OBJECTIVES: In this study, we assessed soft tissue asymmetry that occurred after open reduction of unilateral zygomaticomaxillary complex (ZMC) fractures. We proposed a simple method to assess soft tissue asymmetry after reduction surgery by evaluating the symmetry between the affected and the unaffected sides. The factors affecting soft tissue contour after surgery were also analyzed. MATERIALS AND METHODS: Subjects included patients admitted to Wonkwang University Dental Hospital from 2008 to 2013. Cone-beam computed tomography (CBCT) images of asymmetric patients who underwent open reduction at least 3 months prior were compared with healthy patients. RESULTS: The degree of asymmetry was measured in both the open reduction and control groups. Landmarks that showed a statistically significant difference between the two groups were zygion (1.73+/-0.24 mm), bucclae (1.08+/-0.26 mm), point of cheek (2.05+/-0.33 mm) and frontozygomatic point (1.30+/-0.31 mm). CONCLUSION: When compared with the normal group, asymmetry can occur in the affected side, which usually shows depression of overlying soft tissue and is statistically significantly different. Evaluation of soft tissue asymmetry with CBCT images after open reduction of ZMC fracture is useful.
Cheek ; Cone-Beam Computed Tomography* ; Depression ; Facial Asymmetry ; Humans ; Zygomatic Fractures

This correction is being published to correct the author's name.

Intussusception can develop at any age but about 95% of patients are children under 2 years-old. Adult intussusception is a rare condition. Unlike children, nearly all adults with intussusception have a lead point such as benign or malignant small bowel tumors, intestinal tuberculosis, or Meckel's diverticulum. First case is a 48-year-old male who was admitted with 2 days of diffuse abdominal cramping pain and no other associated gastrointestinal symptoms. Barium enema revealed ileocolic intussusception with a round cecal mass after barium reduction. An ileocecectomy was performed electively. The pathologic report was cecal cyst, which was an intraluminal structure with an epithelial lining of colonic mucosa. The second case, a 53-year-old male, was admitted with 1 week of diffuse abdominal cramping pain and watery diarrhea. Barium enema revealed ileocecal intussusception. Emergency surgery (ileocecectomy), revealed a polypoid small bowel mass. The pathologic report was lipoma. Recently, we experienced two cases of adult intussusception and report these cases with a brief review of the literature.
Adult* ; Barium ; Child ; Child, Preschool ; Colic ; Colon ; Diarrhea ; Emergencies ; Enema ; Humans ; Intussusception* ; Lipoma ; Male ; Meckel Diverticulum ; Middle Aged ; Mucous Membrane ; Tuberculosis

STUDY DESIGN: A retrospective study. OBJECTIVES: The aim of this study was to examine the usefulness of axial and sagittal-reconstructed CT images in the evaluation of spinal canal encroachment by thoracolumbar burst fractures. SUMMARY OF LITERATURE REVIEW: The dimensions of spinal canal encroachment by burst fractures have been described using axial CT images in the thoracolumbar region and sagittal-reconstructed images in the lower cervical region. However, the validity and reliability, depending on the measuring method, have not been fully evaluated. MATERIALS AND METHODS: A hundred and ninety-nine patients, who had diagnosed as a thoracolumbar burst fracture, were included in this study. Three orthopedic surgeons independently measured the canal encroachment of the burst fragment in the axial CT images and the sagittal-reconstructed images using the ratio of spinal length (method 1) and the ratio of area (method 2). The validity for the evaluation of the deformity and fracture stability was evaluated. In addition, the reliability of each method was assessed. RESULTS: Sixty-seven stable burst fractures and 132 unstable burst fractures were assessed. The mean kyphotic angle of stable and unstable burst fracture were 11.89 +/- 8.49degreesand 15.90 +/- 9.63degrees(P=0.005). The mean canal encroachment ratios of stable fracture were 17.21 +/- 15.82 % (axial-method 1), 16.71 +/-16.49 % (axial-method 2), 19.54 +/- 17.03 % (sagittal reconstructed-method 1), and 11.75 +/- 12.33 % (sagittal reconstructed-method 2). The mean canal encroachment ratios of unstable fracture were 31.54 +/- 17.10 % (axial-method 1), 29.67 +/- 18.47 % (axial-method 2), 28.53 +/- 18.60 % (sagittal reconstructed-method 1), and 21.20 +/- 15.11 % (sagittal reconstructed-method 2). There was no relationship between the fracture deformity and the canal encroachment ratio in all 4 methods. All ratios in the 4 method showed significant differences in the evaluation of fracture stability. All methods except method 1 in the sagittal-reconstructed images showed significant differences in the assessment of neurologic compromise. CONCLUSIONS: The measurement of a canal encroachment area using axial and sagittal-reconstructed images was valid in the description of fracture stability.
Congenital Abnormalities ; Humans ; Orthopedics ; Reproducibility of Results ; Retrospective Studies ; Spinal Canal

