The goal of cleft lip surgery is to reconstruct normal shape of the lip. To acomplish this goal, various operative method were contrived and concept of the method decided the shape of reconstructed lips. According to the operative result, some operative methods were disappeared or have been developed with a little modifiation. Traditional Millard's rotation-advancement method for unilateral cleft lip patients is largely accepted and developed as proper method for acquiring these functional and anatomic purposes. As a trial for this development, Mulliken add some modifications. He uses exaggerated high rotation incision and it lengthens into midcolumella without backcut. Also he dosen't steal from alar base or lateral lip for vertical height. C-flap is used to lengthen the affected columella and upper lip. The isolated orbicularis oris muscle is coaptated each other for more functional result. With supraperichondral dissection of alar cartilage and transpositioning of caudal septum, he performs synchronous repair of cleft lips, nose and sometimes alveolus. It is still debated when is most suitable age for surgical correction of nasal deformity of cleft lip patients. Done at the time of primary lip repair, there are both some apprehension and inducement. The former are based on technical difficulties due to shortage and fragility of neonatal tissue and possibility of progressive deformities with growing because of iatrogenic injuries to the alar cartilages. But te latter is rationalized because early reposition of deformed nasal cartilage in proper position would induce more natural growth of nasal structures. Some long-term follow up reports reveal the early operation innocent of any growth deterioration. Mulliken treats his cleft lip patient for separated lip and nasal deformities with single operation, and does gingiovoperiosteal alveoloplasty at the same time if necessary. He uses Latham appliance from 4 to 6 week after birth in case of severly collapsed lateral alveolar segment or wide alvolar gap, and perform the definitive opertation at the age of 4 to 6 months. I use lip adhension method to correct more than 10 mm alveolar gap without severe collapse of lateral alveolar segment, but if lateral segment was severely collapsed and away from alvolar arch, I apply the Latham appliance somewhat modificate from original type, which has a metal ring fastened at the front limb of appliance for rubber banding to coaptate easily. I have experienced repair of cleft lip by Mulliken's concept with some modification of my own to 44 cases of unilateral cleft lip patients and conclude that it was very flexible method. Doing with synchonous repair of cleft lip nose, we could get harmonious lip and nose with symmetric nostril sill, cupid's bow and red line. Columella was lengthened primarily. Normal growth of nose was anticipated by anatomic repositioning of alar septal cartilage.
Alveoloplasty ; Cartilage ; Cleft Lip* ; Congenital Abnormalities ; Extremities ; Follow-Up Studies ; Humans ; Lip ; Nasal Cartilages ; Nose ; Parturition ; Rubber

Eczema herpeticum is a herpes simplex virus infection with disseminated skin involvement superimposed on a pre-existing dermatosis. Dariers disease has been reported to be among the dermatoses susceptible to the sudden onset of a widespread vesicular eruption accompanied by high fever known as Kaposis varicelliform eruption. We report a case of eczema herpeticum in a 46-year-old woman associated with Dariers disease.
Darier Disease* ; Eczema* ; Female ; Fever ; Humans ; Kaposi Varicelliform Eruption* ; Middle Aged ; Simplexvirus ; Skin ; Skin Diseases

No abstract available.
Connective Tissue Diseases* ; Connective Tissue* ; Diagnosis*

In the past years skin grafts, local flaps and free flaps have been used in reconstructing skin of soft tissue defects and deformities of the face where primary closure is not feasible. A number of local flaps have been used for reconstruction of facial defects and deformities, but the size of a defect that could be treated in such a way was restricted and the donor site deformity was another problem of local flaps. Introduction of the tissue expansion technique has made it possible to cover even wider defects with neighboring skin and advantageous in facial reconstruction in that such defects can be resurfaced with skin of similar color, texture and thickness, a match superior to that of skin obtained elsewhere. We used tissue expanders in reconstructing defects and deformities of the face(post-burn scar ; 17cases, post-traumatic scar ; 7cases, congenital nevus ; 3cases, total 27cases) from Mar. 1990 to Sep. 1996. We used expanders of various size and shape according to the site and size of the defects. We prefered to use round or croissant type tissue expander for the reconstruction of small-sized scar on medial cheek and to use rectangular type expander for large-sized scar on lateral cheek. Ports are placed under the scar or scalp. Expansion period ranged from 28days to 97days (mean 7weeks) and overinflation (mean 170%) was done. And various methods are used for prevention of complication. We have made anchoring sutures of the remained capsule to the underlying periosteum for prevention of ectropion. We have got satisfactory results from that aesthetically and functionally, so report the results with a review of the current literature.
Cheek ; Cicatrix ; Congenital Abnormalities ; Ectropion ; Free Tissue Flaps ; Humans ; Nevus ; Periosteum ; Scalp ; Skin* ; Sutures ; Tissue Donors ; Tissue Expansion Devices ; Tissue Expansion* ; Transplants

