At the present day, the metallic rigid fixation is used universally in facial bone fracture surgery. However, these metallic plating system have problems associated with growth restriction in pediatric patients, intracranial migration, increase risk of infection, palpability, and exposure. To overcome these problems, absorbable devices have been developed and used in the reconstruction of pediatric craniofacial deformities before early stages and in the facial bone fracture of adult recently. However, the usefulness of fixation for the force vector affecting region was not verified. From October 2000 to August 2001, absorbable fixation system(BiosorbFX(R) Bionix Implants inc.) was used in 10 open reduction of facial bone fracture with malocclusion; 5 patients with Le Fort I or Le Fort II fracture, 1 patient with maxillary-sagittal fracture, 4 patients with mandible fracture. All the patients, the malocclusion was corrected with no complications, and stabilized fixation was achieved after average 8 months follow up period. These results show usefulness of absorbable devices for fixation of force vector affecting region.
Adult ; Congenital Abnormalities ; Facial Bones* ; Follow-Up Studies ; Humans ; Malocclusion* ; Mandible

Neural tube defects are reported one of the important congenital malformation in the world, with an incidence of 1.4 to 2 per 1000 pregnancies. Maternal serum AFP at the second trimester is used as screening test. But this is associated with numerous causes, including twins, fetal death, misdated pregnancies, cystic hygromas, teratomas, renal abnormalities, esophageal atresia and aberrations in the placenta. If the AFP level was elevated, targeted ultrasonography should be evaluated for confirming the gestational age and fetal viability, fetal number. Then if the ultrasonographic examination is nondiagnostic, or if an NTD is suspected, amniotic fluid AFP should be measured with acetylcholinesterase. But the false positive rate of the AF-AFP is high, and there is 0.3% of the false positive rate in amniotic acetylcholinesterase. This time the women with normal ultrasonographic examination continue the pregnancy after counseling of family history, past history with follow up of ultrasonography. We report a case with elevated second trimester MS-AFP, AF-AFP and positive amniotic acetylcholinesterase, but in which repeated sonographic findings were normal and result in delivery of a healthy baby without anomalies.
Acetylcholinesterase* ; Amniotic Fluid ; Counseling ; Esophageal Atresia ; Female ; Fetal Death ; Fetal Viability ; Follow-Up Studies ; Gestational Age ; Humans ; Incidence ; Lymphangioma, Cystic ; Mass Screening ; Neural Tube Defects ; Placenta ; Pregnancy Trimester, Second ; Pregnancy* ; Teratoma ; Ultrasonography

No abstract available.
Meningitis* ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pneumonia* ; Pneumonia, Mycoplasma*

Classically autologous split-thickness skin graft or flap surgery has been applied to the case of full-thickness skin defects. However, simple skin graft causes postoperative adhesion and scar contracture, and flap surgery could cause functional and aesthetic trouble due to the scar at the donor site. It is well known that the thicker dermis is transplanted, the lesser adhesion and contracture can be resulted. In spite of all advantages, this thicker layer of dermis can also cause pain, infection, hypertrophic scar and delayed healing at the donor site. Two treatments have been developed and applied to solve the problems mentioned above: one is acellular dermal matrix(Alloderm(R)) and the other is Terumo(R) as a silicon coated artificial dermis on the complex of fiberized collagen from calf skin and athecollagen. In the conventional treatment, skin graft is executed when one layer of Terumo(R) or Alloderm(R) is covered and its survival is sure. This method, however, showed certain limits in the appliance: delayed healing time, longer period of hospitalization and limits of dermis supplying, etc. We have applied multi-layer coverage of these materials with simultaneous or delayed skin graft to shorten healing time and to achieve a better effect of dermis. Among those who need flap surgery because of soft tissue defect, or when severe depression or scar contracture can be expected after surgery, a total of 13 cases have been studied: 7 multilayer Alloderm(R) graft with simultaneous thin split-thickness skin graft, and 6 multilayerTerumo(R) graft with delayed skin graft. In all cases, transplants were successful without any difficulties in healing process: no delayed healing time, no functional deficit as contracture, no contour deformity as depression or hypertrophy.
Allografts* ; Cicatrix ; Cicatrix, Hypertrophic ; Collagen ; Congenital Abnormalities ; Contracture ; Depression ; Dermis ; Hospitalization ; Humans* ; Hypertrophy ; Skin ; Tissue Donors ; Transplants

