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

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

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

Cryptococcosis is recognized as one of the most important complications in an organ transplant recipient. Cryptococcosis occurs in 2.5-39% of renal transplant recipients. This infection generally presents as symptomatic disseminated disease with an accelerated clinical course, involves multiple sites including the central nervous system, lungs, and skin. And if diagnosis or treatment is delayed, the prognosis is generally poor. The asymptomatic infection is rare and there are no case reports of asymptomatic disseminated cryptococcosis after renal transplantation in Korea. We experienced a case of asymptomatic cryptococcal multi-organ infection detected incidentally in a 51-year-old male received a living related renal transplant 35 months earlier for end-stage renal disease due to diabetic nephropathy. We treated successfully with amphotericin B and fluconazole and hereby report this case with a review of the relevant literature.
Amphotericin B ; Asymptomatic Infections ; Central Nervous System ; Cryptococcosis ; Diabetic Nephropathies ; Fluconazole ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation ; Korea ; Lung ; Male ; Middle Aged ; Prognosis ; Skin ; Transplants

Peritonitis is a major cause of morbidity in continuous ambulatory peritoneal dialysis (CAPD) patients. Achromobacter xylosoxidans is a rarely reported cause of peritonitis in CAPD patients. In this report, a peritonitis case due to Achromobacter xylosoxidans in a 60-year-old male patient with end-stage renal failure receiving CAPD for 7 years, has been reported. White blood cell (WBC) count in peritoneal fluid was 3,160/mm3 with 95% neutrophil. Gram staining of the peritoneal fluid yielded gram negative rod. Empirical antibiotic therapy with ceftriaxone was initiated intraperitoneally. But drug sensitivity test revealed these regimens were resistant. On fourth hospital day, Achromobacter xylosoxidans was cultured from peritoneal effluent, the antibiotic regimen was switched to piperacillin/tazobactam intraperitoneally. The patient rapidly recovered and the WBC count of the peritoneal effluent decreased. The therapy was continued for 14 days and then the patient was discharged. The peritoneal catheter was not removed.
Achromobacter ; Achromobacter denitrificans ; Ascitic Fluid ; Catheters ; Ceftriaxone ; Humans ; Kidney Failure, Chronic ; Leukocytes ; Male ; Middle Aged ; Neutrophils ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis