BACKGROUND AND OBJECTIVES: Percutaneous intervention has become an established technique in the treatment of peripheral arterial obstructive disease. This study was performed to evaluate the procedural success and long-term outcome of percutaneous intervention of the superficial femoral artery (SFA), and to determine the factors that influence the long-term outcome. SUBJECTS AND MEHTODS: Eighty-eight consecutive lesions, in 76 subjects (mean age 65) with chronic lower limb ischemia and SFA obstruction, diagnosed with angiography were included in this study. The angiographic success was defined as residual stenosis <30% and the clinical success as an improvement by at least one clinical category. The clinical patency was defined as an absence of symptom recurrence and target lesion revascularization during the follow up period. The predictors of the outcome were also determined. RESULTS: Balloon angioplasty only was performed in 39 lesions and thrombolysis only in 2, whereas stenting was performed in 47 lesions. Seventy four of the 88 attempts (84%) at recanalization were angiographically successful, while 73 (83%) experienced clinical improvement. The twelve month patency was 67%. Critical ischemia (versus intermittent claudication)(relative risk 4.2, p=0.020) and renal failure (relative risk 4.1, p=0.016) were independent negative predictors of the patency. CONCLUSION: Percutaneous intervention of the SFA yielded a high procedural success rate, with an acceptable long-term outcome. Symptoms of critical ischemia and renal failure were predictive of a low long-term patency.
Angiography ; Angioplasty ; Angioplasty, Balloon ; Arterial Occlusive Diseases ; Constriction, Pathologic ; Femoral Artery* ; Follow-Up Studies ; Ischemia ; Lower Extremity ; Outcome Assessment (Health Care) ; Recurrence ; Renal Insufficiency ; Stents

PURPOSE: The cephalic index (CI) is used to classify the head and every race has its unique characteristics. Previous studies published in Korea were limited to demonstrating the periodical change of the CI. This study was done to determine the CI change in 0 to 20 year-old Koreans by sex and age. METHODS: The measurement was done on 1,222 Koreans ranging from 0 to 20 years of age, randomly selected from 2,156 who were diagnosed with simple concussion, had no other diseases or anomalies, and took cephalographs from January, 2000 to July, 2008. The files were obtained from Marosis(R) and then photogrammetry was done by Photoshop(R). To standardize the cephalograph, the Frankfort horizontal line was selected as the reference line on lateral view and the line connecting both lateral-orbitales on AP view. The maximal length was obtained from the lateral cephalograph and the maximal breadth from the AP cephalograph. RESULTS: The CI showed no difference by sex (p=0.4848). The CI and age showed negative correlation (p<0.0001). Analyzed separately by the male and the female, the CI showed statistical significance in the male (p<0.0001), but not in the female (p=0.4741) group. Comparing the CI above the age of 11, the CI of the female became greater than that of the male. CONCLUSION: This study contributes to the standardization of CI measurement and the authors were able to obtain the average CI by age. We concluded that the CI decreased according to age and most Koreans belonged to barchycephalic or hyperbrachycephalic.
Continental Population Groups ; Female ; Head ; Humans ; Korea ; Male ; Photogrammetry

BACKGROUND AND OBJECTIVES: This study is to prospectively compare and analyze the aerodynamic changes in the patients with thyroid cancer before and after surgery. Changes in vocal function before and after thyroidectomy were examined using aerodynamic and related assessments. MATERIALS AND METHODS: Twenty one patients were evaluated preoperatively, 5-7 days and 6-7 weeks postoperatively to assess aerodynamic outcomes after thyroidectomy. Glottal input power (GIP), glottal efficiency (GE) and maximum phonation time (MPT), were determined the time of before surgery, 5-7 days after surgery and 6-7 weeks after surgery. RESULTS: According to the comparison analysis of the three periods, GIP with /pi/ phonation was significantly reduced at time of 5-7 days and 6-7 weeks after surgery, but not in the /p(h)i /and /p'i/ phonations. GE was significantly reduced in the /pi/, /p(h)i/ and /p'i/ phonations at time of 5-7 days and 6-7 weeks after surgery. MPT was significantly reduced at time of 5-7 days after surgery significantly. CONCLUSION: Aerodynamic assessment showed systematic changes in vocal function associated with thyroidectomy. These results should be useful data for vocal management in individuals who have had thyroidectomy and for assessment of voice disorders in clinical settings.
Humans ; Phonation ; Prospective Studies ; Thyroid Neoplasms ; Thyroidectomy* ; Voice Disorders ; Voice*

