No abstract available.
Follow-Up Studies* ; Poisoning* ; Sodium*

No abstract available.
Prostheses and Implants* ; Tooth*

No abstract available.
Larynx*

The nasal ala is a challenging area for surgical reconstruction, with thick sebaceous skin, the lack of an ample tissue reservoir, and an adjacent free margin. Numerous flaps have been reported for the repair of alae defects. A 71-year-old woman with simultaneous basal cell carcinomas involving both nasal alae was treated by Mohs micrographic surgery. The surgical defects measured 1.5x1.5 cm on the center of the right nasal ala and 1.0x1.0 cm on the left nasal ala, including the alar crease and rim. The right nasal ala was used as a nasolabial transposition flap and the left nasal ala was reconstructed by an island pedicle flap. The final shape and texture were satisfactory. The flaps survived and nasal symmetry was preserved. Combined nasolabial transposition and island pedicle flaps thus offer a superior esthetic and functional result owing to minimized tension. This may be a valuable reconstructive option in the repair of bilateral nasal alae defects.
Aged ; Carcinoma, Basal Cell ; Female ; Humans ; Mohs Surgery ; Skin ; Succinates

Sleep is a vital, highly organized process regulated by complex systems of neuronal networks and neurotransmitters. Normal sleep comprises non-rapid eye movement (NREM) and REM periods that alternate through the night. Sleep usually begins in NREM and progresses through deeper NREM stages (2, 3, and 4 stages), but newborns enter REM sleep (active sleep) first before NREM (quiet sleep). A period of NREM and REM sleep cycle is approximately 90 minutes, but newborn have a shorter sleep cycle (50 minutes). As children mature, sleep changes as an adult pattern: shorter sleep duration, longer sleep cycles and less daytime sleep. REM sleep is approximately 50% of total sleep in newborn and dramatically decreases over the first 2 years into adulthood (20% to 25%). An initial predominant of slow wave sleep (stage 3 and 4) that peaks in early childhood, drops off abruptly after adolescence by 40% from preteen years, and then declines over the life span. The hypothalamus is recognized as a key area of brain involved in regulation of sleep and wakefulness. The basic function of sleep largely remains elusive, but it is clear that sleep plays an important role in the regulation of CNS and body physiologic processes. Understanding of the architecture of sleep and basic mechanisms that regulate sleep and wake cycle are essential to evaluate normal or abnormal development of sleep pattern changes with age. Reduction or disruption of sleep can have a significant impact on daytime functioning and development, including learning, growth, behavior, and emotional regulation.
Adolescent ; Adult ; Brain ; Child ; Eye Movements ; Humans ; Hypothalamus ; Infant, Newborn ; Learning ; Neurons ; Neurotransmitter Agents ; Physiology* ; Sleep, REM ; Wakefulness

OBJECTIVE: This study was conducted to identify 3 to 5 years of future management issues in hospital information systems (HIS). METHODS: Two rounds of interview surveys were conducted based on the sample survey of 50 managers from 28 hospital information centers utilizing the Delphi method. RESULTS: From the survey, management issues in HIS were identified in the following order: 'top management support', 'close relationship with users', 'PACS', 'disaster recovery', improving IS strategic planning'. Compared with the 1999 survey, the issues that rank within the top 10 management issues were as follows: 'top management support', 'security and control', 'close relationship with users'. Recently surfaced issues are 'disaster recovery' and 'standardization'. The issues that dropped out of the top 10 ranks were 'network management', 'recruiting and developing IS human resource'which were very fundamental issues in the initial state of the introduction of the hospital information system. CONCLUSION: The two main significance of this study involves predicting future management issues based on the comparison of the current issues with the 1999 issues and recommendingmanagement strategies based on the classification of issues by importance and persistence.
Classification ; Hospital Information Systems* ; Humans ; Information Centers

