Microform cleft lip is a mild form of incomplete cleft lip, also known as a minimal occult, abortive, forme fruste cleft lip. However, it has no definition and few methods have been reported for its correction. A microform cleft lip is characterized as the incomplete union of the superficial portion of the orbicularis oris muscle. It is more prominent during facial expression than in a resting state. We confined microform cleft lip in our study to the absence of philtral skin change and a contracted position on the top of cupid's bow. During the past 5 years, 17 patients of microform cleft lip were operated on. We corrected the defect of the upper vermilion border and nostril sill with minimal incision, and repaired the underlying lip musculature in superficial discontinuity. Reduction of the widened alar base was performed. Deformed alar cartilage was dissected via rim incision, and suspended in a medial and upper direction with pull-out sutures. The most important thing is precise repair of the superficial portion of the separated orbicularis oris muscle via minimal incision, and it is best to operate after 1-year of age for accurate repair. The results were satisfactory and the parents were also satisfied. The advantages of this procedure are as follows: 1. Less visible, minimal scar on upper lip 2. Simultaneous correction of vermillion notching, deformed cupid's bow and nasal deformity. 3. Eversion of philtral ridge due to tenting effect of horizontal mattress suture 4. Philtral elongation effect by reduction of alar base and Z-plasty of cupid's bow.
Cartilage ; Cicatrix ; Cleft Lip* ; Congenital Abnormalities ; Facial Expression ; Humans ; Lip ; Microfilming* ; Parents ; Skin ; Sutures

PURPOSE: This study evaluated the efficacy of an intra-articular injection of sodium hyaluronate in the treatment of early stage osteoarthritis of the ankle. MATERIALS AND METHODS: Early stage ankle osteoarthritis (Takakura stage I and II) patients who received hyaluronic acid injection therapy were retrospectively reviewed. Patients underwent intra-articular injections of 2 mL of sodium hyaluronate for 3 consecutive weeks. Clinical evaluation and Visual Analogue Scale (VAS) scoring were performed at every three months after treatment. RESULTS: Total 27 patients were involved and mean age was 55 year old (range 33 to 77 years). There were 13 male and 14 female patients. Mean follow up duration was 13 month and. Pre-intra-articular VAS score was 8.9+/-0.7 and three month follow up score was 3.8+/-2.8. VAS score of last follow up was 3.2+/-3.4. The effect of hyaluronic acid continued about one year when analyzed the VAS score change of the patients followed for more than one year. Patients' satisfaction was "very satisfied" in nine, "satisfied" in 12, "fair" in one, and "not satisfied" in five patients. Overall satisfaction rate was 82%. There were no ankle osteoarthritis stage changes in serial follow up radiograph. CONCLUSION: Symptomatic relief of signs and symptoms of osteoarthritis of the ankle was achieved by injection of an intra-articular hyaluronate injection. Efficacy of Hyaluronate acid injection persisted more than 1 year in our study. Intra-articular hyaluronate injection to ankle osteoarthritis is safe and effective as knee joint and should be considered as a valid conservative treatment for ankle osteoarthritis.
Animals ; Ankle ; Female ; Follow-Up Studies ; Humans ; Hyaluronic Acid ; Injections, Intra-Articular ; Knee Joint ; Male ; Osteoarthritis ; Retrospective Studies

