No abstract available.
Scalp* ; Skin* ; Transplants*

BACKGROUND: Few studies have investigated magnetic resonance (MR) characteristics of traumatic posterosuperior rotator cuff tears involving the supraspinatus and infraspinatus. We hypothesized that traumatic rotator cuff tears may have MR characteristics distinguishable from those of non-traumatic tears. METHODS: Preoperative MR arthrography and intraoperative tear size measurements were compared in 302 patients who underwent MR arthrography and subsequent arthroscopic rotator cuff repairs for traumatic (group T, 61 patients) or non-traumatic (group NT, 241 patients) tears. The inclusion criteria for both groups were posterosuperior full-thickness rotator cuff tear and age between 40 and 60 years. For group T, traumas were limited to accidental falls or slips, or sports injuries, motor vehicle accidents; injuries were associated with acute onset of pain followed by functional shoulder impairment; and time between injury and magnetic resonance imaging (MRI) was 6 weeks or less. RESULTS: In group T, 72.1% of shoulders (44 patients) had tendon tears with blunt edges while 27.9% of shoulders (17 patients) had tears with tapering edges. In contrast, 21.2% of patients in group NT (51 patients) had blunt-edge tears, while 78.8% (190 patients) of tears had tapering edges. These results were statistically significant (p<0.001) and estimated odds ratio was 9.6. The size of tear did not vary significantly between groups. CONCLUSIONS: We found no exclusive MR characteristic to define traumatic tears. However, oblique coronal MRI of traumatic tears showed a significant tendency for abrupt and rough torn tendon edges and relatively consistent tendon thicknesses (without lateral tapering) compared to non-traumatic cuff tears.
Accidental Falls ; Arthrography* ; Arthroscopy ; Athletic Injuries ; Humans ; Magnetic Resonance Imaging ; Motor Vehicles ; Odds Ratio ; Rotator Cuff* ; Shoulder ; Tears* ; Tendons

The basic technique for total reconstruction of the microtia was established by Tanzer, who utilized autologous rib cartilages for constructing the auricular framework. In order to decrease the number of surgical stages and to achieve maximal convolution, we employed a surgical procedure with simultaneous three layered costal cartilage grafting for the high profiled auricle, concha formation and lobule rotation. However, we performed ear elevation as an additional procedure for some patients who had decreased helical height due to absorption of cartilage framework or postoperative trauma and who had wanted to wear the spectacles or to have more natural appearance of auriculocephalic sulcus. From August 1988 to October 1997 we had performed surgeries for the ear elevation of 58 patients in 177 patients with total ear reconstruction, using various elevation methods; skin graft, local flap, and local with costal cartilage block. When the ear elevation was performed with skin graft, postoperative contraction of the grafted skin was inevitable. In cases with two skin flaps, it was difficult to stabilize and maintain the correct projection of the constructed ear. So we elevated the reconstructed ear by utilizing a costal cartilage block, two skin flaps to cover the posterior region and skin graft. We conclude that the local flap with costal cartilage block is one of the most favorable methods in ear elevation which can maintain the adequate projection and make natural looking auriculocephalic sulcus.
Absorption ; Cartilage ; Ear* ; Eyeglasses ; Humans ; Ribs ; Skin ; Transplants

No abstract available.
Cleft Lip* ; Congenital Abnormalities*

Neurofibromatosis is a complex hereditary disease involving many organs and systems. The incidence in pregnancy is less frequent and has been reported as 1/5000 to 1/18500 deliveries. Therefore, little is known about the interactions between neurofibromatosis and pregnancy. A survey of relevant literature suggests that patients with NF have an increased risk of perinatal complications (pregnancy induced hypertension, IUGR, preterm labor, abortion, stillbirth, high cesarean section rate) and maternal disease aggravation (rupture of an aneurysm, sarcomatous degeneration of neurofibroma, activation of pheochromocytoma). Refined ultrasound, flow studies and fetal monitoring allow us to provide improved pregnancy care for neurofibromatosis. However, It should be remembered that even now, neurofibromatosis places pregnant women and their fetuses in a high risk group with the potential to develop life threatening complications. We report a case of vertebral artery aneurysm and preeclampsia complicating a pregnancy with neurofibromatosis."
Aneurysm* ; Cesarean Section ; Female ; Fetal Growth Retardation ; Fetal Monitoring ; Fetus ; Genetic Diseases, Inborn ; Humans ; Hypertension ; Incidence ; Neurofibroma ; Neurofibromatoses* ; Neurofibromatosis 1 ; Obstetric Labor, Premature ; Pre-Eclampsia* ; Pregnancy* ; Pregnant Women ; Stillbirth ; Ultrasonography ; Vertebral Artery*

Tanzer reported microtia reconstruction using autogenous costal cartilage, thereafter so many plastic surgeons have tried various modification to get further refinement of reconstructed auricle. But the multiple stages of ear reconstruction required prolonged hospitalization and cost. In order to decrease the number of surgical stages and for the maximal convolution, we have employed a surgical procedure with three layered costal cartilage graft for the high profile auricle, concha formation and lobule transposition at the same time. However, it has still been difficult to reconstruct the tragus in cases of microtia that lack such component. We reconstructed the tragus using part of the microtic ear in addition to our above procedure simultaneously. This procedure is started with transposition of the lower two-thirds of the microtic ear to make lobule and then the upper third of the microtic ear is elevated as a chondrocutanenous flap which is then transposed 120-180degree C downwards to reposition at the area anterior to the conchal cavity. Using this technique, we have reconstructed 28 microtic ears. Adequate positioning of the auricle and tragus have been achieved and a more natural auricle obtained.
Cartilage ; Ear ; Hospitalization ; Transplants

