Distraction osteogenesis has become an alternative technique to treat craniomaxillofacial anomalies. It was initially used to treat mandibular dysplasia and now it is applied to other regions of the craniofacial skeleton. We now present our clinical experience of midface distraction with the use of rigid external distraction for the treatment of an 8-years-old girl with midface hypoplasia in Crouzon's disease, who had undergone fronto-orbital advancement at the age of 6. We performed midface advancement by Le Fort III osteotomy with rigid external distraction system(RED II, KLS Martin, Jacksonville, FL). The active distraction was initiated on the 3rd postoperative day and was continued until the 20th postoperative day for 18 days. The rate of distraction can be adjusted during this time according to clinical judgment and cephalometric assessment. On completion of distraction, the RED II was left in place without activation for 25 days for rigid retention. The RED II was then removed and an orthodontic facemask was applied with elastic traction for 6wks. The total amount of distraction was 18.5mm, 28.5mm, 10.5mm, 14.5mm at right inferior orbital rim, left inferior orbital rim, right intraoral, left intraoral area respectively. The photography, cephalometry, and 3D CT(3 dimensional computed tomography) show that facial convexity was improved. We could correct midface deficiency successfully by LeFort III osteotomy and rigid external distraction.
Cephalometry ; Craniofacial Dysostosis* ; Female ; Humans ; Judgment ; Orbit ; Osteogenesis, Distraction ; Osteotomy ; Photography ; Skeleton ; Traction

Purpose: The purpose of this study was to evaluate the usefulness of multiphasic CT and 18 F-fluorodeoxyglucose (FDG) PET/CT for the differentiation of combined hepatocellular carcinomacholangiocarcinoma (cHCC-CCA) from hepatocellular carcinoma (HCC). Materials and Methods: From January 2007 to April 2016, 93 patients with pathologically confirmed HCC (n = 84) or cHCC-CCA (n = 9) underwent CT and PET/CT imaging. Contrast enhancement patterns were divided into three types based on the attenuation of the surrounding liver parenchyma: type I (early arterial enhancement with delayed washout), type II (early arterial enhancement without delayed washout), and type III (early hypovascular, infiltrative appearance, or peripheral rim enhancement). Results: cHCC-CCAs (89%) had a higher PET/CT positive rate than did HCCs (61%), but the PET/ CT positive rate did not differ significantly (p = 0.095). Among the 19 cases of the type II enhancement pattern, 3 (21%) of 14 HCCs and 4 (80%) of 5 cHCC-CCAs were PET/CT positive. cHCC-CCAs had a significantly higher PET/CT positive rate (p = 0.020) in the type II enhancement pattern. Conclusion The PET/CT positive rate of cHCC-CCA was significantly higher than that of HCC in lesions with a type II enhancement pattern. The 18 F-FDG PET/CT can be useful for the differentiation of cHCCCCA from HCC in lesions with a type II enhancement pattern on multiphasic CT.

Purpose: The purpose of this study was to evaluate the usefulness of multiphasic CT and 18 F-fluorodeoxyglucose (FDG) PET/CT for the differentiation of combined hepatocellular carcinomacholangiocarcinoma (cHCC-CCA) from hepatocellular carcinoma (HCC). Materials and Methods: From January 2007 to April 2016, 93 patients with pathologically confirmed HCC (n = 84) or cHCC-CCA (n = 9) underwent CT and PET/CT imaging. Contrast enhancement patterns were divided into three types based on the attenuation of the surrounding liver parenchyma: type I (early arterial enhancement with delayed washout), type II (early arterial enhancement without delayed washout), and type III (early hypovascular, infiltrative appearance, or peripheral rim enhancement). Results: cHCC-CCAs (89%) had a higher PET/CT positive rate than did HCCs (61%), but the PET/ CT positive rate did not differ significantly (p = 0.095). Among the 19 cases of the type II enhancement pattern, 3 (21%) of 14 HCCs and 4 (80%) of 5 cHCC-CCAs were PET/CT positive. cHCC-CCAs had a significantly higher PET/CT positive rate (p = 0.020) in the type II enhancement pattern. Conclusion The PET/CT positive rate of cHCC-CCA was significantly higher than that of HCC in lesions with a type II enhancement pattern. The 18 F-FDG PET/CT can be useful for the differentiation of cHCCCCA from HCC in lesions with a type II enhancement pattern on multiphasic CT.

