Sheen's ground rules can help avoid many of the pitfalls in secondary rhinoplasty. There are 1) establish realistic patient expectations; 2) defer surgery until the final resolution of the tissues; 3) have a well-defined aesthetic concept; 4) make a proper diagnosis; 5) limit the dissection and 6) use only the autogenous materials. The authors tried to ascertain which rule is the most important and should be strictly obeyed, what is the effect if the rules not obeyed, and what is the important aspects of any other rules not mentioned. Eight females cases(n=8) of secondary rhinoplasty from 1992 to 2002 were analyzed according to Sheen's ground rules. After surgery, the implants or the grafted tissues were either exposed or extruded, in two out of the five cases that did not follow the second principle, in two out of the four cases that did not the sixth principle, and in one case that did not the fifth principle. The authors conclude that all the principles of the ground rules should be obeyed if possible, most of all, it is very important to obey the first principle i.e. establishing the a realistic expectation, and second principle i.e. deferring the surgery until more than a year. Though it is undoubtful that the use of the autogenous materials is the best choice, the authors believe that a limited incisions and dissections and the use of smaller implants can help reduce the risk of complication if the alloplastic implants should be used.
Diagnosis ; Female ; Humans ; Rhinoplasty* ; Transplants

PURPOSE: Early postoperative arrhythmias are a major cause of mortality and morbidity after open heart surgery in the pediatric population. We evaluated the incidence and risk factors of early postoperative arrhythmias after surgery of congenital heart disease. METHODS: From January 2002 to December 2008, we retrospectively reviewed the medical records of the 561 patients who underwent cardiac surgery in Kyungpook National University Hospital. We analyzed patients' age and weight, occurrence and type of arrhythmia, cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time, and postoperative electrolyte levels. RESULTS: Arrhythmias occurred in 42 of 578 (7.3%) cases of the pediatric cardiac surgery. The most common types of arrhythmia were junctional ectopic tachycardia (JET) and accelerated idioventricular rhythm (AIVR), which occurred in 17 and 13 cases, respectively. The arterial switch operation (ASO) of transposition of the great arteries (TGA) had the highest incidence of arrhythmia (36.4%). Most cases of cardiac arrhythmia showed good response to management. Patients with early postoperative arrhythmias had significantly lower body weight, younger age, and prolonged CPB and ACC times (P<0.05) than patients without arrhythmia. Although the mean duration of ventilator care and intensive care unit stay were significantly longer (P<0.05), the mortality rate was not significantly different among the 2 groups. CONCLUSION: Early postoperative arrhythmias are a major complication after pediatric cardiac surgery; however, aggressive and immediate management can reduce mortality and morbidity.
Accelerated Idioventricular Rhythm ; Arrhythmias, Cardiac ; Arteries ; Body Weight ; Cardiopulmonary Bypass ; Child ; Heart ; Heart Diseases ; Humans ; Incidence ; Intensive Care Units ; Medical Records ; Retrospective Studies ; Risk Factors ; Tachycardia, Ectopic Junctional ; Thoracic Surgery ; Ventilators, Mechanical

The authors developed a computerized documentation system to record and store all the data pertaining to an endoscopic examination of the upper digestive tract. The system was programmed using the database management system Clipper Version 5.01. It is easy and convenient to use due to advanced deaign of input screen using menu bars and pull down menu and windows. The system was designed to permit the easy storage and retrieval of data by personnel who lack computer skills and who may only have limited typing ability. Today this system has been in daily use for 1 year at the endoscopic units of 8 different branch hospitals of Catholic university,medical college. Overall the experience in these centers has been positive, with excelient or good participation. Characteristics of this system are a menu-driven system, data input by predefined list, instantaneous report generation, on line access to previous examination, late entry of yathologic regerts. and record retrieval, listing according to different criteria. For the description of endoscopic findings and diagnosis, structured input is maintained. All of the findings are chosen from predefined list using pop-up screen and also free text typing is allowed. Therefore time effort was not increased compared to conventional documentation. Structured input and the resulting categorical data affer several advantages.
Database Management Systems ; Diagnosis ; Endoscopy ; Endoscopy, Gastrointestinal* ; Gastrointestinal Tract ; Hospitals, Satellite ; Information Systems

As leiomyosarcomas of smooth muscle origin are rare tumors found in adults, they are even more uncommon among children. Therefore, most of the existing literatures concerning pediatric leiomyosarcomas has been limited to case reports. More recently, ultrastructural and immunohistochemical studies revealed that some tumors may have properties more suggestive of nerve cells or vascular endothelial cells, rendering the gastrointestinal stromal tumor a more popular term. We experienced a 13 year old boy who was diagnosed and treated as iron deficiency anemia. Even after iron therapy, he had persistent anemia and endoscopic examination revealed a huge mass in the gastric cardia. Proximal gastrectomy was performed with margins free of tumor. The tumor cells showed high mitotic activity suggesting malignant nature. The immunohistochemical staining was positive for smooth muscle actin while negative for S-100 protein. Brief review of the literatures are presented.
Actins ; Adolescent ; Adult ; Anemia ; Anemia, Iron-Deficiency ; Cardia ; Child ; Endothelial Cells ; Gastrectomy ; Gastrointestinal Stromal Tumors ; Humans ; Iron ; Leiomyosarcoma ; Male ; Muscle, Smooth ; Neurons ; S100 Proteins

