No abstract available.
Skin* ; Tibia*

PURPOSE: If significantly influenced by chronic otomastoiditis(COM), mastoid pneumatization and the position of the sigmoid sinus affect the operative procedure and postoperative complications in middle ear surgery. We evaluated mastoid pneumatization and sigmoid sinus position, and their relationship in COM, especially its during onset. MATERIALS AND METHODS: Using temporal bone CT and referring to any relevant medical records, we retrospect+tively analyzed 107 cases of COM and 49 cases of normal ear. The total case load comprised an adult group, aged above 16 years [100 cases of COM (M:F=46:54, mean age = 45 years), and 42 cases of normal ear,(M:F=20:22, mean age = 44 years)], and a childhood group, aged less than 16 years [7 cases of COM (M:F=4:3, mean age = 8.4 years), and 7 cases of normal ear (M:F=4:3, mean age = 7 years)]. We determined the thickness of the mastoid bone by measuring the shortest distance between the outer cortex of this bone and the deepest border of the sigmoid sinus; the depth of the sigmoid sinus; and the degree of mastoid pneumatization and sclerosis. Fifty-three patients whose medical history clearly included the onset of otomas-toiditis were divided into a child-onset group and an adult-onset group, and the relationship between the onset of otomastoiditis and the thickness of the mastoid bone was compared between the two groups. RESULTS: The mean axial thickness of the mastoid bone was 9.672 <+/-2.745 mm in COM and 12.430 +/-3.027 mm in normal ear. The difference was statisfically significant (p < 0.0001). The mean depth of the sigmoid sinus was 7.557 +/-1.868 mm in COM and 7.591 +/-2.315 mm in normal ear, with no statistically significant difference. In the childhood group, the mean axial thickness of the mastoid bone was 8.672 +/-2.978 mm in COM and 11.778 +/-3.087 mm in normal ear. This difference was statistically significant (p < 0.05). In the adult group, the corresponding figures were 9.742 +/-2.731 mm in COM and 12.538 +/-3.041 mm in normal ear, a dif-ference which was also statistically significant (p < 0.0001). Among patients with an obvious history of COM, child-onset cases totalled 24 (mean axial thickness of the mastoid bone, 9.2.0 +/-2.158 mm), while there were 29 adult-onset cases (mean axial thickness, 10.08 +/-2.99 mm). This difference in thickness between child-onset and adult-onset COM was statistically significant (p < 0.05). CONCLUSION: In COM, the degree of mastoid pneumatization is proportional to the axial thickness of the mastoid bone, and inversely proportional to the degree of sclerosis, anterior location of the sigmoid sinus and the onset of COM. If the sigmoid sinus is properly located, COM may inhibit mastoid pneumatization.
Adult ; Colon, Sigmoid* ; Ear ; Ear, Middle ; Humans ; Mastoid* ; Medical Records ; Postoperative Complications ; Sclerosis ; Surgical Procedures, Operative ; Temporal Bone

BACKGROUND: Combining blepharoptosis correction with double eyelid blepharoplasty is common in East Asian countries where larger eyes are viewed as attractive. This trend has made understanding the relationship between brow position and height of the palpebral fissure all the more important in understanding post-operative results. In this study, authors attempt to quantify this relationship in order to assess whether the expected postoperative brow descent should be taken into consideration when determining the amount of ptosis to correct. METHODS: Photographs of ten healthy female study participants were taken with brow at rest, with light elevation and with forceful elevation. These photographs were then viewed at 2 x magnification on a computer monitor and caliper was used to measure the amount of pull on the eyebrow in relation to the actual increase in vertical fissure of the eye. RESULTS: There was a positive, linear correlation between amount of eyebrow elevation and height of the palpebral fissure, which was statistically significant. Brow elevation increased vertical fissure, and thereby aperture of the eye, by 18%. CONCLUSIONS: Although the eye-opening strength as well as height of the palpebral fissure is improved with ptosis repair, the true effectiveness of ptosis surgery is diminished by the associated descent of the brow from relief of the involuntary frontalis muscle action and this should be taken into account prior to surgical intervention. Regardless, the combination of frontalis muscle relaxation and the increased eye-opening strength from ptosis repair gives the eye and the periorbital region a more natural look.
Asian Continental Ancestry Group ; Blepharoplasty ; Blepharoptosis* ; Eyebrows* ; Eyelids ; Female ; Humans ; Muscle Relaxation ; Muscles

