By the human is getting older, the factors which can the reason of the aging process in the frontal region are divided, static factor and dynamic factor. the static factor is gravity, and the dynamic factor is repeatitive competition of depressosr muscles and elevator muscles. the depressor muscles are corrugator muscle, procerus muscle and orbicularis oculi muscle and the elevator muscle is frontalis muscle. Correction methods of this aging process are divided to non-surgical and surgical method. Non-surgical method are Atecoll and fat injection, and using botulinum toxin. But the effect of these method is temporary and limited, and if the skin laxity is great, this method cannot be used. Surgical methods are laser, chemical peeling, dermabrasion, classical forehead lift which is dissected superficial to galea aponeurosis or subperiosteal plane through coronal or hairline incision, and endoscopy method that the corrugator muscle and procerus muscle are transected by using endoscope, and then the posterior elevation of forehead flap is induced. the endoscopy method is the most popular method in recent years, which has the many advantages of minimal incision, less amount of bleeding and lower complication, but expensive equipment, adaptation and training period are needed. We present the result of 10 patients from May. 1996 to Jan. 1997. After the superior orbital rim exposed through upper eyelid incision, the corrugator muscle was resected while careful attention to the supraorbital n. which was located behind the orbicularis oculi muscle. A communication was made through both sided of medial canthal area, and after the procerus muscle was resected, the fat graft was inserted between them. Finally, we made periosteal incision superiorly, and subperiosteal forehead lift was done without using endoscope.
Aging ; Botulinum Toxins ; Dermabrasion ; Elevators and Escalators ; Endoscopes ; Endoscopy ; Eyelids ; Fibrinogen ; Forehead* ; Gravitation ; Hemorrhage ; Humans ; Muscles ; Orbit ; Skin ; Transplants

No abstract available.

BACKGROUND: A variety of therapeutic regimens has been used in the treatment of hypertrophic scars/keloids with onsatisfactory final results. Application of cryosurgery could be beneficial sinee it was reported to produce less scarring and recurrence after treatment compared with other methods. Objective This study was undertaken to evaluate the effect of the cryosurgery through objective, quantitative measurement of hypertrophic scar/keloid thickness and to assess the influence of the cryosurgery on fibroblasts. The latter was achieved through fibroblast cultures established from hypertrophic scars/keloids. METHODS: Eight patients, ageA 17 to 47 years old, with hypertrophic scars/keloids were treated with liquid nitrogen using the cantact method. One freeze-thaw cycle of 10-30 seconds per lesion was employed, and if needed, treatment was repeated every 20 to 40 days. The thicknesses of the lesions were measured objective,ly with ultrasound in five patients, before and after cryosurgery and were compared with controlled scars in other areas. In three patients, we cultured fibroblasts from the treated and the untreated lesions and exmuned the rate of fibroblast proliferation and collagen production. RESULTS: In all five patients, thicknesses of the hypertrophic scars/keloids decreased compared to those of controlled areas after treatment. Five of 6 hypertrophic scar cell lines demonsbated decreased fibroblast proliferation rates in comparison to control fibroblast lines. Collagen produced by the fibroblasts was variable. CONCLUSION: Cyosurgery was effective and safe in the treatment of hypertrophic scars/keloids.
Cell Line ; Cicatrix ; Cicatrix, Hypertrophic* ; Collagen ; Cryosurgery* ; Fibroblasts ; Humans ; Keloid* ; Middle Aged ; Nitrogen ; Recurrence ; Ultrasonography

Scleroderma renal crisis is defined as the new onset of accelerated arterial hypertension and/or rapidly progressive oliguric renal failure. The pathogenesis is not well understood but there is increasing evidence that renin- angiotensin system is involved. We report an one female patient with diffuse scleroderma and renal crisis. Initial treatment with ACE inhibitor was not effective in controlling blood pressure until the temporal initiation of hemodialysis. Predialysis serum creatinine level was 8.4 mg/dL, but after initiation of hemodialysis, adequate control of blood pressure was achieved with ACE inhibitor alone. This case illustrated many features of the syndrome of scleroderma renal crisis and supported the early use of captopril and emergency hemodialysis if indicated.
Angiotensins ; Blood Pressure ; Captopril ; Cough* ; Creatinine ; Emergencies ; Female ; Humans ; Hypertension ; Renal Dialysis ; Renal Insufficiency ; Scleroderma, Diffuse ; Tic Disorders* ; Tics*