PURPOSE: Ultrasound (US) and US-guided fine needle aspiration biopsies (FNAB) are considered the modalities of choice for assessing lymph nodes suspected of containing metastases, but the sensitivity of FNAB varies and is specific to the operator. We analyzed the risk of FNAB providing false negative results of lateral neck node metastasis, and evaluated diagnostic accuracy of FNAB, in patients with papillary thyroid cancer. MATERIALS AND METHODS: FNAB was performed in 242 patients suspected of having lateral neck node metastasis on preoperative imaging. Thyroglobulin in the fine-needle aspirate washout (FNA wash-out Tg) and computed tomography enhancement (Hounsfield units) were measured. Patients with negative results on FNAB were examined by intraoperative frozen section. The false negative and true negative groups were compared. RESULTS: Of the 242 patients, 130 were confirmed as having lateral neck node metastases. In 74 patients, the metastasis was identified by FNAB. False positive results were observed in 2 patients (0.8%) and false negatives in 58 (44.6%). Risk analysis showed that patient age <45 years (p=0.006), tumor size >1 cm (p=0.008) and elevated FNA wash-out Tg (p=0.004) were significantly associated with false negative results on FNAB. The accuracy of FNAB increased significantly when combined with FNA wash-out Tg (p=0.003). CONCLUSION: To reduce the false negative rate of FNAB, patient age (<45 years), tumor size (>1 cm) and FNA wash-out Tg (>34.8 ng/mL) should be considered in preoperative planning. Accuracy may be improved by combining the results of FNAB and FNA wash-out Tg.
Adolescent ; Adult ; Aged ; Biopsy, Fine-Needle ; Carcinoma/*diagnosis/*pathology/radiography/surgery ; False Negative Reactions ; Female ; Humans ; Lymph Nodes/*pathology/radiography ; Lymphatic Metastasis/*pathology/radiography ; Male ; Middle Aged ; Multivariate Analysis ; Preoperative Care ; Risk Factors ; Sensitivity and Specificity ; Thyroglobulin/metabolism ; Thyroid Gland/*pathology ; Thyroid Neoplasms/*diagnosis/*pathology/radiography/surgery ; Tomography, X-Ray Computed ; Young Adult

PURPOSE: To determine whether gadolinium enhancement is helpful in rectal tumor staging determined by MRI and using an endorectal surface coil. MATERIALS AND METHODS: Between January 1995 and July 1996, we studied 17 MRI scans in which the scanning procedure had involved the use of an endorectal coil ; this was a prostate coil in six patients, and a colon coil in eleven. Eight patients were male and nine were female ; they were aged between 39 and 77 (mean, 59) years, and the tumors which had presented were adenocarcinoma (n=15), lymphoma (n=1) and villous adenoma (n=1). Precontrast scanning showing invasion of the rectal wall and perirectal fat were interpreted, and postcontrast T1WI and pathological findings were then compared. Fifteen patients underwent surgical resection but the other two (one adenocarcinoma and one lymphoma) underwent only an endoscopic biopsy. RESULTS: On precontrast scanning with the prostate coil, accurate staging was possible in three cases (one of stage T2, and two of stage T3) ; we overstaged two cases of stage T2 as stage T3. On postcontrast T1WI, however, we additionally understaged one case of stage T3 as stage T2. In a case of adenocarcinoma proven by biopsy, no definite difference was noted between pre- and postenhanced scan. On precontrast scan using a colon coil, accurate staging was possible in six cases (two of stage T1, one of stage T2 and three of stage T3). We overstaged a case of stage T2 as stage T3 and understaged three cases of stage T3 as stage T2. On postcontrast T1WI, however, we accurately diagnosed one additional case of stage T3, not diagnosed on precontrast scan. In one case of bioptically-proven lymphoma, no definite difference was noted between pre- and postenhanced scan. CONCLUSION: In rectal tumor staging, pre- and postenhanced scans are both 60% accurate. In MRI using an endorectal surface coil, gadolinium enhancement is not, therefore significantly helpful.
Adenocarcinoma ; Adenoma, Villous ; Biopsy ; Colon ; Female ; Gadolinium* ; Humans ; Lymphoma ; Magnetic Resonance Imaging* ; Male ; Prostate ; Rectal Neoplasms*

