Background: Blepharoplasty has both aesthetic and functional benefits in patients with pseudoptosis; however, previous studies could not demonstrate its beneficial effects quantitatively and objectively. The authors objectively analyzed the visual field before and after surgery and investigated whether measurements of the visual field can be applied as a suitable predictor of surgical outcomes. Methods: In total, 18 eyelids in nine patients with pseudoptosis who had undergone simple skin excision blepharoplasty were evaluated prospectively from February to May 2016. The visual fields were analyzed preoperatively and 3 months postoperatively using the Goldmann kinetic perimetry test. The visual field test area was assessed using Adobe Photoshop. Results: Blepharoplasty had an average 4.99-fold beneficial effect on the superior visual field. In particular, more improvement was seen in the superior temporal quadrant than in the nasal quadrant. No correlation was found between the preoperative margin-to-reflex distance 1 (MRD1) and the surgical outcome (P=0.119). However, there was a strong correlation between the preoperative superior visual field and the surgical outcome (P=0.001). Conclusions Using the Goldmann kinetic perimetry test, we objectively and quantitatively proved the beneficial effect of blepharoplasty on patients with pseudoptosis. Furthermore, we demonstrated that the preoperative visual field is a better preoperative surgical outcome predictive factor than the preoperative MRD1.

OBJECTIVE: This study examined the epidemiological characteristics of bicycle injuries and the wearing of a helmet. METHODS: A cross-sectional observational study was conducted using the emergency department-based Injury In-depth Surveillance data from 2013 to 2016. The study population consisted of patients related to bicycles of all ages. The variables associated with helmet wearing were sex, age, type of location, activity at injury, alcohol use at injury, and time of injury. Multivariable logistic regression analysis was conducted to estimate the risks of nonuse of helmets. RESULTS: Among the 31,923 eligible patients, 3,304 patients (10.3%) were wearing helmets at the time of the injury. The adjusted logistic regression model showed that females (adjusted odds ratio [aOR], 0.675; 95% confidence interval [CI], 0.614–0.742), teenagers (aOR, 0.265; 95% CI, 0.232–0.302), old age (aOR, 0.378; 95% CI, 0.326–0.438), road except for bicycle lanes (aOR, 0.510; 95% CI, 0.467-0.557), leisure (aOR, 0.290; 95% CI, 0.252–0.334) or vital activity (aOR, 0.188; 95% CI, 0.162–0.218) at injury, alcohol use at injury (aOR, 0.329; 95% CI, 0.253–0.427), night time (aOR, 0.609; 95% CI, 0.560–0.663), and winter (aOR 0.734; 95% CI 0.619–0.872) were significantly associated with the nonuse of helmets. CONCLUSION: This study identified the factors associated with helmet use during bicycle riding. Strategies aimed at increasing the use of bicycle helmets targeting the risk population are needed.
Adolescent ; Bicycling ; Emergencies ; Female ; Head Protective Devices ; Humans ; Leisure Activities ; Logistic Models ; Morinda ; Observational Study ; Odds Ratio

PURPOSE: Herpes zoster, or shingles is caused by reactivation of varicella zoster virus lying latent in the ganglion of the dorsal root. It is rare in hand and upper extremities. The aim of this study is to report the shingles occurred in the hand, upper extremity along the various dermatome. MATERIALS AND METHODS: Between October of 2006 and August of 2009, patients with herpes zoster infection in hand and upper extremity were reviewed. The mean age of the patients was 61.4 years, and there were four female patients, one male patient. With the appropriate diagnosis, antiviral agent such as acyclovir(Zovirax(R)), Zovirax(R) cream were applied within 72 hours of skin lesions. Analgesics and wet dressing were commonly applied for relief of acute pain. To prevent the secondary infection and postherpetic neuralgia, tricyclic antidepressants, anticonvulsants and opioids were also prescribed. RESULTS: Herpes zoster infection was occurred along the distribution of ulnar nerve in three cases, radial nerve in one case and medial antebrachial cutaneous nerve in one case. Four patients developed unilateral vesicular eruption with dermatomal rash in addition to severe pain. But, one patient did not show any significant signs on physical exam except dysesthesia along the ulnar nerve distribution in hand and forearm. All of the patients were relieved acute pain, skin rash within 1-2 weeks. There were no recurrence and complications during the one year follow-up period. CONCLUSIONS: It is important that hand surgeons should not misdiagnose the possibility of herpes zoster infection even without developed skin rash. Early diagnosis, appropriate treatment can lower the risk of its complications.
Acute Pain ; Acyclovir ; Analgesics ; Analgesics, Opioid ; Anticonvulsants ; Antidepressive Agents, Tricyclic ; Bandages ; Coinfection ; Deception ; Early Diagnosis ; Exanthema ; Female ; Follow-Up Studies ; Forearm ; Ganglion Cysts ; Hand ; Herpes Zoster ; Herpesvirus 3, Human ; Humans ; Male ; Neuralgia, Postherpetic ; Paresthesia ; Radial Nerve ; Recurrence ; Skin ; Spinal Nerve Roots ; Ulnar Nerve ; Upper Extremity

