No abstract available.
Mandibular Fractures*

No abstract available.
Rhytidoplasty*

Objective: To characterize the patients in the inpatient rehabilitation facility who were transferred to acute care facilities and identify the frequency of and reasons for the unplanned transfer. Methods: Medical records of patients admitted to the inpatient rehabilitation facility from October 2017 to December 2018 were reviewed. Patients were categorized according to their diagnoses. The included patients were divided into the unplanned transfer and control groups based on whether they required to transfer to another department for acute care before completing an uninterrupted rehabilitation course. The groups were compared in terms of sex, age, length of stay, admission sources, and disease groups. The reasons for unplanned transfers were classified based on medical or surgical conditions. Results: Of the 1,378 patients were admitted to the inpatient rehabilitation facility, 1,301 satisfied inclusion criteria. Among them, 121 (9.3%) were unexpectedly transferred to the medical or surgical department. The unplanned transfer group had a higher age (69.54±12.53 vs. 64.39±15.32 years; p=0.001) and longer length of stay (85.69±66.08 vs. 37.81±31.13 days; p<0.001) than the control group. The top 3 reasons for unplanned transfers were infectious disease, cardiopulmonary disease, and orthopedic problem. Conclusion The unplanned transfer group had a significantly higher age and longer length of stay. The most common reason for the unplanned transfer was infectious disease. However, the proportions of those with orthopedic and neurological problems were relatively high. Therefore, further studies of these patient populations may help organize systematic strategies that are needed to reduce unplanned transfers to acute facilities for patients in rehabilitation facilities.

The hemodynamic feature of the tetralogy of Fallot (TOF) is best characterized by equality of left and right ventricular peak systolic pressure. The interventricular septum is flattened and thickened. Even after the right ventricular pressure is normalized in the postoperative period, the morphological abnormality continues for some time We have analyzed the morphological changes of the IVS echocardiographically after total correction and tried to correlate them with the prognosis of the patients. Forty five patients underwent total correction of TOF between May 1991 and July 1992.The IVS morphology was assessed with 2-D echocardiography before and after surgery. The control group consisted of 15 normal subjects(8 with functional cardiac murmur and 7 with non-cardiac diseases).We also evaluated the influence of the residual pulmonary regurgitation(PR) or pulmonic stenosis (PS) upon sequential changes in the end-systolic configuration and the thickness of the IVS. The following results were obtained. 1) Four months after total correction the IVS thickness and configuration at end-systole of the study patients were normalized, and they were not significantly different compared to those of the control group. 2) The postoperative residual PR of mild to moderate degree did not influence the course of morphological normalization. On the other hand, the postoperative residual PS greater than moderate degree hindered the normalization process. And the morphological abnormalities in the patients with the residual PS lasted longer than in the patients with the residual PR. 3) It would be necessary to perform cardiac catheterization in order to evaluate and to take care of the residual hemodynamic abnormalities if the IVS morphology remains to be abnormal even after one year after total correction.
Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Echocardiography* ; Hand ; Heart Murmurs ; Hemodynamics ; Humans ; Postoperative Period ; Prognosis ; Pulmonary Valve Stenosis ; Tetralogy of Fallot* ; Ventricular Pressure

OBJECTIVE: To assess the reliability of quantitative muscle ultrasonography (US) in healthy subjects and to evaluate the correlation between quantitative muscle US findings and electrodiagnostic study results in patients with carpal tunnel syndrome (CTS). The clinical significance of quantitative muscle US in CTS was also assessed. METHODS: Twenty patients with CTS and 20 age-matched healthy volunteers were recruited. All control and CTS subjects underwent a bilateral median and ulnar nerve conduction study (NCS) and quantitative muscle US. Transverse US images of the abductor pollicis brevis (APB) and abductor digiti minimi (ADM) were obtained to measure muscle cross-sectional area (CSA), thickness, and echo intensity (EI). EI was determined using computer-assisted, grayscale analysis. Inter-rater and intra-rater reliability for quantitative muscle US in control subjects, and differences in muscle thickness, CSA, and EI between the CTS patient and control groups were analyzed. Relationships between quantitative US parameters and electrodiagnostic study results were evaluated. RESULTS: Quantitative muscle US had high inter-rater and intra-rater reliability in the control group. Muscle thickness and CSA were significantly decreased, and EI was significantly increased in the APB of the CTS group (all p<0.05). EI demonstrated a significant positive correlation with latency of the median motor and sensory NCS in CTS patients (p<0.05). CONCLUSION: These findings suggest that quantitative muscle US parameters may be useful for detecting muscle changes in CTS. Further study involving patients with other neuromuscular diseases is needed to evaluate peripheral muscle change using quantitative muscle US.
Carpal Tunnel Syndrome* ; Healthy Volunteers ; Humans ; Neuromuscular Diseases ; Peripheral Nervous System Diseases ; Ulnar Nerve ; Ultrasonography*