Renal thromboembolism almost always occurs in the setting of cardiac disease. Acute renal infarction may occur rarely in middle-aged patients without apparent risk factors for cardiac thromboembolism. We report a 40-year-old man who developed bilateral renal infarction and had no cardiovascular risk factors, except smoking. In middle-aged healthy patients with renal colic without lithiasis, the diagnosis of idiopathic renal infarction should be considered, especially if lactate dehydrogenase is elevated.
Adult ; Heart Diseases ; Humans ; Infarction ; Kidney ; L-Lactate Dehydrogenase ; Lithiasis ; Renal Colic ; Risk Factors ; Smoke ; Smoking ; Thromboembolism

The proliferation of high-technology infusion devices has greatly influenced the practice of anesthesia by allowing precise delivery intraoperatively and postoperatively of intravenous anesthetics, analgesics, and vasopressors. During continuous drug administration to pediatric patients, unfavorable pharmacologic effects have occured. These effects were attributed to variations in flow from infusion devices. The intent of this investigation was to evaluate the influence of infusion devices on the accuracy and continuity effused fluid. Hartmann's solution was run through eight infusion pump at 5, 10, 15, 20, 25, 30, 40, 60, 80 and 100ml/hr. The volume of the fluid was measured for one hour at each flow rate using a infusion device analyzer(IDA-2) in vitro. Flow accuracy(ml/hr) was calculated by dividing the effused volume by the effusion time ; this value was subsequently expressed as a percentage of the desired flow rate. Flow continuity was expressed by the coefficient of variance(CV); analysis of variance with SAS was used for comparisons. Results were as follows ; 1) The flow accuracy values ranged from 98.8% to 114.2% of the desired rate. 2) Seven infusion pumps had flow rates within 5% of the desired rates at each flow rate but one pump had more than 10% of desired rate. 3) Each of the respective infusion pumps produced various levels of flow continuity and ranged from 0.7% to 2.5%(CV value). Conclusion , further evaluations are needed to differentiate continuity from other infusion devices(e.g., syringe infusion pump) in vitro and evaluations are needed to define the clinical significance in vivo. Future use of flow-rate data will likely be of significant value in establishing policies and procedures for the utilization of infusion devices and guidelines for product selection.
Analgesics ; Anesthesia ; Anesthetics, Intravenous ; Humans ; Infusion Pumps ; Syringes

OBJECTIVE: This study was performed to evaluate the influence of maternal age on embryo quality and the frequency of multiple pregnancy in IVF-ET program. METHOD: 86 conventional IVF-ET cycles were divided into three groups according to the age by 5 year (group A: 26-30, group B: 3135, group C: 36-40 yrs). The in vitro fertilization and development outcome (fertilization, cleavage and high quality embryo rate) and the pregnancy outcome (pregnancy, implantation, G-sac/high quality embryo and multiple pregnancy rate) were examined. And then, these results were compared among the groups. RESULTS: The rates of fertilization (62.7, 68.5 and 65.4%, respectively) and cleavage (95.6, 97.6 and 98.0%, respectively) were not different among the groups. And the high quality embryo (HQE) rate also was not different among the groups (61.8, 62.9 and 62.8%, respectively). The pregnancy rate of group C (23.3%) was significantly lower than that of group A (41.2%) and B (48.7%). And the implantation rate was significantly decreased to group B (32.2%) and C (14.3%) when compared to group A (71.4%) and B (36.8%). CONCLUSION: The pregnancy rate was significantly decreased over 35 years. The G-sac/HQE and multiple pregnancy rate were significantly high below 31 years. Thus, these results suggest that the number of high quality embryo transferred should be limited by the age and another criteria for embryo quality evaluation were required for single embryo transfer.
Embryonic Structures* ; Female ; Fertilization ; Fertilization in Vitro ; Maternal Age* ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate ; Pregnancy, Multiple* ; Single Embryo Transfer

Neurostenalgia is a neuropathic pain that results from continuing irritation of an anatomically intact nerve by a noxious agent. The pain resolves promptly after surgical release of the nerve. The authors report a case of neurostenalgia of the radial nerve in which the posterior interosseous branch was compressed at the arcade of Frohse, presenting with severe arm and elbow pain. The pain was immediately relieved after surgical release of the nerve.
Arm ; Elbow ; Neuralgia ; Radial Nerve*

