methyl prednisolone induction therapy and was maintained on steroids, mycophenolate mofetil, and tacrolimus. Graft function was normal immediately after transplantation, but decreased urinary output and elevated serum creatinine was noted on POD 5. On POD 6, a graft biopsy revealed acute cellular rejection (Type IIa) and antibody-mediated rejection (Type II). On 9~13 days after transplantation, additional plasma exchange was performed every other day, and steroid pulse therapy was performed 3 times. After normalization of urinary output and serum creatinine, the patient was discharged and is being followed up on. In conclusion, immunologically careful preparation and pretransplant treatment may be needed on the negative cross match in cadaveric kidney recipients with high levels of PRA.
Antibodies, Monoclonal ; Antibodies, Monoclonal, Murine-Derived ; Biopsy ; Cadaver ; Centers for Disease Control and Prevention (U.S.) ; Creatinine ; Early Diagnosis ; Graft Rejection ; Humans ; Immunization ; Kidney ; Kidney Transplantation ; Mycophenolic Acid ; Plasma ; Plasma Exchange ; Prednisolone ; Recombinant Fusion Proteins ; Rejection (Psychology) ; Rituximab ; Steroids ; Tacrolimus ; Tissue Donors ; Transplants

No abstract available.
Eosinophilia* ; Fever* ; Glomerulonephritis*