Seminal vesicle cysts have been rarely detected. Most of them are caused congenitally, and two- thirds of them are accompanied with ipsilateral renal agenesis or dysplasia. They are usually present with dysuria, urinary frequency, perineal pain, epididymitis, pain after ejaculation, scrotal pain or infertility in the second to fourth decade of patient's life. Occasionally cysts are palpable by digital rectal examination, but radiologic imaging study is necessary to diagnose. We report a case of an infant with seminal vesicle cyst accompanied with ipsilateral renal agenesis detected incidentally in postnatal sonogram. The infant's right side of kidney was diagnosed as antenatally multicystic dysplastic kidney.
Congenital Abnormalities ; Digital Rectal Examination ; Dysuria ; Ejaculation ; Epididymitis ; Humans ; Infant ; Infertility ; Kidney ; Kidney Diseases ; Male ; Multicystic Dysplastic Kidney ; Seminal Vesicles

PURPOSE: Although congenital bronchogenic cysts in the cervical region, especially in the thyroid or perithyroidal area, are rare, distinguishing them from other cervical cystic lesions (e.g., thyroglossal duct and branchial cleft cysts) and metastatic cervical lymph nodes is difficult preoperatively. Additionally, cystic degeneration of metastatic lymph nodes is common in patients with thyroid cancer. We investigated the clinical characteristics and proper treatment for individuals with cervical bronchogenic cysts. METHODS: Of the 18,900 patients treated for thyroid cancer, 18 patients with pathologically confirmed bronchogenic cysts were retrospectively reviewed. Bilateral total thyroidectomy or less than total thyroidectomy with central compartment node dissection, including cystic mass excision was done and cystic mass was confirmed by postoperative pathologic examination. RESULTS: All cervical bronchogenic cysts were asymptomatic. Their mean size was 1.2 cm (range, 0.3 to 3 cm). Of these 18 patients, 15 did not have any abnormal radiological findings, except for lymphadenopathy during preoperative evaluations. Most bronchogenic cysts were detected around the thyroid and paratracheal areas. On preoperative imaging and intraoperatively, most were indistinguishable from metastatic cervical lymph nodes or other cystic lesions. CONCLUSION: Although cervical bronchogenic cysts are rare and benign, they should be distinguished from other cystic cervical masses, especially metastatic cervical lymph nodes associated with thyroid cancer. Possible cervical bronchogenic cysts found during thyroid cancer evaluation or surgery should be surgically excised.
Branchial Region ; Bronchogenic Cyst* ; Humans ; Lymph Nodes* ; Lymphatic Diseases ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms* ; Thyroidectomy

