Cartilage extension and nasal envelop expansion play a main role incorrecting short or contracted nose. Despite numerous studies for cartilage expansion, there has been no reports of nasal skin elongation methods. We hereby preport a new method for expansion of nasal envelop with a comprehensive understanding of anatomical structures. From April 2009 to September 2010, 6 patients underwent operations to correct short or contracted nose. Two separating procedures were included for nasal envelop elongation; division of muscle(Procerus, Transverse nasali, Levator labii superior alaque nasi: PTL muscles) confluence located at nasal hinge and release of transverse nasalis sling. To estimate the degree of nasal envelop extension, forced skin traction test was performed. Comprehensive research with fresh cadaver was held to study the relationship between nasal SMAS and surrounding structures. Average 3.8mm elongation was documented by forced skin traction testafter the procedure. In the fresh cadaver study, transverse nasalis sling and PTL muscle confluence were firmly attached to the supportive framework. From our clinical experience and cadaver study, we discovered that release of transverse nasalis sling and division of PTL muscle confluence are the main factors for nasal envelop expansion in short or contracted nose.
Cadaver ; Cartilage ; Congenital Abnormalities ; Contracts ; Humans ; Muscles ; Nose ; Nose Deformities, Acquired ; Rhinoplasty ; Skin ; Traction

Nasal osteotomy for aesthetic results is required in patients who have broad nasal bone. Since the procedure is difficult, many operators hesitate the surgery. From January 2007 to July 2009, we performed 77 cases of nasal osteotomy, consisting of paramedian oblique medial osteotomy or median oblique-medial osteotomy and percutaneous lateral osteotomy. Most of the patients had satisfying results, however three patients had asymmetric shape and inappropriate inward movement of nasal bone which required revision with percutaneous lateral osteotomy. Osteotomy procedure varies, depending on surgeon's preference and experience, however, each surgeon should be aware of good and weak points of those procedures and use the most suitable method. In order to achieve maximal satisfying results, preoperative analysis of patients and minimal invasive handling should be done. Based on these efforts, this method could broadly be used in the aesthetic field.
Handling (Psychology) ; Humans ; Nasal Bone ; Nose ; Osteotomy ; Rhinoplasty

Hyper-activated depressor septi nasi is an important factor caused a nasal tip drooping and many studies have been carried out, however it still remains controversial. This study presents a surgical modality for its intervention, based on the anatomical study. Eleven fixed and six fresh cadavers were used for the study. We found that the depressor septi nasi was consisted of three fascicles. Medial fascicles were inserted into the dermocartilaginous ligament, and deep fibers of the medial fascicles were attached to the anterior nasal spine. After superficial fibers were interdigitated with the orbicularis oris, they were attached to the alveolar bone. Intermedial fascicles were inserted to the footplates of the medial cruses and the caudal septum. After they were interdigitated with the medial fascicle and the orbicularis oris, they were attached to the alveolar bone. From April to August 2008, five patients had surgical intervention for hyper-activated depressor septi nasi. Medial and intermedial fascicles were detached completely from the anterior nasal spine and the septum through intranasal approach. Tip droopings were improved in all cases. Specific complications were not found. We believe that surgical intervention through intranasal approach is a useful method for correction of tip drooping.