Purulent pericarditis is an infrequent but fulminant and frequently lethal disease. Purulent pericarditis tends to occur as direct extension of bacterial pneumonia or empyema in past. In recently, purulent pericarditis tends to occur in adult via contiguous spread from an early postoperative infection after thoracic surgery or trauma, infection related to infective endocarditis, extension from a subdiaphragmatic suppurative source, and hematogenous spread during bacteremia. Endogenous causes of purulent pericarditis are frequently characterized as esophageal perforations. Common causes of esophageal perforations related to purulent pericaditis which usually develop in association with mediastinitis, pneumonia and empyema include corrosive esophagitis, complication after esophageal and tracheal instrumentation and Boerhaave's syndrome. There is very little reference to the development of pericarditis in associated with esophageal perforation which does not directly communicate with the pericardium. while, although most uncommon, it is well documented that the esophagus can perforate directly into the pericardium and produce pericarditis. We experienced a case of acute purulent pericarditis after esophageal and pericardial perforation by a small fish bone in a previously healthy man. The patient was treated successfully with systemic antibiotics and pericardiotomy.
Adult ; Anti-Bacterial Agents ; Bacteremia ; Empyema ; Endocarditis ; Esophageal Perforation ; Esophagitis ; Esophagus ; Foreign Bodies* ; Humans ; Mediastinitis ; Pericardiectomy ; Pericarditis* ; Pericardium ; Pneumonia ; Pneumonia, Bacterial ; Thoracic Surgery

BACKGROUND: Cardiovascular injury is a potentially fatal complication of blunt chest trauma. The diagnosis of cardiovascular injury in blunt chest trauma is not easy because of concomittent injuries of thoracic cage or lungs and early death from cardiovascular injury. Diagnostic tools such as electrocardiography or cardiac enzyme studies are not specific to cardiovascular injury. Two-demensional echocardiography can visualize anatomic and functional disturbances from cardiovascular injuries in patients with blunt chest trauma. Purpose: This study was designed to evaluate the usefulness of echocardiography in detecting cardiovascular injury of patients with blunt chest trauma. METHODS: We performed echocardiography for detecting cardiovascular injury in 151 patients with significant blunt chest trauma including sternal fracture, multiple rib fractures or pulmonary contusion. Echocardiography was performed within 6 hours since patient arrived emergency department. Electrocardiography was traced on arrival and 24 hours after admission. Serial determinations of cardiac enzymes including MB fraction of creatinine phosphokinase were also performed every 8 hours after admission. RESULTS: 37(25%) patients had echocardiographic evidences of cardiovascular injury. Abnormal echocardiographic findings were 10 pericardial effusion, 9 regional wall motion abnormality(RWMA) outright ventricle, 5 aortic injuries, 4 reduced left ventricular ejection fraction, 3 RWMA of left ventricle, 2 right ventricular dilatation, 2 valve injuries, and 2 other cardiovascular injuries. Electrocardiographic abnormalities were associated with echocardiographic findings. However, CK-MB/CK ratio was not associated with echocardiographic findings. Significant proportion(65%) of patients with abnormal echocardiographic findings needed cardiovascular management during hospital stay. CONCLUSION: Two-dimensional echocardiography is useful for detecting cardiovascular injury. Echocardiographic abnormality in blunt chest trauma is associated with high probability of need of cardiovascular management.
Contusions ; Creatinine ; Diagnosis* ; Dilatation ; Echocardiography* ; Electrocardiography ; Emergency Service, Hospital ; Heart Ventricles ; Humans ; Length of Stay ; Lung ; Pericardial Effusion ; Rib Fractures ; Stroke Volume ; Thorax*

