Epiblepharon is frequently encountered n oriental eyelid, especially in children. It is characterized by a horizontal fold of redundant skin and abundant orbicularis muscle near lid margin, which the lashes vertically, or posteriorly towards the eye. Surgical therapy of epiblepharon in correcting the trichiasis includes lid bracing sutures, burried sutures, skin resection, a Hotz procedure or its modification, and a Jones procedure. In our opinion, these procedures are not sufficient, because these procedures will not correct the epicanthal folds. Epicanthal folds have been a one of the characteristics of Asian over 50 percents of population in Japan and South Korea, and it either reduce the aesthetic result of the double-eyelid procedure or make the correction of the entropion and epiblepharon difficult. Although many surgical procedures are available to eliminate epicanthal folds, scarring on the medial canthus is in still and obstacle for surgeons to overcome. From January of 1998 to October of 1998, we used half z-plasty procedures in 5 cases to correct epicanthal folds in epiblepharon. There were few complications in our series. We believe that half z-plasty can get a good result in the correction of epibolepharon and oriental epicanthal folds.
Asian Continental Ancestry Group ; Braces ; Child ; Cicatrix ; Entropion ; Eyelids ; Humans ; Japan ; Korea ; Skin ; Sutures ; Trichiasis

PURPOSE: Male hypertrophic nipples can lead to psychological distress and physical discomfort. The authors present a new technique of male nipple reduction and describe its advantages. METHODS: The neonipple is designed to reduce diameter and height of nipple while preserving the subdermal plexus. After the central wedge excision, additional four triangular section of nipple skin is excised. One of the remaining two flaps is amputated partially and both flaps were approximated using 4-0 PDS and 6-0 Nylon sutures. RESULTS: From December 2007 to January 2009, 52 nipple reductions were performed in 30 male patients (mean = 29.5 years). Postoperative recovery was rapid and few complications were observed. The mean diameter of the hypertrophic nipple was 9.1 +/- 2.5 mm (range, 7 to 15 mm). The mean diameter of the neonipple was 5.0 +/- 0.7 mm (range, 4 to 6 mm), with an average reduction of 3.8 +/- 0.6 mm (range, 2 to 11 mm). In follow-up, the neonipple had a natural appearance, with less projection and an inconspicuous scar. CONCLUSION: The wedge and triangular skin excision and partial amputation are easy to perform and yields consistent results. This technique decreases both the diameter and height of any size nipple and can be modified to meet patients' preferences.
Amputation ; Follow-Up Studies ; Humans ; Male ; Nipples ; Nylons ; Skin

We report a cace of 69-year-old man who developed massive pulmonary hemorrhage and subsuquent adult respiratory distress syndrome following intravenous urokinase for acute myocardial infarction. Pulmonary hemorrhage is a rare but a potentially life-threatening complication after thrombolytic therapy and should be considered in the differential diagnosis of pulmonary infiltrates of falling hemoglobin after thrombolytic therapy for acute myocardial infarction with no obvious site of bleeding.
Adult* ; Aged ; Diagnosis, Differential ; Hemorrhage* ; Humans ; Myocardial Infarction* ; Respiratory Distress Syndrome, Adult* ; Thrombolytic Therapy* ; Urokinase-Type Plasminogen Activator

PURPOSE: Severe type of inverted nipple (cannot be pulled out above the areola plane by manipulation, grade III) usually cannot be corrected by a relatively simple pursestring suture technique. Most patients want to avoid visible scars. To treat the severe case and avoid visible stigma, we introduce this invisible dermal flap method. METHODS: This new surgical procedure makes bilateral incisions on the sidewall of nipple and dissections vertically to free the ducts from the contracted tissues. After dissection, the tunnel is formed. We insert "dermal flaps" into the tunnel underneath nipple base. Then through-and-through sutures are performed vertically (6 o'clock and 12 o'clock positions) and the purse-string suture is added with 4-0 nylon. RESULTS: We had treated 35 primary inverted nipples (grade III) in 27 patients and 13 recurrent nipples in 7 cases. The results were excellent in 45 nipples (93.7%). All but 3 recurred cases was fully or very satisfied with the results. CONCLUSION: This technique is effective for the correction of severe inverted nipples and recurrent cases. We can avoid the visible scars on the areola surface
Cicatrix ; Contracts ; Humans ; Nipples ; Nylons ; Skin ; Suture Techniques ; Sutures