BACKGROUND: There has been increasing interest in facial contouring procedures throughout Asian countries. As such, botulinum toxin A injections for masseteric hypertrophy have become a common procedure provided to patients who desire non-surgical correction of a square-angled mandible. We published a retrospective review of our initial results and our technique and treatment protocol in 2005. We also completed a long-term follow-up of the results (average follow-up period of 4.28 years) and the efficacy of repeated injections in 2010. The purpose of the current study is to systematically evaluate the changes to the masseter muscle at weekly intervals to determine the physiologic effects of botulinum toxin A injection. METHODS: Eight patients were prospectively followed on a weekly basis after botulinum toxin A injection for masseteric hypertrophy. Eight patients were followed for 15 weeks and four patients were followed for 25 weeks. Changes in the thickness of the muscle were recorded and analyzed. RESULTS: A reduction in the muscle thickness was found during the clenching phase of the muscle in the first week followed by a reduction in thickness during the resting phase in the second week. The reduction in muscle thickness continued until the eleventh week after which there was a gradual, but incomplete, return of muscle thickness over the study period. CONCLUSIONS: There is a predictable, phasic reduction in muscle thickness after botulinum toxin A injection for masseteric hypertrophy. This reduction first occurs during the clenching phase followed by a concomitant reduction during the resting phase. Maximal size reduction occurs at 11 weeks followed by gradual muscle size recovery.
Asian Continental Ancestry Group ; Botulinum Toxins* ; Botulinum Toxins, Type A* ; Clinical Protocols ; Follow-Up Studies ; G0 Phase ; Humans ; Hypertrophy* ; Mandible ; Masseter Muscle* ; Nerve Block ; Prospective Studies ; Retrospective Studies

Pulmonary involvement is more common in systemic lupus erythematosus (SLE) than in any other connective tissue disease, and more than half of patients with SLE suffer from respiratory dysfunction during the course of their illness. Although sepsis and renal disease are the most common causes of death in SLE, lung disease is the predominant manifestation and is an indicator of overall prognosis. Respiratory disease may be due to direct involvement of the lung or as a secondary consequence of the effect of the disease on other organ systems.
Cause of Death ; Connective Tissue Diseases ; Humans ; Lung ; Lung Diseases ; Lupus Erythematosus, Systemic* ; Prognosis ; Sepsis

PURPOSE: We evaluated patterns of tumor recurrence after nephron sparing surgery for sporadic renal cell carcinoma MATERIALS AND METHODS: From December 1992 to October 1997, 20 patients(21 renal units) underwent nephron sparing surgery(partial nephrectomy, wedge resection, enucleation) for sporadic renal cell carcinoma at our department. Mean postoperative followup period was 25.4+/-0.3 months. All patients were evaluated with a medical history, physical examination, blood chemistry, chest x-ray, abdominal CT every 6 months. The clinical course and outcome for patients who had recurrence after nephron sparing surgery were reviewed retrospectively. We also reviewed 122 patients who underwent radical nephrectomy at the same period for patterns of tumor recurrence. RESULTS: Renal cell carcinoma were recurred after nephron sparing surgery in 3 patients (15%, 3/21 renal units:14.2%). Local tumor recurrence with(1) or without(1) metastatic disease developed in 2 patients(10%). Metastatic disease without local tumor recurrence developed in 1 patient(5%). One patient with only local recurrence had positive resection margin. Initial pathological tumor stage and period to tumor recurrence were T3a and 4 months for patient with local recurrence, T2 and 10 months for patient with local recurrence and brain metastasis, T2 and 12 months for patient with lung metastasis without local recurrence. Renal cell carcinoma recurred after radical nephrectomy in 8 patients(6.6%). Local recurrence was none and all recurrent tumors were distant metastasis. CONCLUSIONS: The incidence of metastatic disease after nephron sparing surgery for renal cell carcinoma was not different from that occurring after radical nephrectomy but the incidence of local tumor recurrence after nephron sparing surgery was greater than that occurring after radical nephrectomy. Nephron sparing surgery must be done with enough negative resection margin.
Brain ; Carcinoma, Renal Cell* ; Chemistry ; Follow-Up Studies ; Humans ; Incidence ; Lung ; Neoplasm Metastasis ; Nephrectomy ; Nephrons* ; Physical Examination ; Recurrence* ; Retrospective Studies ; Thorax ; Tomography, X-Ray Computed

BACKGROUND: Dobutamine echocardiography is a useful method to detect myocardial viability in ischemic heart disease. Recently myocardial contrast echocardiography(MCE) is reported to be a new method to evaluate myocardial viability by assessing microvascular integrity of dysfunctional myocardium. We hypothesized if the microvascular integrity is maintained, the dysfunctional myocardium would improve its function by dobutamine infusion. METHOD: 10 myocardial infarction patients (acute : old=8 : 2, M : F=7 : 3, mean age=61+/-11yr) were included in the study. 2 dimensional echocardiography was performed before and during dobutamine infusion and after contrast injection to right and left coronary arteries in the catheterization laboratory. Echocardiographic analysis was done in parasternal short, apical 4 and 2 chamber views. Left ventricule was devided by 20 segments from 3 views. In each segment, will motion score(graded 1, normal, to 5, dyskinesia) before and after dobutamine infusion and opacification grade(0, 0.5, 1 denoting no, intermediate and normal opacification respectively) was compared. RESULTS: The number of segments with abnormal wall motion at baseline were 57 segments. 5 segments was exciuded due to poor image quality. Among 52 segments, 25 segments improved it's function during dobutamine infusion. Improvement of regional function was more frequent in hypokinetic segments than akinetic or dyskinetic segments (69% vs 15%). The improvement of dysfunctional regional wall motion by dobutamine infusion was observed in 80%(19/24), 67%(6/9) and 5%(1/19) of normally, intermediately and none opacified segment respectively. The correlation between wall motion score with opacification grade was 0.598 at baseline and increased to 0.766 after dobutamine infusion. CONCLUSION: In patients with myocardial infarction the dysfunctional segments but intact microvasculature assessed myocardial contrast echocardiography improves function by dobutamine infusion. These findings myocardial contrast echocardiography would be a useful method to detect myocardial viability.
Catheterization ; Catheters ; Coronary Vessels ; Dobutamine* ; Echocardiography* ; Humans ; Microvessels ; Myocardial Infarction* ; Myocardial Ischemia ; Myocardium