The melanotic neuroectodermal tumor of infancy(MNTl) is a rare, usually benign, pigmented lesion which most frequently involves the maxilla. Skull, brain, and mandible are other craniofacial sites; this anatomic region accounts for 87% of all cases. The vast majority of MNTl, nearly 95%, present in infants of both sexes within the first year of life. Most cases of MNTl follow a benign course, with a 15% propensity for local recurrence. MNTl is regarded as a primitive neuroectodermal tumor with polyphenotypic differentiation. We report a classical MNTl which occurred in left lower maxilla in 6-month old female infant. She developed an ill defined, firm swelling on the left alveolar ridge and gum during 3 weeks. Mass excision reveals ill defined, grayish-tan hard mass, measuring 2.0x1.6 cm. Microscopically, the tumor reveals irregular alveolar pattern of melanin-containing cuboidal cells and nests of small round cells. The immunohistochemical staining for melanoma-associated antigen, neuron-specific enolase and cytokeratin show positive reactions. Ultrastructural examination showed intracytoplasmic melanosome, tonofilament and desmosome.
Infant ; Male ; Female ; Humans

Narcolepsy is chronic devastating disease that characterized by excessive daytime sleepiness, cataplexy, which often precipitated by intense emotion or excitement, hypnagogic, or hypnapompic hallucinations, sleep paralysis and nocturnal disrupted sleep. In child onset narcolepsy, the presentations of narcolepsy can be very variable, making misdiagnosis as seizure disorders or delaying diagnosis as much as several years after disease onset. For the diagnosis of narcolepsy, overnight polysomnography(PSG) and multiple sleep latency test(MSLT) should be evaluated. Test for Cerebrospinal fluid hypocretin(orexin) concentration and human leukocyte antigens(HLA) would be great helpful to confirm the narcolepsy with cataplexy even in early stage of disease in children. The mainstays of treatment are that reducing the excessive daytime sleepiness, preventing the intrusion of the REM related phenomena including cataplexy and consolidating the nighttime sleep. Central nervous system stimulators such as methylphenidate or amphetamine decrease excessive daytime sleepiness and tricyclic antidepressant(TCA) or selective serotonin reuptake inhibitors(SSRI) can prevent cataplexy. Recently, new therapeutic agents such as modafinil and sodium oxybate are emerging in clinical practice with much effectiveness. Counseling for poor school performance, social isolation and depression should be provided. Early diagnosis and treatment can greatly improve the quality of life. Awareness of excessive daytime sleepiness in children or adolescent will allow pediatricians to effectively identify hypersomnia such as narcolepsy.
Adolescent ; Amphetamine ; Benzhydryl Compounds ; Cataplexy ; Central Nervous System ; Child ; Counseling ; Depression ; Diagnostic Errors ; Disorders of Excessive Somnolence ; Early Diagnosis ; Epilepsy ; Hallucinations ; Humans ; Leukocytes ; Methylphenidate ; Narcolepsy ; Quality of Life ; Serotonin ; Sleep Paralysis ; Social Isolation ; Sodium Oxybate

We report a case of Kyrles disease occuring in a 19-year-old man with chronic renal failure. The patient had multiple hyperkeratotic papules with central plug on the upper extremities, lower extremities and buttocks. Histopathological findings showed epidermal invagination filled with parakeratotic column and basophilic debris. Many dyskeratotic and vacuolated cells were present below the keratotic plug, and penetration of the parakeratotic column into the dermis was seen.
Basophils ; Buttocks ; Dermis ; Humans ; Kidney Failure, Chronic ; Lower Extremity ; Upper Extremity ; Young Adult

The ectrodactyly-ectodermal dysplasia-clefting(EEC) syndrome is a rare autosomal dominant disease which has multiple congenital anomalies characterized by ectodermal dysplasia, distal limb anomaly, cleft lip and palate, and lacrimal duct anomalies. There is wide variability of clinical expression of this syndrome, and occasional nonpenetrance. We report a 1 year old girl with typical EEC syndrome manifestations, who presented dry skin, light colored sparse hair on scalp, cleft lip and palate, microdontia with oligodontia, partial syndactyly of the hands, total syndactyly of the feet and mild developmental delay, including ocular defects and skin lesions. Ocular MRI showed microphthalmia with cystic mass on both eye globes and atrophy of the optic nerves. Vesicle like skin lesions were consistent with nevus lipomatosus cutaneous superficialis by pathologic study.
Atrophy ; Cleft Lip ; Ectodermal Dysplasia ; European Union ; Extremities ; Female ; Foot ; Hair ; Hand ; Humans ; Magnetic Resonance Imaging ; Microphthalmos ; Nevus* ; Optic Nerve ; Palate ; Scalp ; Skin ; Syndactyly