The treatment of fingertip amputation is difficult and controversial. Although the microsurgery has been accepted as a procedure of choice, in distal location, however, both reattachment of amputated portion as a composite graft and microvascular anastomosis are prone to failure. The fact that microscopic reconstruction of vessels is safer means of replacing amputated digits, makes considerably smaller the need to use the technique of composite graft nowadays. Nevertheless, there still remains a group of distal digital amputations which cannot be replaced by microsurgical procedure and the composite grafting is the only way of achieving a full length digit with a normal nail complex. Nowadays, it is generally accepted that replacement should be made as early as possible for the prevention of bacterial and proteolytic activity. However, if the replacement is made so quickly that bleeding doesn't stop, there is a layer of clot blocking adhesion between the two surfaces, and the union will not be achieved. We report a new strategy: the tie-over dressing ensures not only fixation, but also hemostasis, and the drainage application is used to drain retained blood, so composite graft doesn't need to be delayed until the bleeding stops. We achieved good results by using this new technique.
Amputation* ; Bandages* ; Drainage ; Hemorrhage ; Hemostasis ; Microsurgery ; Transplants*

Craniofacial cleft is a rare congenital anomaly with a wide range of clinical manifestation and severity of deformity. In 1976, Tessier announced classification system on the basis of anatomical observation derived from clinical finding or operative dissection. Nowadays, this system is in common use because it is in accordance with terminology and observational finding and clinical manifestation is accordant with operative finding. Median facial cleft(No. 0-14 facial cleft) has a wide range of congenital malformation from a midline cleft upper lip to orbital hypertelorism, among which the bifid nose is frequently associated with hypertelorism. The manifestation of a bifid nose is variable from a simple central groove at the nasal tip to a complete clefting of the osteocartilaginous framework. In consequence, the planning of correction of the bifid nose must be individualized. We contrived correction of bifid nose using rib bone graft containing small amount of costal cartilage with maneuver of 2mm incision on nasal root skin together with fixation with 9mm miniscrew through an open approach in two No. 0-14 facial cleft patients with mild hypertelorism and bifid nose. With this method we could obtain satisfactory results in the standpoint of function as well as aesthetics. We think that this method is appropriate for correction of bifid nose of mild median facial cleft.
Cartilage ; Classification ; Congenital Abnormalities ; Esthetics ; Humans ; Hypertelorism ; Lip ; Nose* ; Orbit ; Ribs* ; Skin ; Transplants*

Purpose: Metatarsal pads are prescribed to decrease forefoot plantar pressure. However, the appropriate metatarsal pad placement location remains a debated issue. We aimed to identify the most effective insole design that reduces forefoot plantar pressure and determine the optimal position for metatarsal pad placement. Materials and Methods: We recruited 16 healthy adult volunteers, and measured their plantar pressure data during walking while using an in-shoe system. The volunteers were randomly assigned to one of four insole conditions: 1/16-inch insole (i.e., control), 1/4-inch soft plastazote (SP) flat insole, metatarsal pad positioned proximal to the metatarsal head (MTH) on the control insole (P0), and metatarsal pad positioned 10 mm distal from the proximal border of the MTH on the control insole (P10). A masking protocol was created by dividing the forefoot into three subareas, distal to the MTH (dMTH), beneath to the MTH (bMTH), and proximal to the MTH (pMTH). The participants reported their comfort level for each insole using a visual analog scale. Results: The SP flat insole and metatarsal pads both had a forefoot plantar pressure-reducing effect and provided insole comfort. Of the three insole designs, the SP flat insole was the most effective. No clear difference existed in efficacy in terms of the location of the metatarsal pad placement. Conclusion Considering the possibility of discomfort caused by improper metatarsal pad placement, the SP that increases shock absorption may be more clinically useful.