Total hip arthroplasty (THA) is rarely performed in below-knee amputee patients. To the best of the authors' knowledge, periprosthetic femoral fracture in such patients has not been previously reported. Such devastating complication can occur even with minor trauma. To prevent occurrence of such events, there may be several important factors to be considered in performance of THA surgery in below-knee amputee patients and during the course of rehabilitation. In this report, we describe a case involving a below-knee amputee patient who experienced multiple periprosthetic femoral fractures after THA.
Amputees ; Arthroplasty ; Femoral Fractures ; Hip ; Humans ; Knee ; Tacrine

BACKGROUND: The purpose of this study was to assess the intra-articular patterns in the rotational deformities of bucket handle meniscal tears (BHMTs) based on arthroscopic findings and their clinical relevance. METHODS: From 2004 to 2009, 42 patients with a BHMT diagnosed by magnetic resonance imaging underwent arthroscopic surgery. The arthroscopic data (all procedures were recorded) were evaluated retrospectively, and BHMTs were classified according to the rotational directions of centrally displaced fragments. To assess the reliability of the agreement in this classification, 2 orthopedic surgeons re-classified BHMTs, 1 week after first trial. Intra- and interobserver reliabilities were assessed using kappa statistics. In addition, we address specific tear patterns, associated anterior cruciate ligament injury, medio-lateral difference, reducibility, chronicity, and reparability. RESULTS: Most of the tears could be categorized into one of 3 morphologic patterns. Of the tears, 4.8% could not be categorized. BHMTs were classified, based on the rotational directions of centrally displaced fragments, as follows; the upward rotation group (type 1), the downward rotation group (type 2) and the reverse group (type 3). The most common intra-articular pattern was type 1 (29 patients, 69%). The occurrence of the other patterns was: type 2 in 7 patients (16.7%), type 3 in 4 patients (9.5%); we were not able to make a classification of type in 2 patients (4.8%). Intra-observer reliability was 0.86 in terms of kappa statistics, which implies almost perfect agreement. Mean interobserver reliability (0.73) showed substantial agreement. Type 1 and 2 tears were easily reduced, whereas all type 3 tears (4/4) needed additional procedures to achieve reduction. CONCLUSIONS: Based on arthroscopic findings, we describe a comprehensive BHMT classification scheme that encompasses 95.2% of all tears. Tear type was correlated with reducibility.
Adolescent ; Adult ; Anterior Cruciate Ligament/*injuries/pathology/surgery ; Arthroscopy/*methods ; Female ; Humans ; Knee Injuries/classification/*pathology/surgery ; Magnetic Resonance Imaging ; Male ; Menisci, Tibial/*injuries/pathology/surgery ; Middle Aged ; Reproducibility of Results ; Retrospective Studies

Until the recent development of the Q-switched lasers, it was not possible to remove tattoos without permanent scarring and pigmentary changes. Among the Q-switched lasers which was introduced under the concept of selective photothermolysis, Q-switched Nd-YAG laser has a longer wave(1064nm), deeper penetration, and lesser pigmentary change of skin than other type Q-switched laser. So, proved effectivity in removing pigmented lesion and tattoos without scarring and pigmentary changes. But repeated treatment is essential for a good result and than there is no agreement on the treatment interval in using Q-switched Nd-YAG laser. In this experiment, the author tattooed on the back skin of rabbits and treated them twice using Q-switched Nd-YAG laser in 5 groups of different treatment interval(1,2,4,6,8 weeks). The authors analysed the histology and final therapeutic results of the 5 groups to find a reasonable and shorter treatment interval by which we can obtain an effective therapeutic result without causing permanent tissue injury and change of the skin texture. The result shows that the 4 week treatment interval of Q-switched Nd-YAG laser for the tattoo removal in rabbits is the shortest term by which we can get effective therapeutic results without permanent scar and pigmentary changes.
Cicatrix ; Lasers, Solid-State* ; Rabbits* ; Skin