PURPOSE: Partial necrosis of skin flaps remains a substantial problem in reconstructive surgery. We investigated the potential use of an adenovirus vector encoding the VEGF, COMP-angiopoietin-1 gene in an attempt to promote the viability of the inferior epigastric artery flap in a rat model. METHODS: Three by six cm lower abdominal transverse skin flaps, supplied only by the left inferior epigastric artery, were designed. After skin flap elevation, the adenovirus VEGF and adenovirus COMP-angiopoietin-1 were injected into the distal portion of the flap, which has a high tendency of developing flap ischemia. Control animals were injected with the same volume of normal saline. On 3, 7 and 14 days after the flap elevation, the flap survival and vascularization were assessed using Visitrak digital(R), CD31 immunohistochemistry in addition to evaluating the general histological characteristics. RESULTS: There was a significant increase in the mean percentage of flap viability by 89.8%, 91.1% and 94.8% in flaps transfected with adenovirus VEGF, COMP- angiopoietin-1, coadministraion of VEGF and COMP- angiopoietin-1 at seven days, and by 95.6%, 94.8% and 96.3% at 14 days. Histological assessment revealed that there were more blood vessels formed after adenovirus with VEGF, COMP-angiopoietin-1 or VEGF plus COMP- angiopoietin-1 than with adenovirus Lac Z. CONCLUSION: The results of this study suggest that adenovirus-mediated VEGF, COMP-angiopoietin-1 gene therapy, promote therapeutic angiogenesis in patients that undergo reconstructive procedures. Key Words:
Adenoviridae ; Angiopoietin-1 ; Animals ; Blood Vessels ; Epigastric Arteries ; Genetic Therapy ; Humans ; Immunohistochemistry ; Ischemia ; Necrosis ; Rats ; Skin ; Vascular Endothelial Growth Factor A

BACKGROUND AND OBJECTIVES: To evaluate the relationship between age and anesthesia method used for tympanostomy tube insertion (TTI) and to provide evidence to guide the selection of an appropriate anesthesia method in children. SUBJECTS AND METHODS: We performed a retrospective review of children under 15 years of age who underwent tympanostomy tube insertion (n=159) or myringotomy alone (n=175) under local or general anesthesia by a single surgeon at a university-based, secondary care referral hospital. Epidermiologic data between local and general anesthesia groups as well as between TTI and myringotomy were analyzed. Medical costs were compared between local and general anesthesia groups. RESULTS: Children who received local anesthesia were significantly older than those who received general anesthesia. Unilateral tympanostomy tube insertion was performed more frequently under local anesthesia than bilateral. Logistic regression modeling showed that local anesthesia was more frequently applied in older children (odds ratio=1.041) and for unilateral tympanostomy tube insertion (odds ratio=8.990). The cut-off value of age for local anesthesia was roughly 5 years. CONCLUSIONS: In a pediatric population at a single medical center, age and whether unilateral or bilateral procedures were required were important factors in selecting an anesthesia method for tympanostomy tube insertion. Our findings suggest that local anesthesia can be preferentially considered for children 5 years of age or older, especially in those with unilateral otitis media with effusion.
Anesthesia* ; Anesthesia, General ; Anesthesia, Local ; Child ; Humans ; Logistic Models ; Middle Ear Ventilation* ; Otitis Media with Effusion ; Referral and Consultation ; Retrospective Studies ; Secondary Care

BACKGROUND: Millard’s rotation-advancement repair, which is used by many surgeons, can make a natural philtral column, but most surgeons use a modification of the rotation-advancement flap. The purpose of this article is to introduce a modification utilized by the authors and to provide detailed surgical procedure. METHODS: We retrospectively reviewed 82 patients’ medical records and presented surgical technique and outcomes. The main features of the authors’ strategy are emphasizing horizontal length of the lip, orbicularis oris muscle duplication for improving the definition of the philtral column, overcorrection of domal portion than the non-cleft side in order to compensate for the recurrence during growth. Two judges rated two times the appearance of the patients’ nose and lip using Asher-McDade aesthetic index. Intra- and interobserver reliabilities were determined using Cohen’s kappa statistics. RESULTS: All patients recovered eventually after surgery; however, two patients have a minor complications (wound infection in one patient, wound disruption due to trauma in the other patient). The improvement of the aesthetic results can be achieved with this modified Millard technique. Total mean scores of the Asher-McDade index was 2.08, fair to good appearance. The intraobserver reliabilities were substantial to almost perfect agreement and the interobserver reliabilities were moderate to almost perfect agreement. CONCLUSION: We modified Millard method for repair of complete unilateral cleft lip. The surgical outcomes were favorable in long-term follow-up. We hope our technique will serve as a guide for those new to the procedure.
Cleft Lip* ; Follow-Up Studies ; Hope ; Humans ; Lip ; Medical Records ; Methods ; Nose ; Recurrence ; Retrospective Studies ; Rhinoplasty ; Surgeons ; Wounds and Injuries