PURPOSE: Foot infections are common complications in patients with diabetes. The patients are usually immune-compromised; therefore the pathogens could be resistant to narrow spectrum antibiotics. Those drugs, however, are categorized as specially managed antibiotics, and access are difficult without confirming of the pathogens. Our aim was to analyze the common pathogens in diabetic foot infection and figure out the proper antibiotics. MATERIALS AND METHODS: We studied 68 patients treated with diabetic foot infection. The pathogens which caused the infection and their sensitivity to initial antibiotics were analyzed. We also investigated the change of the antibiotics after the confirming of the culture result and average time to get the result. RESULTS: Among the 68 patients, 56 (82%) received cephalosporin and beta-lactam antibiotics. Only 12 (18%) who were confirmed the drug resistant pathogens from previous culture, were treated with broad spectrum antibiotics such as vancomycin and tazoperan. Average culture study time was 6 days. Methicillin-resistant staphylococcus aureus (MRSA) was cultured in 19 patients (28%), Methicillin-resistant coagulase negative staphylococcus (MRCNS) in 11 patietns (17%), pseudomonas in 11 patients (17%). Total 44 (65%) including 3 of other antibiotics resistant pathogen needed broad spectrum antibiotics. Thirty two patients (47%) were resistant to initial antibiotics.irt follow up culture, 2 MRSA and 2 MRCNS were found. The antibiotics resistant pathogens were confirmed in 48 (71%) patients at last. CONCLUSION: Diabetic patients with foot infection need proper antibiotics from initial treatment. The proper broad spectrum antibiotics should assigned to the patients from the first time without the confirming of the culture results.
Anti-Bacterial Agents ; Coagulase ; Diabetic Foot ; Follow-Up Studies ; Foot ; Humans ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Pseudomonas ; Staphylococcus ; Vancomycin

BACKGROUND: Lidocaine is a well known antiarrhythmic agent. However, recent reports indicate that indocaine has myocardial protective effects on acute myocardial ischemia and reperfusion. The exact mechanism of myocardial protection of lidocaine is still not clearly understood. In this study we intended to assess the effects of lidocaine on high energy phosphate metabolism in cats subjected to myocardial ischemia-reperfusion by using 31P MR spectroscopy. Effect of lidocaine on size of infarct will also be evaluated by 2, 3, 5-triphenyltetrazolium chloride(TTC) staining. METHODS: Twenty-seven cats were used for this study. The animals were divided into three groups : for group 1(n=10) and group 2(n=7), animals were subjected to a 90 min of LAD occlusion followed by a 90 min of reperfusion ; for group 3(n=10), a 20 min of occlusion followed by a 90 min of reperfusion. In group 2 and group 3, lidocaine(5mg/kg/hr) was infused continuously during the occlusion and reperfusion periods with an initial bolus injection(1mg/kg) before ligation of LAD. In-vivo MR spectroscopy was performed on a 4.7T Biospec System(Bruker, Switzerland). A home-made surface coil(diameter : 1.5cm) was used to receive31p signals from the myocardium underwent ischemic and reperfusion damage. RESULTS: Decrease of PCr during ischemic period was not different between each groups : PCr showed less than 30% of the baseline value at L-30 in group 1 and group 2 and at L-20 in group 3. More than 90% recovery of PCr was achieved at R-30 in group 2 and group 3, whereas less than 50% of PCr was recovered in group 1. Decrease of ATP during ischemic period was less pronounced in group 2 than in group 1 : in group 2 ATP depleted down to 25% of the baseline at L-90, whereas in group 1 ATP decreased to 50% of the baseline. Recovery of ATP during reperfusion period was not signiflcant in all three groups. On TTC staining, evidence of infarct was seen in all cases of group 1 : the area of infarct was 12.3+/-2.7% of the left ventricular mass and 23.9+/-6.1% of the area at risk. On the contrary, there was no evidence of infact in any case of group 2 and group 3. CONCLUSION: In this study, we found that lidocaine has myocardial protecitve effects on ischemia-reperfusion in cats. Lidocaine improves high energy phosphorous metabolism during ischemia and reperfusion as well as reduces infarct size.
Adenosine Triphosphate ; Animals ; Cats* ; Ischemia ; Lidocaine* ; Ligation ; Magnetic Resonance Spectroscopy ; Metabolism ; Myocardial Ischemia ; Myocardium ; Polymerase Chain Reaction ; Reperfusion ; Reperfusion Injury