PURPOSE: Trochanteric pressure sores management has been improved through the development of musculocutaneous flaps. But it has many drawbacks such as donor site morbidity and functional muscle sacrifice. With the introduction of perforator flap, it is possible to use in every location where musculocutaneous perforators are present. We have reconstructed trochanteric pressure sores using perforator-based flaps from the ascending branch of lateral circumflex femoral artery. METHODS: Between May of 2006 and April of 2008, we performed six cases of perforator-based flap from the ascending branch of lateral circumflex femoral artery for the coverage of trochanteric pressure sores. For identifying perforators, a line was drawn from the anterior superior iliac spine to the superolateral border of the patella as the vertical axis, from the pubis to the trochanteric prominence as the horizontal axis. In the lateral aspect of the intersection of these two axes, various flap were designed according to its defects. The flap was raised in the subcutaneous plane above the fascia and the pedicle was traced by doppler and identified. The pedicle was meticulously dissected not to injure the periadventitial tissues and transposed to the defect. The donor site was closed primarily. RESULTS: The mean age of patients was 56.2 years. Four male and two female patients were studied. Five patients were paraplegic. The mean defect size was 6 x 4 cm. The largest flap dimension was 14 x 7 cm. Donor sites were closed primarily without any complications. All flaps survived completely without necrosis, hematoma or infection. There were no recurrence during the follow-up period. CONCLUSION: Trochanteric pressure sores using perforator-based flap from the ascending branch of lateral circumflex femoral artery can be performed safely and it would be a reliable option for coverage of trochanteric pressure sores with minimal donor site morbidity.
Axis, Cervical Vertebra ; Fascia ; Female ; Femoral Artery ; Femur ; Follow-Up Studies ; Hematoma ; Humans ; Male ; Muscles ; Necrosis ; Patella ; Perforator Flap ; Pressure Ulcer ; Recurrence ; Spine ; Tissue Donors

Morphea is a subclass of localized scleroderma, and this is a connective tissue disorder that is limited to the skin and subcutaneous tissue. We report here on a case of a 43-year-old woman who presented with a solitary skin colored plaque in the vertex area. The histopathologic findings showed basal hydrophic changes of the basal cells, multiple melanophages in the upper dermis and broadened, compact, eosinophilic collagen fibers in the entire dermis. We finally made the diagnosis of morphea in the vertex, and the vertex is an unusual site for this disease.
Adult ; Collagen ; Connective Tissue ; Dermis ; Eosinophils ; Female ; Humans ; Scleroderma, Localized ; Skin ; Subcutaneous Tissue

OBJECTIVE: This study examined whether the depth of chest compression (CC) recommended by current cardiopulmonary resuscitation guidelines is equally appropriate to both men and women. METHODS: Retrospective analysis of the chest computed tomography (CT) findings was performed. The anteroposterior diameter (APD), internal compressible depth (ICD), and anterior chest wall thickness were measured at the midpoint of the lower half of the sternum. The residual diameter (RD) for simulated CC was also obtained. If the RD was less than 20 mm, it was assumed that a potential injury would occur. RESULTS: A total of 319 adults (173 men, 141 women), who underwent chest CT at the emergency room, were enrolled. A statistically significant difference was observed between the mean APD and ICD between men and women. The mean APD and IPD were 8 mm shorter and 9.5 mm shorter, respectively, in women than in men. When adjusted for age, height, weight, and body mass index (BMI), the differences in the value of these parameters increased even more. In simulated CC with a 60 mm depth, the predictors of RD of less than 20 mm were weighed (odds ratio [OR], 0.888; 95% confidence interval [CI], 0.826–0.954; P=0.001) and BMI (OR, 0.706; 95% CI, 0.579–0.862; P=0.001), and all cases with RD of less than 20 mm were women. CONCLUSION: Chest compression of more than 60 mm may increase the potential risk of injury, particularly in women. The maximum allowable chest compression depth of less than 60 mm should be emphasized for women.
Adult ; Body Mass Index ; Cardiopulmonary Resuscitation ; Emergency Service, Hospital ; Female ; Humans ; Male ; Retrospective Studies ; Sternum ; Thoracic Wall ; Thorax ; Tomography, X-Ray Computed