We examined the possible anti-inflammatory mechanisms of gabapentin in the attenuation of neuropathic pain and the interaction between the anti-allodynic effects of gabapentin and interleukin-10 (IL-10) expression in a rat model of neuropathic pain. The anti-allodynic effect of intrathecal gabapentin was examined over a 7-day period. The anti-allodynic effects of IL-10 was measured, and the effects of anti-IL-10 antibody on the gabapentin were assessed. On day 7, the concentrations of pro-inflammatory cytokines and IL-10 were measured. Gabapentin produced an anti-allodynic effect over the 7-day period, reducing the expression of pro-inflammatory cytokines but increasing the expression of IL-10 (TNF-alpha, 316.0 +/- 69.7 pg/mL vs 88.8 +/- 24.4 pg/mL; IL-1beta, 1,212.9 +/- 104.5 vs 577.4 +/- 97.1 pg/mL; IL-6, 254.0 +/- 64.8 pg/mL vs 125.5 +/- 44.1 pg/mL; IL-10, 532.1 +/- 78.7 pg/mL vs 918.9 +/- 63.1 pg/mL). The suppressive effect of gabapentin on pro-inflammatory cytokine expression was partially blocked by the anti-IL-10 antibody. Expression of pro-inflammatory cytokines was significantly attenuated by daily injections of IL-10. The anti-allodynic effects of gabapentin may be caused by upregulation of IL-10 expression in the spinal cord, which leads to inhibition of the expression of pro-inflammatory cytokines in the spinal cords.
Amines/pharmacology/*therapeutic use ; Analgesics/pharmacology/*therapeutic use ; Animals ; Antibodies/immunology/pharmacology ; Behavior, Animal/drug effects ; Cyclohexanecarboxylic Acids/pharmacology/*therapeutic use ; Cytokines/*metabolism ; Disease Models, Animal ; Injections, Spinal ; Interleukin-10/genetics/immunology/*metabolism ; Male ; Neuralgia/*drug therapy/metabolism/pathology ; Rats ; Rats, Sprague-Dawley ; Recombinant Proteins/biosynthesis/genetics/pharmacology ; Spinal Cord/metabolism ; Up-Regulation ; gamma-Aminobutyric Acid/pharmacology/*therapeutic use

Citalopram and paroxetine are selective serotonin reuptake inhibitors and also have antinociceptive effects. We investigated the antiallodynic and antihyperalgesic effects of intrathecally administered morphine, citalopram, paroxetine, and combinations thereof, in a rat model in which peripheral inflammation was induced by complete Freund's adjuvant (CFA). Drugs were intrathecally administered via direct lumbar puncture. Mechanical allodynia was measured using a Dynamic Plantar Aesthesiometer. Thermal hyperalgesia and cold allodynia were determined by measuring latency of paw withdrawal in response to radiant heat and cold water. Behavioral tests were run before and 15, 30, 45, and 60 min after intrathecal injection. Intraplantar injection of CFA produced mechanical allodynia, thermal hyperalgesia, and cold allodynia. Intrathecally administered morphine (0.3 or 1 microg) had antiallodynic or antihyperalgesic effects (24.0%-71.9% elevation). The effects of morphine were significantly increased when a combination of citalopram (100 microg) and paroxetine (100 microg) was added (35.2%-95.1% elevation). This rise was reversed by naloxone and methysergide. The effects of citalopram and paroxetine were also reversed by naloxone and methysergide. We suggest that the mu opioid receptor and serotonin receptors play major roles in production of the antiallodynic and antihyperalgesic effects of morphine, citalopram, paroxetine, and combinations thereof, in animals experiencing inflammatory pain.
Analgesics, Opioid/administration & dosage/*pharmacology ; Animals ; Behavior, Animal/drug effects ; Citalopram/administration & dosage/pharmacology ; Disease Models, Animal ; Hyperalgesia/etiology ; Inflammation/*chemically induced/pathology ; Injections, Spinal ; Male ; Morphine/administration & dosage/*pharmacology ; Pain/*prevention & control ; Pain Measurement ; Pain Threshold/drug effects ; Paroxetine/administration & dosage/pharmacology ; Rats ; Rats, Sprague-Dawley ; Receptors, Serotonin/*chemistry/metabolism ; Serotonin Uptake Inhibitors/administration & dosage/*pharmacology ; Temperature ; Time Factors