The prominent mandibular angle is one of the disfiguring features in the Oriental, commonly seen and considered to be unattractive. Because it gives a square and muscular facial appearance, its surgical correction is dine frequently as a modality of facial contouring surgery in the Oriental. The reduction mandibular angleplasty is not a simple surgical technique for the unexperienced surgeon. We adopted C-arm fluoroscopy as a method of identifying the osteotomy line for the beginners. The reduction mandibular angleplasties assisted by C-arm fluoroscopy were performed in 9 patients, providing symmetric and satisfactory results. Now we are sure that the reduction mandibular angleplasty assisted by C-arm fluoroscopy can be an accurate and safe method for the unexperienced surgeon, especially the patient with deep-seated prominent mandibular angle.
Fluoroscopy* ; Humans ; Osteotomy

PURPOSE: This study was performed to investigate the differences in career choice motives and moral reasoning ability between students in baccalaureate and graduate-entry medical programs. METHODS: Forty-five students from a baccalaureate program and thirty-eight students from a graduate-entry program participated in this study. The students were required to fill out both the Career Choice Motivation Inventory and Defining Issues Test(DIT). The Career Choice Motivation Inventory is a 20-item questionnaire, which investigates five dimensions: effect of others, job security, interest in science, service and working with people, and working condition. Independent t-test was performed to compare the two groups. Pearson correlation coefficients were calculated to investigate the relationship among variables. RESULTS: There were significant differences in career choice motivations between the two groups. Students in the graduate-entry program were more likely to be motivated by scientific interest and opportunities to care for people. Status and job security were stronger factors in the baccalaureate students. For the students in this program, there were positive associations among their motives- interest in medical science, serving people, and working condition. There was no significant difference in moral reasoning ability between the two groups. CONCLUSION: Students in the graduate-entry medical program seem to have more professional and altruistic motivations for entering medicine. Although there is nostatistical significance, graduate students have numerically higher moral reasoning abilities compared to their counterparts. These results validate that a graduate-entry program provides an important alternative for student selection.
Career Choice* ; Humans ; Motivation* ; School Admission Criteria ; Surveys and Questionnaires

BACKGROUND: The aim of this study is to evaluate the influence of immunosuppressants on in-hospital mortality from sepsis. METHODS: Using data of the Health Insurance Review & Assessment Service, we collected data from patients who were admitted to the hospital due to sepsis from 2009 to 2013. Based on drugs commonly used for immunosuppression caused by various diseases, patients were divided into three groups; immunosuppressant group, steroid-only group, and control group. Patients with no history of immunosuppressants or steroids were assigned to the control group. To identify risk factors of in-hospital mortality in sepsis, we compared differences in patient characteristics, comorbidities, intensive care unit (ICU) care requirements, and immunodeficiency profiles. Subgroup analysis according to age was also performed. RESULTS: Of the 185,671 included patients, 13,935 (7.5%) were in the steroid-only group and 2,771 patients (1.5%) were in the immunosuppressant group. The overall in-hospital mortality was 38.9% and showed an increasing trend with age. The steroid-only group showed the lowest in-hospital mortality among the three groups except the patients younger than 30 years. The steroid-only group and immunosuppressant group received ICU treatment more frequently (p < 0.001), stayed longer in the hospital (p < 0.001), and showed higher medical expenditure (p < 0.001) compared to the normal group. Univariate and multivariate analyses revealed that age, male gender, comorbidities (especially malignancy), and ICU treatment had a significant effect on in-hospital mortality. CONCLUSIONS: Despite longer hospital length of stay and more frequent need for ICU care, the in-hospital mortality was lower in patients taking immunosuppressive drugs than in patients not taking immunosuppressive drugs.
Comorbidity ; Health Expenditures ; Hospital Mortality ; Humans ; Immunosuppression ; Immunosuppressive Agents ; Insurance* ; Insurance, Health ; Intensive Care Units ; Korea* ; Length of Stay ; Male ; Mortality ; Multivariate Analysis ; Risk Factors ; Sepsis* ; Steroids

OBJECTIVES: The aims of this study were to know the prevalence of cognitive disorders in patients with thyroid cancer, and identify related variables to them. METHODS: Subjects were consisted of fourty-two patients with thyroid cancer, who were admitted for radioiodine ablative therapy at 6-12 months after total thyroidectomy. The data were obtained from interviews about history and assessments of depression and cognitive function(Korean Version of the Montreal Cognitive Assessment, MoCA-K). RESULTS: 1) Among subjects, those with below 22 of total score of the MoCA-K were twenty-one(50.0%). 2) Upon age, education, Pre-radioiodine therapy thyroid stimulating hormone(TSH), there were statistically significant difference between subgroup with above 23 of the total MoCA-K score and those below 22. 3) The total scores of the MoCA-K in subjects had significant correlation with age, education, comorbidity, Pre-radioiodine therapy TSH, total score of the HDRS-17. CONCLUSIONS: Cognitive disorders were more prevalent among patients with thyroid cancer before radioiodine therapy. Therefore, further study should be needed to clarify the mechanism for the cognitive disorders in thyroid cancer. Furthermore, physicians should pay attention to the cognitive function and prepare preventative measures for cognitive disorder during management of thyroid cancer.
Carcinoma, Papillary* ; Comorbidity ; Depression ; Education ; Humans ; Prevalence ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroidectomy ; Thyrotropin