BACKGROUND: Nonsyndromic craniosynostosis is a relatively common craniofacial anomaly and various techniques were introduced to achieve its operative goals. Authors found that by using smaller bone fragments than that used in conventional cranioplasty, sufficiently rigid bone union and effective regeneration capacity could be achieved with better postoperative outcome, only if their stable fixation was ensured. METHODS: Through bicoronal incisional approach, involved synostotic cranial bone together with its surrounding areas were removed. The resected bone flap was split into as many pieces as possible. The extent of this ‘multi-split osteotomy’ depends on the degree of dysmorphology, expectative volume increment after surgery and probable dead space caused by bony gap between bone segments. Rigid interosseous fixation was performed with variable types of absorbable plate and screw. In all cases, the pre-operational three-dimensional computed tomography (3D CT) was checked and brain CT was taken immediately after the surgery. Also about 12 months after the operation, 3D CT was checked again to see postoperative morphology improvement, bone union, regeneration and intracranial volume change. RESULTS: The bony gaps seen in the immediate postoperative brain CT were all improved as seen in the 3D CT after 12 months from the surgery. No small bone fragment resorption was observed. Brain volume increase was found to be made gradually, leaving no case of remaining epidural dead space. CONCLUSION: We conclude that it is meaningful in presenting a new possibility to be applied to not only nonsyndromic craniosynostosis but also other reconstructive cranial vault surgeries.
Absorbable Implants ; Brain ; Craniosynostoses* ; Osteotomy* ; Regeneration

Multi-vessel coronary artery disease (MVD) frequently features ambiguous or intermediate lesions that may be both serial and complex, suggesting that multiple regions require revascularization. Percutaneous coronary intervention (PCI) is associated with various challenges such as appropriate identification of lesions that should be treated, the choice of an optimum revascularization method, and limitations of long-term outcomes. Optimal patient selection and careful targeting of lesions are key when planning treatment. Physiology-guided decision-making (based on the fractional flow reserve) can overcome the current limitations of PCI used to treat MVD regardless of clinical presentation or disease subtype, as confirmed in recent clinical trials. Here, we review the use of physiology-guided PCI for patients with MVD, and their early and late outcomes.
Coronary Artery Disease* ; Coronary Vessels* ; Humans ; Methods ; Patient Selection ; Percutaneous Coronary Intervention* ; Physiology* ; Prognosis

No abstract available.
Tomography, Optical Coherence*

PURPOSE: To report the clinical features and treatment of canaliculitis associated with SmartPlug punctal plug insertion. METHODS: Case selection criteria included patients with canaliculitis, who were managed at Seoul National University Hospital from January 2006 to October 2008, presenting with a history of punctal plug insertion. The operation reports were reviewed to identify patients in whom SmartPlug was discovered during the operation. Six patients (8 eyes) were identified, and a retrospective chart review was performed for all the patients. RESULTS: The mean age of the patients was 34.3+/-8.6 years, and there were 1 men and 5 women. Common symptoms were mucous discharge (6 eyes) and conjunctival injection (2 eyes). The mean time from insertion of the plug to onset of symptoms was 27.0+/-27.0 months (range 4 to 77 months). All patients underwent surgical removal of the punctal plug by one-snip punctoplasty, canalicular retrograde compression using 2 cotton-tipped applications (2 eyes), or canalicular curettage (6 eyes). All patients had resolution of symptoms after the procedure. CONCLUSIONS: Canaliculitis should be considered when there is conjunctival discharge or injection in patients with SmartPlug. One-snip punctoplasty and retrograde compression of canaliculus can be attempted preferentially as a minimally-invasive treatment option.
Corneal Ulcer ; Curettage ; Dacryocystitis ; Female ; Humans ; Male ; Patient Selection ; Retrospective Studies ; Canaliculitis