OBJECTIVE: Treatment decisions in patients with unruptured aneurysms required detail assessment of the risk. The most important things to prevent the subarachnoid hemorrhage (SAH) are the measuring of risk of rupture of intracranial aneurysm and the decreasing of operation risk at aneurysm neck clipping. METHODS: Between January, 1994, and April, 2003, data regarding a series of 1586 aneurysm operations performed by a single neurosurgeon (J.H.S). Among them 158 patients with unruptured intracranial aneurysm (UIA) were analyzed retrospectively from the medical records and radiological findings (CT, CT angiography, MR angiography & angiography). The type of aneurysm was classified by three categories : Group 1 : incidental (asymptomatic, unruptured), Group 2 : symptomatic unruptured, Group 3 : UIA with SAH from a separate aneurysm. Unoperated cases were excluded. RESULTS: The treated aneurysms were 91 patients with 103 UIAs. Group 1 : 41 patients with 49 UIAs, Group 2 : 5 patients and Group 3 : 45 patients with 49 UIAs. In Group 1 the results of treatment were 0 mortality and below 4% morbidity. The cases with morbidity were a giant aneurysm, old age patient and the UIAs of posterior circulation. CONCLUSION: The UIA with SAH should be treated surgically and/or endovascular therapy. The treatment of the unruptured, asymptomatic incidental intracranial aneurysm was recommended but the patient's age, size and lcoation of aneurysm, and the skill and experience of neurosurgeon were considered honestly and carefully.
Aneurysm* ; Angiography ; Humans ; Intracranial Aneurysm ; Medical Records ; Mortality ; Neck ; Retrospective Studies ; Rupture ; Subarachnoid Hemorrhage

OBJECTIVE: The aim of study was to review our patient population to determine whether there is a critical aneurysm size at which the incidence of rupture increases and whether there is a correlation between aneurysm size and location. METHODS: We reviewed charts and radiological findings (computed tomography (CT) scans, angiograms, CT angiography, magnetic resonance angiography) for all patients operated on for intracranial aneurysms in our hospital between September 2002 and May 2004. Of the 336 aneurysms that were reviewed, measurements were obtained from angiograms for 239 ruptured aneurysms by a neuroradiologist at the time of diagnosis in our hospital. RESULTS: There were 115 male and 221 female patients assessed in this study. The locations of aneurysms were the middle cerebral artery (MCA, 61), anterior communicating artery (ACoA, 66), posterior communicating artery (PCoA, 52), the top of the basilar artery (15), internal carotid artery (ICA) including the cavernous portion (13), anterior choroidal artery (AChA, 7), A1 segment of the anterior cerebral artery (3), A2 segment of the anterior cerebral artery (11), posterior inferior cerebellar artery (PICA, 8), superior cerebellar artery (SCA, 2), P2 segment of the posterior cerebral artery (1), and the vertebral artery (2). The mean diameter of aneurysms was 5.47+/-2.536 mm in anterior cerebral artery (ACA), 6.84+/-3.941 mm in ICA, 7.09+/-3.652 mm in MCA and 6.21+/-3.697 mm in vertebrobasilar artery. The ACA aneurysms were smaller than the MCA aneurysms. Aneurysms less than 6 mm in diameter included 37 (60.65%) in patients with aneurysms in the MCA, 43 (65.15%) in patients with aneurysms in the ACoA and 29 (55.76%) in patients with aneurysms in the PCoA. CONCLUSION: Ruptured aneurysms in the ACA were smaller than those in the MCA. The most prevalent aneurysm size was 3-6 mm in the MCA (55.73%), 3-6 mm in the ACoA (57.57%) and 4-6 mm in the PCoA (42.30%). The more prevalent size of the aneurysm to treat may differ in accordance with the location of the aneurysm.
Aneurysm ; Aneurysm, Ruptured ; Anterior Cerebral Artery ; Arteries ; Basilar Artery ; Carotid Artery, Internal ; Caves ; Choroid ; Female ; Humans ; Incidence ; Intracranial Aneurysm ; Magnetic Resonance Angiography ; Male ; Middle Cerebral Artery ; Posterior Cerebral Artery ; Rupture ; Vertebral Artery