OBJECTIVES: To investigate brain oscillatory characteristics according to brightness and color temperature of light emitting diode (LED) light in young and elderly subjects. METHODS: We analyzed 22 young (age, 29.0±5.2 years) and 23 elderly (age, 64.8±4.5 years) healthy subjects. A LED light source was used with a combination of two color temperature (6,500 K vs. 3,000 K) and two brightness (700 lx vs. 300 lx) conditions. Participants were exposed to each light condition in relaxed wakefulness. Then, we analyzed power spectral density and functional connectivity from eye-open electroencephalography. RESULTS: A main effect of brightness on delta (p=0.044) and theta (p=0.038) power was significant in the elderly subjects. Bright light enhanced delta and theta power in the frontal region. By contrast, power spectral density of young subjects was affected by color temperature; high color temperature significantly increased beta-band power of the central region (p=0.034). Regarding functional connectivity, a significant effect of color temperature was observed in delta (p=0.006) and beta (p=0.046) frequencies. High color temperature light enhanced beta connectivity of young subjects (p=0.007), while not affecting that of elderly subjects (p=0.979). CONCLUSIONS: The present study demonstrated that spectral power and functional connectivity as well as subjective feelings are affected by the brightness and color temperature of LED light. These results might help us to understand the neurophysiological effects of light and identify the optimal indoor lighting conditions for an individual's environment.
Aged ; Brain ; Electroencephalography ; Healthy Volunteers ; Humans ; Wakefulness

As in other domains, artificial intelligence is becoming increasingly important in medicine. In particular, deep learning-based pattern recognition methods can advance the field of pathology by incorporating clinical, radiologic, and genomic data to accurately diagnose diseases and predict patient prognoses. In this review, we present an overview of artificial intelligence, the brief history of artificial intelligence in the medical domain, recent advances in artificial intelligence applied to pathology, and future prospects of pathology driven by artificial intelligence.
Artificial Intelligence ; Humans ; Pathology ; Prognosis

OBJECTIVE: The point-of-care ultrasound of the airway (POCUS-A) is a useful examination method but there are currently no educational programs for medical students regarding it. We designed a POCUS-A training curriculum for medical students to improve three cognitive and psychomotor learning domains: knowledge of POCUS-A, image acquisition, and image interpretation.METHODS: Two hours of training were provided to 52 medical students in their emergency medicine (EM) rotation. Students were evaluated for cognitive and psychomotor skills before and immediately after the training. The validity measures were established with the help of six specialists and eight EM residents. A survey was administered following the curriculum.RESULTS: Cognitive skill significantly improved after the training (38.7±12.4 vs. 91.2±7.7) and there was no significant difference between medical students and EM residents in posttest scores (91.2±7.7 vs. 90.8±4.6). The success rate of overall POCUS-A performance was 95.8%. The students were confident to perform POCUS-A on an actual patient and strongly agreed to incorporate POCUS-A training in their medical school curriculum.CONCLUSION: Cognitive and psychomotor skills of POCUS-A among medical students can be improved via a limited curriculum on EM rotation.
Airway Management ; Curriculum ; Education ; Education, Medical ; Emergency Medicine ; Humans ; Learning ; Methods ; Pilot Projects ; Point-of-Care Systems ; Schools, Medical ; Specialization ; Students, Medical ; Ultrasonography

Various methods for reconstructing partial upper lip defects have been reported, some of which, such as the Abbe and Estlander flaps, involve using the lower lip. However, determining the appropriate reconstruction method for large upper lip and oral commissure defects is particularly difficult because of the need to preserve the function and sensory ability of the lips and oral sphincter while achieving a satisfactory appearance. We describe our successful experience of using an extended Estlander flap to reconstruct a large defect caused by the excision of basal cell carcinoma on the upper lip and oral commissure.