PURPOSE: We conducted a prospective comparative clinical study to determine the field efficacy of the 2010-2011 influenza vaccines [Influenza virus strains; A/California/7/2009 (H1N1), A/Perth/16/2009 (H3N2), B/Brisbane/60/2008] in healthy Korean children under 18 years of age. METHODS: In this study, we enrolled subjects aged between 6 months and 18 years and divided them into 2 study groups: a group who received the influenza vaccines (407 subjects), and a control group who did not receive the influenza vaccines (230 subjects). Ours was a multicenter study that involved 7 hospitals, including the Korea Cancer Center Hospital. The study was conducted between September 2010 and February 2011. We collected nasal wash or throat swab samples from subjects who presented with acute febrile respiratory or influenza-like illnesses at the hospital. We used PCR to confirm the presence of the influenza virus in the respiratory samples and characterize the virus type. RESULTS: In this study, we collected 22 respiratory samples from the influenza-vaccinated group and found 3 cases of influenza virus infection. Similarly, we collected 21 samples from the control group and found 12 cases of influenza virus infection among 10 subjects during the study period. We determined the field efficacy of the 2010-2011 seasonal influenza vaccines to be 83.2% in healthy Korean children and adolescents. CONCLUSION: In this study, we determined the field efficacy of the 2010-2011 seasonal influenza vaccines in healthy Korean children and adolescents. We found that the field efficacy of 2010-2011 seasonal influenza vaccines was adequate.
Adolescent ; Aged ; Child ; Humans ; Influenza Vaccines ; Influenza, Human ; Korea ; Orthomyxoviridae ; Pharynx ; Polymerase Chain Reaction ; Prospective Studies ; Seasons ; Viruses

PURPOSE: To report a rare case of solitary eyelid schwannoma. CASE SUMMARY: A 60-year-old female visited our clinic with a small cyst-like mass of the left upper eyelid, which had developed 3 years earlier. A 3x3 mm-sized, nonpigmented, cyst-like mass was located in the lateral area of the left upper eyelid margin. We performed an excisional biopsy under local anesthesia. The tumor was well encapsulated, easily dissected, and could be completely removed. Histopathologic examination showed cellular areas of spindle cells with Verocay bodies forming palisades and less cellular myxoid areas. Immunohistochemical analysis for S-100 protein showed a strongly positive reaction. Based on the histopathologic features, a diagnosis of benign Schwannoma was made. CONCLUSIONS: Schwannoma should be also considered in the differential diagnosis of a well-circumscribed mass lesion in the eyelid.
Anesthesia, Local ; Biopsy ; Diagnosis, Differential ; Eyelids ; Female ; Humans ; Middle Aged ; Neurilemmoma ; S100 Proteins

PURPOSE: Surgical procedures using robot-assisted surgery, including pancreatic surgery, have recently become popular. This study aimed to report our initial experiences with distal pancreatectomy procedures using the robot-assisted surgery system. METHODS: The clinical records of 28 patients who underwent robot-assisted distal pancreatectomy (RDP) between July 2012 and January 2016 were reviewed. RESULTS: Of the 28 patients, 5 (17.9%) were male and 23 (82.1%) were female. Their ages ranged from 11 to 78 years, with a median age of 44.5 years. The mean diameter of the pancreatic tumors was 3.6 cm. The median operative time was 192.5 (range, 100~390) minutes, and the median blood loss was 200 (range, 50~1,900) ml. All of the 28 RDPs were successfully completed. Spleen preservation was achieved in 16 (57.1%) patients. Clinically significant postoperative pancreatic fistula was detected in 4 (14.3%) patients. Postoperative complications were evident in 5 (17.9%) of the 28 patients. CONCLUSION: Our experiences suggest that RDP is feasible for patients with benign or borderline tumors at the body or tail of the pancreas. It may be considered as an effective surgical procedure for benign or borderline tumors of the pancreas in the future; however, further studies to confirm this are warranted.
Female ; Humans ; Male ; Operative Time ; Pancreas ; Pancreatectomy* ; Pancreatic Fistula ; Postoperative Complications ; Spleen ; Tail

PURPOSE: To report a case of chronic dacryocystitis caused by Achromobacter xylosoxidans. CASE SUMMARY: A 73-year-old female was referred to our clinic for management of chronic dacryosyctitis from which she did not to recover despite empirical therapy. A. xylosoxidans was isolated from purulent discharge. Based on the results of susceptibility testing, therapy was changed to fortified ceftazidime eye-drop 6 times a day and intravenous tazocin 4.5 g/20 ml (piperacillin 2 g/tazobactam 0.25 g) 3 times a day. All symptoms were resolved after treatment with sensitive antibiotics and external dacryocystorhinostomy. CONCLUSIONS: To our knowledge, this is the first report of A. xylosoxidans dacryocystitis. A. xylosoxidans are rare but potential pathogens which cause dacryocystitis. The cultures and sensitivity test were collected and processed to detect the presence of unusual pathogens in a case with persistent infection despite conventional treatment.
Achromobacter ; Achromobacter denitrificans ; Aged ; Anti-Bacterial Agents ; Ceftazidime ; Dacryocystitis ; Female ; Humans ; Penicillanic Acid ; Piperacillin