A child born with spinal dysraphism and encephalocele faces the multiple and serious hazards of meningitis, hydrocephalus, paralysis and deformity of the lower limbs, and urinary bladder paralysis. The improvement in surgical management, and the advent of the shunt device for the control of hydrocephalus have so greatly altered the immediate prognosis that even a child with an extensive myelomeningocele must be considered to have a good chance of survival. We have presented a case of myelomeningocle, and two cases of meningoencephalocele and immediate repair techniques, and prognosis. 1) Surgical repair should be undertaken urgently, if possible within the first 48 hours of life and its role was the preservation of motor, sensory and intellectual function. 2) Carefully dissected the nerve filaments from the sac and replaced them into the dural canal and excised the functionless filament for prevention of spine deformity. 3) Shunt surgery should be considered before operation or immediate postoperation, in situation of huge meningoencephalocele.
Child ; Congenital Abnormalities ; Encephalocele ; Humans ; Hydrocephalus ; Lower Extremity ; Meningitis ; Meningomyelocele* ; Paralysis ; Prognosis* ; Spinal Dysraphism ; Spine ; Urinary Bladder

PURPOSE: This study was conducted to evaluate the development of osteolysis and the outcome of performing primary total hip arthroplasty using a non-cemented Multilock femoral stem with a proximal circumferential porous coating. The patients were followed up for a minimum of five year and we include the follow-up clinical and radiological results. MATERIALS AND METHODS: We reviewed the clinical and radiological results of 44 total hip arthroplasties in 40 patients, and these patients were available for a minimum of 5 years follow-up (average: 90.6 months), A Multilock femoral stem and Harris-Galante II acetabular component was used in all the operations, and the operations were performed between June 1993 and February 1997. RESULTS: The average Harris hip score improved from 54.5 points preoperatively to 91.5 points postoperatively. The stability of the femoral stem, based on Engh's evaluation schema, showed stability with osseous ingrowth being noted in 43 cases (98%), stability with fibrous ingrowth being noted in 1 case (2%), and there was no unstable fixation. Femoral osteolysis occurred in 17 cases (38%), which was mostly restricted to zones I and VII. Acetabular osteolysis occurred in 9 cases (20.5%), with zone II being the most common location. There were no cases of femoral stem revision. 7 cases of acetabular revision were done due to polyethylene liner dissociation in 3 cases and osteolysis of a large area in 4 cases. The mean revision period was 73 months (range: 37~112) from the initial operation. CONCLUSION: The femoral stem was devised to press fit through the circumferential proximal porous coating and the flute type distal stem has the benefit of excellent fixation and prevention of particle invasion to the distal bone canal, which is caused by proximal bone ingrowth. However, the frequency of revision was great due to the increased rate of wear by the structural defect of the Harris-Galante type II acetabular cup and the high occurrence of osteolysis.
Acetabulum ; Arthroplasty ; Arthroplasty, Replacement, Hip* ; Follow-Up Studies ; Hip ; Humans ; Osteolysis ; Polyethylene

PURPOSE: Congenital factor VII(FVII) deficiency is a rare bleeding disorder and surgery can cause excessive bleeding due to an extrinsic pathway problem. It can be diagnosed by increased PT and decreased FVII level in coagulation test. Symptom varies according to the level of FVII, but it is essential to prevent intraoperative excessive bleeding. METHODS: In this report, we described the orthognatic surgery experience in a mandibular prognathism patient with congenital F'VII deficiency, in which recombinant activated factor VII(rFVIIa) was used to manage the bleeding. Rsults: We could get a successful result without any complication and there was minimal intraoperative bleeding. CONCLUSION: The orthognathic surgery could therefore be safely performed in patients with congenital factor VII deficiency using rFVIIa.
Factor VII ; Factor VII Deficiency ; Factor VIIa ; Hemorrhage ; Humans ; Orthognathic Surgery ; Prognathism ; Recombinant Proteins