BACKGROUND AND OBJECTIVES: The aim of this study was to determine the efficacy of induction chemotherapy with docetaxel and platinum in patients with hypopharyngeal carcinoma. SUBJECTS AND METHOD: The medical records of 66 patients who were diagnosed with hypopharyngeal carcinoma at our department from January 1996 to December 2008 were reviewed and retrospectively analyzed. The patients were divided into four groups according to treatment method: Group I was treated with radiation and induction chemotherapy consist of docetaxel and platinum (27); Group II was treated with surgery and induction chemotherapy consist of docetaxel and platinum (28), Group III was treated with radiation and induction chemotherapy consist of 5-FU and platinum (9) and Group IV was treated with surgery and induction chemotherapy consist of 5-FU and platinum (2). A total of 186 chemotherapy cycles were administered to patients and most of the patients received at least 2 cycles. RESULTS: The T-stage distribution at diagnosis was 7.5%, 42.4%, 28.8%, and 21.2% for T1, T2, T3, and T4, respectively. The N-stage distribution at diagnosis was 48.5%, 22.7%, 10.6%, 15.2%, and 9.1% for N0, N1, N2a, N2b, and N2c, respectively. The overall 3-year survival rate was 44.3%. The 3-year survival rate of each group was 42.6% in Group I, 54.8% in Group II, and 11.1% in Group III. There was no significant difference in survival between Groups I and III (p=0.074). There was no difference in sex, age, and N stage for 3-year survival rate. CONCLUSION: Although any valid conclusions could not be drawn because of the small number of patients examined here, induction chemotherapy consisting of docetaxel and platinum may improve the outcome of patients with hypopharyngeal carcinoma.
Fluorouracil ; Humans ; Induction Chemotherapy ; Medical Records ; Platinum ; Retrospective Studies ; Survival Rate ; Taxoids ; Treatment Outcome

This study reports the first two clinical cases of spirometrosis caused by Spirometra sp. in cats in Korea. In these two cases, the cats vomited, and long proglottids of tapeworm were recovered. The sick cats presented with anorexia and lethargy. However, they unexpectedly showed no diarrhea, which is the main symptom of spirometrosis. Based on a fecal floatation test as well as morphological and molecular analyses, the parasite was diagnosed as Spirometra sp. The 2 cases were treated with praziquantel. This study suggests regular monitoring of health and deworming in companion animals, even when animals are well cared for, with regular preventive medication. Additionally, spirometrosis should be considered in the differential diagnosis in cases of gastrointestinal symptoms in Spirometra endemic areas.

This study reports the first two clinical cases of spirometrosis caused by Spirometra sp. in cats in Korea. In these two cases, the cats vomited, and long proglottids of tapeworm were recovered. The sick cats presented with anorexia and lethargy. However, they unexpectedly showed no diarrhea, which is the main symptom of spirometrosis. Based on a fecal floatation test as well as morphological and molecular analyses, the parasite was diagnosed as Spirometra sp. The 2 cases were treated with praziquantel. This study suggests regular monitoring of health and deworming in companion animals, even when animals are well cared for, with regular preventive medication. Additionally, spirometrosis should be considered in the differential diagnosis in cases of gastrointestinal symptoms in Spirometra endemic areas.

PURPOSE: Hematuria is a frequently encountered clinical problem in kidney graft recipients. The causes are variable, may be benign or malignant, but imperative to affect long- term graft function and survival. We have evaluated renal recipients who had hematuria using a newly defined algorithm. METHODS: We evaluated 1060 renal transplant recipients from March 1, 1992 to February 28, 2000. In 93 recipients, hematuria was transitory and spontaneously resolved within 3 months. We tried to identify the cause of persistent hematuria in 126 recipients. Patients were evaluated with plain x-ray, sonography, cystoscopic examination and/or graft biopsy. RESULTS: The mean duration of hematuria onset after transplantation was 17.81+/-14.6 months (4-70 months). The causes of gross hematuria were urolithiasis (n= 15), benign bladder mucosal bleeding (n=3), bladder cancer (n=2) and kidney cancer from an original kidney (n=1). Graft kidney biopsies were performed in 96 patients and the results were as follows: chronic rejection in 18, IgA nephropathy in 16, cyclosporine toxicity in 8, acute rejection in 5, focal segmental glomerulosclerosis in 3, the other glomerulonephritis in 2, and tubular atrophy and interstitial fibrosis in 19 patients. Combined pathologic findings were detected in 15 patients. In 8 patients, no pathological diagnoses were made. We were unable to evaluate 9 patients due to patient's refusal. CONCLUSION: The causes of hematuria after kidney transplantation are variable from benign to malignant disease. If the cause of hematuria is uncertain on ultrasonographic examination, cystoscopic examination and/or graft biopsy should be performed for making a definite diagnosis.
Atrophy ; Biopsy ; Cyclosporine ; Diagnosis ; Disulfiram ; Fibrosis ; Glomerulonephritis ; Glomerulonephritis, IGA ; Glomerulosclerosis, Focal Segmental ; Hematuria* ; Hemorrhage ; Humans ; Kidney ; Kidney Neoplasms ; Kidney Transplantation ; Transplantation ; Transplants ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urolithiasis