PURPOSE: The bony mallet finger injury is generally managed by conservative treatments. But operative treatments are needed especially when the fractures involve above 30% of articular surface, or when distal phalanx is accompanied by subluxation in the volar side. This is the reason why they often result in chronic instability, articular subluxation and cosmetic dissatisfaction. In this report, We describe new method using the hook plate as an operative treatment of mallet finger deformity. METHODS: Among 13 patients with mallet finger deformity who came from February 2006 to February 2008, six patients were included in surgical indication. Under local anesthesia, H or Y type incision was made at the DIP joint area. After the DIP joint extension, the hook plate was put on the fracture line, and one self tapping screw was used for fixation. 2 hole plate which was one of the holes in 1.5 mm diameter was cut in almost half and bended by approximately 100 degrees. RESULTS: In all six cases which were applied the hook plate, complications such as loss of reduction or nail deformity were not seen. In only one patient, hook pate was removed due to inflammatory reaction after the surgery. In 2 weeks after the operation, active motion of DIP joint was performed. The result was satisfactory not only cosmetically but also functionally. In 6 weeks after the operation, the range of motion of DIP joint was average 64 degrees. CONCLUSION: The purpose of the operative treatment for mallet finger deformity using the hook plate is to provide anatomical reduction with rigid fixation and to prevent contracture at the DIP joint. While other operations takes 6 weeks, the operation using the hook plate took only two weeks to enable active motion. Complication rate was low and the method is rather simple. Thus, the operation using the hook plate is recommended as a good alternative method for the mallet finger deformity treatment.
Anesthesia, Local ; Congenital Abnormalities ; Contracture ; Cosmetics ; Finger Injuries ; Fingers ; Humans ; Joints ; Nails ; Porphyrins ; Range of Motion, Articular

PURPOSE: Hands are the chief organs for physically manipulating the environment, using anywhere from the roughest motor skills to the finest, and since the fingertips contain some of the densest areas of nerve endings on the human body, they are continuously used organ with complex functions, and therefore, often gets injured. To prevent any functional loss, a detailed anatomical knowledge is required to have a perfect surgical treatment. Also it is necessary to have a thorough understanding of arrangements of the human extensor tendons and intertendinous connections when tenoplasty or tendon transfer is required. We performed a study of the arrangements of the human extensor tendons and the configuration of the intertendinous connections over the dorsum of the wrist and hand. METHODS: A total of 58 hands from Korean cadavers were dissected. The arrangements of extensor indicis proprius, extensor digitorum communis, and extensor digiti minimi tendons and intertendinous connections were studied. RESULTS: The most common distribution patterns of the extensor tendons of the fingers were as follows: a single extensor indicis proprius(EIP) tendon which inserted ulnar to the extensor digitorum-index(EDC-index); a single EDC-index; a single EDC-middle; a double EDC-ring; an absent EDC-little; a double extensor digiti minimi(EDM), a single EDC-index(98.3%), a single EDC-middle(62%), a double EDC-ring(50%), and an absent(65.5%) or a single (32.8%) EDC-little. A double(70.6%) EDM tendons were seen. Intertendinous connections were classified into 3 types: type 1 with thin filamentous type, type 2 with a thick filamentous type, and type 3 with a tendinous type subdivided to r shaped 3r type and y shaped 3y type. The most common patterns were type 1 in the 2nd intermetacarpal space, type 2 in the 3rd intermetacarpal space, and type 3r in the 4th intermetacarpal space. And in the present study, we observed one case of the extensor digitorum brevis manus(EDBM) on the boht side. CONCLUSION: A knowledge of both the usual and possible variations of the extensor tendon and the intertendinous connection is useful in the identification and repair of these structures.
Cadaver ; Fingers ; Hand ; Human Body ; Humans ; Motor Skills ; Nerve Endings ; Tendon Transfer ; Tendons ; Wrist