Congenital auricular deformities such as lop ear, cup ear, prominent ear, and Stahl's ear can be corrected nonsurgically in the early neonatal period(first week after birth) obtaining satisfactory results. Auricular cartilage consists of chondrocytes and intercellular materials that are mainly assembled from collagen, elastin, and a proteoglycan aggergate. Cartilageelasticity is dependent upon the concentration of the proteoglycan aggregate. Hyaluronic acid, which is a constituent of proteoglycan aggregate and is increased by estrogens, has an important play on disconnecting the proteoglycan aggregate. So the increased estrogen results in the lack of elasticity. The circulating levels of free estradiol are higher during the first 72 hours after birth and decreases thereafter, so the ear is soft and easily malleable in this early neonatal period. In this study, we have applied aluminium splint (90 degree-angulated, 180 degree-angulated, and rolled) on rabbit ear. All of the rabbit was divided into 3 groups containing 3 types of deformities. In group 1, estrogen was applied to the deformed ear with regional injection to the perichondrium of auricular cartilage. In group 2. estrogen was applied topically with ointment. In group 3, as control group, saline was injected to the perichondrium. Four weeks later, in group 2, the shape of the deformed rabbit ear was maintained, and did not return to its original shape even after splint removal. From these results, we concluded that estrogen ointment could be tried as adjunctive therapeutic modalities to the nonsurgical treatment of the congenital auricular deformities.
Chondrocytes ; Collagen ; Congenital Abnormalities ; Ear Cartilage ; Ear* ; Elasticity ; Elastin ; Estradiol ; Estrogens* ; Hyaluronic Acid ; Parturition ; Proteoglycans ; Splints

OBJECTIVES: Fatigue is a primary human factor for decreased job performance in the workplace. It is well documented that drowsiness is a typical symptom of fatigue and is closely associated with commercial drivers'safety and well-being. However, few studies have been conducted to develop or validate fatigue symptom instruments for a working population. The main purpose of this study was to develop a general fatigue checklist and a driving fatigue checklist for Korean commercial drivers. METHODS: A total of 287 bus drivers in a commercial transportation company participated in a self-administered survey that was designated Study 1. Based on the statistical results of Study 1, a focus meeting with 16 professional consultants was conducted to revise the fatigue symptom instrument for Study 2. In Study 2, 288 commercial drivers (156 bus drivers and 132 truck drivers) participated in the revised questionnaire survey. All collected responses were entered into a SPSS worksheet and the data analysis was conducted using SPSS software 11.1. The exploratory factor analysis used in this study followed the principle component factoring rule and the varimax rotation method for factor extraction. The criteria for item selection were an Eigen value of 1.0 or greater, a communality score of .50 or greater, and no 'fence rider'property over the extracted factors. RESULTS: Through Study 1, the consultant meeting, and Study 2, a general fatigue checklist was developed with a total of 3 factors and 11 items, and a driving fatigue checklist was developed with 2 factors and 10 items. The 3 factors of the general fatigue checklist were physical fatigue, psychological fatigue, and chronic tiredness. The two factors of the driving fatigue checklist were physical fatigue and perceptive and functional fatigue. CONCLUSIONS: The primary contents of general fatigue were different from those of driving fatigue according to the two fatigue instrument factors developed in this study. The primary fatigue symptoms of the commercial driving population were identified as physical fatigue and perceptive and functional fatigue.
Checklist* ; Consultants ; Fatigue* ; Humans ; Motor Vehicles ; Questionnaires ; Sleep Stages ; Statistics as Topic ; Transportation

Severe bronchospasm at the termination of the cardiopulmonary bypass period is an unusual but dangerous complication of open-heart surgery. We report a case of severe unilateral bronchospasm detected at the end of the bypass period on the basis of high airway pressures with remarkable difficulties to deflate the right lung and it was relieved with bronchodilator therapy by intrapulmonary percussive ventilation. Fiberoptic bronchoscopic examination revealed unobstructed, free tracheobnncheal airway and capnographic finding was obstructive pattern. As in the previously published cases, the exact cause of bronchospasm remains unknown in our patient as well, but the possible causes of the bronchospasm are described.
Bronchial Spasm* ; Cardiopulmonary Bypass* ; Humans ; Lung ; Ventilation

Vertebroplasty (VP) can effectively treat pain and immobility caused by vertebral compression fracture. Because of complications such as extravasation of bone cement (polymethylmethacrylate, PMMA) and adjacent vertebral fractures, some practitioners prefer to inject a small volume of PMMA. In that case, however, insufficient augmentation or a subsequent refracture of the treated vertebrae can occur. A 65-year-old woman visited our clinic complaining of unrelieved severe low back and bilateral flank pain even after she had undergone VP on the 1st and 4th (L1 and L4) lumbar vertebrae a month earlier. Radiologic findings showed the refracture of L1. We successfully performed the repeat VP by filling the vertebra with a sufficient volume of PMMA, and no complications occurred. The patient's pain and immobility resolved completely three days after the procedure and she remained symptom-free a month later. In conclusion, VP with small volume cement impaction may fail to relieve fracture-induced symptoms, and the refracture of an augmented vertebral body may occur. In this case, repeat VP can effectively resolve both the persistent symptoms and problems of new onset resulting from refracture of the augmented vertebral body due to insufficient volume of bone cement.
Female ; Flank Pain ; Fractures, Compression ; Humans ; Lumbar Vertebrae ; Polymethyl Methacrylate ; Spine ; Vertebroplasty