PURPOSE: Hypernatremia most frequently occurs in the immature newborn and be severe in association with intraventricular hemorrhage (IVH). This study examined the frequency, onset and risk factors of hypernatremia, and the relationship between hypernatremia and IVH in very low birth weight (VLBW; <1,250 g) infants. METHODS: We retrospectively reviewed the medical records of 55 VLBW infants admitted between January 2006 and December 2009 to the neonatal intensive care unit of Wonkwang University Hospital and who survived over 7 days. Serum sodium concentration, sodium intake, fluid and weight loss, as suggested risk factors of hypernatremia, and the incidence of IVH were evaluated. The infants were divided into a hypernatremia group (> or =150 mEq/L) and nonhypernatremia group, and were compared. RESULTS: Incidence of hypernatremia in the VLBW infants was 52.7%, and mean starting time of hypernatremia was 2.8+/-1.3 days. There were no differences in the sodium and fluid intake between the two groups. Weight loss at day 3 after birth was significantly higher in the hypernatremia compared to the nonhypernatremia group (P<0.05); thereafter weight loss was non-significantly higher. The incidence of IVH in VLBW infants was 38.2%, and the difference between the two groups was not significant. CONCLUSION: Hypernatremia occurs commonly in VLBW infants and is most commonly caused by weight loss in the early days after birth. Incidence of IVH is not likely influenced by hypernatremia with marginally elevated sodium concentration.
Hemorrhage ; Humans ; Hypernatremia ; Incidence ; Infant ; Infant, Newborn ; Infant, Very Low Birth Weight ; Intensive Care, Neonatal ; Medical Records ; Parturition ; Retrospective Studies ; Risk Factors ; Sodium ; Weight Loss

Hypertension may be due to either vascular (renal artery stenosis) or nonvascular (urologic) causes in hypertensives with unilateral small kidneys. Generally, the occurrence of hypertension in association with difference in kidney size suggests the presence of prolonged renal artery stenosis. This condition can result in decreased volume of the poststenotic kidney. Another cause of small kidneys is unilateral renal agenesis, renal dysplasia with or without reflux, tubular obstruction, and hydronephrosis. Hypertension can be attributed to abnormal-sized kidneys. Nephrectomy of the small kidney or correction of the stenotic artery normalizes blood pressure. De Jong and associates reported 8 cases of young women thought to have hypertension caused by unilateral renal parenchymal disease. Renal angiography, however, disclosed significant renal artery stenosis in the contralateral kidney of all 8 patients. Revascularization of the kidney with stenotic lesions cured the hypertension. The data suggests that in patients suspected of having hypertension caused by unilateral renal parenchymal disease, not only should renal venous renins be determined, but nephrectomy should not be peformed as well until renal angiography has been performed to exclude contralateral renal artery stenosis. We report a case of unilateral renal artery stenosis with contralateral hypoplastic kidney in a 22 year old woman; hypertension was corrected by successful anastomosis of the stenotic artery without nephrectomy of the contralateral small kidney.
Angiography ; Arteries ; Blood Pressure ; Female ; Humans ; Hydronephrosis ; Hypertension ; Hypertension, Renal* ; Kidney* ; Nephrectomy ; Renal Artery Obstruction* ; Renal Artery* ; Renin ; Young Adult

The use of a pneumatic torniquet to obtain a blood less field in the extremities is essential in the precise operations of present-day plastic and orthopedic surgery. There have been studies conducted regarding systemic and metabolic change in response to torniquet ischemia and complication, associated with torniquets have been reported such as injuries to nerves, muscles and blood vessel. The purpose of this investigation was to examine changes in the systemic circulation, blood gases serum potassium and base status on release of torniquet ischemia in adult. The results were as follows: 1) The mean blood pressure and heart rate did not change significantly after torniquet release. 2) The pH decreased significantly after the torniquet release. 3) The PaO2, and PaCO2, did not charge significantly after torniquet release. 4) The HCO3, and BE decreased significantly after torniquet release (P<0.05). 5) The serum potassium levels tended to increase after torniquet release but the changes was not significant. There-fore to minimize the predictable complications, the ventilatory control and rapid volume replacement are needed during the time immediately preceeding and following torniquet release.
Adult* ; Blood Circulation ; Blood Pressure ; Blood Vessels ; Extremities ; Gases ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Ischemia ; Lower Extremity* ; Muscles ; Orthopedics ; Plastics ; Potassium