Sequencing depth, which is directly related to the cost and time required for the generation, processing, and maintenance of next-generation sequencing data, is an important factor in the practical utilization of such data in clinical fields. Unfortunately, identifying an exome sequencing depth adequate for clinical use is a challenge that has not been addressed extensively. Here, we investigate the effect of exome sequencing depth on the discovery of sequence variants for clinical use. Toward this, we sequenced ten germ-line blood samples from breast cancer patients on the Illumina platform GAII(x) at a high depth of ~200x. We observed that most function-related diverse variants in the human exonic regions could be detected at a sequencing depth of 120x. Furthermore, investigation using a diagnostic gene set showed that the number of clinical variants identified using exome sequencing reached a plateau at an average sequencing depth of about 120x. Moreover, the phenomena were consistent across the breast cancer samples.
Breast Neoplasms ; Exome* ; Exons ; Genetic Variation ; Humans

BACKGROUND: During coronary anastomosis in off-pump coronary artery bypass surgery (OPCAB), hemodynamic alternations can be induced by impaired diastolic function of the right ventricle. This study was designed to examine the effect of milrinone on right ventricular function and early outcomes in patients undergoing OPCAB. METHODS: Forty patients undergoing OPCAB were randomly assigned in a double-blind manner to receive either milrinone (milrinone group, n = 20) or normal saline (control group, n = 20). Hemodynamic variables were measured after pericardiotomy (T1), 5 min after stabilizer application for anastomosis of the left anterior descending coronary artery (LAD, T2), the obtuse marginalis branch (OM, T3), the right coronary artery (RCA, T4), 5 min after sternal closure (T5), and after ICU arrival. The right ventricular ejection fraction (RVEF) and right ventricular volumetric parameters were also measured using the thermodilution technique. For evaluation of early outcomes, the 30-day operative mortality and morbidity risk models were used. RESULTS: There was no significant difference in hemodynamic variables, including mean arterial pressure, between the 2 groups, except for the cardiac index and RVEF. The cardiac index and RVEF were significantly greater at T3 in the milrinone group than in the control group. CONCLUSIONS: Continuous infusion of milrinone demonstrated a beneficial effect on cardiac output and right ventricular function in patients undergoing OPCAB, especially during anastomosis of the graft to the OM artery, and it had no adverse effect on early outcomes.
Arterial Pressure ; Arteries ; Cardiac Output ; Coronary Artery Bypass, Off-Pump ; Coronary Vessels ; Heart Ventricles ; Hemodynamics ; Humans ; Milrinone ; Pericardiectomy ; Stroke Volume ; Thermodilution ; Transplants ; Ventricular Function, Right

BACKGROUND: Glycopyrrolate given as reversing agents of muscle relaxants has been reported to be effective in reducing postoperative catheter-related bladder discomfort (CRBD). However, it remains unclear whether glycopyrrolate as premedication is also effective. This study aims to investigate the effectiveness of glycopyrrolate as premedication on preventing CRBD in the post-anesthesia care unit (PACU). METHODS: Eighty-three patients who received elective ureteroscopic removal of ureteral stone were randomly assigned to the control (n = 43) or the glycopyrrolate group (n = 40). The glycopyrrolate group was treated with glycopyrrolate 0.3 mg as premedication while the control group received 0.9% saline 1.5 ml. The incidence and severity of CRBD and pain score using numerical rating scale (NRS) were measured in the PACU. RESULTS: The incidence of CRBD (26 of 40 patients vs. 41 of 43 patients, relative risk [RR] = 0.68, 95% Confidence interval [CI] = 0.53–0.86, P = 0.001) and the moderate to severe CRBD incidence (6 of 40 patients vs. 20 of 43 patients, RR = 0.32, 95% CI = 0.14–0.72, P = 0.002) were lower in the glycopyrrolate group than in the control group. Also, postoperative pain NRS score was found to be lower in the glycopyrrolate group (median = 1 [Q1 = 0, Q3 = 2]) compared to the control group (3 [1, 5], median difference = 1.00, 95% CI = 0.00–2.00, P = 0.002). CONCLUSIONS: The use of glycopyrrolate 0.3 mg as premedication in patients receiving ureteroscopic removal of ureteral stone reduced the incidence and severity of CRBD, and decreased postoperative pain in the PACU.
Glycopyrrolate* ; Humans ; Incidence ; Pain, Postoperative ; Premedication* ; Ureter* ; Ureteroscopy ; Urinary Bladder* ; Urinary Catheterization