OBJECTIVES: Many studies have demonstrated that suicide is related to low serum cholesterol level, whereas conflicting results have also reported. The aims of the present study are to determine whether suicidal attempters have low lipid concentration and to identify the relationship between suicidal attempt severity and serum lipid levels. METHODS: Subjects were 50 suicidal attempters who visited the emergency room in Korea University Medical Center between July 1998 and June 1999. All subjects had been interviewed by psychiatrist and evaluated with Risk-rescue rating, HDRS and BPRS. They were diagnosed as major depressive disorder (n=29), personality disorder (n=19), and schizophrenia (n=2). Serum lipid levels in 50 suicidal attempters were compared with those in 50 nonsuicidal psychiatric inpatients corresponding to the age, sex and diagnosis of the suicidal attempters. We also examined the Spearman's rank correl-ations between the serum lipid levels and risk-rescue score. RESULTS: The serum total cholesterol level (t=-3.29, p=.001), total lipid level (t=-2.62, p=.01), and LDL level (t=-2.64, p=.011) in suicidal attempters were significantly lower compared with non-suicidal controls. In major depressive patients, total cholesterol level, total lipid level, and LDL level in suicidal attempters were significantly lower than those of nonsuicidal controls. In personality disorder patients, however, only serum total cholesterol level was significantly lower. Risk-rescue rating score was negatively correlated with serum total cholesterol level (t=.-293, p=.039), and positively corre-lated with BPRS (t=.544, p< 001), and HDRS (t=.488, p=.001). CONCLUSION: The lipid levels in suicidal attempter were significantly lower. Suicidal attempt severity was also significantly correlated with serum total cholesterol level. These findings suggest that low serum cholesterol should be related with severe violent suicidal attempt.
Academic Medical Centers ; Cholesterol ; Depressive Disorder, Major ; Diagnosis ; Emergency Service, Hospital ; Humans ; Inpatients ; Korea ; Personality Disorders ; Psychiatry ; Schizophrenia ; Suicide

Septal extension graft is valuable in elongating the nasal length which projects and rotates the tip. It is very effective for improving the nasal tip, therefore, it has widely been applied to correct short noses and drooping tips. In the field of Asian rhinoplasty, many operations are conducted using a septal extension graft, and variable techniques and methods have been introduced by several surgeons. However, there are difficulties in harvesting a sufficient amount of septum from Asian noses, therefore, appropriate designs and definite fixation of a graft are important factors. Furthermore, when applying the harvested septal cartilage to the L-strut, stability depends on the method and the location of the graft fixation. When the graft is unstable due to its pivot motion, the tip will be drooping, deviated and decreased in projection. We herein introduce a pivot locking suture that can firmly stabilize the septal extension graft and explain the factors related with septal stabilization. From September 2006 to February 2008, we performed unilateral septal extension graft for aesthetic purposes in 64 patients. After classic compression suture between L-strut and unilateral septal cartilage graft, pivot locking sutures were performed. Pivot locking suture fixed the meeting site of septal extension graft, and cephalic and caudal margin of L-strut using "figure of 8" suture. Then, we confirmed the stability with a vertical stability test and horizontal stability test. We could follow up with 20 patients. All patients were satisfied except 2 patients with the tip deviation. Therefore, we believe that pivot locking sutures together with classic compression sutures can overcome limitations of stability inherent with conventional methods, due to unstable septal extension graft cartilage.
Asian Continental Ancestry Group ; Cartilage ; Follow-Up Studies ; Humans ; Nasal Septum ; Nose ; Rhinoplasty ; Sutures ; Transplants

Monoclonal antibodies (mAbs) specific for the abnormal prion protein isoform (PrPres) are indispensable for diagnosing chronic wasting disease (CWD). In this study, eight mAbs were developed by immunizing PrP knockout mice with recombinant elk PrP and an immunogenic PrP peptide. The reactivity of the mAbs to recombinant PrP and the PrP peptide was measured, and their isotypes were subsequently determined. Among them, four mAbs (B85-05, B85-08, B85-12, and B77-75) were shown by Western blotting to recognize proteinase K-treated brain homogenate derived from an elk suffering from CWD.
Animals ; Antibodies, Monoclonal ; Blotting, Western ; Brain ; Mice ; Mice, Knockout ; Stress, Psychological ; Wasting Disease, Chronic

Inflammatory pseudotumor is a infrequent, benign tumor that affects at all ages and involves the lung, gastrointestinal tract, and salivary gland. They are the most common, isolated, primary lesion of the lung in children, and usually present as circumscribed, peripheral, parenchymal tumors or endobronchial tumors, which may be usually static or increase slowly in size without causing symptoms. Surgical excision is the treatment of choice because of the location and benign nature of this lesion. The prognosis after resection is excellent. Other therapeutic modalities include radiation and steroid therapy. We experienced two cases of inflammatory pseudotumor of the lung parenchyme and endobronchus. We report these cases with a review of literatures.
Child ; Gastrointestinal Tract ; Granuloma, Plasma Cell* ; Humans ; Lung ; Prognosis ; Respiratory System* ; Salivary Glands