PURPOSE: To evaluate the tensile strength and repair-site profile of a technique of resorbable barbed suture tenorrhaphy. METHODS: Forty-eight flexor digitorum profundus tendons were collected from the 8 adult cadavers. In the test group, the tendons were sutured using absorbent 2-0 barb knotless sutures in a 2-strand or 4-strand zig-zag pattern. In the control group, 2-0 Prolene and 3-0 polydioxanone (PDS) were used to suture the tendons using the 2-stand Modified Kessler method and the 4-strand cruciate suture method. Using a tensile force measurement machine, the breaking load (N) and the stiffness (N/mm) were measured. The types of rupture were categorized into suture breaking, knot rupture, and pullout. RESULTS: In the comparative analysis between the absorbent 2-0 Quill (Angiotech Pharmaceuticals, Canada) suture that used the 2-strand core suture and the 3-0 PDS and 2-0 Prolene sutures, the average breaking load for the 2-0 Quill suture was 26.83±7.47 N, and 21.96±6.78 N and 17.20±4.93 N for the 2-0 Prolene and 3-0 PDS sutures. In the comparison using the 4-strand core suture, the average breaking load for the 2-0 Quill suture was 62.50±13.34 N, and 22.35±5.72 N and 18.67±4.27 N for the 2-0 prolene and 3-0 PDS sutures. The most common type of rupture were knot rupture. CONCLUSION: For flexor tendon sutures using the absorbent barb sutures, compared to the conventional 2-0 Prolene or 3-0 PDS sutures, absorbent barbed sutures have a higher tensile strength.
Adult ; Cadaver ; Humans ; Methods ; Polydioxanone ; Polypropylenes ; Rupture ; Sutures* ; Tendons ; Tensile Strength

OBJECTIVE: The purpose of this study was to assess long-term clinical outcomes and radiographic changes in patients with lumbar spinal stenosis with grade I degenerative spondylolisthesis who underwent microsurgical bilateral decompression via unilateral laminotomy, as a minimally invasive surgery. Method: Medical records of twenty-five patients who underwent the surgery between 1999 and 2005 were retrospectively evaluated. Clinical outcomes were evaluated through interviews over telephone with standardized questionnaires. Preoperative and postoperative radiographs were taken from all patients in neutral and dynamic lateral views. The mean follow-up period after surgery was 38.5 months(range 9-57 months). RESULTS: Seventy-two percent of patients were either pain free(48%) or doing well with occasional acetaminophens(24 %), and satisfied with the treatment. The most improved preoperative symptom was neurogenic intermittent claudication, which was ameliorated in 94.7% of patients(excellent 84.2%, good 10.5%, fair 5.3%). Postoperative vertebral slippage was also measured and appeared to be slightly increased but this was not statistically significant. Postoperative dynamic angulation did not change significantly compared to the preoperative value. CONCLUSION: Microsurgical bilateral decompression via unilateral laminotomy achieved a satisfactory decompression and symptomatic relief without extensive destruction of the weight-bearing structures and functional mobile segments. This treatment can be an effective modality for patients with lumbar spinal stenosis associated with mild degenerative spondylolisthesis.
Decompression ; Follow-Up Studies ; Humans ; Intermittent Claudication ; Laminectomy ; Medical Records ; Surveys and Questionnaires ; Retrospective Studies ; Spinal Stenosis ; Spondylolisthesis ; Telephone ; Weight-Bearing