OBJECTIVES: The concept of natural head position (NHP) was first introduced by Broca in 1862, and was described as a person's stable physiologic position “when a man is standing and his visual axis is horizontal.” NHP has been used routinely for clinical examination; however, a patient's head position is random during cone-beam computed tomography (CBCT) acquisition. To solve this problem, we developed an accelerometer to record patients' NHP and reproduce them for CBCT images. In this study, we also tested the accuracy and reproducibility of our accelerometer. MATERIALS AND METHODS: A total of 15 subjects participated in this study. We invented an accelerometer that measured acceleration on three axes and that could record roll and pitch calculations. Recorded roll and pitch data for each NHP were applied to a reoriented virtual image using three-dimensional (3D) imaging software. The data between the 3D models and the clinical photos were statistically analyzed side by side. Paired t-tests were used to statistically analyze the measurements. RESULTS: The average difference in the angles between the clinical photograph and the 3D model was 0.04° for roll and 0.29° for pitch. The paired ttests for the roll data (P=0.781) and the pitch data (P=0.169) showed no significant difference between the clinical photographs and the 3D model (P>0.05). CONCLUSION: By overcoming the limitations of previous NHP-recording techniques, our new method can accurately record patient NHP in a time-efficient manner. Our method can also accurately transfer the NHP to a 3D virtual model.
Acceleration ; Cone-Beam Computed Tomography ; Diagnostic Techniques, Surgical ; Head* ; Humans ; Imaging, Three-Dimensional ; Methods

BACKGROUND: Experimental and clinical studies have suggested that remifentanil probably causes acute tolerance or postinfusion hyperalgesia. This study was designed to confirm whether remifentanil given during propofol anesthesia induced postoperative pain sensitization, and we wanted to investigate whether pregabalin could prevent this pronociceptive effect. METHODS: Sixty patients who were scheduled for total abdominal hysterectomy were randomly allocated to receive (1) a placebo as premedication and an intraoperative saline infusion (control group), (2) a placebo as premedication and an intraoperative infusion of remifentanil at a rate of 3-4 ng/ml (remifentanil group), or (3) pregabalin 150 mg as premedication and an intraoperative infusion of remifentanil at a rate of 3-4 ng/ml (pregabalin-remifentanil group). Postoperative pain was controlled by titration of fentanyl in the postanesthetic care unit (PACU), followed by patient-controlled analgesia (PCA) with fentanyl. The patients were evaluated using the visual analogue scale (VAS) for pain scores at rest and after cough, consumption of fentanyl, sedation score and any side effects that were noted over the 48 h postoperative period. RESULTS: The fentanyl titration dose given in the PACU was significantly larger in the remifentanil group as compared with those of the other two groups. At rest, the VAS pain score in the remifentanil group at 2 h after arrival in the PACU was significantly higher than those in the other two groups. CONCLUSIONS: The results of this study show that remifentanil added to propofol anesthesia causes pain sensitization in the immediate postoperative period. Pretreatment with pregabalin prevents this pronociceptive effect and so this may be useful for the management of acute postoperative pain when remifentanil and propofol are used as anesthetics.
Analgesia, Patient-Controlled ; Anesthesia ; Anesthetics ; Cough ; Fentanyl ; gamma-Aminobutyric Acid ; Humans ; Hyperalgesia ; Hysterectomy ; Pain, Postoperative ; Piperidines ; Postoperative Period ; Premedication ; Propofol ; Pregabalin

BACKGROUND: Inhalation induction with desflurane can cause airway irritability and sympathetic stimulation. The aim of this study was to investigate whether lidocaine and fentanyl could reduce these unwanted reactions. METHODS: Seventy-five patients who had premedication with midazolam were randomly allocated to one of three groups to receive intravenous saline (S group), lidocaine 1.5 mg/kg (L group), fentanyl 1 microgram/kg (F group), respectively, before tidal volume induction with desflurane in oxygen and nitrous oxide. We recorded airway irritability such as cough, apnea, laryngospasm and excitatory movement and hemodynamic changes. RESULTS: Airway irritability was not significantly different between the groups. In F group, mean blood pressure at LOC ver and LOC BIS and heart rate at LOC ver, LOC BIS and just before intubation were lower than those of S group (P < 0.05). Other results were not significantly different. CONCLUSIONS: The results of the study showed that intravenous fentanyl and lidocaine had no beneficial effects to reduce airway irritability, but intravenous fentanyl could significantly reduce hemodynamic stimulation during inhalation induction with desflurane in the patients who were premedicated with midazolam.
Apnea ; Blood Pressure ; Cough ; Fentanyl ; Heart Rate ; Hemodynamics ; Humans ; Inhalation ; Intubation ; Isoflurane ; Laryngismus ; Lidocaine ; Midazolam ; Nitrous Oxide ; Oxygen ; Premedication ; Tidal Volume