Bilateral mandibular hypoplasia is found in Treacher Collins syndrome, Pierre Robin sequence, and bilateral craniofacial microsomia. It causes many aesthetic and functional problems such as facial deformities with malocclusion and airway problems. We have corrected bilateral hypoplastic mandible with distraction osteogenesis, which is a highlighted method in mandibular lengthening. For last 3 years 8 months, We applied this method to four bilateral cases, where were Treacher Collins syndrome patients and bilateral craniofacial microsomia patient in rapid multidirectional fashion. A complete ostectomy was made at angle of the mandible and the mandible was fixed 5 days after lengthening was started serially 1mm every 12 hours. After consolidation period for one to three month, the device was removed. We have distracted the mandibles in vertical plane, left.18.8mm, right. 13.4mm, in horizontal plane, left 13.9mm, right 13.7mm on the average. We could achieve good aesthetic results, and their airway problems were improved without any complications.
Congenital Abnormalities ; Goldenhar Syndrome ; Humans ; Malocclusion ; Mandible* ; Mandibulofacial Dysostosis ; Osteogenesis, Distraction ; Pierre Robin Syndrome

PURPOSE: To investigate the problems of the Hanaro stent (Solco Intermed, Seoul, Korea) when used in the palliative treatment of patients with inoperable malignant biliary obstruction. MATERIALS AND METHODS: Between January 2000 and May 2001, the treatment of 46 patients with malignant biliary obstruction involved percutaneous placement of the Hanaro stent. Five patients encountered problems during removal of the stent's introduction system. The causes of obstruction were pancreatic carcinoma (n=2), cholangiocarcinoma (n=2), and gastric carcinoma with biliary invasion (n=1). In one patient, percutaneous transhepatic cholangiography and stent insertion were performed as a one-step procedure, while the others underwent conventional percutaneous transhepatic biliary drainage for at least two days prior to stent insertion. A self-expandable Hanaro stent, 8-10 mm in deameter and 50-100 mm in lengh, and made from a strand of nitinol wire, was used in all cases. RESULTS: Among the five patients who encountered problems, breakage of the olive tip occourred in three, upward displacement of the stent in two, and improper expansion of the distal portion of the stent, unrelated with the obstruction site, in one. The broken olive tip was pushed to the duodenum in two cases and to the peripheral intrahepatic duct in one. Where the stent migrated during withdrawal of its introduction system, an additional stent was inserted. In one case, the migrated stent was positioned near the liver capsule and the drainage catheter could not be removed. CONCLUSION: Although the number of patients in this study was limited, some difficulties were encountered in withdrawing the stent's introduction system. To prevent the occurrence of this unusual complication, the stent should be appropriately expansile, and shape in the olive tip shoud be considered.
Catheters ; Cholangiocarcinoma ; Cholangiography ; Drainage ; Duodenum ; Humans ; Liver ; Olea ; Palliative Care ; Seoul ; Stents*

Acquired perforating dermatosis (APD) is a skin disorder occurring in the patients with chronic renal failure (CRF), diabetes mellitus (DM) or both. The purpose of this study was to clarify the clinical and histopathological features of APD, and evaluate role of scratching in the pathogenesis of APD. Twelves patients with APD associated with CRF and DM were enrolled in the study. In six patients who required hemodialysis, the lesions appeared 2-5 yr (mean 3 yr) after the initiation of dialysis, 18-22 yr (mean 19.3 yr) after the occurrence of DM. The other patients who did not receive hemodialysis noted the lesions 4-17 yr (mean 9.5 yr) after the onset of DM. All patients had an eruption of generally pruritic keratotic papules and nodules, primarily on the extensor surface of the extremities and the trunk. The histologic features of our cases showed a crateriform invagination of the epidermis filled by a parakeratotic plug and basophilic cellular debris. The period of treatment for patients who suffered from severe (7 cases) or very severe (3 cases) on the pruritus intensity was longer than that of patients who had mild pruritus (2 cases). These data showed that scratching appear to play a critical part in the pathogenesis of APD.
Adult ; Aged ; Diabetes Mellitus, Type I/*complications ; Diabetes Mellitus, Type II/*complications ; Female ; Histamine H1 Antagonists/therapeutic use ; Human ; Kidney Failure, Chronic/*complications ; Male ; Middle Aged ; Phototherapy ; Pruritus/drug therapy/etiology ; Skin Diseases/drug therapy/*etiology/pathology ; Tranquilizing Agents/therapeutic use