BACKGROUND/AIMS: Current international guidelines recommend colorectal cancer screening for average-risk people over 50 years of age. Accordingly, we aimed to estimate the prevalence of colorectal neoplasms in all age groups and evaluate associated risk factors. METHODS: Data of 14,932 subjects who underwent colonoscopy from July 2006 to January 2012 at Health Promotion Center, Gangnam Severance Hospital (Seoul, Korea) as part of a health check-up were reviewed retrospectively. RESULTS: The overall prevalence of colorectal neoplasms and adenoma were 34.6% and 25.3%, respectively. Colorectal adenoma was found in 3.2%, 13.0%, 21.7%, 33.8%, 44.0%, 50.5%, and 54.2% of subjects under 30 years, 30-39 years, 40-49 years, 50-59 years, 60-69 years, 70-79 years, and over 80 years of age (trend p<0.0001). Independent predictors of colorectal adenoma included male gender (OR 2.38, 95% CI 2.084-2.718), positive occult blood (2.266, 1.761-2.917), positive serology of Helicobacter pylori (1.253, 1.114-1.409) and hypertriglyceremia (1.267, 1.065-1.508). Compared to the 30-39 years of age reference group, the ORs for each age group were 0.195 (under 30 years), 1.634 (40-49 years), 2.954 (50-59 years), 5.159 (60-69 years), 5.640 (70-79 years), 11.020 (over 80 years), while the 95% CIs were 0.071-0.536 (under 30 years), 1.340-1.992 (40-49 years), 2.421-3.604 (50-59 years), 4.109-6.476 (60-69 years), 3.822-8.322 (70-79 years), and 2.809-42.234 (over 80 years). CONCLUSIONS: Colorectal adenoma prevalence increased proportionally with age. Only subjects under the age of 30 years had a definitely lower prevalence of colorectal adenoma. Male gender, positive occult blood, positive serology of H. pylori, and hypertriglyceremia were associated risk factors of colorectal adenoma.
Adenoma/*epidemiology/etiology ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Colonoscopy ; Colorectal Neoplasms/*epidemiology/etiology ; Female ; Helicobacter Infections/complications ; Helicobacter pylori ; Humans ; Hypertriglyceridemia/complications ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Republic of Korea/epidemiology ; Retrospective Studies ; Sex Factors

PURPOSE: Velopharyngeal insufficiency(VPI) during articulation development period can cause compensatory articulation like glottal stop, which can maintain VPI symptoms such as hypernasality and nasal emission despite of recovered velopharyngeal function. METHODS: A girl visited our department with speech problems such as hypernasality, compensatory articulation patterns, and nasal air emission. She had history of post-palatoplasty fistula which was repaired after 1 year follow-up. RESULTS: After treated with speech therapy without surgery, her hypernasal speech problem was corrected. From this, we could assume that the fistula during articulation development period induced VPI, which leads to glottal substitution and this compensatory articulation maintained VPI though the fistula was repaired. CONCLUSION: In this report, we could observe that palatal fistula in articulation development period can have detrimental effect on articulation, and also we could confirm that evaluation of soft palate mechanism with using speech sample without compensatory articulations prevent the patient from unnecessary operation.
Fistula ; Follow-Up Studies ; Humans ; Palate, Soft ; Speech Therapy ; Velopharyngeal Insufficiency

Objectives: ：The aim of this study was to determine how the efficacy and compliance of positive airway pressure (PAP) varies depending on the depressive symptom with obstructive sleep apnea (OSA). Methods: ：We collected data about baseline Apnea-Hyponea Index (AHI), sleep and mood state and demographic information from 125 obstructive sleep apnea patients prior to the start of positive airway pressure treatment. The Apnea-Hyponea Index and daytime sleepiness were examined as indicators of efficacy of positive airway pressure and daily average usage time and the utilization rate (%) for more than 4 hours were calculated as indicators of compliance of positive airway pressure at the time of 1, 3 or 9 months after the start of positive airway pressure. Repeated-measures ANOVA and linear mixed model (LMM) with adjusting age, body mass index and baseline Insomnia severity index were used for revealing any significant differences between groups over time passed. Results: ：This difference was confirmed at 9 months after starting positive airway pressure, between the two groups and the usage rate for more than 4 hours in depressive group was lower than that in non-depression group (56.2% vs. 67.5%). Conclusions ：We demonstrated that there would be a difference in the compliance of positive airway pressure among patients with obstructive sleep apnea according to depressive state. Therefore, we suggest evaluating depressive symptoms in patients with obstructive sleep apnea before starting positive airway pressure, to increase the compliance of the positive airway pressure, which is essential to maintain the efficacy of the positive airway pressure.