The author made a clinical study of postoperative respiratory function and analgesic effect of intrathecal morphine HCI which had been administered to 40 of a total 80 adult male and female patients who underwent abdorminal operation with spinal anesthesia from March, 1980 to September, 1981 at Department of Anesthesiology, Pusan National University Hospital. The results obtained were as follows: 1) Vital capacity during 6 to 12 hours after operation was significantly increased in patients given intrathecal morphine as compared with other groups of patients. 2) Patients given intrathecal morphine showed a significant increase in tidal volume during 6 hours after operation. 3) There was no significant change in the level of arterial oxygen tension at pre-and postoperative period in all groups of patients. 4) The average duration of postoperative analgesia was 33.6 and 33.8 hours respectively in patients who were given intrathecal morphine.
Adult ; Analgesia ; Anesthesia, Spinal ; Anesthesiology ; Busan ; Female ; Humans ; Male ; Morphine* ; Oxygen ; Postoperative Period ; Tidal Volume ; Vital Capacity

PURPOSE: The prevalence and morbidity of asthma, allergic rhinitis and atopic dermatitis are increasing worldwide. The International Study of Asthma and Allergies in Childhood (ISAAC) was a standardized method to evaluate the prevalence of these diseases, and to compare it between countries. Using the standardized protocol, proposed by ISAAC Steering Committee, the prevalence of allergic diseases in Korean children was reported in 1995 and 2000. In this study, we aimed to evaluate the prevalence and changing patterns of morbidity of allergic diseases in Korean children for recent 10 years. METHODS: From October 2006 to November 2006, Korean ISAAC written questionnaires were completed by the parents of 37,365 children attending 438 elementary schools in Seoul and 14 provinces. The questionnaires consisted of the questions about wheezing, rhinitis and eczema. RESULTS: The prevalences of "wheeze, ever", "wheezing, last 12 months", "diagnosis of asthma, ever" and "treatment of asthma, last 12 months" were 10.53%, 4.7%, 7.81% and 2.51%, respectively. The prevalences of "rhinitis, ever", "rhinitis, last 12 months", "diagnosis of allergic rhinitis, ever" and "treatment of allergic rhinitis, last 12 months" were 37.7%, 32.8%, 27.94% and 21.44%, respectively. And prevalences of "itchy eczema, ever", "itchy flexural eczema, last 12 months", "diagnosis of atopic dermatitis, ever" and "treatment of atopic dermatitis, last 12 months" were 20.99%, 15.91%, 28.22% and 13.91%, respectively. CONCLUSION: From the results of this study, the prevalence of asthma decreased slightly compared to previous studies. In contrast, the prevalences of allergic rhinitis and atopic dermatitis are still increasing in Korean children in 2006.
Asthma ; Child ; Dermatitis, Atopic ; Eczema ; Humans ; Hypersensitivity ; Korea ; Parents ; Prevalence ; Surveys and Questionnaires ; Respiratory Sounds ; Rhinitis ; Rhinitis, Allergic, Perennial

OBJECTIVE: For the optimal use of antidepressants, it is important to consider the behavioral effects of drugs affecting the real lives of depressed patients, as there is little difference in therapeutic effects between drugs. The aim of this study was to determine the acute pharmacodynamic effects of two recently introduced antidepressants, venlafaxine and mirtazapine, on psychomotor performance, motor activity and daytime sleepiness. METHODS: Twelve healthy male volunteers received a single dose of venlafaxine 37.5 mg, mirtazapine 15 mg or amitriptyline 25 mg (positive control) at one-week intervals in a double-blind, placebo-controlled, crossover design. Volunteers wore an actigraph on their non-dominant wrist for the duration of each test day. A battery of psychomotor tests was performed prior to dosing and at 2 and 6 h post-dose. Subjective daytime sleepiness was also assessed at the end of each test day. RESULTS: Venlafaxine did not affect psychomotor performance, motor activity and daytime sleepiness. Mirtazapine decreased thresholds in critical flicker fusion frequency, increased reaction times in choice reaction tests, and increased peripheral reaction times in compensatory tracking tests. It also caused significant daytime sleepiness and decreased motor activity. CONCLUSION: The differences in the behavioral effect profiles presented in this study should assist in the selection or scheduling of antidepressants.
Amitriptyline ; Antidepressive Agents ; Cross-Over Studies ; Flicker Fusion ; Humans ; Male ; Motor Activity* ; Psychomotor Performance* ; Reaction Time ; Volunteers ; Wrist ; Venlafaxine Hydrochloride