There remains controversy regarding the appropriate surgical treatment for coarctation of the aorta because of relatively high rate of recoartation and high mortality in the cases associated with complex anomalies. We evaluated 31 consecutive patients who underwent surgical repair of coarctation of the aorta from May 1992 through June 1996. Nineteen patients(61.3%) were neonates and 26(83.9%) were under three months. Nine patients did not have major associated anomalies(Group I), 15 patients had ventricular septal defect(Group II), and 7 patients had major complex anomalies(Group III). 35.5% of the patients had arch hypoplasia. Surgical procedures performed were as follows: extended end-to-end anastomosis in 17 patients, combined resection-flap procedure in 7 patients, and subclavian flap aortoplasty in 7 patients. Residual coarctation occurred in 7(25%) of 28 patients; 2 after subclavian flap aortoplasty(2/6, 33.3%), none after combined resection-flap procedure(0/7, 0%)), and 5 after extended end-to-end anastomosis(5/15, 33.3%). Higher incidence of residual coarctation was noticed in the group with arch hypoplasia. The incidence of postoperative coarctation at a mean follow-up of 20.5 months in survivals was 12.0%(3/25); 2 cases after subclavian flap aortoplasty(2/6, 33.3%), none after combined resection-flap procedure(0/7, 0%), and one after end-to-end anastomosis(1/12, 8.3%). The mortality rate related to coarctation repair was 9.7%(3 patients, all in Group III). This study revealed that isolated coarctation of aorta and coarctation with ventricular septal defect(groups I and II) can be repaired with low mortality, but repair of coarctation with complex anomaly had a high operative mortality. Also the patients with arch hypoplasia had higher incidence of post-operative residual coarctation.
Aortic Coarctation* ; Follow-Up Studies ; Humans ; Incidence ; Infant, Newborn ; Mortality

The seminiferous tubules merge and connect with the tubuli recti that form the spaces known as the rete testis. Cystic ectasia of the rete testis is a rare benign testicular lesion. We report the cystic ectasia of the rete testis in a 66-year-old man.
Aged ; Dilatation, Pathologic ; Humans ; Rete Testis ; Seminiferous Tubules ; Testis

Anterior cruciate ligament (ACL) rupture leads to weakened quadriceps muscle strength and a decline in proprioception, impairing the neuromuscular control of the lower extremities. ACL reconstruction, aimed at addressing such structural and functional instability, has become a primary treatment method for young and active patients. Consequently, there have been significant advancements in surgical techniques, resulting in improved clinical outcomes. However, achieving successful outcomes after ACL reconstruction is not solely dependent on the surgery itself; pre- and postoperative rehabilitation and management are equally crucial. A well-designed functional recovery program based on medical evidence before and after ACL reconstruction plays a vital role in restoring function to preinjury levels. The process of the functional recovery program, from presurgery to sports return, should adhere to certain principles. These principles involve prompt and accurate clinical diagnosis and patient classification after injury, systematic programs addressing joint swelling and inflammation control, reduction of arthrogenic muscle inhibition, restoration of range of motion, muscle strength recovery, and proprioception restoration. Postoperatively, it is essential to go beyond traditional methods (such as range of motion restoration and muscle strengthening) by implementing a functional recovery program that includes enhancement of proprioception and neuromuscular control system from the early stages, considering the biological healing response of the graft. This comprehensive approach is vital for achieving optimal outcomes in the recovery of function after ACL reconstruction.