A herniated nucleus pulposus (HNP) during pregnancy has been a rare occurrence with a reported incidence of 1:10,000 case. It is hard to diagnose because of the potentially hazardous effect of ionizing radiation to the fetus when complaining back pain during pregnancy. In this case, magnetic resonance imaging (MRI) provide safe and useful modality and in general, back pain usually respond readily to conservative treatment. Cauda equina syndrome or severe and/or progressive neurologic deficit is a medical emergency that necessitates prompt surgery during pregnancy. She admitted at 31 weeks gestation for sudden development of right leg paresthesia and ankle motor weakness, an MRI showing compression on right nerve root at the level of L5~S1. After 4 weeks treated with bed rest and analgesics, we delivered by cesarean section and laminectomy at the same time. We have experienced a pregnancy with HNP, so report of this case with brief review of literature.
Analgesics ; Ankle ; Back Pain ; Bed Rest ; Cesarean Section ; Emergencies ; Female ; Fetus ; Incidence ; Laminectomy ; Leg ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Paresthesia ; Polyradiculopathy ; Pregnancy* ; Radiation, Ionizing

An intussusception in adulthood is an unusual cause of bowel obstruction. It accounts for up to 5% of all intussusception. Approximately 90% of cases are secondary to a definite lesion such as malignancy or lipoma. Most patients are asymptomatic and the lesion is often detected incidentally at colonoscopy, operation and autopsy. Strangulated intussuscetion is a rare case and also requires emergency operation. A 32-year-old woman visited our emergency room because of severe epigastric pain. Abdominal CT revealed a low density mass in bowel loop and distended small bowel loops filled with fluid. Colonoscopic finding showed huge purple-colored coil-spring lesion in the ascending colon. From this findings, we diagnosed a strangulated intussusception. Surgically removed specimen revealed a small intestinal lipoma.
Adult ; Male ; Female ; Humans

PURPOSE: The presence of epicanthal fold and the absence of supratarsal fold are characteristics of Korean eyelids. There has been many surgical procedures to eliminate medial epicanthal fold but those procedures focus on the lengthening of horizontal palpebral fissure and the shortening of intercanthal distance so that the shape of eye had tendency to be sharp. The authors suggest that the supermedial shifting of epicanthal fold enhance the aesthetic result. METHODS: From Sep 2006 to May 2007, total 17 women(mean age 22) with Type III epicanthal fold underwent epicanthoplasty using author's modified Uchida method. The design for epicanthoplasty was drawn superolaterally along epicanthal fold and split V-W plasty was done to shift the epicanthal fold superomedially. Also non-incisional double-eyelid operation was underwent. RESULTS: The epicanthal fold was shifted in superomedially, intercanthal distance was shortened and double-eyelid was achieved. The patients were satisfied with the result and no major complication was noted. CONCLUSION: This method can be effective in correcting the epicanthal fold of Korean eyelid by shifting the epicanthal fold superomedially to make the shape of eye aesthetically without noticeable scar.
Cicatrix ; Eyelids ; Humans ; Sterilization, Tubal*

PURPOSE: Gluteal perforator is easily identified in the gluteal region and gluteal perforator flap is a very versatile flap in sacral sore reconstruction. We obtained satisfying results using the gluteal perforator flap, so we report this clinical experiences with a review of the literature. METHODS: Between November of 2003 and April 2006, the authors used 16 gluteal perforator flaps in 16 consecutive patients for coverage of sacral pressure sores. The mean age of the patients was 47.4 years (range, 14 to 78 years), and there were 9 male and 7 female patients. All flaps in the series were supplied by musculocutaneous arteries and its venae comitantes penetrating the gluteus maximus muscle and reaching the intrafascial and suprafascial planes, and the overlying skin forming a rich vascular plexus arising from gluteal muscles. Patients were followed up for a mean period of 11.5 months. RESULTS: All flaps survived except one that had undergone total necrosis by patient's negligence. Wound dehiscence was observed in three patients and treated by secondary closure. There was no recurrence during the follow-up period. CONCLUSION: Gluteal perforator flaps allow safe and reliable options for coverage of sacral pressure sores with minimal donor site morbidity, and do not sacrifice the gluteus maximus muscle and rarely lead to post- operative complications. Freedom in flap design and easy-to perform make gluteal perforator flap an excellent choice for selected patients.
Arteries ; Buttocks ; Female ; Follow-Up Studies ; Freedom ; Humans ; Male ; Malpractice ; Muscles ; Necrosis ; Perforator Flap* ; Pressure Ulcer* ; Recurrence ; Skin ; Tissue Donors ; Wounds and Injuries