PURPOSE: To investigate the morphological characteristics of keratocytes and the interconnection of keratocytes with adjacent keratocytes using the flat preparation method and scanning electron microscopy with a frontal section of the human corneal stroma. METHODS: The thin, corneal collagen lamellae were carefully dissected from the cornea (n=7), which had been stained by the flat preparation method. The remaining tissue was fixed in 3% glutaraldehyde and observed by transmission electron microscopy following the frontal section. RESULTS: The flat preparation revealed the corneal fibroblasts between the lamellae of the collagen fibers and showed that the ramifying cellular processes of the keratocytes were in contact with the cytoplasmic processes or cell bodies of neighboring fibroblasts. Two types of discrete subpopulations of keratocytes were identified: a smaller, cellular type of keratocyte with spindle-shaped nucleus with heterochromatin, and a larger, cellular type with a large indented nucleus with relatively scanty cytoplasm. Collagen fibers ran parallel to each other toward the fenestration of the cytoplasmic wall of the keratocyte. CONCLUSIONS: These flat preparation method results showed that the keratocytes within the corneal stroma are interconnected with the adjacent keratocytes, which indicates the presence of a functional communicating network through the keratocyte circuits within the stroma. A smaller, cellular type of keratocyte with spindle-shaped nucleus was morphologically differentiated from a larger, cellular type with a large, indented nucleus by flat preparation and transmission electron microscopy.
Middle Aged ; Microscopy, Electron, Transmission ; Microscopy, Electron, Scanning ; Intercellular Junctions/*ultrastructure ; Infant ; Humans ; Corneal Stroma/*cytology/pathology ; Child, Preschool ; Child ; Cell Size ; Aged ; Adult ; Adolescent

We compared the visual outcome after phacoemulsification through the scleral pocket incision between non-diabetic patients and diabetic patients, and studied the factors influencing the visual outcome and postoperative complications in diabetic patients. retrospectively. The subjects operated by one of the authors were composed of 277 non-diabetic patients (277 eyes) and 90 diabetic patients (113 eyes). An average of the best corrected visual acuities at postoperative 8 weeks was lower in diabetic patients than that in non-diabetic patients, but there was no statistically significant difference between diabetic patients who had no or background diabetic retinopathy and non-diabetic patients. In diabetic patients the visual outcome was significantly related with severity of diabetic retinopathy, duration of the diabetes, and insulin dependency, but not related with the rupture of posterior capsule during surgery. Among the complications there were posterior capsule rupture (10.6%), hyphema (7.8%), posterior capsular opacity (4.9%), and posterior synechiae (4.9%).
Diabetic Retinopathy ; Humans ; Hyphema ; Insulin ; Phacoemulsification* ; Postoperative Complications ; Retrospective Studies ; Rupture ; Visual Acuity

Recently the 2nd generation laboratory composite resins were introduced. Although the mechanical properties of these composite resins have been improved, there were some disadvantages such as discoloration, low abrasion resistance and debonding between metal and resin. The purpose of this study was to evaluate the tensile bond strength between non-pecious dental alloy(verabond) and four veneering reinforced composite resins: Targis(Ivoclar Co.,U.S.A.), Artglass(Kulzer CO., Gemany). Sculpture(Jeneric Pentron Co., U.S.A.), and Estenia(Kurary Co., Japan). All test metal specimens were polished with #1,000 SiC paper, and sandblasted with 250micrometer aluminum oxide. After then, according to manufacturer's instructions metal adhesive primer and veneering resins were applied. All test specimens were divided into two groups. One group was dried in a desiccator at 25degrees C for 3 days, the other group was subjected to thermal cycling(2,000x) in water(5/55degrees C). Tensile bond strength was measured using Instron Universal Testing machine and the fractured surface was examined under the naked eyes and scanning microscope. Within the limitations imposed in this study, the following conclusions can be drawn: 1. in no-thermal cycling groups, there were no significant differences between Estenia and VMK68 but there were significant differences between Targis, Artglass, Sculpture and VMK68(p<0.05). 2. in no-thermal cycling resin groups, the highest tensile bond strength was observed in Estenis and there were significant differences between Estenia and the other resins(p<0.05). 3. Before and after thermal cycling, there were significant differences in tensile bond strength of Targis and Artglass(p<0.05). The tensile bond strength of Artglass was decreased and that of Targis was increased. 4. in no-thermal cycling groups, Artglass showed mixed fracture modes(95%), but after thermal cycling, Artglass showed adhesive fracture modes(75%).
Adhesives ; Aluminum Oxide ; Composite Resins* ; Dental Alloys* ; Sculpture