PURPOSE: B cell-activating factor (BAFF) is a tumor-necrosis factor (TNF) superfamily member best known for its role in the survival and maturation of B cells. BAFF activity is observed in naive cells as well as in effector/memory T cells. We aimed to explore whether BAFF in sputum is expressed at elevated levels in asthmatic airways and associated with eosinophilic inflammation, pulmonary function, and bronchial hyperresponsiveness in children. METHODS: One hundred and fifty-four asthmatic children and 98 healthy children were enrolled in the study. Sputum supernatants were collected and sputum BAFF and eosinophil cationic protein (ECP) levels were measured. We performed pulmonary function tests and methacholine challenge tests, while measuring total eosinophil count, total serum IgE, and serum ECP in all subjects. RESULTS: Asthmatic children had significantly higher levels of BAFF in induced sputum [26.50 (10.50-100.27) pg/mL] compared to healthy children [18.32 (7.68-44.63) pg/mL; P=0.011]. Sputum BAFF positively correlated with sputum eosinophils (gamma=0.406, P<0.001) and sputum ECP (gamma=0.789, P<0.001). Significant negative correlations were found between sputum BAFF and FEV1 (gamma=-0.291, P<0.001) or post-bronchodilator FEV1 (gamma=-0.334, P<0.001), whereas nonsignificant correlations were found between sputum BAFF and bronchial hyperresponsiveness, serum eosinophil count, and serum ECP. CONCLUSION: These findings suggest that BAFF may play a role in childhood asthma, and BAFF levels in sputum could be a supportive marker that represents airway inflammation, especially eosinophilic inflammation.
Asthma ; B-Lymphocytes ; Child ; Eosinophil Cationic Protein ; Eosinophils ; Humans ; Immunoglobulin E ; Inflammation ; Methacholine Chloride ; Pneumonia ; Respiratory Function Tests ; Sputum ; T-Lymphocytes

PURPOSE: The list of genetically engineered crops is growing. Traits introduced into these crops include insect protection, delayed ripening, virus resistance, modified nutritional composition, herbicide tolerance etc. Most traits introduced into crops result from the expression of new proteins. FAO/WHO organised joint expert consultations had recommended that substantial equivalence be an important component in the safety assessment of GMO plants for human consumption. As the first step to assess the allergenic potential of GMO food, the immunological and physicochemical characterization is needed. METHODS: We made crude extract from GMO soybean, wild soybean, curd and soy milk and performed SDS-PAGE. After acidification with HCl, the samples were divided to globulin and whey. To evaluate the changes of protein composition, the samples were heated or added with pepsin. PCR with primer coding 35S-promotor, NOS-terminator, and EPSPS gene were performed respectively for detection of GMO component. RESULTS: Although there was difference in protein composition in SDS-PAGE of GMO and wild soybean, the same protein bands are observed in globulin fraction after acidification. The heating made difficult to see the protein distribution exactly. After adding of pepsin the same bands-20 kD, 37 kD, and 68 kD-were preserved in GMO and wild soybeans. The 3 PCR procedures showed same results that GMO soybean and some curd included GMO component. CONCLUSION: There were no definite differences between GMO and wild soybeans in respect to immunologic and physicochemical characteristics. To assess the allergenicity of GMO food, the more researches including in vitro and in vivo immunoassay are needed.
Clinical Coding ; Electrophoresis, Polyacrylamide Gel ; Excitatory Postsynaptic Potentials ; Food, Genetically Modified ; Heating ; Hot Temperature ; Humans ; Immunoassay ; Insects ; Joints ; Organisms, Genetically Modified ; Pepsin A ; Plants, Genetically Modified ; Polymerase Chain Reaction ; Referral and Consultation ; Soy Milk ; Soybeans*

Reactive hemophagocytic syndrome or hemophagocytic lymphohistiocytosis, is characterized by the proliferation of benign histiocytes showing phagocytosis of blood cells in hematopoietic organs including bone marrow, spleen, or lymph nodes, accompanied by fever, hepatosplenomegaly, hepatic dysfunction, pancytopenia, and hypertriglyceridemia. The pathogenesis of reactive hemophagocytic syndrome is unknown. It is often associated with infection, malignant neoplasm, autoimmune disease, drugs and various immunodeficiencies. The prognosis of this syndrome is poor and the causes of death are hemorrhage, infection, or multiorgan failure. We experienced a case of hemophagocytic syndrome with terminal ileal ulcers, not associated with other causes. Thus, we report this case with a review of literatures.
Adult ; Fatal Outcome ; Humans ; Ileal Diseases/complications/*diagnosis ; Lymphohistiocytosis, Hemophagocytic/complications/*diagnosis/pathology ; Male ; Tomography, X-Ray Computed ; Ulcer/complications/*diagnosis