Human pulmonary dirofilariasis has been documented from many parts of the world, but not in Korea so far. We experienced a patient of pulmonary dirofilariasis who had visited a local clinic because of chest pain for 1 month. On chest radiograph, a coin lesion of 2 cm diameter and enlargement of the mediastinal lymph node were shown. An exploratory lung resection was done. Pathologically the lesion was a pulmonary dirofilariasis complicated with necrotic pneumonia, fibrosis, and infarction. At the center of the lesion, degenerated nematode sections with multilayered cuticle, thick musculature, and bilateral internal ridges on each side were found, which was identified to be Dirofilaria immitis. This is the first report of human pulmonary dirofilariasis in Korea.
Case Report ; Dirofilariasis/pathology* ; Dirofilariasis/diagnosis ; Human ; Lung Diseases, Parasitic/pathology* ; Lung Diseases, Parasitic/diagnosis ; Male ; Middle Age

PURPOSE: In this study, we evaluated the effects of training for survival prediction of terminally ill patients in terms of medical professionals' confidence, accuracy and knowledge of survival prediction. METHODS: Twenty-nine participants completed a self-administered questionnaire where they scored their confidence, accuracy and knowledge of survival prediction before and after the training session. The training was provided in July 2009 at a university hospital located in Gyeonggi province, Republic of Korea. The participants were instructed by a professor of family medicine specialized in hospice palliative medicine to predict survival of a case using the palliative prognostic score and objective prognostic score. The training was provided in the form of a PowerPoint presentation for 40 minutes. RESULTS: Participants' confidence in survival prediction significantly increased from 4.00+/-1.73 (mean+/-SD) (0~10, visual analogue scale) to 5.83+/-1.71 after the training (P<0.001). Before training, participant's level of confidence significantly correlated with their age (P=0.04). The training significantly improved the correlation between the confidence level and the number of terminal cancer patients whom they have experienced (P=0.005 before training, P=0.017 after training). Participant's accuracy in survival prediction also significantly improved from 14 of 29 (48%) to 27 of 29 (93.1%) (P<0.001). The change in knowledge of survival prediction was too small to be statistically analyzed. CONCLUSION: After training, the confidence and accuracy scores significantly improved. Further study with a greater number of participants is needed to generalize this finding.
Hospices ; Humans ; Palliative Care ; Prognosis ; Republic of Korea ; Terminally Ill ; Surveys and Questionnaires

BACKGROUND AND OBJECTIVES: In head and neck reconstructive surgery, the stability of vital signs is important for patient recovery and flap outcome. We aimed to determine the better sedation protocol by comparing two protocols, namaely, midazolam/morphine (MM)-based and remifentanil (RF)-based sedation protocols, in the immediate postoperative settings of head and neck reconstructive surgery. SUBJECTS AND METHOD: We retrospectively reviewed the medical data of patients who underwent reconstructive surgery after the ablation of head and neck cancer involving MM sedation (n=34) or RF sedation (n=28). Parameters related to vital signs, flap outcomes, occurrence of delirium, length of stay and nursing burden were compared between the groups. RESULTS: The length of stay at the intensive care unit and flap outcomes were similar in the two groups. However, blood pressure as measured by frequency of variation was more stable in the RF group than in the MM group. In addition, the number of medical calls from the attending nurse due to the fluctuation of vital signs was less in the RF group than in the MM group. CONCLUSION: RF-based sedation for the postoperative intensive care unit care after head and neck reconstructive surgery is more effective in cases where vital signs are less stable. This type of sedation may decrease the nursing burden for these patients.
Blood Pressure ; Delirium ; Free Tissue Flaps ; Head and Neck Neoplasms ; Head* ; Humans ; Intensive Care Units* ; Critical Care* ; Length of Stay ; Neck* ; Nursing ; Postoperative Care ; Retrospective Studies ; Vital Signs