Polymorphonuclear leukocytes(PMNs) infiltrate to the wound site within a few hours after excimer laser photorefractive keratectomy(PRK). Oxygen free radicals produced by the PMNs may be injurious to the surrounding corneal tissues and also acts as an inflammatory mediator that deepen tissue damage. In this study we examined that the application of ascorbic acid would decrease corneal haze following excimer laser PRK. Excimer laser PRK was done in 9 rabbits (18 eyes). Ascorbic acid was injected subconjunctivally in one eye and BSS was injected in the opposite eye. The corneal epithelium re-surfaced by 2.6 +/- 0.5 days in the ascorbic acid treated group and by 2.7 +/- 0.7 days in the ESS injected group. Corneal hazes examined in postop 2wk, 4 wk, 6 wk, and 8 wk were 1.6 +/- 0.5, 1.4 +/- 0.5, 0.7 +/- 0.3, 0.5 +/- 0.2 in the ascorbic acid treated group and 2.1 +/- 0.6, 1.7 +/- 0.5, 1.1 +/- 0.3, 0.9 +/- 0.2 in the BSS injected group, respectively. These data suggest that ascorbic acid would decrease corneal haze after excimer laser PRK without significant complications.
Ascorbic Acid* ; Epithelium, Corneal ; Free Radicals ; Lasers, Excimer* ; Oxygen ; Rabbits* ; Wounds and Injuries

Purpose: To analyze the changes in subfoveal Haller layer thickness (SFHT), subfoveal choroidal thickness (SFCT), and central macular thickness (CMT) after intravitreal aflibercept injection. Methods: This was a retrospective analysis of 36 diabetic macular edema patients who underwent intravitreal aflibercept injection between December 2016 and June 2021. The SFHT, SFCT, and CMT before and 1 month after the injection were compared using spectral-domain optical coherence tomography. Results: Mean baseline SFHT, SFCT, and CMT were 214.28 ± 80.00 μm, 307.89 ± 96.30 μm, and 525.64 ± 133.24 μm, which were reduced 1 month after the injection to 199.56 ± 75.76 μm, 290.36 ± 94.63 μm, and 409.72 ± 98.45 μm, respectively (p = 0.001, < 0.001, and < 0.001, respectively). There was a significant correlation between baseline SFHT and 1-month post-injection best-corrected visual acuity (BCVA), while thicker subfoveal Haller layers before the injection were associated with better BCVA after the injection (ρ = −0.342; p = 0.041). Conclusions In diabetic macular edema patients, SFHT, SFCT, and CMT decreased significantly over 1 month after the first intravitreal aflibercept injection. Greater SFHT before the injection was a good short-term predictor of BCVA after injection.

Elimination of the apocrine glands by a radical surgical procedure has been known to be the best solution for axillary osmidrosis; however, it is often accompanied with a marked scar. Ultrasonic tumescent liposuction is a safe procedure for removal of subcutaneous fat tissue. Herein, we describe our modification of the traditional osmidrosis operation(subdermal excision or superficial liposuction). The first, pre-suction "scrape" could require adequate plane of skin flap; the second, "ultrasound-assisted liposuction"; the third, post-suction "rasp" helped subdermal curettage; the last, "endoscopic approach" could visibly remove remaining apocrine glands. It is named SURE technique. From April 2007 to September 2008, 43 patients underwent our "SURE" method for axillary osmidrosis. All patients were followed up for 3 to 12 months with an average of 6 months. The total satisfaction rate was 91 percent(39/43). The complications(skin slough and subdermal band formation) rate was 14 percent(6 of 43). However these complications were temporary and complete recovery occurred without special cares. We emphasize four components of our SURE method procedures. In conclusion, "SURE" method can be one of alternatives for osmidrosis treatment.