BACKGROUND AND OBJECTIVES: Tianeptine is a tricyclic antidepressant that has a novel pharmacological property: it increases the reuptake of 5-hydroxytryptamine. Recent studies have reported that the prevalence of depression is greater in patients with tinnitus than in control subjects who do not have tinnitus. The purpose of this study was to assess the efficacy of tianeptine for the relief of tinnitus, especially in patients with depressive mood. SUBJECTS AND METHODS: Among a total of 52 tinnitus patients, 15 had depressive mood. The depressed tinnitus patients were prescribed Stablon® 12.5 mg once daily for 1 month without any other drug. We assessed the severity of tinnitus, level of depression, and the quality of sleep in these patients by using the Tinnitus Handicap Inventory (THI), Beck Depression Inventory (BDI), and Pittsburgh Sleep Quality Index (PSQI). Hearing impairment and severity of tinnitus were measured with pure tone audiometry, speech audiometry, and tinnitograms. These evaluations were conducted before and after medication treatment. RESULTS: For the 15 depressed tinnitus patients, THI scores significantly correlated with BDI and PSQI scores prior to medication treatment. These results showed that the discomfort of tinnitus was closely related to depression and sleep disorder. After medication treatment, THI and BDI scores significantly decreased, indicating that tinnitus and depression improved. However, no significant alteration in PSQI score was observed, indicating that there was no improvement in sleep quality. CONCLUSIONS: In the treatment of depressed tinnitus patients, tianeptine might be an efficient drug to treat both tinnitus and depression. However, tianeptine is unlikely to improve the quality of sleep in these patients.
Audiometry ; Audiometry, Speech ; Depression ; Hearing Loss ; Humans ; Prevalence ; Serotonin ; Sleep Wake Disorders ; Tinnitus*

PURPOSE: The aim of this study was to confirm the efficacy and safety of regorafenib for advanced gastrointestinal stromal tumors (GISTs) reported in the GRID phase III trial in Korean patients. MATERIALS AND METHODS: Fifty-seven Korean patientswith advanced GISTwho experienced both imatinib and sunitinib failure were enrolled in the management access program between December 2012 and November 2013 and treated with regorafenib (160 mg orally once daily in a 3 weeks on/1 week off). RESULTS: None of the patients achieved a complete or partial response while 25 patients (44%) showed stable disease for ≥ 12 weeks. With a median follow-up of 12.7 months (range, 0.2 to 27.6 months), the median progression-free survival and overall survival were 4.5 months (95% confidence interval [CI], 3.8 to 5.3) and 12.9 months (95% CI, 8.1 to 17.7), respectively. Interestingly, 15 patients (26%) experienced an exacerbation of their cancer-related symptoms (abdominal pain in eight and abdominal distension in five) during the rest period for regorafenib, but all were ameliorated upon the resumption of regorafenib. The most common grade 3 or 4 adverse event was a hand-foot skin reaction (25%). The regorafenib dose was reduced in 44 patients (77%) due to toxicity, which manifested mainly as a hand-foot skin reaction (n=31). CONCLUSION: This study confirmed the efficacy and safety of regorafenib for advanced GIST after imatinib and sunitinib failure in Korean patients. Considering the exacerbation of the cancer-related symptoms observed during the rest periods, further exploration of the continuous dosing schedule of regorafenib is warranted in future clinical trials.
Appointments and Schedules ; Disease-Free Survival ; Follow-Up Studies ; Gastrointestinal Stromal Tumors* ; Humans ; Imatinib Mesylate* ; Skin